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HomeMy WebLinkAbout09-03-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Estate of Justin B. Meredith also known as Deceased COUNTY, PENNSYLVANIA File Numberrx} ~ - C~ - 0~3a Social Security Number 196-70-0637 Petitioner(s), who is/aze 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) rv C7 `-~.:; F_„ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~ `fumed in the last Will of the Decedent dated and codicil(s) dated ~'`0 - to ,'.~ -~ r_ -t7 - . - - - -~ ,_~ _ '.a=7 ~ (State relevant circumstances, e.g., renunciation, death of executor, etc.) ~ f -, J -.,I L Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of th"~~strument<~Yoffered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -rt ~ ~~ u~ ©B. Grant of Letters of Administration (lfappticable, enter: c.t.a.: d. b. n. c.t.a.; pendenteltte; duranteabsentia; duranteminoritate) 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.) Name Relationshi Residence Berk B. Meredith, III Father 11967 Forge Hill Rd., Orrstown, PA 17244 Jodie R. Meredith Mother 17097 Gorman Dr., Fort Loudon, PA 17224 (COMPLETE /NALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 11 Pin Oak Lane, Shippensburg, Shippensbure Township, Cumberland County, Pennsylvania 17257 (Gist street address, tawWcity, township, county, state, =ip code) Decedent, then 23 years of age, died on June 20, 2009 at 35 West King Street, Shippensburg, PA 17257 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 $ 118,603.80 situated as follows: 11 Pin Oak Lane, Shippensburg, PA 17257 Wherefore, Petitioners}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: Si nature T ed or tinted name and residence Berk B. Meredith, III, 11967 Forge Hill Rd., Orrstown, PA 17244 Form R4Y-02 rev. !0.13.06 CUMBERLAND Page I of 2 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 or affirmed a~td subscribed J Signature of Personal Representative be ore me the.,, day of r,,;a ~ '~ ~ _ ~~ ~~~ Signature of Personal Representative ~.-' ,. _~ {- ~ e=~ //''11 Ixt 7 . LL -y ~] to - For the Register Signature of Personal Representative t- ~ ~ ~i - ~ T> r- , ,.. __~ ,: _' ~ - ~J File Number: ~ 1 ' Oci - O o 3~' r J 1~~ :~ ~ Estate of Justin B. Meredith_ _ ,Deceased ~ Social Security Number: 196-70-0637 Date of Death:June 20, 2009 AND NOW, ~p~M~ r ~ ~, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Berk B. Meredith, III in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the FEES Letters ............... $ ~oD - c~ Short Certificate(s) ........ $ g • y~ Renunciation(s) .......... $ S ~ c~ ... $ S• Uti ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $a~CS ~ ~ ~ (and Cpdicil(s)) of Decedent. of'Wills Attorney Signature: Attorney Name: Jdm9s M. Supreme Court I.D. No.: 84133 Address: 28 South Pitt Street Carlisle, PA 17013 Telephone: (717) 245-9688 Form RW-02 rev. 10.13.06 Page 2 of 2 10~ 8115 RF.~' i0110'i LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given is correctly copied from an original Certificate of Death duly tiled with me as Local Registrar. The original " certificate will he forwarded to the State Vital Record; Office for pe r~~nent filing. P~ 15708362 J o7 z? ~ Certification Number r_~~ Date Issued ~ Local e~istrar ~~ --; >; -: O ~~ . . `!J (/) is r _._ ~ ~ - ._ ___ __ --- - F { _ _ : (l I ( ' , ~ ~ - - GrJ -- -- - . . ~ , (_ .. ~, _ ._ ___ . ,. ~ ' H105.1aa REV 11~ ' ~~~ N COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ` ,• p PERMANENT CORONER'S CERTIFICATE OF DEATH ~u I BLACK INK 1132-051 (See Instructions and examples on reverse) STATE FILE NUMBER C.Ji )` e ~~ w w 1. Nuns d Decedus (Feel, midda, bp, Wax) 2. Sax 3. Sxkl Securely Number 1. Date d Deets (Marsh, day, year) Justin B. Meredith Male 196 - 70 -0637 June 20, 2009 5. Age (gyp ButhdaY) Under 1 per Under t day 8. Dated &M (MOnm, day, er) 7. ~ ( arp vale «ladgn coun6y) 88. Place d Dum (Chad only ae) Mwaw ~~ ~ M~ May 23, 1986 Hapsel: Omer: 23 Chambersburg PA ^ ~S ecg M ^Olh ^N p H R ^ ^ , er y: ena p DOA ur ng ama es hpelienl ER/DMpplerli vre. 86. Caudy d Death Bc. ~ . d Dasth Btl. Fadsy Noma (D nd ndsubon, pre pred end number) 8. Wu DeoMNrs d Hispanic Origin? p No ^ Yu 10. Race: AmeDan Ndien, Black, While, uc. ( ~ Cumberland Shippensburg White 35 West King Street iMxiar R ican,erc.) 11. Deadarn's Usual bon Kaq d woM tlme rtgp d Ne. Do not Ebb retire 12. Wes Decedent aver m the 13. Deadus'c EMation (Spedfy Dory tcpiest gratle compuad) ta. Medal Sblus: Manied, Never Martied, 15. SurvivNig Spouse (II wile, gNe maden name) Kits d Work ' Ked d Bupnecs / IMalry U.S. Amed Forces? Ebmentery / Secrondary (012) College (1 ~/ or 5i) Witlowed, Divorcetl (Spedly9 Painter Dyna Corp. ^Yea [$Na 12 years never married • 16. Decedent's Maikng AOMess (Sired, celY /lows, oats, zip code) Shi ensbur TW ~adem'e PA Lade ln~a~d Decetlenl LNetl in PP 9 P • Twp vas 1?c 17 d R id S 1 1 Pin Oak Lane . . , Ace es ence 9. ipe CJ rowrohq? y?d. ^ No, Deadem lmtl wilds Coady Cumberland l?b Shippensburg, PA 17257 . Aciw LimiUd city/Bom 18. Femer's Nero (FUp. nstlde, Mp, euDix) 16. Momar's Name (Post, mpde, maiden aumame) Berk Blaine Meredith, III Jodi R. Hill 20e. DdMmaM's Name (Type /Pmt) 206. hdomlam's Mating Adtlress ISMUt ay! town, ebte, l'0 rotle) Berk Blaine Meredith, III 11967 Forge Hill Road, Orrstown, PA 17244 21a. Mphsld d DMpoagron ^ Cremation ^ Danetion 21b. Dde d Diepoptbn (MOdh, tlay, par) 21c. Pba d Disposgion (Name d cemdeN, aempory or other pkce) 21d. Loatron (CM / ~'^~ pate, zp ~) [~ a,nei ^ RemovplranSlale ^ Other. $p,d/y; 1YrCmrodon«Daud«AuMalad M Mescal Eundrwr y C«aer? ^ Yu ^ No 6-26-09 U er Path Valle =Cemeter PP Y Y S rin Run PA 17262 P 4 a • - . Spulua Jtaeral Service L6eni0A(ecfiq u each) n!+/y/^~ (v~':.'~ 226. Licerae Number FD-012984-L 72c. Name ud Ad6ees d Fadlgy Fogelsanger-Bricker F eral Home Inc., Shippensburg, PA 17257 Complete Ibrra 23ac ody Mien arWinA 23a. To 8ie best d my ImowMdge, deem oocurted d the Ilene, tleb end pbca paletl. (Signature arp title) 23b. license Number 23c. Due Signed (MOmh, day, year) phypdu 6 riot evaiahle at brie d OeeM b terMy auu d dean. • Dams 2/28 mop ce aanplebd by pereon 2d. Tare d Deam Aprx . 25. Dale Pmrouncetl Dud (Mom, day, par) 28. Wes Case Referted to Medical Exemnar / Caoror I« a Beeson Other then Cremelrcn or Donation? ' ""'a p°'°'a'~dB°" 3:00 A. M. June 20, 2009 Yea ^No CAUSE OF DEATH (Sea Insuu«IOna and examples) r Approximek nlenel: Pert II: Emu emu ~ 28. Did Tobacco Use Cambde to Death? Dam 27. Pen I: Enter me rLea.pttYam4 - doeases, Myuries, ar mnpimtiats- cop dnectly aueed me tlum. DO NOT adar farming evade such u ardiac anat. r Oneel to Dam Dal not rensang n Ne untlerryMg sue gores n Pan I. ^ vas ^ ProDdsy reapkeKKy ants. a ventripser fbn'Mibn wshdn ahoMng the etidogy. Lip ody one case a each Pre. ^ No ^ linknorm IMMEDLITE CAUSE (Final tlieease or r mndiun raapng yr aennl -,~ a. Opiate 10X1City 29. M Femdv: ^ N t ithi t Due to (or u e mracequence o0: i ot gegrien w n pes par ^ Pregnant p tlme d dulh Seprenle8y Yst condsbrGS, q aM. D. r bayq b 8re aUee hpetl an Moe a. DUB to (or u e ronsegaroe oQ: I G CAUSE {] Nd pregronl, but pregnant within 42 tlays i Edo 8r UNDERLYIN (tlitaase or iryrxy that nllia~ad me c r m) LAST DM d of dam • averse ruu g m ee . Due to (or u e consequence dl: i ^ Nd prepanl, bd pregrenl 43 days to 1 yur d before dam ^ Udnmm q pregnant wDdn me put par 30e. Was u Autopsy 30b. Were Aubpry FeMkps 31. Manner d Deelh 32e. Dale d M}ey (Modh, day, pert 326. Descsbe Hoe' Injury Oaurred 32c. Place d Mjury: Home, Famk Sired, Fedory, Pubrtrod7 AvailablePnorloCargleban d sauce d Deem? ^Nawrel ^Hamicpe June 19,2009 Injection of Heroin ~"~"~pa~(~'h)Home A,-~ pU Yee ^Mb Yea ^Na AtdtleN ^ PerKMrp Invectlpdpn 32d. Tme d Injury Unknown ffie. Ir}ay at Work? 321. H Tdnspwlation MIXY (Spudly) 32g. Locdbn d Injury (Sired, oily I town. pate) PA b r Shi /~ ^~~ ^~~~~ ^vee ~~ ^D,,,,r,~,mIX ^pa„~er ^p~,,;,,, . u g, ppens W. King St., P . M. Other ~ Syxdyy: 33e, Certlliu (dad ary one) 33b, Signehue end Tnk d ' CMDymp Phyaklen (Phywaan artMr9 reuse d tleath Mien uMhu physiden has ganwiced deem end mrylefed Item 23) ('.Or One r - To dre eastdmy knoaMdge, deem occrased sue to the auu(al and m.mwuppul_________________ ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pmnanclnp and cuUMryDM•INen (Phyalden bdh pronoursip tluM arts ad'Ayirq b sae d d.em) ^ l d d l M d d 33c. Lkerwe r 93d. Dale Signed (Modh, tley, par) mannuaaMtao------------------ Ton.I»ad my lurowbtlga, sem Daunts pits f sb,.n p aa,a ebits auea(s).n ow Jul 23 2009 Y • • MadkalEUmirorlCororor M.m ursad p de Inre aM due to Uw saute) aM nrmsr u Wbd ~ On Ilr bob d aumiroUon antl l « InvMlppbn n my apNSon dab and plea _ , , , , , " ~. llaaa upNMresa,d Podai M!~ Canoktad Ca~e ~~Yj~lp~~71-Type 1 Pdm 1 11 C i 18 ~ 3G. Regipmr's Signdure and ~ del r z ~ ~ ~ 36. Dale Yed (Madh, day, you) Basehore Road Suite 411 6 3 7 5 - ' z7 fpm Mechanicsburg, PA 7050 %~~ • - - Dispoption Pemp No, l'J.~~ ~ ~ /~`- RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of Justin B. Meredith 1, Jodie R. Meredith (Print Name) Mother Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Berk B. Meredith, III (Date) ~ (Signature) 17097 Gorman Drive (Street Address) Executed in Register's Office Sworn to or affirmed L'nd subscribed bef e me this ~ day of Zy~~ uty r Re ister of Wills Fort Loudon, PA 17224 (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 on this day of , Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~--, c~ cap ~° -,. ~ _ - ~ _ ~~ :~,-;. -- ~.,, _:; ~' ~ -~- ~, Form RW-06 rev. !0.13.06