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HomeMy WebLinkAbout06-10-10PETITION FOR PROBATE AND GRANT OF LETTF,RS REGISTER OF WILLS OF CUMBERLAND Estate of Robert K. Danner COUNTY, PENNSYLVANIA also known as Deceased File Number ~D ~ („~ Social Security Number 204-52-9695 Darla Maurer Petitioner(s), who is/are 18 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 "' © named in the t ., last Will of the Decedent dated and codicil(s) dated ~~ _Q ~.... ,~'r. _ " •.; ~p ..,.. .1 ~. ,., , (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 bom or adopted after execution of t~i~pstrument(offered»-~ -~~~~ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ y ~ ::`' ~ ..J t~ 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 any) and heirs: (If Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationshi Residence Darla Maurer Mother 5211 Pine Hill Road, Dover, PA 1'7315 Wanda I. Johnson Sister 48 Persian Liliac Drive, Etters, PA 17319 (COMPLETE INALL CASES:) Attac~addttional sheets if necessary. ~t ~ ~ ~~~r a?~ ~~>~~ ~ ~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at P. O. Box 1534, Mechanicsburg, PA 17055 (List street address, town/city, township, county, state, zip code) Decedent, then 48 years of age, died on May 21, 2010 at Harrisburg Hospital, 1.11 South Front Street, Harrisbure, PA 17101 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 5,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 70,000.00 situated as follows: 214 West Allen Street, Mechanicsburg, PA 17055 Form RW-02 rev. 10.13.06 Page 1 of 2 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the Brant of Letters iri the annrnnriarP form r~ ~` ~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioners will well and truly administer the estate according to law. /~ Sworn to or affirmed a//no~d subscribed be e me the U~ da of ,.,~/~ V V,~ . /I ~ or of Personal ~ r~ Signature of Personal Representative -~-- Signature of Personal Representative ~ ~,3. r" m ~^T1 ~ -- _.., C. ' ~ . .s. O ,t ..r ~_ ~ -: y -~ ~ , --- _-, t ~. ~ _~ .. , ~, File Number:~n, ~ ~~ CA Estate of Robert K. Danner Deceased Social Sec Number: 204-52-9695 Date of Death: 5/21/2010 AND NOW, ~ , ~ ~1 ~ , in consideration of the foregoing Petition, satisfactory proof having been presented b fore me, IT IS DECREED that Letters of Administration are hereby granted to arla Maurer _ in the above estate and that the instrument(s) dated N/A described in the Petition be admitted to probate and filed of recor the last Will (and Codicil(s)) o~ Decedent. ~° FEES ~ _. s~.y~.(" -~:% ~ -/ZL~,%-~ ~ ~~ (~' Register Wi s Letters ............... $ ~~~~."°. Short Certificates} ........ $ , L Attorney Signature: ~ ~ ~~ Renunciation(s) ....... $ R. Mark Thomas ' S ~ S Attorney Name: ,Esquire ~- ... $ ' • • • $ =~ ~ Supreme Court I.D. No.: 41301 ... $ Address: 101 South Market Street ... $ • . • $ Mechanicsburg, PA 17055 ... $ ... $ ' $ Telephone: 717-796-2100 ... $ 0. TOTAL .............. $ i Form RW-02 rev. 10.13.06 Page 2 of 2 llm;,~l> I:F !uliiC~ FOAL. REGIST'RAR'S ~ER~'11=1A'~'ION 01= ~- -'R t~~~RNING: 1t i ~ illegal to dup~liCate phis > f~~r~t ~~c-ta;~tat III' ~a~O~O~~a~~~~~. l et ft)1 (hiti ~~K.~14171L ii t('. ~(~.~ )( f ~~~'1'ti~VL'iill(111 ~_:l?I~~~~ i ITEM # 2 / /~ SHOULD READ AS FOLLOWS: `~~rr rri ,,- r rrl ~ ~ ~_ J~J r '~. , ' _ : ~~` ~~ ~~ -~ ~` ,` ?h`- s s , :i'• k+-• ~: ems. ">~"',., '•,~E~~~ ,4 ~° r''= / + t ~.,. ~!f`, te• r°!l'ii . 1';? ;9t~ Ill;',?,.1?l~if1~.191 ~t,'1'ti° `_9` 1.'ll 14 rS'1~~~+~ 1'~`1k'r.f ~ !!. I' 7 + t:_'ll! l~ ~. t111?t =8il' r'~ ~)t ![~l tli` itl;.',9 ~'< 1(; ° ~ ,tf ~~'ti ;`?`,try!!- ~ ~jc -d9~_'I11~2i )r~±)L r_r. grit ~ 1 (~~~° ',t~t~~ ~t'Ir,~.ll F ~~~~%~ MA~YZ ~~1010 -_ _ _ _ _ ._. _ _ .__ -~ _ 1 ___ _r _ ._ _ _ . e •t C^/~c~ rr7 ~ ~ t~il/T' ~~ n ~~ ~+~ ;.~ ~a rn ~~ -~> - ~, :-~ ~~ c~ ~~ :~ :~~ ~-~ -, ~~ ..~ --I l3 REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS /PRINT IN RMANENT CERTIFICATE OF DEATH ~acK INK (See instructions and examples on reverse) CTATC CII C r, 111~.1O C^ ~ ,:. ~ .,~ ~~ ~ r ~>> ~ -. ,:;' ,_. _ .~, ~ _..; - o .~.~-~,r ~~~ ~:. - t--- _` W ~~ .. 1. Name of Decedent (First, m' e, la t, suffix) '- ~ „~ 2. Sex male 3. I ud Numbe ~~~ N ~2 9695 4 Date of Death Month, da , ear ) a ~~ lr:f~~''~',^ _ May 21 , 201 0 5. Age (Last Birthday) Under 1 ear Under 1 da 6. Date of Birth Month, da , ear 7. Birth lace Ci and state or for ' count fie. Place of Death Check onl one - 48 Months Days Hours Minutes 1961 OCt.28 Harrisburg, PA Hospital: Other: Yrs. , Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Residence ^ piper - S eci P N 8b. County of Death tic City, Boro, Twp. of Death Bd. Facil'Ay Name (II not institution, give sheet and number) 9. Was Decedent of Hispanic Origin? No ^Yes 10 Race: American Indian, Black, White, etc. Dauphin Harrisburg Harrisburg Hospital Of yes, specify Cuban, ~ e Mexican, Puerto Rican, etc.) -- "' ~ I1. Decedent's Usual Occ anon Kind of work d one B urin nwst of workin I'de. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (SpeciN only highest grade comp leted) 14. Marital Status: Married Never Married 15 Surviving Spo use 4U wife gwe maiden name) Kind of Work dishwasher Kind of Business!Indust restaurant U.S. Armed Forces? ~ves^No Elementary /Secondary (0.12) 12 College (i-4 or 5+) , , Widowed, Divorced (Specify) never married , " 16. Decedent's Mailing Address (Street, ciN /town, state, zip code) Decedent's Did Decedent Penns 1 v a n i a Y Live in a ^ Actual Residence 17 st t P . O . Box 1 5 3 4 , 7c a. e - a Yes, Decedent Lived in Twp. T wn hi ? " Mechanicsbur PA 17055 p o s Cumber 1 and 17d. No, Decedent LNed within 17b.CounN j~ ME.chanicsburg g ~ Actual Limits of CiN 1 Boro 16. Father's Name (First, middle, last, suffix) 19. Mother's me (Fit d aiden surname) ` '`" ` Edward K. Danner ~~iams ~ i Darla 20a. Informant's Name (Type I Print) Darla Maurer 20b n n's M " g Jtddress (S t, c' /own, et zip c PA1 731 5 °~over ~~~ ~ine '~i~~ }~c1 . , , 21 a. Method of Disposition r ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (City! town, state, zip code) " ~, Burial ^ Removal from State i Was Cremation or Donation Authorized May 2 5 , 2 01 0 R o 11 i n g Green Cemetery H i 11 Cam P A 1 7 01 1 ^ Other • S i r by Medical Examiner/Coroner? ^Yes^ No p , a. S' atur4of Funeral ae Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Facility " FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043 omplete items 23ac onN when certifying 23a. To the best of my knowledge, death occurred at the time, date and place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year) phys~ian is not available at time of death to certify cause of rkath. " Items 24-26 must be completed by person 24. Time of Death . t 25. Date Pronounced Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? ~ who pronounces death. ` Q? / O /. M. ^ Ves ~No CAUSE OF DEATH (See instructions and examples) r Approximate interval: Part II: Enter other significant conditions contributing to death 26. Did Tobacco Use Contribute to Death? Item 27. Part I: Enter the chain of events -diseases, injuries, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest, ~ Onset to Death but not resulting in the underlying cause given in Part I. ^ yes ^ Probably respiratory arrest, or ventricular fibrillation without showing the etiobgy. List only one cause on each line. r ^ No ^ Unknown IMMEDIATE CAUSE (Final disease or ~- ~ e' ~ i r condition resulting in death) ~~l] i /i/~ ~/ ~ f ~ ~ ~' 29. If Female. , _~ a. E~ , pC i ~ ~ /`~ /// ^ N Dua to or as a consequence o , ot pregnant within past year Sequential)yy list conditions, it any, ~u /~' ~ /t/~i`~~ ~,~Z~r ~/~~ j~j`~ 1 b' _ , leadin to the cause listed on line a ~ ~'~ ~ i~1 .5 ^ Pregnant at time of death ^ g . Enter the UNDERLYING CAUSE Due to (or as a consequence of): r Not pregnant, but pregnant within 42 days (disease or injury that inRiated the c r events resulting in death) LAST. r of death ^ " Due to (or as a consequence ot): r Not pregnant but pregnan143 days to 1 year 1 • d. r r before death ^ Unknown it pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Man~@r of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury Home, Farm, Street, Factory, Performed? Available Prior to Completion r~ Office Building, etc. (Speciy/ ral ^ H i J N t id L a u om c . e of Cause of Death? ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Injury (Specify) 32g. Location of injury (Street, city r town, state) ^ Yes No ^ Yes ^ Na ^ Suicide ^ Could Not be Determined ^Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian M' ^ Other -Specify: /~7 33a. Certifier (check only one) 33b. Signature and Tille of CertiBe • Certifying physician (Physician certitying cause of death when another ph sician has ronounced death and com "^ leted Item 23) L(s ` ~ ~7; y p ~ p ` N~ G 14~/~ ,j i ~ p To the best of my knowledge, death occurred due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Pronouncing and ceriitying physician (Physician both pronouncing death and certiying to cause of death) 33c. License Number / ate Signed (Month, day, y ar) To the best of my knowledge, death occurred at the time, date, and place, arW due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ v S 5 C .5 G r ~-' y , , ~- rn - . J • Medical Examiner/Coroner On the basis of examination and I or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated ^ 34 Name and Address of Person Who Completed Cause of Death (It m 27) Type !Print ~% Jahn z~orn o sa. 35, Registrars Signature and ict Number ~ ~ /' ~ f ~ 36 Da (M t /° U " ~t/• ~~" J ~~/' ~_ / t t•-jlf~ ~y, year) / ~ / o - ~ I ~ ~ '~ / tl Disposition Permit No. o / / V~ ! ~ ,/ Y RENUNCIATION c~ ~, :~., ~ REGISTER OF WILLS a ~ ~ ~~ >~ ~., '+ ~.., _ CUMBERLAND COUNTY PENNSYLVANIA -' ~~ ~' r ,. . ~ ~ ~ ' ' , ~ ...yam ~ ...y.=y ~ J~ . © ~ .. ~.J e~ Estate of Robert K. Danner ,Deceased I, Wanda Johnson , in my capacity/relationship as (Print Name) sister of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Darla Maurer June 2, 2010 ~ ~~ (Date) (Signature) 48 Persian Lilac Drive (Street Address) Etters, PA 17319 (City, State, 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 within on this ~ N.j'~ day of )) ~N ~: ~~,~~ic> ---~ / _ ~ , ~. ~~ tart' Public y Commission Expires: 7 ~~ °~ ~~~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) 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