HomeMy WebLinkAbout12-28-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Estate of ~A ~ ~ L ~ /~,/ ~ ~IJtJ .SrG File Number ~ ~ - nq ' ~ ~ q
also known as
[l F l ~ gj /f q ,Deceased Social Security Number ~ ~ ~ -~ ~D . ~~ ~~]
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' ar 'B' BELOW:)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / aze the '~ r~ ~/~ (alw~ named in the
last Will of the Decedent dated / 3 /=~ ~ pT'7' and codicil(s) dated
(State relevant circwnstances, e.g., renunciation, death of executor, etc.J
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrttmrtq~s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ c°~. --3
~.. -T; t -'-s
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^ B. Grant of Letters of Administration -~~ ~ ~ n r-~'=' x'-
(Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; duriFip' 7~in~Sd~itate) ~ ~-{ .} .,1~
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following e~j~~ any)~d heirs:; (lf-~ ;
Adntittistration, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) t;"~ :.' ~
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Name Relatinnshin R ~ nr> w . E ~~~~ i '"
(COMPLETE IN ALL CASES:) Attae/t additional sheets if necessary.
Decedent was domiciled at death in /° (~ ,f j County, Pennsylvania with his /her last principal residence atlgy
(List street address, town/city, township, county, state, zip code)n /
Decedent, then ~~ years of age, died on DES ~ (~ at ~t • G(7
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ ~• DGG
(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 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
~ tEV ~ • G' c, ~ - /~ ~ of A~ ~H~ I a
Forst RW-01 reg. !0.!3.06 Page 1 of 2
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 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 and subscribed
before me the ~_ day of
\:JVI ~KJJ~`- .~
For the Register Signature of Personal Representative ``'~ C a ~. ~ r: "' ;'.;,
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File Number: ~ ~ ' ~~ ' ~ ~ 9'oZ
Estate of Hd~ ~~ ,~ ~ A ~~OUS~-C_ ,Deceased
Social Security Number: ~ 81' ~~O" 5 4 < b Date of Death: 12' I g ~ ~
AND NOW, ~e A.+r~-Q~... ~_, CJC)q in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TarYi
are hereby granted to ~~ ~{- y o~~
in the above estate
and that the instrument(s) dated 2 1 O
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. A
FEES
Letters ............... $ ~ (~
Short Certificate(s) ........ $ $ • ~~
Renunciation(s) .......... $
1~-i1 ... $ IS ~ c.>o
Jcs ... $ Z3.Sc~
Q.uto n.a~ - o~n ... $ S, y0
$
...
$
...
$
...
$
...
$
...
... $
TOTAL .............. $ Fsl .~~_
J ~~(~~ G4
Signature oJPersonal Representative ~ N
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Signature of Persona! Representative
M ~w'.. -~
Regisler of Wills
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Fw~m RW-0•' rev. IU.13.06 Page 2 of 2
1f19.F05 }2HV fQ~1071
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 15934214
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.
d`.
DE 2 1 ' ~9
Local Registrar Date Issued
~ Irv t+~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
E I PRIaT RI
i'~'~` CERTIFICATE OF DEATH
(See Instructions and examples on reversal
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1. Nrr d Decedent IFirr. name, be4 eulfac)
Adeline A. Louse 2. See 3. Sodel Sewlty Nwlhsr •V m 4. Deb d DrM (MaMr, day, rear)
F male 187 - 16,-5416 December 18, 2009
s Age Md SeaOeYt Ihrda t IHldx 1 a. Dsb d alts ~. rd ebb « ee. Plea d t3Wh Cneck are
86 Yla. MmN DeYe Hour Miter
January 16, 1923
Steelton, PA Hospibt:
llPdbrd ^ ER ! Oubeaent ^ DOA Other:
^ Nutebp Home ^ Reeiarice ^ Olur ~ Spactty:
!b. Caany d DeWr tla Coy, Boo, Twp. d prM Sd Faday Nerr (M nd hrYYAbn, Aha Weal end n«nber) A. Wr Deatlad d H
n Indian, Sbck white, eh.
~F ~? ~ No Yr t0.
Cumberland ast Pennsboro Twp. (tt yr, epecly C
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Holy Spirit Hospital
Hnderr,PUerbRian,eb.) White
11.OeadaR'a I1rW dwak done mold ae. Do rat slab rotl 12. Wr Dsadaa eve b tlu 13. Deadaa'e Eduatla ISpedq airy hl9lur 9ro0e rsanpleted( 14. AbdW Sbor: Maded, Never Mertbd, 15. Srrsivirp Spouse (II vela, Ah• maiden name)
d Wpk KlnddBrlae/1Mnly
House~uties U.S. Amud Faae7 EbmeMry l Secadery (o-i~ Cdl•B• (1J a Sr) Wl'ed ~ (SP•ctlY1
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18. Dsadre'a Meip Addrer (Street, ' I bwn, ebb, xip catla)
3rd St. Extended Decederwe Dld peaderd y
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DeadentLNWb East Pennsboro
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Enola, PA ] 7025 .
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Adrl Limbd ~ CirylBoro
1A. Palace Nrr (FrL nadde, baL ardfia)
John Fortino 1A. Hollers Write (Firq, nldde, mear eumartu)
Maria Magnelli
2W. FlMmaa's Nano (Type I RM)
Steven L
Louse 2ob. IMamed's McIMg Amrs (Slats. dry / bwn, stab. aID code)
. 3rd Street Extended Enola, PA 17025
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(Cary mown, stele, zip code)
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27a. Siprrea d F«brd Ssaloe ~ (« perecn rdlnp r each) 71b. Uanr NuMa 22a Name end Addror d FedAy
FD 012774-L Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025
caobb tlar 23et eery wwn arllybp
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13iepalbn Permit No. ~~ .2 V o~c l r Q
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~~z~t 31~i11 ttn~ (~T. P~t~zmPnY
OF
ADELINE A. GOUSE
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I, ADELINE A. GOUSE, of East Pennsboro Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this to be my Last Will and Testament hereby revoking all other Wills
and Codicils by me at any time heretofore made.
ITEM I: I direct that all of my just debts and currently due debts and
funeral expenses shall be paid from my estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II: I give, devise and bequeath my entire estate, whether real or
personal and wheresoever the same maybe situate, to my son, STEVEN LEE GOUSE. In
the event that my son, Steven Lee Gouse, should predecease me, then I give, devise and
bequeath my entire estate to the SUMMERDALE METHODIST CHURCH.
ITEM III: I nominate, constitute and appoint my son, STEVEN LEE
GOUSE, Executor of this my Last Will and Testament. In the event that my son, Steven
Lee Gouse, is unable or unwilling to serve, then I appoint JEAN E. HARIG as Executrix
of this my Last Will and Testament.
ITEM IV: It is hereby directed that my Executor shall pay all inheritance,
estate, succession and legacy taxes to which my estate for the transfer of any property
hereunder maybe subject, and to charge such taxes as a part of the expense of the
administration, payable out of my residuary estate.
ITEM V: I direct that no Executor or other fiduciary named, nominated or
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appointed in this my Last Will and Testament shall be required to post any bond or give any
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security of any type for any purpose whatsoever, any law or rule of the Court of the
Commonwealth of Pennsylvania or any other jurisdiction to the contrary notwfthstanding.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ 3 day of
February, 2007.
ADELINE A. GOUSE
Signed, sealed, published and declared by the said Adeline A. Gouse, xhe above
named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her
request and in her presence and in the presence of each other, all being present at the same
iur names as witnesses hereto.
Residing ~/' l/~`
Residing ~~~~-~`~~r''`-~ ~~~
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Commonwealth of Pennsylvania
SS
County of Dauphin
We, Adeline A. Gouse Francis A. zulli ,and
Elizabeth Walsh-Velez ,the Testatrix and the witnesses, respectively, whose
names are signed to the attached or foregoing instrument, being first duly sworn and
qualified according to law, do hereby declare to the undersigned authority that we were
present and saw the Testatrix sign and execute the instrument as her Last Will and
Testament and that she signed willingly (or willingly directed another to sign for her), and
that she executed it as her free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as
witnesses and that to the best of his or her knowledge the Testatrix was at that time eighteen
(18) years of age or older, of sound mind and under no constraint or undue influence, and I,
the said Testatrix, do hereby acknowledge that I signed and executed the instrument as my
Last Will and Testament, that I signed it willingly, and that I signed it as my free and
voluntary act for the purposes therein expressed.
Subscribed, sworn to and acknowledged
before me by Adeline A. Gouse ,
the Testatrix, and subscribed and sworn
to before me by Francis A. Zulli ,
and Elizabeth Walsh-Velez ,witnesses,
this /~~~ day of February, 2007.
Notary Public
COMMONWEALTH Of PENNSYLVANIA
NOTARIAL SEAL
KAY L. D!NULET, Notary Public
City of Harrisi;urg, Dauphin County
My Commission Expires March 19, 2010