HomeMy WebLinkAbout05-04-11IN THE COURT OF COMMON PLEAS OF CUMBERLAI'~TD COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of s /.~. ._ j~,~ "T `' ,Deceased ESTATE NO: 21- ~ ~ ~ ~~
a/k/a: --
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a/k/a: SS NO: ~/ci ~ ~~ -- c ~`~
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
'GSA. Probate and Grant of Letters Testamentary 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 aforementio ed Letters %~'
~ _T ,~.~ err ,~-,~~~ under
the last Will of the above-named Decedent, dated `fiZ .Z 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):
^ B. Grant of Letters of Administration
(1t applicable, enter d.b.n., pendent lite, durante absentia, durante 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 tc- a pendin~~..__dY~~,ivorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g~xcept as fol~vs:
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Name Address Rt~ot ~ hi to D ent ~' ~
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USE ADDITIONAL. SHF.F.TC rF ntFr~cce ov :~
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THIS SECTION MUST BE COMPLETED: ~-
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At ~. a S ~ n pi's' ~~. ~
(Street address with Post Office nd Zip Code, Municipality: Township, Borough, City)
Decedent, then ears of a e died ~// ~'
(Month, Day, 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 $
Total Estimated Value $ ~ ~ .~/ ~`_ ~-`
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s)
Name(s) & Viailing Address(es)
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court ~ Page 1 oft
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 Petitions are true and
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represe,ntative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
befo ~e this ~~~' day of
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DECREE OF PROBATE AND GRANT OF LETTER t ._
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Estate of ~ 1 ~'/c' /` ~ 1. L ,Deceased File Number: 21- ~~ - ~~~
AND NOW, this ~ day of ~ , in consideration of the Petition on
t reverse side hereon, satisfactory proof having n presented before me, IT IS DECREED that Letters
Testamentary of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
l'/ /~' ~ ~ :~ _ _ in
the above estate and that instruments(s) da d % '~ - ;~ ~~'~ described in tht~ petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
Glenda Farner Strasfiaugh, ~,~(~-j
Register of Wills
FEES:
$ ~~ . ~~
Letters .................. .
Will ....................... " C1~
Codicil(s) .............. .
( ~) Short Certificates D~
( )Renunciations.......
Bond ............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE .................. 23.50
TOTAL ................ $ ) `"
Signature of Counsel Required to Enter Appearance
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone: __
Fax:
Interim Form RW-02 revised l 2.26.10 by Cumberland County pending action by the Court Page 2 of 2
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LC~~AL REGISTRAR'S CLR~'IFI~,A~('1~N (~~ ~E~,''"I-
'W'ARNING: It is illegal to duplicate this ~:s~py~ ~y p~?c~to~;tat ~;I' phOtogra~:~l~.
}~e~ for this cl~rtiii~atc~_ S(~.i)(-
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H105-143 REV 11/2008
TYPE /PRINT IN
PERMANENT
BLACK INK
1. Name of Decedent (First, midde, Iasi, suffix)
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
2. Sex 3. Social Security Number 4. Date of beam (Monet, day. Year)
Shirle M. Hartzell Female 210 - 26 -6574 April 9, 2011
5. Age (Last Birthday) Under 1 r Under 1 6. DaM of Bidh Marrm, da , 7. Bi C and stale w f 8a. Place of Deem Check one
76 ~°"'~ D~ ""xe '~'~'~ March 27, 1935 Hospital:
Other:
Yom. Mt. Holly Sprin s,
^ Inpatient ^ ER / outpatient ^ Doa ~NUrefrg Hans ^ Residerxor ^ other - Spaciry:
Bb. County of Deem 8c. City, Born, Twp. of Deem 8d. FadNty Name (tt not instlhttlar, give street and number) 9. Was Decedent of
Hispanic Origin? ~ ~ ~~ y~ 10. Race: American Indian, Blade, White, etc.
Cumberland Carlisle Sarah A. Todd Memorial Home ("''~'~°'''`~"'
Mexican, Puerto Rican, eta.) White
11. Decedents Usual lion Kind of work done d most d hYe. Do not stela reAred 12. Was Decedent ever in the 13. Decedents Eduptlon (Speriy any highest grade completed) 14. Marital Status: Maned, Never Marred, 15. Surviving Spouse (tt wife,
KhW of Work Kind of Business/Industry U.S. Amred Forces? Elementary /Secondary (a12) College (1-0 or 5+) Witlowed, Divorced (Specify) 9~ maiden name) -
GrOCe Store ^ Yes ®Na 8 Widowed
16. Decedents Matting Address (Street, dry 1 town, state, zip code) Decedent's Did Decedent
1000 West South Street Actual Residence 17a. State Pp' Townshi ~ 17c. ^ Yes, Decedent Lived in -_ T
Carlisle, PA 17013 ,ro.Couny Cumberland v' ,7d.[~No,DecedentLivedwimin _ ~
Actual Umits of ~? r~ 1 _e City / Boo
18. Fathers Name (Frst, middle, last, suffix) 19. Momers Name (First, middle, maiden surname)
Ira Cohill Elva Bitner
20a. Informants Name (Type /print) 20b. IMomrenYs Mailing Address (Street, city /town, state, tip code)
Mari7on K. Mattesky 317 N. College Street, Carlisle, FAA 17013
21a. Metrod of Disposttion r Cq Crematbn ^ Deletion 21b. Date of Disposition (Monet, day, year) 21G~ n --
^ Burial ^ Removal tram State i Wu Cramatlon w DorrsHon ArMarized [IOi~p ~"~11~~@L-31 t10Iile iii 21d. Lacatkxt (Cityltam, state, nP code)
^ other- ' byMedlwExammer/Coronn? ^ Yes^ ~ April 12, 2011 Cremato Carlisle, PA 17013
22a. Sigretu Funerel as such) 22b. Licerree Number 22c. Name and Address of Fadlily
- 138504 Hoffman-Roth Funeral Home & Crematory
Complete items 23e n prtilying 23e. To the best of my ,seam occurred a ,date and piece stated. (Signature and title) rl i s 1_ e , PA 17013
physician is rat available at Nme of deem ro _ 23b. Upnse Number -
/ • 'r. 123c_ Date Signed (Monet, day, year)
126. Was Case Referred to Medical Examiner /Coroner for Reason Omer man tan w Donatan7
^ Yes ~ No
'art 11: Enter omer slmifrant candid c contdb rrinq to 3U),
but not resutiing in the undertying pose given in Part I. 28. Dd Tobacco Use Contdbute to Deem?
~s ^ ply
^ No ^ Unknown
_ ~7~'rE~'~„~~Ep f~X"'~ L
- 29. It Female:
^ Not pregnant wtihin past year
^ Pre~ant at 8rrre d deem
^ Not prelprenL but pregnant widrin 42 days
or d
m
ee
^ Not pregnant, but pregnant 43 days to 1 year
before deem
^ Unknown ti pregnant wimin me pest year
32c. Place of Injury: Home, Farm, Street, Factory,
office Build'mg, ero. (Sperily)
^ Yes t-I no ^ Yes ^ A~~I ^ Pen3 Inver' ton 32d. Timo of Irgary 32e. I 'u et Work? 32r. N T Wry (Specify)
^ No n8 trga' 'M ry ransportation In'
32g. Loption of injury (Strsret, city /town, state)
^ Suicide ^ CoWd Nat be Detemdned ^ Yes ^ No ^ Ddver/ Operetor ^ Passenger ^ Pedestrian
Y cause of deem.
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items 24-26 rtwst be completed b1' person
who pronounces death. ~
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24. Time of Deem ' _Lp"I
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25. DaLte , / ~ / ( ( m, day, y'earl 1
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CAUSE OF DEATH (Sea InstruMlon and examples)
fleet 27. Part I: Enter tire chain of events -diseases, kyuries, w cortpfications - mat drectly caused me death. DO NOT solar terminal events such as prrNac ane
t ~ Approximate interval
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respiratory arrest. or venhicular fibrillation vritirout slowing the etiology. List any one cause on each Nne. i Onset to Deam
IMMEDIATE CAUSE (Fetal disease w C
condition resuHing in rleam) L~ p D r
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Duero (w as a ur
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BeNV Nat mx9tlons, if /
lea ro the pose Meted on Nine a. b' ` ~ ~ i '~
Eller UNDERLYING CAUSE Due to (or es a conaequerxx of).
(disease w Injury that Initiated the r
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events resuMing m deem) LAST.
Due to (or es a consequence of):
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30a. Was an Autopsy 30b. Were Autopsy Flndirgs 31. Manner of Deem 32a. Date of Injury (Month, day, year) 32b. DescrPoe How In'u Occurted
Pedomred? Available Pdor to Completion l ry
of Cause of Deem? Naturel ^ Fromicide /
dd
L
M' ^ Omer - Spedly:
33a. Certlfler (dxsdc any one)
• ~YIrt9 PM'+k~ (PhY cenNying pose of deem when erotiter ptryskien eras Prwourtced Beam and 33b• Signature rn
To the bast d my lorowledge, deem occurred due to the cartgieted fleet 23)
cause(s)andmannerasststM---------------------------------
• Pronouneing and aartlMng PhY~n (fin bdh Pr«wundrg dim and prtny;,g ro pose of deem) 33c. Lkense Number 33d. Date Si
To drs bast of my laroarladge, death oecurtad et Ura tlme, date, and place, and due to the ^ (Month, day, year)
• MMkall.xaminar/Cororrar ~aNs)andmannaruststad-'---------------- a.ln"~V~~~J~~G'-~ ,~.~I ~tp
On 1M Mats of axsminstlon and / or Imestigatlon, in my opinbn, d~tlt occurred a< the Uma, rlete, and place, and due to the
eausa(a) and manner as stated_ ^ 34. Name and Address of Person Who
completed Cause of Deam (nom 27)1'ype /Print
35. Registrera and .Date Flled (Monet. day, Year) ~"' IiJ~.i ~ S~. KHtiIF~ ice` , W/I10
k! ~.c~~~ -~ ~ t ~..~ ~ r ~ ~ ~ ~ IqZ~ sP'K~a.rL ~~ cl~L.~stiiz, /~ i
Disposition Permit No:. l 1 C~ ~~ "1
LAST WILL AND TESTAMENT
of
Shirley M. Hartzell
I, SHIRLEY M. HARTZELL, of South Middleton Township, Cumber:larid County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly
revoking all Wills and Codicils heretofore made by me.
1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my Executrix to sell any realty owned by me at my death,
and not specifically devised herein, at either public or private sale, and to give good and
sufficient deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate to my
son, RODNEY LEE HARTZELL, and if he is not living at the time of my death, to 1'VIARION K.
MATTES KY.
4. I nominate and appoint MARION K. MATTESKY to be the Executrix of this my Last
Will and Testament; she is to serve as such without bond.
5. I hereby suggest that my personal representative retain the services of~ Irwin &
McKnight as attorneys in the settlement of my estate.
ACKNOWLEDGMENT AND AFFIDA VIT
WE, SHIRLEY M. HARTZELL, CHERYL L. CLELAND and SHARON L.
SCHWALM, the Testatrix and witnesses respectively, whose names are signed to ithf; 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, that she had signed
willingly, that she executed it as her free and voluntary act for the purpose herein e~,pressed, and
that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a
witness and that to the best of their knowledge the Testatrix was, at that time, eightef~~i years of
age or older, of sound mind and under no constraint or undue influence.
~.
S R M. HARTZ
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C YL L. CLELAN
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SHARON L. SCHWALM
COMMONWEALTH OF PENNSYLVANIA
SS:
COIINTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by SHIRLEY M. HARTZELL, the
Testatrix herein, and subscribed and sworn to before me by CHERYL L. CLE:LAND and
SHARON L. SCHWALM, witnesses, this ~-''"' day of January, 2007.
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Nota y Public
COMM JNWEALT OF PENNSYLVANIA
~, _ rial Sea!
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Oct. 3, 2008
Member, Pennsylvania ~+ssociation Of Notaries
3
IN WITNESS WHEREOF, I have hereunto set my hand and seal this _ `v ~ day of
January, 2007.
~ ~~
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SHI EY M. HART LL
Signed, sealed, published and declared by SHIRLEY M. HARTZELL,, the above-
named Testatrix, 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 other have subscribed o~ur~ names as
witnesses hereto.
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