HomeMy WebLinkAbout03-22-10PETITION FOR PROBATE AND GRANT OF I~ETTER~
REGISTER OF ~vILLS OF ~.~~y,~,-~ii.~,~ c~ COL~TZ", PEti~tiS~"L~,~A~L~
Estate of_~/~ ~% T`"/{ ~ /'`~ / ~' _ ~
alp la:ov:n as ~~----
Deceased Soci21 Security Number 2U~ ~ ~~..f' -'~ / ~~5~'
Petitioner(s), who isiare 1 S years of age or older, apply(ies) for:
(CO,fIPLETE 'A' ar 'B' BELOGi%)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~~ L--C-~~ f /~'. r ,~
natned in the
last Will oFthe Decedent datedyT/1~! ~ '~C~O, and codicil(s) dated ~11j~
N/ S' 9'~ '~~7--vim ~ ~° ~~ rS'~ /~~ « v~ ~,~ /C z+
(State relevan cu-cumstnnces, 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 insttument(s i offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~- ~ ..,. ~
-~.a _
~~ ~
^ B. Grant of Letters of Administration r,~ ~ y,. ,
(IJapplicnble, ewer-: c. t. n.; d. b. n. c. t. a.; pendente lire; durmue nbsentin; d~rr_'~~a~~rirnte)~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived b the followir.a`~ ~~~ N r
Adnrinisu•ation, c. t. a. ord.b.tt.c.t.a., enter date of Will in Section A above and complete list of heirs.) y ~ s~$ s~~f any) and heir's: (If ~~~
C~ ; , --:;
Name Relationship oe,.a_Y.a _
(CO.LIPLETE IN ALL CASES:) Attach~~a~~dditional sheets if necessary.
Decedent was domiciled at death in (..Cl~/~-'~ s-~/In. ~~ County, Pennsylvania with his /her last principal residence at ~G'C(~
(Lrstst~eet addre~s [own/ctty totivnshrp, county, state, a code) e
Decedent, then ~''~years of age, died on f~6 7' ~' i at /f'I~= SS'i~/t 1!• ~~ ~ ,z C~ .s ~ `,,, /1/ r fit,, f v,ra
~/~ L-~ / /
Decedent at death owned property with estimated values as follows
(If domiciled in PA) All persona( property ~ / C%v ~Y"r
(If not domiciled in PA) Personal property in Pennsylvania ~
(If not domiciled in PA) Personal property in County g
Value of real estate in Pennsylvania e
sihta.ed as follows:
Wher~Fore, Petitioner(s) respecttiilly 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:
l r Si~nanrre Typed or printed name and residence
G-: G" C
Form ~P4V-03 rev. 10.13.06
/ ~-c-~~;
Pale 1 of 2
Oath of Personal Representative
CCr~,1:~1ON'v~,"EALTH OF FENNSYZVANIA
SS
"The Petitioner(s) abo~~e-named swear(s) or affirm(s) that d:e statements in the foregoing Petition are t~-ie and con~ect to the best of
the kno~~~!edge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) wii] well a:~d traly
ad~:ninister the estate according to law.
S~~orn to or afnrmed and s~scribed
t
beore me the ~ ~ ~~~~ day of
~l,'-~ `t ~~ 11 ,.
For C(i Register
_ ~a 7r 'U-~-E' ~~~ l . ~~~~; ~~
Srgnatur r~lrsaaa! Represertari,
Signarw-e ojPersoaa! Representative ^,
C:~
~~
Signature ojParsaral Representative ~~ J ~ ~..~ m
,.~?.!- ~
i : > mt ~
T~ ~ r
-;'n ~t.:
File Number: '' ` ~` "'"'
~~ w ~ i
Estate of ~~~~' ~ ~~~~ ~ ' ~ ~ ~L:= ,Deceased ~ ~= '
W ~~
Social Security Number: ~~ f~°' ~~~9 Date of Death: ~C-Q . .,~ ~ .~G~~j
AND NOW, ,~~'~ ~~~~ ~~~ ~~I~C~ ~ ~..~ ~ , r~~ l~' , in consideration of the foregoing Petition, satisfactory proof
haying been presented be ore me, IT IS DECREED that Letters ~-Ca~fCt 1 ~ LC n ~L ~` ~
are hereby gras;ted to L~I~'Pl. ~ ~~..~~ ~ ~~ ~ ~ t~ ~~ l(e b" ~'~ _ _
and that the insh~ument(s) dated __ ty ~~~~~,~~'C_I
described in the Petition be admitted to probate and fi
FEES
L
t
e
ters ...............
ShortCertifeate(s) ....... $
. $
Renunciation(s) ......... . $ l4~ • U'~_-
. c _ ..
.. . $__u~t~_L'~~
_ . . $
_ . .$
_ . .~
.. . $
_ . . $
.. . $
TOTAL ............. . $-~ ..
in the above estate
f record as the last Will (and Codicil(s)) of Decedent.
//RegisteryyoJWi Is ( ( `~ l4 r} ~_ ~,~(J,~Gt - 1,,~ .
Attorney Signature: Ci(/~,C~~~•~~ ~ ~-~e.- J
Attorney Name: ~, L ~.i/lJ "~ ~ .~ C./ ~"~V`~'~'Gv~
;z ?- ~ v~
Supreme Court LD. No,:
Address: .~ ~`I` /<<~ `~~~
~.S'T.~ ~ „?~
Telephone
Form RvV-0? rev. 10.13.06 Pn~e 2 O`i 2
e 1 '` 7 "~ +~ .l 'snt. ~,. ~~
' 1~ .. m , s $~ ..-','~ ~,a~ ..
i, ,
e °+° ..•.£) .., lo't',-. l+i
i
n PV
c:'~
'
~ c~
~
S
?~ `~ x+•
I-~~~ ~
rn
~J r~
I'~1
:_~~~
-
~-i -
S7 C.J - T i
TJ ---'I _
"
?~ ~
,.
f.:
jHt05~143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
/ TYPE / PRINT IN
PERMANENT
BLACK INK CERTIFICATE OF DEATH
(See instructions and examples on reverse) cTgTF FII F r.. L.o~o
WI
`~
, ~.e,~F N oar:.,ann vnsl, miwie, last, sunlx)
DOROTHY C. RICE 2. Sex 3. Social Secudly Number 4. Dale of Death (MOnt4 day, year)
Female 201
18
1759 F
b
_
_
e
ruary 26, 2010
5. Age (Last Birthday) Untler t year Undn 1 day 6. Dale of &nh IMOnIh, day, year) 7. &Mplace ICiy ant stale ar loregn coudry) Sa, place of Death (Check only one)
Morwa Sys Raxs Ntksnn
85 vra. June 21 , 1924 Hwpital: Other:
Landisburg, Pa
~~{
^ Inpatient ^ ER! Outpatient ^ OOA Lj Nursing Home ^ Residence ^Olner - $peciy:
Bb. County of Death &. City, Boro, Twp, of Death az. FaciGy Name (If wl imtkufion, give street and number)
Cumberland Upper Allen Tw ~.y~
p ' 1 ' \e 3 S`t 9. Wes Oecedanl of Hi
spans Origin? ®No ^Ves 1tl. Raw: gmencen Indian, &acN, Wnlle, elC.
of yes, epecy aben, (spenM
cL~'~ v'l (l Q ~ Mexican, Puerto Rican
aro
)
i
It. Deceded's Usual Occu lion Kbd d work d
ow dui most of tile. Oo not cpte retired
f 2. Wes Decedent ever in the
13. Decedents Education (Seedy wty hi
hest
rade
l
t
d ,
. Wh
t e
Kind d Work Kind d Business I Industry
U.S. Armed Forces?
El
t
/S g
g
comp
e
e
) Id. Medlal Stelw: Monied, Never Married,
Wid
d
D 15. Surviving Spouse III wile, give maaen name)
Housewife Homemakin emen
ary
econdary (O~f 2) Cdlege (1-4 or 5+) ewa
,
ivorceE (Spedly)
g ^vee ~lo ------------ ----2--______ Widowed
• 16. Decedent's Mailing Address (Street, cdY /faun, stale, zip rode) Oecetlent's
810 Car01 tilrC le gdual ReNtlence f79. gate _ q0 Decedent
. P2nnSylVHnla ~
77c.^Yes, Decadent Lured in
wnsh
New Cumberland, Pa 17070 nb.coudy pe
Twp
o
Cumberland na.fl;Ne,Dexedentlmeaw;min New Cumberland
IB. Famer's Name (Frsl, middle, test, suku)
Charles W. Crozier Actual limks of City I Born
19. Mother's Name (First, mbAe maklan wmame)
Annie Dunkleberger
20a. Informant's Name (Type / Pdnp 20b. Informants Maiarg gtltlress (Street, dry /town, stale, zp code)
Peggy Spellman 810 Carol Circle, New Cumberland
Pa 17070
,
21 a. Method of Disposkbn ~ ^ Gematico ^ Dweaon 21 b. Date of Disposabn (Mwm, day, year 21c. Place d D'
) epwkion (Name of cemetery, aemelary a Omar pWCe) 21tl. Locatbn ICIry /town, 91816. xip cotle)
® Budal ^ RemovauromSmte ,
W°c'am°d°^,rD°^a°e^AmN~u,.w March 4
^ Omar ~ Spedfy: ~ M Matlleal ExenNrrr I Corarr7 ^ Yes ^ Na , 2010 Restland Cemeter
Y L o y s v i 11 e , P a
~ 22a. Sgrabre aI Servbe (« n 'ng az such) L2b. Lkerme Number 22c. Name and Address of Fadlay
. ~ ~,NN~_~ FD-012909-L Ronan Funeral Home, 255 York Road, Carlisle, Pa 17013
Crvlplel I 23a<any when cenilymg
physidan is nd evadable el time d deem b 23a. To me best al my kwwledge, deem wcured at me ame, dale ant place stated. (Signature and tkM) 23b. License Number
23c. Date Signed (Month, day, year)
ceniy rouse d tleam.
Items 24-26 mu51 pa led
wmOM W person
who pnaloMV:es death. 21. Time of Deelh
25. Dale Prpwuwed peed (Month, day, year)
/ /„ ~1 ~ M
%~
-
~- 26. Was Case Referred to Medical Examnet / Conner for a Reason Other Inan Cremalbn or Donation?
.
V! OC (~ Oc
~ (47 r~O J C7 ^ Yes ^ No
CAUSE OF DEATH (See Instrw:tlona end examples)
Item 27. Pan I: Eder bw chain dove rs - 6seases, injuries, or wmpkcafions - mat dkedy rausetl the deem. DO NOT enter terminal ev6 , Approxlmale'mtenal:
nls such as cardiac arrest Pan IL Enter Omer 5 an'ficant caWlxln
m,
con L'19 t
2a. Did Tobacco Use Cwldbule to Death?
respiratory arrest, or ventricular fibnllalbn without showing the elidog/ List ody one tease On eadl line. ,
Onset ro Deem 1
but not resuaing in me underlying rouse given n Pad I. Y
^
es
^ Preoaay
INMEDNTE CAUSE IFinal tlisease or ?
conalron resdling'm In)
i h~
~ i r
~
r~
yet ~w ^ unkmwn
_~ a. y{~ a n
a
D ~ D Q.G/ S f2N6 ~i cth ~t° VYl/ L(
7 C f $ 2e. a Fam~yr
ue to (or az a consequ~en~c~e, eft., ~/~ )
ScquenlWy Ysl Candtiort5
tl arry
/~
~ q
~
~ ~
t T -y
/ ~NOt pregrenl wimm past year
~
,
, b.
E
l
/~ rJ LZL1 ~Cn l .U ('
lea W Ih x listed on line a. Ike to
/- r
uarlw op
Enter UNDERLYING CAUSE for as a conse
1 ~
~~~/ 'f'G Nr', i (.~,0%(~(
!!/ - -
-'~~ ^ Pregnant at lime of dBalh
q
.
jtisease a kryury IWI klitlaled me c 7
t ^ Na pregnant, dll
pr 5nanl within 42 dare
events rewaing in tleam) LAST.
Dw to (ar az a consequence oll: of deem
d ^ Not pregnant, but pregnant 43 days to 1 year
~
30e. Was en Autopsy 30b. Ware Adapsy Fnrangs 31. Ma d Deem 32a. Dale d Inury (Mwth, day, Year) 32b. Descdba How bjury Occurred
P
d
d? before deem
^ Unknown 4 pregnant wkhm me posy year
e
orma
Available Pdor b Completion
of Cause d Death Natural ^ Hadcide 32c. Place of Injury: Home, Fann, great Faoory.
Olflw Builtli etc.
~ (~H)
~
~
^ Yes ^ Yes ^ Acddant ^ Pentling lnrosligelbn 32d. Time d Injury 32e. Injury at W6tk? 321. II Trenspodation IMury (Seedy/ 32g. Loradw el Injury (STred, city I lawn, state)
^ Sdcide ^ C6dd Nal fx Delemwred ^Ves ^ No ^ Ddver / Opereta ^ Pessem3er ^Petlesuian
M. Omer' Spea'yy
33a. Ceniber Icheck my one)
• CMKying phyeielan (Physkden caniMng cause of deem when anamer physkian has
To Iha beat of m k fwwwunCed death ant completed Item 23)
Y nawlatl
a
tleaN OCCer~
d O
l
tM 33b. Signature d Tile d Canifwr
N
/
`
g
,
e
tte
e
C]W!{8)and r118nl1ef eE 8f811a ________~______
• Prorrwnckg and ceNying physlclan IPhysiclan Cdh pronowlcirg deem ant caraying ro reuse d aam) ______~_________ ,
D
J
'
7o the Iwat d my knorMtlga, dam coeumd at the tlme, deb, ant place, ant due tome ewee(s) ant manner ae ataletL
• MedlctlExamlrlerlCaontt
_ _ _ _ _ _ _ _ _ ^
________ 3&. Licen66 Number
~/^~v/~S~i/~
33d. Dale Signed (Mwm, day, year)
On the Wets d examlNaon antl / W InvndgetltM
In my oplnlon
death oxurtetl al the IIrM
sale
entl
l oa-a~-ate
,
,
,
,
p
ace, arttl tlue to t he oase(s) eM manner az Slaletl_ ^ 3/ Name and gdtlress of Perron YAro
Canple
led
aue
C
e
al
Deam
a
(ll
Bg
m 27) Typal
nt
~i•~''' `
15. Rogisuer's S arq
m~ Date Fled jMwm
d /
/
,~~~~/ ~l /
/
J
A
l
~
y
'
L
7
7 R
~
S/T/"'~ r/ 'V~~z~A
/~
~
~t
~ I ~ I 1 12
I ~
I (1 I .
,
aY• Year) :
r
.,,
n
'
'
.
, ~ <~ ~
Yt7
A2.(,EhJ D.P.~ lit /~CHfFNiCJi3v~2G, py /~?
Disposition ParmH No. v. 0 ~'~ ~~+1_ Q
~ ~.1
-,~O ~_.~
~. ~ ..~.
~ ~C7 J
='' ~ ~.}
n-'Cf~~ N
I, DOROTHY C. RICE, widow, of New Cumberland, Pennsylvania, deel~his -~,
{-~ ~._
to be my last will and revoke any will previously made by me. ,.~- =~ ` ~'
~> .~-
u:
II
III.
IV
I direct that my funeral and burial be conducted in accordance with pre-
arrangements made and funded at the Ronan Funeral Home, Carlisle,
Pennsylvania, with interment in the Restland Cemetery, Loysville, Pennsylvania.
I give and bequeath the sum of Two Thousand ($2,000) Dollars to each of my
unmarried grandchildren..
I give and bequeath all the rest, residue and remainder of my estate of every
nature and wherever situate in equal shares to my beloved daughters, JANE
LOUISE RICE, GLORIA JEAN STONGE, and PEGGY SUE SPELLMAN,
providing they shall survive me by thirty days; otherwise, their issue per stirpes
living on the thirty-first day following my death.
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 residue of my estate without apportionment or right of
reimbursement.
V. I appoint my three daughters, JANE LOUISE RICE, GLORIA JEAN
STONGE, and PEGGY SUE SPELLMAN, or the survivor(s) of them,
executrixes of this my Last Will.
VI. I direct that my executrixes shall not be required to give bond for the faithful
performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 9th day of
January, 2007.
!~ ~. ~ (SEAL)
DOROT C. RICE
The preceding instrument, consisting of this and one other typewritten page
identified by the signature of the testatrix, DOROTHY C. RICE, was on the day and date
thereof signed, published and declared by DOROTHY C. RICE, the testatrix therein
named, as and for her last will, in the presence of us, who, at her request, in her presence,
and in the presence of each ther have subscribed our names as witnesses hereto.
.,
~~ -~
~- J
~~~iyL'i2~ ~~i ~3 ZS~
n
O
OATH OF SUBSCRIBING WITNESS ES -~~~
~~ `J
-.=;f~ ~~
GISTER OF WILLS ` ~ `'
C ~ ~ ~~, t,
COUNTY, PENNSYLVANIA ~ -,
Estate of Y /~~ ~' ~'
./
.,...
a ,
~~.
h;
1"V
~. _ ~
w
_, Deceased
(each) a subscribing witness to
(Print Names)
the Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that sh / h ~ they was /were present and saw the above Testator Testatrix sign the same
~~___ ~
and th sh ~'/ he /they signed the same~and that. sh / he ~ they signed as a witness at the request of
the Testat /Testatrix in he /his presence and in the presence of each other.
.~ 7
U Si''~ ~ ' ~/ `
(Signature) ~ z
(Signature) ll/i ~/ !' ,rt ,n.~ S f i~ ~. /L:-C_~.
(Street Address) "~ C~ ~~~~ `' ~ `~ ~ -"~ ~'`' '~ ~3 ~!
(Street Address) ~
• ~
(City, State, Zip)
(City, Slate, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this `~ `~' ' ~- day
...
of~_ l~~ ~. ~ ~1!
Deputy for Register of . ills
Executed occt of Register's Offcce
Sworn to or affirmed and subscribed
before me this
of
day
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.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization.
Forir~ RW-03 rev. !0.!3.06
C7 ~.,
c''
C.
OATH ®Ii \®~-SUB~+C~II3I~G `VITI~ESS (E~~~m
} L
- ~ i~
REGISTER OF WILLS
~ ~'='1'j~!
~ _; `'
_:.E;. _
~~ /~~ ~y~'/~~~ ~ COUTiTY, PENNSYLVANIA =~', ~;' ~
~- , .--,
w
Estate of ~~~i C~ ~/f~r C ~
~~ C
`
~~
Deceased
~ ~
_ /-- p_ T~ 1~-k ~~~r~i~~~ and
(each) being duly qualified according to law, depose(s) and say(s) t t sly, / he /they w~ % were we(1-
acquainted with ~- ~ ~ ,.~,~ ~ ~ ~ J`,p:-~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of ~%` ~ ~~ ~ `~c~=~-
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of .1 -~~<-~.~~ ~'. /C~~~
is in his/her own proper handwriting.
l;Sh-e~l Address')
,,~,t,,.
F_xecuted in Register's Office
Sworn to or affirmed and subscribed
before nae this ~ ~ ~~ ~~~ day
i h~~~' . ~~ ~ ~~~~
lleputy for Register of ~ lls
i
i~
~ ,.
~y'
--- `~_;~
/~7 fly ~i'~-2+" ~~'~/1~-~. - ---
~'treet Address) / / Q
(Ciq-, Slnte, `Lip)
form RW-04 rev. 10-13.0(
C7 r-:.
C ~
T o
i
-"J ~
~,sc~ _.
~.
~.,
~,
=-T'~ rv
RENUNCIATION _
~
~~ ~?
_
~ ' -t.,
~.
_. ~ ~
~
_~ W ~~~
`REGISTER OF WILLS
/
~~
( _
~p r- ''
w
--c~/J3~-
.~~<y
COUNTY, PENNSYLVANIA
y v ='1?f-'j~, ~'V ' E~ ~-% f~ (= C _Ff ~~ ,'`.' '~~ JY Ci/ "-~ `'/ V ~=~Ili ~ /'1
~'- ~
LJtatC Gf ~~~r--~
c
f~~L
Deceased
(PnntiVame) , in my capacity/relationship a~
~~~~~'~~'~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Dare)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
Deputy for Register of Wills
day
saue~oN ;o uoreloossy eluenlRsuuad '~agwatry
G iQZ 9 oap sa~ldx3 uopss(wwo~ ttyy
~;unoa pue~agwn~ '•dml uapy ~an~o~
apgn~ tie3oN '~ayeyg e(ouled
lead leue~oy
Form RYd"-06 rev. 10.!3.06 b'!;4~,e~ I~S~'Nl ±'d3/1rii4Qt^f'nr ~-
'~ ~~~~ ~;
----,
l
(Sign`ature)
~~;
-n( ~.,
~C~~ l/~~'ZP rJi~L; ~ l iG'~
(StreetAddress/)~ /;
~~ ~/ U l f S ~hL~ ~ ~ ~~~ l ~~
(City, State. Zrp)
Exec uted o ut 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 /.~ ~h day
--'" > 'C`am f ?~(., /r '~''~
Notary Public
My Commission Expires: / .~ I ~ ~~ ~~' ~ t
(Signature and Sea( of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission. )
r ~~
.-~
C~ ~;
~~ ~
RENUNCIATION ~ T ~ ~ }
- - - :T~ N -
- ,
-~~__ :;
REGISTER OF WILLS `' ~' `~'
COUNTY, PENNSYLVANIA ~~ ;~- ' `~',
Estate of C'~~-~-~''/ ~ . / C ~ ,Deceased
I' ~~`~~~~ ~~~~~~~~ ~~ CSC , in my capacity/relationship as
(Print Name)
=~-~`~~~~'~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~ -~~" /~
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
i~
nature)
~~~ ~rr~ol ~~
(Street Address)
~ ~"O~~ ~~.z_.
(City, State. Ztp
Execrated 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 a 5 -~~ da
l Y
of " ~', ~~ ~~ fit. ~ ~~
-_.
Notary Public
My Commission Expires: ~' ~ ,) ~' ~'
(Signature and Sea( of Notary or other official qualiisd tc,
administer oaths. Show date of expiration, of Ttotary's Commissior..l
Farm RW'-O6 rev. 10.13.06