HomeMy WebLinkAbout03-08-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~-~ ~ ~t R ~~ ~ COUNTY, PENNSYLVANIA
Estate of _ Dpl`~`{~y ~_ MC(_Gtuq ~,~ ~, File Number ~` - ~~'~~,~~
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
Deceased Social Security Number ~ ~?q ' ~ L}- [.~-~ /
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~~C~Cc.{~S named in the
last Will of the Decedent dated M ol~~c~n 3 f ,(9D6 and codicil(s) dated
-- ~r0~cv ~ • N~~ Lau~~lir. c ~eoQ ~\0 V'.,~~~ a 1 , aD 1 d
- Y1/1e ~ t Ssq y~.t~ ~~ ~(~ ~ to ~~C1 ~ ~ ~ ~ \tss c~ ~-~tw~e 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 of the instrument(s) offet•ed
for pt-obate, was not the victim of a killing and was never adjudicated an incapacitated person:
0 B. Grant of Letters of Administration
(If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente life; durante absentia; durante rninorit~j
c~ 't'_:
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followi~use (if ai4~ and 1~'~irs.; t
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 (~ _ ~ci ~., ..~ ~._~
....
,:~ ..., r... ~,__
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.• ~? t'rJ `_.:::~ .dry
(COMPLETE W ALL CASES:) Attach additional sheets if necessary
D d C
W
CT
ece ent was domtctled at death to ~ Vti ~J-(V' ~ of ~^~ Count ,Pennsylvania with his /her last principal residence at
a i o o gek-}- C Nee (~ ~ I v ~( ~ec u~ ~ c s~ vYq .~ d- -'7 c~ s a
(List street address, cown~ctry, township, county, state, ztp code) .
Decedent, then ~ ~ years of age, died on ~~~J ~~a ~ Z7 COI D at
~ I D'D ?3e~ Cre~e1~ -~I~d tl~l~c wtcs~w~ ~-- ~-Z ~-r~
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: ~ ~-
$ S, ~C1Z~ , E~
$ ,
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Wilt and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the un~lersi~~ned:
Sisnatute T ed or rinted name and residence
/y~1- lti1~e Liss a V~ ~ Ld k 1. r h ~ b /w~ Me t~sso~ u-
J
12 y- po ~~Fe R
~Wave~ ~or~C. 1~-
Y'-4- ~~ vs-a
Forst ]iW-07 rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
CO~I~ION'~V"EALTH OF PEA tiSYLVANI:a
SS
C O iJ iv T 4' O F C-u wl~ t Rc.~]7
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in tlce foregoing Petition are hue and cocz'ect to the best o`
the kno~~~ledge and belief of Petitioner(s) acrd that, as personal representative(s) ofthe Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed a~1d subscribed
.~-"
before cne tl~e day of
- ~ ~~ ~2..Q..~
For thz Register
Si~nn,eu•e ~ sonn! Rzpr-eser+tar /}
i c~
Signature of Person+nl Represenrn i ve ~.. Q °
=~~~
S~gnat:u•e of Personal Representative
File Number: a ~ /O - C_7~3 ~
C. ~ 5,..~
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- - --- - - - CT'-
Estate of ~ `- ,Deceased
Social Security Number: ~`X.S~- ~ ~ ' ~ ~S `~` ate of Death: ~' v2 `~l - 1 O
AND NO'J~', ~~~' ~~ b ~} / C~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~~~ M ~ ~ t~~ - -
are hereby granted to _~YLQ ~ ti ~ cA '~ ~~ ~,r-~ ~~>~ ~ ~h cs J~1 r ~.G~.~le ~ ~ ~ ~...~,
and that the instrument(s) dated
described in the Petition be admitted to probate acid filed of rec~rd~ the last Wil ,~(~id Codicil(s)) o,~Decedent.
FEES
Letters ...............
v~
$ ~ '
Short Certificate(s) ........ $ ~ -~-~
Renunciation(s) .......... $
~'~1~~. ... $ l ~ _ U~
Jc ... ~z•~.~=~
... $
... $
... ~
... $
... ~
... $
TOTAL .............. $ ~~ , ~aU
Attorney Signature:
Attorney Name:
Supreme Court I.D. No
Address:
Telephone
Register,
in the above estate
BSc a .~ ~ ~ ~
~Drrrs o-^ -
~ 3 l ~fi3
~0 36,E Z3 ~
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l'oru+ R!V-U' ,•~~. io.~;.v~ 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, $6.00
P 15936105
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
t1`'' MA .0 3 10
Local ~egistrar ~,.. Date Issued
Cd
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P~ti
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3 REV 11/2008
R/ Pt~IN
J-CK INK
1. Nara a DawMrp (FxM, mddie, lea, auMbr)
ro F ~g~i l' n
S. Aq (Lest day) lkrder 1 ear Under 1 de r
87 Mont" I]•ye Ixeee Mimre
Yrs.
8b. l;any a Daalh 8c. Gy, Boro, Twp. a Deetlr
CtIIIbP.r18I1d Silver Snril
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
2. Sex 3, _
Female6914,- 4818 Februa
e rv~ r ~ ...__.,. .--- - --
land a wax Kra a Blrkree /NrduMry
~Y~ Depatment Store
18. Deadenye MdBng Addreee (SIrsM, sty / bwn, Meta zIp code)
2100 Bent Creek Blvd.
hlechanicsbur~, PA 17050
18. Fetltera Name (FNM, nAdde, ast, aufflx)
Archibald Fox
20a. In(pr~a NMne yp• / Pdrd)
rv
3:.. ---,
~ r..~; "
~ ::~ ~ ~::
~ ~' '=
~, ~, ~
27, 2010
5, 1922 'verhead, IVY "0ep"°I' Other.
8d. FscNMy Name (M na xrtldrtlan, ghro MreM end ^ Inpetlerp ^ ER / Ou~etlent ^ DOA ($ I~hneinp Home ^ ReMdertce ^ Other • Spedly:
'w"'berl g. Wm Deaderp a Hleperpc Oppn4 ~]] ~ ^ Yes 10. Race: Artrrbarr Indan, Back, wipe, etc.
(M Y•a epeclly Cuban
Br • ,-, e3 at Bent Creek _ Mexican, Puerto Rkxn, gib.) (hate
12. was Decedap ever In the 13. Decedents Eduatlar (Spectly spy IpglrM grads oonpaarl) 14. Manta stelae: Martled, Never Herded, ts. SurvMng Spouse (tl wife, glue maiden name)
U.S. Artad Facet? / Secortdery (0-12) ~1 wldawed, awned (SPecily)
^ Yee g] No 11 n a ~) W1dO~Wed
DersdenYe Dkl Deadern e~,~.
Acdrl Rmkknce 17a. State Pen113V lVatlla Ip4 17c. ~ Yes, Decedent Loved a Sl lyer ~'a ~ Twp.
17b. County Clmberland 17d. ^ No, Decederd Lived wltlpn
AauM L1mMe a CMy/Born
18. Mothefe Nave IFxM. middle- mNA•n ~•n....r
Me issa Rimer 20b' onne°r~B:°; ha~0atifcs}burg PA 17050
21e. M
s
ltad a Dapoeitlon r ^ C
^
tl 2
b ,
rr
gq
Idl Burial ^ Removal hom Sale rema
on
Daupbn
i Wa flamaUon a Donatlorl Autlwrlaerl 1
. Des a Dapoeltlon (Morph, day. year) 21c. Place a
~ (N~ a anp0ery~ aemMay a other plea)
21d. Locatbn (City/town, Mate
zip code)
^ ~« -
?2a
d F r by Medeal Exrrprterf C«asl'1 ^ Yea^ ,~ March _4, 2010 Rolling Green Memorial Park ,
Camp Hill
PA
.
uneral Servla a
~ ) 22b. Lbenee Number ?~. Name and Addrem a FeclMy
M
ers-Ratner timers
Home ,
phyex;an a na M tl ru a d.Ml, b y
,
014819 1903 Market S
x 7011
23a. re 1M bell a my krawledpe. dwlh accumd M 1M tlrn•, sale and ~ b
I~ Mated. (slgnee,re and tltls)
l
aertly rare a ee.l,. }~ i2 tJ b
Naab
1~. N 5 ~l I ~ 5 g 23c. Date sicgn~e+a~7cMa>,b, d.y, yarn
O 1
` 2
~
Memo 21.28 mull b. wmplMed by pareorl
wlto pronolexre deetlt. 24. rhr a Death
! ~ ~ Y 5 p. M 2s. Des Pranaelad Deed (Morph. d•Y~ yM
27 ,Z ~
:2 -
O
•[, I
~' 0 o•m Relarr^ed ~ Medleel Exernxrer 1 Caster for a Ramon Otlrer pren Crernetion a Donetion7
,
CAUSE OF DEA I ~
.
am 77. Pan I: Eller tlr rbeh a evens _ TM (ees Msauctlor,..na .x;aenplp)
y ~, a vernrlrapr ~ tlone - that directly auaied the death. DO NOT erHer tem~el everts such m cardiac r M ~8~: Pan II: Enter d~
•n••t, r Orreet b Death urldepyxg ease given h Pert I.
ehoalrq the etlobgy. UM spy one rxrlre on each M1s. r but rat reeultxq b the
r
(F~ r~:~,~.~,~ r
r
Due b (ae ~a oaregrnae of). r
W oorrdtlar, M any. b. ,(JE~"E+~+'f7r4- r
b CWN Neled al Ina a
EJMef UNDERLYMIO CAUSE Due b (a m e oorregrrrlce oQ. r
(aeean a x*av rial xptlebd the r
event napYrls In deMhl LA8T. o• r
Due b a ere a
1 Irna o1): r
d. r
90a. Wm an Aubpey 30b. Were Aulopey Fingge 31. Maxrer a Death r
Palomfsd'1 Available Prbr b Conrgstlm 32a. Deb a hrjury (Marpr, day, year) g2b. Deecrlbe Hoe, Injury Ocaxred
a Caren a Death? ~•~ ^ Harddde
^ Ym ^ Probably
^ No
29. If Femeb:
0•Aot pregnant witlpn pmt year
^ Preprsnl et tlnle a death
^ Nor Ix•9nent but pregnant wltlpn 42 days
a deeM
^ Not pregnant, but pregnant 19 days b 1 year
bNaa dmlh
^ UNaawn tl pregnertl wMMn tlr peel year
32c, Place a Injury. Home, Farm, Street, Fecbry,
OIAce BWldrq, eb. (Spscly)
^ Ye. 1~1v~ ^ Yee C~'] No ^ aocldap ^ Pending tmroMlpaMa, 32d. rxna a IMun 32e. Mjury M worxa 32r. M Traneporttlun Injury (Spscylr) 32a L exam a kyury (sheet, dly / bwn, sate)
^ Sulfide ^ Court Nabs Dsfarrrkrd M. ^ Yes ^ Db ^ Driver/~~ ^ Pemerger ^ Pedmhlen
33a. CertlAer (check any errs) ~''
• raC ~P~n (PhY~ anMYbg care d deetll aTen enahsr oatpkad lam 23) ~' ~~e end Title a CenNkr
all bga'adge, deMh oocvrad fits ro tls PhY~ hen pronoawed death end ,t ~C~ _ ,~
- Ta and owUlylrq plryYeien (Plyaxien both prarorrdrp deatlt end
~a)~artlyxgbaueeadaMh) ------------------------- ^ 33c.UaneeNuMer -v_
I.r b~MdOe, daaM, ocrprned n the ttlrte, dw, rtd pMoe, and err ro dw arse(.) end nran.r a eaad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ O S t, U S S 7 C/ _ L ~. oaa ~~ (Mmlh, day, lfey)
• Itl.ew EtsatYsr/Cor«sr .3 - Ol •- J,v/a
on tls tlaaa d rsmYstlm rd ~ «Mwetfpatlon, M my apYpon, deMll accrand at Ms tbu, des, and plea. and dw ro tls ease(s) and .. eaMd_ ^ s1. Nmne end Addreee a Person Nita
Conplebd Ceuee d I)atlf (Meet 27) type / Pant
I_~t rl •~I ~ ~ ~. ~,~ GREG R• EMGARTNER, D.O.
I I ~d/D ya o~~ /~ l~ ~I'~
Dlapae,tla, Pemdt No. 0453431
LAST WILL AND TESTAN~N'T
OF
DOROTHY F. McLAIIGHLIN
I, DOROTHY F. McLAUGHLIN, of Camp Hill, Cumberland County,
Pennsylvania, being of sound mind, memory and understanding, do
hereby make, publish and declare this to be my Last Will and
Testament, revoking hereby all wills and codicils at an~~~me
? -~ C7 ~
:.~ ~~ r"`
heretofore by me made. ~_---arn i
..,..~w~. ~~ ~
`. ~~ ~°~
I . ~ ~~ ~ N
I direct that all of my just debts, together with the
expenses of my funeral and the cost of a gravemarker, be paid as
soon as practicable after my death.
II.
I give, devise and bequeath all the rest, residue and
remainder of my estate, both real and personal, of whatever kind
and wrieresoever situate, of which I shall die possessed or of
which I shall be entitled to dispose at the time of my death, to
my beloved husband GROVER H. McLAUGHLIN.
PAGE ONE OF THREE PAGES
--- r
DOROTHY F. McLAUGHLIN
~_, -,
E ';-; ->
-> - ~~
<~ ..:-`
`' "__
-,::t
III.
In the event my husband GROVER H. McLAUGHLIN shall
predecease me, dies simultaneously with me or dies within thirty
(30) days after my death, my aforesaid devise and bequest to him
shall lapse and, in that event, I give, devise and bequeath all
the rest, residue and remainder of my estate to my beloved son
DENNIS A. McLAUGHLIN and my beloved daughter MELISSA A. HUMER,
per stirpes.
IV.
I hereby nominate, constitute and appoint my husband GROVER
H. McLAUGHLIN as Executor of this my Last Will and Testament.
In the event he shall for any reason fail to qualify, or having
qualified shall cease to act as Executor hereof, then I
nominate, constitute and appoint my son DENNIS A. McLAUGHLIN and
daughter-in-law MELISSA McLAUGHLIN as Alternate Co-Executors of
this my Last Will and Testament or, in the event one of them
predeceases me though I nominate, constitute and appoint the
survivor as my Alternate Executor or Executrix, as the case may
be.
V.
I direct that all taxes that may be assessed in consequence
of my death, of whatever nature and by whatever jurisdiction
imposed, shall be paid from my residuary estate as a part of the
expense of the administration thereof, without apportionment.
,~,_,..~
DOROTH F. McLAUGHLIN
PAGE TWO OF THREE PAGES
VI.
I direct that no person serving as Executors of this Will
be required to enter security in any jurisdiction in which they
might act.
IN WITNESS WHEREOF, I have this ~ ~~~ da of (x~C'~
Y ~ ,
2006 hereunto set my hand and seal.
Signed, sealed, published and declared by the above-named
Testator, DOROTHY F. McLAUGHLIN, as and for her Last Will and
Testament in the presence of us, who, at her request, in her
presence and in the presence of each other, all being present at
the same time, have subscribed our names as witnesses.
WITNESS:
~l V - r I V"
of
of
OROTHY F. McLAUGHLIN
PAGE THREE OF THREE PAGES
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
We, DOROTHY F. McLAUGHLIN,
Thomas P. Lyon
SS
Herschel Lock
and
the Testatrix and the Witnesses
respectively, whose names are signed to the attached or
foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority, that the Testatrix signed and
executed the instrument as her Last Will and that she had signed
willingly, 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 their knowledge
the Testatrix was at the time Eighteen (18) years old or older,
of sound mind and under no constraint or undue influence.
DORO'~HY F. McLAUGHLIN
t
~~ ''~~
Subscribed, sworn to and
acknowledged before me by
DOROTHY F. McLAUGHLIN, the
Testatrix, and subscribed
and sworn before me by
Herschel Lock
WITNESS
WIT SS
and Thomas P. Lyon
witnessed,
t i s3 day o f ,
~~ 2006.
~[, G~ .~
Notary Public /~' --
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it,; Oii~'i il6 ~l~ ~~i'~.'HY i.e~L~r i~ V~ ~~~ ~mb~ ~~~y,~ W