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HomeMy WebLinkAbout04-15-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of Harold E. Hilbish also known as Deceased COUNTY, PENNSYLVANIA File Number ~ _~~ R Social. Security Number 1 ~/-- `L~~~ Petitioner(s), who is/are l8 years of age or older, apply(ies) for: (COMPLETE 'A' or '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 named in the (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 i~~stniment(s) offered for probate, was not the victim of a killing amt was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if airy) and heirs: (If Administration, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationshi Residence Edith Hilbish Mother ']i~Lewisberry Road, Lewisbenry, PA 17339 _~ Q "".~ ' ' _.r ~ :.:.z;3 (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~T~-~ ~ `'D t::a_ ~ ' .-> Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal ~ ,: ;,, ~~ ~~' °"' ~ 41~N 2nd Street. Wormlevsbure Cumberland County Pennsylvania 17043 s::'`. ~;~ '~' -'` ~ ''-~~ (List street address, town/cety, township, county, state, zip code) ~ -~-` a t'~ ~!7 _ 4..... :. _y - :~~-.~ '" Decedent, then 60 years of age, died on March 26, 2010 "~ C.: r at East Pennsboro Township, Cum~lSitD1 County ,_.,,. ~'rv"=' ~; Pennsvlvania -,ten, _ ~ t ,~ ,~ Decedent at death owned properly with estunated 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 $ 11,000.00 situated as follows: Vacant Lot (No address), 400 Block of River St., Wormleysburg, PA 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 tore T or 'fed name and residence Kathryn Davis, Sister of Deceased, 746 Lewisbenry Road, Lewisbeny, PA 17339 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition aze 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 affirfned and subscribed before me the ~ day of ~~ ~. For the Register Signature of. Signature of Personal Representative ~a Signature of Personal Representative ~ ~- -- ._ , ~ ~y __ ., ~ _ ~ ~ . , ~. n ` , f r` `~1 File Number: ~}' 1 ' ~~ ' ~ U I `-~~` C3 ~--~ "Ct ¢ti'~ . c_^~"i Estate of Harold E. Hilbish , Dec~se~d •• " ~ ~ .~"' , ,t Social Securi Number: _ q~ ~7 "~ t}' ~ l / - ©` ~~ ~ ~ Date of Death: March 26, 2010 AND NOW, ~ d in consideration of the foregoing Petition, satisfactory proof having been presented efore me, IT IS DECREED that Letters of Administration aze hereby granted to Kathryn Davis in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and f led of record as the last Wi11 (and Codicil(s)) of Decedent. FEES Letters ............... $ Short Certificate(s) ........ $ ., L Renunciation(s) .......... $ ~~ ~ YY1,Q1 ~1 ... $ e, (Sly ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ crj(J. n nn Attorney Signature: Attorney Name: Richard A. Cairo Supreme Court I.D. No.: 27733 Address: 1204 Chelsen Cross Mechanicsburg, PA 17050 Telephone: 717-731-9997 Form RW-02 rev. 10.13.06 Page 2 of 2 1ns.Rnc RFV mvm~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph.. ~ Fee for this certificate, $6.00 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. • P 16176293 Certification Number ITEM # ~ _SHOtJLD READ AS FOLLOWS:______ ___w_ _____ ~ ~_ _ __.___ . _ _ ,~ Local Registrar Date Issued aEV 11rzoo5 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRIM IN K NK CERTIFICATE OF DEATH (See Instructions and examples on reversed cTerc ru c .n u.nrn ~ (~ --- ~: .,..; ...::. J ~ , .~ ..,~ _i`.7 ~ 3a•' -~ ~"y~ is ~ ~ -, ~~ -- '~" ~ ~~ awry.. (...~ ~ ~ ) '=r ;=~ ' ~~ ~~' 1 i. name of uececertt (Flrot, ntMQe, , sulPoc) ~ / 2. Sex 3. Social Security Number 4. Date of Death (Month, day, Year) ' S ` ~ 7 _ ~a ' 3o S, ~~ 6 A 5. ge (Last &rthday) lhtder 1 Under 1 B. Date of Birth Mordh, da , 7. and ata~ a cou 8a. Place of Death Check on one ' Morwa OM Hour MYwMa HOBpNBI: Dtl1er: Yro. ~ ~' ~ ^ Inpetlent ^ ER / Otrlpetlent ^ DOA ®N ridng Home ^ Reskience ^Other • S ecity: e p Bb. County ~ Death 8c. Clry, Boro, Taw , of Death 8d. FadAly Name (N not ktatllutlon, glue and g. Waa Decedent of Hiepenk Origin? ~,Iltf ^ Yes 10. Race: American Indian, Black, lMtNa, etc. N / ( Yee, speoNy Cuban, , Mexican '~ ~ P t Ri ~ , uer o can, etc.) ~~ /. ~~•_ G ~/ t~ 0 11. Decedents Metal Kind of work done moll of INe. Do not aisle 12. Was Decedent ever In the 1 a (Syeclty ony grade cortpleted) 14. Martial Status: ManWd, Never MaMed, 15. Surviving Spouse (If wNe give maiden name) Kind of Work Kk U S Arm d F d f B 7 , . . e r o usiness I kWuatry ro-rc-,ea ~ Elementary / SecorMary (412) College (1-4 or 5+) Widowed, DHorced (Spst~ •' ~ r ~ .c.~ c1 t ~a.. ^ Yea l(~O ` ~ ~ • d 16'.JDecedents Mellkp Ad~sa ( dty / to11wn, slate, zip code) Decadenra ~/1~ Did Decedent ' Actual Residence 17 T ~ ~ /~ • ~ A St t / S' p , a. a ,, e T , 7 Live in a 17c. ^ Yes, Decedern Lived in Twp -~f Towrudtip? ~„~ C~ .~.ry /!/ ~ ~ / Q ~-~ 17b. County ,~ 17d. ~ No, Decedent Lived wNNn Lf/d/'~J ~ A i ~w e duel Lkngs d / CNy / Boro 18. Fadbr's Name (1-haL ,last, ' 1 g. MoMer'a Name (Firot, mldde, maiden su ) 20e. IMonneM's Name (Type /Print) 20b. InMnrrnta MsNing Addroaa (Street, dty /Gown, stale, zip code) e 21a. Method of D ~~ ,,,,,aN~ ~ c.!/~`'J '~ ~ c j/ ^ Donation 21b. Dab of DlelaeNlon (Mrxdh, day, yar) 21c. Poece of Dispoaifion (Name of ^ Burial ^ Removal hom Slate ~•ry. °Brt1e otlrer P~•1 21d. l.ocatlon (CNy / t ,state, zip coda) s~ ^ odter . sv~h% MaAcalExrMnarora x1 L`SYee ^ No ~ ` ~f cy ~ ~ d; p ^ ~i~ ~~ ' 22e. Signature of Funeral 3ervfce (or person octlnp a wch) 22b. Licertw Number 22c. Name artd Address of FedlNy ' J~ + ~ / ~ ~ e Items 23ac only when certMyfr~ 23a. To dre beet at the time, date and "' • physician N rat avagable at time of death to ~e sue' ( tltle) ~ 23b. License Number 23c. Date Signed (Month, day, Year) ~ rxtrtlfy cause or death. ~ _ 1 ~ / U L- • Hems P4.~ ~ ba ~ 24. Tl of Deem MM~~yyy" wfa ~ ~ ~~ ~ ~~ ~ ~ ~• Deb Pronotxtced Deed ( /.r~ ~' ~ - ~ ~ ~ 26• Woe Case Referred Examiner /Coroner for a Reeson OMer than Crematbn or Donatbn7 M o ~I ~ • d ^Yea [ CAUSE OF DEATH ( Irutructioru end szampka) A xknete Interval: ~ PDro Nam 27. Pert I: Enter the g~p„Q(,By~g - dlasae, iMuries, or cortrptlcetloru -that r9rerNAr rxiused the death. DO NOT enbr terminal eveme such u carder arrest Pert II: Enter other 28. Did Tobacco Use Contribute to Death? , respiratory arrest, or ventNtxder I~dlktlon wNhout shotMng the etldogy. List oMy rite cause on each fia. r Onset to Death but not resWtlng M tfte underlylrp cause given in Pan I. ^ Yes ^ Probably r IMMEDIATE CAUSE Fkral disease or ~ ~-- ~~ ~ r rxxxl ' resulting In ) s ^ No nknown _~ a ~ -CZ-/ z+'~- ~Pit~ Cfs~/ i Due to (or es a coraequertce of): r 2g. N Female: aNy fiat crorWHiona, N arty, r b ^ Not Pregnant within pest year ~ro the cease Hated on tine a. ' i Eller UNDERLYMIG CAUSE Due to (or ae a consequence on: ^ Pregnant at time of death ' r or tlut kdtlst the r reeuldn death) ~ c• r ^ Not Pregnant, but pregnant within 42 days ' Due to (or as a consequence of): r M death • ~ ^ Not pregnant, but pregnant 43 days to 1 year d r before death ^ ~ Unkrawn N pregnant within the past year 30a. Was an Autopsy 30b. Wero Aubpey Fxrdrrps 31. Marner d Death 32a. Data a I ~ (, ~, ~ 32b. Deecr6e How h~ury Occurred 32c Perlomted7 AveNabb Prior a Completbn ~ HOme, Ferm, Street, Fact Nry~ cry , Neturol ^ Homicide Office Bufidl e of Cause of Dath7 ng, (Specify) ^ Yes No ^ Yes ^ No ^ ~~ ^ Pendng InveaNpetbn 32d. Time of Injury 32e. Irrytrry at Wank? 32f. N Treneportatlon Inryry (Spedly) 32g. Locetbn of Injury (Street. dty /town, state) ^ Stridde ^ Cakf Not be Detemtkred ^ ya ^ ~ ^ Driver I t)perotw ^ Passenger ^ Pedestrian M 33a. CerlNfer (dteck only one) Other - SperNly: C•rtlrying PhY~ (PNYalden certllykrg cause of loth when anotlrer physidan ha prorauraed deem and 33b. Sigreture and Title of Certifier completed Hem 23) ~- K To ill bat of my ImowNdge, death ocaxnd due b tlw souse(s) and rtwwter a NaterL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • _ _ _ _ _ - _ _ _ _ - ^ - _ - - - - Pronoutlcblg and rxrtlyrhlg PM~n (PM~en batlt pranouraktg loth end txrtllykrg b rxuea of death) . . Lkxnee Number .Date Signed (Month, day, year) To the but of my Imowledge, loth or:curnd at fM tlra, daM, and Place, and duo b the oase(s) and manner a stated- - _ _ _ - _ _ _ _ • _ _ - _ _ • _ rreate~ Examhter / ceren.r ©Scx~s ~ ~L - r O on the trey of exankwtion and / « 1 ~ ~ 3 - Z 9 matlgatlon, In my opinbn, loth aaurred at the time, deb, end place. end due b tM oase(s) end manner a ebbd ^ _ - 34 end Address of Person Who use of Daelh (Item 27) Type /Print 35. Reg~shar'a S' re end'Dlat r 38 D t F ~~ Li~7J - isvrt~ ~ Io11 / ~ ~ ~ ! ~ /I . a e Ned (Month, day, Year) ~ 3 .~o o ~ , CIf , ~,llOv C ~~ l..c_. t~ > r70I ~ DispoeNlon PermN fVO. ~ 7 f ~ ~ J {.....! _....~~ 4 ~'~ AYE ' 4rh' N4..r ~ 4 ~..,.n'r ~ .»J ,,,~ . "9~ ( f RENUNCIATION ~~~ ~ =;~ ~ w ~~~; _ Y : ~!~ ~~ ~'.1 REGISTER OF WILLS ~ .~ Cumberland COUNTY, PENNSYLVANIA Estate of Harold E. Hilbish Deceased I, Paula Drewyer , in my capacity/relationship as (Pant Na»+se) sister of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to my sister Kathryn Davis ZalO (Da ) ~~~) 38747 Hughsville Road (SYr~cr Aalclresa) . Leesburg, VA 20175 (cry, srok ~l Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills 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 .~~'~ da y Notary Public My Commission Expires: (Signature and Seat of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Forn- RW-06 rev. JO_ I3.06 COMMONWEALTH OPT VAI~IIA ~~T .', ~ ! ~ I SEAL Ric.har~i •~ ~.;~~,~~ ~; ~~~,rary Public City of riarri~hur~, C~~u~t~in County My commission ex ices December 28, 2012 RENUNCIATION REGISTER OF WILLS ~ Cumberland . ~-1~- Estate of Harold E. Hilbish COUNTY, PENNSYLVANIA -.~-~r~z.. i-~ ~-.~ m _t,,,. L ~ ~ "'"^~ ~~ ~ ::G~; .:~ ~ ~ c r...~ I, Edith Hilbish (Print Name) Mother r ~ lsignature) administer the Estate of the Decedent and respectfiilly request that Letters be issued to my daughter Kathryn Davis April ~ , 2010 (Dare) 746 Lewisberry Road (Street Address) Lewisberry, PA 17339 ~c;ry sire, zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 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 ithin on this ~ aay of .,~ ~ G ~ ~,, _ '^ ~_ , ; ^'~w , ~ ': ~ --Q ~ _ ':; ~_,~-; _a.,) ~ -~ -:~ ~ ~~'r _ .' ~ J U .~`- . '~+~Y~ . _, Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to Notary Public NIy Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEp-LTH OF PENNSYLVANIA NOTARIAL S~-t-~blic Richard A. Cairo, Notary City of Harrisburg, Dauphin County M commission ex ins Daember 28 1012