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HomeMy WebLinkAbout02-03-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of / f ~/ ~~~ ~~ ~ ~ lL'~GL~, , neceased ESTATE NO: 21- ~ ~ ~ ~ ~ ~~ alk/a: a/k/a: a/k/a: SS NO: /G~ - ~ to - ~ / ~ Petitioner(s) who is/are I8 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: '"`' ^ A. Probate and Grant of Letters Testamentary or ^Administradon c.t.a., or d.b.n.c.t.a. (co~lete Part also and aver that Petitioner(s) islare entitled to the aforementioned Letters ~ ~~ un: t ~. . the last Will of the above-named Decedent, dated and codicil(s) dated :~~~ ~ ~ , ~ ~. ~CnX ~ ..:z7 ["7 ~_.., .~ (State relevant circumstances, e.g. renunciation, death of executor, etc.) C'3 C -n -''`-~~ =-j Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after~e~cution d~te ~ =- 'T' instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated perm, and wag~ot a `'`~ party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as dAined in 23 Pa. C.S.A. § 3323(8): B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent tile, durante absentia, daraate miaoritate) C. Petitioner(s), after a proper seazch, has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (If Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(8), except as follows:- tva®c ~~~ ~, ~ -°---- ~~ ~ l ~m ~ l i~'/a~~L U ~ L'~U bfr ~ ~ S k USE ADDITIONAL SHEETS IF NECESSARY THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence (Street address with Post Office and Zip Co~c~palrty: Township, Borough, City) Decedent, then -~ years of age, died /~~ (v~/ / at J~enS r ~ hrly/~~.~i/i ~ (Month, Day, Year of death) (City an State where death occurred) Esti®ated value of decedent's property at death: _If domiciled in PA All personal property $ .~f not domiciled in PA Personal property in Pennsylvania $ ! d"t-~ ~ a U _If not domiciled in PA Personal property in County $ Value of Real Estate in Pennsylvania $ - Total Estimated Value $ ~•~ Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ ~ / ~ i ~ ~)l~ ~ ~ ~ YYI~C~r~Chi~J/-~'!r ~ • ~ /~~ 1~/ C:anafi~rllal Name(s) & Mailing Address(es) ---s----- -~-- ~. Cove iyy~l ~~na ~'!~ ~ /Yl.~~~ s7 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioner(s) herein named swear or affirm 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. n `~.; Sworn to or affirmed and subscribed ,/ Q ~ ~ ~., 3rd ~- i~ ~ ~~ c:~ f e this da of ~r} ©~ ~ - ~ n For the Register DECREE OF PROBATE AND GRANT OF LETTERS [~ ~~ Estate of ~~ 1 CP N\ t~~Y 1~~1~~ 1r1 ,Deceased File Number: 21- ~ ( -~_ AND NOW, this ~ day of ~e r a-b (1 , in consideration of the Petition on the reverse side hereon, satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary /of Administration are hereby granted to: (If appliabk, enter cta., d.b.n., d.b.e.c.ta, etc.) in the above estate and that instruments(s) dated described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. Farner Strasbaugh, Register of Wills FEES' Signature of Counsel Required to Enter Appearance Letters ....................s ~D ~(~ will ........................ Codicil(s) ................. (r}) Short Certificates (~) Renunciations....... Bond ............................. Other ............................. .............................. Automation FEE......... 5.00 JCS FEE ................... rr2~3~.550~ ~~~ ~ TOTAL ................$ Arty°s signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: r....,.:... c....... D117 n~ .e......,.+ / ~ ~c / n ti,.. ~.....ti,,.L...,/ ~ ................/:..........,... ~,...ti., r,..... n....,, ~ ,.vim 105.805 REV [Ol/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 This is to certify that the information here given is copied fi~om an original Certificate of Death correctl y duly filed with rtie as Loca] Registrar. The original certificate will be forwarded to the State Vital Records Office ~ permanent filing. P 17242542 lal~llL Certification Number Local Registrar o Date Issued ~ p ~ ~ ~ __-_ __ _. _____ ___-_ p p ~~~ C7v ~] ~r' ~ ri P'-''1 i-'Y'7 _. ~ __ ~ rr ~ - -r7 ___ _ _._. _ __..... _ _. _._ ~ n ~ C N ;y~ , COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS A ~ `n.~ NIO6N7 REV 11200Y w r CERTIFICATE OF DEATN r ~M (SN InstruCtbPls and exampNe 0P1 rowrae) STATE Fllf NUM BEII ' BLACR wN 2 Sr 7. Soda S,a,e/ W'e•I 8017 36 62 ~. tar a Wr0 luaq rT. YolO Januar 26. 2011 I.wm.aorr.+lr+r'"m'•"'~"~'1 Female - - 1 Alice Marie Eshleman UMa 1 T „r,r,« i. OW d arl Y,M. e.Pexeaorn w ~ OYI,c i Aq, liar irrNl IMiea 1 Ilan Oq, Ilar IMew 1946 Harrisburg, PA tober 24 O ~ ,or,w ^Enloprw ^ooA ^ "~•~• ^"~'~ ^aeY'srr+F t 6a4 ~Mr, I d 64 Yn. o d O c , S7. F,ollP N,w, (Y n,1+e10doe. ~ reM ad waw,A 9. wr 0«erw d Ni,prrc aqe? No Yr i•d/ ~• W r l . rl. 10. ~ ~ CIIaR' a Oxr • r !. ralP• Bolo. T,q Hershe Medical Center S M t • rcax Frr nr,•. «e.i White w,q r z?.. Dau hin De T . . VN, Dawra ew n w f2 13 Wrrre', EdurOr ISwcb odl Mwd 7+r m"'aM•a 11. rare Sau: Wllre. Now rre0. Yldowl, Dlwlno lSWM1 r IS. S+n+•r2 Spar IY •M. i~• ^w 11. p,o,ere',la•d Nintldeak dYl, maid W.Do IIrWa Il1dddawNaOrW - . u.s. ~Inwa FewrT Erewren ~ SewllrY 1a121 4CorB,11~ «s.l Widowed wrawa Re istered Nurse Medical e ^ Yr ®"° ' T.a nc.^Yr.are.+la.ao wA. Pennsylvania I H ~`p~,~.f~q,~rlstid,ullar,,,aa.,4m r T ~ ~TL~ lH.aerr Mechanicsburg crYleew 'Td~ ~ 21 Rife Drive a Dauphin _ Im.cam Mechanicsbur PA 17055 19 ~w,~y,I, IF,r aypE,••agr aae+rl u. crr. ar•e 1s;IK a:eBA rr eaBq Raymond Melvin Todd A i e a n ~,,.,~,,,~.,,I~a,,,ar,,,a,,.,v~en 2B. w«ew'swrRYai~q 5251 Simpson Ferry Road, Mechanicsburg. PA 17055 Alice C. Todd ~ ®Galiral ^ Oallrr 210. ola d o+POlnal laawi. rY. Y••D 21c. 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(~ ,,, ~/ COUNTY, PENNSYLVANIA A ~ ~ Estate of ~/i « /n ~Sh Ic ~»a ~ ,Deceased 1, C. in my capacity/relationship as ' (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 S~~ r s t3.lJ 1, a s d! ~ u ~ 3 ~/J~~ (Dare) ~1~P~~1' •~ _ ~ ..r (Signature) ~a5/ f~ S ~ n c s ~ -~ ~ u ~o~~J (Street AdJress) /_~~I~~,GLtr ~ (ten U ~ °' /~ ~ / 70 ~' a (City, State, Zip) Executed in Register's Office Sworn to or affirmed end subscribed before me this ~~ ~y of G1M:t ~~u.l. • ~21~--• ~~U Vl A~ L Deputy for Reg 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)