HomeMy WebLinkAbout10-26-10PETITION FOR PROBATE AND GRAI~TT OF LETTERS
REGISTER OF WILLS OF C. L- ~n/I -3 ~ L~G~ l~/n COUNTY, PENNSYLVANIA
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Estate of s~ / ~L~~ /((' /~ ~ ~i~rt~o~.y File Number ~ ~ _ ~ ~.. '°" ~ ~°
also known as
Deceased Social Security Number ~` 7G~ ~' / ~..~~
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
(State relevant circwnstances, e.g., renunciation, depth of executor, etc.) ~`~ ,;, ,
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution q.~t}e lnsti-umen~~S~j offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~- ~ ~ __;
~-~,~ ; ..
tJQ B. Grant of Letters of Administration -
(Ifapplicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; dtiratrte nir~~ritnte) -~-r
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sp~§titsei;if any) and~heirs: (!f ,.'-
Adrrtirtistration, c. t. a, ord. b. n. c. t. a., enter date of 4hi11 in Section A above and canplete list of heirs.) ~;;
I Name Relationship Residence
(COiY1PLETE IN ALL C.=1SES:) Attach adcfitio~za[ sheets if ~tecessary.
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Decedent was domiciled at death in Gyk~ rGR~if~i~/1'!~ County, Pennsylvania with his i her last principal residence at
(List street address, totiwi/city, township, county, state, zip code) o
Decedent, then -~ ~- years of age, died on i at ~~ C/-=/y Tr% G4 S T. _ /= jYG~c- ~" `G¢ ~ 7~~~
Decedent at death owned property with estimated values as follows: ~~
(If domiciled in PA) All personal property $_T~°'C~d, U ~
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ °~~~~~~" ~~~~
situar~d as follows: ~~.s Ci~IY~~ f~ ST, t NOG ~ ---~ /J~~" ~ ~G' ~"
Wherefore, Petitioner(s) respectnilly 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:
Signature Tv ed or Tinted name and residence
Foivn RYV-t)? re,-. !0.13.06 Page ;l of 2
named in the
Oath of Personal Representative
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CONI~IONtiVEALTH OF PENNSYLVANIA C""~ :-
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COUNTY OF : _°_:. __,: ~ ~ ~~; ,
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The Petitioner(s) above-named swear(s) or affirm(s) that the statements~in the foregoing Petition are true and eo~•ect ~o':~he best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s)' wxll~ell aiui~-truly '
administer the estate according to law. _- ~ ~,,
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- -,
_;~ ~ -
S~~~orn to or affirmed and subscribed
Lefore me ti.e -,-) ~-~{ day of
~__ ;
For the Register
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Signature of Persona! Representative
Signature of Personal Representative
Signature of Persa,al Representative
File Number: --~ ` ~ I ~~~ - ~ (` 1
Estate of t~~ y ~%' ~ (~ ~i .~-~ C "~~ ~~Y~ 1 ,Deceased
Social Security Number: , ~? ~ `~ 1 C - ~ ~~ ~ ~ Date of Death:
AND NOW, .~.~c_~:C ~k~_ ~ ~ '~ _l , i~nc{onsideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ,!~(1/~~( .i' F'1 I~~ ~ ~ ~ ( f~°(~
are hereby granted to ~ ~ ~ f 1 ~"~ ~-~-' , ~t.~`" "~ 7~C'11
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicils}) cf Decedent. /
FEES ;'.~ ~ ~~ ~ ..~_
Register of W'tl ~~~ .,
Letters ............... $s~~~i .~'~ r'~ ~~-~',°~ ~~. ~ '~ L L' `~~ ; ~' ~-~_ ~U
Short Certificate(s) ........ $ ~~~ _ ~.~ ~~l
Renunciation(s) .......... $ t~~~ ~ v~
... ~"~
-,-,-- ~
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ r
Fa"u, RW-ll' rev. l v. l3.or>
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
G~ti ~..,
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Page 2 of 2
~Jt~l~NwNG: !t is ~Ilegal t0 r~upli~ate than (~p~ ~~~ ~)hCltO~~:at or p~c~t~:•87~~.
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REV 11/2006 ._
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS I- ./ ~ r
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1ANIENTN CORONER'S CERTIFICATE OF DEATH
~K INK
~E Z 7- Z S 1 See instructions and exam les on reverse
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STATE FILE NUMBER
1. Name of Decedent (First, middle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day. year)
Steven A Bartron Male 1 3 6 - 7 0+ 3 9 5 3 October I 2010
S. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, year) 7. Birthplace (City and state or for eign country) 6a. Place of Death (Check only one)
Months Days Hours Minutes Hospital: Other:
Yrs. 1 CaITC)en, N. J • ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home Residence ^Other -Specify:
8b. County of Death Bc. City, Bor Tw of Death 6d. Facility Name (If rat institution, give street and number) 9. Was Decedent of Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black, White, etc,.
~ (If yes, specify Cuban, (Specify)
Cumberland East Pennsboro 203 Center Street Mexican, Puerto Rican, etc.) White
11. Decedent's Usual Occu tion Kind of work done Burin most of workin life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Married, Never Married, 15 Surviving Spouse (If wile. give raiden name)
Kind of Work Kind of Business /Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Specify)
'IYuc1c Driver C-Pare Cd[Tlpaily Yes ^No ~2 Divorced
16. Decedent's Mailing Address (Street, city /town, state, tip codel Decedents pA Did Decedent
East Pennsboro
203 Center St . ~
Acual Residence 17a. State live in a 17c. Yes, Decedent Lived in Twp.
Township?
Cumberland 17d ^ No. Decedent Lived within
Eno1a, PA 17025 17b. County Actual Limits of Cily I Boro
16. Father's Name (First, middle, last, suffix) 19 Mother's Name (First, middle, maitlen surname)
Glenn Bartron Patricia Karcher
20a. Informant's Name (Type !Print) 20b. Informant's Mailing Address (Street, city /town, state, zip code)
Glenn W. Bartron 836 Erford Camp Hill, PA 17011
• 21a. Method of Disposition '~Crematbn ^ Donation 21b. Date of Disposition (Month, day, year) 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Location (City !town, state, zip code)
•
^ Burial ^ Removal from State !Was Cremation or Donation Authorized
October 6 2010
Holt roger CranatOT~7
Mt . Holly Springs PA 17065
^ Other - Spedfy: by Medical Examiner /Coroner? Yes ^ No ' ~
s
22a. Signature of Funeral Borneo Licensee (or person acting as such)
b. License Number
22c. Name and Address of Facility
. - ;~'D 012774-L Richardson mineral Hone Inc. 29 S. Enola IJr. Enola, PA 17025
Complete Items 23a•c onty hen certitying 23a. To the of knowledge, death occurred at the time, date and place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month. day year)
physician is not available at time of death to
- certify cause of death. -
~ Items 24.26 must be completed by person 24. Tme of Death 25. Date Pronounced Dead (Month, day, year) 26. Was Case Referred fo Medicaf Examiner !Coroner for a Reason Other than Cremation or Donation?
who pronounces death. A Y.X. 6:30 P.M' October 1 2010 Yes ^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 directty caused the death. DO NOT enter terminal events such as cardiac arrest, r Onset to Death but not resulting in the underlying cause given in Part I. ^ Yes ^ Probably
respirelory arrest, or ventricular fibrillation without showing the etiology. List only one cause on each line. r
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^ No ^ Unknown
IMMEDIATE CAUSE (Final disease or r 2S li Female:
condition resulting in death) _>• a. Gunshot
tO Chest ~ [] N
_
Due !o (or as a consequence of) r ot pregnant within past year
Sequentially list conditions, ii any, b ~ ^ Pregnant at time of death
leading to the cause listed on line a. Duero {or as a consequence ot): r ^ Not pregnant, but pregnant within 42 days
Enter the UNDERLYING CAUSE r o1 death
(disease or injury that initiated the c r
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d
h
LAST
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events resu
ng m
eat
)
.
Due to (or as a consequence of) r [] Not pregnant, but pregnant 43 days to 1 year
r
• d. r before death
Unknown if pregnant within the past year
?Oa. Was an Autopsy 30b. Were Autopsy Findings 31, Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred I n t e n t io na 1 S e 1 f I n f 1 i e t e 32c. Place of Injury Home, Farm, Street, factory,
Pedonned? Available Prior to Completion
of Cause of Death?
^Natural ^Homaide
ctober 1 2010
Gunshot - Hand un Otilce Building. etc. (Specr(yJ
Home
yam.,,
^ Yes 170 No
^ Yes [] No ^ Accident ^ Pending Investigation 32d. Time o1 Injury A rX
p 32e. Injury at Work? 321. If Transportation Injury (Specify) 32g. Location of Injury (Street, city /town, state)
T\ ~ Suicide ^ Could Not be Determined
6:30 P. M ^ Yes ~ No ^ Dnver ! Operaar ^ Passenger ^Pedestnan
^omer-speci/y. ~
Conte eat, Enola, F'A
33a. Certifier {check only one)
• Certttyin
hyslclan (Physician codifyin
cause of death when another
h
sician has
ronounced death acrd com
leted Item 23) 33b. Signature anct3it ~ /
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y
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To the beat of my knowledge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - Y'C l~-f:Y -' ~ -"~-t =---~=~---~ o r o ne r
• Pronouncing and certlfyfng physlclan (Physician both pronouncing death and certirying to cause of death)
^ 33c. License Number 33d. Date Signed (Month, day. year)
To the beet of my knowledge, death occurred at the time, date. and place, and due to the cause(s) and manner as atated_ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ 2 010
4
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b
• Medical Examiner /Coroner o
er
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On the basis of examination and / 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 an ddr of P son C m feted Ca of Death tam 27) T pe /Prig
~'o~d ~. "~c~C~nro"~e, G~oro~ier
35. Registrar's Signature a trio Number ~ '~ J /' 1 %
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'. 36. Date Fil ~kJpo ,day, year)
C' 6 3 7 5 Bas e ho r e Rd . , S u l t e ~~ 1
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.$ ~~C Mechanicsbur Pa. 17050 __.__
V Disposition Permit No. ~ J ( ~~ 0 /°
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RENUNCIATIQN ;- ~ ~ `~~~" -
__. 1 ~
REGISTER OF WILLS -~ ~ '~~°
~U~ ~ EeQ. L-~/Y~ COUNTY, PENNSYLVANIA c '
~1 - ~~; - ~~~1 !
Estate of ,5' % ~(/~rt~ f~~ U~ l~f~.~~ U/'~ ,Deceased
~~
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in my capacity/relationship as
~ -.
(Print Name)
~c~~T~~~B, of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
G ~~ ~,~ u/ - ~~ ~T~~l~
~.~~ ~~-.~ ~v
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
N-~
Deputy for Register of Wills
~~
(Signature)
(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 renunciat}for the
pu~,os s stated within on this o~~..~" day
// -
~~
Notary Public
My Commission Expires: ` - ~j~ -~~
(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
n~/wnMM~1
~:°`~"~'''~~. VERONICA L. EKLUND
~. Notary Public-Minnesota
~~ -
~+~s;;„.'`'' My Commission Expiras Jan 31, 2015