HomeMy WebLinkAbout03-11-11Register of Wills of Montour County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of ~~ ~/~ I~~e ( ~ /y(G~ ~OCJ rl No. ~, - ~ ~ - C~ ~~ ~
Also known as
,Deceased Social Security No~7 7 ~ 3Z ~yZC~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW:)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the execut
Will of the Decedent, dated
and codicil(s) dat
named in the last
State relevant circumstances, e.g. renunciation, death of executer, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of
the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent, and was not a
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as provided
in 23 PA C.S. section 3323(g):
B. Grant of Letters of Administratio
(d.b.n.ct.a; pendente life; durante absentia; durante minoritate)
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:
Name Relationship Residence
I c e lc ~1~L ~1 ~ r~ ~'~ /t / ~ ~~
c.
~_ _
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(COMPLETE IN Al-L CASES:) Attach adppdit~~ional sheets if necessary. ~
VtA'199 h~~' ~~,,. ~ ~ ~ _a ~ ~ ~ ~ ~'
Decedent was domiciled at death in ~ CoiSlnty, Pennsylvania, with his/her last family or principetl residende at
1 ~/1 ~/A/y .- -~.
~__.
(list street, number and mun~ ipality) ~ - ; ~
Decedent, then '~ dears Cif age, died F,r~j r~ ~ ,20 ~ , at
C~ t
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ ~IJU. °"
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
Situated as follows: ~f ~C~.[~x~icr~/~ ca/L.)
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and
the the grant of letters in the a~opriate form to the undersigned:
~I~ ~~
_ / )Yl~
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Montour
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) the Decedent, Petitioner(s)
will well and truly administer the estate according to law. ~~ = = z~
___ - _ ._
_~, G F
Sworn to or affirmed and subscribed --
. _
before me this ~' day of _ ~ f ~'? a
n a .Weaver _
.. `, ~
Register & Recorder ~° -~ _~.Y C
For the Register ~~ ~®mmNSSiion ,~X - r~ ._r~
_ 2~!r3t. ofi Jain.. ~~4~
No. ~ i -- I I- 0~~ 1
Estate of ~~~ ~ ~.l'C~`'2 C.~ y ,( Ci ~ N~C%~ r G~ n _ Deceased
Social Security No: ~ ~ ~ - ~ ~ " 7~~ Date of Death: ~ ~ ~ ~ ~ ~ ~ ~
AND NOW, rte'-11~~1 l ~ ~~ , 20 ~ in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ^ Testamentary ~ - Of Administratio
d.b.n.c.t.a.; pendente lite;durante absentia; durante minoritate
are hereby granted to ti~ i C ~~' (~~1«.V~ C~~~~~
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 of Decedent.
FEES
Letters ...................... .
Short Certificate(s)
Renunciation .. ~..........
Affidavits ( ) ...........
Extra Pages ( ) .....
Codici I ........................
JCP Fee ....................
Inventory ....................
~t ti e r ~~. n~Z C,~;~ ~.... .
Total ..............
$ ~+~ .~D
$ ~~~~~
$~~ -
~ ~~- ~U
$ ~~ (~
$ ~~~~ ~
'~' r ~ ~~ L~-~'I~C~ li l ls~ E~
Attorney:
I.D. No:
Address:
Telephone:
TIl1G R(IG RFV rn~,n,, _ _ _. - _
LOCAL REGISTRAR'S CERTIFICATION OF DEATF~
WARNING: It is illegal to duplicate this copy by photostat or photograp~~. ,
Fee for this certificate, $h.0O
P 17244413____
Certification Number
a~'rrhnir~i~\,~ ~hls IS rll l'CI-tlt~ ti7aC the IlltOt'mall(lIl here °IVell IS
,,,aye; -`~ F~h = ~'t>rrecaly ctthlec3 I~r~l•il~ ~Ir I~ri~~in~ll Ct:,rtit~icate of Death
~`°o~~ ``~~~ cltll - a~~leci ~+~ith I~It~ ~;1, Llsc~~tl Re~~ .
~~r ~ ) ~(str':u~~ The orl~lnal
~~_, ~z ~~~rtiti~~ate ~~~~11 k~e.° 1{:r~,narded to the State Vital
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MtOSta3 REV t1,20p6 COMIYIONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~ ~"~.) _ -;y
TYPE PRINT IN _
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PE&R,+cM~-+N CERTIFICATE OF DEATH °
(See Instructions and examples on reverse) -_..._ ~~ ~
STATE FILE NUMBER
1 Name d OSpdarN (First ntrdrNe, last suffix) 2. 5« 3. Soda) Swrgy NumGr ~. DNS d OeaOt (Monet, day, ysr)
Dr. Michael C. Maroon Male 377 - 32 - 7420 Februar 25, 2011
S. Age (LJM &rNWSY) Urtdar 1 Under 1 da 6. DaM d &rm MonIA, 7 and slaw a Ba Plop d beam Clwtk ate
Asonms Oays Maus rarsen ~
7 8 rrs. July 10 , 19 3 2 Wh e e 1 ing , WV ®4rpawnt ^ ER / ongppent ^ ooA ^ Ntwfng Moms ^ Resrderlp ^ oNw . specJlr.
- Bb. Canty d Deem Bc. CAy, Born. Trop. d Dam 80 FadYry tarns (d na irtttpWbat
0
N
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• . gwe streN and number) 9. W« Oeaedent d Hnparuc Orign? ®No ^ Y« f 0. Reds: Amureart b6ri Blyd~ WAY, eft:
Dauphin
De T
M.S. Hershe
Medical Center IN y«. spealy Cuban.
~~• ~ ~. •tl (SPK'~/9
White
t 1 Depdenys Usual Kind d work la w dur moN d w. Do not stale r 12. Was Decadent ewr n ma 13
Deahnfs Edtrcabm
l
l
h
f
S
KinO d Wok Kind d Bwkts«; Irxdwtry
U.S. Armed Faros? .
pea
y
( al
y
g
tea grade aarrpletedl 11. MarAal Sutw: Martwd, rover 1Aarried,
Widowed
Divaad
S
l t 5. Sunmrg Spau« (N tears. giro msgrt rtertw)
Dentist Dental EknwrNary f Secartdary (0.12) College (1-1 a 5+) ,
ytaa
yj
(
Dv« ®No 12 5+ Divorced
t6. Decedents Maikrtg Address (Street pY / rown, :tau, zp mde) Decedent's
°
ed"~`
1508 Louisa Lane A~a,al~sa«>c. na.SUle Pennsylvania ~
;
,?a ^Y«DSCederNUtrWn
Mechanicsbur , PA 17055 ,7b.ca,asy T.e.
Cumberland Tom? '?d ~
d edw~
i
t8. Fameh Name (First mills, last stdfilt) Acat~
Mechan
csburg CityfBao
Asad Maroon 19. Motttels Name (Feat middle, maiden sunl•rtrl
Anna Maroon
20a. irtbrtttartfs Name (Type /Pmt)
Ms. Michele Maroon 20D. kNOrrttenys wtkng AOdnss (Street py r torn. afro, ztp codel
5 Cleo Court Danville PA 17821
21 a MSNbd d Otalwsrpon ~ ®Cremaean ^ Oonaport 21D. DaN d Dis{tasr0on lMOrtet, dsy, yearl 21c. Ptap d Oupoelron (wrrta a cenwtery, aemabry a oeter pap) ltd. Location (coy r roan. state, ztp awel
^ BtetN ^ RertavN tronl Stale
r Wee Crernelton or f3ortadon AWbslald
^ om.r- 'pywawEaarttirwfcorw,erT ®r«D No March 2,
2011 Cremation Society of PA Harrisburg, PA 17109
22a d FunerN // a person acprg s sucnl 22b. tiprtae NtntOer 22c. Name and Address d Faakry
A
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i
~ C~ 1i-~-..~ FD-138753 uer
remat
on Services of Pennsylvania, Inc.
Compute /ants 23se onty wtNn
pAysicrrt a nd availade N Erne d b 23a. To tfw beet d my knowledge. deem ocaned N tfte tints, des arW
plop stated. (Sgnapue and tide)
23D. Liprtse Number
23c. Date
SigtW (MortNt day, fl+ntl
arrfy at.. a deem.
perm 2428 mtW be conpletsd Oy Dersan
wlro pratotrtpe dealt. 2t. TxrN d D«m
/
r- P 25. DNS Pronounced Dead (Mmm, day, year)
' 26. Was Cass Ref ro Medial Examnsr ! Coraw fa a Reason Otltw tAm GenteOOn a Dorrmt?
~
,
M, t.t, Q. 2.- s Z o r ^ Y«
No
CAUSE OF DEATH (SN Inatruetlona and axamplaa) r Approxmaq nnrvN: Part II: Enter oNwr 28. Od ToOacco ll« CortsibtAe b Osuh?
IWn 27. Pan I: Enter dN (ban d evams - dissa«s, , a campkptxarta • tnN dkeary causal tM deem. DO NOT Sher temwlN events sucfl as cardiac arrest t Onset ro b
m
respinbry an«t a verarxxYN fibrASeOn witlbu[ IN
srrorwg elorogy. Uet ortty ar cause m each kw. ea
but rat n n lr ^
r SulfYtg urtdenyeg cause gnert n Part I.
IIelED1AiE~AgUSE IFinai di«ase a .I ['
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Due (a « a cnrueQMt{oe d1: 29. l FenWe:
, ^ Nd preprws wink put year
W 0011d10'~. ~ any, D. ~ Gt.t.-t G M v D C Q/'Gt, e~ dL. I r/~ i-Q
b ptaa Nbd an kte a.
D
Ent
b
80E .r'C t~'r~ b'!n i ^ Pngrr at Ynte a deeNt
ue
er I
(a at a cawgtwtp ol-:
Rlyr10 CAUSE
Id«a« « n
mar ntl ~ D Nd pregrtrN, put prgtrtt will a2
~
jury
erd dte c.
ewga reetlbtg n dean) LAST. , d da/Nt
Due 4 (a «a oatcsquertce oQ: i
^ NA prgtrK bul pregrtrs a3 days b 1 yet
d. ~ Oebn deeNt
r ^ UrtlubwT A pravterN wltWn Nte poet yes
30a W« an Autopsy 30D. Wen Aubpey Fatdrtgs 31 Mamer a Dean
32a. Dw d lrytry (Monet. day. year) 320. DeeatDe Mow kywp oatxrw
Pe~~?
Available Prior ro Canpleuon
d Cau« d D«dt? ®wturN D lromicw 32c. Plop a try,ry Norte, Fang Street Faebry,
Olbp Btarabtp, ale. /Speeyl
^ Y« ®No ^ Y« ^ w ^ Aaadsnt D P,yrldrtg mr«appon 320. Time d Way 92e. trytay N Warlfy 32f. N TraroportYieort nary fSP•GYl 32g. t.ocation d irtjuy (Street sly ! bwn, star-
^ Stxdde ^ Could Wot be De4mlirwd M D V« ^ No ^ Dnwrr Operala ^ Pas«rtgN ^ Pedestrwt
33a CersBer (rdteck airy onel Olfw • Spealy:
• C•ro-yww OpY•tu•n IPttYSiaart c•rtNyng caw. d deem wrest artoswr ptywart rtes porrowtcW asam and completed item 23) 33D. and 7~« d Carafes
Totl+eOeNamykrawNdge,der0oeewndau.bMeeaw(.)andmenw«auMd----------------
•
----------------- ^ -
V
P-wbtarcYtg and artiyYp pOyekWt (Plty,inart Oom praroutartg dean and oartlyrp ro caws d d«m)
To Ute peat of my tnowledga, deetlf aaurrad at the tMte, dent, and plea, anti dire b dM eawa(s) and mrtrtar « ste40 33c. Number
~ 33d. Dam S~gwd (Maim, ley, yeNl
_
• weptEsanWnrlC«aner _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
M ~ - ~F ~J I ~ Z- Z Z S ZD ~ (
On die Oaek al axaminadort and / or . in my optrdon, lento oatme N the Urns, dale. and plea. and dire n tM oase(s) and mrwtsr « etaMd_ ^ 3A. Nanr and Andress d Pawn Wno CampNted Cause d Dean (porn 27) Type t Pmt
35 RagcVah a I a ~ atioZ I ~
- ~ DN. FeW IMaren, day, yes) J e ,~,~. I ~~-- G~-~. ,~~ I f ~ ~ M. S. Hershey Medical Ctr.
j ~
oiapaeiport Pemel No. 0 6 0 5 4 81
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~; i'-7 _ ~ ;-~-~
RENUNCIATION ~ ~`~' -~~v. ~ ~ ~ -~
...~_~
,, ~-__
- - .,
n -
REGISTER OF WILLS ~ ~=f;''`
f ,- , - ~.a
Cumberland COUNTY, PENNSYLVANIA ; ~ `` ~`_~
~; --,-~
Estate of Michael C. Maroon, Sr. ,Deceased
I, Michael C. Maroon Jr. -
m my capacity/relationship as
(Print Name)
son
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued. to
Michele S. Maroon
~r~.ii
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
C ~..
(Signat~~re)
~y~ f rerc~ Q ~=~~ ~1~~~r: ~.~, v~e
(Street Address)
(City, Sta ,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 __ ~ R o day
of lYla th , a o l ~
,~ ~~
Notary Public
My Commission Expires:,j~ 1~ I~1 a0 f'~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Nota 's Commission.)
OFFICIAI. SEAL
NOTARY PUBLIC
STATE OF WEST VIRGINIA
EU.EN P. BOLYARD
* * 203 SAVANNAH STREET
~+.,~ ~~~ ~~.~ MORGANTOWN, WV 26501
My COmpliMion expires JWy 15, 2017