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HomeMy WebLinkAbout11-04-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Estate of r ~ f t ~~~ d"~QO also known as Deceased COUNTY, PENNSYLVANIA File Number ~' f J~ ~ ~ / ~--' / Social Security Number _ ~ J ~ - ta- ~ '~ '? 7 Petitioter(s), who is/are 18 years of age or older, apply(ies) for: (~COMP~LETE 'A' or 'B' BELOW.) t!~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the e C (,t_`~{"' t last Will of the Decedent dated _f - ~ t-~--~( named in the o tL and codicil(s) dated _. (State relevant circumstances, e.g., renunciation, death of executor, etc.J 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: ^ B. Grant of Letters of Administration ty appucaote, enter: c.t.a.; d. b. n.c.t.a.; pendente lire; durance absentia; durnn[e minoritateJ 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 Adntittistratiott, c.r.a. ord.b.,t.c.t.a., enter date of Will in Section A above and complete list of heirs.) (COMPLETE IN ALL CASES:) Attac dditiot:al sheets if tteces ary. Decedent was domiciled at death in unty, Pennsylvania with his /her last principal residence at~t"(,t„ ~ ~~~ (List street address, tow,dcity townshi coun t t i d , p, ty, s a e, z p co e) Decedent, then years of age, died on ~ ©- ~ ~-O ~t ~ (' p~..V~ I U d ~i ~ ~ ~-- Decedent at death owned property with estimated values as follows: ~1 ~~1 ~~ G..CG~" (If domiciled in PA) All personal property ~6~~"- S /' .( x~ ~ l (If not domiciled in PA) Personal property in Pennsylvania $~~""~~ ""LL (If not domiciled in PA) Personal property in County g Value of real estate in Pennsylvania $ situated as toll 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 approprir O a t e undersigned: ~ ~~° ~`~ ~pOCvO Q~z~~Q a O~~~aw c~ v c~ C ~~ ~ U Fa-m RSV-0? reic 10.13.06 PaC Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA p y-y~ SS COUNTY OF ~it~,~ ~ 1~`~~~ , The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine and con•ect to the best of the knowledge and belief of Petitioner(s) and that, as personal administer the estate according to law. Sworn to or affirmed and subscribed before me the ~~'~' day of t V.0'J'~P v>n~ , a oy q V:. Q~ For the Register File Estate of Deceased Social Securit Number:_1 ~~ --7 ~ ~ -~~ii~_i• ~ '~~~ ~ D y ~"' / Date of Death: AND NOW, ~~ (J'f ~~~~, ~, in consideration of the foregoing Petition, satisfactory proof having been presentee are hereby granted to in the above estate and that the instrument(s) dated ~~ described in the Petition be admitted to probate and filed of recojd as the last Will (and Codicil(s)) of Decedent. ~ ; , FEES Letters ............... $ Short Certificate(s) ........ $ Renunciation(s) .......... $ $ ... $ ... $ ... . . $ . $ ... $ ... $ ... $ ... ... $ TOTAL .............. $ resentative(s) of the Decedent, Petitioner(s) will well and truly Personal Representative Signature ojPersonal Representative Signature of Personal Representative ~ ~ - w 10~~ of Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: w ~,; "" O ~ et E~ E~ W~p ~;:_ ~ ~ w ww pOi= ~ ~ O U - Q W ~ ~ a O ~ O ~; ~WN r ra,„, Rw-n? rev. fu.l.t.u~ Page 2 of 2 105.805 REV (01/07) '"~,I -/oi-/~(J LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certify that the information here given correctly copied from an original Certificate of Deg duly filed with me as Local Registrar. The origii certificate will be forwarded to the State Vi Records Office for permanent filing. P 14807895 Certification Number °,~~ vz[t Lo+<g s IEV 1t/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CIE IN ,KINK CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER J~O x~. ~.. v v Q~z~~L w Wz a `~ `~: ~~N O~ ~i 1. Name a Deadem (tarn, mans. Irl, adna) 2. Sea 3 Sodd seaady Number r 4. Dare d Deem (. ay yrr) Female 237 - 12 - 1777 October 4, 2008 5. Ape (tad BidMeY) lAaer 1 Under 1 dry 6. Date d Birth Madh, daft year) 7. ~ ICY end dare a caunhY) fie. Rea a Death (Check one) dwaw Oeys Naas Maer Haeprt Otlren 90 Yrs. lurch 13, 1918 Pardee, DA ^ hpetleM ^ ER / Outpatient ^ DOA ®Nurdng Nome ^ ResaerKe ^om.r . spealy: !m. CauMy a Dean, ec. clry, Bad, Twp• a Deem ed FacWy Narc (n na irfJdna4 gNe sheet mid aanb«) g. Wr Receded a ~ tnePeraa Odpm. )~] No ^ Vr 10. Race: Artidicr krtlr, Bkck, Whr, etc. (n yr,,pedly cwr,, l er Carlisle Sarah Todd Tiemorial Hose "'~dan~~~°^•°b> ite 11. Deaded'a Iterl d wva done mod d W. Do not ehM 12. YYr Detaaed aver b the 13.Oeadan's Ehrcdbn (5yedy only Nplieat grade anipbad) 14. Mrnd Stetr: Herded. Never Marrd, 15. SurviNng Syarde Pf wile. give maiden name) IOnd d Wok Kea d BrakNea I Mriry U.S. Armed F«ae? Ebnierrry / SecaMery (0.12) CaAege (1~4 a 5t) ~ ~~ Retail Self to ed ^Yr ®~ 12 Widowed 18. D.arnrs Hwq Aaaw (strrL ah / Mm, dab, ap code) 1906 Dartmouth Street °eatlen1'° Petulsylvani8 lDi ro H° ;ed°'" 17a. ^ ~~ oaL~aadx I;rea ~ T Ach'°I R"'d"'a 178 ~'" PA 17011 Camp Hill wp. Ta~T 1m. carmY Ct>I~berland nd. ®No, Deadaa LNed wilhn Hill Camp , ,~,,,, Unata d Cny / Ono t. FamerY Name (fkp, naddN, IW, eulnc) 19. abn~s Nam, (Fast, middle, maden dxnrb) Eli ah Bobbins Naffiie Lewis 20e. Idormea's Name RYro / PIIa) 20b. MaanmiYa Haig Addmes (SaeeL aY / bwn. ateea rip ode) Sue bell 1906 Dartmouth Street, Camp Hill, PA 17011 21s. Memod d ONpoeeon ®Crxrtlon ^ Ooradori 21b. Deb d DMpodtlon (Noah, day, year) tic. Plea d Diepodtlon (Name d araldV, aermrory a dher deal ltd. Lacatlon (Coy /town, stare, dp ode) ^ BiaW ^ Rarravd ham Sbte i Wr CreniWerr «O«rdbn Autlroriaed ^ om«. ayHasedEa,whrrrcaorrrr yr^No October 7, 2008 Cremation Society of PA Harrisburg, PA 17109 zaa a ttarrr(«peremadhgr«rcn) zm.UaaaNrt« 22a.NemarrdAddrredFBQ~Aner liemorial Home and Cremation Services, Inc. - FD 013376 - L 4100 Jonestown Road, Harrisbur , PA 17109 23ea arty why 23e. To are bed d my knodedge, drm amned d the Hr,°~ aM pYa,tekd. (Siyraee end 1Ne) 23b. Liarre Number 23c. Dare Sipred (Horan, dY~ Yrr) e aavelehMdllmea b ~n,.~. ~ ^Vlvl.a`~u~.. ~-~V.~ Q~ (ld l 0 ~~SL. QrC~tr~Ai.U ZOCU rrla 2426 rtes! be artipleled by perm 24. TNr a Drm 25. DW Prma,ced Dead (Ham, day, yseYj 26. Wr Cre ReMred b Meded EsemMr / Canner for a Reaem Other mr Creme6m «Oonatlon? veto praaurar OeeYr. I ~,r S M. ` ~..~ Q ^Yr ^ No CAUSE OF DEATN (Sea Nrtructlom and exrrgNa) r Appradmeh krryd: Pen II: Enter omd . 2B. Da Tabsca Use CaWWAe b Dedh7 Irerrt 2y. Pon I: Fsler tlb - dasrea, , a canpYatlar - tlrd dkacay aimed tlw deem. DO NOT err ternaW avada ardi r andlec erred, r Ord b Deem but M ieeaarp h me unrrh/krp are gNen fn Pert I. ^ Vr ^ Pmbedy rea~bry anad, a vertrialer Abrianon wiead ehow~91M enobAf. tid ody one our on sea ir. r r ^ ~ ^ llrYaiOwn c~b radn dNm) « ~ 29. n Female: AS ca ~ ; ~ h a _ . Due b (« r a arm.qudres d): ~ ^ Nd aennea wNan Prt Y~ fd cprdnar. n airy, p, ; ^ Preganl of tme d seem ~ a. Due b (« r a aauegrnca on: ; ^ Nd Pr•9n~. Od Pregara wdan a2 ays Edr bIROF~MIA ~C M I9 E y ~ d m e a. r a arm ( H~a ~ ~ a ewia ye 'tASf Ms Dab (a r a canrprra ot): i ^ Nd pNgrred, da pregienl 43 days l01 year d. ~ aloe dBNh ^ Unknown n pre¢xM wimp me ~ Yrr 3lx the r Aubpey 30b. Wen Aulopey Frakrga 31. Mama a Dedn Sze. ~ a IMtey (Rath, day. year) 32b. DBBaDe Now kpuy Oanxred 32c. Pdoe d kyiry: Han, Fenn, Shed Faaay Perbmed? Avaa~M Prbr b CarriPieGan _N° ^ ~~ OnICe aiNn9, ek. IsP•dN1 a cry a Deem? ~ ^ Vr yc~t No " ^ Vr ^ Na ^ Accaed ^ Pig 32d. Time d HM' ffie. aNY d Wok? 321. n Trarwportanm ~Y (",+OeaYY) ^P d d ^ ~ / ~« ^ P 32g. Lxdan d apwY (Street, aY /town, state) ~l ^ Sddde ^ Coed Na be DMemaned esarg« e ed en ^ Vr ^ No H Omd - gPecily" 33a CerlWx Idbdr ady one! • C•rnMaq tMrelden ( ardYkq are d deem why amtli« physiden hr pionaaiced seam aM axnpleted Item 23) 33b. s and yak a cenirier ~~''11 ~ V 1 P - - • v ~~ 1~l To tleebrldnry aawkdge, deatlr aaeared drto the earae)da ner,ierrsWed--------------------------------- ^ • Prono«ahtg eta aMlyerg phy,icYn (Phyddr hdh proridr~ciiq death and aN7ying bare d drml a m wdm s a» a aa t m d t e ^ T ~ ~ 33c. Liarree Nunar 33d. Dare Signed g4mm, day, year) - _ _ _ - - r a««r e r. ,r r a ea,ran)., m.nnerre ate _----------- a~,r Fr Mw ~ • HOed Ial r~r,'D X16 ~Vf 1 G cxT b. 200 8 On the iwh d esdnFrenm eM I a pwe,tlgdion, m my apblon, dra aeeund d tM tlme, Mb, and plan, end dr b tlr cdrae) end mrnx r aided- ^ 34. N o ma and Addreu d Parsm yYta uee d Deem nom 27) Type /Pan r1 ~ M' ~ Re lsOar's ana Dtahia NuM« 35 38 De1e Frd (Hadh eaA r / ~ ~j/y. J ~ ~ ~ 2 h t76 d ~V p . g - d'-~ I dl ~ I ~I / I' I . , r. Y /D D~ 96U 1s~2' Q2 ~ CTrW,( 6• MST °~ . r~ o ~. _. ... _ .... 0287032 tt~Y 3f~i11 ~cn~ ~P~Y~zmEnY ~~ I, VIRGINIA SHERWOOD, of Cumberland County, Pennsylvania, declare this to be my Last Will and Testament hereby revoking all prior Wills and Codicils. ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ITS II• I hereby reserve unto myself the right to make a list disposing of items of personal property. If I make such a list, from time to time it wi 11 be signed and dated, will describe the items to be devised and the individual devisees thereof. If no such written statement or list is found and properl Y identified by my Executor within thirty (30) days after the issuance of Letters Testamentary or Letters of Administration, it shall be presumed that there is no such statement or list and any subsequently discovered statement or list shall be ignored. Any reasonable distribution expenses incurred with respect to tangible personal property, including but not limited to packing, shipping, storage and insurance expenses, shall be paid by my Executor as an administrative expense ~~ ~~~ ~.~ „~ o ~: :~~.~^~- .;~o~ w~Zwz ~~: Q f p c.~~. ;7 ~ ~ m N PAGE I OF II of my estate. These items are of negligible value and are being distributed as a remembrance of my life. ITEM III. I give, devise and bequeath all of the rest, residue and remainder of my estate of whatsoever kind and wheresoever situate to my friend, SUE CAMPBELL, per stirpes. ITEM N. I nominate and appoint my friend, SUE CAMPBELL, Executrix of this my Last WiII. ITEM V. I direct that my Executrix or her successors shall not be required to give bond for the faithful performance of the appointed duties in any jurisdiction. ITEM VI. I direct that all taxes due at my death or as a consequence of my death shall be paid from my residuary estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day of , 2006. VI~~RGI41I SAER~~~ wtss d U wirrrESs ACKNOWLEDGMENT COMMO11fti~VEALTH OF PENNSYLVANIA , COUNTY OF DAUPHIN ~ SS I, VIRGINIA SHERWOOD, the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledg before me by VIRGINIA SHERWOOD, the testatrix, this ~~~ day of 2006. VIRGI SHERWOOD Notary Public AFFIDAVIT COMMONWEALTH OF PENNSYLVANLA SS COUNTY OF DAUPHIN We, ~ and ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw VIRGINIA SHERWOOD, the testatrix, sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the Will as a witness; and that to the best of our knowledge the testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by the above-named witnesses, this day of 2006. WITNESS WITNESS Notary Public OATH OF SUBSCRIBING WITNESS(ES) REGISTER OF WILLS j~i,n,~~ COUNTY, PENNSYLVANIA Estate of ~ r t od Deceased (each) a subscribing witness to ~Yt ~. `~ (P t Names) depose(s) and the ill ^ Codicil(s) presented herewith, (each) being duly qualified acce tator to est 'trix sign the same say(s) that she I e /they was were present and saw the above T and that s e / e /they signed the same and that she e /they the Testat /Testatrix n er his _,~ . , signed as a witness at the request of presence and in the presence of each other. t (SignatuQe) (Street Address) 1 ~ ~1 (City, State, Zi ) Executed in Register's Office Sworn to or affirm ~~a~n~ subscribed before me this oo~° day of G ~iz~- 1c, i.v _-• (Signature) (Street Address) ~~~1sl~v~ ~~ 1~~~~ (City, State, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this ~ ~ day of ~~•~ ~e.w~b-frt.., a C~1~ a• ~_ w v: ~' .~ v J~~w; ., MMONWEALTH OF PENNSYt_VA a Public ~ `'" ~ ~ Deputy for Register of Wills ~~~ seal M Commission Expires: l~ ~Z~ ~Q 1 I ~ ~ Z ~ ~ TH OF PENN6YLMM"MA ~"~ ~• ~'"e' Notary PubNc ature and Seal of Notary or other official qualified to EaStPenn.SbOrD Twp., Ctxnt>ertarxl dm islet oaths. Show date of expiration of Notary's Commissio (~ f p v NOTARIAL. SEAT My commission E~ires Dec. 21, 201 t ~ o Cy11RtES A. HAitBOI•D, Notary Pabiic ~ ~ c~ ~y~ r~~ Member, Pennsylvania Association of Notaries CBQy HIM Dlf1~~ CYill ~7 p~~Q horized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form R W-03 rev. 10.13.06