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Home My WebLink About03-23-11~ `^.,~ a~ `~1 A~~ ~~ , IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of ~~~,j~~~p~,, ~~ ,~ ~~~ ,Deceased ESTATE NO: 21- ` - '° ~~' J(t; a/k/a: ---~-~-~ alk/a: 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 (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 ~:Kecution of the ~_ ~ instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated~p€rson, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been :~statit~l~ed as: defined in 23 Pa. C.S.A. § 3323(8): __ ,_ ,_.__ jai B. Grant of Letters of Administration - . _, (If applicable, enter d.b.n., pendent lite, durante absentia, durante'rxrinoritate) C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived~sy 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 c;ompleie 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: ~ ~ aaaress '~ ~ Relationshi to Deced~ ~~ f ~'~- J 7 r-. r a r ''~ '~ t~'"~ ~~ / ~~ ~ A ~ K- ~ ~ ~ 7 1 USE ADDITIONAL SHEETS .NECESSARY ~ ~ ~ THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberl County, Pennsylvania, with his/her last fa3ni~ or principal resi _ ,~ , . ~, n„ __ nt treet a ress with Post Office and ip Code, Mu icipality: Township, Borough, City) V " Decedent, then ~ ~ ears of a e died '' ~ ''D at ,~~ ~ , (Mont ,Day, ear of death) (C ty and State w ere death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property $~' ~`~ ' U4 •- _Ifnot 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) ~'l i c- ~i ft ~ ~ z ~ 7 ~ ~i~~ s~~ Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court /'- ~`~~N l 703 ~- Page 1 of 2 rt~ ~N ---- --- ~-~ ~ ~* ,,,' ~°'1 Oath of Personal Representative COMiV10NWEALTH OF PENNSYLVANIA SS COUNTY OF 'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are time 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. .r Sworn to or affirmed and subscribed /f' ~ ? ~' r Signature of Persona! Re sentative ;-- ~'; ` before me the day of ~ - ., - Signature of Persa:al Representative - 1~:_ ;:. For the Re ister , -, ~, 6`' Signature of Persona! Representative :', - --~ _~. ''t -~ File Number: ~. ~ ~- ~ ~ "~.% '~ ~ftl Estate of _ ~ ' :_,~ ~~ YY1 r'~ ~ r-t f ~ ~ y'•1 ~~~ ~ t;' (~~ ,Deceased Social Securit Number: ;~ ,;~ ~ ~ ~ , ~~ "' "' -' ~~ -a -, _ , ~ y 1 c. ~ " 1 rY " ~ Date of Death: AND NOW ~'- ~? ~ '`~, f ' , ~' ~ ' ~ ~ "- ~ ' - ~ 'fit' ~~' ~ ` , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS ISE REED that Letters ,~ ~-y-~a y-~,r~y~'j~ ./`jifr are hereby granted to __ `~"/~ ~ '- `~ ~r ' + ~~~~ ~~ in the above estate and that the instrument(s) dated r`""~~ ~f -~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s) of Decedent. , ,y,, ,~ FEES x~~~ °~,(, ~ \' h-~~ ~~ Letters ............... $ ~(.! ~' Register of Wills ~: Short Certificate(s) .~ ...... $ : ' ,~ Attorney Signature: R iunciation(s) .r~....... • $ ~:%~z' •-"-~ i - ~ - $_ ` ;, ~ , Attoi-~ley Name: ;, Supreme Court I.D. No.: ... $ - • • $ Address: ... $ ... $ ... $ • • • $ ~ Telephone: ... $ _ TOTAL For,n RW-U' rev. lUJ3.U( Page 2 of 2 ' ~. /I rr V4~)r'~~1~!l~tlf,~: ~t i~ oi~egrli ~ ~~.a~~~~~~:;t~ a~~~~ ~~a, ~ ,_,~ ~,~,,~;~.,, ~,~; r~ . .. ~'c'i' I(,t' tl1i ~~~,L.tiki~`:til°. ~:r, ; ~{; %r'''krrr MY `°a.,~r r ',:, '~ 3 _ I w id ~~.~ pr,~, t, S._,'. rr '., ~..a _ . a ~ ~ ~ ~ i i P 17243817 ` `~~ ' ~~ ~ ~ ~` r ~; .ill, ,. ~ ~ ~ °t, ' m t4 1 • ~ ,_I[l~l~ ~,,, _ __ - - 1, ~- ,~, ,: ~.;f. ~ ' . ~r..- 1~ .. - .. t i .,i i _- } H,OS-t43 REV „2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS , TYPE .PRINT IN - PERMANENT BUCK INK CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMEtER 1. Name d Decadent,Fust nkddW, rst, wnu) 2. Ses 3. Saual Secunry Nurturer o Dar d Deem (Harem, day. y.ar) James Carlin Welch Male 192 - 34 - 5773 Februar 17 .2011 5. Aga (Last &rmrtaYl Under t Under 1 da 6. Date d Bain Monet, da , 7. Bi e G and stile a la coon 8a. Plea d Daam Chedt ore llonea Data Hpurs Mnura Hospital: Omar: 6 9 Yrs. Dec . 1 19 41 T i O a Count P A ^ InDatwnt ^ ER r Cutpakent ^ DOA ®tVtxsng Hare ^ Resrdenca ^ °a,e, . ~rM • fib. Caunry d Dean ec. C4y, 13ao, Twp. d Dean ed. Fxlay Name pl na utstiWran, qve sweet and number) 9 Was Oecedsnl d ? Ilf Yes. spenly Cuban, °r~f 1 ~ No ^ Yes ,o. Rea: Am.r~can M,dan. eladC wAir..ke. ^~; Cumberland East Pennsboro Tw Golden Livin Center ~•s~^.PwnoRrcan.etc) (~ ~~ „. Decedent's usual Crc tan Kind d work done der react d Wa. Do na slate reined 12. Was Deceo.d ever n ore 13. Decedent's Education $ Whit e Kind d Busrwss/ lrkdustry U.S. Armed Forces? l ~'N o"h' hgrwst gran axnplaled) 14. Mental slues: Mamed. Never Maned, 15. Survnng Spouse In wds, gwe rttaden woe) Kind a work Eiementa /Sec Widowed, Divorced f~h1 Unskilled Laborer Labor ^ Yea ®rb " 12 °~" lo•t2) conege It-4 « s.) t6.Decedenra Never Married Maikng Aaeress (Bosom, cdy t rows. sur, zip code) Des 770 Po lar Church Road AcwatResldert~• i7a.state _ Pennsylvania o~nDeaedent ,~~ P Tav~p~ ®Yes,DecedattLlwdn_,East Pennsboro Tt,p. Cam Hill, PA 17011 ,~oc«a,ty Cumberland „d.^No,~,~,,,,~„„,ti„ te. Fathers Nertr (Feu. nkddk, last suffix) Actual LuMS d CGy/ Boeo ,9. MotMfs Nartw (Fuel nkdde, ntaaen sumarty) 0 al Ma Carlin 20a. Informants Name (Type / Pmq 20b. udomwa's Madng Address ISireat wry r town. state, zp code) Mr. Michael J. Welch 227A Pleasant View oad alt ax 2, a. Me,nod of Drsposrtxxt r 2, b Dwe d Dr g.-17 0 3 2 o . r ~ Cremabon ^ 13aratan sposdan (Month. say. year) 2,c. Place d Orspo:,tion (Name d cerrrrry, uematory a Diner Pie) 21d. Lawtbn ICiry/town, stag. aD code) w ~ ^ OUwrerral ^ Remove tram State r Wq CrenWion a DorWlen AuUpnaW ~Dywdlcwexw,trtwrcerener? ~res^NoFebruary 22, 2011 Cremation Societ of PA Flarrisbur PA 17109 ~ 22a. Sgna d Fwreral ~ra L,ansee rsan acorg as such) 22b. Lcense Numar 22c Name and Adasss d Fankly ~ ~ ~ ~ ~''"~' - FD-138753 Auer Cremation Services of Pennsylvania, Inc. 4100 Jonestown oad arri bur aertts z3a< ony wrwn 23a. To dw best d my krgw40ge, seam ooaxnd at the Dine, der and plan stated. (Signature and utbl 23o L.canee Number PhY~ ~ not avaaabr u tine d deem a 23c. Dar Sgned (MoM, day, Ye•rl cerNMy cwt d aaalh. ~ .~ 9 ~ v~ ~ ,fib,- o i ~ ~ Irrtr 24-26 must pe cmrpleted a/ person 24. Tune d Death 25. ronounced Dead (Monet. day, year) 26 Was Case RetemW to Medical Examner ~ Goraxr la a Reason C+fw Crenreon a Datetiort? ~ who pronancss Beam. - : 1 M. 1~ V ~ ~Q-~tr ~ ~ ^ vw .fit No CAUSE OF DEATH (See instruetbns and eaempNs) ~ Approxmar Imerval Pan II Enrr other Item 27 Pan t. Enrr ms ~gy~ - diseases, uyurws, a canpkcaoons . Uul direcyy caused nN tleam. t>D N0T enter rmunal events such as cardac arrest. r aTJh. 29. Use CaretDlae b Dealt? Onset a Oeam ,~/ ^ ProbeWy respuaary arrest. a wntrcuiar tAnaabon wtmout atawnrtg dw eoobgy List only one terra on each Wte. r but not restuWg n me u/idenyvtg comae green n Part I L~3yuY-aa M~WE~p~ TE CAUSE FumW dw.ase a ' ^ DrYUarw, esulttrtg ~ 1 -~ a. f ~ q 'Q s T7 ~ t~ .~GL r / No ~h /¢7l~th-l ' ~ ~„ C f/y~y n.~y plt~ %124~/-•~-Y zs n Femar: owe a w ^ Nd wren ~aYy ofl /' ~n J ~i / b 6~itg r dte~ rn lone a. b ~ ~~ / O 1.. ~7` ~i i ~(~ tic ~ ~J//-~ i ! ~ C (~ ~T _ / ~ ^ Pregrrv at Ome d O.M Enrr er UNDERIYMG CAUSE Due b (a a o~_ n~' '~f'~ r -~~ GC/ f Gr Z - Idissase a xthry ntu satiated tM l / i -' ^ No, preprtwtl, bu preywN waM 42 d.ya swots nwlDrtg n Beam) LAST. c. J t~'1/~ L !~. y A~ >lG~-s/ ~~A~-~ r d ~ t ~ Due to la as a wrtsegtrrtce oil. t Year ~ d ~ ^ Not preytara, W pre¢twa 43 deya b f i bebn dawn ~ 30a Was an Autopsy 30D. Wen AtrlOpsy Fndrtgs 3, Maurer d Dean r -- ^ lltautown A pwgrtwe wftn er pot yew '~ PeAcmra? AveJabr Prat a Completion 32a Dar d lrtµuy (Monet. day. year) 32b Descnbe Flow Iryury Oaurred d Corse d Dsam? P Nanuw ^ Fromicide 32c. Play d MMrY' Hans. Fartq Steel Fatlay, ,~ Office Bnl6rg st ISpK/Y) ^ Yss L7 No ^ yes ^ No ^ Accderrt ^ PerFtirg mwsbpa0on 3E0. tone d MwrY 32•. mNry at wont? 3zr. n rransporrUOn Irk' lSp~rlyl 32g. LxaOOn a uYun/ (Str•sl dry r town. star) ~ ^ Stacrde ^ Caad Nd bs Dermwwd M ^ Yes ^ No ^ Diner I Operates ^ Passenger ^ Petlesbrrt Ottw • Syxwty: ~ 33a. Cerofier (check aniy Orel • C•rtilying physician IPhysicori certAyng cause d Beam when stainer physician toms prorioixtceo deem and cmtpleted resin 23) J3D. Sgnature of Garotter - To tM Dew d my Itriowlsdge, dsatlt occumd din to tM cause(s) and nwirier as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ ~ /i_ Praiotatcyty and artgywtq phyaicw IPnysiuwt Dom praatutcutg deem and arfiyrg a c~iue d d•aml - - - - - - - - - - - - - - - - - 73c. Ucense Number 33d. Dar ~ (Harem, day. year) `~z io tM sew of my w101•l•d9•, deetlt o«urred w tlr ems. aw, and W+a, and aw W tlr ausy.) and mwrr a. sWsd- - - - - - - - \.. kleeicw Esrtwter / Carorw - - - - - - - - - ~ ~ ~~ QZ f ~2!//r~ ~ Os tin trW Of •xarrtklWen and nwwiyw+on, m my spoon, death oaurred w dte tiny. der, and o plea, and dw to tM cause(s) and manner a syrd_ ^ 34 Nuns and Address d P~r, Canpsrd C d Deam Qrm 27) type ~ Pont • s • I[Y - ~~ ~ ~ d ~ _r F ,Monet. day. yearl / ,a Disposmort PsmM No. _ 0 6 0 5 4 2 8 r -s - RENUNCIATION REG TER OF WILLS COUNTY, PENNSYLVANIA Estate of Twin ~S ~'~-~/ire _ ~~~ _ Deceased I, ~ (Print Name) , in my capacity/relationship as -- S~ ~ T rP of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued t _ ~ f 1 1, ~ ` r` ~d (Date) °~ ~ , \! (Signature ~ ~ Q~ ") l~ ~ J ~ _ , (Street Address) j ~~ ~~o ~ ~ 1~ (City, State, Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed before me this Before the undersigned personally appeared the of day party executing this renunciation and certified ' that he or she executed the renunciation for the purposes stated within on this ~~_ day of ~ Cott ,_ Deputy for Register of Wills Notary Public H OF PENNSYLVANIA My Commission Ex i NO ARIAL SEAL. p ~#tARLES E. bYELFLEY JR., Notary public Clty of Duncannon, Perry (Signature and Seal of Notary or ~t ~~ N18~ 183 administer oaths. Show date of e Form RW-06 rev. 10.13.06 ._ = ^r ~- `` -,..-„ , ~., - -~ M1 ,~ , - . :. _~. Estate of •~ f -._ RENUNCIATION C~; ~-- ~ ~ _. ~ ~._ , REGISTER OF WILLS COUNTY, PENNSYLVANIA C _ _ / ~. Deceased (PrrntName) , in my capacity/relationship as `~' of the above Decedent, hereby renounce the ri ght to administer the Estate of the Decedent and respectfully request that Letters be issued to ~~~h~~~ T ~, ~~ ~~ 1~ ~ ~~1j (Date) ~.:.:ecutea' in Register's ti,Jftce Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 Q ) .> (Signature) F (Street Address) ."~ ,'~' ~~ ~~~ ~~~ (City, State, 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 ,_ ~'N,, day of l~1 G ~ i~ ~.o ~ 1 ,_ .~~~ Notary Public My Commission Expires: M ~,,- „t, i , ;~ of ~~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Yi.VAWA lOI~Mr ~ McE+c L fit. Wc~1ary ~Jbsf~ Lemoppe 8c~0, Cwraberlpad Cotatt~r ~O~ Marck-11, 2Q 13 '~#. P$nris}rlvani~ F.ssnai~~n at I~ttrries RENUNCIATION REGISTER OF WILLS ~ _ ,_,, ,. C - _~_ C~ . ~-~ ~ ~ ~ ;~~ `'t~i~'~Lya~'tQ/ COUNTY, PENNSYLVANIA -, 1 Estate of Deceased _____~~ ~ (Print ame) , in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ ~~ ~~ (Date) ~~ / J(/ 1 ,~ ~ ,.,= . /~~ r/~ (Signature) `'' ~ n.. ~ v~ (Street Address) (City, State, Zip) -'~~ Executed in Register's O face Sworn to or affirmed and subscribed before me this day of __. Deputy for Register of Wills Form RW-06 rev. 10.13.06 Fxecr.~te~l out of??egisteY's C;J~ice 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 ~ ~~~L Notary Public ____ My Commission Expires: g'I 1 ~ ~ t "~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) -~- ~. .~ - ~ ~. ~. -~...o..... ,.~;'r~~ Pie•,~ LORAA. SMITH °,r «``o ~ Notary Public -State of e:torida ~ , •e My Commission Expires Aug 11, 2012 ~~ +~ L'-r ~'• Commission # t)LI ;x'78476 'iFO~ ~~0?~~ ''"~~~~~•• Bonded Through Nationa,i NataryAssn. RENUNCIATION ~,,~~_-_ ;-- - , ~ - ,~,,- -{ REGISTER OF WILLS COUNTY, PENNSyI,VANIA Estate of ~~ /~ Deceased I' ~ 4 ~,~ (PrinrlVame) in my capacitytrelationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to . _ ~, ~' ~- ~~ i~ ~~~ (Signature) (Street Address) ,~ ~~ (City, State. Zip) Executed in Register's Offic Sworn to or aff rmed and bscribed before me this day of ~ ~` Deputy Register of Wills COMMONWEALTH 4F PENNSYLVANIA ~~• ~NO~ Notary Public Comndpion~~ Tio~a County Member, Pennsylvania Assodatlon of No~ries Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation. and certified that he or she executed the renunciati for the ]pure s stated within on this ~ - day of ~ ~,~ Notary Publi My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notar}r's Commission. ) Form RW-06 rev. 10.13.06 RENUNCIATION - _:,_- ~ - C~ -, ,~ _~, ~,, RE ISTER OF WILLS ~ '`'` ~ + - ° _ , ~~^~ COUNTY, PENNSYLVANIA Estate of G,C/ I, Gt~~e-~ S Deceased (Print Name) , in my capacity/relationship as of the above De cedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to _ - ~-// (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills ~1 ,~. (Signatur //,,,,, 5~ '' ~ C~Ci KG,/ (Street Address) ~1/ o~ ~~ / 7~ 7 y, (City, Stat ,Zip) Executed out of Register's Office Before the unders~ e~dr~rso all ~ a'~ ~ ~ ~ 1 ~ p y ppeared the party executing this renunciation and certified that he or she executed the renunc'~tion for the purposes stated within on this ~~~` da of r~ ~,f~ y <~ ~, ~' ,_ J' -~ /' ~' _~~ }~-- ; .~,~ , ro ary & Glerk of Courts 1V1y Commission Ex iresr:, ~:; ; ~mfie~d Boro., Perry Co., PA p i ,+ .:,n~mission Expires tan. 3, 2012 (Signature and SeaC of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06