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HomeMy WebLinkAbout02-23-10P~~'I~'IOl~ ~'®l~R PIZ®BA'I'E AN]D ~~N'I' OI]F ~E'I"I'ERS REGISTER OF WILLS OF ~ 4--'-'~ 4~'7eLA•~ COUNTY, PENNSYLVANIA Estate of ~Q,-Yle°~$ R • ~Q.CO~ also known as ,Deceased Petitioner(s), who is/are 18 years of age or older, app]y(ies) for: (COMPLETE 'A' or 'B' BELOW:) File Number .Z,/ - /d "~~ ~~ Social Security Number oZb ] - ~ ~{ ' .S / O$ ^ 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 ~„j 0 - _- - - __- 4 J ~i '~ ~ (Slate relevant circumstances, e.g., renunciation, death oJexecutor, etc.) ~ ~ *t ~ ^~~ ri~C") ~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution o~t}~i~ttvme ) offe~ret~ -i -t =-y ~ ~~-1 GaJ ~i , ,.:J _. for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - ; -~ 1a B. Grant of Letters of ...: t ~C~ a -. i ;~~ ~ :,_li __ _ ?7 tL1 (Ifnpplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente tile; durnnte absentia; duran~ninoritate) W "' ' '~'~ GJ'1 Petitioner(s) afer a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Ad~r[inish•atiort, c.t.a. or d.b.[:.c.[.a., enter date of Will in Section A above and co»:plete list of heirs.) Name Relationshi Residence bA•N M • f4•CogS M>a ~3 !u, S'/A/PSO~U sT /1~1E11Cdil~ll,~'6, R~4 5 D .?'. n cvL 3/sTt /•h QaP~ /G9~G Gy42oy~ 2 /? Si er ~S ~ f i ~ ~~ ullAt'GG/' /DES ~.Od1/C 6i~tcC t~eCtA/CIt~ /j4'S CC// .,S!!r!'i(~ lrr ~l.S /1?~~w^4~a~~lae~/YOS/oellf~ b/` iSSk~ (COMPLETE INALL CASES:) Attach additional sl:ee~s if necessary. Decedent was ~iomiFiled at de th in C U--k- ~PGh~a1'!d~ Coun ~ nnsylvania with hisl~•last rinci~al residence at 33.3 Gf/. aSl~e/) ~ ~ (List su• et «ddress, [own/city, wnship, courh' state, zi code) c~L. ~d addnes~ q,KQI hG /ofto~ If4 /I'lC dwf,- lv KI~ . TiEt 7l Sr <~lgAZpC ~L~RA/i~ % oil 4/ttZ1~ C~-+"T't R ta.~G AILS n ~i'Yt/13tG1 ~ bn p~ . Decedent, then 5 ~1 years of age, died on ~s.6./i~ 2D/o at fi/a/v~.,S/oi/'if J'yoS~Or~j ~"' . ~2/lyj~S~A~n ~~, Decedent at death owned property with estimated values as follows: (If domiciled in PA) Al] personal property g /r, ODD• ~ (lf not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ N,f/~ 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: Si nature Ty ed or printed name and residence JJ Tcrt/u nl • J~tCoBs 3 ~ 3 w. S.iji~ru-/ St• C~.. Y.rr..., ~)_ ~~ n ~.,. r /~CC~I[L'/f/C3~76tN, P/F /To$'s Form H 6V-O? re,c 10. t 3.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF C.Lt,1Y~~1/~"~-D The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me the ~~ rd day of ,~~ ~ ~ Fo a Register /17, ~?!-Co~S 5 Signnhtre of Persona! Representative Signatw•e of Personal Representative N O -*'t f'*'~ tU W _=,~ ~a;' ~ r~r' `'. ~ ~r;~~ ~` ;~"~~ . 'Tl ~f~i - ~i r--' ~L~7 w _ - `- ~J c~ t,7 a File Number: ~ ~~" ;;. ~ C ~ ~ ,~ :~~ Estate of cT/¢~~ /r. ~/~~D~s , Deceas~l~ ~ Social Security Number: 0~7 'y~' Jr/~ g Date of Death: ZlG /~/O 2r AND NOW, ~3 CJl" ~L~Q.1~U , o'~/ D , in consideration of tLhe foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED t a Letters of .~d~in,'S1S'Q.J7 vsc are hereby granted to ~ f~/V ~ • .T/~-D~-S in the above estate and that the instrument(s) dated N described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES ~ A11 Register ojWills Letters ............... $ V tJ Short Certificate(s) ........ $ i~ Attorney Signature: ~~ Renunciation(s) .......... $--~IC~~~ C`j~/'lG5 ~ es`J t°~IC~~S J $_G~Z~ Attorney Name: ~ ... $ ~ ~~ Supreme Court LD. No.: 3&s~ ... $ ... $ ...$ ...$ ...$ ... $ ... $--JU TOTAL .............. $ , Address: (Q C!'DUSe-- ~OtL~ /IIechwn ~'es 6u ~, a°~ i pass Telephone: 7~7" 7~6 -oZO~ Fm u+ R6V-0? +•ev. 10.13.06 Page 2 of 2 ;~. RENUl~CIATIOl~T REGISTER OF WILLS CG(/Y11~E72LJ1-~ COUNTY, PENNSYLVANIA Cp `~„ ~7 ~sn _~ ~' m t•~;~ ;~-~ ` :~ ~ --~,c-~ -~-~ v Estate of JR'~~ ~• ~~-~~S I, SrIFNm~2~ ~: ~ LE ..~..J o ~:7 ' ~-: 's vo ~ 4..:, ~ r~3~k ; ~.:t ~ f~: w `, > 4 cn _, Deceased in my capacity/relationship as (Pri»t Name) ~~57~11h~E1.0 of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to a //~~2e r fl (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Fornr RN%06 rer. 10.13.06 x ~M.~~- (Signature) s/a'/UI~R,.f •T (t~LF ~o ~ /6 S/6 (Street Address) G~1yE720KE-Z~, ~UL' ~ br7/ ~ (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 renunciation for the purposes stated within on this // ~t day of~~i '2~/ ~ . ~ ~ =N Z Z avN C- i/~{r~~~~~~ Z ~ c ~ o ttl o ~ ~ . Notary Public ~ a mzz-+ ~ N = a d y ~~~~ ° ~ My Commission Expires: ~ ~ ~ ~ ~, v w ~~ ~- o ¢¢~ Zy P.O a (Signature and Seal of Notary or other official qualified to W ui F- » c administer oaths. Show date of expiration ofNotary's Commission.) ~ ~ ~ o ri CC.'4hMC'NWEALTH OF PENNSYLVANI!' t U ~ ~ ~ ~ r~.~.,. _ Notarial Seal ~ O i+an,QS E- Shields Ni, Notary Public U i*ttairoe Twp., Cumberland County qty Commission Expires June 20, 201 M1~lern~®r, Pennsylvania Asseciatien of Not- IOJ.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 16054130 Certification Number This is to certify that the information here given correctly copied from an original Certificate of Deat duly filed with me as Local Registraz. The origin certificate will be forwarded to the State Vit; Records Office for permanent filing. L ~ ~~i~.~DGt-tax' FE/~ 9 ~ ZO1~ . __- --_ Local Registrar Date Issued C Irv o ~? © 'Tt "~ ~~.< r.1<., ~ (+'1 C~7 .~3 t_~ ~ ~ LTJ C: `' {fir; t'rT rV rr^i ~ i C:7~ C..~C_:~ C~ ~ C~ -,~ -:-w ' ~ --I ~O ~ .__ ; ~ c .~ w .o , tr (1D~ H7a6.1H REV 1111008 TYPE I PRpIT NI pEWMNENf BLACK xx ._ n COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIflCATE OF DEATH (See Ineauctions and examples OII roveree) STATE FlLE NUMBER ~}L-177 t fwn d orrNd (Fbl, rdae.lr, wibcl z sw s. 9ade18cu9y NumMr 1. Der d Derh (AbND, dry. Yer) James R Jacobs Male 207'-44 - 5108 Februar 6 2010 S. Aya (<eM 8M8~ lFrrl IAldr1 B. DerdBM 7. endrrr Ba. PbrdDrB(Chedr ar 56 Yn wwr. ~ Hww lre.. Oct. 2, 1953 Mechanicsburg,P ^~l ER/ate ^DDA ^NueYp Her ^1MWerioe ^Cxr-9pedly: m. caudr a Dwa1 fie. ary, TN0. Derl el FOP/ NMr ry nal Yrrlbn pw rer err nedeq B. Wu DeaMM a 11NPrla alpha No ^ Yr 10. Roar. Mlrlan ban Brat war, elc. ( ( Cumberland East Pemmsboro mre ican Indi r i ~ ~1•.ca A Holy Spirit Hospital 11. Deud.lfe I1BW d was our nrM d Ye. Do nr eYr 12 Wr Dertlrl ew b 8r 19. Decearfe EauxBn IBPeaN adY ~~ 1F~ 11. MerW 91rt tAenfea, New 1lenrd 15. SurNYp Spar (x wxs, pw meiM nrr) wlerr.DNOruelSp+rN IOMdYba IfbddfduYSlbdueey Sho U.&ArmedFawe7 EbnrntrylSacoMery(0.12) Cdlepe(1•a5t) 12 Divorced ®N ^r p Re Drum O « - 1e.DeuarreMer~pMa..(sr.r.arlaw•ew•*~~ °soid""'' Pennsylvania ~b°e:°nt "m"1°'""°"`s"e -' na®vr. DeudrllMdb ~+ranklin T•P, 714 Range End Rd. ur.dwwln ~~~ York Co. T°"~""D~ na.^ ~ 1° 0a'g ' Dillsbur PA 17019 a ' j 1& Feerh Nrr 1~•t •~• Yr. ~) 18. AIOBeIS Name (fisl, mule, meNen rrrer) Joan M. Gilbert ames D. Jacobs 20. blomrre rrr (Tylr ~ Pda) 23a blamrRa 11rnu Mare (96ar, ~ I raw1,>W, ap cede) PA17055 Mechanicsburg son St Sim 333 W Joan M. Jacobs , . p . 2te. 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M Trrwporlrm bley (BPrb1 ~1F LOUIbn a bJuy (BAer, dY f ban. rre) ^,M ~~ ^ Yr ^ ~ ^ Yw ^ f'l0 ~~ ^ PeMrgr ^ ^ SaMdtle ^ Cadd Nd r DewmMlea M ale. CedM laletlc alN ar) • aaybopl,~,rlea(plywienwrw~lpol.eae.nwlwl.rBerpMaamlwpm~rlalydaeanw.llclMeawm2st --------------- ^ da/l raved erbar mMN eM ~rnrrlYblL bd e d b 99D. 91praas end ~ Coroner ----------------- br 8 , lwy fi 8r flM • PmnwNie elr orl8YYl8 ppeklr lRlyddr Ua6 Pananr'e deee rr pleylebrueareb) ^ 99e. lkwme NUrr 99d Dale aprd lMUr4dry,Yrrl To tlr lrrdaq brwbtl8s,a.a seen.armeer.a+e,rdPbr,.ewbe.rl..tg ewe M.a..arra------------------ February 8a 2010 • MeadllErwerlCOnrrr oaer6.reawra6ronndfabwal~lw~,bnrwrla4arnwan.drllralr,d~b~.rpron.ra.rwwrNNrrm..rrwea_ r D„p,~ a 2nTmafpda ~ ~'o~"o "4 °' Pr N°'l ° "' ner cenro t. . ~c lo ~ ~^^ I ;l I I I al I 16 l ~ j~~ HeE (Akr4 dry. Wrr) ' 6375 Basehore Rd. , Suite #1 17050 P i b h [ ~lrtvt a~~><~ ~ a. an cs ur Mec lli.orwYlen vans Nu - -CS~f-?~3:3 Oa.