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HomeMy WebLinkAbout07-14-09PETITION FOR PR~O~ByAy~TE AND GRANT OF LETTERS REGISTER OF WILLS OF _~~`~-` COUNTY, PENNSYLVANIA /,~ ] Estate of ~ `'`e t/" t ~ ~i 1^'`_v~--- ~ ~ ^ ~ 1 - bl.C~ li O File Number also known as ,Deceased Social Security Number ~f _'~ l~ 0 7~ Petitioner(s), who is/are 13 years of age or older, apply(ies) for: ,(-,C-,OM~PLETE A' or B' BELOW:) ~~ I!Q A. Probate and Grant of Le ers T~f tamen ary and aver that Petitioner(s) is /are the { ~`"~S ~~(" i vcti.named in the I 11 of the Deced~eent d ed ~ /7 r• i J and codicil(s) dated ° ~ 4 (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 born or adopted after execution of the instrument(s) offered for probate, was not^th~evictim of a killing and was never adjudicated an incapacitated person: V ~ ~~ C"~ ~' B. t of Letters of Administration ; . ~` ~ Q .°a -'~~ I a licable, enter.• c.t.a.,, d. b. n. c.t.a.; pendente fire; durance nbsenna, dura~i tt~u ritnte) ~ LJ , ~ r ~1~~ t"' t r; L7 Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followingsBd~St~f any)~„fd hetts+~~~`,`i Administration, c. t. a. ord. b. n. c. t. a., enter date of Wi11 in Section A above anti complete list of heirs.) .:~Cld ~ --"• --~~` (COMPLETE IN ALL CASES:) Attach additional s/Teets ifppnecessary. Decedent w domiciled at dea rn ~""'`~~'-~lQ`^~ Count Penns ]vania with y> y ~Ther last principal residence at (List sheet ndd~e~s, town/city, township, county, star , ztp code) `~` I Decedent, then ~_ years of age, died on 3 J Lth,z ~~~at ~2 ~ ~4 S ~ ~c(itC t tpCP. ` ~C SIC~~YlC~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania situated as follows: $- j~ 7~ ~~~ 6 c': C Wherefore, 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 form to the undersigned: Simon re T ed or rioted name and residence f ~ ' ~, F='~L~ t~: C' ~ l'1nyt~~ Form RW-0? re,~. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA C,(~,rn be~r' ~a r~ c~ : SS COUNTY OF 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 (and subscribed befo e me the I 'f ~ day of t Fo e Register r ~~~ ~;- - Signature ojPersonal Representative Signature ojPersonal Representative ra ca .~, t~~ f"` } ~" ~ ..._ TJ s- Signature ojPersonal Representative '~-~ -r ~ r _I ~ ~. --r-~ _,.,~ W File Number: ~ ~nnnn~ Estate of Q Q Q~~ I ~~' f l ,Deceased Social Security Number: i D I !1 ~~ 0 1 ~~b Date of Death: .~.ne ~~~ AND NOW, ~~~ having been presented before m , IS are hereby granted to .~ L,_ C ~ '~ J IF r'1 _ ~~-~ ~_, _~~ ^~ _-) ~~, in consideration of the foregoing Petition, satisfactory proof in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters $ ~C(I/D,(.V RegisterojWills Short Certificate(s) ........ $ ~r~'~ Attorney Signature: -~R.ernunciation(s) .......... $ ~ D' ~~ dy I~) ... $ ~rJ.I~U ~~ rna+~O n ... $ GJ• OC7 ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ Attorney Name: Supreme Court I.D. No.: Address: Telephone: corm RW-0? rev. lU.l3.0( Page 2 of 2 InA.Rp~ REV .n(Imr -- - - - - en-1-(~~ -~Lp ~/ ~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 1~5~4~~~ Certification Number i'~OSIY REV 1:1211116 TYPE' PRINT IN PEFPdAN[NT BUCK INK This is to certify that the information hl~re given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for ermanent filing. - N Local Registrar Date Issued COMMONbVEALTH OF PENNSYLYANfA • D~PARTtAENT OF HEALTH • VITAL RECORDS OERTIFICAT~ OF IDEATH fSee instruCtfons and Ezamnlec ntl rPVaarSa.t C'3 4 ~- O -~. ~ `~ w _ ~ t-~ __., ; :. ~ r~ = ~ ~ c :~ f ...r )-7 Q ' ~ CSC tJ ': C..,7 N ~~ '; ") ' JrHIC t'lIt IVUMbtM 7-Name o. Decedem IFrsI nadleJasl, suHh) 2. Sex 3. Sooal Secant Numher 4. Date of Death (Month, day, veal Faye W. Grimm Female g _` g_g'~g June 3, 2009 S. A e ;last &nhda UMer , f S YI year User 1 tlay 6. Date o! Sinn (Month, day, year( ;. ginhp!ace (C:F/ and sb s breign ccun;ryl 8e. Plats of Death (Check only ore) lea Mru Data Rars a,m~ra, 89 ~„ July 6, 1919 11~sPitat Omer: Tyrone Pa. '~ 86 Ceun tn C' Oe ^ Inpallenl ^ ERI Outpatient ^ OOA ^ nursing Nome ®Residence ^Omar- Spedty: . ry a 8c. City, Roro, Two of Deatn int. FacdAy Name';1i ncl institution, ( g,ve street ar,d nu~', 9. N/as Decedem of Hispanic Origin? ~ No ^ Yes 10. Race American IMiar 9WCk WMte et Cumberland Silver Spring 16 Foxann , , . c. nfyeaapediyaDan (spec; M a D i r ve Mexlca4 Puerto Rican. etc) Whit e !1 Dttedem's Usual Cccu Lion KrY. W work sane Burin rg51 d works Ida Go not 5edk .retired 72. Was Decedent ever 1n me IG ' I 13. Cecedenfs Education ($pl .qty' only htghesl grade cwnDleletN 14. Malire5retus: Mamed, Never married 75. Sunni a If wde ive maitl n9 ~s ( nd ct N+rk Ksrd of Business' ~ndu< U. S. Armed Forces' C 1 e r k `" , .g en namal Eieman,ary~ s~d+aary ro",z) college n-a nr s,) wdowea, aydmea (saar;rn Oil Com an ^Yes f}~Nn 12 Widowed 1E. Decedem's Maieng Atldress i$heet. city r twin, stale. riF cadet DecedenYS Da Decedent Actual Residence 17a. State 6 Foxanna Drive ~ raj LNe in a ~ yg, pecedent Lived n Silver S p r i n a "` Carlisle, Pa. 17015 n6cn¢ny T ~o Tdwnmip? Cumberland nd.^Nn,Da~demLmadwamn t8. Fathers Name (First. middle, lasC suffix) Actual Umi6 d Ci &ro N ' John Johnson 19. Mother s Name (First medal, mal0ensurneme) j i Anna Calderwood ' 20a. Inm'manl's Name iTYCe i Pnnh Thomas A Grimm , 20D. !nhrman:'s Mailing Address f57ree4 cry!lown, stale. zip coda) . 20 Ridge Drive, Carlisle, Pa. 17015 ;.I a. Memod c( Dgposihal ~ Crenlatan ^ Dbnatign 270 Date or D14patieon (Month, day, year) 211. PIacE 0' Deposition (Name d cemetery. creme or dth¢r tort Wesel 2ttl. Local s1(City. town, state. zro code) l~ Burial Fem val tram St t ^ ~ o a e Y4 : Was Cremation or Donalten Authorized ^ Ome spec7y ; byMedinlExaminerlcdrorrer? ^y¢a^rw June 9, 2009 i Oak Grove Cemetery Tyrone, Pa. 16686 zza. s gna~aa nr wne~al sen- ~_~er~ee ( ~ ng as ee=ro z2D. tkenu NumD¢r rsa, zzt. Name and Adtlesa d Facdln - FD-012145-L F e 11 e r Me m o r i a 1 Home s g17 h~. 15th St. , T tone, Pa. 16686 j Conplele hers 23ac only when cerafy',ng 23a. fo the Dent y knawpdge, Death occurred t me tlme, dare and pal rated. (Signat ure and tide) 23b Li N physipan 5 ad evadable d nine d Beam to ~ cerfity cause el dam . cense umber 23c. Date Signed (MdnU, day, year) . a.35 8 ~ b L 3 a-v ~ N,ems 2e.26 must be wmpeled by pvson 2e. Time of paal/~'j P e P tact Dead jManm. Day, l r d yea,) 26. Was Case Referred ro Medical Examiner; Coroner for anon Other Than Crem ti v r ro p onouca eem. y 5s 1 ' dA. (~ a on a Oorption? ^ Yes ~1Go CAUSE OF DEATH (See InstruMiona an amplas) Item 2'. Pan L Enter the Uia r of eveNS - dlseasas, injuries. or m,-,plirafions - Iha1 dira¢tly oaruad ;,e Bath. 0 NO7 enter terminal event Approxxnare Imerval. Pen If Errter olharsonifmanr con~ien~wntW~g'ng is deo^.h, 2g. 0itl ToDflooo Use Contdbuta to Dearh? s such az ca dlac alrresl i respvabry arrest, or vEMdmdar fibrtYatlon withWl shdwllY~ IM edobgy. List ofd) orla Cause an acD Ere. ~ Crscet to Dram I ; .ht nd resdlirg In Ore underying cause given in Pan 1. ^ Yes n Probably "' pn^^'' n 1 (~ I INMEDUITE CAUSESFnal dseasea Q Unkrown 1 i L.1, R/o ( -y ~O ~.,[ condfuon'esulGng m. ,ealht , / ~ /~ ~ ~ ~ VVI ~• _ n ~ a ! !! ` 1 V\ i~[ 1 K t 29. II Fem~ Due M (e as a consequerroa t) ~ ' Seq'¢ntlelly list canddions, if an r ~eganl wdhin past year b ~ . '` leadi'~g to the cause fisted pn nne a. } 5' `~"-fsi~ "`z~'+U v -/ ~I ~" ~~~~i i ^ Pregl6rt atVme ddealh ate Eller the UNDERLYING C0.USE `^2 as sequence a!) ` \J - (d~.sease or inju.y :hat imlated me 1/ ~ I ^ Na ptegrranl bs pregnant wAh~n 92 days events rewltry m deaM~ LAST of doalh ..ue tc (a as a Corsequence cD: I ; "-' ^ Nd pregnant but pregnant 0.9 days ;01 year d. , before Beam ^ Unkrgwn d pegnad witNn tM past year 3tla. Was an Autopsy 3Db. Were AUmpsy Finrltrys 31 Manner of 0¢etn 32a. Dare of ;njury jNgnlh. day, yen 3gb. Describe How Injury Ocaned PeMm~ed'+ AvailaG' Pd roC k e a amp licn ~ 1 Natural ^ Homicide f C L f 32c. Place of Inury: Heine, farm. Sueel, Fattory, OHa~s BulMlr ; 9 n . ause o Daih? ~/ o ^'tes ~yJ No ^ Yes ^ No ^ Acudent ^ PerMing !nresugu[ 32d. Time of Injury g, s c, ( ya tyl 32e. Iryyry aI WoM1? 321.117ransDOdatidn Inryry lSpecih) 32g. Location of Inury (Street, ary: bwn, state) ^ Suitlde ^ Caua Nd be Detemnrred ^ Yes ^ Yo ^ Orrver r Op¢rator ^ Passenger ^Pedestdan M ^Omer - Spetlry 33a. Certifier ;check odt' a1e1 33b. Sigalure anryTNe or Cer6lie~ ' CeAifylrg physicon (Physidan cenitying cause el Beam when andher physcian has prarwuncetl death and cortpletetl item 27) ~~~~ syd J ..* 1 To the best of my krwwledge, detrth occurtetl due to the Cause(s) and manner as sNted Q ~ CifP~ ~VM~ - / ~ _ _ _ _ _ _ _ _ • Prondundn era ce i tl h i h _ - _ - _ _ _ _ _ ^ ~ _ _ ~ _ _ - - ~ - ~ ~ - - - - - g r ng p ys c h n (Physiciar~ Ddh pmnouxing death and cenilyug to cause of death) n I Ta the bell N try trgwkdge, death ocNlred at the gene, date, and Iece, and due k m¢ tau P se(sl end manner as stated__ • Medial ExaMner'Coronw 3, c. License Number I 33d. Dale Signetl (Mmm, day. year) ___'___'_'_"_"_ [ ©~~~~~ / On the basis d examination and / or imesti egon in m o ini tl U ~ Q L-. g , y p on, ea ocwrred at the Time, date, and place, and due to the teasels) and rtlenner as staMd_ C 57 N A ' 35. Reg~,s.ra's Sig a and Distrzt Vu - i~l~lo iY ~~ I . ame era ddress d ersan Vy,c Completed Cause of Deam jllem 271 'ype' P' ' 36. Dare Fled Month, day, year) S~ A J-H r to 0 n+-r Q P~ o~-as_e Y 39i2~7R~NDC~ ~.~y ,~~~~ P2 1 ~o~l 0 0 Dbposltwn Pe'nul NC. V ~ ~ ~ ~ ~-~ LAST WILL AND TESTAMENT OF FAYE W. GRIMM I, FAYE W. GRIMM, of 4603 Locust Lane, Lower Paxton Township, County of Dauphin and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare the following to be my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. FIRST: I direct that all my just debts and funeral expenses be paid as soon after my decease as may be found convenient. I further direct that all estate, inheritance, transfer, legacy or succession taxes, which may be assessed or levied with respect to my estate, or any part thereof, whether or not passing under my will, shall be paid out of the residue of my estate as an expense of administration and without apportionment. SECOND: I give, devise and bequeath all of my furniture and other personal property located and being in my home at the time of my decease and all of my personal effects, includ- ing all my jewelry whereever located to my beloved daughter HELEN MARGARET GRIMM. THIRD: I give, devise and bequeath all of the remainder of my estate, real, personal, mixed or of whatsoever nature or kind or wheresoever situate to my beloved children,JAMES P. GRIMM, THOMAS A. GRIMri and HELEN MARGARET GRIMM, share and C o share alike . --' O `° ~*~~ L ~ ~ ~_ ~,; r -z:, A rte- ~".' c r _ _f ~~ ~T ITS ~~. . _ _ ~ ~ ! '{.'! .-'' ~ x '~ _~.'~ .. ~ :~ -~: ..,.. . "ti LAST WILL AND TESTAMENT OF FAYE W. GRIMM I, FAYE W. GRIMM, of 4603 Locust Lane, Lower Paxton Township, County of Dauphin and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare the following to be my Last Will and Testament, hereby revoking and making void any and all Wills by me at any time heretofore made. FIRST: I direct that all my just debts and funeral expenses be paid as soon after my decease as may be found convenient. I further direct that all estate, inheritance, transfer, legacy or succession taxes, which may be assessed or levied with respect to my estate, or any part thereof, whether or not passing under my will, shall be paid out of the residue of my estate as an expense of administration and without apportionment. SECOND: I give, devise and bequeath all of my furniture and other personal property located and being in my home at the time of my decease and all of my personal effects, includ- ing all my jewelry whereever located to my beloved daughter HELEN MARGARET GRIMM. THIRD: I give, devise and bequeath all of the remainder of my estate, real, personal, mixed or of whatsoever nature or kind or wheresoever situate to my beloved children,JAMES P. GRIMM, THOMAS A. GRIMM arrd HELEN MARGARET GRIMM, share and = rv share alike . =~ ~ ~:~ - ` ~ ~~'., ~ ~~ r"' ~ =a r- ` c-' ' --ice ., Z7 ~ w .~~ ~ ~~ ~ "1'7 FOURTH: I hereby nominate, constitute and appoint my three children, JAMES P. GRIMM, THOMAS A. GRIMM and HELEN MARGARET GRIMM, as Executors of this my Last Will and Testament. My Executors shall serve without the necessity of filing bond or security in any jurisdiction in which they may be called upon to act. My Executors or the surviving Executor or Executors shall have full power and authority to do any and all things necessary for the complete administration of my estate. IN WITNESS WHEREOF, I, FAYE W. GRIMM, Testatrix, have to this, my Last Will and Testament, typewritten on two sheets of paper, set my hand and seal this ~/'- day of C~~~~ 1989. ~ (SEAL) aye W. Grimm SIGNED, SEALED, PUBLISHED, AND DECLARED by the above-named Testatrix as and for her Last Will and Testament in the presence of us who have hereunto subscribed our names as witnesses at her request and in her presence and in the presence of each other. J ~~- ~,~~m e s i d i n g a t "? oc / D c:~a c~a-u~ , residing at ,/a7~~y(~ OATH OF SUBSCRIBING WITNESS(ES) Estate of REGI TER OF WILLS COUNTY, PENNSYLVANIA ~I -~~- OC~~B 6.. (, SSc ~, C~r~ wtcr~-~ Deceased (each) a subscribing witness to ~~ ~~ (Print Name/s) the ~'W>11 ^ Codicil(s) presented herewith, (each) being duly qualifi jaccording to law, depose(s) and say(s) that she / h /they was /were present and saw the above -o Testatrix sign the same and that she / h /they signed the same and that she / he they' signed as a witness at the request of the Testator Testatrix in her / is presence and in the presence of each other. ~~/~ (Signature) (Street Address) ~'~It~s~~ ~~- ~ ~~~s~ (City, State, Zip) Execacted in Register's Office Sworn to or affirmed and subscribed before me this 'r"`1 day of ~ ,C~• Deputy for Register of Vills ~~,~+-d.4CL. V r (Signature) (Street Add/ress) (City, State, Zip) Execaated oast of Register's Office Sworn to or affirmed and subscribed before me this of day Notary Public My Commission Expires: (Signature and Seal of Notary or other of5cial qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 ~ na c~ RENUNCIATION '~ ~ ~'r ~ ; _, REGISTER OF WILLS ~ J ~ -~ ~ c "~ CUMBERLAND COUNTY, PENNSYLVANIA ; ~ ~ w :'~ ~14V/ ~ VUl /U ~ N Estate of Faye W. Grimm ,Deceased I, in my capacity/relationship as lrnnr ~vame~ ~! AU~/~1~E? of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to 73 ~a~) (Street Address) ~ARGlSG~~ ,Afl / 70/j (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills ~m (SiS~+~e) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the p ses stated within on this 3~ day of oZ o0 9 Notary Public My Commission Expires: ~ ao, a ao `'~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date ofexpiration ofNotary's Commission.) coMMONwEALTM o~ ~NNSrI.vANU- Form RW-06 rev. 10.13.06 NOTARIAL SEAT. USA ANN NIGHLNrDS, NOTAlIY Pt1SL10 81WER 8PRIN©TWR, CUMBERLAND COUNIY MY COMMISSION E~IRES AUGUST Z0, >ii>08 n co ~~ RENUNCIATION ~~=c-a _~ ~, ~- ;-. ,~ r-n y cra ~ REGISTER OF WILLS ~~ ~~ =-r CUMBERLAND COUNTY, PENNSYLVANIA `-`~~ a ~3I -~~- D~ ~8~ Estate of Faye W. Grimm I, ~JClr~~`~ ~ ~r'ii<~i (Print Name) rv c+ .,~- ~ ~; ~:; , -r.! _ ~__ , `` ; ~.. ~ a , ~ a ;~ ...o ~ ~ .' ~ ~{ ~ _ , ~.. .~T, ~ .-~: -~ -, Deceased in my capacity/relationship as So ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to .~ J~ ~ y Joy q (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this p day of ~~, Deputy for Register of Wills ~v1 ~~ S~ S lri ~ G ~ /J ~ (Street Address) (city. state, ip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpos stated within on this ~ ~_ day of ~, X,~:~J' Notary Public / My Commission Expir _ _ _ ,,,,,,,, (Signature and Seal of Notary or o L ••, a' 'fled to EWA RYBA administer oaths. Show date ofe ti ~'si -State Ot Florida =N` ~ My Comm. Expires Aup 4, 2012 -'' A•` "' ;F of ~ ~~;•• Commission f DD 811730 Form RW-06 rev. 10.13.06