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HomeMy WebLinkAbout03-04-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C ~~ ~.~E~z~v~ ~ COUNTY, PENNSYLVANIA Estate of _ ~'rF f'T~'e 7 D .5~~'~ File Number ~ ~ ~ 1 ~ -- O also known as Deceased Social Security Number ~ Lh `~- 3 b - q ~ 4 t-} Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) ~ C7 ~' ., _:~, A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the =~ aD ~C `.r.:: ~ ~ last Will of the Decedent dated name~t°t~t~thq and codicil(s) dated Tt ~ ~ ~ ~: ;;; ....r~ _ , (State relevant 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 .c~th~eiinstrumer~s) off~~l ~~ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -t' N `"~ ~~ a Y'~I B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d. b. n. c.t.a.; pendente life; durance absentia; durance minoritate) Petitioner(s) after a proper search has 1 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 (3on,~~ s Residence 1-} a rs e Si-e~~eh r~ o,,~sk s`S~`~ aS~ A~l~ce La he rvew dr'I- i~ -~a~ ~ bra+l~-~•- to a E Vct IIr ~c) man{q I~~ I~ d ZS Pa{f~ vx 4~ S cS r- 72 5 S . ilwu~~ SFree f- ct~ [(P 10,,4 k""~~~/lY Sc lava{ f Scs(-~-- ~ a S S . d~a~~ q ~s,,r{ le ~- ~Ur~ (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ ~ r 17o-,t-3 Decedent was domiciled at death in C w"^S~v_ (a ~~ County, Pennsylvania with his /her last principal residence at I l o q ,~ I p r, ~~ -{- 3 ~ c a K t rs (o ~}- 17 o S s (List street address, totivn/city, township, county, state, zip code) M C ~1t6t N ~C S ~l'ov Decedent, then ~ ~ years of age, died on _ ~2~ ~vq ~~ (b~ 2a 1 o at (4 kS reS rota bi,c ~ Decedent at death owned property with estimated values as follows: (If domiciledin PA) All personal property $ I-{$ OC-O , U° (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: ~ ~^2 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 t3o-n~a~ S . Halsey 2 So ~41~c ~ ~cttie ~ New o, +~ ~ -~©7t~ P ~v~c~~sK -oZ 6 V~{IfYY ~~ , ~NO(c, I~ 1~CZS Form RW-O2 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF G~ ~"~ fat R-~-~w' 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 c ~ , C .~..~.~~ For the Register Signature ojPersonal Representative File Number: ~• ! _ 1 d ~ ~~ ~ Estate of ~t.~ ,Deceased Social Security Number: ~~fc~ _ ~~ ~ ~~ ~-+- Date of Death: ~ - ! to - 1(3 AND NOW, ` , ~A.~"CIr`- ~ ~}~ C~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~~~ n'1 n are hereby granted to ~x ~.. S ~+~`- 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 ~ ~' ~~ Register ojWills ',~ Letters ............... $ ~' - (~ Short Certificate(s) ........ $ a~ • UL7 Attorney Signature: ~ ~ Renunciations .......... $ ~ . c ~ C~ G (~) ~ Attorney Name: - ~ ° ~ ' ~~~~'~ ~ /~~'a MG~~ 1 L Y~ ... $ ~ C)~ Supreme Court I.D. No.: ~ 3 ~ y 3 ...$ ~~ ~~ Z32_ $ Address: ... $ • • • $ Telephone: C ~ ~ ~ I ~ 2 ~ Z 3 0~ ... $ TOTAL .............. $ 151 • S ~ ocd~ Form RW-0? rev. 10.13.06 Page 2 of 2 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Certification Number it05 t+a REv I I.200ri TYPE ' PRIN f IN PERMANENT BLACK INK 0 N JLJL-L LV t Name d Decedent IFrsl. mddle. Usl. su"al Jeffrey 0 5 Age ILasI &nndayl Under 1 year Under I day Moans Days Nwrs Mvwras 61 Y.s This is to certify that the information here given is correctl~~ copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital R rds Office for permanent filing. a 3 ~ Local R gistrar Date Issued rv C~ ~' ~ C ~ ~, " ~• ~..7..~ ~ i_~. ~ G~~ ~ ~. _ ~ ~a< .r,~ 1 . ,. ~,µ ~.,, ~ _ i~:: r .~.~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS :,,;,~~~ "'~ `- ""- CORONER'S CERTIFICATE OF DEATH -~ ~ `~-~. i"r`t (See instructions and examples on reverse) "'L7 " STgTE FILE f1~1BER ~ N '~ ~~ Y 2. Sex 3. $oQal Sactinty NurnMr o. Dale d Death ( .year( Sees Male 202 - 36- 9£344 February 16, 2010 6 Dale a Birth (hbnlh, day, year( 7 &nnpace (City ono slalt a brB CaxNry) 8a. Poace a Death (Check ony one) HOSplal Other Oct. 1, 1948 Harrisburg, PA ^Inpat~,t ^ER,pu I ^~ ^ Bb Gounry o, beam & C ro p of Death 130. FacJily Name (II not msmutan, qve strrrM arW pumper) ~ »n A Nursing Home ~ Residence 9. Was Decedent d Hispanic Oriryn~ ~NO ^ Yes ^Other Speary t0 R A Cumberland Mechanicsburg 1108 Apple Drive 1"'"s'9Q°"yC1D8f1• . ace nancan Irldrall 31a~. wrvle rIc (SPe~rM 11. Decedaru's Uswl Occ tin (Knd d work done moll d Gle. Do rid sure reaed 12. Was Decedent ever in the Mexica 13. Decedent's ElAvcalion (Spenty ont sl cede Y nt9M 9r cOrnplelW) n, Pwno Rican. ek.) 10 M i Whit e Krx) d wont Securit Offi Kind d Busineu / Indust r1' ' U.S. Armed Forces ? Elementary /Secondary l4 t 21 CoNSge (t•4 a 5+) . ar W Status: Marryd. Never Married, Widowed. Divorced (Specify) t 5. Surviwnq Spwse (" wda. give maden name! cer t ' Federal Gov ~ ^~ 12 ever Married 6 Decedent s Maring Addess (Brest. clty! sown, state, zip code) 1 1 0 9 App 1 e Drive , Apt . 3 Detxdant's Did Decedent - _ - - - - - - A""~ R.ed«,a ' 7a B"' P A '~'^ a ,?~. ^ Y.:. Dewaenl urea k, Mechanicsbur PA 1 7055 Townatkp? Twp t>b.ct>unty Cumberland ,7d.~1 ~ a edwilrw, Mechanicsburg 18 Falners Ndme jFvsl. mdWe. Usl. sulhxl Cev BJrO Oliver W. See:, tg. Mother's Nartw (First. middle. maiden wmartlal 20a Informant's Name (Type i Pnnl) Marian L. Parsons Bonita S. Heisey 20b. InfanwlY3 Maiknq Address lS1reN, CMy / bWfl, Slat.. Ip wdel 2t 250 Alice Lane, Newport PA 17074 a. Mally0d d asposllgn ^ CYematx7n ^ Donapon Banal Removal Iron Bate ® ^ ~ Wu Cremation a 13tsrtation AuMOrIaM ^ Omer ' s kf U M 2tb. Date d Disposition (Monts, day. year) 2/ 2 6/ 1 0 , ztc. Place a Ditpowtion lName a CeII1Nery. crematory a adter plan) 21d. Laation (City r town, state. zip coast y. p y edical Examiner ! Coroner? 22a S natws a F rw I S i p Ye: ^ No I n d i a n t o w n G a N a t i o n a l C e m P E . Hanover Twp P A g u erv c see ( ring usucnl - 22D. license Number 011825-L . , ?2c. Name and Alldnts d Fardliry Shalonis FH, 206 Maple Ave., Marysville, PA 17053 Compete Hams 23et aruy wM niying 23a. To IM best a my knowledge, death occurred «tM time, date and puce sated (Si vtwe and trtk pnysrcran is not avLlable alp death k g . ) 23b. License Number 23c. Date Srgrted (MOnN day year) certify oauSe of deem , , Items 2a~26 must Dec ontpleted py person 2a Time d Death r X . P 25 Gate PrataxKed oeaa (Maw, ear) da wnop«w,rrx.sdeam 6:00 A. M. ' y, Y Februar 18 2010 26. Was Case Referred to Medical Examirwr I Coroner for a Reasm OtMr man Crematxxl a Donation CALICF AF flCaTY rC.. t__.-.. , _..___ __~ _ ~ru ^No w Z .. ,.--- ••••.. w...an.• .rm .xampr•e f ~ Approxvn«e wervat van u: Enter dater Hem 27. Pant Ent« tM ruin aevents - dwases. xyunes, a corrKrticatnns -toot directly causal the death. Ip NOT enl« temrw wears such u cardiac arrest ~ .. 28. Dq Tobacco Use Contribute to Deam~ . , respvalory arrest. a venlncular libn"ation wntqul shows tM a .List Onset b Death n9 pology only one Cause on each Ikle r btx Trot rssukw~g n IM undenyky cause arts in Pan I ^ YK ^ Probaay I IMMEDUTE CAUSE (Fnal assess a r conditx7nrewpuyindeaml -~. a. Atherosclerotic Cardiovascular Disease ~ ^ pfd ^ ~~,n DM Dw to (or as a consequence ol(: r $ep,entlaay ksl CorglUms. A any. D ~ 29 If Female ^ Not ptgrwnt wMn put year badnQ to Uw cause 45ted on ix,e a r Due to or En h ^ Pregwk al ume d Oeatn ( ter t as a consequence oll. t e UNDERLYWG CAUSE (disease or awry teal vvoared Ins t c ^ Nor pegwtt. Out aegnaru wnrvn i2 lays events rewltu,g N aaaml UST. r Oue a for as a consequence oft t d death d. ~ Na prerytant. but p egnant a3 Oars ie I year r 30a Was an Autopsy 30p Wert Autopsy Futdvtgs 71 Mam« d Dsam 32a. Dolt d kyury (MOntlt, day. year) 32b. DeacriW How Psnormed' AvaJatxe Prior b Competan Way ~~ nelae deem ^ U^k^ow'n J Gregnant w~vun the ~a>I rear d Cause d Deun~ ~Nawral ^ lialycpe 32c. Place d kyury, Horne. Fenn. Ore«. Factory. onict ar,arsng. «~. r.spe~ry, ^ Yes No Yes No ^ Accxlenl ^ Penang Investigauen 32d. 7me d Iryury 32e. Injury al Wak? 321. If Translwrtalgn ^ ^ kMaY (Spedly! 32g. Location d Injury (Bre«, my :town sulel ^ Sux;ge ^ DouW Nor De DllermirMd M ^ Yes ^ No ^ Dover / Oper«a ^ Pass«ger ^Pedestrian . Other' Sped/y.~ 33a Cem6er Icneck only ones 33b. Signature • Cenirying IN,ysKian iPnvsK~an certlyrnq cause of deem when arwtMr pnyyctan pas ponounced death arq competed uem 231 To tM D f l es o my knowledge, death occwred dw to tM cause(s) and mannM as sated_ _ - • Pronouncing arW certif in h i i n Pn ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~ - ~ - ~ - ^ - C O r O n e y g p ys ( c a ys~c~an born ponouncmg death and cemty~ng to cause d deem) 33c Lx;ense Numper To tM Wet of my knowledge. death occurred at tM Ume, d«e. and place, and dw to tM teasels) and manner as etaled ^ T 33d Dale $ ~ ned M _ _ _ _ _ • Medical Examiner I Coroner ------------- g j Onln day year on tM basis a ex nation rid / a investigation, in my opinion, dwtn occuned « tM lime, dale, and pets. and dw to tM tau February 19 , 2 010 eels) and manner as sated_ ~ ~ Namt arW Ada f , us o Parson W Compared C use a as : sure Dau um r Todd C -- Ec enro~e a to (Item 271 Type ~ Prn1 C~ a . ~ e / ~ , Iy I I I / I cal 36~Ftn,~~~ 5375 Basehore Rd. , t roner Suite ~~1 170 0 D~sposnan Parma No ~~ RENUNCIATION Estate of Jeffrey O. Sees _ l _ No. also known as ,Deceased The undersigned, sisters (Relationship) (Capacity) Of ~1 the above Decedent, hereby renounce(s) the right to administer the est ~~5 ~~~ ~~~~~- ate and res/pectfully re est(s) that Letters of Administration be issued to Bonita S. Heise '"~%/ S ~ ~.~. v ~ ~2 v ~t2w1 .~z Witness ~- hand this ~ 'r~~l d~of a0 1 c~ Sworn to or affirmed and subscribed i^~ before me this '3 d f N ry Public M Commission Expires: n v ~ ~ ~, ~+ t (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) t~ignature) Patti Buxton 725 S. Main Street Ma sville PA 17053 (Address) (Signature) Kimberly Schardt 605 S. Main Street Ma sville PA 17053 (Address) Stephen sk (Signature) Y Valle Road Enola PA 17025 (Addr C7 ~' MMUNVYEALTH QF P M ~'---- E -~,~ `~''" =,~ ~ ~ ,~"' ~:} r ~ `' ` ~ ---~ A~Y1-VANJA N [~ _ ~ o-.arfal Seal cn R ~ 3 ~ ~ ~,,. :~ r -4 r ~ . .>bifc Y East pro Twp MyCarnmissicm ~i ,::? C -_..~ - ~ ~- ,..._ z w .~ rn re$ sYov. v .. NOTE: Renunciations executed outside the Office of Register of Wills are required in some counties to be notarized. RW-3 8~} ,t,. .ry •. _