HomeMy WebLinkAbout06-09-10~'~~'I1'~ON ~'QR ~'R~~A~~ AllT1~J ~~~~' Q~' ~~T'~'~R~
REGISTER OF WILLS OF C [~ rn B E~2L~!-~!p COUNTY, PENNSYLVANIA
Estate of 1~orof'hy Z • ~Cl.~~eS File Number ~ ~- /D - (~ ~ ~ Z
also known as
Deceased Social Security Number ~ 9~ ~ X60- Sl~ie4'/
Petitioner(s), wl~o is/are 18 years of age or older, apply(ies) for:
(CONIPLETE 'A' or 'I3' I3ELOK!)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(~•is /,ate the ,~XPE~LI~' named in the
last V-till of the Decedent dated ~ /~+ ~d/ ~
(State relevant circumstances, e.g., rentutciatiar, 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 probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(Ijnpplicable, enter.• c.t.a.; d.b.-t.c.t.a.; pendente life; dirrnttte absentia;
Petitioner() after a proper search has /have ascertained that Decedent left no Wil] and was survived b}~ the fo]
Adtrtitrisdation, c.t.a. ord.b.tt.c.l.a., eater date of Neill in Section A above and complete list of Heirs.)
Name
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• 11'v ~~ry _
C ~ M I
(CONIPLETE INALL CASES:) Attach additional slTeets if ttecessaty. p,
QQ~~Decedent was domiciled at death //in~n pCltR,~ bt.~-~Msd C//~~ounty~~, Pen~~nsylvania//w~ith.lx//e..,~ her(~st princ-paI residence at ~d I /1/,
'I1R~i ~~ ~Olts~ d /NP~J~I,. 11~ S ~~b-A Laia.bl~lau ~ l~urdi. I'~/IIMt~vwL. ~
(List street address, town/cit)~, tl7Wnship, counh~, state, zip code) ~ " V ~ _ L _ ~
Decedent, then ~ years of age, died on Tune ~+ 201 ~ at ~ ~• ~E t~,~:~ rnCC/X~/LLC.S6N
Decedent at death owned property with estimated values as follov-~s:
(If domiciled in PA) Al] personal property $ 10~ o~Op• iO
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania __ ~~"" n 1- ~ $ ~S per, oD
situated as follows: 30g N ~ o~'; ~D1•p ~ 1'1'~Ce~'1[1A•LICS6t,t ~b~rlaM.( ~~[
4~rhereforc, Pctitioncr(s) respectfully request(s) the probate of the last Nrill and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name and residence
/~ LYNI+I /rR P~rst.~s, I o711 t.e.p ~ Sit~ctsbu,ry d.
Furor /il•I'-U3 rer. lo.ls.a~ Pabe 1 of 2
Oath of Pez-so7zal 1~epreselltative
CUArI1~~10N~~'EALTI-l OF PENNSI'LVANIA
COUNTY OF CAM a3~12L/F~
SS
The Petitioner(s) above-named swear(s) or affirn~(s) that the statements in the foregoing Petition are true and con•ect 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 accordin; to law. _
Swoi7~ to or affirn~ed and subscribed ~ ,, (~ ~__.Q.(
~ Si~nnt •e Persarai Representative
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before me the
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~}tC~ ~ Signature oJPersonni Represerrtntive ~Q
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For the F.egister Signntw•c of Petsonn! Representative '`'" ;~ m E -~ '
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File Number: ~ ~ -
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Estate of
y . ,Deceased
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Social Security Number: ~ s" ~6" ~ ~ Date of Death: Jl~.rfC 3 i Za/ O
AND NOW, , ~~, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, ITS REED that Letters TC.Sa~A'1P/'1fRt y
are hereby granted to Ly nh 14: /~G~~tS
in the above estate
and that the instrument(s) dated ~~1 ~µ, ~~~0
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
r~IJs
Letters ... . ........... ~ ~ w
Short Certificate(s) ........ ~ ~ - ~
,~R,,,,elJnunciation(s) .......... $
VVi ~~ ... $ ~ 110
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TOTAL .............. ~ ~J~7- SZ~
Attorney Signahire:
Attoi~ey Name:
Supreme Court LD. No.:
Address:
Telephone:
Register oQf~N~il~s ~ U
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1O5.8p5 REV lf)VO7l
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate_ ~t~l.UO , , %~~~~"""~=-:~ 'flhis is to certify that the information here given is
~,;~~P~.~H OF P~y~%
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correctly copied from an original Certificate of Death
duly tiled with me as Local Registrar. The original
certificate will he forwarded to the State Vital
lZecords Office d~or permanent filing.
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Certification N~iu>>17c r --~-=-~' local Registr~u- Date Issued
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Ht05.143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~- ~
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CERTIFICATE OF DEATH
~F~uNa
etACtC INK fSee Inttttructlona and exam~bs OIl reverse) CTeTC CII C ul IV~ N `'''k
1. Name d Dsariia (First, middle. last. suffocl 2. Sex 3. Sadel Saaaity Nurrbi 4. Dab d DeaM (Monts,
Dorothy I. Peebles Female 195 - 16 -4481 June 3 2010
p~ d DeaM ale
5. Age (last Bktlday) lJrtdi 1 lJrtdi 1 6. Della d Bfrdl 7. and state « can
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OMer
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Monllls Days hlalrs Mkxas
March 11,1923 Cumberland County, Pa. ~ lrtpalkM ~ EA / Qlpadsnt ~ DOA ~ rilx::,g liana ~ oMi - speay:
87
Yrs
ffi. CouMy d DeaM 8c. City, Bono, Twp. d Death 6d. Fedily Name (M net ketltllion, glue sae9t and raatrber) 9. Was Decedent d Fiepanie Origin? ~ No ^ Yes 10. Pace: Anarian Indian, Blade, Whin, ek.
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Cumberland Mechanicsburg 309 N. Race Street (ran, Puerto ~, sb)
White
• 1 t. Decedent's lletW KirM d worir daa most d IAe. Do not sea 12. Was Decades soar in Me t 3. Daoadia's Edualion (Sped(y any hiptaat 9r•ds oornpletad) U. Medal StaNS: Monied. Never Married. t 5. Surviving Spouse (q wife. give rtaiden tame)
w1O01""d' DNOf~ ISOedNI
Ked d Work IOM d B,arrass/ Irldueay U.S. Amad Fads? E~„„~,y ! s,~„~,y (0.12) Cogege (11 a 5+)
Home Maker Own Home ^ Yes No 12 Widowed
16. Decedem's Meiirtg Address (Street, dh I town. sae, zip aide) tent's PA Live nDeeedent 17c
Decederu Loved in Twp.
~ Yes
309 N. Race Street ,
.
Adttal Residirce 17a. Stan
T°""'"p? nd No Decoders hived wllkn
Mechanicsburg
Cumberland ~
Mechanicsburg, PA 17055 ~iy,eao
,76.ca1mY
Ad~lumiad_
16. Faders Name (fiat. nldde, alt )
Charles S. Yinger 19. Models Nana (Fist middle, maiden sumirle)
Elvis V. Anderson
20a. Intorntera's Noma (Type / Prird)
Lynn A. Peebles 20b. kdarrterlt's Mang Address (Stroet ah /town. ear, zip cads)
10791 Upper Strasburg Rd. Upperstrasburg, PA 17265
21a McMOd d DiapoeiUon 1 ^ C~tio„ ^ Donation 27b. Daa d Diepaitlort (Monts, day, year) 21a Plan d oapoa'6on (Name d aemNery, Y «ather place) 21 d. Location (City/tam, sea, zp Dodo)
_
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p 2010
June 7 Mechanicsburg Cemetery Mechanicsburg, Pa. 17055
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72a. Ftaarel as such) 220. Liaree Number 22c. Name aM Address of FedMy
FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
~
iWn wMn artllyYrg 23a. o best d my , deaM ocasred ffi the time. and pace sated. ( and d1Ie1 23b. License Number 23c. Date Signed (Mail, day, year)
pltysieYrt is not avaMabk at time d daaM b ~ R ~1 3s 6 3 a~iv
caddy awe d dwdl.
lens 24-26 treat be cartlpated by piaan 24. Time d Deatlt 25. Dab Dead (Moreh, day, Year) 26. was Cass Refarprsld b Medal Exitwar !Coroner Reason Idler Men Cremation a Donalion7
^ Yes ~
x No
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who PmmM~•s daeM, i
CAUSE OF DFJITH (See Inatructiona • etump4a) , Approxknab iderval: Pad II: Enbr other ?8. Did Tobacza Use CoreribNa b DeaM?
Yas
~~ Probably
irgaies~ «canpicatiaa -Mat dkec~gy cawed Me deaM. DO NOT err lernlnel evils sots as cardiac arrest I Onset b Dead) but rat rosltirg in tla underykg dose given kl Pan I. ^
Pert I: Enbr the I~OIO
gHri01a - diceasae
lam 27
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reepirobry arteet « venbiallar IbriaGan vviMout slgwYg Me s6olo9Y. t.ist Orly Ora reuse on each fns. ~ Ld rvo ^ Unknown
1
Ntl1EDIATE C~AAUSE ((FF'nW Jessie « ! - ~ 29. d Finale:
oaldl6on raeWtinp in deNh)
r L ~° `~~ i `tip ' 'Yi'p--"" , ^ Nd Pr•pant wiltlin Pest Year
~_ a
Due b (a as cnreeQlatae . ~ ~ ; ^ Pregnant at time d deaM
fiat condlfore, it arty, b ~ ~ ;
^ Nd program but pregnil vlMin 42 days
b woes lead an Yne a.
~~DERLYIrx~ cAUae Due b (« as a cansequend d1 ~ a deaM
(dNaase a injurryy Mat kltisad the ~ I ^ Nd pregnilt, but pregnant 43 days b t year
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n dea
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averse raa~ltlrg
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. Due b (« as a oonsegwnce d)~ i before dash
I ^ Urlvlown N pregnant witlln the peat year
d. I
30a. Was en Autopsy 30b. Waro Aubpsy FrWirgs 31. Manner d DeaM 32a Dots d bjury (Monts, day. Yar) 32b. DaecrBe Fbw Injury Oatiared 32a Play d Injury: Hone. Farts. Street Facbry,
Ofka BuikNg, ek. (Spearyl
Perfomled7 Avaiabla Prior b CartpbUOn
M?
D ,~ u~ ~„~ ~ Hanidde
"'°""m
d Cauca d
aa y
^ Aeddent ^ Pendrg Investigation ~. Time d kljay 32e. Injury at Work? 32f. H Tronsp«adon kjury (SpadNl 32g. Loation d irywy (Street sty !town, stag)
^ Yes ~ ^ Yes ^ No ^ Yea ^ No ^ Drivi/Operator ^ Paseilgi ~ Pedestrian
^ Sticide ^ Cold Nd be Delemined M. OUar ,
33e. CerGtkir (check arty aa)
• G,ygkrg physblan (Physician ceNMkq doss d deaM avian anodar pnysican nos pronounced deaM and completed Item z3)
1~7 33b. Stgature ild Tnk d Costar , ~.
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TotMbwtdmylagvrNrga,daalhooeurroddwtotlaeauaa(a)andmnniaaatxed---------------------------------
33c. License Nurnbar ~' 33d. DMe (Monts, day, Year)
• Pronoleldn0 and oartNyNg phyafdan (Physidan 6aM prorauraing deadl its adilyirp b clues d deaM)
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To thebaftotmyluawtadga.daathoaw+edsetMiMa.dNa,rMplw.andduslothsauaNs)idmannsrasstaad-------------'---- ' ~
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• Radical FayrNnar/Caoni
On tlM bYk Of examMrtbn and! «Invastlpatial, b my oWnbn. daMh xcurtM at the tuna, e.a, an0 pea, and dw b Ua ewaya) its miter sa stasiL ^
(lam 27) T ! '
erson Who Canpbted Cave d Dsalh
3<. Name and Addroas d P
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2
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35. s and 3Q Dace Fled (Monts, day, yei) ~
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tI
aspdibal Pertrdt No. ~ ^r ` / 1 ' ! V
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OATI3 OF SUBSCRIBII`~~ '~~VITNESS(ES)
P.EGISTER OF V~rILLS
C UlM : ~N.~ COUNTY, PENNSYLVANIA
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Estate of ~ero~i y = • Pta b/e S ,Deceased
u(,,rnq ,~'isC,ryllat,~,Gr' l~ C-~'1et,r'~cS +F ~ielc~,S ~$' , (each) a subscribing witness to
(Print Name/s)
the ~ Will presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that ~./they ~sJ were present and saw the above 'her/ Testatrix sign the same
and that ~".~~/ they signed the same and that n/they signed as a witness at t11e request of
the ~~tw~t~~ Testatrix in herd-kis presence and in the presence of each other.
~'
(Signature) Cy,,¢„¢~~ slyi~
~o L' ~ol,~scr ~~•
(Street Address)
(Cit}~, State, Zip)
L'xecicted in Reb iste~•'s Office
Swor1 to oz- affirmed and subscribed
before e this day
of , ~~~
Deputy for Register bf V~/ills
X l/L
(Signature) ~~~d ~~~~/~~
(Street Address)
/y1e an~~5bcc,~q, ~~ ~ 7oss~
(Cit}~, State, Zip)
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Executed oast of Registe~•'s Office a,
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Sworn to or affirmed and subscribed w
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before ~e this
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Notary Public
h~Iy ColTUnission Expires:
(signature and Seal of Notary or other official qualified to
administer oaths. Show dale of expiration of Notar~~'s Commi ssion.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of insuument(si at time of notarization.
Form h l•1'-03 rev. l 0.13. tJG
2 ~ -l ~ ~~S~Z~
LAST WILL AND TESTAMENT OF DOROTHY I. PEEBLES
I, DOROTHY I. PEEBLES, unremarried widow, currently of 309 North Race Street,
Borough of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing
mind, memory and understanding, do make, publish and declare this my Last Will and Testament,
hereby revoking and making void any and all prior Wills and Codicils by me at any time
heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situate, I give, devise, and bequeath to be divided equally and distributed
amongst my three (3) sons, to wit: RICKEY L. PEEBLES, LEE WILLIAM PEEBLES
and LYNN ALAN PEEBLES.
In the event any of my said sons predecease me, his share shall go to his issue, per
sti pes. In the event any of my said sons predecease me and has no surviving issue, his share
shall be distributed to his surviving siblings or sibling's issue, as the case may be.
3.
It is my intention that beneficiaries named before or after the date of this Will on my
life insurance, annuities, individual retirement accounts (IRAs), in Trust for or joint ba~
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~
accounts and an other assets for which I ma desi nate beneficiaries will receive suc ~ ~ ~
~'- ~,~ f ~ti
investments and that my Will provisions shall not control such investments. 'r ="'~ ~ ,~-; , ~~t
C~~ A
~~ ,.
I nominate, constitute and appoint my son, LYNN ALAN PEEBLES, to be the k f
cn
Executor of this my Last Will and Testament. In the event that he is unable or unwilling to
act as Executor, I appoint my son, LEE WILLIAM PEEBLES, to be Executor in hi.s place
and stead. I further direct that they shall nit he reau;red to file hnnd nr ether cP~„r;t~~ ;n the
Signed, sealed, published and declared by the above-named DOROTHY I.
PEEBLES, as and for her Last Will and Testament, in the presence of us, who at her request
and in her presence, and in the presence of each other, have hereunto subscribed our names as
witnesses.
~~~~
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