HomeMy WebLinkAbout06-10-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of D Q V •~ (~ U . ~n n~ _~ ,Deceased ESTATE NO: 21- -
a/k/a:
a/k/a:
a!k/a: SS NO: ``T ~ ~ ~ ~ 2 _ `1
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 t.,,,
a .-"
f~n
(State relevant circumstances, e.g. renunciation, death of executor, etc.) ~ f-- i~^ --
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after e,~e t~t of t~ ~~:':::
instruments offered for probate; was not the victim of a killin was never adjudicated an inca acitated ers .~ ~ e~vas not a ~ ~ ~ i`'~
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been esta>~ defi'i~d in `~'°~
23 Pa. C.S.A. § 3323(g): ~~ -~ ;~:;:
1"`~'. 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 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:
Vame
address
'ut
S
~ ~ Gi ~ un nciauvusm w Lecea~
TTCTi ATTiTil11UA 7 eIIL`L`mG~ iT.` 1-TT /'.T (~cr . Tc)
THIS SECTION MUST BE COMPLETED:
Decede t was domiciled at de th 'r~ C f
At 1 ~ 21 ~l ,~ r-~h ~ i ~+ -~
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then ~p ~ years of age, died ~ z , Q ~ ~ 2. ~ ~ ~ at l.. °~,, bQ Yl 0 !1 ~~
(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 $ _~,~'~jt ~~
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 $ 0.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Srej~s,)
lvania, v~th his/her last family or principal residence
f c-~ -
Interim Fnrm RW_!17 ro.,,~oa 17 7~ in 1... n......t,._i.._a n_---`-- --_-''-- .. ..
-- -----~ r----...a ...,...,...,, ...., ~.,,., ~ rage 1 of Z
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.
Sworn to or affirmed and subscribed
before me this ~ da of
^ ~,
-o . ~
For the Register
r`''m
~~~
DECREE OF PROBATE AND GRANT OF LETTERS ~o`
~~
f ..
Estate of ~j ~ d {'~ ~,!(~~ ,Deceased File Number: 21- ~ I ~~`' ~ ~ La
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AND NOW, this ~~day of t_ Cf Vl~ r~E J ~ j , in consideration of the Petition on
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters
Testamentary ~ of Administration are hereby granted to:
~,,' ~,, (If applicable, eater c.t.a., d.b.n., d.b.n.c.t.a., etc.)
_4~-~~ 1'~~L ~ ~ 0' y~,0~ in
the above estate and that instruments(s) dated described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
„~lGrr~ r~alvrLr~ ~tra,U~l~7
~'lenda Farner Strasbaugh, ~"
Register of Wills `~~ ~~'~~
FEES:
Letters ....................$
Will .......................
Codicil(s) .................
(~) Short Certificates ~ • (~
( )Renunciations.......
Bond ............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
~d
TOTAL ................$ ~--~Q-
Signature of Counsel Required to Enter Appearance
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 1054090
Certification Number
This is to certify that the information here given is
correctly copied from art original (Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
L ~ix~ Q~ ~ • F $ 2010
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Local Registrar Date Issued
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H105.143 REV 11!2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TMPE~RM NIE~NTiN
BLACK INK CERTIFICATE OF DEATH
(See instructions and examples on reverse) RTATF FII F NI IMRFF
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1. Name d Deaderd (Fksl, middle, bat, su66c)
David B. Jones 2. Sex
MALE 3. Sodel Serxxty Nuttba
466 _ 82 _9719 4. Date d Death (Mash, day, year)
February 4, 2010
5. Age (Last &rntd.y) Under 1 Under 1 de 8. Dote d BMh (Mash, ~ 7. Bktliplece ( end able a ) 8e. Place d De.6t Check only one)
62
tom.
wrxa.e
Apri 1 4 , 1947
Virginia HoaplW: OIMr:
Yre ^,,,~„~,,, ^ ER / oulpaaertt ^ DOA ^ Nuraktg Hans ^ Reeidena [~lotner - 0 S P I C E
8b. Cotxtly d Doh 8c. CNy, Boro, Twp. d Deatlt 8d. Faedoly Name (9 nd tatlarNon, give streN and amber) 9. Wee Decedent d FliepeMc Origin? ~] No ^ Yes 10. Roca: Amarkxet Inden, Black, wltNe, etc.
LEBANON S0. LEBANON TWP VA MEDICAL CENTER (g~•'~'~'°"• (Sp°`~white
Mexican, Puerro Rkxm, ero.)
it. DeadertYa !kart d wak date moat d Ws. Do rtd attle 12. Wee Dscedwtl aver ro the 13 Daadwa's Eeltcstlon (Beady arty ttigtteet grade arnpblad) 14. MerMl Smw: Menisd, Never Mertbd, 15. survwing Sparce (n wife, give msklen name)
lOnd d wade qnd d ~'"kr" / kideey
Owner/Operator Painting Co. U.S,.~A{~rmW Farce? Eyn,~, / Seeortdery (o-12) CaNege (1-a «5+) ~OWSd~ ~~
~+}res ^No 1 Divorced
16. DaadwBe Mefirtg Addreee (Sheol, dy /roast, mme, rlp code) Dsadertra Did Daadent
1121 North Pitt Street "~'°' R.rdana "` sob
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17 ^'r°°, °~e0e1N 1•"ed M r"~.
Carlisle, PA 17013 er an
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,m.coanty "d~~ ~a d"""~" Carlisl
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CNN / Bao
18. Faeces Name (Fkal, rttidde, beL aANx)
Harry Howard Jones 19. Mo6rr's Name (Fkat, midrib, nriden atarrme)
Elizabeth Bruce
20e. Infomtanrs Name (Type / PdnQ
Jason Jones 20b. InfonanYe trbNrg Addreea (Basel, cNY /roam, dente, bP code)
123 East Main Street, Shiremanstown, PA 17011
21a McBtod d Dhpodliort ^ CremaNm ^ Dorrtlort 21b. Deb d Obpodtlat (Manlh, day, year) 21c. Place d
Dbpoei9at (Nana d ametsry, aemalay a otlbr place)
21d. Laalbn (Gy /town. sbb, ~P txde)
~Burw ^ hard w«aawl~, Feb. 10, 2010 Indiantawn Gap Nat'l Cemetery Anriville, PA 17003
^ ^~^~
~e• F'"'"a °~ ° ~'') ~• I'a'"' "~ ~• Ndne ~ Adae~ d Fey Hof fman-Roth Panora Home & Crematory, Inc
- 138504 219 North Hanover Carlisle PA 17013
CaIpMN Mrrr aNy wltert ad6yktg 23a. To the beat d ml' krtoaledge, des6t ocaered al the tlme, dab and plea slated. (Sigrhaa and Ntle) 23b. Lkxirtse Ntanber 23c. Deb
Yom)
day
~~ (gym
phyeldart b not avalahb at tlme d death ro .
,
arlKy revs d death.
Mena 24.26 must be alrpleled by person 24. Tlms d Death 25. Deb Prataawrod Dead (Month, day, yep 28. Was Case Retorted ro Marital Examkbr /Coroner for a Reason Otlbr than Crema6at a Donatronl
wtta f~rartae,taee aebh. 11:2 5 A M rN. February 4 , 2 010 ^Y~ QN~
CAUSE OF DEATH (Sea Instrttatlona and sxamPba) r Approdmate kderval:
hen 27. Pan I: EnNr the Id18O d awnb - dleaeaea, ktjtefea, a atargNaaoM - 6W dkactly eased 6r deatlt. DO NOT ceder temtinal everts eudt ae ardiec arrest, r
Orteel b Deelh Pad N: EMar eater
but not reaultlng b the udetlying ease given in Part L 28. Did Tobacco flee Conabtde ro Dee6t7
~ Yea ^ Pmbehly
raapirabry arrep, a venMCder hbrlNa9ort wletout ettowlrtg the etlobgy. l bt ardy ar carve on each Mrte. r
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deatl,)'
art
S q u a ID o u s Cell Lung Cancer ~
reeal6rt 29. H P
b:
a
Due to (a es a txxtaequertca d): ~ ^ Not pregnant wilhit pest year
Net artel0ons, 6 arty, h, r
~b a aw Nbd an Nns e. r ^ Pregrterd at tkrr d death
11I~ERLYINti ~~ Duero (« as a oateegrrnce d): r
^ Not pregnant, but pregnant widtkt 42 days
~tryary~aeaae,s «~u ~ lsya~ ~ r
ivenb reeuMip7rn death) LAST. c• r
r d loth
Due to a as e
( ooruegtrerta af): t
r ^ Not pregnerd, but pregnerd 43 days to 1 year
d.
r bdore deeM
UNotowrt q pregrrM wltltkt the D••t yr
31b. Was an Auropey
Perbmts07 30b. Wars Auropay FktArtge
Avaibbls Prig ro Cmtplelfan 31. Memer d DesM 32e. Deb d kthay IMan~, deY, Y•s~ 32b. Deeabe How inN7 ~~ ~ 32c. Pba d atjury: Flome, Farm, , Factory,
d Caere d Death? St,.,.~.~~
A,A"°""°' ^ Hank9de D~ B ero. IBPedy)
^ Yee [~ No ^ Yes ^ No ^ ~•nt ^ Pwtdng Irtveetlgeaon 32d. Time d lNurY 32s. tnhxl' el Work9 3N. M TrmepoMtlon ktitxy fSpedty) 32g. Lacetion d Injury (Btreet, coy / rover, state)
^ Stidde ^ Cotdd Nd be Detemthed ^ Yes ^ No ^ ref / Operate ^ Peaenger ^Pedesden
M Otlter - Spetsly:
33a. CeN6er (dtedc sty ate) 3~. Siprbaae and of Certifier
• ~Mn6 I~rY•kd•n (PMdcien w ease d aea6t when artoma pttyeldan has praqunced death end anple(ed Item 23)
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To tlb a.al a my krwwladge, aa6t ooaaree a lne 6me, dam, «a elec., ana a,e l0 6,e auae(e) and m.rner a. sbb4- - - - - - - - - - - - - - •. - - - w
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