HomeMy WebLinkAbout08-11-09PETITION' FOR PROBATE ADD GRAi~TT Off' LBTT~RS
REGISTER OF ~ti"ILLS OF Cy~ be ~ /a,~~ COUNTY, PE~~SYLti'ANIA
Estate of _ ~.D/Q~ ~ ~~ ~ Z~ / 9 / P ~'
also known as
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO;~IPLETE 'A' or 'B' BELOW:)
Deceased
File Number ~ ~ ~ ~ 1 " ~~,-7
Social Security Number,~0~ ~ ~~ ' oC /~
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are th "~DY1 ~- r~ U ~~ ~ ~` named in the
last Will of the Decedent dated and codicil(s) dated C
(State relevnnt 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 instctiment(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: e.t.a.; d. b. n. c. t. a.; pendente life; durante absentia; durante mirroritate)
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
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
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(Lis! street address, tower/city, towns/tip, cocr ~, state, zip code) / ~ '~r"?
Decedent, then g7 years of age, died on at Q ' ~'J ~ (/~'~L ~` / I~ r/ 4 b
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:
$ ~~~ ~
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Fornr R6V-0? rev. ro.l3.06 Pale 1 of 2
(COrY1PLETE IN ALL CASES:) Attach additional sheets if necessary. ~::~5 C~ - ;~
~,. /Decedent was dot icil ~d t death in ~U~'y~ ~ ~ ~ Q~ Count Penns lvania with his / last r ci al r dt~ice at
~ ~ ~ ~ y~ ~ Y ~~ pJda P ~ ~-.
Whe~~efore, Petitione~~(s) respectfully request(s) the p~~obate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
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
(before me the ~ ~~~ day of
~~ ~~ i
Signature of Personal Representative
~~
Signature of Personal Represent i e
For the Register
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Signature of Personal Representative -' " '-'
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File Number:
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CT
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Estate of r- ,Deceased
Social Security Number: 20 2., -ZU ' 2~ Z~ Date of Death: Z~
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been present ore me, IT IS DECREED that Letters STIR
are hereby granted to . ~,,.tC 1"Y? 1Y~Gl.r C~~ne~ es r_.~ •_ __
in the above estate
and that the instrument(s) date d` Z~ -- ~~$"'1
described in the Petition be ad mitted to probate and filed of record as the last ill (and Codicil(s)) of Decedent.
FEES t
Letters ............... f ~
$ °~ - a~ Register of Wills
~
Short Certificates ........
() S ~ Att~rncy Signature: ~
Renunciation(s) .......... $
Vet ~ L ~ $ ~ ~ , Attoi7iey Name:
J~ ... $ f C7 • 00 Supreme Court I.D. No.:
1.7~.~1)• ... $~~
$ Address:
... $
... $
... $
' ' ' $ Telephone:
... $
TOTAL .............. $
Furor RW-lJ? rev. l 0.13.06 Page 2 of 2
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 25~~2~0
Certification Number
This is to certify that the information here 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 permanent filing.
J U L 2 7 2009
~~ e s u Date Issued
REV 1112008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
MNENT
PRINT IN CERTIFICATE OF DEATH
CK INK
(See instructions and examples on reversal __.__ __ _
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1. Name d Decedent (First, middle, last, sudix)
2. Sex
3. Social Security Number
4. Date of Death (Month, day, year)
Loretta F. Zeigler female 202 - 20 ~ 2729 July 25, 2009
5. Age (Last BiMxfay) Under 1 err llrrder 1 rla 6. Date of Birth Month, de , r) 7. Birdtplece City and state a country) 8a. Place of Death (Check on one)
Months bays Haws IXnuMs
Hospital: Other:
$ 7 yrs. October l , 19 21 Shiremanstown , PA ^ inpatient ^ ER /Outpatient ^ DOA ®Nursing Hone ^ Residence ^Om
i
S
er .
pec
ty:
8b. County d Dwm tk. City, Boro, Twp. of Death Bd. Fardllly Name (If rra irtsdkdtori, give street and number) 9. Was Deoedent d Hispanic Origin? ®No ^ Yes 10. Race: American Indian, Black, White, etc.
Cumberland Middlesex (dyee,specdycuban, (~;,~
Tip. Claremont Nursing & Rehab Center Mexk:an,PuendRican,alp.) white
11. Decedent's Uerxd Kira d wodr d ab most d tlfe. Do rqt sled 12. Was Decedent ever in the 1 3. Decerent's Educetbn (Spedly only highest grade com bted) 14
M
nt
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Kind d Work
Kind d Brakress /Industry
U.S. Armed Forces?
Elementary I Secondary (0-12) p
Cdlege (1-4 a 5+) .
a
e
a
us:
on
ed, Never Married,
Widowed, Dfvaced (Specvty) 15. Surviving Spouse (If wife, give maiden name)
Homemaker Domestic ^Yes ®Np 12 widowed
1 e. Decadence MaMirrq Address (Sheet, cdY /town, state, zip code)
1000 Claremont Road Decedent's Did Decedent
Ac1ualReaiderrce 17a.state Pennsylvania l.iveina 17c
®y~
n,~~ Middlesex TWD
Carlisle , PA 17 013 .
,
. T,,,p
Township?
17b. co~mr Cumberland ~ 7d. ^ No, I~cedent IJved widwn
' Actual Limits d City / 8oro
18. Fatlter
s Name (FksL midrib, lest, sudiz) 19. Mother's Name (First, rrudde, maiden sumeme)
Clayton E. Wolfe Catharine H. Brubacher
20a. InfonrrenYs Name (Type /Print) 20b. Infomtant's Ma9irg Address (Street, ary /town, state, zip code)
Patricia M. Martin 304 Dorwart Circle, Etters, PA 17319
21 a. Memod d Disposition ^ Cremation ^ Donetiar
[~ &xial ^ Rertavel iron State W
C 21 b. Date d
Disposition (Month, day, year)
21c. Place of Disposition (Name d cemetery, crematory a peter dace)
21d. t.es:ation (City /town, state, zip code)
a
ntnstlon a Dorrtlon Authorhed
^od,er-sa«.ary: bylMedlcalEzamhrer/Coroner? ^YeaDNo
July 28, 2009
Rolling Green Cemetery
ower Allen Ttap.,PA 17011
22a. 9lgnetrre d Funeral ( 1 22b. lxense Nrxnt7er 22c. Name and Address of Facility
- ~ ~ FS 012 849 L Parthemore FH & CS Inc.,
~ P•0. Box 431, New Cumberland, PA 17070
Congbte~~ma23ec
only
pftyaiGan b nd avaibbb at tkrte o 23a.Tome d knovA
my edge, deem occurred at rite Ibre, date and pbce stated. (Signature and title) 23b. Lkxnae Number
23c. Date Signed (Monet, day, year)
candy ease d dim.
Items 24-28 mtatt be corttpleted by person 24. Time of Deam 25. Date Prawurtoad Dead (Month, day, year) 26. Was Case Referred to Medk,el Examiner /Coroner for a Reason Other man Cremation or Donation?
who prorrorxx,~es deem. ti,, ^ Yes ~No
CAUSE OF DEATH (See Instnuctbns and exempbe) r Approximate kderval:
dam 27. Pan I: Fatter the -diseases, ktJudes, a rwntp9catiorrs -that dsedty caused the death
DO NOT enter tenMnal events such as cardiac arrest Part II: Enter other '
~ 28. Did Tobacco Use Contribute b Death?
.
, r Onset to Death
roepiralory arrest, a ventricular fibMbtion widaut eUobgy. List oMy one cause on each line. r but not resudi in the undo cause
dYm9 given in Pert I.
n9
^ Yes ^ Probably
r
~E~ TE~A
USE
Fne~dsease or r ^ No ^ Unknown
~
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-~. a 29. H Female:
.
Due to (or as a consequence oq: ~ ^ Not pregnant within past year
list crorrdidorrs, tl any, b
~ ^ Pre
nant at tim
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th
.
~adlrq to came YsNd on Nrte a. g
e o
ea
Due to or as a con ~
Eller Bte UNDERIYMW CAUSE ( sequence of): ^ Not pregnant, but pregnant within 42 days
(~~~ that ~~ c• r
evade m deem
D of death
ue to (or as a consequence oi): ~ ^ Nor pregnant, but pregnant 43 days to 1 year
r
d r before tleath
^ Unknown H pregnant within rite past year
30a. Was an Autopsy
Perfomred? 30b. Were Autopsy Fktdxtgs
Availade Prbr to Completbn 31. Manner d Deem 32a. Date d Injury (Month, day, Year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, farm, SreeL Factory,
of Cause of Deem? ^ ^ Hom~rde
Natural Office Buiktktg, etc. (Securty)
^ Yes ~ ^ Yes ~ ^ AaVdenl ^ Pendnq Investigatbn 32d. Tkne of Injury 32e. Injury at Work? 32f. II Transportation Injury (SpeGlyJ 32g. Location of Injury (Street, dty /town, state)
^ Suidde ^ Could Not be Daterrrtkted ^ Yes ^ No ^ Driver 1 Operates ^ Passenger ^ Pedestrian
M Omer - Spedty:
33a. Certifrer (check only one)
33b. Sigrtelure and Tide e
'
• Certfyhg physkisn (Physician certifying cause of death when another
physician has pronounced deem and completed dam 23)
To th
b
t
f
k
ed ~
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es
o
my
now
ge, death occurred due to the cause(s) and manner as e4ted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
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Pronouncin
and cartN
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an bom pronourtdng deem and certitying to cause d deem)
Tp the best of my knowledge, death oceurrod at the time, date, and place, and due to the cause(s) and manner as stater!_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Medical Examiner / Caorter 33c. License Number
' 33d. Monet, day ye r
~
O
h
b
i ,) .
n t
e
as
s of axaminaUon and / a investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner es stated. ^
y, Name and Atldress of Person Who Cause of oeam (Item 27) Type /Print
35. Registrar's lure and Dia '
~"~ ~ f ~ ~ ~.
36. Dale Fled (Monet, day, Year) ~r ~~ ff n,f~
Disposition Permit No. ~ ~!-~l (/%~ 1~\~ / ~~~..)~/ '~~ / • /, ~~
LAST WILL AND TESTAMENT
OF
LORETTA F. ZEIGLER
I, LORETTA F. ZEIGLER, of New Cumberland, Cumband unty,~~~~
Pennsylvania, being of sound mind, memory and underst~~~g,c`~o
hereby make, publish and declare this as and for my Ix~~~Til~ ant'' ~_-
~ t ~ -~, .
Testament hereby revoking and making void any and all;-'cher ~lls~~_. ~~.:
-~, .--,<
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by me at any time heretofore made . ~ ~, ,., ,,
I.
I direct that my Executors hereinafter named shall pay all
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~~
my just debts and funeral expenses as soon as conveniently may be
done after my decease.
II.
I direct that my Executors hereinafter named shall convert
all of my property into cash prior to distribution.
III.
All the rest, residue and remainder of my estate, whether
-real, personal or mixed, and wheresoever situate, I hereby give,
devise and bequeath as follows:
A. One-half (~) unto my son, NORMAN R. ZEIGLER, JR.
B. One-half (~) unto my daughter,. PATRICIA M. MARTIN.
I hereby nominate, cc
~,
IZEIGLER, JR., and my daughtE
bf this, my Last Will and TE
IV.
s
nstitute and appoint my son, NORMAN R.
I
r, PATRICIA M. MARTIN, as Co-Executors
stament. If either the said Norman R. ~~
r
Martin is unable or unwilling to serve
LAW OFFICES
`Zeigler, Jr. or Patricia M.
B'
JON F. LAFAVER
917 THIRD STREET ;'the other shall serve alone .
NEW CUMlERLAND. PA. B'
Page one of two Pages
~~~
I
•
V.
No fiduciary acting under this Will shall be required to
post bond in this jurisdiction or in any jurisdiction in which he
may act.
IN WITNESS WHEREOF, I, LORETTA F. ZEIGLER, the Testatrix,
'.'have unto this, my Last Will and Testament, set my hand and seal
~... ~.. c
this ~~ day of /~~~ A. D. , 1987 .
=1
~,.: ~ ~ ~k ...../ ( SEAL)
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:= SIGNED, SEALED, PUBLISHED and DECLARED by LORETTA F. ZEIGLER,
the above-named Testatrix, as and for her Last Will and Testament,;
a
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yin the presence of us who, have hereunto subscribed our names as
'witnesses at her re uest in the resence of the said Testatrix
q ~ p l
sand of each ~ other .
~~ I
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LAW OFFICES
JON F. LAFAVER
917 THIRD STREET
NEW CUMBERLAND, PA.
i
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2~
w/
P ag'e
two Pages
OATH OF NON-SUBSCRIBING WITNESS(ES)
/~J~~ ~~ REGISTER OF WILLS
~-U~l ,d ~ y' ~QrI d COUNTY, PENNSYLVANIA
Estate of
Deceased
L° ~ ~ ~'. and ~ 0'~~ ~'f/~
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with (~`'~ ZZC'c T, ~°~q/P~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of e/ /C'~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
/" 2 Q ~~ ~ ~" is in his/her own proper handwriting.
~ G~~~~~
(Signature)
~ ~ ~~~~JQ~~ ~/~,
(Street Address)
(City, State, Zip)
Executed in Register's Office
~ ~'~G~~~
(Signature) / J ~/ ~/
(Street Address)
(City, State, Zip)
Sworn to or affirmed and subscribed
~~
before me this ~ ~ day
o f ^-~ Zut~~(
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put for egister of Wills
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Form RW-04 -•ev. 10.13.06