HomeMy WebLinkAbout06-29-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C G!~'r bP_d' l ~-/- c/ COUNTY, PENNSYL`JANIA
/ , ,1 ~ ~-
Estate of , C_ File Number
also known as
Deceased Social Security Number 1~~ -' CJ ~ '- ~ ~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of Letter Testa entary and aver that Petitioner(s) is /are the -C~C,f'~ U~ ~ named in the
last Will of the Decedent dated and codicil(s) dated
(State relevant circumstances, e.g., renunciation, dent/i of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executio~_i~e insttun~r t(s) offeied .
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ ~ c`7 +
..._ -:G~ tda `~~ s ~ -
^ B. Grant of Letters of Administration ~ .--. -- ~
(Ifappticabte, enter: c. t. a.; d. b. n. c. t. a.: pendentelite; durantenbsentia; dur~tiide,tl~'nbi~t'tnte) ~;, ~`
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following s~~~t~ (if any) a ~ heirs,: ,~(~f~~.~
Administration, c. t. a. ord. b.n.c.t.a., enter date of Wil! in Section A above and complete list ofheirs.) r> ~ -`~ a
.>G"'
~ Name Relationship Residence ~
(COMPLETE W ALL CASES:) Attach adcfitiorial sheets if i:ecessary.
eceden was domiciled at death in ~~ ~ ounty, Pennsylva i w'th his /her last principal residence at~~- dv S
a 2 ' ~~ 7 j .
(Llst st,•eet add,-ess, town/ci y, township, county, state, zip code)
Decedent, then _S~ years of age, died on D `E' l7 ~ U at / V ~ ~ C~ ~ ~/(
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ ~-~ C1 u ca
(If not domiciled in PA) Personal property in Pennsylvania $ ~_
(If not domiciled in PA) Personal property in County $ ~~
Value of real estate in Pennsylvania $ ~ ;
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petitson and the grant of Letters in the appropriatE; form to
the undersigned:
Signature T ed or rimed name and residence
_~~./ v r~ '~~~',~~'~~ - ~ l Z / ~r~ I/~Pr~~ I~r~ G~.1„~ ~r'~~, p,4-. / 7 U l1 ~ ,
Form R4V-OZ re,-. to.t3.o6 Pale 1 of 2
Oath of Personal Rcpresentati~~e
CO~~I~,ION'~~"F_~LT>-i GF PE~i~;S~'LV:a~;I.~,
coi/~NT~~ 01; ~l~1J~~~.~1~?~~.
SS
The Petitioner(s) above-named swear(s) or affuzt~(s) that the statements in the foregoing Petition are true and con•ect to tl-ie best of
the kno~.vled~~ ar.d belief of Petitioner(sl at:d that, as personal representative(s) of the Dece~ent, Petitioner(s) svil(well and truly
administer the estate according to lacy.
S~.vorn to or affirmed and subscribed
be e me the day of
,.
n
1
th eg;SteC
v
File Number:
r r ~J
~~~dd"
of Pcrson~~l R2prese~,rnrive
_
~ r.y
Sign~.rure of Personal R2pr252nrnrive _
_,, (~
~ - -.
% ' ~.
f -
C
=? ~ .
~' ~ ",
Si;,;nrure ojPersa,a! Represenrarive . - -~ ~.D --_
'; .
~ ~. ~ ~ J ?y C~ " 'z
.~'
Estate of ~ .~~i~- /t ~~ ,Deceased .
Social Security Number:2-U~ ~ (~ ? - ~~~~ Date of Death: ~~' .
AND NO`vV ~f C~`
'~ ~~ ri'/1 ~ , __ ~~Yi con,ideratton of the foregoing Petition, satisfactory proof
having been presented befor~° me, IT IS DECREED that Letters ~,,~%l.%~'2~
are hereby granted to ~~-~"~~-'a (. , ~ ~ Jf~-
in the above estate
and that the instrument(s) dated
described in tl~e Petition be admitted to probate and filed of record a~ t~i ast Will Viand Codi~il(s)} of Decede~i,
FEES
Letters ............... $ C,) ~ ~
Short Certificate(s) ........ ~
Renunciations} ... .. ~ ~ J
... ~
... ~
... ~
... g
... S
...
TOTAL .............. S
te~• ojWills
Attoizley Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telepll~:rte:
~~„~„,qn~-a~ ,~,~. ~r>.r_.vr, 1'a~e 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
1MARNING: It is illegal to duplicate this copy by photostat or photograph,
~ z~~a, illi~ this ci~rtil~icate. `~(~.01)
P 15 ~ ~ 6 ~_~-_~_-_--
Certii~ic~atitm Nun)he I'
rr~M #~ rr~j'
SHOULD READ AS FOLLOWS:
,'~
./
~'~~-~' ~ -ea=t'` , t'-.-
~ir1iYL ~ ! ~~'
I 3 REV 11/'2006
I PRINT IN
1MANENT
ACK INK
/D,C~'J
,
~
'r„ This is t:) cel-til~~, t;~;It the ini~r~r}~~}~)tiun hf~re given is
ZN ~f
~f
,It''r~
P~- PFiy `\
~ ~ue}rreraly r~>~ied IttPn1 ~ln t~ci~tinal ('ertificate of Death
,
,
~~'~~~~%~"
~.~`~~--~
~
~ ~ duly t~i{L:d ~~~~ith )~~~ t:~~, 1_l~t .~al Re~risCrar. 1,he (~ri~~ir~}al
,
~/
1~~1
~ ~ ;~ ~
.; ~ a
,
°v t ~ertifi~are ~~~ilV i14' f(~r~~~~
1~:ec+~rlis (ltf~i~:~ !l~r i~ernlr}~ }r(1cd t(> the Sta(e Vital
}enr. fili~~)~~7~
,
,
O ,:~,~~
,= ~~ ,~ ~~r
X99`, ~~ ,,.,f
- _-
~
AP 2 0 1010
1
--- -- ---
"~~.....~~nruir/
--
~17c~11 ~erl~traj- ~~'lle ISS~Ie(~
r~~
~' -
~ , ,
~_
~- ~ 1
(~.}
C_ - J
_
-~~ ~
ti
.. __~
-
~`
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
fSL+e Instructions and examloles on reverse) CTATC CII C All I\JGCF1
1. Name of Decedent (Flret, middle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
Fdwin K. Beck Male 204 - 03 :,- 8458 ril 17 2010
5. Age (Last Birthday) Under 1 ar Under 1 da 6. Date of Birth Month da ear 7. BI a C' and slate or 1 co Ba. Place of Death Check onl one
MonMS Days Hare Minutes Hospital: Other:
• gg ,,,~ st 28, 1921 Harrisburg, PA ^ Inpetlent ^ ER / Outpatient ^ DOA Nursing Home ^ Residence ^ Other -Specify.
County of Death
6b 6c. City, Boro, Twp. of Death 6d. Facility Name (If not Instltutlon, give street and number) 9. Was Decedent of Hispank Origin? No ^ `!es 10. Race: American Indian, Bladc, White, etc.
. (R yes, speciy Cuban, (Spaeil}~
• C~berldllC1 L. Allen ~. 111iC YYl)lJll~ at l~li~. ~ Mex~en, Puerto Rkan, @tc.) ytfallte
11. Decedents Usual Lion Kind of work d one Burin most of wo INe. Do not state reti 12. Was Decedent ever in the 13. Decedents Educatbn (Sperdfy Doty highest grede completed) 14. Martial Status: Married, Never Married, 15. Surviving Spouse (lt vole, give maiden name)
Divorced (Specyry)
Widowed
Kind nt Work Kind of Bustrassllndustry U.S. Armed Forces? Elementary I Secondary (0.12) College (1.4 or 5+) ,
W1d~W~
Clerk US Postal Servi g] tae ^ No
• 16. Decedent's Mailing Address (Street, city /town, state, zip coda) Decedents Penns lvanla Did Decedent I . Allen
• Twp.
~ live in a
Decedent Lived in
17c
~ Yes
~
824 Lisburn Rd p
^
.
,
Actual Residence 17a. State
Townshl ~
~ 17d. ^ No, Decedent Lived within
'1
1
~
Camp Hell, PA 17011 ~r
at1
m
17b. Cou
nN Actual Limits of City / Boro
16. Fathers Name (First, middle, last, suffix) 19. Mother's Noma (Flret, middle, maden surname)
Ral Beck eon Kirb
20a. Informants Name (Type /Print) 29b. Informants Mailing Address (Street, city !town, state, zip code)
James Beck 3127 Beverl Rd. Hill PA 17011
21a. Matted of Disposltbn r ^ Cremation ^ Donaton te of Disposition (Month, day, year)
21b
D
a 21c. Place of Disposftkxt (Name of cemetery, crematory or other place) 21d. Location (City! town, state, zip code)
• ~ Burial ^ Removal from state ~ Wee Cremation or Donation AuthorWd
^
^ n
~
~
04-24-2010 Rolling Green Cemetery Camp~:Hill, PA
Yes
No
^ Qlher • S r try Medical ExemlrarlCoroner?
•
22e. S' Funeral Service or acts such)
22b. Ucense Number
22c. Nerve and Address of Faciliry
Compote items 23e-c only when certifying
sican Is rat available at time of death to
h 23e. To the best owledge, death at the rime, date and place stated. (Signature and tltle) 23b. License Number
R
y1
~
5 2 (
C 23c. Date Signed (Month, day, year)
a o/ o
/~ ~ e 7
p
y
Certtly CaUSe m death. ~,, j~j
~
1,
o ,
• hems 24-26 must be completed by person 24. Time of Death 25. Date Pronounced Dead (Month, day, year)
• 26. Wes Case Referr-re~d~to Medical Examiner /Coroner for a Reason Other than Cremation or Donaton?
^
•
who pronounces death. /
/ ~ .' ~ M.
I l Z, ~ a / ~
~ n Yes LQ No
CAUSE OP DIeA1H (Sere Instructlona and examples) r Approximate interval:
Part I: Enter the chain of events -diseases, injuries, or complications • that rCrectly caused the death. DO NOT enter terminal events such as cardiac arrest i Onset to Death
ltem 27 Part II: Enter other;;wniYx•Ant canditbns cc+ntdburtingJo death.
but not resulting in the underlying cause given in Paft I. 26. Did Tobacco Use Contribute to Death?
^Yes ^ Probabty
.
respiratory arrest, or ventricular tibritlation wRhout showing the etiology. List only one reuse on each line. r ^ No Unknown
IMMEDIATE CAUSE fFlnal disease or I j~~ ~ i ~ ~ C' ~
corditlon resulting m death)
C.Gt'/}P~,t 6 ~tJ l~~)1(~'N /~ IC/I i J
- 29. If Female:
nant within past year
^ Not pre
~ a
Due to (or as a consequence of): i g
^ Pregnant a1 time of death
R any
~~
~
{ ~
list conditions
c8-Q
S~eqqu~entiall - ithi
42 d
^ N
.
~
,
,
y
, b.
leading to the cause listed on line a. n
ays
ot pregnant, but pregnant w
Due to (or as a consequence oq: ~
Enter Bra UNDERLYING CAUSE
disease or in'u that inHiated the r
( I rY
.
- of death
s tc i
nant 43 da
ear
r
nant
bui
re
N
t
c,
events resulting rn death) UST. r y
,
p
g
y
o
p
eg
• Due to (or as a consequence of): r
i
- before death
Unknown if pregnant within the past year
• d.
30a. Wes an Autopsy 30b. Were Autopsy Findlrtgs 31. Manner of Death 32e. Date of Injury (Month, day, year) 32b. Describe How injury Occurred 32c. Place of Injury: Home, Farm, Street, Fedory,
Offae Building, etr.. (Specify)
Performed? Avatlade Prbr to Completion [~?Jeturel ^ Homidde
of Cause of Death? ^ Accident ^ Pending Inveatlgetbn 32d. Time of Injury 32e. Injury at Work1 32f. If Transportation Injury (Sperry) 32g. Location of injury (Street, city /town, state)
^ Yes ~o ^Yes ^ No
^Yes ^ No ^ DriverlOperator ^ Passenger ^ PedesMan
^ Suicide ^ Could Not be Determined M omar - spacYy~
33a. CerlMier (check only one) 33b. Si stare d Title o1 Certifier
9n
CertMying physklen (Physician certifying cause of death when another physician has pronounced death and completed Rem 23)
_ _ _ _ _ _ _ _ _ _ _
_
d due to the auss(s} end manner as stated
urr
th
k
l
d
d ~ 2~~~ ~ V !h
_ _ _ ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_
ea
ca
e
now
e
ge,
To the best of my
• Pronouncirp end arttiylny physician (Physician both pronourxing death and certllytng tc cause of death)
To the beet of my knowledge. death occurred M the time, date, and place, end due to the cause(s) end manner ss stated- _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ - ^ 33c arise umber
Tj ~`'-'[ e~ _ L
f J 33d. Crate Signed (Month, day, year)
(--~ ( (~, c ~.
• MsrNal Examiner/Coroner
(Al the task of examinetlon end / or Investlgetlon, In my opinion, death occurred ffi the time, date, end plea, end due to the ease(s) and manner as atetsrt_ 34. Name and Address of Person Who Completed Cause of Death (item 27) Type /Print
L~Ug (`Sir ~~ S"r~~>~ti` N~-A
Registrers S tare end District Number - ~ I ~ I / I ~ { / I~ ~ th de
O
36 Date R ~a Z Po ~ I~A+~ Clw +~ (fie(- i C,~ uL~ kh L ~-~ I ~ l rj 0 I I(
~O
O`
- ~ 1 ~ Dispositlon PermR No. _~Q~~~1
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
C~rn~~-ll COUNTY, PENNSYLVANIA
+' Deceased
Estate of ~ ~~~ ~~hi ~i',C L
~~~~~ ~ ~ ~~~~ and -~/~%a~1'l t'1 C~ ~ - ~l ~.~' ~ ,
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with ~~`W~~'~/ ~~lt~ ~~ Cam- and atn/are farriiliar
with the handwriting and signature of the decedent, and that the signature of ~ ~ ~--~ ~~~ ~~-1~-
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~a~~ ~ ~~_
~~ ~~._
is in his/her own proper handwriting.
(Sim lure)
(Street Address)
~y ~~ ~
(City, State, Zip)
Executed in Register's Off ce
Sworn to or affirmed and subscribed
~~~~~
before this , day
(Sigrzat re)
(Street Address)
J ~ ~ l~~ll
(city, state, Zi )
c~
_,
=, =~~ ~ ~
` sue.,
_ _
_
rr ~ ~~
-~.1 J
~~^I
~l ~'-r'y
yy
Form RW-04 rev. 10.13.Ob
/~~i -" ~y ~' ~A
111 ~"
`~. '- ~ ~ ~ ~ ~i,
:' -
,f ~: .
Z~~O J~~~~ ~9 P~~ Z~ 04 ,
RENUNCIATION
REGISTER OF WILLS
L ~t i~ ~ i~ G-~1~COUNTY, PENNSYLVANIA
~L~F~`y{: ~~
r~ -j R7
~~ il, ~-~,... ~ , ? , ~~,
Estate of _ ~ ~ ~ f ~ lC (: ~t/11' r~ L= C ~~ ,Deceased
I, ~-~ L ft N' rill. ~ , ~ C~ L~SyL , in my capacity/relationship as
(Print Name)
-~~L~-c'' ,f~-1~_ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~ /a
(Date)
Executed in Register's Office
(Sign lure)
/ ,~ ~ ~ Z' .
(Street Address)
(City, State. Zip)
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
Sworn to or affirmed an subscribed
b~f`or me this ~ ~ day
o ~
LAST WILL AND TESTAMENT
OF
EDWIN K. BECK
~ ~
_ _
~~
..
_~,
,
~
-~ .
te '
z : r
-- =~ _
,
-
~
~ -. `'~
J~ ~
J
i ..
.. ,
~
4 ..
z- ~ :-
I, EDWIN K. BECK, residing at 2014 Harvard Avenue, Camp
Hill, Cumberland County, Pennsylvania, being of sound mind, mem-
ory and understanding, do make, publish and declare this to be my
Last Will and Testament, hereby revoking and making null. and void
any and all Wills and Testaments, or writings in the nature there-
of, by me at any time heretofore made.
ITEM I: I hereby give, devise and bequeath a1.1 of my
property, real, personal and mixed, unto my wife, Katherine Beck.
ITEM II: In the event my wife shall predecea_~e me, or
in the event that my wife and I shall die in a common di.sast:er,
or under such circumstances that there is no evidence ofd survivor-
ship, then and in that event, I make the following provisions:
A. All of my property, both real and personal., I give,
devise and bequeath unto my children: Jeanne L. Reese and James
E. Beck, share and share alike, equally.
ITEM III: I hereby nominate, constitute and appoint my
wife, Katherine Beck, Executrix of this my Last Will anci Testament.
In the event the said Katherine Beck shall predecease mE>, then
and that event, I nominate, constitute and appoint my daughter,
Jeanne L. Reese, and also my son, James E. Beck, Execut:ors of
this my Last Will and Testament.
Wi tomes s :~
f,, ~.
.~~~ ~'.
/ ..
i
a - ~P~-.~.,~
,. ,. ,. .,
~F-~ / ,. i
e ~/~ ~a
C~ ~~~~.. (SEAL
Edwin K. Beck
IN WITNESS WHEREOF, I~ EDWIN K. BECK, have hereunto
set my hand and seal to this my Last Will and Testament, consist-
ing of two (2} typewritten pages, this ~ ~>`~~ day of May, 1977.
I Y
r / r A~T
~'
~ .,~,~,--`•~.; ~. ~ / ~- '~-.-~ (SEAL
Edwin K. Beck
Signed, sealed, published and declared by the said EDWIN
K. BECK to be his Last Will and Testament, in our presence, who,
at his request and in his presence and in the presence ~of each other,
we, believing him to be of sound and disposing mind and memory, have
hereun-o subscribed our names as witnesses.
A
~~-~ -L,.,._ `~ ~ ~ ~ ,.~.,~ residing a tJ ~~` ~ 1 ~ ,~ ~,.
. _
_.~~~-~ i~-` ~ ~ ~~~-_ -~-r_~..~ ,~-. residing a t :~ ~ r gyp, %i%`_ ~.., P -~ :.,r _~ . ,,~~~/,
.~~- ~~
_ _.~ ; , ~,
~°'