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HomeMy WebLinkAbout03-21-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITIO (N`~ FOR PROBATE AND GRANT OF LETTERS Estate of ~~'(~ ~~t2~ ~ y f`t ~ ,Deceased ESTATE NO: 21- l ~- C ~ ~ a/k/a: rr a/k/a: SS NO: Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as a plicable: ~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 aforementipned Letters P f ~ Qh ~r ~ under the last Will of the above-named Decedent, dated ~ ~ /~' / ~S 9~ and codicil(s) dated A n m~ ~ O --- = z ~, ~. _ (State relevant circumstances, e.g. renunciation, death of executor, etc) ' j ~ r? ^' ~ Except as follows, Decedent did not many, was not divorced, and did not have a child born or adopte~i~i`-~cecut~#~ of the instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitaterdp~tsart, and was nova party to a pending divorce proceeding at the time of death wherein grounds for divorce had beep-e~~sheda~ defined ins -- 23 Pa. C.S.A. § 3323(g): r - ~ -" - ~ ~~ ~-~.7-~ ~ _. ;-n --~ ^ B. Grant of Letters of Administration b c..• .-~ (If applicable, enter d.b.n., pendent life, dursnte 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(g), except as follows:- Name Address Relationshi to Decedent ~ e ~~. o1~t~ 1 DO [..+~~ ~ 1 INt f~ ~44 2'c- R d ~ ~, ~o,, rto od g ~ r we, a ~ ?I'z~ ~,.. UJZ!, AUUI CIVNAL ~HEE'f5 IF NECESSARY THIS SECTION MUST BE COMPLETED: Dece er~t was domiciled at death in Cumberland Cqunty Penr~sylvania, with his/her last family or pri cipal esidence At U ~ 'N - c~nay~~C" ~;, Go.c-\t~e . N~-1 i ? 01 x~'_154 ~' C".,a~c~~.~C'le ~©c-~W ~~• (SQtreegt address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then Z~ O years of age, died ~ t ~.D ~~ at G A`r} \~ ~ , Y (Month, Day, Yeaz of death) (City and State wher death occurred) Estimated value of decedent's property at death: If domiciled in PA All pzrsonal property $ _If not domiciled in PA Personal property in Pennsylvania $ _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.) Signature(s) Name(s) & Mailing Address(es) ~.. ~, w. A 31 ~~~ ~-. ~~~ ~ ~ c~~~?~ tntenm Norm Rw-U2 revised 12.26.10 by Cumberland County pending action by the Court Page i of2 Oath of Personal Representative COIvIVIONWEALTH OF PENNSYLVANIA COUNTY OF ~~~d~rrlX~C~'r~~-) . The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con-ect 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 /;zr before me the / day of ij ~ C!! '~~~~~ L~ ~ ~ ~ F'or the Register .~ , z~ Signature ojPerson presentative ~ _ ~ - - ~ AJ' I Signature ojPersona( Representative `t,. ~' ~ ~ -- - ~ s? ~: ~' %C7 J~ t i T °- Signature ojPersonal Representative _i ~ t_-., _ : T - v • _.. - n c. File Number: ~j' I l' C~ ~(~~ Estate of ~ 2 ,Deceased Social Security Number: zUU - ZZ ' S 75`~ Date of Death: J I ~y ~ t C ' S= AND NOW, f~ , Ze ~ / ~, ~in~c~sideration of the f/oregoing Petition, satisfactory proof having been presented before me, IT IS ECREED that Letters n~~%C(I~G'~'VYI;.~V~~,c/ are hereby granted to 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 FEES Letters .......... $ Short Certificate(s) ..... ... $ rs~ •`` R enunciation(s) ....... . $ J INI ~~ ... $ c. .~.~•rj ... $ ,5,oc~ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL ........... ... $ ~.~~J.7D Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: il(s)) of Decede.^.t. of Fern, RW-0? rev. 10.13.06 Page 2 of 2 ERK OATH OF SUBSCRIBING WITNESS ~,~~,_, ,-,~,,;~,T REGISTER OF WILLS C V M lT ~~ G An! Q COUNTY, PENNSYLVANIA ZI- I1-o t~~l Estate of ~ ~ r 9 ~ ~~e ~ /~'!', /g ~l mow. Deceased Ch 4 r ~~s E ; ~e,7!~~ t ~~/ ~~~r; f c C `p ~i'~~- , (each) a subscribing witness to (Print Names) the'~Will ^ Codicil(s} presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that sloe-,t-ka/they -nv~s-f•were present and saw the above T.es#ate~-/ Testatrix sign the same and that slime /they signed the same and that sl~e.J~e-/they signed as a witness at the request of the T.estater /Testatrix in her /-~s- presence and in the presence of each other. (Signature) (Signature) ,>' S 1 p r,,~ ~ a,., f~ (Street Address) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills ~ -~ ~ P~_ >" ~ ~~ ~ (City, State, Zip) Executed ottt of Register's Office Sworn to or affirmed and subscribed before me this ~ day of , ,,~. N a Public ommission Expires: ~~~' (~ /. ~~~~ (S ature and Seal of Notary or other official qualified to administer oaths. Show date of e;cpiration of Notary's Commission.) NOTE: To be taken by Officer authori2ed to administer oaths. Please have present the original or cop)~p~~r~t~e8~~tlNzra~tion. O EE SYLVANtA Form RW-03 rev. !0.13.06 KELLY PNROBERTSSNotary Public Paxtang Bcro., Dauphin County My Commission Expi; es January 27, 2013 :~ ~ -/i -o'er ~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or' photograph. Fee. for this certificate, $6.00 P 17296650 Certification Number This i~ to certif~~ that the I;~fonnation here given is correctly copied fmrn an of I,zinal Certificate of Death duly filed with Ina as Loc~Il Registrar. The original certificate will he forwarded to the. State' Vial Records Office fi>r permanent filing. Local Registrar Date Issued ,,, , - _ C7 - . :~ ~ ~ °`" ~ C7 ? :-.;~ i ti 7 r~-i r~ ; ' ; '. ` ~ ~- J ~ __ L ~ !~ ~ ) J _ - 1~ ~ C.; tT-1 l Y -... L N10S113 REY 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -T~ P~wAANENr" CERTIFICATE OF DEATH {' a.ACK YY( (See Instructions and examples on reverse) STATE FILE NUMBER 1. Nenb d DecadaY IFexL nYtlde, heL aMM1x) 2 Sax 3. Social Seway Nuniwr I. Deb d beam (Maim, dry, YaM Margaret M. Adams Female 200 _ 22 __ 5759 3/14/2011 5. Aga flan Bi6tley) IAldr 1 llndu 1 8. DW d Butlr MaM, a 7. Bi aM stab a w. Plea d Deem Gbdc one Mobs. Dare Hare Mmes Upper Turkey Foot HospOel: own: 8$ Yrs. 5 / 30 / 1 922 ^ Inpaaed ^ ER / Ou¢albnt ^ DDA Nueinp Hann ^ Residence ^ Dtlia - Specay !m. Courny d D«m Bc. Crcy, Bao, Twp. d Deem ed FmMy Nsme IX not xbheAion, 9v obasl azM nemwr) 9. W« DacadsM d 19~enk Oran? ~ No Y« 10. Rea: Amaaen Inaen, Black. Whit, em. C~nnberland Carlisle Church of God Home 1. Ara1a ~+. rca White 11. Dscederfs Mewl Yon IOM d was d ab ~ mat d Me. Do nd ebb retl 12. W« Deeded axe n Yb 13. DecedMYS Eduwtbn (Spedly ady hgwr gn0a conV Mted) 11. Medal Sbhe: Menbd, Nwer MenieQ 15. Suahbg Spo use Ill wYe, give meitlen rium) Knd d Wak Kkxl d Buairiaea/ndMhy H k US. Armetl Faua? Ebmenbry / Setxmdery (P72) Cdbge (td a Sv) Wed' Dlvwad (~/ ome er Own Homema ^ Y« C~Na 1 WidoAaed 16. DeadeMS Maang Addmae IShmt lily / kmn, slab. nD aodel 31 KenFUOd Dr DaxltlellYS Did DeaUrtl aces ~«~•~ na ebb PPS3n_Sy].vania TYe n. nc. ^ r«. Daman Loved In rwp. . Cumberland °"'b"D~ nd.C~;ia D W.d~dmn Carlisle Carlisle PA 17103 ~ ~~ 1n.ca,dy ay/Bona 16. FaYbfs Name (Fkn, nYdde, krL sdYa) 19. MamMa Name (Errs, nktlda, maiden u.nral Wilson Mauls Della Ansell 20e. mlombMS Name (Type / PrkY) 20b. kYanbd's Mel ig Addme (SMeL dY / bwsL slab. zp mM) W. Adams 31 Kenwood Dr. Carlisle, PA 17103 21 a. Issued d OiePOOitlon ^ Crematbn ^ DaMYOn 21a. Ore d Dispodtlm IMmrt daY, Y«r) 21c Phu d Dbposgm (NaaM d cemsMry. orarrWOry or otlbrDlace) 21 d. Lonam (LYry(kxvn. sMte. ap mda) [~ axitl ^ Rmbval Yen stns ' w.. cmmmon a Donetlon AWmdssd 3 / 19 / 2011 ^ oYbr . r w Mosul Pyem /Caorbf! ^ Y«^ Na Woodlawn Memorial Gardens Harris PA 17109 27e. Sigrbaee d F 22h. L'xxxbe Nanhsr 22c. Nome aM Ada«s d FacMYy II N~~ll~e~} Ho~y1 ~1 - FD 013239 L 1 7 P A 3401 Market Carrpleb hems ody when axYlyng 23e. To ab oar d my knowledge, a«m orcurrm at the arse. dale aM DMU abbe (SlgnaWra aM title) r z3E. ti un os N a n t M 23c . O ne 9i gnm lalarah. day. year) Dhyeiaanb ira.nhme ddeMb adrcy caws d Ham. ~ , /~ l ` ' I ~ ( ( ~ } ~ RN c7 sp~ ~y M 5 y ~ A ~ ~ r' `.^'x~ t Zo c I Rama 2aT6 mur w mnPlebd W person 21. rena d Dmm 1 2S Dale Pmroaxad Dam ( .day. year) 26. W« Casa Rde m Medlor Exvdner I Coroner to a Reason OYbr man Cremaam a OaxYm? ~ wtn Drawac« deMi. I Q 4M. 2 `l..i ~ I ^ Y« No CAUSE OF DEATH ( Inatruetbns and example) ~ Approxinbb intervr: Pm II: Eder attar ' 26. Did Tdbem Ilse ContdE W M Deals? trm 27. Pm 1: Erner Yr dbn d e«nb - tlheems, k{raba, a carpkreYab - tlut elreay cawed w seem. DD Nor errs bmwbl evens soar «rerdac arnr, Orbr m Deem bd nd dsYmlg n tlb wdsyiq awe gNen In Part I. ^ Y« ^ Prooedy raepkray arrau. a vergiclrhr fbrehYOn wtllad showirq Yb eaobgy. Lin mly ab reuse on mat bb. ~ No ^ Unbpwn MIMEDIATE CAUSE hW dwaeea 1 caidtion rewWng n ~) ~ a ~ f\d St 2q ''1[v 'J~~~V~.SOY\ S 29. ~~X77FIISmb: Nd nt ahn r Die to (a « a un6e9lbrn dl: Drepb w pee year p~ ^ PregriM al lime d dmm ~ CpldNtlb. Y ~, b ^ b ewe Fbtlm bb a. UNDERLYING CAUSE Due to (a « e m aquena afl: Na pagnem. oul pra¢Mm wimn 42 days (deaem a kq,ry dw kYwbd ma c. evade rabtip n deM) LAST a meet ^ . Da b la « a u«a7uern dl: Not aePuW, M prepbn10.7 aye b 1 yes betas deem a. ^ lMlmown rc pregned wkhn w P«t Year 30e. Wm m Aukpry 3W. Wero Aubpay Finarpe 31. Harmer d Dmm 32a. Dab d In(ury (MUYk day, yes) 32a. Deeaw New h7aY Orcunm 32a Pbu d Iry' xy. Ham Fem. Stren. Factory. Pedanbtl7 Aveibde Prior b Camgeaon N w r ^ N x Olin Buidng, a¢. (Speary) d caaM d D.em? e r m ade ~ ^ Y« ®No ^ Y« ^ No ^ Attidenl ^ Penang lnvasdpation a2^. r a Inlay aze. Iryay r wok? ^ ^ 3zr. rc Trruponedm Injury !s'PaaNl ^ Orivarlopsnlar ^ Paseanpa ^ Ped«nhn 3xg. Lncmon d kkury (sheet. my / wwn. ahb) / ^ Suicitle ^ CouM Nd w Detemxrbtl M Y« No ^ OYbr ~~. 33a. Certlkar (dbdc ady ab) • Cemayktp phyokion (p7ndan arolyrp awe d aem rman anawr ptyaidon has pananatl deem eM ungbad Ibm 231 33b. S' T ~ I n ,/1 - " ` / Y /~~ !~ Taw was my bw.wlge,emm acewr.d eu•bwau.ygw mmner«arm--------------------------------- - ^^"ll.. • Prawrmdng en0 crYying phyelcbn IPhaeidan hom prawunckq dmm aM ar0rykq b awe d dedhl wwrd m l bbd b et x drtw tu dr e k t T tla w d mm ^ 33c. Licen« Number Swim IManm, day. yes) 33d. Dace ' y ab go, e a :rare «, e, rr p •x, e a. awyq an o o eunner«e __________-- _ _ _ _ _ _ • lamlal Fsamlrr/Corer p l.,'p 03`1 CS C, L 31 ~ \a 1 Z-d' ~ I On w txeob d eumnrbn ere / a Irwutlptbn, In my opnbn, d«th orxvema r Iw tkrb, Mb, eM plw, eM deto w awelq em manner «otated_ ^ 31. Name sld Adams d Parson Wro ll nn Cmpbted Cau« d Deem (Item 27) Type / Pnm ~~ ~ 11 35. ~ s sigrbaxe aM ~ Naehs I ~{ / la I / ICI b (Monet. ay, yeap aU , G r~ ~ r 3e3 N .\3.a,L~k-LV~c\,e., Q~ 1-l! tyc;lt 5 ,-,~, o~ news ~ i/ QJY~ ~~/6 Dispuiwn Parrdt No. I } LAST T~TILL AND TESTAP~IENT I, MARGARET M. ADAMS, of 3700 Sharon Street, Harrisburg, County of Dauphin, Pennsylvania, do hereby make, publish, and ~ f li-t;?~,l declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior ?gills and codicils, in manner following, that is to say: FIRST, that I direct that all of my just debt~~ and funeral expenses shall be paid by my Personal Representative as soon as this shall be practicable. SECOND, that upon my deati~ I give, devise, anc~ bequeath all of my estate, real, personal, and mixed, to be divided equally among my children, SHERRY LEE LACZKOWSKI, ROBERT E. ADAMS, JR., and BARRY W. ADAMS, per stirpes; that is, if any of. my children have predeceased me, then the share of said predeceased child shall pass to his or her surviving children, in equal shares. If said predeceased child is not survived by any children, t~ his_T_~ -~? _ _; ,~ _, or her share shall be divided equally between my surviving;';r~ -~ '' -_ ~ ~~ , children. _ "'~ - - ; `-., ~, _; , THIRD, that I hereby appoint my son, BARRY W. ADAMS a-S.~~he - =? -, , _-; ~. ,__ y ''' Executor of my estate. If he is unable or unwilling to perform inn this capacity, then I appoint SHERRY LEE LACZKOWSKI and ROBERT E. ADAMS, JR., as the Co-Executors of my estate. I direct tY1at my Personal Representative shall serve ?without tYie necessity of posting bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 13th day of November, 1992. MARGARE M. ADAMS i ~ } WE, the witnesses whose names are hereto subscribed, DO CERTIFY that on the 13th day of November, 1992, the Testatrix; above named did subscribe her name to the foregoing instrument in our presence, and, in our presence and ~iearing, declared the same to be her LAST WILL AND TESTAMENT, and requested us and each of us to subscribe our names thereto as ~ritnesses to the execution tizereof, which we hereby do in the presence of the Testatrix and of each other on the date of the said Will. WITNESS aJ.~/~.(/~.t/~. L ~~~a-vim WITNESS