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HomeMy WebLinkAbout03-24-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS K ;~ -, Estate of ~~ ~,~ G; > ~' 1- ~ c~e.1C ,Deceased ESTATE NO: 21- '~ C=.. :~ ~~ _.'> a/k/a: a/k/a: a/k/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 Testame-_tary or ^Administration c.t.a., or.d.b.n.c.t.a (complete Part Calso) and aver that Petitioner(s) is/are entitled to the aforem tinned Letters ' ~~~-~-c: ,.~`cr,-~~r-~~ under the last Will of the above-named Decedent, dated ~ 1 ~ - C~ _ 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 after execution of the instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(g): O B. Grant of Letters of Administration (If applicable, enter d.b.a., pendent life, durante absentia, durante minoritate) _ , 'i.-.. ] C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survive~he ~` ~~` following spouse (if any) and heirs (1f Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section -ai complete§list a~"~ • ~- heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a p~~y~j~pen i g divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 332 }apt as~~'-llows. c~7 r:; Name Address ; - R ` bi t eced r' ~ ,,.,~.. ,. ~:.. rc r ~~~,.yuw,wi~fai..~rir,r,-~1r 1~C.1"GJJAKY THIS SECTION MUST BE COMPLETED: ent ; .,_.r c~:~ ~ '~'~ Decedent was domiciled at death in Cumberland County, Pen'lvania, with his/her last family or principal residence (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then ~=t `~ years of age, died ~ 3 % I 1 ~ ~ t ~ at C-- ~1- ~S ~~ ~~ (Month, D y, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA All personal 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 Location of Real Estate in Pennsylvania: (Provide full address if possible.) Signature(s) Total Estimated Value ~ L, OC> ~~ . ~:~ CJ Name(s) & Mailing Address(es) GJ~ U ^~ ~~~«~~~~~ r.,~~~~ rtw-ac rcv~sea i~.~o. iu oy ~umoenana ~ounry penatng acnon oy the court -J Page 1 oft Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~v.n~ >G~1 ~. The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine 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. G~ Swe-~ .. io or affirmed and subscribed ~ f ~' Signature ersona R resentative before me the __ /~ day of J' ..~ ~ ~~. {~' ~ i - ~' C ~ ~ Signature of Personal Representative " n _. For the Register SignatureojPersa,alRepresentative Y`i ~";~ "`~ ^' File Number: ,,~.~ /'" ~ j" (`-'~ ~~r .~ -~-~ t,.~, ~ ,:. -~ - , . `s" 1 Estate of „~.,.~~-Y~ C. ~ ~_._..(~~~~ ,Deceased r. Social Security Number: r `7 / - L~~ • f .~ t' ,~' Date of Death: : _~~ AND NOW '•-;,.`~.,~-~ .,~ ~,~; ~ ~•~>,.~ZL, ~ ,> in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT I~ SCREED that Letters '" ~ • ~^ ~ - y ~ ~~ are hereby granted to t(j7/t"c 2~.(~'~/ ~,i~ ,~.c~}=~.,~. ~yi ~ T ,- - ,, _ in the above estate and that the instrument(s) dated "M ''C- described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. .. FEES ~~ --~~ ,~^, ~ ~ • .. , $ ,t~ ,~ ~ Register o" Wills ,, Letters ....... Short Certificate(s) ........ $ ( ~ - Renunciation(s) .......... $ ~" s ~ ; ~: •.l ~ t} ... `x ,. $ ~- `' `> ~' ... $ Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: ... $ ... $ ... $ ... $ ... $ Telephone: TOTAL .............. $ ~ % '~ F~,~„~ Rw-o' rev. lu.l3.or, Page 2 of 2 LOCAL REGISTRAR'S CERTIFICAT'IOIV OF DE'~- W i~ RNIN G: It is illegal to duplicate this cvp~r b~~ p hoto~mtat c:~(° ~-hotoclt+~:):r3 .. (~ee fir th)~ l.hrtifir~itt:. `~(~ C±t) -- _ j-;, ,,,,,,,.,, „r upp ,E (; ) ~ (~i)r.) ~ tt i~ ! ,,i,~(7 i~ ~tt,~,t~~~~-lf~ Uf j~IC~~~,~,~ ~, , ~? l 1-i ) :1~ (~ !9: ~ -'+` I j .I.)Eft i +'} ~ ~~ <(i!1 ~~~ (r ~` ,~ ~, ' J 't ~, <i 1~~t,'ll) ~ ' ~f-t,i `~ ( t sl; , I ~ tlj (ii ~l f+ Ef ii) ( r5) )))i.Ei llt~ (I;fo ~ _ ~~ ` , . , _ . . ,. .,._ P 1729657 - --- ------------._ -.-__. __.... ~y,~~~ ~ / ~ '~4 tit f [ ,/r~ 'Y , ~ ~~ j _ ~ jJ~ '1 7 r ~ z .- i L . ,~ ~t'I'titiCiltl(1fl Nllll)I~+~i ~/j";r'-=" > 7 I r ;~.,... --]~} -1J ~;,t~. ,, F ~ t... _. ~ Tl I"*J ... ~ ^~f ' + A t~ . .. ..., t J ~ l ~ om " '` ..r t~ `~ O ~• Ht05-143 REV 11/1006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE I PRINT IN PERMANENT CERTIFICATE OF DEATH BLACK INK (See instructions and examples on reverse) ~r,r< <„ ~ ,,, ,,,ems„ 1. Name a Decedent (First, middle, last, suffix) 2. Sex 3. Social Setxxiy Number 4. Date of Death (Monts, day, year) Helen E. Hale Female 159- 24- 9718 March 11, 2011 5. Age (Last Birthday) Under 1 r Under t de 6. Dare of Birth Month, da , 7. Bi lace C and state or fo rei coon fia. Place of Death Check one 95 Monms Days HD1f5 Mn'~ March 18, 1915 Mechanicsburg, Pa. Hospital: _ Other: Y~ ^ Inpatient ^ ER / Ott~alient ^ DOA Nursing Home ^ Residence ^ Odter - Spealy: Bb. County of Death tic. city, Boro, Twp. a Death 8d. Fatality Name (If not instiNtion, give street and number) 9. Was Decedent a Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black, White, etc. Cumberland Middlesex Claremont Nursing t& Rehabilitation ( R~°; ; ~ (S0B°M c , e~_) n White 11. Decedents Usual Pion Kind a work d one d - most a I'rfe. Do nd state retired 12. Wes Decedent ever n the 13. Decedents Education (Specify only highest grade txxnp leted) 14. Marital Status: Married, Never Married, 15. Surirving Spo use (If wife give maiden name) Kmd d Work a Bust / Intltrsrtry Seamstress I~anuacturin U.S Amred Forces? Elementary !Secondary (t}12) Co6ege (1-4 Or 5+) yYdowed, Divorced (Sperrly) Wid d . g ^ Yea owe 16. Decedents Mailing Address (Street, city /town, state, zip code) Decedent's PA ~ decedent ~~t Middlesex 1000 Claremont Drive Actual Residence 17a.Stare Liveina ,7c..,~i.Yes,DecedenlLivedin_ Twp Carlisle, PA 17013 Cumberland Township? 17d.^No,DecedentLivedwithin 17b.Counry ActualLimitsa City/Boro 18. Father's Name (First, midde, last, suffix) Gettis Blumanstock 19. Mothers Name (First, middle, maiden surname) Margaret Reed 20a. Informants Name (Type /Print) 20b. Informants Mailing Address (Street, tary /town, stare, zip code) Gary Hale 1578 Baltimore Road Dillsburg, PA 17019 21a. Method of Disposition r ^ Crernalion ^ p~a~ a 21 b. Date of Dispositbn (Monts, day, year) 21c. Place of Disposition (Name of cernefery, crematory or odrer place) 21d. Location (City/town, stare, zp code) ~-Burial. ^ R~avalhomState ~ waacram.uenalwn.tl«~Aa ^ r March 15 2011 Mechanicsbur Cemete g ry Mechanicsbur Pa 17055 F-xarninsr/Co Yes^ No ^ ther-S , . g~ 22a. a Funeral Se (or as such) 22b. License Number 22c. Name and Address of Facitiry • - ~ FD-012662-L Myers Funeral Home, tnc. 37 East Main Street Mechanicsburg, PA 17055 Complete -c ly when certifying a , deaN otxxrrred at the time, date ard{11ace stated. (Sgnature and tills) 23b. License Nunber 23t;. Date Signed (Month, day, year) physkaan re not available at time of death to ~ermy cause a death. ' •~~ J ~ ~\)~n ~ ~G ~', ~ ~i ~ L_ ~ -l ~ ~ 61 Items 24-26 must be txxttpleted by person 24. Tme a Death 25. Date Prawunced Dead (MOah, day, year) 26. Was Case Referred to Medical Examiner / Coster for a Reason Other than Cremation or Dtxration? - wfw praraunces death. / ~ ~ ~`( 1..1 M. C> 2~ - 1 t - ~ t ~r ^ Yes ~IJo , Approximate interval: CAUSE OF DEATH (See Instructions and examples) Part II: F-Mer other ;~gttificaa mndkions contributing to death, 28. Did Ta>acco Use Contribute to Death? Item 27. Part I: Enter the rdtain of events -diseases, kqudes, a txrmptications -that direclry caused the Reath. DO NOT enter terminal events such as cardiac arrest, ~ Onset to Death bN rat resulting in the underfyirg cause given in Pan I. ^ Yes ^ Probably respiratory arrest, or ventricular fibdlWtbn without showing the etiology. list only one cause on each line. , r [~ No ^ Unkrgwn IMMEDIATE CAUSE (Final disease or txxditiat resuPorg in death) _~ v a. ~ ~ r 29. If Female: ~ N r Due to (or as a consequence of): SeouenGaAy Nst conditions. 'rf arty. b. , leadwg to the cause fisted on line a . ot pregrianl within past year nant~time of death ^ . Enter Bte UNDERLYING CAUSE Duero (or as a consequence oft: ~ ~ _ ~ preg 4 but pregnant within 42 days (disease or irNury that initialed the r events resulting m death) LAST. ~' r a death ^ Due to (or as a cortsequer>ce of): r ' _ Na pregnant, txn pregnant 43 days to 1 year r ~ d. r r _ before death ^ Unknown if pregnant within the past year 30a. Was an Autopsy d 3W. Were Autopsy Findings 31. Manner of Death 32a. Date a Injury (Monts, day, year) 32b. Describe How Injury Occurred 32c. Place of Iryury: Home, Farm, Street, Factory, Pe onned? Available Prior to Completion N t l ^ H ka l Office Building, etc. (Specify) a Cause of Death? a ura om t e ~i ^ Yes ~ No ^ Yes ^ No ^ Acadea ^ Pending Investigation 32d. Time a Iryury 32e. Injury at Work? 32f. If Transportation Injury (Speriry) 32g. Location of injury (Street, city !town, state) ^ Suicide ^ Could Na be Determined ^ Yes ^ No ^ DrNer/Operator ^ Passenger ^ Pedestrian M ^ Other - Specify: 33a. Cemfier (check onty one) 33b. Signature and Title of ,e iffier • Cartifying ptryslclan (Physician certifying cause a death when anodter physiaan has pronounced death and completed Item 23) To the best of my knowbdgs, dssM tkcurred due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - • Pronouncing and certifying physidan (Physician both prtxwurxang death and certilyirg to cause of death) 33c. License Number .Dade Signed (Month. day, year) To the best of my knowledge, death oceuned et the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medial Examiner/Corater 11 ~ of / / / / On the bssls of examinatbn and / a Investigation, in my opinion, death occurred at the time, data, and place, and due to the ause(s)and manner as atated_ ^ 34. Nam e and Address a Person Wltc Completed Cause of each (Item 27) Type; Print n ~ 35. Reg' s Signature and ' tiicl umber ~~ / I ~.I / I ~ ~ ~' ~ Z ~I to FileQ (Month, day, year) ' y ! ~ O 1 /~ ~ ~ i ~ ~ Ate? ~ ; , .UUi ~h / ,ZOI d6 U C ~ ~a/d ~ ~ ~ ~! ' ~ U Disposition Permit No. Q/ tU 7`~' LAST WILL AND TESTAMENT I, HELEN E. HALE, of the Township of Monroe, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and "Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor hereinafter named as soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares unto my three (3) grandchildren, namely, GARY G. HALE, TIMOTHY L. HALE and BRIAN E. HALE, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my grandson, namely, CJARY G. HALE, to be the Executor of this, my Last Will and Testament, but if for any reason he should fail to qualify as such Executor or cease so to serve, then and in that event, I nominate, constitute and appoint my grandson, namely, BRIAN E. HALE, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, HELEN E. HALE, have hereunto set any hand and seal to ~ ~ E ~, _...... i i,..~ < ~~ I ti - ...~ t~ ~; i J ~- ~~M . ~_ ~ _::W ~..:... r w c..a this my Last Will and Testament, which consists of this single typewritten page (and attached witness provisions) to which I have affixed my signature this 15th day of April, , A.D., Two ~rousand Ten (2010). _~ ~.' .~ ~''W - `l~ (SEAL) .} ~~a ~'~ Helen E. Hale ~-~~. t..~. ~~' v The preceding instrument, consisting of this one (1) typewritten page, identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by HELEN E. HALE, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each ether, have subscribed our names as witnesses hereto. LAW OFFICES SNELBAKER SC BRENNEMAN, P.C. /~~~ r COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) c ~~~ Testatrix Witness ,, /'f~ r ~!(/fib`/ y~l Witness Subscribed, sworn to and acknowledged before me by HELEN E. HALE, the Testatrix, We, HELEN E. HALE, RICHARD C. SNELBAKER and SUSAN L. MATRAZI, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the T estatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix ~~vas at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. and subscribed and sworn to before me by RICHARD C. SNELBAKER and SUSAN L. MATRAZI, the witnesses, this 15th day of April, 2010. ~~!'11P,~A~'',h:~`~'~'~- ^,' ~ "-~ ~~" ~PhINSYLVANtA _ ~sc~~ ~ =a ::~:~l~~ Sa~rci~ K~ ~#~z:.4~,;~r;~, I'~~~ry Public `~~~ _~ ~ :g~ ,:, r~ y~rc-~ l~c~~~ <?~, 'fit" ~. r ___....... ... _ ~~ Notary Public LAW OFFICES SNELBAKER SC BRENNEMAN, F.C.