HomeMy WebLinkAbout02-19-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Estate of ~ ~~
also known as
,Deceased
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 /are the
last Will of the Decedent dated and codicil(s) dated
File Number ~I ~1 lJ ~~' W v
Social Security Number ~ r ~ `~'
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--- named irrmihe
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~~~~ -~~
(State relevant circumstnnees, e.g., renunciation, depth of executor, etc.) ^;:~;7 C ~ C c" ~' ~`
i a CD ~ -v ~ ` ;'
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiot(iif~ instrum~t(s) ol~ered
-v ..
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
4
~B. Grant of Letters of Administration
(!f applicable, enter: c.t.a.; d.b.n.c.t.n.,, pendente lite,, durnnte absentia; durnnte minoritnte)
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
Adr,rirristration. c.t.a. or d. b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
(List street address, [owr city, township, county, st ,zip code) '
ears of a e died on a>11tAI~L. ~~ o~~~b ' at ~ b~ {~ (Y~
Decedent, then _~ y g
Decedent at death owned property with estimated values as follows: $ ~ `~~ -
(Ifdomiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania $ ~-- -
Personal property in County $ ~~ "
(If not domiciled in PA) $ _ ~ -
Value of real estate in Pennsylvania
situated as follows: *~~' ~ ~ b ~ ~ •
Wherefore, Petitioner(s) respectfully reyues[(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
Page 1 of 2
FormRW-OZ rev. 10.13.06
(COMPLETE !N ALL CASES:) Attach additional sheets if necessary.
Decedent was doxnicile~l at death in~, A~~j.1 n County, Pennsylvania with his /her last principal residence at -
Oath of Personal Representative
CO~IMON'NEALTH OF PE~'tiSYLVANIA N
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COUNTY OF ~
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~-re
oing Petition are tr
e
f
ct the r:;
be~t'dF ;
e
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in t g
or
E,,, l~rEell
Petitioner ~
he Decedent
f ar~?'til y •-~ ~ ~~
the know9ed;e and belief of Petitioner(s) and that, as personal repre entative(s) o c ~~~
,
t "D , ,~
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,
i:_~C:?~ ~.~ ~ ,
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administer the estate according to law. i ;'
r c a ~ fV '-
s r~i
Sworn to or affirmed anJd~subscri~ed
before me the ~----day of
~Y1.CL11~eso. _ .
For tl egster
of Pers4pnnl Repr~sentnrrve
Personal Rapresznmtive
Signnt:u~e oJPersaml Rzpresentntive
~ L lC~ ` DI~oA'
File Number: j~
Estate of t ~~ ~-~--~-!~~~ ~ ~ ' ~~ ---~ Deceased
1~~~ -_~'R~ Date of Death: ~~
Social Security Nurnber.~_
D in consideration of the foregoing Petition, satisfactory proof
AND NOW, ~(Yr~~}t.t~ I ~ Q,
--~
having been presented before me, IT IS DEC D that etters
are hereby granted to ,
in the above estate
and that the insh~ument(s) dated
described in the Petition be admitted to probate acid filed of
FEES
Letters $
Short Certificate(s) ........ $
Renunci [ion(s) .......... $==LZ; 2;I Z~
- ... $ ~~
.$
... S_______------
... ~_---
...
TOTAL .............. ~
as the last Will (aud Codicil(s)) of D
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Regis ter• of 6Yills
Page 2 oil
Fenn RtV-U' rev. lU.I3.0(
I05.805REV(UI/071 ~ ~ ~~~~~~~
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 15934779
Certification Number
REV 17RW6
PRINT iN
1ANFM
,K WI(
L Nsre a Deadea IRreL ntlddi., bsl,
Lester E. HowE
s. Age (ust endear) u
raoam
65 YR.
to camr. a Gam
- _ Keid a wax
McCl'lan1C
Jr.
ear lAtdr, aey
o.ra r•wx t•aw
Bc. Ciry, IROro, Twp. a Dim
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.
~~.. ~ °`, ANA 5 2~,u
Local Registrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
2. Sax 3. SaiN Sacudry Numbx 4. Dale a Deem (Monts, deY. Year)
Male 206 - 32-L 1184 anuary 11, 2010
Car~ers~i"ip
13 Cottage Ct.
Mechanicsburg, PA 17050
18 FeMx's Nara (Poll, ntitlAe, bet, stdRx)
2, 1944 Harrisburg, PA ^ lrpmtba ^ ER / OutpaBent ^ DDA ~aarsin9 Home ^ Reaitlarce ^Other _ speary
Bd. Fedihy Name (N not nmliONOn, give slreat and rxanber) 9. Wes DeadeM a HiepaniC OnPn? ®No ^ Yes 10. Rxe: American nxlien, Black. While, etc
("yea, apediy Gtren. (0 1Y1i to
Blue Rid e Mountain East "~"'~"• P'"n° `~'~ eba
f z. was Decedem ever n tln 13. Deadens Edtrcatbn Miry only Ndrat grede conpblad) f e. Manbl swat: Marred, Never Martied, t s. samdn9 Spouce 01 woe, give mermen name)
U.S. Armed Farces? Elamgggry 1 Secondary (0.12) Colbge (1 d or 5«) Witlowed' Ovorcetl (SpeaM
~YN ^~ 1iJ Divorced
Deadenrs °idt Silver $AYl.nft ran.
Aaa~ , „a ~„e Pennsylvania ? „~. [~Y.a.l3ecedenllived n.
Cumberland red. ^ Na, Deadenl Lived winMt cm I eom
,T6. Gann Actual UmBS a
19. kbdwrs Name (RrsL nddAe, maiden srenama)
e . W 1 L •
20e. lraorrrbrrl's rkme (TYpe1PriM' 20b. IMamaa's MaYnA Adders (sires, dlY I tam, stab, m aw)
19 Rutter Rd., Halifax, PA 17032
Nicole Marie Garr
Dale a OspaAion (Noah, day, year)
216
21c Rea a Dupocidm (NNa a anmlery, aemetay or amer place) x,d.l-«a~n(cMlt~,n.ael.,>;P~da)
^ DoneOOn
x1a. aleead a DspoMtlon ;
^ ~ ^ Ranpval hero sbb ~ yr,e~~a 13arWlwt Autlbrhed
^ No
Y
• . ,
i rv
Mt .
11 r in s PA
es
^ om~ - ~,~, a r.aer Eaaada.r 1 caraart
s wdi) 226. Llar•e pterEer 22c. ylrrb end Address a FadNy Myers-Ilarner Funeral Home
,,. d Fdbpl a
- 014819
• s dale and dace sbbd. (s~H~ and mb)
urrad el the inns
M
d
23b Lbense Number
23C. Dale Signed (Noah, day. year)
Ctblpleb 23ac drllY wAen altlryeq ,
e
9e.
23a. To tlb bets d my Iaa
L I ~ ` L - i l - ~ o ~ 1,
pt~,a n as aYeieOb at dos a deem b
- arory aaea a d~1L ~~
. ./T ~
4- < ~
26. Was Case RNartetl to Medal Examner I Caroar for a Beacon Other man Cremation a Donatbn?
ee W Person
2a 2a. nme a Deem 25. Dale Pmlaaned Dead lMomh, ,Year)
~ ^ res ~+o
~
• ~ L~ ` .'OOH
M. /iL« cc ~
Approxinbb bbnal: Pan I
t: Fsw atler ' ~
2B. dd Tauxo Conlnhule ro Deem?
CAUSE OF DEATH (Sae Instructions examples) r
BY~i- lea. aywi~, a conglk~om - ttel MdN °~ed me death. DO NOT enter temlirel erenls such as artFec aeasl. r Omer ro Deah bs M residlin9 b me uiderMn9 ~uee 91wn in Pen I.
Pan I: Eraer db fbYO
d
27
• Ib Yes Probe6ry
^^ ~ ^ lMkravm
-
.
.
m
rmpnabry uresl, a venuxWer RbrRblion limas shoaitg the etidogy. list ants erne arms an aech Roe. i
- r 29. h Femtle:
~~FFab~e
1•a~W.STI~'1rG Lame CANCFIQ
~i~reauRn9ndamla a _ ~ ^ tiapregmmwlm»pestyear
.
-~
Due b (a es a cansetiueam oq: r
r ^ Pregnant at lane a deem
~ ^ Na pregnant, Da Ixe7lea whtkn 42 days
61 artdaona, N any, b.
b aW Rand a the e. p11e ro (a ea a axmeQuBnca oQ:
r r d daNh
FaNr IIRIDERLYN6 WUSE
. ,_ . ,
^ Not pregraM, OW pregnen113 days l01 ypr
~ gym
~ d
a~ i balsa deem
•
~ ro la M a ~ ~; ; ^ unknown n preymnl widen me pass year
• d.
Meremr a Deem
31
32a. Date a mWry (Month, dry, Year)
326. Descdb Fbw nMUrY ~~ 32c. Rea a In(ay: Mane, Farm, Street, Factory,
Omer Bimdn9, ero. (SpxYfy)
3ne. Wes an Autopsy
per? 30D. Were ANbpay Fmdr~
AvaM6b Pna ro Corrgbsm
.
rn
Nam ^ F1a~xb
Location a mp,n Isree6
32
trey 1 town. amb)
d Came a Deem? Y(
^ Acddera ^ Peaeng imrestlgdion 32d. rme a IMury ? 321. R Trsrmpabtlon miary BvedNl
32e. r M wak
^ Gvar /Operate ^ Passenger ^Padeehian 9.
^ Yea ~ No ^ Veer ~ No ^ Suicide ^ Cadd Not 6e Glerrraried M ^ ~
^ Yes Omer - SpeaYY:
m arts ampMed hem 23,
G~KK (~R «aY q1B) d 33b. Sgneaxe end TRb a ~~ h b
ee
• Cae,ye,e d,Ya,a•,,Rrysiden andrro9 tmwa a amts when enotller dm~ ~ Prendexed
ro db eaa+a my tmadwge,dMNecalrrM du. to meewee(p aldl nlMebr as ehlalL-------------------------------- ^ 33c. Liaae Nrarber 33d. Deb signed (MOnm, day. year)
Prortoalksg and carlMyhlg PI+Mlolen IPhy~n mm Pr°'p"'dn9 deem end artllydng to ease a deem)
-----'-- OSOOyvgyL ahNAtR -I 20 to
Ta tlr beet a my taiowbdge, de.m aauned M me tMne, eeb, and plea, and due ro the eeuWsl erne manner a ebtsd- _ _ -- - - - - -
• Mediw Exrnirbr / Groner 3a. Name aid Adkess a Penan Who Compwed Luse a Gam (hem 27) Type I Pmt
G Bb ibab a examirudon and I a ImeMigalbn, in my oplaen, death occurred N the dme, date arW plea. and due to tM auae(e) and nunar u atated_ ~ h6~MQ L ~„ Ntt ~ 0
3s. Gte (, , daY, Yar1 1 S'x!4 M e-rfh 1sa404~t t K V f
Ftegistrere ~ ~ - ~-LI ~ i ~ I % I ~ I /~% /L' hMraht 1 ~ Pw 14 u e
- ~..,,~,~,~ Permit Nn 0453315 _
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RENUNCIATION i~ ~ ~
~ ~ ~
,,o ~
N ~r
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G -~
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:
REGISTER OF WILLS tv ,;>
~
sr~//~z o~ COUNTY, PENNSYLVANIA
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~.
Estate of
I G'T ~ G~r~
Deceased
in my capacity/relationship as
~~ (Print Name)
j~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
~~ ~- w
~~ ~~~~
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirme and subscribed
befor e this ~~~ day
.V - -
Deputy for Register of ills
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 day
of
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06