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HomeMy WebLinkAbout03-02-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of E~ t Z'~t ls~ ~ M) R E ~ 9 ~~y u sT ~ P.1 ` ,Deceased ESTATE NO: Zl- ~ ~ - ~~ a/k/a: a/k/a: a/k/a: SS NO: /~•3-3d -/S/Z Petitioner(s) who is/are 18 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 ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part2~also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters ~ = und~,,~ the last Will of the above-named Decedent, dated and codicil(s) dated 'Cr'~~ N _~ '~ (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 aft~~c~tion d~2he - ~'' instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated pe s~ and waglot a ~~ rn party to a pending divorce proceeding at the time of death wherein grounds for divorce had been est~lished asc~e~ fined i~ L a 23 Pa. C.S.A. § 3323(8): ~. Grant of Letters of Administration (It applicable, enter d.b.a., pendent lite, durante absentia, durante minoritate) C. 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 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:- Name Address Relationship to Decedent M,t~,c.~,~,~ 3~~+ t_E-Y 0 ~a rh 1701 '~~~~~~ ~aoL ~ ~Fm E /3~1y s e,r I~r 8 n s lea ~ ~~ E2rc. ~tv~~s-r~r1tG t•ol 3 Pa~oGlc.t:.ss ~rE PA~ t~~lt .5°~Q 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 At 13 mqK A,rE ~Fr-9 P t~ t«~ PA t7oi/ i}t~iM r'~~„I 7-o wnlstl t t° (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then ~3 years of age, died .11F•J l `/~ 2° ~ I at CAMP 1-J t t ~, O~ (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA All personal property $ 3 . 0O0 If not domiciled in PA Personal property in Pennsylvania $ If not domiciled in PA Personal property in County $ -Value of Real Estate in Pennsylvania $ ~n i 6~ Total Estimated Value $ (p3.0- Location of Real Estate in Pennsylvania: (Provide full address if possible.) 13 Ofd K ~} JE ~ i?M P H t t t~ /~ / 7o i 1 Signature(s) n ,~ Name(s) & Mailing Address(es) AMY` ~~ J W G >< 0 ~Q ~ii~I /~'Q/~'O ~~/ s ,, /~, ~~a /t.t J r~K s ~ /~OC7 ,2 ~~` ~~c-.,57~,~~ e~i $ 9lLeGr.FsS /~oE /.fi 5F3~I~G-~ tR 1~1-~ Interim Form RW-02 revise .26.10 by Cumberland County pending action by the Court Page 1 oft ~-~ ~~ - . Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA f ' ~/~ In /~ SS COUNTY OF ~~l~tA r l v~l 1(~_ 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 \ _/ " ""V Sign re of before me the _ day of .~~~- Sig r r~ ra,7 .-.~ Lam. ~ :,';e `Fo[ Register SignatureoJPersonalRet~entative ~Z-~~-~ .~ `-~,.~# ~~ C`3d`n = -i•-t ~_ Q' ~ File Number: ~' '' ~ ~U Estate of I ZQ -~JL., ,Deceased Social Security Number:~~,Q~ ^~"~J " ~~~~3 Date of Death: ~ J ~ ~ `~ AND NOW, of ~~t !~ Lt.L~~ having been presented before me, IT IS DECREED that Letters are hereby granted to ~MyXt_ ~~~~ ~ ~~ consideration of the foregoing Petition, satisfactory proof ~i,NiS~n-,-rte _ in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............... $ Short Certificate(s) ........ $~w • v~ Renunciation(s) .......... $ ... $ ... $ $ ... $ ... $ ... $ ... $ ... ... $ ... $ TOTAL .............. $ Attorney Name: Supreme Court I.D. No.: Address: Telephone: Form RW-0? rev. 1U.13.Ob Page 2 of 2 Attorney Signature: 10?.A05 REV (01/(171 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 17046768 Certification Number t REV 11l200S J PRalT IN tldANEHT ACI(INK d '39-447 This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Recordys,O~ffice for permanent filing. LGnrt~ ~'! ~ lAM~171(111 Local Registrar Date Issued r-_, n ~ ~ ~ ~b ~„r;`~ c~ rte'- ~e3 c_,; ~U .. i ~; i ~, {,.F-, 6 ~~ _-~% ~~ ~ ~~~ A Cr:~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (SM instn3ctlons and examples on reveres) STATE FILE NUMBER ,. Name d Deaelda (FMr. mmde, rel. euahc) ~ ~ 2 9ez 3. Sand Seaxlq Numbs 4. Dde d Deem (Hank. aey, yrr) Elizabeth. R Augustine Female - *- January 14, 2011 a. Apo (UM BINNY) ikMd 1 UMw 1 B.DMa d BkM 7. aM eme a Ss. Plea d Daalh Chaac an omer. uw~+ ~ Mw.. ar..r August 5 , 19.27 West Pittston Pa ^^ k 83 a ^ ER I ^ DOA ^ Nulaa Home ~I ReeMrae ^omer ~ s eoa a q lp er y n yr. • s. caldr a Dark x Dnw Bad a Deem ea FadM/ Nrr m ka kledbMon, plw abed end dero•r) e. wr Dsoadnd a rlrn.de olgr'+ ~] No ^ yr to. Rap; /vnMan.kMlen, prdr, wdr,.b. ~ ( • Cumberland Hampden 13 Oak Avenue ~ ,«~a White 11.OandeRe Uaud d oak dorr mod d IN. Do net dda ,2 Wr Derddn ever mtlte i9. DsoedalYa Eduaabn (t/Nedty aiy klplyd prone carprra) 14: larks 9rhle: Memrd Nava Mdtisd, 15. Slavrirlp SPare (M woe, give nuMan mme) Widowed ONacM (Spd#51 IOM d Wok IDrM d Brrelar I IMrhy . U.S. Amnd FarcrP Ekeamtry / Secondary (612) Cdrpe (1~4 a 5.) ^Yee No 16. Derdera't akaaq Addler (Shoal, d1Y I bwn, err, tIF aide) Oeafdenl'a Did DecedrR Adud Raekrrce 17t sm. PA Lhn b e 17c. Deaa.a Llv.d m Twp. 13 Oak Avenue ~ (y mthearl aTyr) TAT na. ~ ar.d asrl ,Tb ~ / ear . 1a. Fearl~ Name pM rdtlaa, tat auAa) 19. MWrfa Nrna (Flra4 mkMle, nrMr aumarr) Geor a W. Reid Ethel Messick 20a. x+okllraY Name (type / Prtd) zdb. knomrmY Ma91q Aaaeee (Sled, dP/ / bwA dde, nF mde) Mar aret Boole 21e. Maabd d OYpaMm ^ Crdrnam ^ Daa/m 210. Der d Drpoanlal (MaNh, aY, Y•rl 21a Rena d DYpaNtldi (trnn d amMdY. aemday d atlw perl 21d. (Cny l bwn, eWe, m mee( • ~ Bond ^ Remow trap s~ ^ oarr•sFeay: w`~ Ekr~e° r »r+Al""~ad ^ v« ^ Nd a Januar 18 2011 Rolli Green Manorial a ecrq ~ euch) 27b. Ltcalra Numbr rtc. lame end Addreae d Fedlkr ~ 011654-L ers-Hamer Funeral Home Inc 1 23ee way air n re bed a my rb•raz•, wool oodal.a d ar mr, ma and pro acrd 1 end weal 23b. Lianee Numhr 28C. ode sipr.l Iklalm, an roM plydaan r rol eardr d rr d awn b atMy ceuea d daeal. Aanr ~ muq ~ ~, Fri 2/. Time d Deem 25.OW Prmoukad Dead (MdnM, day, year) 2B. Wr Case Relerted b AleaCd Ekrdrrr I Camr br a Rsrm Onnr tlm Crernedon a Dondbn4 ~~ ^~ , wl,op,orbaewaedn. Aprx. 1600 A. M. January 14, 2011 CAUSE of o~T-t ce» krtrtlesol» rla aarnplse) , Apprahnar hrrvet ' Fan o: Emrr aver za. ad Tarxo ur caabua b Dadra EUdt-drawer, krtdr, a Oarrlplmtlar-aW dWeey woad er swain DO NOT rrr IemeW Beds ouch r narAee und, I Lard b Deedt PrI k Bad ar phah NBII19 d but na ndatllq h ar laldenyaq owe 9k'r b Pul 1. ^ Yea ^ Pnn~hj . . . raaphebry airs, a veanaler 16daatlan wehod aha4rlp tlM etlokpy. LM M/ ar our an each M. ' r ^~ ^ caldtlalA~rauEnp~darh) i e ~•Hypertenaive Cardiovascular Disease ~ 2e.nFrlr.: ^ Na d nhi d Due b (a r a aawglrma dg ' p any b r M carldzorr w vraw n Fe w•r ^ Pregnant N rrie d daatll , . , ~~ ~~ e. Due m (a r a aawprna on: ~ . bd ptepwd waNn /2 days ^ a ~ ~! ~ c d ~y , , ~ p,~ . _ - .. - I I ~'w~a ^ Nd peVw. bd pgwM /3 dWa m t year Due m (a r a mrreawae aQ: • I d ^ Urealown q PI•PWa scan an Ped 1r•r , 30e. Wr r Aulopey 3ab. Wen Aubpey ~Na 9,. krrrrd Daeal 33 DW d k~aY (~~, mY•)earl 32h. DeeaM Mow bh•Y Ocaered 300. Pb d bM•Y~ Mar. Frm, SreL Feday, OIAce dlaarq, do. f5yedfi'1 ParMmad7 Maeda Pda b Cargrfon d Crre d paAn ~ Nehed ^ HaNdde ~ N Y ^ ^ Yr No ^ ,,~yyp ^ p,~q W 32a. Trr d h~lay 32a. M•N d wain 3v1. n Tnrrparlrn k}ay (Spedly) 32p. leruarn d h}ey (~, dy ~ knm, dWl o ^ r ^ 8uklda ^ Coub Nd be DarrtnYlad ^ ~ ^ Drlar I Opd,br ^ Parergr ^PedeahW ^ Yr M Gala Span/ 33t Cer9W ldndc way ar) ~,pp,yrs.,(pnyda.,,,nlryk,prr.de.a,w,,.,,len,pydd.,,1~,p,a,a„redrmrdoa,prrdlrm2~J -------------------- ^ darn oharnaarbar aeeae(elaM mwrrrarri---_`------- rra e r a 930. Tre d CarlEd ~ , Chief Deputy Coroner . , aq g To ar red p • Frellear9lq aM aWykq plydern (Ryaldxl nor plonaaainp dash and odayhq b our d dell) ^ 33c. Lirrre NuniMr 33a OM SpM (MaAi. day. Ywl Teereaaamyrlerrepa,ernorl.nadr.unr,dde.endF~.MauabraeavKa).lea.la.rraard------------------ January 17, 2011 cosec Errnaner / Ceiolw oknrbewa.uldnraleaa/awweal~oa.rmyavrrk.eaanaameaamewa..er.dlaa~•..kaalmm~rrrN.Idam.ewrerrd..'~1 ~~t~°~a~~°~,~'~,,,,~y~~u>~% Coroner ;wyrera d,e ~ "' ICI ~ I al ~ I~ I 9e.arwed(abnm,aey,yar) 2Ge/ /// ' 6375 Basehore Road, Suite ~ Mechanicsburg, Pa. 17050 . V DhprEar Fermi) No. ~ CJ `7 ~/ ~" C