HomeMy WebLinkAbout10-08-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ COUNTY, PENNSYLVANIA
Estate of ~ .~ I _ ~ `~ _ /~~
~ File Number (~
also known as
,Deceased Social SecurityNumber_ `~l"~p•~~
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
last Will of the Decedent dated and codicil(s) dated named in the
`-~
-=A ~
(State relevant circumstances, e.g., renunciation, death of executor, etc.) , - `
L n n
Except as follows, Decedent did not marry, was not divocced, and did not have a child born or adopted after execution of't t _ --~t
rr~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: 1}e~n~Itumenj,(~ offet,e~l
1, . f "'L'1
B. Grant of Letters of Administration ~ ..
(IJapplicable, enter.• c.t.a.; d. b. n. c. t. a.; pendente lire; durance absentia; durance minoritate) --._ . '~ c-_
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) amend 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.)
RaSL
Decedent was domiciled at death in County, Pennsylvania with his /her last principal residence at_
(Liao street address, town/city, township, count), state, zip code)
Decedent, then ~_ years of age, died on ~~ at
~.
Decedent at death owned property with estimated values as follows
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania $~~0
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania m
situated as follows:
Form RW-0? re~~. I D.13.06
Page 1 of 2
(COMPLETE LNALL CASES:) Attach additioz:af s/wets if zzecessary.
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) p~sented with this Petition and the grant of Letters in the appropriate foam to
the undersigned:
Oath of Personal Representative
COMiV10NWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~~~~ ,
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) ofthe Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ day of
4 a ,~ ,~.Oi~?
1. i
F r the Register
Signature ojPersonal Representative ~_"~
-~ '~
:? ~ C'7
Signature ojPersonal Representative - "'~- ?"'~-1
'-~
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File Number: ~ ~ ~ ~V ~ / ~ ~ ?'' .~
0
Estate of 1 Y ®~,~ ~j t~~ (~s~n Deceased
Social Security Number: _ ~ ~ ~ _ .~ (.p " (`~[D S ~ Date of Death: ~ ~ ~L
/ ?~
AND NOW, ~ ~~ ~>~ l J ; {'j f?~ ZL~~LI , in considera~ti/on of the`foregoing Petition, satisfactory proof
having been presented before me, IT IS DE REED that Letters Yl`l I !'l 15 I N ~i~ G'j/~~
are hereby granted to ~~~~'{ ~,~ Q ~(' (~ ~
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) o,~Decedent.
FEES
Letters ............... $~_
Short Certificate(s) ........ $ ,~~~'1
Renunciation(s) .......... $
C S -r--_ ... $~~
G ... $ ~ ,CAD
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ I•
Register of
Attorney Signature:
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
in the above estate
;. ,-
r-~,,n Rw~oa rev. lo.lj.o~ Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee tier this ce,i~icate. 56.00
_ P 16809259___
Ccrtifir.uion Number
This is to cc•rti(~~ that the int~n'matio)1 here ~i~e^
correctly col,icil !~rl~lu an i)ririn;il Certificate of De.
duly filed ~a itl, me a, Lu~~al Re~~istrar. The (~rigil
certificate ~lii~. he fon~~.u~ded t(~ the Slate Vi
Records OfiG~e liar herma)rens ttilin~~.
1.~~__~ _~~_ ~ 3~,
Local Re«istr~ir Date Lssued ~~
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N1Q6.143 REV 112006
TYPE/PRINr IN
COMMONWEALTH OF PENNSYLVANIA• DEPARTMENT OF HEALTH • VITAL RECORDS
PERMANENT
BLACK INK
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE N UMBER
1. Name d Decedent (Fv# mdde, lazt suRa) 2 Sec 3. Sooal Secupy Number
Troy L. Beaverson 1. Dab doean
~"°nm•d'I'•n~
B. Age (last BVtlMay) lhldrl a Male 171 - 56 - 0656
UrMrt fi. DapdR#h 7
and stak« ' August 29 , 2010
wuM DM .
nceu Ba PpcedDeam Check oNyore
Noun AIYa1u
43
vrs. taw olnr
September 30, 1966 Hanover, Pennsylvania
^ k4#rlt ^ ER I Ou~a/eM ^ pOA ^
Bb. Coudy doeam Bc. Day. 6om. Twp.dDeam Ba. Fadiq Nme(It rbt bs6erfon, yYe ue#and anther) Nursing lbme ®Res#ence ^Omr-Spay.
9. Was Decedent dF9spaNc Origin? ®No ^ Yes 10. Race: Amricm IMian, &ack, Whit, eb.
Cumberland Hampden 6110 Charin Cross (rms.weaWCaem. (
g Mexican Pvab Rbm, e¢.) W h Its
11. Decedent's ((soot Occupapon IGM d wcrk acne most d ~ IiFe. Do notstap reprea. 12 Waz DeceMnt ewr in me 13. DxeMN's Eallcalbn (Spedhy oNy highest grant conpkkd) 14 Madt# Sfads: Mmbd, Never M 15. $uryi'An9 Spouse (pwik, Site maiden nano)
KinddWOrk Kauld&#iressllMtatry U.S.Amed Forces? Epmentary'/Secondary (1F12) CoR9e (I./«sq Widowed, Diva¢b(Spri/y)
Lawyer State Government ^ree ®No 5+ Married Anna J. Malcein
18. Decetlenrs Mairg Adtress (Spe# c0.Y / bwn, spk, sip cede) DeceMN's Did Decedent
6110 Charing Cross P40i1~i°G1Ce naspp PA Liveba „". ®ree.oeceamttivedb Hampden
Mechanicsburg, PA 17050 1Te.camty Cumberland T"a"y va ^ No.DxeaedLnadwimin Twp.
P.cWffi lirip d City / Dorn
16. Fameys Name (Frst rridde, pR suRe) 19. MMMs Name (Frst nedde, nuiden s«nm)
Elwood Beaverson Mayola Krebs
zoo Id«maN'sNmle (type/Prhp
Anna J. Malcein- - __ Zoe. Inbm,ad~M'^`grso-`:`csaee`d`Y/°e""''Me°.»D`°de)
z1s MemoEMDispositlon -- - ~- - - -- ~ 6110 Charing Cross Mechanicsburg, PA 17050
^&riffi ^Removffi pan Stale ; Was®Cr#lWpe«Don^iMn Autlbdaad 210. Dab dDisposiem (M«dt day, Year) 21u Place dDisposieon (N~madcenebry, crrnabrr «amr pace) 21 d. I.xappn (DKy/mvml, slab, >ip code)
^ °tl"r • ) ~'~~a~YC~n•r+ ®res ^NO August 31, 2010 Conolite Cremato
zze dFunerffi ry Schaefferstown, Pa. 17088
tea'"' ~ ° ~) 21p. LiDassa Number 22c. Name orb AdAeaz of Faciry
~ FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
Conpkb pare «aY when catihilq 2 die ee#d . deem orc«ree #me Mme. dab ma DMCe sMlea. (sgnahae,,,a Btle1 zap. ucrose Number
physitlan s not avaiade ffitme d Mam b 23c. Dab Sigred pbNh, day. year)
cerBtY cause ddeam.
pens 24-26 must he c«rObbd M person 24. Time d Deem 16. Dale Prorouced De (MoNh, My,
26. Was Case Reprtedb Medical Fxamirir/COrorw l«Yeason Otlermm Crana6m «Dmapon9
wdn pmnoaces loam. ~•-~ ~ M. ~j LG ZO(O ^ Yes
!! ® No
CAU OF DFal7H (See Inafruetlans and eaamplss) ~ gpprosblab iriservffi: Part II: Er4r dtenaNBemtamitlma 'p NuM b ,rn 26. Did Tohacce Use C«bibule b Deam7
pem 7/. PMTI: Eds mechan deuaip-diseases,inj«ias,«mrpica0oru"m#dia9y caused me dealR DO NOT mbrlembiy etarltl sucp azcar6x xresL ~ DnsaLb Deatlt bd not resilMgin me
reap'rabry mast «verobula 6pwaeon wMbm showing me elelogy. Lbtanly ore rouse on each Me. underlying cause given h Parll. ^ Ya ^ Probapy
IMMEpATE CAUSE(Final dbease« ~NO ^Urknown
unrld6m resurtlng in seam) -~ VvLaYr F T y e,,,~ ~:, 4 l~ ~{ t }( ~i~ ,.tom z9. p Female:
w Duet 1 aeonseRvmce o0. ~ ^Nd Om9naK wNtsn pazt year
N~edxgb cao~serne aye e. ~~(t'" ~'11+n-QR+~~.V \f1-(tw ~.P <.~~r t`P!-c1 asJ ^PregnaN atime ddeam
Eras lheUNOERLYpIG CAUSE Due to,(w.s. cwueevmce o6.
(dseaze «injurymffiirkdabW me ~-Ia~JZ~c:e~i t L }'l ~t'E- i..c t b ~.Y•~ M:-rr1-1 t y~-- ^ ~ ad we9nam w;B:t 4z says
ev#tp msdpnp in seam }AST. c Due m (or u a coreaqumn o0.
e. ^ dceffih nmt but pmynant /3 days p 1 yea
30s Waz m ^ UNCnown ppmgnant within tle past yea
AumDSY 30b. Wre Aubpsy Findngs 31. Mmrvr d Dean 3h Dap dlnjury (MONK, day, Yea) 3fi. Describe Fba Injuy Occ«red: 32c Place d Injuy Nome. Fam, Stre#, FaJ«y,
Perfmrea7 Avaiape Pdorb Complepon
d Cmsad0eam2 ®NaNffi ^F1crrsNde OIke BWdng,et./Speciyy)
® Yaz ^ No ^ Yes ~ No ^ P.ccideN ^ Pmdng Imiespgatlon 32d. Tune d Iry'«y 32e. Injury ffi W«k7 311. NTrariaporpaon IrquryySpedyyJ 32g. L«aBm d Injuy ISteeL uvry / bwn, spp)
^ Suidde ^DouM Nd be Deeermine0 M ^ Yes ^ No ^DritwlOprabr ^Passerger ^Pedesaian
^D~-S-rdY.
33a CWBr(crbdc ony ore) 33h. a#Title
• Cartllyln0 Wry#Um(Physbun ceNrying curse d Mffih when aromr DhYSician haz Dmreu«ed deem and c«npkbd Han 27)
rem.h..tormyknoed.eg.,a.amou«..aan.mmemaeq:)anemmnaaasw4e------- ____ ____~ ~ (1 M~ . ~3. I~y r.; ~,~ t,~,.~ ~
• Pronoundng and cerlHying plyfldm(Physbpn ham lrOnW^an9 death ant Cerpfying bcaaedceffin) -"-'-'--"""'-
Te the bnt d my knowpdge, seam oceumad #me tlme, ash, Ma Dlace, and Due m me causNsl and manor as states. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ 33c. License Hinder 73tl. Dap Spred (Month. day, year)
Medea) Esaminrl Carona M b e 'v 4 S ~, g ty
• on me hags of esaminatlon and I «inveetlgatlon, m my opinion, Math Dolores # me tlnwf, dab, and ppce, ant due to me causs(a) and mmnr as stated _ p ~tn V-..~) ` ~ r 2~ (
16. R Signaore and D'atrbt N 34. NmR ant Address d PerS~n Wlb Completed Cause d Oeam 0bm 27) TYPe / PriN t
' 36. Dale Fibtl (Month, day. Yea) ~'. N iA l5 12 `{ •~ lrti'~ h b
Lull I~I.l 1vZl/`(~k6~Lr'yf~-3ni~'.w j;;a «^•,.v£.Zsrt-~t ~;v~ (~cz4-t)-6.y v~~r ('7-0~~
Disposition Permit No~ e . Zt~' L 75 bp'