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HomeMy WebLinkAbout09-22-09PETITION FOR PROBATE AND GR~,NT Off' LETTIJR~ REGISTER OF WILLS OF Estate of GG`~/L~ C~ ~ , o?~I-~ L'1 ~-( LPL ~~ also known as .Deceased COU~iTY, PEti~'~`r'L`'~~iIA File Number {~ ~ `0 1' QD ~ ~ _ Social Security Number (} l~" ~~ " Co ~~~ Petitioner(s), who is/are 13 years of age or older, apply(ies) for: (CO,YIPLETE 'A' or 'B' BELOW:) ^ A. Probate and Grant of Letters'I'estamentary and aver that Petitioner(s) is /are the ~ r-~ ni~d in the , last Will of the Decedent dated and codicil(s) dated ~~ ^e~r~ :': t.-~ ; r :n -_ , - (State relevant circwnstances, e.g., renunciation, deadr ojexecutor, etc.) _. ~ ~ r,} _: - _ir~ ^ f, Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execu tion of thy-i4tft~ttli~rtt(s) d'ffered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: :'Z = ^- ~~ =~ _,~ y .. tV ~ l~ iS. Grant of Letters of Administration (/jappficnble, enter.• c.t.a.; d.b.n.c.t.n.: pendentelite; durm,te nbseruin; durnnte nuno~itnte) Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (Ij Administration, c. t. a. ord. b.n.et.a., enter drte of Will in Section A above and complete list of heirs.) Name Relationshi Residence ~a rcG ~" Gam, ~ . .~c~ r~ ~'N , i ~-' ~ Y~ ~ v6 , / N . C,o~ s~c_~ ~ S ~ r~ A ~~ u C,s-- ~ o ti / ~ 7i~ ~ v ~~r,~ r~.~ , dic.~ P ~~ 1 ~ !yl _ ~ A /1, ~ E L ~s U <'~/ ~ 7 /1't / dDC.ES'E k ~~. G/¢~C-C..lS ~ ~' (COtLIPLF,TEINALL CASES:) At[acJc nddilional sheets ifrtecessary. Decedent was domiciled at death in ~~«'+~~E~.~CsglrilJ County, Pennsylvania w'thhis /her last principal residence at (List street address, towrJcity, township, count)r, sate, zip code) /~ /~ ~~ Decedent, then ~~ years of .age, died on ~T~a at (._~/!2(~/ ~~,~ ~~-~' (o~/~~ ~~s/2L~~ 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 $ r--0 ^ (if not domiciled in ]?A) Personal property in Counry $ ~ ~ Value of real estate in Pennsylvania $ -~ ~ '-- situated as follows: Wh'eref'ore, 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: Signanire Tv ed or printed name and residence For», R6V-i13 ,~~~-. lo.l3.06 Page I of 2 a Oath of Personal Representative COivI~IONWEALTH OF PENNSYLVANLA COU\TY'OF SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine and con-ect to the best of the knowledge and belief of Petitioner(s) and that, as personal administer the estate according to law. ~' Sworn to or affirmed and subscribed before me the rr' day of ,. ' ~- For the Register Signature of Personal Representative Signature of Personal Representative Petitioner(s) will well and truly c. C7 ° ~n a' N ~ -p ~ ~1 - - r .~ - ' .F...' ~ i~ ( ! ©-~~ ~~_ ~; - O File Number: c~ I _UG~ - ~ b n Estate of 7e~~rQQ~ ~~ n;,tia ~ ~>>" ,~D~eceased Social Security Number: O~ ~ ~lo ' ~D~iJly Date of Death: (~ " o~ ' V-7 AND NOW, ~(~tQ.KY't~2,~... Z Z ZC:C~rj , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters A('~ m ~ n i `sf rc f t ~~~ are hereby granted to S-~2C~ lUJ ~C~.~u2 ~ ~ - 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 .............. . $ ~ • Ll~ Short Certificate(s) ..... ... $~ (sly Renunciation(s) ....... ... $ 1~ . C~~ JCS ... $ to .~ ~~~-c ~1r,c~-~ o~ ... $ ~~ . O~ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL ........... ... $ J~ •i~J Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: of Wills F»,» ~ Rw-na rev. lo.r3.o~ Page 2 of 2 OCAL REtaISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee (or il~i~ certificate. $6.00 ~„-'~ Thls i~, tl1 certlly that thL inl~urnluuxi hclc ~,'iven is k1~,~~p,~ZH llfpFy;~. rrnlrctl~ cuhicd I~r(ml ~1n t111x~uull C~.rtificttc t~f Death /.k`~p~~ ~~r= duly lilcLi wlth jne ~u Loral Re~_*l~h~ar. The ori~~inal (~~~~~ ~ ~~,z crrtil~icatr, will hr ltin~•arded to the Slate Vial °vl ;a ~ ; ~a~ Rec(~rds Oft~irr i~~,r hcrmancnt I~ilin<a. ~•a~e- P 15 7 2 9 3 7 0 ~``~99 ME~1 oF~``P~? ~ ~`~~ ~~~K~b~-~ Au 4 --------- -------- --- Certification Number ~~~~~~~' Local Rc<~i~Uar Date Iv~ued N 4•.'7 n 4~ C/7 r -, _ ~•*1 '" ~ ...0 ~ C"i O A• J G~ N H105~/43 REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE /PRINT IN PERMANENT CERTIFICATE OF DEATH BUCK INK (See instructions and examples on reverse) STATE FILE NUMBER 7 ~7 ti 1. Name a Decedent (Rrst midde, ast suffix) 2. Sax 3. Sodal Secerity Number 4. Date of Deem ~MOMh,^day, 09 George W. Manuel, Sr. Male 018 _ 26_ 6656 Aug. Go 5. Age (Last &nMay) Under 1 year Under 1 tley 6. Clale of Birth (Month, day, year) 7. &nkplace (City and slats a lore count ) 6a. Place of Death (CMCk Dory one) kkeew 0.y: IlouE IAkxxK Hospital: Other; 73 yrs ,June 10, 1936 Fitchburg, MA ®mpauem ^ERroagaMm ^DOA ^NUrsirg Home ^Reaidence ^omar~speaty: ' 6b. County of Death &. City, Born, Twp. a Death etl. Fadlgy Name (I(irot insliMlak gme street and nareer) 9. Was Decedent OI Hlspank Odgln? ~ No ^ Yes 10. Race: Amerkan InQmi, &ack, While, Bk. Cumberland S. Middleton 7Cwp. Carlisle Regional Medical Center (N yes, specity Cuban, Mexican, PUenn Rican, alt.) (SPedM Whlte 11. DecedenYS Usual lion Kind of work d one tlu' mpsl of weld Igo. W not sale retired 12. Was Decedent ever in Va 13. Decedent's Etlucatlan (Specity only highest grade wmp lefed) 14. Mantel Status: Martie4 Navar Monied, 15. Surviving Spo use (If wik, give maiden name) Kkd d Work Kind dBusiness / mduslry U.S. Ammd Farces? Elementary / Secondary (P12) College (1 d or 5t) Wdowed, Divorced (Speci/)1 Electrician General Electric ®Vea ^Nq 2 Widowed • 16. DecetlenYS M~" 9 A ISlreel, dry 1 lam, sate, nP Dods) DrcetlenYs DM Decedent PA 111 1`I. Ianover St., Apt. 3R Adual Resdanca 17a. sea Tv 17o^rec, Decedent LNaa in TwP. Carlisle, PA 17013 ? ,n.cpanty Cumberland ne.®w,DacedenlLk~eawm,in Carlisle Adwl Limits d city / Bore 79. Father's Name IRM, mitlde, asl, suRa) 19. Homer's Name (First, mitlde, maldsn surname) Raymond J. Manuel Evelyn Smith 20a. Informenl's Name (TYPe I Pnnp George W. Manuel, Jr. 20b. I o s ling ddress (Shea dN I lash, a i code) ~ ~ ~itt Slt., G~ar~isle, PA 17013 • 21 a. McVgd d Dkpnsilion i ®Cremetion ^ Donetien 21 b. Dale d Dispceition (Madh, da ,Year) P m ary creme mar acs) ~`6~~Pna"i-I~b"~9ei ~'un2rall"°1eo~l4e & 21tl. Locaton (City 1 rown, sale, ziP ~) ^ Budal ^ Remcealhansale . weacmmaYlonmDOn.Bonagtlwrlxed ' Aug. 7, 200 Cremator Carlisle, PA 17013 ~ byNadkalExaminaNLOmraY! Yes^No ^ Dlher~Speciy: y 22a Signahae d Fu (a person acllng as such) 22b. Ucense Nunber 22c. Name and Address d Facgiry o man- o t one r a ome r ems t o r y , Inc . . - _ - 138425 219 N. Hanover St., Carlisle, PA 17013 Complete Harm T3ec Dory when certih'i'In9 . To ma best of my WnMatlga, deem averred at me 6ma, dale aril Place staled. (Sigrmture aM tills) 23h. Llrsme Number 23c. Date Signed (Month, day, year) physkdan is nil available at time d deem ro cetmy caws d amm Itwm 24-26 must be canpkad Dy pema 24. Time of Deam 25. Date Pronounced Deed (Moore, day, year) 2fi. was case Referred to Medcel Examiner / Caonar for a Beason Other than Cremation or Donation^. wlwpraiaxweaaam. 11: 46 aM. Aug. 2, 2009 ^Yas p~rf CAUSE OF DEATX (See Inetruetlons arW examples) , Approximate inarval: Pan IC Enter dMr ' 26. Oil Tobacce Use Cantnbule to Deem? Hera 27. Part I: Emer me gbg -diseases, mjunes, a mriplkatbns -Val dmetly caused the death. DO NOT enter temanal events such as cardiac arrest Onset to Death Wt riot msuaiig m the underlying cause given in Pan I. ~ Yes ^ Prabady respiratory arrest a vadnalar fibriMaticn wglxxx showing the elidogy, list Dory one reuse on each Bne. ' ^ Nc ^ Unknown IMYEgATE CAUSE Final cheese a ~. r J f( condition resdung m tleam) (" t ~ 2` ~ ~ ~ ' ~ ~ 29. If Female: ( a. ~ %U (_ 1~,~r PailSl v'(~ .SLIT?/' SO tGIw V;"P IT ^ Due ro for az a con s equence of): Nil pregnam wghin pant veer ~1 YY Seq'~enWNy 4sl condlrora, g any, b. (~,(%Y ~ Iy~nq W the pwe tided m line a ^ Pregnant al time d death . Due to (a as a consequence oQ: Enter hie UNDERLYMG LAUSE ^ N01 Pm9ren1, bN I wghin 42 de s pragren y ' evendseau a kMury that Ingieted da ~ a rewlting m deem) LASE C d death Due to a as a Cons ( equarice at): Nol I, bN t 43 da s ro 1 ear ^ pregnan pregnan Y Y d. before Beam ^ unknown g pregam wgnin Ina past year 308. Was an Adopsy 30b. Were Autopsy RMings 31. Mannar of Oeam 32a. Date of In1+ry (MaBh, day, year) 32b. Describe How Injury Occurted 32c. %ecw of Injury: Hone, Fenn, Saeet Fadary, Perlanad? Avagabk Prror ro Gxnpletion rt-f Natural ^ Humidtla Ogke &tidug, etc. (Speedy) d Cause d Deem? Id51 ^ Yas 4a'r~ ^Yas ^ No ^ AcciOerrt [] Periling Investigalbn 32d. Tree d Injury 32e. Injury el Werk? 321. II Tram{wnetim Iryury (Speedy) 329. Location of Injury (Buser, coy /lawn, sate) ^ Sukide ^ Gxld Nil he Delermned ^ Ves ^ No ^ Dr'wa / Opemror ^ Passenger ^Pstlestnen M Omer ~ spedx 33e. certifier Itlralc wry pne) 33b. SlpaNm one d Csnifier • Certlying plrymklan (fiyskian caNtying cave of deem wcen another physician las pranancetl ceem and rompalad gem 23) p/ 7o tlm beslwmy lorowledge, deem occurred dlrerotM ceuse(a)aM msnmr es sgrorL____ _____ _______________________ ~ 4f. • Pranounchg and cengytig physlclm (Physician bdh proriamdrg death amt cenllying to rouse d deem) ~~jj.. To tle beat M m kmwkd e deem oeeurretl 81 the tl d h il l il d t Ir Liceme Numbar 33d. Date Signed (Moore, day, year) y g , ma, o , ar p xe, ar ue o a tauae(s) and manner as sbtetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ LJ ~ ` • Metlkal ExamlMrl Came ^ C~77 ~3L ~ C On the basis W examineson sntl I or investigation, In my oplnron, death oxunetl at the time, date, end place, and due Yo the uuse(a) and manner as atarorL ~ ~~ ~ Address of Person Who Canpkted Cause of De am (Item 27) Type / rim 35. Registrar's 5' a end ~ (~ urLr 3 . D8M Filed ( nm, day, year) ) / /q/ ~ (1 ~I Sp (".Y' ' C ~ ~ p r 3 . ~~'/ r3'r P/ ~ L~ - ~{ , °~ I~ I ~ I ~I I I~ I ~ ) Bryarf Reti~i, i Disposition Permit No, l,J 7 s(l~' ji~ RENUNCIATION `° =~~ r REGISTER OF WILLS -~--r'~~,.~-' ~'`' _ -' ~~~/~,~ ~1~1J COUNTY, PENNSYLVANIA ; ~~=~ ~_,~ ~ a - ; ~'.~ -, cs Estate of ~-~',~ ~~ /~,/ ~ ~LIAnL~~_ _ ~ : ,Deceased I, --~~,~1~,~ ~-~~ ~Y7~_%2G11~' , in my capacity/relationship as (Print Name) .~~~~~~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to q -~; ~, ~ ~~ a (Date) (Signa e) "~ ~ e (Stre ~ dress) (City, Stale. Zrp) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciation for the purposes stated within on this -~- day . 2 n.~ Deputy for Register of Wills Notary Public My Commission Expires: June ,~1 2U10 (Signature and Sea] of Notary or other official qualified to admi 'ster oaths. Show date of expiration of Nota 's Commission.) NO?ARIAL REAL ROlIN l STARKER ~Y Pt~Nc CARL16tE ~RaUOti, CUAi6EgL~1Np COUMY Form RW-06 rev. 10.13.06 ~ C ~ ~.j~~ ~~0 .~.~ 0 C7 a C p `° cn ._~ ~ ~ ~ V i.. . RENUNCIATION ;1= ~r ~ N ~- c~ o _„ ~ ~', REGISTER OF WILLS __, ' ~'.,('~(~~1~J~t/p COUNTY, PENNSYLVANIA~~' Q Y Estate of ~~- '~ ~~~ ~,(, l?'1,Gln~ ~~ C,i __ ,Deceased I, ~,~C R 12./ F< ~~e~tr- ~ ~ caF~C_. ~ , , in my capacity/relationship as (Print Name) ~ ~`-~ of the above Decedent, hereby renounce the right to (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Form RW-06 rev. 10.13.06 (Signature) (StreetAddr,^ss) ~ 7.~~~ (City, State. ZipJ 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~or the purposes stated within on this ~- day Notary Public My Commission Expires: ~~r,~ 3~ t20\O (Signature and Seal of Notary or other official qualified to admi ate`"'~ mission.) NO~DIRIAL 161E ROl~i ~ f~1RlER ~Y R~lNC CAR~I.E 90ROUpH, CUAlERLMD COUNTY My CarlrnMilon Expil~ .1{111'17. '101 ~ administer the Estate of the Decedent and respectfully request that Letters be issued to N G~ n c~ RENUNCIATION ~ ~ rn CJ -~ ~`' ~z3~r ~; , 7 REG STER OF WILLS 6> c,: ;~ ~ -- ~~-v-~l~~v~cc. COUNTY, PENNSYLVANIA ~ ~ J~ J - _~ O Estate of ~ '~ ~ ~ . ! ~ lG~,t/~,~ e,, ~ ,Deceased ~ ~v I, ~ L ' ' `Q-~ lv7 ~ in m ca aci /relati (Print Nart~,l -~ y r ty •nsh>p a ,_„~ of the above Decedent, hereby renounce the right to administer the Estate of the Deced,(e~n~t and respect tfully request that Letters be issued to ~ ~~~ ~ ~~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 ~~~~ 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 Oda ~ day of Q Q ~m ~ 2CY~i Notary Public My Commission Expires: ~U~~ o~~,2U10 (Signature and Seal of Notary or other official qualified to admin' w te_ofexoirationofNotarv'sCommission.) NOWt1Al :EAL R09M1 l STARNER Nol~y PublfC CAFB~SLE BOROUGH, CUb6ERLANp COUNTY My Car~rtM~NOn Expk~t .lun Z7, X010 (,Street dress) CLJJJ l l t ~' ~ ~ 7~ ~J ~'(C'ity, State. Zrp)