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HomeMy WebLinkAbout03-14-11. ~ *,. IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Vincente Concepcion a/k/a: a/k/a: alk/a: SS NO: 561-54-3955 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 Part C also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters under the last Will of the above-named Decedent, dated and codicil(s) dated n =-_ ~ -, _ _ ' (State relevant circumstances, e.g. renunciation, death of executor, etc.) r Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted afterex~eutron ofthe instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated per~vs,r~irx~ was 7sot a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estals~i lted~as defined in 23 Pa. C.S.A. § 3323(8): :. ~,.__, „ __ -~ D B. Grant of Letters of Administration ~' - -~, (If applicable, enter d.b.n., pendent lite, durante absentia, durance 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:- Manuela Melville 251 Meadowbrook Drive, Mechanicsburg, PA 17050 xeianonsm to uecea Daughter IiCF ATITTTI/~NAT CLTL'~~rc rT: wicrcc~c~•r. ~, ent THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 5251 Meadowbrook Drive, Mechanicsburg Hampden Township Cumberland County Pennsylvania 17050 (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 83 Estimated value of decedent's property at death: If domiciled in PA If not domiciled in PA _If not domiciled in PA -Value of Real Estate in Pennsylvania 5251 Meadowbrook Dr., Mechanicsburg, PA (City and State where death occurred) All personal property Personal property in Pennsylvania Personal property in County Total Estimated Value $ 0.00 $ 0.00 $ 0.00 $ 0.00 $ 0.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s~~ ~ ~~ IYame(sl & Mailinn Addrecc(eal Manuela Melville 5251 Meadowbrook Dr., Mechanicsburg, PA 17050 Interim Fnrm RW_n~ rrvicPri t ~ fir; t n t,., r,..,,tio.t,,..a n...._... ___~:_ years of age, died 12/5/2005 at (Month, Day, Year of death) Deceased ESTATE NO: 21- I ~ -" ~~ ~ .,vumy Ncuumg acuun oy lt7C I.OnR Page 1 of 2 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. Sworn to or affirmed and subscribed ~ ~'~ 1 n l f~~ ~_ ,~ r~ufu ~cc~~~ ~ ore me this ~ 1~ ~ da of C ~ ,~-- ~I ~ _; ~ li l1, ~`~ f>> ~~1-~ir>1 For the Register -. ,-~~ J ~.%C> ~_) _~"? DECREE OF PROBATE AND GRANT OF LETTERS ,A ~., ~ _ ~~~ ~.n ~ e~.~ --ci Estate of Vincente Concepcion ,Deceased File Number: 21- ~Gf 1 ~- - (i ~'~ ~ AND NOW, this ~ day of ~ ~~~~, % /i%( , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters -Testamentary x of Administration are hereby granted to: (It applicable, enter c.t.a., d.b.n., d.b.n.c.t.r., etc.) Manuela Melville 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. in ~, Glenda Farner Strasbaugli, zo ~srlir '`~ Register of Wills FEES: Letters ....................$ .?iC ~~~ Will ........................ Codicil(s)......... (.'))Short Certificates ~ ( )Renunciations....... Bond ............................ Other ............................ ................................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 `.~~; TOTAL ................ $ . --- ~n -?~ -; J -Lj - ~. T_c 7 _'~ a Signature of Counsel Required to Enter Appearance __.__ .. Atty's Signature .~ PRINTED Name. Craig A. Hatch, Esq. Supreme Court ID No.: 76371 Address: Gates, Halbruner, Hatch & Guise, PC 1013 Mumma Rd., Ste. 100 Phone: (717)731-9600 Fax: (717)731-9627 Interim Form RW-02 revised 12.26.10 by Cumberland Counry pending action by the Court Page 2 of 2 ,, • - -r L ~ -~ ~ ~,,~ ~~ U, 1; Ifs t C('~? Ih.:i U?t' II1tOflTlllt1017 (le]-l' }ilVtrll IS COI-I-C'Ctly COhleli i1~011! ;~il +''1I^It;.li ~3' +I 1_,,~,(I RC~Ti~tr:.l). ~?~e I),~i~~ii~~(! certil~ic~Ue will be f<~r~~u'ded to the Slat, V;~ ~; ,`<,~~,)~(} . ~ , ti y1/AF~NING: It is illegal to duplicate this copy h~,~r phrtlost.~t a~.r. r ~,,~i -.~ I~ ~ ,~~y l-ce fc~r Ihi; c~~rtl(ialle. 56.00 ~ 1211373 M105 ,•3 Rev 2/87 ~f~ e~ ~ ~-e ~ln s~je r `~~ ~ s ~~ I t7 ~_ -~ ~ _r., (, r--~ r-- :_ - . ~.~ ' ,G ts~~. •v- TYPE/-RINT ~ NAME G PERYA aucK O a i W U 0 ~~ _:. ,.~ z n;~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH ENi N'K "=`-cvcni Irrsr, MAraa, Les11 _. _-. SE% SOCIAL SECURITY NUM~ER DATE OF DEATH (Haan, Day, Year) ,. Vicente Concepcion , Male ,. 561- 54 ' - 3955 December 5 2005 AGE + , (Usl Birthtlay) NDER 1 YEAR UN ER 1 DAV DATE OF BIRTH BIRTHPLACE (City W PU F AT n on - • Monms D•YS Hove Mirvnea tMOnM, Day, Year) Stale a Fa•Ipn Coumry) MOXPRAL: ~` °n OTHER: 83 vr, A r 5, 1922 Fort Stotsenber w.Y.n a. p 9, ' ^ awouVw.m ^ I>DA ^ IWYn 7. -.... •. a anw «. 11•m• ^ R••C•nw® Isp•WI ^ - COUNTY OF DEATH CITY, BORO, TWP OF DEATH FACILITY NAME Q, not instdueon Dior alr«I and nlsnher) WAS D , ECEDENT OF HISPANIC ORIGIN? RACE -AmNlcan h16en, BMgI, Wllq• •Ic Cumberland Hampden 5251 Meadowbrook Drive "°~1 Y°'n uY•.,apwraD.rl. (BD°r'i9 ° m '° M'" " P ~R ~d ~ " • "" 'u"' •~ Pacific Islander ' a DECEDENT S USUAL OCCUPATION KIND OF BUSINESS /INDUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUCATION MARITAL STATUS - Yarrisd, ,0. (O•w•t•b of vnrL •orud•1,,• m1 U.S. ARNED FORCES? I ~ •a cwep.Md SURVIVING SPOUSE r k M ww na Neyr MartW W~,~ .. ao na uu riN, Federal Government Yea® N°^ El.m.nayra•swwsrY DgNp• Div«ced( ) '"""'•°""'N.""'°'1 E ' ,:. ,,. 12 7e Marrte va Skorupinski DECEDE ' NT ,s S MAILING ADDRESS (Stroel, Gryrfawn, State, Zp Cotle) DECEDENT'S 17a. State etl„ Hampden 5251 Meadowbrook Drive Ac7uAL Pa. Dk „° ~l y„ d,D,«,dY 1 RESIDENCE decedent Iwp Mechanicsburg, Pa. 17050 (s«Irlstrugiona Ilw"la ~ aeceantyv« 1e. on otter aide) 17E. County Cumberland lownsnip? t7d. ^ wee yl M r OCb arlX• d uYlDao. FATHER'S NAME (Fnl, MkNe, last) MOTHER'S NAME (First Mkda, Maksn Surname) ,e. Antonio Concepcions ,e. Cresencia Abella ' INFORMANT S NAME (Type/Prhp INFORMANT'S MAILING ADDRESS (SIreM, own, Slate, Zp Code) 2w. Eva Concepcion ,oe. 5251 Meadowbrook rive Mechanicsburg, Pa. 17050 METHOD OF DISPOSITION DATE OF DISPOSITION PLACE OF DISPOSITION-Name o, Csmeb Cr Burial Cremauon X Removal from Stale rye •m+taY LOCATION -Cay?own, State, Zip Ca« ^ ^ ^ ^ (Moon. Dry Y•w) a Other Plaos Da l , o an ,,,. otna Ispe~dy) ^ ,,, Dec 7, 2005 2,e Conolite Crematory 210 Schaefferstown Pa. 17088 ' , SIGNATURE OF FUNERAL SERVICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBE~i NAME ANO ADDRESS OF FACILITY D 0 :s+. 230. F - 12662-L 22e Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, Pa. 77055 Carlplea «mc 29a'< °MY when o•r+irYnG To the beat o, mY knowletlpa, d«U occum« al dla lime, data and place ataletl. physic an u na avaaaole a Iona of Oeam to LICENSE NUMBER DATE SIGNED (Sgnaturo ark Title) canAy cau« d death (Mmm, D+Y Year) 2,a . t,b. 3,•. Ibms 2428 must Oa compMletl DY TIME OF DEATH DATE PRONOUNCED DEAD (MmN, DaY. Year) WAS CASE REFERRED TO A MEDICAL E%AMINER /CORONER? pason who promurcea d«In. / i /~~ r \ 21 6' '7 Ja ~ ~ - ^ . M. 2i. i 0 2i. Yaa © r L/ No FnMr tl 27 PART I N . n r : •••.•s, Flvrl•• w a.mea.au.n. v.hloh ••usN •,. d••N. D• net •nYr M mea. M •Y•W. •u•h •• ur•I•• er n••Ir•rery ur••t •hwY •r Mw 1•Yw•. LW •nM err cease •n note Yn•. Apprownate PART p: Omer siprlficem caldilbna wrWiblaq b Gatn, laA intervN between cwt ro•uanp n tM urvledyaq cau« even n PART 1 11WEOIATE CAUSE (Final ~ ~ /~ _ ~ auM ark d«Ih disease a c°rlditlon L , / ~ h roalslag ndeam)~- ° ~ / ~~ DUE TOIO ASA ClN,BEDUENCE OFI: S•QuanaallY eat corkiUOni b any, aadnp a imnediale DUE TO (OR As A CON6EOUENGE OFT cause. Emsr UMDERLYINO CAUSE (Disease a aqury c 111M a"aaled evM18 DUE TO lOR Aa A CONBEpUENCE OF)' roaupalp a, deals) usr d WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE MOW INJURY OCCURRED. PERFORMED? AVAIUBLE PRIOR TO (Moon, Dry. Y•u) COMPLETION OF CAUSE NalurN ® Flgnicke ^ OF DEATN7 Accident ^ PerWnp Inveslpalion ^ Vas ^ No ^ Yea ^ No 0 Yes ^ No ® Suicide ^ Cook na W dBlermin« ^ `0i~ ddb. M~ ,ee, ,«, PUCE OF INJURY - At ha«, farm, sweet laaay, olfic• LOCATION (Sorel, Ciry/faan, StN•) 24. 2w. ,f. MrMe •M.lsP.dM1 s« . ,a. CERTIFIER IClwch amy ale) SIGNATURE TITLE IER •CERTIFYINO PHYSICIAN (Pnysicien w cause of deaN wnen another physician has pror~ouncad 0«N erltl completed item 23) - ' Te tM b•N b my know)«0e, Math ooeu d« a tll• cau«•(sl and m«n•r « •be« . ....... ^ • ......................................................... Nh. i /f 'PRONOUNCING ANO CERTIFYING PHYSICIAN (Ph skian Goth E NUMBER PATES D ( , Ysan y PronourKaq death ark cartMinp to cause of death) Te qe enl o/ m anew) y •de•, tl•ath oecurr« at tll• Im•, dab, sod pla«, and due L° a• eau«gU «d manna as aabe . ...................... ^ „°, M 3 E s,d. ' WeDICAL EXAWNEIIICORONER NAME ANO ADDRESS OF PERSON WHO COMPLETED CA SE DEATH (Item 27) Type a Prim On tll• baMa •1 •aaminatlon anNOr Inv«tleaUOn, In my oplnlon, death oooum•d al the tlm•, dab, end pae•, sod dw to M• eaus•s(s) and John P m.nna a.wad Zornosa . ..........._ ..................__..._............................................____......................................................... ~ ss 1000 North Front Street Wormleysburg PA 17043 s,a. ............ ^ RE013 M '8 NATU AyD NU BE ~ ~ ~ 12 1 ~ DATE FILE Madh, Day, Yea) ,, - . N ,. ~~ eM~~e- 7, ~ees