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HomeMy WebLinkAbout12-01-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF l j1Y'YII~?X~C' COUNTY, PENNSYLVANIA ~~ ~ File Number ~' ~ Estate of MQS ~ms also known as ~~ Social Security Number / 7 9 ~ ~ °~ / °2 ~ who is/are 18 years of age or older, apply(ies) for. ra Petitioner(s), ~ a (COMPLETE 'A' or 'B' BELOW.) ~ T and aver that Petitioner(s) is /are the W ©A. Probate and Grant of Letters Testamentary and codicil(s) dated ~ t7 last Will of the Decedent dated j .,» h o executor, etc.) V n ~' '`~ (state relevant circumstances, e.g.. r¢ma~iation, Beat f o~iq~sttument c~offere~ j was not divon~d, and did not have a child bom ~ adopted after execution ~ ~ `• ~ Except as follows, Decedent did not marry, was never adjudicated an incapacitated person: _------- .~ for probate, was not dte victim of a killing -~- B. Grant of Letters of Administratioa'applicable, enter: c.t.a.; db.nc.t.a; penderue life; durance absentia: durance minoritate) that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Petitioner(s) after a proper search has /have ascertait-ed Administration, c.t.a. or d.b.n.e.t.a., eater date of Will in Section A above and complete list of heirs.) o,._aer~a r~zs~ z5~ was~otniciled at death in (List sfreet address. town/city. township, eowity, state. zip code) ~~ f7l~tR ~S blM'~ ~ Us ~ 1 L. / ears of e, died on l (~ 13 ~ ~0 I O at TFt~- ~ Ol.~ Decedent, then _.~.._._. Y with estimated values as follows: S ~(~ QQQ Decedent at death owned property ~ personal property (If domiciled in PA) Personal property m p~ylvania S (If not domiciled in PA) Personal Property ~ County S (If not domiciled in PA) $ Value of real estate in Pennsylvama situated as follows: of Letters in the appropriate form to Wherefore, P~itioner(s) resPeccfiil1Y requesKs) die ~°ha~ of the last Will and Codicil(s) presented with this Petition and the grant the undersigned: T or tinted name and residence Si store (~ , ~` L e r-y ~~ tt lJT ~"' Page 1 of 2 Form RW-02 rev. 10.13.06 .~~ (COMPLETE INALL CASES:) Attach additiond sheets if neeessarl'• ~,.,..,«., vPnncvlvania with his /her last principal res"t~dencfe/a't ~ . ^ ~~-~~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~~I ~ + i ~ ~~n~~~ ~LI~~ above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of The Petitioner(s) the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and tru y _ administer the estate according to law. ~ ~~ ' ` - n .L. ~/ l ~~~ '~~ ~ Sworn to or affirmed and subscribed Signature of Personal Represent i..~ ~" day of before me the _____-_- tive t ~ ,p ~'~7 i-~` ''-~~ ~+ ~ a X- 3'V7/(1 Signahr-eofPersonalRepresen ~ C ') ~'",,? -~ n esentative l R ~cn ~ ~,. ~.J epr For Register Signatw'e of Perso-tt+ O O w - - 37 . N ~ ~ :.n O ~ I ~ d ~ ' ~ 7~' - File Number: 1~ l~ U I -P -' 'l ~ ~~~ .Deceased . - n~,nn/i c 1 A Estate of nn ,~~,~ f o~--V Date of Death: ~~ -~g ~ ~ j , Social Security Number: n ,~ ~~ ,,., G ~ /~ ~ d v ~ ~ in consideration of the foregoing Petition, satisfactory proof ( AND NOW, (l7 ~K- been presented before me, IT IS DECREED the Letters i ng hav 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 rec~ ~ as the last Wilt ~andr~Codici~ ~ ~oA FEES ~o, _ Letters ............... $ ~ ~~ Short Certificate(s) ........ $ `0 Renunciation(s) . • • • • • • • • • $-1 t ... $--~--- °N\... $ ... $ ..$ ... $ ... $ ... $ $ . -9:99- TOTAL ............. Register of Wi1Es ~l r Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Page 2 of 2 Form RW-O2 rev. 10.!3.06 .i-l~- 1~~8' ~OCq~. REGISTRAR'S CERTIFICATiONoOF tDEATH WARI~i1NG: It is illegal to duplicate this copy by ph .. fnr , ~-~~~3ti~ , , -~{# p___17 0 0 0.5.1.9__._... t .1.i s ii~~)~ H705.149 REV 111200fi rrPE~R~NENT Buuac r+L i. Nnee a 6.Pp (W ee.cbtmA THOMAS E AMSPACHER t aAdey) rhdx 1 ear lltidu 1 de Ilorn- Oep Xan IIeeM 59 Ym. - Phis i~ to certify i9).i. the in#onnat+on he)c ~)~en )s correctly copied fr~~u: a+~ c~)~ii7i+~at C~cul~)r~+t~ ul Leath dul}' filed with )»;. ~• Loc il Rez~ist)~tr. Th t7r~~inal to the 5t +tc Vital certiticate will L: furw~uded Records Office fog ~cnrlai~C)~l ~ih+il,•. -------- Ali /~ _ a egistrar r•> .. Date Issued d ~, ;-*-t +~ ~ ~ . ~° ~ ~ ~ I ~ ~ 1 ~~Q c ~~.7`T, Z ~ - -r, c ©~ N t--• COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ _-.{ ~ .;./3 CERTIFICATE OF DEATH 3> ,_ (See Inttructlons and sxsmPks rM ravens) 8TATE FILE NUMBER • •.. 8. SaY BwnrrY Nunhee 4. Daa a Dean PAoMh, dex Yw1 ber13 2010 eaa TWv. d Dean Chambersburg Franklin i KMawae Scheduling Supervisor 16. pecedue'e Meip Addme (81na'riY lta 16 Scrafford Street Shippensburg, PA 17257 1& FeMere Nnr (Rre1. nddde, Ir4 rlle) Earl Amspacher Tk Ndomra'• Name t+YP• r PrM Teresa M. Ams ache 21e. Memad d DMpoeiYar XD_ Budel ^ Mmevel kan gab Pte. 8lpneeee d .4r 0 RN247768L Novem er , a Reeeon omer nen pwnslbn en porodmT b 26. var cr rMlened b Mead Eranrrr 1 caaer r ©~. ~"° a). qd Teneroo Ur CoaiDW a Deana ErMr ana tr na mwprpbre a>dat¢'~ppre glwnbPenL ^+~ ^ p No ^ u>taewn 78. r remeM: Na prep~ea'MB1n Pr+r•u Pmpraarieeddeem ~ NaPmpaa.advmpWdambezaere a wean ode Prepua l9 deyebtyeer I-I u~Ymown~r ar~+•~^n•Pr+v~ ~~? AreYenk puorb CompMron ~Naaa ^+~e 32e. ir~rrawain 321.rTeampMeron hFer +~ed'yl aceoe~ao..ua ~ ~ srdTbeaWar ^onwrava.mrC1P~' p rr px No ^ ~ ^ ND p suidda ^ court Na ee 0ewm~ed M. ^ Yr ^ "° a.,, swc~~-, m simer. end TWO d cenwr Male 1951 I Hanover, PA ^r Nrre la ea rrosumA ~ w.a and meeber) Chambersburg Hospital 179-38-2120 Novem tJ ER I Ouperm u ""^ ~--- . _. - - 10. Rear. Ane4oen Irr6u~, sack YT9e, Nc. Wr Dsadea d HhpeNc Q7Ci^T ~ Ne ^ Yr Irrr.~+'~" t~r1 White Mellon Puerb wmrL ac) --• moss Me DOnaeore 1s WeepepOnerwrnme u.a limed ranea ,~.,••--..------_ - t-4«6d . EraraaY r seonderv to-+ff corps 2 ._-_--~ - Teresa M.Klunk Married rod a aiaYer r iea.rr of Health 8 Welfare t a xD'~« ~"• ad oeadem Southampton _Teq. ~eu"'db . p o.rdenre Pennsylvania rdeelne rn.l7we. ~~) /ygy Rrbnrr t7e. aW ToxreNPa ~ •~" CIy I Bao tYd ^ Cumberland . ~ ~ +~ ~,~, FD-012984-L r ne tYnne, a,e...,.,,_....._..--- - 16 Scrafford Street Shippensbur PA 172 s,a+o~reet+sil+~e1~'~0°d•) deG Y•u) 21o.RwdOMP~011lWmedorrMY.aur+ayaoma Piw) Shippensbu , PA 17257 2010 Sprin Hill Cemete ne em1 AOReee d FdtY =o elsan er-Bricker Funeral HoZ e~112W Kin St. PO Box 3~36~Sh'i~ ens~ur~, PA 1725 ""'' b 13 2010 ~eplae llnne 49rc aiy aen onNyYq ~~...__..,-------~ RN pnyadenrea.wreiearranenb - oeNy sane adeem. 2s. ow Praeuroed i>.ed fMa+M der,1+) ~`• •""' a °""~ November 13, 2010 s,,,,~smuawoopebdMP~ 5:35 P.M. graven an Pmnarcr dea^' hstreeoaom rM ) eAUeE of oEwTN (ser e. drs. Bo Nor eaer NnarW eeeea eudr. erdee eme4 ~ Drab ixan Mem Y7. Pall: rtl aeaetlreeolpp•lla oar aeaw on eecrt lne. ~ i 45-60 minute -~ e RTE~~, °~° a ,. Cardiopulmonary artest ' aebtar.aeeea~af to vomiting ~ ~,re1y n Aspiration secondary ~ b am Madmke e. Drbta r.a+r4+r~•al• i ~~b o. Cardiogenic shock wee a orb (a r e oanalr~ dl: e a Acute myocardtei infarction ~ ~~ s1.MbeiaaDaOi ffie.owalryar0•b~.dn,rru) aoe wr en Aawer sro. was a~owr lid 39e. GeNler (~ p+r ae) oudYerr our d arm •lieri enaMr prryadae hr P°'°"1°° deer end mrnrered mim 23) • CeeB+YrrY WMaam lPlNaam_ reYeL-_---_-°-----'-----~-----------~ 93c.+dcane rom.eeaa.,~y'a~«+nrbyq~l~"mnnawrc+waam'.naoeAA'~+ub0W1°adrm) _ ^ eNrdr btlM wmep)~ mrrerrared----------------- 32c. PYoe a None, Fenn, ama, Feaay, ~ea..b.ri dry r ben sere) M.B.B.S. ae aped (MaMt dW~ Y•u) November 14, 2010 • To mr bbnleeYe, eeetlr oxand a dr Wr, aMe, end PMa, ^ end aveev r etaei ^ cane d Deem (~ T/l ~YDe r rnn INdka EraMrr l caonw opaamed aloe 1Yr, deb, end pier, end 4e b rig eaueel l 91. Nre agAmeeta d Pmm Woo canptaed o„y,eerrea.undnararbal«a~q'd°°•b ~ ~.~,.yr,) Arshad M Safi, M.B.B.S.. ~ ~~~~ 12' 7 I Z I J ~ ~ D 755 Noland Avenue, Suite 201, Chambersburg, PA 17201 ~ 0532372 ofgo.ina, Puma No. uu n :v ° ~}::a _ . ~ r.,~ ,, rt -;, '~ ; = RENUNCIATION ~r~ 9=' - ~ : rr r'f c1-- ~; ,~ c ~ o no--~ ..9 a _ :_~; __ REGISTER OF WILLS ~, ' ~ ~ `~, ~ ' COUNTY, PENNSYLVANIA ~..u~1~~i an~ p '' _ ~I I(i 117 Estate of ~' ~- ~"` ~ ; ,~,~ Deceased ~. ~ /~ ~ ~ ~ ~ L ~- , in my capacity/relationship as I, r ~ ~ (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~ ~.~ ~,e_r rsi~~~ ~~( iv ~ur~~ ~ S~. (Street Address) `J~r k ~`~r i ? ~~~ (city, State, Zip) 1 j.~~lj'1G ~tte~ Executed in Register's Off ce Sworn to or affirmed~d subscria y before me this ~ '~~_ of Deputy for Register f Wills 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 of ' 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.) Form RW-06 rev. 70.13.06 C7 r.a ~' " ~O ~ 1 ~'3 .... RENUNCIATION ~ REGISTER OF WILLS (-- ``-~ a ~ ~ N --= ~= C~rY1IT,}Q,!'~GCnd COUNTY, PENNSYLVANIA D ~,,~ ~" o ~~ -1 l Estate of ~~1QfY~GI-s ~ ~S GI~P~-~ Deceased ~ ~ , in my capacity/relationship as I, enn ~ ~ (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 ~.rtsa M • ~5 la / , ~, (Dare) Executed in Register's Off ce Sworn to or affirm ~ end subscri a y be~rne,~me this ~t of Io~l ~Y12- ~~~'l, , ~• ~" ~~~-~ 1 ilk Deputy for Register of ills (S~ e~ / 0 ~ 7~ n'la l~e~ (StrCet~A,ddr~e~ss) r~ ~ ~ ^ c~'~ h~~~ C~ ~ I , I (City, State, iP) U 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 thy purposes stated within on this ____--- da of 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.) Form RW-tM rev. 10.13.06