HomeMy WebLinkAbout06-29-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF f rn 1 ~,.~
p ~~'~~ COUNTY, PENNSYLVANIA
Estate of ~G/~! f7 . ark'/z°~,e~ ~
also known as File Number O~ I ~ y L ~,~ ~~
,Deceased Social Securit Number ~!
y I ~..~ -~ ~ y/
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' or B' BELOW:)
~A.. Probate and Grant of Letters Testamentary and aver that Petitioners is / ar
last Will of the Decedent dated // ~~~~ ~~9~~ and codicil(s) dated O Nf~ the CXeCt;.e.{~-
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instruments of
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
O feted
^ B. Grant of Letters of Administrati
(IJappticable, entei:• c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; duaii'~7t
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following~p~
Administration, c. t. a. or d. b. n. c.t.a , enter date of Wil! in Section A above and complete list ofheirs.) ' ,~ .
Name ~ , rJj
Relationshi
Re~~,
(COtY1PLETE lNALL CASES:) Attach a/dJditional sheets if necessary.
Decedent was domiciled at death itt (.,[(ryt ~j~~. ~~n
G~/o ff a y ~ ~ ~ ~ County>
(List sleet addicss town/city township, county, state, zip code) r
Decedent, then ~ years of age, died on
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled itt PA) All personal property
Personal property in Pennsylvania
(If not domiciled in PA)
Value of real estate in Pennsylvania Personal property fn County
situated as follows: /"~,*nG,.'.
$ . -~ ~~
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicils N +
the undersigned: Opresented with this Petition and the grant of Letters in the appropriate form to
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anyd heirs: (~f J
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with his /her last principal residence at~_
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i~?~v~ ~t.__/~Grr,sbu/~ f~sp~ ~/
/ iy eo or rioted name and residence
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Form R6V-p~ re n. 10.13.06
Page 1 of 2
Oath of Personal Representative
COivI~IONbVEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect 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 or affirmed aQnd subscribed
before me the c~ / _ day of
,; ~~~
tcc
l For the Register
Signaka•e ojPersona!
Signature ojPersaial Representative
Signature oJPersatnl Representative
File-Number: ~ , V "1 l,.' l4!
Estate of / / /~ h~ fla!?l ~d'-'K "~~l K /Pr!)GL~,
Social Sec~ulrity Number:
AND NOW, ~/ `~
having been presented before , IT IS
are hereby granted to _ ~ ~7 ~ ~
C7 rv
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Deceased
~"~ ~ y~ t~~ Date ofDeath: / ~ /G'i , ~3 ~Q~
~> _ <=UU ~ , in consideration o~the for going Petition, satisfactory proof
EED that Letters ~-7~~~~~ ~: '~r-, `~
~G_ LC'.c1't c+ C.~ ~
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters ....~~~'.
dl+~f$ ~'~ac
Short Certificate(s) ... ~ U .. $
Renunciation(s) ........ .. $
1 .. . $
-----_-
.. . $_
.. . $_
.. . $_
.. . $_
.. . $
TOTAL ~_
the la t`Wi I ~nd~ C~oAdicil ) of
~/G~ ` ~ ~.
Register of Wills
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
in the above estate
Form RW-OZ rev. 10.13.06
Page 2 of 2
LOCAL REGISTRAR'S CERTlFICATI®N rJF' EATH
WAFiMIh1G: It is illegal to duplicate this copy by photostat or pho#ot~iraph.
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CORONER'S CERTIFICATE OF DEATH
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1. Name d Deceam (Frsl noddle, lest, aulfix) 2. Sex 3. Saw) Secuary Number 1. (Ma1m, day, yp@rJ~ ,.. ~-.
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Hancock Harkleroad Female 192 - 12 - 4189 3, 2009 ~V ~
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5. Age (Last BirUgay) UrWx 1 year Urdw t bay 6. Dale d Binh (Mahn, Oay. year) 7. Binhpaoe (Coy and state a bre gn ) Se. PWp d Deem (Check arty orej
soon Om Naxa stxx,lm Hospael: Gar •~
88 Yrs. Sept 27, 1920 Johnstown, PA ®mpaaem ^ ER r wtpatierr ^ Don ^ Nursag Homo ^ Rasiderwe ^omer spedM
8D. Counry d Deam Bc. Gry, Boo, Twp. 01 Deem 9d Farrry Name Ill rid nsaNbon, give Greet and nurMer) 9. Was Decedalt of Hisperac Odgkt? ®No ^ Yes 10. Race. American ndan, Black, White, ek
Dauphin
Harrisburg
Harrisburg Hospital (n yes. specny Cuban,
Max;p,,,, P„e„° R~,,, ~_) (Specryq
White
tt. Depdent's Usual lion Krd d work d one du ~ most d sb. Do rot stet retr 12. Waz Decedent mar n the 13. Decedent's Edlration (Spedty aNy nigrrest 9'aa axnp bted) t /. Martial Salus MartieQ Never Marti W, 15. Surviving Spo use (n vole, give mairbn nelre)
I4M d WoM1 Kntl d Business I Indusq U.S. Amled Farces? Elementary / Secorxlary (0-12) College (1 d or 5+) W doweq DnorOed (Specilyl
Teacher Education ^Yes ®Np 12 4 Widowed n a
16. Decedanl's Mailing Adtlress (Street ay /town, state. w code) Depded's Did Decapnt
PA
810 Charlotte Way Suite #204 ^ 17c. ®Ves, Decedent Lwed h Fact PPnnc Pnrn Tvq
""~' a 17a ~"e
T
msiu
PA 17025
Enola p
ow
a''~"'Ih"
,7b camry Ctnnberland ,7d. ^ ~D
, ,
Clry / Boo
18. Fattwr's Name (Pest, rnitlda, ~, sdrlx) 19. Homer's Name (Frst midde, markn surname)
Edward David Hancock Minnie Lynn
20a. inlwmard's Name (Type / Pnd) 200. Inbrtpds Mating Address (SaeL tilt /lam, spte, ZV cpde)
Pennie Cavanaugh 228 Brian I?rive Enola, PA 17025
21a Hamad d Disposition ®Crertatkln ^ Donation 21 b. Date d Disposagn (Maw, day, year) 21 c. Place d DS9osrion (Name d cenwlery, crolnalory a der place) 210. Lpcanan (py! mvrtt stole, zy ooda)
^ Burial ^ Removal Irom Slate Ws Cremation a Donation Adhodxed
^ Gar - spepxy: ; br Medial Examiner /Coroner! ®Yea ^ Np
Ma
Forest Lawn Cremato
ohnstown PA 15902
Sgrenlre F Service Lkemee la person aranc az slrh) 72b. Licenu NuMer 22c. Name and Adtlress d Fediry 1521 Frankstown Road
` ' nchnan era) Hone
Complete n y when ceNyng 23a Tome oast d my Mnowkdge, deem pzvrrea at the tree, axle ant place stated. (Syrunee and title) 23b. license Kumar 23c. Date Sgred (Hoorn, day, year)
ptrysbian E availade M time d deem to
carry cause d seam.
hems 24.26 must a pngldee by person 24.7xne d DeaM Pronounced: 25. Da4 Pronounced Dead (Haw. Gay. yev) 26. ryas rasa Referted m Medial Examiner / Caprtar br a Fkasm Other Gun Cntmatiaa or Donaam?
wa pmllounces Beam. 01:52 F, M. May 23, 2009 ~ Yes ^ No
CAUSE OF DEATIi (See Instntationa arsd elumpfes) t Approximate intervd: Part II: Emsr der baiapm mnerkxe mmrmleirq b deem, 26. Dn Tobacco Use CanoDde b Deem?
Item 27. Pan L Eder methen d evems - dlspas, injuries, a oanplptials - mU directly calsea la deem. DO NOT arer tamMWl evrxrs such az prdac arreR, r OnSel b Deem do not resukatg n rte ugeryrp pose 9h'en n Pan L ^ Yes ^ Pmably
respiretay crest, a vemriCUlar hawlnn witltod slwwrg me ~gy List oNy one pose on each Ina. r
r
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^ No ^ tlnknavm
IMMEDIATE CAUSE IFreI duase w
condition resdtilgn thl _~ a Pending 29. tl Female:
^
Due b (a az a conseouenca oQ: r Na prepnam wilNn pas?year
^ Pre
nam at tole d detA
SeQll
dely list cabnions, tl ery, b,
e g
n
g
E a Due to (a a; a mnsequence of). t
Eder meroUNDERLYING C
A
U
S ^ Na pregna 1, ha preglanl mmn 62 days
t
e
d
1
(~ se o°rl~n d~eath~) LAST c. r
t d loam
Due b (or as a cprlsequence or):
r ^ Na Dra¢lem, ba pregrunt 43 days b t ysr
a. i area deem
^ unw,owm a pregnem wain me pest year
30e. Was an Aubpsy 30D. Were Aubpry Fintingc 31. Manner d Death 32a Date d InjlMy (Morro, my, year) 72b. Describe How Injury Ocarted 32c. Place d Irfury: Home, falm, Street, Parlay.
Performed? Arerable Prior to Compldbn
^ Nawa ^ Hantida lMwe Butldng, eta. /Seedy)
d cease of Deam?
^ Yes ®No ^ Yes ^ No
^ Amdenl ~ Pendrq Imestigalia+
320. True d Ilyury
32e. njury at Wwk1
321. h TranspoMeon Iryuy (Spxey)
32g. Location d hNY (Street city I ban, state)
^ Sucitle ^ Codd Nd a Determr N ^ Yes ^ No ^ ~! Opereta ^ Pa56erxJBt ^ Pedastdan
M. abet . ,:
33a. Cerafwr (dledr any are)
• CMNyng phYekWl (Physxdan prtifyng pose of deem wfen ender pnysidan haz prtxmunced deem erd wrtlpkteo nem 23) 33D. sigrleWre end rme aCgtilier ..,
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To the betld my knowledge, deem accunsM duebUe puae(s)and manners amed_______________________ _________ ^ ~ ~ Lisa A. Potteiger, Chiet Deputy
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• Prwrotardrg orb cutilyin9 pgaidan (Physician bdh pmpux:nq Beam arN csrdying ro pose d aaml
d
^ 33c. lice mbar 33d. h Signed (Moab, day, year)
- - -- - - - _ _ _ _
To the best d rm logwleege, deem «curred st tns time. ew, one place, and due m the cause(s) ant mannm as sule
_ _ .. _ - _ y 25, 21)9
• Nedkal Exrdner / Caorer
On the Osia d examinshon arM / a hrvesligation, n my opiNOn, dsm occurred H the erne, eaM, arq Plea, and due to the puae(a) and manner s abted_ ®
3a. Name erA Address d Per.,pn Who Congkted Cause d Deem I Item 27) Type / Prra
Lisa A
Pottei
er
36. Regatraj'~ Siprlaoae end Oist~ Nlanber ,T
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~ ~ 3rf a Fred IMonm, day. year) .
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1271 South 28th Street
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' ~ ~ Harrisburg, PA 17111
y Disposition Parton No. '~ C~J $ ~ ~/' ~ .Y'
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AST 1~VILL AND TESTAMEN'~-T~~~ N
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OF .~,
MARY H HARKi .EROAD
I, MARY H. HARKLEROAD, of the Borough of Westmont, County of
Cambria, and State of Pennsylvania, being of sound mind and body, do make, publish
and declare this as and for my Last Will and Testament, hereby revoking all former Wills
by me at any time heretofore made.
FIRST• I direct that my debts and funeral expenses be paid by my
Executor as soon after my death as conveniently may be done.
,~ ~FC'nND• As to my worldly Estate, and all the property, real, personal or
c~~ mixed, of which I shall die seized and possessed, I give, devise and bequeath unto my
;~~
~;~~ children ZENAS EDWARD HARKLEROAD AND PENNIE LYNN CAVANAUGH, to
~ ~ be divided equally share and share like.
~j
T~ Should one of my children predecease me, then his or her share in
my estate shah pass to his or her children, per stirpes.
.u
`~; FOURTH: I nominate, constitute and appoint my daughter, PENNIE LYNN
CAVANAUGH, as Executrix of this my Last Will and Testament to serve without bond.
FIFT Should my daughter, PENNIE LYNN CAVANAUGH, predecease
me or be unable to act as Executrix, then I nominate, constitute and appoint, my son,
ZENAS EDWARD HARKLEROAD, to act as Executor of this my Last Will and
Testament to serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
30th day of November, 1995. _/j //
Signed, sealed, published and declared by the above named Testatrix, MARY H>
HARKLEROAD, as and for her Last Will and Testament, in the presence of us, who at
her request and in her presence and in the presence of each other, have hereunto
subscribed our names as witnesses thereto.
STATE OF PENNSYLVANIA:
COUNTY OF CAMBRIA : SS:
I, MARY H. HARKL,EROAD, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly; and that I signed it as my free and voluntary act for the purposes
therein expressed.
Sworn or affirmed to and acknowledged before me by MARY H.
HARKI,EFOAD, the Testatrix, this 30th day of November, 1995.
STATE OF PENNSYLVANIA:
COUNTY OF CAMBRIA SS:
~.
N
Notarial Seal
Kimberly A. Miller, Notary Public
Johnstown, Cambria County
My Commission Expires Sept. 13, 1999 .
We, D.C. NOKES, JR. and LYNN ANN GEISEL, the witnesses whose names
are signed to the attached or foregoing instrume tebatrg di nand execute the ingstrument
do depose and say that we were present and saw g
as her Last Will and Testament; that MARY H. HARKI.,EROAD signed willingly and
that MARY H. HARKI,EROAD execute daltr n hand eghtanof the testa raxtsigned the Will s
therein expressed; that each of us in the h g
at that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and subscribed to before me D.C. NOK_ES; JR. and LYNN
ANN C~EISEL, witnesses, this 30 day of November, 1995.
Notarial Seal Public
Kimberly A. Miller, Notary
Johnstown, Cames~Septul3 1999
My Commission Exp