HomeMy WebLinkAbout11-10-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~~,/IYI~~li9-t../J> COUNTY, PENNSYLVANIA
Estateof~~~"~ ~j~f/,y - ~. ~ - ~ ~ I ~~
File Number i
also known as ~ _ c--?
Deceased Social Security Number ~~~- `3~ JJ ~y
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
last Will of the Decedent dated and codicil(s) dated
(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 born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
~ Ca
`~ L' Grant of Letters of Administration C o ~,
(/fapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; dur ritate) ~ ~; a c'~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived b the followin sp~ E-""~
Administration, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) y g ,~ ~ Y) atOeirs: '. (`
,c._ C!> ~
CJ C , ;~ .~
-~ t
Name Relationshi Resid " ~~ Z - ~'
/~J ~ ~ -'
(COMPLETE INALL CASES:) Attach/additional sheets if necessary.
Decedent w do filed a[ death in ~-Gt X71 !~/" C' County, Pennsylvani with his /her last principal residence at
r~
(List street address, town/c/inty, township, county, state, zip code) /~ / '
Decedent, then `~ ~ years of age, died on ~ 7 ~~~ /~ ~/ at _ /~ ~ ` LV 1.~, { Y1 ,
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ C!/rJ ~~ , tr~/
(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 Petition and the grant of Letters in the appropriate form to
the undersigned:
f,j I ~ - ---- -.,.__.....
Form RW-01 rev. /0.13.06 PagC I Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ~_ SS
COUNTY OF c !I ri1?GQl~~~
s above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
The Petitioner( )
wled a and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and tru y
the kno g o '""
C7 -.3:~
administer the estate according to law.
Sworn to or affirmed and subscribed
of
before me the ~.-- day
~ c~ ~~~
For the Register
Ck? -g C~ -^ '~--%
Signature of Personal Representati
i ~ ~
O .__, ~.~,
r~,~ ' ' ~'
~•~~
=
~
.-o ;
~;
-
Signature of Personal Representative ~ ~ -
. ~
.r
-~
Signature of Personal Representative ~.~
File Number:
G ~ --+~~ ~~~ ~L ,Deceased
Estate of ~ //~ ~ v
Z ~3(p r s.37 Date of Death:
Social Security Number: ~ I
AND NOW, I~ ~ 1~~TcI1PYYlb~Y
having been presented be re me, IT DECREED that Letters
are hereby granted to ~ w '~~ ' `
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES ~.
Letters • • ~ ' $
Short Certificate(s) .. - • • • • • $
$ `"'~
Renun iation(s) ..
•. •.: $
...$
$
...
$
...
$
...
... $
... $
... $ c,9~
TOTAL .............. $
in the ao~ve G~~a~~
e r as the last Will (and Codicil(s)) of De
Register of Wills
Attorney Signature: ~' ~~
Attorney Name:
30 ~z 3 9
Supreme Court I.D. No.:
,~D. 7ox l ~~
Address: ~ /,~0~.~~~~
l~~ ~ s>/3u~C log
~,~- ~ss~-sy~ d
Telephone:
Page 2 of 2
of the foregoing Petition, satisfactory proof
Form RW-02 rev. 10.13.06
105.805 REV (01/07
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 16804295
Certification Number
3 REV 712003
/ PRYtT 1N
,r
ADFC rx
This is to certify that the information here given
correctly copied from an original Certificate of De?
duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vi
Records Office for permanent filing.
SE~1~~010
Local Registrar U Date Issued
a
~' p
;-
~
~y Z ,
~
Gam? .~'J
~ C/~ 7C Q ~~ `~
~ - '~'f
~ .t" ~
COMMONWEALTH OF PENNSYLVANU • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~
'-~
CERTIFICATE OF DEATH N
L°~
~~G.
' ~
(See Instructioin and eyurmpba on reverse)
STATE FILE NUMBER
,.wmea ~~•~~ ~ z
°. Se Dt
A~an J
hn F
it
o
r
z
male 20236 . -5374
201
S. Age ft•r Bpridryj IAWr 1 loran 1 8. Dee d BMm T. rr rre a ee. Place d DWn CMa ae
6 3 v~ waww D"` "a°° ~"" Nov , 2 0 ,19 4 6 Camp H i 11, PA N••Wvl ^ ER / dipeWd ^ DOA ^ Ru,>hg Nana ^ Rerdrioe ^ onr • soryy
m. Cosily d Deem ea CMY~ Bon, TwD• d Oeetli Bd. Feoiy Nrrr 1r M MNtlNMa4 ghw treat err nanber) 9. Wr DeadwA d Heprpe Oilpn? ^ yr 10. Rer: Arrwlcen nWn, Berk While. ee:
Cumberland East Pennsboro Holy Spirit Hospital ~~~.~) white
11. DecwderA'a llwY a wakd or morel i. Dond afro 12 Wr Deudre aver n me 13. Decadwre EaLatlon (9parJly say higler V•d• aarip erd) 11. Merhr SlruK Mrrled, New 1Mn4d, 15. SuMVpp 3pa uee (p wlh, giro npdden rear)
Fardawap aroae.wrr/maepr
driver u.s. Amra Farr? Elenrnery / secmmn lalz) Colege (1~ a s<) Wldeaea' Dharcaa ~h1
1 ^ Y« No 12
e.oe~ar+'eM~gAm~etse.x~r/1~n•e~,~oare) D^°°~"'e Pennsylvania ~
°e;°e1X ~ Lower Allen
19 2 9 Kent Dr . ti
Aduel RrNrre "` ewe rovmMq? ,Tp. Yr. Dorset ~." ~ TwP.
Cum er an vd
^NO
OrwdrMUVadwhhm
Camp Hill, PA 17011 .
,
,ncamy
Araw uses cM/Bon
18. Fegefe Nerve (Fhr, nydae, kr, edAe) 1g. Models tNme pTrel, n~dde, neNr nerertr)
Jesse R. Fritz Mar orie Huller
20e. kdawed'e Nrr RYD•/P~ Eric Fritz zw.lda~nr°MMngAm.°tsar'`a,/~n'ae`'~`aa')
1929
t
Ken
Dr., Camp Hi11,PA 17011
zu Mdnd a DYpoeear ~ ^ Daeuon zm. ore a Dierornm ttAOrh, aey, ywer) zu. PYr a Dleroeuon prone a crnewy. a.meay saner Dort) z1a loatlon (Cly/mn,, mr, by coael l 7 0 65
^ Bprw ^ Remorrhan&re ~ ~~~ Sept.14,2010 Hollinger Crematory t.Holly Springs
PA
r^~ ,
d FerN Uoenee la P•r•r rdlnp r rdrj 37D. tkww Nuroer 72c. Nrne end Maw d FeoIIy
Q FD-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043
CarpMFe rerr?3ec aiy edrn aMylrp 33e. To Eerplmy kaed•dW~ deeAr asterd rgr tore, dW rb DI•o• eeed (SpeNe erdtltle) z30. lhwnee Neri6er 230. Dra 817ud (~ d•Y~ Y••r)
`~ °rdmeaerma
r a ~~
•e~t /r
~~
G tI
~'~ Ot2
2
'
p 2
l
e ~ t
i
/.
ap T/
,f
~
.O
r
~ 2e-18 mnr ~ ~~ hy, ~~ N. Tmr d Drm 25.Ore day, year)
~ ~
~
~ 26. Wr Car FeMnd a eNrrl Ewaner / Caarr b e Reeeon Over mn Crrrtlon a Doneeon?
^ Y
N
who parrewr deem. ~
u
~
..A t ~ r
o
CAUSE OF DEAM (9•• IrrtreeAber erw ~) r AppraanW Mdervet Pen II: Eder Dora ' 28.ON Tdean Ur r Drm?
gem 27. Frl L Eder the gjy)~g(,e~ - dheeer, Wes, a arpycWae -mrdyedy/ coeod tlw dMR DO NOT era WniW erode ouch r audYC otter, i Orwt fo Derh del not reeulYq h the underykp epee PWr h Perl 1. ^ Yr ^ Protehly
neptray error, a walarW IhrMlon wend rawhg re eaAcpy. LYt ady ar oerre m eecfi yne. r
r ^ No IAppnwn
~q
mMlar"n~eaaign ~1 ~ `
f~~ ~ ~ l '~•
~
~. G n. h Femre:
^ Na
l
q~
e
py~
• '~~/'
G~ ~~~T a 4I~ r
<
. ` ....~ ~e~cr. r
h
"" ~~~ ,r.gnea w
wn aer rear
^Prgryarynrdarm
^
~
. ~~<
~
..
; ~ NaP,dpgep~enlwrene2de,.a
r
a ~° ~ ~ -: Q. •r ; ~.~ ^ U~MOnwri X PnQwp Mmm dr
eel
ear
y
P
30e. Wr n Adppry 380. Wen Adopey FYdnge 31. Menw d Deam 33a. Dee a hlhey pAOnrr, day, yeerf 320. Dwm6e Flow mMey ~
Shat, Fecbry,
320.0 k
Perlerrted? Avepehb Prla b Canprbn
dCaurdDrm? ^ ~~ /may/
e &
^ Yr ~No ^ Yr~No ^ ACCider ^ Prdrp ImeMlpdhr 32d TNne d mluY o ~r o rebr ^ Prari
er ^ Paaelden
^ Ddrr O ~. I.ocelbn d ~r Isp.e6 an / bwn, wile)
^SuhJde ^Coad NdaDeMmMd M Nil g
p
, diet-~,
Sae. cooler (ohedr any ar)
da
m
d
dl~
F
e
h
.d
h
z3)
r 33h. rdTde d CMMer
G
/
~ ~~
e
r,
e
n
.ner
r
rP,rde~n
pa~
wrP
• •.w~•ee•~P~r•~~r..darnw
r
___
deem emeeeddete rr erogp eed rrrwrrelMtl
_ ^
Tebherole
YrowMd
e -
~,,~
~ r..
a.rt~.. ~+-~
_
____,._______________________
g
,
d
• PmnrreYerd oerNyYMP~IPhyrrJn hom pararrl'ig deem mr aeWyYp yo oeurddeem) 39a Lirnr Nunber 33d Dre Siprd aq, year)
TebMrdey mneYdge,aurr oeoeewrllrYrrle,drAend plat, rM arbre ereeyq eM mwprrnred__________________^
rCaaw
• Y
id 6
Y ~2y2.f- ~ g ~~ ZS ~Q
rr
e
rer
Gn tlrlrYdrreMeAareMlalevrYplkn,Hmy•PMr•r4 derA aearrMriM tee. dolor err pYee,rd dr lolM eerwp)rd avrewreYYd_ ^ 3l AdMerdPe Who CarrpNYd Crra z~wlPae
e~..a.~~
4. rf • ~~ s
~ t
. w.~~
RegYhele „d Diee,d
~ is i ~ ~ a i ~ ~ ~ ~ ~~~ao ~ /.~.1 r
/~
- l-~
.
.
.., ,
O DMpaem PerMt No. D y Y of Y 8 t1
RENUNCIATION
//'~~~ ~ REGISTER OF WILLS
`-wri1~e[~~ COUNTY, PENNSYLVANIA
~~
rn C7
ti ~-
~~~
~_a
j~_?
N
0
-c
0
.~-
N
CT
~a
~. , --,
,~ ~:~~
c ~=, ~r~
___. , _;
_ __
__ .-r,;
..,
Estate of ~~~ `l ~x`'`^, / ~i/ T~ ,Deceased
I, ~ ~~~~~ ~~ T~ , in my capacity/relationship as
(Print Namef
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
G,eic ~',e~ rz
T1 ~atid
(Date)
Executed in Register's Office
Sworn to or affirmed ands scribed
before~ ~r~e this ~ day
of /(/~13i/~~~.e ~/
(Signatur
~jl~. ~c ~ c-~~ S~
(Street Address)
(Cdry, 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 r the
purposes tated within on this ~ day
~f-~d/~I 2~ ~ u
.,. ,
Deputy for Register of Wills
Notarv Public
My Commission
(Signature and Seal of Notary or
administer oaths. Show date of
TH OF
R. CARANCI, Notary Pub{ic
Cumberland County
~t~mires June 15, 2014
Form RW-06 rev. 10. /3.06