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HomeMy WebLinkAbout07-24-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF ~~'ILLS OF C~lyl~~/~'/~ COL~~TY, PE~+~S~'L~,"~~+I Estate of ~L~ ~-~'~~ ~ ~~~ ~isifC~ File Number ~~ ~~~ ~~~~ also known as ~L<Z /~8f ~ ~- ~<S~~~Q 2 Deceased Social Security Number ~0~ ~~ ~~- ~~J Petitioner(s), who is'are 13 years of age or older, apply(ies) for: (CO,YIPLETE 'A' or 'B' BELO6V:) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the last Will of the Decedent dated and codicil(s) dated (State relevant ci,-cu,nstances, e.g., renunciation, death ajexecutor, 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 the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (Ijapplicable, enter: c. t. a.; d. b. n. c. t. a.: pendentelite; durmue absentia; durnnte minoritnte) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Adirtirtisb•ation, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) r-. na Name nee ~ ~`' C ;__ , ,,, t - - r-fl ~ (COtYIPLETE LV ALL CASES:) Attach additional sheets if necessary. ~.q "' `!_ - y .'~ Decedent was domiciled at death in ~~7i/^/ /V ~ County, Pennsylvania~ith his /her 1~~st~p~rinc~pal•~ denf~ at ~~ ~''~~!-/~/LLt ~ a tfro j~12L1.S`/t ~l.L/47'R~K/~w/~ (QL~~~~' (List sn yet nddre.rs, town/city, townslup, counter, store, zip code) ,~y Decedent, then ~ ~ years of age, died on ~'r f 3~ ~~~t C~i~<S~ ~'C/a"~~L ~~<~- ~~1/rLS~Z Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 2~ G°Q • ° C (If not domiciled in PA) Personal property in Pennsylvania ~ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania 3 $ situated as follows: G ~. ~ ~vr ~ G'~'[S' t ~ . C'~~'~s~/ ~~/ ~ ~"~~~ -~ Wherefore, Petitioner(s) respecttirlly 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: Fornr RW-0? ren. 10.13.06 named in the O'f Page 1 of 2 `KTJ ~~ Oath of Personal Representative COVI~IONbVEALTH OF PENNSYLVANIA `~ ~- ~/ SS COUNTY OF C~,O1~~i''~~ 'The Petitioner(s) above-named swear(s) or affirm(s) tha ~ statements in the foregoing Petition are h11e and con-ect to the best of [he knowledge and belief of Petitioner(s) anal that, as perso a - resentative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me the ~~ day of uvl ~~ :~G'~~I i or the Register ~.' ~nl Representntive ~ ~S~ ~~~~ Si,~nnture of Personal Representative ~ r-.~ r~ - PTO Signature oJPersonal Representntive a `~ <~. ~ ~ - r rrrn , h~ _ _ --- ' -C ; + r -- , ~ ,-. File Number: ~' ~ -: c_... -;.~ ~, Estate of ~` L'/'2 •g,BLs T~ /`~~/N ~t_S.fG°'2 , Deceas~b -"i ~' ZCt~' -.Z`~ - 0 33 Z Date of Death: ~ 3 t2 ~~ ~ ~ Social Security Number: _ ~ 1 AND NOW, ay~ l,~- , ~> in consideration of the foregoing Petition, satisfactory proof having been presented before me, I IS DEC D that Letters +~~ ~fi~ ^/~ r ~170'~ are hereby granted to s ~"L~I ~#~ ~/ G • /ci S ~L°2 and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letters ....a..Q~.... $ a~ Short Certificate(s) ...°.Z.... $ Renunciation(s) ...°~..... $ (o \~ ... $ lb t ~~.` 4~ ... $ s ... $ ... $ ... $ ... $ ... $ ... $ ... $ ~, Wit, TOTAL .............. $ J~ Attorney Signature: Decedent. in the above estate Supreme Court I.D. No.: /2 ~ ~ `ms`s Address: ~^~~' 'wFa~~~ ~~ cry-~.s'~~ ~/I " ~ ~ oe 3 Telephone: ~~~ ~ Z~.i `~ ~3~ Fa'm RYV-0_' rev. 1U-13.06 Page 2 Of 2 Attorney Name: L// l! ! ~'~ ~ ~~~ ~'~ ~ I(IS.B(K R6V i01ip'i LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, X6.00 Certification Number „__ ~~m__~ ~ -f~-b5 j~:~:~ _ This is to certify that tf)e infon~ruion here r~i~~en correctly cop)e~i From an (irigina? Certificate of Dee duly filet Yy~ith me ~~~ Local Reg)strar. The origin certificate ~~ill t~~° for~yarded to the State Vi1 Records; Offi'_e fi>r permanent filing. L'_~~. ~~~e~.c~_~ct~C' MA~( 18~ 2fJ~ Local Reaist)~zu Dale Issued ~ c~ r~s a ~ - - ~ ~. , ;.~ i`~'a~ 7 ~ r-- 'Yy r . ~ ., .~ C ~ _„_- -- r ~, ~ _ - `~ ' e= ~ = , ~ H706-143 REV 11RWfi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE / PPINT IN PERMANENT CERTIFICATE OF DEATH BLACK INK ~1Y /~ (~~ (See instructions and examples on reverse) STATE FILE NUMBER vN ~ l 1 ~Y ~ f n l~ r /~ i~ -i ) .~ 1. Name al Decedent (Fist, midde, IesL wK) 2. Sex 3. Sodal Security Number a. Date of Deatn (MOmh, day, year) Elizabeth Ann Fisher Female 200 _ 22 _ 0332 May 3, 2009 5. Age (Last Birthday) Under 1 year UMa 1 my 6. Dale of BiM (Month, tla ,year) 7. BIIVQIap (City antl slate w faraign country) 6a. Place of Death (Check any one) slonrM pays Nw.s Mkxnea Hospital: Omer: 77 m Dec. 5, 1931 Carlisle, PA Inpatient ^ERIOwpatienl ^DOA ^Nursing Homo ^Resitlence ^Otf~er-Speciy: 6b. CWny of Death &. Cly, Boro, Twp, of Death Bd. FaciAty Name Qf rot institution, glue sircel all number) 9. Was Decedent o/ Hispank Origin? ®No ^Ves 10. Race: American Intlian, Black, yMee, etc. (S°a"y) White Carlisle Regional Medical Center t aa~~ eo ~ Cumberland S. Middleton Twp. l v R ,em.) 11. DepdenYS Usual bon Kid of work done N ~ mast of life. Do not slate retired 12. Was Decetlenl ever in tM 13. Decedent's Etlucetkn (Speciy oNy highest grade campkted) 14. Marital Status: Menial, Never MemeQ 75. SurvNirg Spwse Qt wife, give maiden name) Kirp of Work Kintl d Business I Ildustiy U.S. Amxad Forces? Elementary / Secontlary (612) College (1-0 or 5+) Wi~weQ Drvoreel (Spealy) Inspector Rubber Co. ^raa f]Np 10 Never married 16. DecetlenYs Meiling Atltlress (Street, city /town, stale, zA coda) Thornwald Home Decedem's Did Decedent Atwal Readenp na. sate PA uwama 17c.^Yes, Decedent Livetl in Twp. 442 Walnut Bottom Rd. edpm tivetlwimm Carlisle Cumberland T°""'°b'D? 170.® De Carlisle PA 17013 a i Gry Bwa 16 CO~y 16. Father's Name (First, middle, kai, wmx) Stephen H. Fisher 19. Momer's Nacre (Frst, mitltlle, maitlen wmame) Mary C. Bricker ZOa. InlormanYS Name (Type /Pant) 20b. Informant's Mailklg Adtlress (Street, city I town, state, zip axle) Pam Fisher 1565 Longs Gap Rd., Carlisle, PA 17013 21 a. Mamotl of Disposition ^ Cranation ^ Donaton 21b. Date of Disposton (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory a omer pace) 21tl, Loplion (City I town, state, zp code) ® Budal ^ RemwallromState :Was Cremation«DanegonAutlwrized 9 2009 M Westminster Cemetery Carlisle, PA 17013 ^ Omer 3petiy: kNExaminer/coroner. ^Yes^NO a Y a 22a. S of Funeral Se ' acting as such) 226. License Number 22c. Name and Address of Facility O man- O line ra Ome r ema O r y , nC . ~ ~ / 138504 219 N. Hanover St., Carlisle, PA 17013 Complete Items when centtying 23a. To the bell of my krroM occuned at , dare aAd pkce state/. (Signature all title) 236. license Number 23c. Date Signed (Monet, day, year) physician a akebk at fime of deem lc j w, p , 3 ~ C~ i'> 1 > 4, ~^ - 3 -- Z i:c: cerely pose of dean. ...- . Items 2426 mall be canpeletl M perxm 2<. Time of Deem ' 2fi. Date Praaurxed Dead (Month, tley, year) O 26. Was Casa Referred m Medid Examiner /Coroner for a Reason Other man Cremation or Donation? who pronounces tleam. ©~ . •~~ ~ M. ~ (~ (~ ^ Yes CAUSE OF DEATH (See instruMiona and examples) r Appmximete interval: Pan II: Eller ema gglldialN condfions conlrmuting m aaam 26. Dkf Tabaao Use Contribute to Deem? Aem 27. Pan 1: Emer nre r~yp' y(gygBN -tliseases, inprrks, or mmpHCations -mat directly caused me deem. DO NOT emar tartninal evens such as cardiac anesl, Onset to Death bW rrot resulting in the urdarying cause given in Part I. ^ Yes ^ Pmbaby respi2lay artml, a ventricular fibMation without slwwing me etlokgy. LLq oNy ale cause on each Ana. ^ No ^ Unkrwwn IMMEDUTE CAUSE IF'ral dsease or L7.~ ~) L L/.~' j~ r' cad'dkn rewltirlg in deem) _~ a. t.-. h Gi, ~T ~ a Q • 1\ Q: h Ll ~ LJ ~ S P f-~ J'-~ 1evzAe / `~ r '~ ~ ~S ~ ! l~ {. ~/~r~ ~~7tv/' hFem k: ~ Due to (or as a consaque op: a prafram wihin past year JJ°°^"L Pregrrent at tlme of teeth Seprenfialty Ikl condaorxs, g airy, b, katlxq to me pose listed pit Gna a. UNDERLYING CAUSE Due to (or as a consequence of): t h E ^ Na pregnant, but pregnant within 42 days n er t e (tlisease or m,nry mat irlitiatea ma c a deem event resunirg in seam) LAST. Due to (or as a consequenp op: ^ Not pregnant, bin pregrenl 43 days to 1 year beNre dean d. ^ Unkrrown it pregranl wanin me past year 3aa. Was an ANopsy 306. Wem Autopsy FMirrgs 31. Marxrer of Dwlh 32a. Date of Irpury (Marsh, day, year) 32D. Describe How Irqury Occu?ad 32c. Play of Inryry: Hans, Farm, Street, Factory, Office Bukll etc S ed Penamed? Avatlade Prbr to Completion d Cause d Deam? v-.~•~rsl ^ ~k~ !~I /~ / V rg, . ( p yJ ^ vas ~ ~, ~ ^ vas lyrrvo ^ Accitlent ^ PeaFng Irrvestigaam 32d. Tine of Irpury ~ / 32e. Inlury at Work? 32f. ti Trdnsportatgn InWry (Spearyi ` !1 _ i ^ P ^ / d T 32g. Loptbn of injury (Street. dy I town, slate) / ~'G ^ Suicitle ^ Cared Nm ba Delarminad ~hY ~ / (y~, ^Ves ^ Na ^ Driver / Operat« assenger P e a sh an _ /V/ ~--• • / ^v Omer ~ Spet'ily: 33a. Certifier (MBdr any are) 33b. SigneNre an a of Cerlifi • CerlKying physklan (Physk:ian pNtying pose of dpm when another physkAan nos pmrwunced dean and mmpleletl Item 23) To the beat of my Mnowledge, death acurratl due to the puse(a) end manner as sleted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , ~ Z,w'_ • Pronouncing all cenlrying physkWn (Pnysidan tom pronouncing death and ceniying to cause d tleatnl 33c. License Number 33d. Date Si netl (Monet, day, year) To the best of mY krawletlge, tleeth occuned at the time, tlete, ell place, all due to the cause(s) and manner as amtad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I Corarer • M di l E i / f/ l J V V ~ C' 7 ?' C~ ~ I e m xam ner On the basis of examination acct / ar Investigation, in my opinion, death occurred al me Nme, tlate, and plate, and due to the cause(s) and manner as slated_ ^ , ~ ~ ~~~ Adtlress of Person Wta Cta~mp1kletl' Cause of De (em 2~ Type I y'-Ix (~ ~ i ' Date Fled (Monet year) day ~ a / V 4h ~ S I ~ t"~I ~"V v ~ ~ ~ i 35. Regisimr s grd D s ~~~~ i~ I I I~~ I 1 10 I , , S; ~IN~- ~~ ~~ L t r~,f 1 1 S ~ ~ 3r 1 o 7 f LEY~NDt Z ~ isl_ , Owposition Permit NO. ~ J ~t~t `t~-1 I ~ 1 C! ~ t ~~ ~..:, RENUNCIATION ~~o `-=' ry M1L C7 f.._ REGISTER OF WILLS .~:;,-, ~;,, ;: CUMBERLAND COUNTY, PENNSYLVANIA : <~~}=:~ ~ ,__. __ -. . ;..y -.._.. T~ C' _' Estate of Elizabeth Ann Fisher, Deceased ~ ,~- 1, Caroline J. Jardine, in my capacity/relationship as sister of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Stephen G. Fisher, brother of the above Decedent. i' ~ r-~c-= d ate) Executed in Register's Office Sworn to or affirmed and subscribed Before me this day of , Deputy for Register of Wills ~/ ignature) ~:~~5" (Stree//t ddress)" (City, State, Zip) 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 purposes stated within ~this_~~day of ' 1 ~~i ~. `~lotary Public ~ ' My Commission Expires: co~rn~v~a.TM of ~usnv~wu _,_... t~n~~.s~. ~ ~n~, ~tAa+r Pt~uc cnr~.E eoROt~, cu~uwo coc~m ~r coMMissroN snits, sots ~ a , yj ~ y ~ G C.~19 ~~' RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA `_~ .;-f? ;'~ Estate of Elizabeth Ann Fisher, Deceased '' ~~ ~> ;': _. _, 1, Kevin A. Fisher, in my capacity/relationship as nephew of the above%`~'~ ~, :_ .~J Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Stephen G. Fisher, brother of the above Decedent. ~ 7 a~ (Dat ) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed Before me this day of Deputy for Register of Wills Executed out of Register's Office r•_ ~__~ L - r,=-- ~--- i a~ -. i.,: _ -. C .c- 42 G, ~~~ %7/a`G Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the p ose stated ~x~ithin on this day of , ~?l~Q•~1 ' ~L~ ~- Not y Public My Commission Expires: urn®A ~v ~~~~.~ ~~~ -- , NOTARY' ~'~,:a~( ~ ~iVDOL~s, CUC1t~ ~~ ~+~ _~'~?mmss~on r ~dres , ~3-2010