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HomeMy WebLinkAbout09-22-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cu'~'~ '` 2t.~!~ COUNTY, PENNSYLVANIA Estate of / ' , ~~~ ~ - I t ~ 1~ File Number c-1' ~ V " ~ `I also known as Name Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COtI'IPLETE '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 in the _,_} (State relevnnt circumstances, e.g., renunciation, death of executor, etc.) ~ t--r'- ; _ :~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution t14~iix~'iumer~ offerz'tr for probate, was not the victim of a killing and was never adjudicated an incapacitated person: r^~C Z~r, 'L7` ; . -z= ,~,,~ ter, {y __ ~~1 LK B. Grant of Letters of Administration ~U ~.~''o ~~; (Ifapplicable, enter: c.t.a.; d. b. n. c. t. a.; pendentelite; durante absentia; durante ntirtoritnte) 1,C+ 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.tt.c.t.a., enter date of Will in Section A above and complete list of heirs.) o5P Deceased Social Security Number Z ~ ~ ' C7 7 Relat ~ ~~-~ S~sa.~ l~.v~,ln f«' E !IV AFL CA ttach additional sheets if necessary. Residence Nos ~ivr t/sr /V~ w u/ . , h`r~~~~ i ~ 70~ ~~ Y~~IL / ~~ ./~ ~'Q /i /'Gi.7iot Dece~f nt wa dom ]ed at ath in C..<//VI ~lP_/'~u10- County, Pennsylvan' tth his /her last principal residence at ! 00 O GI/r 3 r ~U(1-/"/n 1~dyr L, a ~'~ ~c.~ 1L i ~~ (3 l ~ _ (List stree! address, townGG/(city, township, coup ~, state, zip code t / / / VCJ F Ll. z! 20/ .Sty l7v C Decedent, then years of age, died on ~- ~ (~ at ~ O d r~ /y~/YS/ I1T Nt ~ 1 ~-~- c~( Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~j~ w ~ ~ t 1 ~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in Counry $ 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 Petition and the grant of Letters in the appropriate form to the undersigned: Signatuye ~ l T ed or tinted name and residence Form R6V-0? re,-. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF C~~~, ~-~ SS '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 knowl~;dge 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 affirmed and subscribed >;efore one file > ~'~ ~ day of Signature of Personal Representative .Mrs l ~ ~ I "! ~~ ~ ...4 ~ . .- // // ! <~' ~/ ~{ ~ For the Register i Signature of Personal Representative ~ , C'~ ~ -,~ ~ `, _ 4 } . _ ,~ U:: ~ N N ..., --~ .. ._ -~ •, File Number: ~ - `Lj - (;° ~ `~ ~ >~ ~ •~ .. `~ ~ ^~ _ _ tV TJ ~, Estate of ~ ~ c, r 1 ~ ~-~~,~``C ~' ,Deceased ~ ~ •'J c- ~ ` S i l S i N J , r oc a e ur ty umber: Date of Death: ~~1 / C> AND NOW, a ~h , ~~ ~ C~ , in c sideration of the foregoing Pe ition, sati sfactory proof having been presented e ore me, IT IS DE ED t at Letters are hereby granted to > ~~ ~ ~ U _ in the; above estate and that the instrument(s) dated _~j~- described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s~ of Decedent. _ FEES Letters ............... $ J a. ~J Short Certificate(s) ........ $ ~ a Renunciation(s) .......... $ ~ ~ ~ C a ... $ - ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~ - ,~ oJPersonal Rep~•esentative Register of Wills Attorney Signature: %'~i1C~-'/ C' C~)f'1., - Attoniey Name: ~ ~~/P ~/ ~ - ~~~+-''' `~-- Supreme Court LD. No.: ~ ~- ~1 ~ ~_ _ _ Address: ~ ~- ~ ~~ ~ ~'^ l~-t- ~ 5 i~ Telephone: ~~ Form RGV-OZ rev. 10.13.or .Page 2 of 2 tO5.Ap5 REV fUUO?I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 16244530 This is to certify that the information here given i^ correctly copied f tom an original Certificate of lleatt duly filed with me as Local Registrar. The origins certificate will be forwarded u~~ the State Vita Records Office for permanent tiling. _ y~ ~/>o cal Registrar ~ UDate [slued C7 0 CD o -T: ~ ~ to r ~(, , ' -: ~ i`r1 c `'~ C-7 C ~ C~-_) -rl ~ ~-i lC~ ,- Certification Number -10.3 REV 112186 /PE /PRINT IN PERMANENT BLACK INN w ~I ~) O COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBER 1. Name d Decedent (RrsL rtia9e, asL safal 2. Sea 3. Socad Secwdy Nunb« <. Date d Death Monts, day. Year( Mary A. Hood Female 203 _ 07 _ 8177 ~ebruary 21, 2010 s. Age (Last &nMey) Udder i year tkxMr 1 M 6. Dare d Bits (Madh, My, Year) 7. (Ctly antl sMe « ) M. Place d Deem (Ghee any one) 88 .wm« ~" Nwa: twew August 16, 1921 Lebanon, PA "°~L°w,,tl5518f Yrs. ^ Inpatient ^ ER / OutPaOwd ^ DOA IGXNurang Home ^ Rasidmia ^Omer - sPeai7 W. Carry d Deam Bc. CM• ~. Twp. d Death Ba. FaciMy Name (n nd iwd0ai0n, gMe Greet ant num0ed 9. Was Deadern d Fispanc Origin? ~ ^ Ves 10. Race: Am«ian IMan, Back, WNa, ek. Cumberland Carlisle Sara Todd Nursing Home ("''8e•~°~'~0an~ ( White MasKen. Punta Rkan, ac.) 1,. Dwwaeds Uaua Kea d wo« d «w ~ rtes d ~ We Do rot dare naiad 12 was Decadent ever n tlw /3. Decedents EdreaOOn (speay odY hip,est grade arrpl eted) 1a. Made Srenrs: Medea. Never ManaQ is. surviving spo use Of woe, glue maiden name) Kid a w«k K'rd lr,auso-y ~ ~ u.s. Amax) Fatale Erementary / sea«,Mry (a,zJ carege ,-a ar s,) ~ Wi°bwe°. °vomad IsP~+hl Widowed iglon e Secretary ^yes q"° tQ DeaMd's MaAng Aadmss (slma, cdY / mnn, state. rap ant) 1000 West South Street Deaaerd's PA Did Deadem '~"+ t7a Sate ~"° m = "°. ^ Y„• °aa.a"" L"°°" T,~. PA 17013 Carlisle ,>n.~y Cumberland T°"""'"p? ,7a.~rlo.DweaaaL;.eawiaan Carlisle , AaW Lenia d cry / aom 18. Fathets Nacre (First triads, asL sulfa) Joseph Nepi ig. Mam«'s Name (Fist. milde, mails sesame) Elvira Capella 20a. IM«naa's Name (Type / Pont) Barbara A. Stevenson 20b. Ni«nanYS Maifng Address (lase aY /town aaN, tp ode) 30b3 N. progress Ave. Harrisburg, PA 17110 21a Manna d Dapas1un ^ Crem~on ^ Duration 2, b. Dale d gaposLinn pJardl MY. Year) 21c. Pace d DoPaieon INama a caretery. amrebry «am« place) 21a. trader (Coy / bwn, state. aD ands) ^ R«naahomsele vhsa«ndon«DOaelionAdMdaad February 25, 2010 Holy Cross Lebanon Lebanon PA 1 7042 ^ Speary: i 0Y Yadical Errarw/ Caorar4 ^ Yas ^ No 27a. d F achq az acs) 22b. Lianas Number Ylc Nate and AMrace d Fadfiy FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055 ConpNle name 23ec ody wren arNYing . To the my aaavadga aeah ocamd al (W time. eats eM pace aaad. Is9naure and title) z3C. Uansa Nunbsr z3c Date signed (Month. aey, year) phyauen a not aaatlade a dme a dram a arsly aa.e a attn. r `~II3/JiJ .t~.c~-r ¢.a~ v ilo uiv~ 2 4~ 4v t ~t U 0~ L~'rJ$ Qufa~~ 21 , 2c t G rams 2446 mud a anroNaa dy pers«~ 24. rxna a Dwn ~ 25. Dae PlaaMrrKea Dean IMo~, day. yur) h 26. Waz case RNerraa re Examiner / canner br a Reason Om« man Cmnation « Donation? was a«a,ncaz ae.m. t M. a5 : S 1:i '}¢ly2~i o11 , Z O L G ^ Yes CAUSE OF DEATH (See inahuttlons and eKampies) , Apwmunae iea«al: Pal IL Eder omw ~ ~ 2fl Dil Tabaca use CaarBW a Deem? Item 27. Pan 1: Enter da>~iaf>L~ - aaeazea, iyiaies. «mmpYaNOra- Ihtl ddctly awed me Beam. DO NOT eder Ismael ev«ds sail az ardac acres, Onsa b Deem Ixa nd realtirlg in da urd«ying reuse given in Pan i. ^ Yes ^ PmbeWy razpiratary aces, «veMrcdar neriatian Whoa awwg da edopgy. tat ady eras awe an each Gne. ~-]'Ro ^ Imknown g1YEDIATEsB /FaW assess « c«AYOn a deem) ~ a I IfA u j ~ O~ r Llx 4~5 29. n~Fse~mYe: Due re (« az a CaneeQaena Cry: SagiwlEW E9 mrNtiav;, A ant. b. t~ E't't'~EIY~! ~ y It,f 1-~ Nd PraWant wdhm P~ Y~ ^ P'aliy^t a tim d Mom ~ayp b ma Cause Lsletl m Yoe a. p„a to (« as a 5Mr it UNDERLYING CAUSE off: ^ Na Dregnra, dA pregant WNn 12 Mys ~n~MSm" j°laa~e `_ r ena reAiNn ( a Mom ea a Dee b (a az a c«aegu«xe dry: Nd pmgnad, da pregad a3 Mys ro t year ^ d. belors awh ^ lktlanwn Y pregad wtlhin me pad Year 30a. Was an Aubpsy 300. Wem Autopsy Frbia)s 31. Hamm a Deah 3?a. Date d Inpxy (MOdh, My Year) 320. Describe How hpury Ou«md 32c Pace d Irqury: liarne, Farm. SLeeI. Fa toy. Pedamea7 Avetlade Poor b CanpMEan ,-,/ N Mal ^ H idM r Office Butldng, ac. (Sped/y) a caws d Dazm+ a an L S ^ Yaz ^ ~ ^ ~ ^ pcddwa ^ pe«ay aaresgptiw, 3za. rare d l~ry Sze. lry'ay a wwrr 321. n rrarwp«aeon inwy lsPeanY/ 3zg. Landon a lrywy (swm, dry /town, sae) ^ S~idde ^ Cats Na M Daeminsa ^ Yes ^ No ^ Driver / Op«aar ^ Passenger ^Pedesharl M ~'~N 33a. Certlder (diedr any one) 330. Signet«e antl • DBmNtN POY+~ IPnysiaan ar0yi5 awe a awn when anodlx phyaMian has prapuKed Hem and mmplaed lam 23) To thebwdmy awwYtl9e.tlam oc«wrad duarelM aueyei artl mmmerru slated_________________________________ • Praaa iN and ~r+nY POY~ IPnysiJen Oom pr«nndrq deem and arraying b ease d awn) ^ 33c. Uamae IAxnaar 33a. Data sigrm IMonm. My, year) To tlrs wmdmy wtoraag.,awnoaurredanr tlnra doe, and pha, aces Mere Uw uuee(a)arM msrowr as slated____________ • Metlkal Exem(nsr / Caterer _ _ _ _ _ _ ,^ C~ 1 Z. (i t.. l r O l (~ l tM the MW d enmmetbn and / «IrwaegatloM1 M mY opkNak deem oearrred a the tin0. date and due to tlw wuse(sl and nrmim az sala4. ^ ant Pas _ .• , . 39. Name ant Address d Person WFa Cause d beam pam 271 Type /Pmt \ Ste 35. R ~ SigWUreand Disbict kAariber 1 ~i ~l ~ ICI 36. Dad Flea (Homo. MY. Yew) . / + ( ~.lrl.Tf1 !) L(. `~.~1 ~) ~y~ L~ 1 ~ ~ 1 ~~./ 13 ~~ ' G 17~IJ < ( ` - ~ o o ~^ rC ` < il ~t, 13 ~, _. n eP ti C 2 C •~ C7 ° : ~. . ~ _© ~- ~ , '~ - ~- rn ~ tv `` ' ' '~ ? , RENUNCIATION ~ ~ T -- ~, ~ __- -._ °` REGISTER OF WILLS ;i ~ c7 • `' ~' Cct~cF~/~-J4in/lJ COUNTY, PENNSYLVANIA `~ Estate cf _ _ ~ ~ ~ N ~° j`~7I4 ~ ,Deceased I, ~~~~-s ~ ~~~(~ ~ , 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 ~~r,~Jx L• ~ool (Date) (Signature Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Farm RW-06 rev. 10.13.06 (Street Address) (city, state, Zrp) Executed out of Ree islet's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpose, stated within on this =' ~ day of ..~ ~ ~.._..._. _ ~ y /(i 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.) STEVEN M KAUf=MAN Notary Public, State of New York Nt~. 465573$ Qualified in Nassau County Commission Expires Aus~. 31.2011 RENUNCIATION REGISTER OF WILLS CEti ~ ~~f~~~ COUNTY, PENNSYLVANIA C~.J ~' C ~ ® r^t - ~'LI ' fT1 C:, ---- ~ f'T1 tU r-; , -;''~ ~ t ~ 7 ~ ~ ~.. _ w --~ -_ ~, = ~- - ~.r Estate of ~ ~~'-1 ~' ~~~ ,Deceased I, _ /~ ~-~t-'~ ~~w ;~ ~'-C , .~ ~c l~~ „~ ~C.~ rt-1 , in my capacity/relationship as (Print Name) .~ t-t~ In ~--~ ~~-- of the above Decedent, hereby renounce the right to ~'" administer the Estate of the Decedent and respectfully request that Letters be issued to ~OSt°n ~ L ~U D CJ `~ ~ Y(, ~ C~ (Date) 1 Executed in Register's Office Sworn to or affirmed and subscribed before me this ~° day of 1'~rrr , , ~ ~- , 4~C>t~~~ ~J Deputy for Register of Wills Form RW-06 rev. 10.11.06 (Signature) C~ ~ ~ ~~ . •,~~ ~~ l~ ~ (Street Address) (City, State, Zrp) 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 Nota ~ ublic ~ ;~ My Commission Expires: ~ ~ ~_ ~,~ -~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Janet K. Rttdy, Notary Public Med~ar>icsburg Boro, CtxrtbeAarW Cour-ty My CAn1R1lS3(On fires Feb. 8, 2011 Member, Pennsylvania Association of Notaries RENUNCIATION REGISTER OF WILLS ~i~cr+~3~+7c.A+Vi~ COUNTY, PENNSYLVANIA c~ t.~ ° C 0 0 -- rte-- -~ t # fi _ C~ ~; ~ --i " `; N - ~_ , ~ ~ t~ ~ ~ - Estate of /~/~-~ ~ ~ • ~~~~ ~ ,Deceased I, `~ in my capacity/relationship as T (Print Name) ~ t) N of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~OSLI~~'1 t... ~ ~ ©D oI (Date) i~ ~o (Signatare) (Street Address) (City, State, ZipJ Executed in Register's Office Sworn to or affirmed and subscribed before me this day of 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 ors e executed the renunciation for the purposes t ted wit in on this day of ~ , , ~ ~ ~„tt,~ ^~`•~ f (icy ~,; '~c ~.~ ~,, fip i Notary Public ~O'L~~1 \ ~ - My Commission Expires: ~I -~-~~..~°~i l-9 s (Signature and Seaf of Notary or other official quaio•., ' • \;~ administer oaths. Show date of expiration of Notary"y ta~isSioii) •• \e.` Form RlV•06 rev. 10.13.06 C'7 r`a ~ C © ,~:, =~ iT 1 ~ ~ vs ; , r-n r'~ _ r-y srt N RENUNCIATION ~_ ~~~ ~ ~ ~ ~`' ~" ° ~ ` ' -rt _ (~ (` ' '_` REGISTER OF WILLS .w ~. ~ -~, ~ -~, CU i+'n3~i2t.~U)) COUNTY, PENNSYLVANIA ~ `r' Estate of ~ R. ~ ~ ~ - ~ ~ °~ ,Deceased I, ~- ~~"~'tz~c~' , in my capacityhelationship as (Print Name) l4-rT~ ~ ~ r.! r rgcT of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) (Signature) Rxecuted in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills l3 ~u ~ ~30~~~-v~rzv ~~ Y (St~re~et]Address) (City, state, zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he e~-ske executed the renunciation for the purposes stated within on this 4~~'h day - 1' Notary Public My Commission Expires: pd,Dbtr ~~, ~.Ot~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) AMY H. PAFiNES Gorrimission # 1814494 L -~, Notary PubOc -California Form RW-06 rev. 10.!3.06 Z Contra Costa County M Comm. Ex Tres Oct 17, 2012 i CERTIFY UNDER PENALTY OF pEpitl~ lN~ii THE L*WS GiF THE STATE OF CALJ»NIA TMATTHE F~ORlQOrif: PARAtiRA~NR T~A~D~-N ~-P, 09/olio