HomeMy WebLinkAbout06-11-09TITION FOR PROBATE AND GRANT OF LETTERS
PE
COUNTY, pE~SYLVANIA
REGISTER OF WILLS OF CUMBERLAND ~~1 ~ cJ~~~
File Number ~ \
Rupp
Estate of A~lYee R .
also known as .Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE' 'A' or 'B' BELOW:)
Social Security Number 162-22-3615
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A. Prolbate and Grant of Letters Testamentary an and codicil(s)tdatedr(s) is / are t e ...
last Will of tine Decedent dated ~~ ~-~
~~J'~-- rte' II-r a
t_:~ F °~
' (State relevant circumstances, e.g., renunciation, death of executor, etc.)
~ Decedent did not marry, was not divorced, and did not have a child born or adopted after execution the instrum~(s) offered"
Except as follows,
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
hcable, enter: c. t. a.; d. b. n. e.t.a.; pendente liter durante absentia; durante minoritatel
/~ B. Grant of Letters of Administration (lfapp
' ' ner s after a proper search has /have ascertained that Decedet~o e and otml p~d list of heirs.) by the following spouse (if any) and heirs: (!f
Petrtto ( )
Administration, c. t. a. or d. b. n.c.t.a., enter date of Will in Section A a
Residence
~~ ,..., P R Pne
~~
n,. _,.t n UnffPr
516 W. Elmwood Ave., Mechanicsburg, PA 17055
602 Cocklin Street, Mechanicsburg, PA 17055
(COMPLETE [N ALL CASES:) Attach additional sheets if necessaryounty, Pennsylvania with his /her last principal residence at
Decedent was domiciled at death in Cumberland
_ ,-_.__ n.,.,,t,artantt ('aunty. PA 170 5
117 1Jast Ma tewui~u~.~••~~ ..----- - --
(List street address, town/city, township, county, state, zip code)
May 31, 2009 at Carolyn Croxton Slain Hospice Residence, Susquehanna
Decedent, then 86 _ years of age, died on
Township, PA
with estimated values as follows: $ 200,000.00
Decedent at death owned property All personal property
(If domiciled in PA) $
Personal property in Pennsylvania $
(If not domiciled in PA) personal property in County
(lf not domiciled in PA) $
Value of real estate in Pennsylvania
situated as follows:
fore Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate arm to
Whcrc
the undersigned: T„„P~ nr printed name and. residence
Page 1 of 2
Form RW-02 rev. l0. i3.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA SS
COUNTY OF CUMBERLAND
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to car affirmed and subscribed
before m the _~..~.~- day of
Signature
Signature of Personal Representative
..~
the Register Signature of Personal Representative
File Number: °C ~ Q~ ~~ ~ ~~ ~
F
Estate of Alyce R . Rupp ,Deceased
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Date of Death: MAY 31 2009
Social Security Number:162-22-3615
AND NOW, ~ ~ ~~'~-~ ~ ~ m consideration of the foregoing Petition, satisfactory proof
having been presented before , IT IS DECREED that Letters of Administration
are hereby granted to Constance R. Pce and Carol A. Huffer in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of records the 11 st Will
FEES
..z..,..
Letters (/ V ~ u~ $ O
Short Certificate(s) ...~ ... $ ~ ~
Renunciation(s) .......... $ ~~
... $ _
... $ ~
... $
... $
... $
... $
_ ... $
_ ... $
... $
0
TOTAL .............. $
Attorney Signature:
Attorney Name:
Codicil(s))
Andrew C. Sheely, Esquire
Supreme Court LD. No.: 62469
Address: 127 South Market Street
P.O. Box 95
Mechanicsburg, PA 17055
Telephone: 717-697-7050
Page 2 of 2
Form RW-02 rev. 10.13.06
IOS.ROS REV (01/071
LOCAL REGISTRAR'S CERTIFbCATI~ONoOF tDEATH
WARNING: It is illegal to duplicate this copy y p
Fee for this certificate. $6.00
Certificafion Number
This is to certify that the information here given is
correctly copied lron~ an original Certificate of Death
duly filed with me .(s Local {Zegistrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~~~~~' ~ ~3 i U~
Local Registrar Date issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ `-~
H105~1J3 REV 1112006 (,~
TYPE!PRINT IN CERTIFICATE OF DEATH +~~ ~ - 1 U
PERMANENT
BLACK WK (See instructions and examples on reverse) STATE FILE NUMBER
2 Sax 3. Scaal SearBy NaMar 4. Date d Death I~nW~ aaY Year)
I NamedD«:edennFn~ midtle,lasLS°n'x' Female 162 -22 X615 May 31, 2009
Alyce R. Rupp
6. Aga (Lail &nndaYl under 1 rear Urder 1 daY 6. Dale d Birb (Month, deY. ar) 7. Badglsca ( Mltl Mate «tir ~ Nunlryl ea. Pam a DeaW (Cneca one)
r~WM: otner.
"°""' Day' ~~" Nnwa, March 23, 1923 Shiremanstown, Pa.
66 ^ hrpatianl ^ ER I Odpatienl ^ DOA Nasirq Nome ^ Resdarke ^Omer Speary.
Vis.
• B0. Counry a Death &. Ciry. Boro, Twp. of Death Bd. Facility Name Ir na hatAUDOn.9Na wheal arq ruMar) 9. Was Decedent d Hispanic Origin? No ^ Yes t0. Race: American Wan. Black. Wnde, et<
(11 yes, specify Cuban, I~iM
Dauphin Susquehanna Carolyn Croxton Slain Hospice Residence Mexkan.PaenoRran,eb) White
tl. Decedents Usual Occ son Nkd d woA done du mast of woMm tile. Do not slate resred 12. Was Decedent ever M W 13. Oecedar8's Education (SpecitY oNY ~~ M~ o«npletad) 74. Manlal Slats. Marraa, Never Married. 15. Sunivng Spouse (n wire, g~va maden r~art~el
U.S.Amledf«ces? ElemerlYary; Secardery (0-12) Cohege It-4«br) VYdowed. Divorced lsy,eciM
Kind a 1YOrk KiM of Business / MAusvy W Ida W ed
Disbursement Officer US Government ^Yea ~°
DecedenYS ~ Decedanl
16 DeadBM'S Maamg AdWess (Slreel, wry / bwn, stale. zip code) Actual flesitlerme 17a. Stale PA lJVe b a 17c. ^ Yes, Decedem Lived n
117 East Maplewood Avenue T°"n~`'"? vd Dered«tlUvedWldvn Mechanicsburg
• Mechanicsburg, PA 17055 nD candy Cumberland ~~~d
le.FameraNamelFastradAeaaw8ix) Iz.ManarsNam.IFirsl.midae.maaenwrn«r~el Gldys Stambaugh
Emmons Roth
20a. Inlormanl's Name (type I PAre) 20b. W«mard's MaiYrg Address IStiea, cdY I town. 51aK, i9 code)
Carol Huffer 602 Cocklin Street Mechanicsburg, PA 17055
216. Deu d Dapoeition (klpph, day. Year) 27c. Place d Dispasilbn INarrn d cemetery. aeealay «drler place) 21 d. Locahan (CatY / bwn. stet., zp mde)
zu MsmuddDuposifwn ^cremaDan ^~~ Cam Hill, Pa. 17011
Fy~~ anal RemovalrromSljte wuCr«re0 «DmationAdh«wd June 4, 2009 St. John's Cemetery P
$ • ^ Other _ , 0y aminM / C««art ^ Yes ^ No
~ 22a. Si d Furreral Seri Liven «per ~ s such) 22b. Lic«ue Nunlbar 22c. Name and Adtlreu d Fachhy
V ~ FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
t ~`"•~ 230. Lcense NurMer 23c Dale Sgrled lMorM, aaY. yexf
e .pane Items ~c odY when ceNtyslg 23a. io Desl a mY . deaN severed at Te Wne, dale andylace soled 1 /N/ ~~•a~ ,~ ,.yA j ']
q,y>rtuan is «a available a (me of dean b jlJy// ~N 7(7Y ~ ~ ~r' Q z/ I °
veiny cause a death
2a Time of OeaN 20. Date Pronalrced Dead (MOMI, day. Year) ^ 26. Was Cau RelMred b Medical Exanaar /Coroner 1« a Reason Cher mm Gematron « Donavan?
hems 5:426 must Da mnlpbiml Dy perwn ' Q tI ^ Yes
wtw garcunces deab +. 0 3~ y l P M.
CAUSE OF DEATH (Sae inszruetlone arld ex s) ~ , ApproxmwM inlervel: Pen II: 6Aer other yggk'%"I oMt c rayr~0utirp b deem. 28. Dd ToOecw Use Contro~aa b DeaA?
Y s PraDady
OW na resulbr b ON urldenYUg muss Dw^ in Per(1. ~ ^
n.:m 27. Pan I: Enter the ffiam9lJiYEf115 - dseases. ny«les, a complaalwns -Nat &ally caused the deab. DO NOT enwr larmnal events such as carUiac arrest, i Onset b Death q Ne ^ UAagwn
List oN one cause m each ine.
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gy. Y
respaalory arev, a venDKam 6bralairon wnhout showing the atw
WMEDIATE CAUSE IIFuul6sease« C/
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condif resumrg b deab)
a
-lam t
Due to is as a consequence d):
'
$erya'aiatlyy list CMOlia~a. a any. B,
kadr9 W th cause 4sled on Yne a. Due to (or as a consequence a):
Enter We UNDERLYING CAUSE
Ibseuse «+~pm1 u~at soused inn
eveds rawnnp m deab) LASL u
d ~
l:
Due to (or as a wnsequence
i
d
30b Were Aaopsy Fmtiigs 31 Manner d DeaN 32a. Data of Irqury (Month. daY. Year( 320.OesrnOs Nav hpury Occ«red
30a Was an Autopsy
Penortned? Avanaae Plioi to ComPleh~u Natural ^ Munuclde
of Cause a Dealn7
^ Accided ^ Penang Investigation 32d. T'nie d Inpuy 32g. L
32e. Way ar Wark7 321. h Trer sporbeon trgluy fSpenty)
^ Diner I Operabr ^ Passenger ^Pedestiian
[~ Yas ~NO ^ Yes ^ No ^ Yes ^ No
^ SwcWe ^ Coud Nd be Detemwied M pher Sv«'ih
330. Sgnalure and Tde CerMier
33a. Cenilar (cnxk only «re)
aician IPm/sioan crWV~n9 cause a1 ddatn wtwn anod~ar physKian has po«mrceo Death ad cornpletad hem 23)
i
d
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• Cer
ty
ng DM
To Ur heal of my tinowMdge. death occuned due to the causets)antl menneru Meted-------------------- --------'---
33c. License Numdar
• Prorlouncinq and cenirying phYskan IPnysk~an Dan pronuunang dean ant cenilyirg to cause d dash) ~ n O3 ~ L ~ 2
end due loth causets)eM mannM as sMled------------------ ^
end plea
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To the Dail of mY knowledge, death accurte b
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73d. DaM Signed IMonb. day yea(
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Medical Examiror /Coroner 34. Name and Addreu~~fpp~y
• On tlx Oasis oy examination and I or invesilgalion. in my opinion, loam occurred at Ina font, dale, ant DMCe, and dw to IsM cause(s) end ntertrler p deled_ apys«,4j ~a~ r°y'(~j~~ ~D
35 R~ ~'v g uicl 36. Dale Flied (MOnaL daY. Y~~) w .FCr _eA•Me 2140 Fl~slh/ er rrR Dad
l~+l 1 17.1 ~ I~.I a 1) IL~b.Jt7s
~..M.,,~ oo.ma ab o 3 L8G 4 'f (717) 766-1795
Twp I
e«e
2a. M FMrWe.
^ Not preglud wihen Pall Yea
^ PlNyrwN al Wns d dnaN
^ Na M•Y~rh~ M PaW'a^t wum 32 daYz
d deMn
^ Not prBgnanl. biA WegnaB 43 MYS b I year
before desb
^ UMrwwn A pregraal willvn iM pas( year
32c. Plxe a awry: Moms. Farm. 50wt. Faaory.
OII¢e Buildng, etc. ISP~M
of tnNrV IStreel atY i lawn, stare(