HomeMy WebLinkAbout10-05-09PETITION FOR PR,~-OBATE A/ND GRANT OF LETTERS
REGISTER OF WILLS OF ~l~~~h //f''f ~ COUNTY, PENNSYLVANIA
A•
Estate of ~i ~/~ .~ ~~ ~,G ~% C2 , Z N~ File Number lX-' - ( /"/ - ~/ / ~_J(Y
also known as G p
,Deceased Social Security Number /~'~ ' ~- G ~ !
Petitioner(s), who is/are 18 years of age or older, apply(ies) for: ~,
(COMPLETE 'A' or 'B' BELOW.) '
A. Prob9te and Grant of Letters Testamentary and aver that Petitioner(s) is /.aEe the ~'.rG c Lt 77c-~' X named in the
last Will of the Decedent dated ~_ ~/_i T ~-~'~rl and codicil(s) dated _~Oi1
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~ C~"J ~;_ ~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution'ct}~@'-jnsttutn~nt(s) o"ffe~e~`~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~a ~trC t ~ :~ ~ '~~
t,, ~ ~ _ i
^ B. Grant of Letters o[Administration -~
" (lfapplicable, enter: e.t.a; d.b.n.c.t.a.; pendente life; durante'absentia; , ante minoritate)' _ _,
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: (lf
Admi,tistratio~t, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list ojheirs;) '
.--- - -
(COMPLETE INALL CASES:) Attach additiattal s/teets if necessary.
Decedent was domiciled at death in Cur-n ~~"~~^' ~ County, Pennsylvania with his /her last principal residence at
1~.a~yo.2- L~~YE~ c~rzus~~= . ~o ry, , ~n/z~~..,, ~`w~< <'c. •~.~~zc13.=„~ C~.~~`Ii
(Liststreel address, town/city, township, county, state, zip code) ~~~~- i ~,.~5-`
Decedent, then G Z years of age,"died on ~$n Z~i'~ at Li/rLUf'~ /IC--~~~^~~ '`T C.y~~~-~- ~'~ ^~~'~~
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:
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
~ y~ Si/nature T ed or rioted name and residence
G ~ 2 a ~ ~~2.s, /~ ~- ~ r~ 3 ~cr
Forut R6V-0? rev. lo.ls.o6 Page 1 of 2
Oath of Personal Representati`-e
COMMON'/EALTH OF PENNSYLVANL4
COUNTY OF ~~~_••-~ /,f~tr ~i}./ ~
SS
'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are t-ue and cor~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 die ~~ day of
1
Fort e Register
t ,[~' ~f,
Signature of Persona! Represenlntive
Signature ojPersonal Representative
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Signnture of Personal Representntive ~ '. ~~ n -~ `t
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File Number: ~~ ~ ~ % ` / / ~l~ ~ ; -~ i
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Estate of 6v. •/~ .e , ~ _ : - s a ~,_~ .._. ~
•~.~, / / ~t ~~2 . ~,~/ , Decea~d ~ ~ _
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Social Security Number: / ~ `~- ~-U --- ~ ~ ~% ~ Date of Death: S'~i° • '~ ~,~ ~O ~ ~
AND NOW, ,~~ ~ ~~~~ , ~~~~, inconsideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~.C-Std-ss-r C--~v>~}-2~•
are hereby granted to _ C,~g.•2.e~e~ /<, LL, L [- a #'
in the above estate
and that the instrument(s) dated ____-?`!~.vu ~~ / 3~~ __ ~ __.
described in the Petition be admitted to probate and filed of record s the last Will (and Codicil(s)) of Dece ent.
FEES
~/~~ /~]~ Register oJWills (___.r].~L/ Cl J
Letters ............. $ (Ji/ ~ V ,~, ~~pp _ ~`" "'
Short Certificate(s) ........ $____~~_. ~ Attorney Signature: ~~/ed_'~e,~-~.,,._, ~ s-~ ~L
Renunciation(s) .......... $-_~~~ G /~ .S', s!/.•fi-iY ~'~GJ'
$ Attorney Name: 'I/r ~-~--~-~
• • • $_ Supreme Court I.D. No.: ~ ~--~-5 =~
... $ ~, -
Address: G' w .L ~-~~ s'.i- ~~i~ ~ :ST.
... $
.. $ c~cc ~ _ ~--+~3
..$
... ~
...$
... ~f ,,
TOTAL .............. $ lY~
Telephone: ~/~ - ~-~j`.% -- ,,5 ~ ~,/
Form R6V-0_' rev. 10.13.0( Pa~Z 2 Of 2
IO~.SUS RED 101/0'71
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph,
Fee for this certificate, 56.00
P 15730216
CertificatiL~~n Number
This is to cer~iC~ Jha( tL~e inli~rmatil>n here ~ri~~e(; i~
coiYectly copied from au uri,~inal Certificate ui~ Dean
duly filed with .ne as Local Re~_*i~tr(r. The ori~~ina
certificate will bk: forwarded to the State Vita
Record~~ Office cur prrmttneslt filing.
[~~e ~~~oac~c~.t-a~z'_OC.~ __~2C~09
Local Registrar ~ ~ ~~ I.h(te l~.ued
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H105-143 REV nngos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE/PRINT IN CERTIFICATE OF DEATH
PERMANENT
BLACK INN (See instructions and examples on reverse)
CT6TF FN F N1 ineAFA
1. Name of Decedent (FUN, mama, Wsl, sump 2. Ses 3. Social Security Number 4. Date of Deam (Month, tlay, year)
' 174 -20 -8793 Se tember 29 2009
s Ape (Last BinhdaY) under 7 year Umier 7 day s. Date of Birth (Halm, day, year) 7. BMPWce (Gry all slate or Iweign country) Be. Place d Deem (check Dory one)
Monms oars Ha.s Mkwles
82 rrs. June 22 1927 Mt•Holl Springs Heent ^ER/ONpetieM ^DOA ^Nweing Fmrne ^Rasiderae ^alrer-Speciy:
B0. County of Death &. City, Bo , Twp. Deem Bd. FazgBy Name (If rat IreUtulpn, gWe sheet all number) g. Wes Decedent d Hiapank Origin? ~ No ^ Yes 10. Race: gmarican Intlien, Black, While, etc.
Cumberland So, Middleton (g yes, weoy DaDSn, Isnacdy)
Carlisle Re Tonal Med Cent Meawn,PuenoRken,etc.) White
11. Decedent's Usual Oct Don Kintl al work done d moll of woddn me. lb rat state retired 72. Was Decedent ever in the 13. Decedent's Eduwtbn (Specify only hghesf grade completed) 74. Manlal5tatus: Married, Never Herded, 15. Survivirq Spouse (if wife, give maiden name)
Kill of Work Kira al Business I Imhlalry U,S. Am1ed Forcas7 Elementary / SecoMary (0-12) College (l-4 or S.) Wtlowed, Divomed (Speciy)
Owner O era r ea ^N~ Widow d
76, Deca0enl's Meiling Atltlress (Street city /town, state, ap code) Decedent's Did Decadent
4 Ladnor Lane AquNReaiOence 17a.Slale }~~ urefna „d.[~rea,DecedentLmetlm So. Middleton Twp, „~
Carlisle
Pa. 1 701 5 Township?
170'D°"nry Cumberl
na 17° Q Acl
~mtsti"~w"Nn
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aa
city / Boro
18. Famer's Name (First midde. lest, sum..) 19. Mother's Name (First, middle, maiden surname)
Ch rl n Rub F, Cle er
20a. Informant's Name (Type / Pnm) 200. InlortnanYS Mailing AtlOress (Street, city l town, state, rip cotle)
'ct r Church Road Gardners Pa. 17324
21 a. Memotl of Dispoaaon ? Q Crerne9on ^ Donedon
• 27h. Daze d Dieposdion (Month, day, year) 21c. Place al D' Name of tamale c
lsposiao^ I ry, remeary or Omer pl0ce)
21tl. Location (Coy /loom, Nara, xip model
[X Burial ^ Removal from Slate
^omer-speedy: iW"`" ~:r~m~ia0?°`~`d^Yaa^Ne Oct. 3 2009 Mt. Holt S rin s Cemeter
y p g y t,Holl S
y pgs, Pa,1706
~ 22 re of Funeral Service tic pere6n ~ such)
~ 22b. License Number 22c. Name and Address of Fadlity 5 01 N
B a 1 t i more Ave
- G ue.e:~.' .
.
FD-011 932-L Hollin er FH/Crematory Inc. Mt Holl S rin s Pa. 1 7065
fete nems 23at oMy when cenByag
physktien'e not avaeeble al time of deem 10
cemry cause d deem. 23e. To Iha best y knowledge, e~m~oc~cuyrt/¢~/\al~me dme, tle~te/ar/q_place 5laletl. (SigneNre all line)
/~~~" ' / "'- ~' ~'"9 ~ ,/ \
L /`~v lJ 236./~Li~c/en~s~e Number _
4?
r _ k;/ ~~> ~~ ~ 23c. Date/S~i~eO (ybnth,/y, yeaz)
l./~/~ v~
Irons 24.26 must ce completed M person 24. Time of Deam n.~ 25. Dale Phn d (Month year)
- mole proraunces deem. 02 10 ~'I~"". V 7 ~ :, ~~ 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other Ihan Cmmation or Donation?
^Yes '~No
CAUSE OF DEATH (See Instructions and examples) r Apprexknale kllen'al:
Item 27. Pan C Enter the main d events - tliseeses, Injuries, or wnpacanms -that directly reused gie Beam. DO NOT emer romenN events such as canNac arrest l
Oreel ro Deam Pan II: Enter other 8ionif M-condaons corn~ksa'no to tlealh, 28, Ditl Tobaaro Use CantdbNe to Death?
but not resultrng in Ure urMedymg mouse gWen in Pen I. ~ Vas ^ Probabty
respiratory artesl, or vemricWaz BOreatian wVlhgM snowing s1e etobgy, fist Doty one mouse on each aria. ^ No ^ Unknown
IMMEDIATE CAUSE (Final tlisease ar ~q r
WMF1gn resunkg in death) -~ a. 9'~ A r b /h~~ ~ ~ ~j 29. If Female:
Due to (or as a rice off: ,
` ^ Not pregnam wimin past year
SequenANty Isl caMiOas, tl any, b. ~eZyy~l ~
z/~y ^ Pregnant al dme of deem
leadrg to tla cause tasted on Hne a. Dpe to or rjm
sa~ue off: l
Ellen UNDERLYING CAUSE ( j
dsease
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t ^ Not Pregnant, bN Pregnant within 42 days
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~renta resanng .n seam) usr. ~ ~! of death
Due to (or as a cansequarae of): ^ Not pregnant, but pregnan143 days to t year
d. before death
^ Unknam tl pregnant within gte pest year
30a. Was an AMOpsy
Penomletl? 3W. WereAUmpsy Findings
Available Prior to ComplNka 31. Manner N Deam 32a. Date of Injury {MOmh, tla% Year) 320. Describe How Injury Occurted 32c. Place of Injury: Home, Farm, Street, Factory,
d Cause d Death?
~ Natural ^ Homaide Office Burdmg. ek•. (SpttylyJ
^ Ves ~, No [] Ves ^ No ^ Acpdent ^ PenrFng Investigation 32tl. lime of Injury 32e. Inryry of Work? 32f. 11 TmnsparuM1nn kry'ury (Specrlyl 329. Laation of lnpuy (Street, dtY l town, stale)
^ Suaae ^ Cab Not 0e Determined ^ Yas ^ No ^ Dover I Operator ^ Passenger ^Petlestrian
M aner - specyry:
33a. Cenif r (deck arty one) 33b. Signature erq T of Certifier
Cenitying phyelclan (Physician ceni114ng mouse of deem when enaher phyNdan has pronouncetl deem and completed hem 23) _
~
re lne heal et my knuwroaga, deem xcerree aaemtne nase(.)ana manner ae atata~-----------------'--------_----- ^ -
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• Prorauncing and cenftying physician (Physcian 6om plaiwmcirg dean are certlFymg m cause W deem)
To the heat M my knowledge
death ocounea al the time
data
end place
all due W the ceuae(s) end manner
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d 33c. LiceRea Number 330. Date Signed IMOnth, day, year)
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Medkel Examiner) Coroner ------
(zlyp X13 `J~ ~,•]„~
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On the basis of examinetion and 1 or Investigation, in my oplnlon, deatn otturred at the time, date, and plow, arM due to the cause(s) and manner ac elated_ ^
34 Name entl Address of Perso
n Who Compleletl Cause o1 Oeath (IIM n 27) Type / Pnnl
35. Regist lure and Dlsl
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' .Date Filed (MOMh, day, year) `
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I, WILLIAM K. PEFFER, 2nd, of South Middleton Township, Cumberla~d~~' c,~
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County, Pennsylvania, declare this to be my Last Will and revoke any will previou~}y~ ~ -~°
made by me.
I. I give, devise and bequeath all my estate of every nature and wherever
situate to my daughter, CAROL K. WILCOX, providing she shall
survive me by thirty days.
IL Should my daughter, Carol K. Wilcox, ,predecease me or die on or before
the thirtieth day following my death, I give, devise and bequeath all of my
estate of every nature and wherever situate to her issue per stirpes living
on the thirty-first day following my death.
III. All federal, state and other death taxes payable because of my death, with
respect to the property forming my gross estate for tax purposes, whether
or not passing under this will, including any interest or penalty imposed in
connection with such tax, shall be considered a part of the expense of the
administration of my estate and shall be paid out of the principal of my
estate without apportionment or right of reimbursement.
IV. I appoint my daughter, CAROL K. WILCOX, executrix of this my Last
Will. Should my said daughter fail to qualify or cease to act as executrix,
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I appoint my grandchildren, DELILAH WILCOX, DYLAN WILCOX,
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and WAYLON WILCOX, as co-executors, or the survivor(s) of them.
executor(s) of this my Last Will.
V. I direct that my executrix, or her successors shall not be required to post
bond or other security for the faithful performance of their duties in any
jurisdiction.
~~
IN WITNESS dVHEREOF, I have hereunto set my hand and seal this ~~ ~ "'
day of January, 2009
~,"`~r. ~~ ~-~~~ ~'"~ (SEAL)
WILLIAM K. EFFER, 2nd
The preceding instrument, consisting of this and one other typewritten page
identified by the signature of the testator, WILLIAM K. PEFFER, 2nd, was on the day
and date thereof signed, published and declared by WILLIAM K. PEFFER, 2nd, the
testator therein named, as and for his last will, in the presence of us, who, at his request,
in his presence, and in the presencepf each other have subscribed our names as witnesses
hereto. ~ ~~.., .,!°', //
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O NTH OF NOS-SUBSCItIBI~TG ~tiIThESS(E~)
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REGISTER OF ~`'ILL,S ~ ~c~7 `~ --~ t',.
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C~~ ti-, ~ ~~~-•~-~~/ COUNTY, PENNS~'L~"ANIA a v~ ~ ~ . f
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Estate of Gv~, L L j~,q.~ /~ /~~---.~i ~-~2:- ~ ,~e~ea~~c'
~',,~r~~~ /~ . G..,-; ~~`c-~` and
~eaehl being duly q ualified according to law , depose(s) and say(s) thatj"~ / he i the; ~~~as i were ~~. el!-
acquainted with lam, /~~_~-~~ l-.~ /'Ci%/ Cam- ~.-"'~~ and amlare familiar
with the handwriting and signature of the decedent, and that the signature of ~fG's~~'`iLT~~-
to the foreoing instrument purporting to be the Last ~~'ill and TestamenUCodicil of _ ~~~ l/.~-=" ~'~
L=~=i Win-, ~ ~~
,.. Ar:~r~ssJ
;a~, S:nie, 1~P)
Executed irr Register's Office
Sworn to or affirmed and subscribed
before gym, je~th~is _ ~~ daGy
Deputy for Register of lls
is i pis zer own proper handwriting.
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(Street Ad~s~ ~, ~ ~_~~/ ~'ifG~C ~"C~ ~~~
(Cite, S~nre. `Lip)
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REGISTER. OF WILLS '"' ~ ' ' -'
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~U~~//~~-/~ ~ COUNTY, PENNSYLVANIA ~ „ =° -;
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Estate of ~~/~~~m ~~• ~~~- y-- ~ ~
Deceased
-Y ~ ~/i~-~ -S, t~ ~'`'~' %~' ~-5' , (each) a subscribing witness to
(Prin! Name/s)
thef~Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that sh~/they ~/were present and saw the above Nest o /Testatrix sign the same
and that she ~-~ie~'/ they signed the same and that she /~ they signed as a witness at the request of
~.
the ~-Testa o /Testatrix in her h s presence and in the presence of each other.
/'~,~ /~
(Signature) (Signature)
(Street Address)
(City, State, Zip)
/'~ ya /~ s, ~ Yoh-~--~ ,~'~
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmc.~ed and subscribed
before me this ~~~ dray
of ~~ ~3P 1'~ ,~~~~ty ~ .
1~ ..
Deputy for Register ills
Executed otct 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 official qualitied [o
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.
FormRW-03 rev.ID.I3.06