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Home My WebLink About04-14-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Larry A. Engberg a/k/a: a/k/a: a/k/a: SS NO: 517-52-1105 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 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): D B. Grant of Letters of Administration (If 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 t~a pending dorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), ~~ as follows: ~''~ -_S, ~-, . t ~ (~. ~~ Name Address R 1 -- e a Dece Diane E. Engberg 5 Mount Rock Road, Newvlle, PA 17241 Wife-~--rn - ~ ,..,._ J _._ ,' ./ ~. ~ ~ . ~ _ _ ~~% 4..-. USE ADDITI "_~ dolt , __.ta ~_:.;: ~ - .. :: ~ ~~ = tI" ' cn ONAL SHEETS IF NECESSARY •-~ °;'1 ~,.; THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 4129 Enola -Road, Newville, PA 17241 Upper Frankford Township (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 64 years of age, died 11/14/2010 at East Pennsboro Twp. Cumberland County, PA 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 (Month, Day, Year of death) Deceased ESTATE NO: 21- ~~ ~ h~ - ~ (City and State where death occurred) All personal property Personal property in Pennsylvania Personal property in County Total Estimated Value $ 50,000.00 $ 50 000.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) 4129 Enola Road, Newville, PA 17241 Signature(s) Name~cl Rr Mailino A.itlraeelncl ,~' Diane E. Engberg v 35~ ~T~ Gzv~.c 2~, e~U~~1 2 Tntarim T'inrm A\II M ~e.....e.d 11 1L to L.. r.__~t__i___~ ~_..._. .. ~. __ _- _ _ _ . J . ~___.. ~_ _~...~. ~. ~, ......J t+v.......b uv..v.. V~ 1114r ~.. VIAI ~ rage 1 of l 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. .._ .p Swoxn to or affirmed and subscribed ~' ~ mm `~~ j~,, ~-, T-, v -.~ ~,-~ ~_a before me this , ~. `h` ' ' ~_ ~ ~ ' , da of --' ~ ~ :~ -.U , :-a ., For the Register --n DECREE OF PROBATE AND GRANT OF LETTERS Estate of Larry A Engberg ,Deceased File Number: 21- ~-''a/~ l I _ ~--~ AND NOW, this ~~ day of (l~' • '' ~ ~ ~ the reverse side hereon, satisfactory proof havi ~ g been presented before me IT IS D ation of the Petition on Testamentary X of Administration ~ ECREED that Letters are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) Diane E. Engberg the above estate and that instruments(s) dated in admitted to probate and filed of record as the last Will and Codicil(s) of Decedent ribed in the petition be lenda Farner Strasbaugh, ~~~~` ,~) .r Register of Wills ~ r ~~l~t :L~~=i.:~t ~', rY~"~_,,, ~; r r.r:~: Letters ....................$ ~L • ~~~~ Will ....................... Codicil(s) .............. . ( ~-) Short Certificates ~ ~ Ct~ (~) Renunciations.......__ ~ (; ~ C'~ Bond ............................ Other ............................ ................................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................ $ b Signature of Counsel Requ,~ed to Atty's Signature PRINTED Name aylor P. Andrews, Esq Supreme Court ID No.: 15641 Address: 78 West Pomfret Street Carlisle, PA 17013 Phone: 717-243-0123 FaX: 717-243-0061 Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2 3105.805 REV (01/f)71 • ~-s,~"""'*"~~ _.-_ ~- LOCAL REGISTRAR'S CERTIFIC i#~'fs:, WARNING: It is illegal to duplicate this copy ~~~~w./ ~~r~~s ~,~ ~~'ee 1~or this certii~icate. $fi.OU ~p~SHOFp~,~ t>(~Ill~ll]I)f) 1)~~re t,iti~~n )s 1 ~ '' r 1 /~~`,~~~~ _ ~.iy~\, r~~l! {'~~rtifi~~)Ce ~If~1)~~ath ~,~'~``'ti ,,~ ~r'_~a~tr(r. ~["he original ,~%' ~~ o ~~ ~ ~ r.'t~~l sf~ tl~c 5tat~~ ti'ital v ~ ~` ~~) ~ ,I~ ,, ,- { P 16855442 ;~o, ~ ,,,, ` ~' -----_ ____ ``'Oq9~ ~~Pti . _ 6 ` Cerhf~)catlc)n 1~lumher :,rMENT OF __ _-.-- _ -- ~ 1 2~~ I_ ~~,~1 lti r Date Issutrd t ~~ ~- _~ __- _ ,, .. ~ sSt~~' r _.} . r. ,~ ' t ~ :::m - ~ ~~ ~~ ,_~ c? ~ t tt. W~ ~ c~ --~ - ` ~ ~` ...rL. _ _ I` 1 ~. ~ _. _~ _ i"" _~ ~ ~.. , ~... t"1"7 ~ . 4 ~~ TYPE /PRINT IN "foslu REV 11~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ""Ti ~r sLACIC INIC CERTIFICATE OF DEATH ~. Ham oeadx~t ( ~ (See Instructions and examples on reverse) ~arry~ .~ng~'erg STATE FILE NUMBER 21~a1e 3' 2 1105 a. oar a oam (Mash, a.y, yar) s. Age (64ekn,dey) MorN' thlder ~ s. oar a Bktll - 11-14-10 "rt D•ri Hours My~ 7• end err a 8a. Prp a oam Check one vim. 6-3-46 Oakland, California "08p"'l` Deter: 8b. County d Death 8c. Clly, Soro, Tjyg. a Dam &1. F ~ ®InpatrM ^ ER / ONpedsnt ^ DOA ^ Nudng Flortie ^ Residence ^ Omer - Spedly: j Cumberland East Pennsboro Holy (Spirit Hospital 9. Wa °BOeder" a °~'"' (H ya, ep.cny Cuban, ~ N0 ^ vas f0. Reoe: American Indrn, aleck, wflne, etc. • ,,. oecederN's usual d wodc done moat d Yfs. oo na arc Mexk;an, Presto Rican, etc.) W~e land a Work 12. Wae Deoedea aver h the 13. Deoeded~a EdurxBon (Specny arily trlgfreet grade ~prrd) ta. Marllel SteUs: McMed, Prof f eSSOr aBuaMlae/ U.S. Ambd Forca7 Ernbnfery / ,, l~voroea /) Mertrd, 15. survwkg Spgpe (n wHe, she ,, name) Dickinson ~",olleg ^ Ya «54a s~raary (a12) 4 (1.a a s+) • f8.oeaMed'aMdipAddras stneet,ay/wam,arr,yPcade) Married Diane Hardy 4129 Enola Load °°°~"~' Penns . oa Decederq Newville Pa 17241 "~ 17e.smr Llvekle 17a.[~Yea,oecedeMlJvedin UAUer Frankford T ~ 18. Femora Name (First, nidde, rat, sulflx 1~• ~A' S~umh P T 1 a n [~ °? 17d. ^ No, Oeadent Lived ainYn T Floyd Engberg ,~~ !~ ACd1a~''a cny/Sara 19. a Neny (Flt 4q ) 20a. krlonnenra Name (Type / Prfit) L~11 S 7. a L'i nd's t r om Diane E. Engberg 20b.lnlornlerM'sMakhgAddroee sh••cdh/rown,arr, aade) • 2,a Mrlmodaorpoeltlon 4129 Enola ~oad Newvi~le Pa. 17241 YE+ Crertxnat ^ DaleBOn 21 b. Der d Drposlnon (Month, day, yar) 21c. Place a ~ • ^ Omer &~ ^ Removal from Srr ~ lNaa Cl'enrMlan a Dartlal Autlarlmd Men1B a ~rrY, aemetay a amer pres) 21d. Locenon (CIry/form, slate, alp coda) bpMadcNExrNrw/CaoreM7 ®Yee^ No 11-16-10 Evans Cremation Services ~'~') 22b. Lkxna Noma„ ~ Nertle ~,, a Farms LeOla Pa ~ FD013945L Ewing Brothers Funeral Home 630 S.Hanover St Carlisle Pa Congrr f>rro 23ac oNy when oer8fykp 23e. o nle Heal a my , deem aoclersd at nr trr, date and PhYarrn r not available at Ikne d deem b Prc• acrd. (Slgrlekse era title) ~ terra d seam. ~ ~~ Number 23c. oar Sgned (Madh, de , • Y Year) Iterro 24.28 neat w conprrd by Person 24. Time a Deem fJ 2s. Der prorloralced Dad (Monet, day, Year) ~ rAq Pronounces deem. 28. Wee Ceee Referred r Medal Exemkep / Coroner kx a Reaean Olher men Cromatlon a Donalbn7 t~(: ov M. No Ve_m fj e~ ~ ~?a t o ^ Ya ®Na _ Hem 27. Part I: Err Bra CAUSE OF DEATH (Sea Inshuctlpna and axrunpla) `..~~ ffilh.~ - dka3eses, kgara, a oonptlcatkar . mat dkarly cased me dam. DO NOT erWer rrmkrl events such as cardac arrest, ~ Approzsnar Marvel: Part II: Eller Deter 28. Dkl Tobacco Use Canbbur to Death9 ~" rsepiratay aneet, a ventrkuler BbrNetlon wl~e slarlrg me enobgy. Uet any ar carn° an each tlne. Onset r Deem ~~~~~~ ~~ a i but rat resultlrp r me urrdarlyinp cause gNan r Pert I. ^ Yea ^^~' a r y.J ~ l 29. If Femab: `, terra Irbd on Ar°mie a. b' i ^ Na prepnent wlmkr Pae1 Year UNDERLYWG CAUSE Due r (a a ( a inkav mat krNferd ma °A' i ^ Pregra>nt al IMne a deem averse ratAWrll M deem) I.AS7. c. r Due to (or ae a ooneaquerrce on: ~ ~ ~~~~ ~ Pregnant wlmin 42 days • r d' r ^ Nd pregnerM, test pregnant 43 days r 1 year ~. WP es~ AubPeY 30b. Wero i bebre deem Aubpey Fkrdkrps 31. a Deem 32e. Date a I ' Month, ^ Ur*rgwn n pregrrent witlrkl the pad yar ~~~ ~ ~ _ AvaNeds Prior r c°mpleha, nNn ( deg Yad 32b. Deecdbe Flow k~ury Ocaxred d Cauca d Dam? 14ehrral ^ Horrrlr9de 32c. Place d k>)tsy: ~, Farm, Sheet, Factory, _ ~C,~ ^ Yee ~No ^ Y,. ^ I,r ^ Aaakr„t ^ 3zd. rkne a l ~ olnce Baikwrg, ex. ~s,~Yyl Perr6rq Invartlgatlcn rMsY 32e. k~lsy at work? 32t, n Tranepalatlon Injay (SpecMyJ U ~ '~ ^ saldde ^ could na w Detennkba M. ^ Va ^ No ^ Ddver/Opanta ^ Passenger ^ Pedeelden ~. l.ocetlon a +njurY (sveel, dy /town, star) a1'. Cartlfler (chadc only °"°) Onrr • Spedy; • TO ~ ~ r10M•dw. daaamnd ddue ro nr~ arnnrsr P ~ p0"01M~ deem and carpleted darn 23) • Slgnaturo end Tine a ., P'°"°'"'d"pa"deaMYNr9Wy~ynl~•~rbam ~e)erwmannarrarad-------- - Aiil oaMykq r aua d dam) - ~/~~ Totlrhatafmyrawladga,daamoxundettMm~dr~ Prq raldwbma ------------------------ 33c.LfcanaNumber u~ ' kladlcal Errrrdnn/Caarr eas(e) and corner a srNd- _ _ _ ^ 33d Der Slgrred (Monet, deY. year) Ontlrbarafaaanrlrrlbnand/a ------------- ~/ rwtloMlon. In my °p+Mal. d.uh ascend x n» P7 Q d / p y s ,- ~ /V ~ ~ r ? GJ~~ ~ Bet., ear, and pre, and drr to ttr i~V oauaa(a) and nrrarer a atatarL ^ 3a. Ns/ny and Addnee d Paean was comp.rd Crre a Dam (Hem 27) Type / Prka ~ Regrtr•r and /~~ N n LH-4 +B . C i.t K .cr ~+J ~ `c I oZ ~ I ~ c3l ~ I ~ d ~ A.d (~ . dY, Y•rJ ~~+) rf~,s r_ /+i v ~t olepagtlp, Permit Na. ` OJ I SIr1 '~F-