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Home My WebLink About07-06-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of DIANNE K. LIBERATOR 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 Testamenta-y or ^Administration c.t.a., or d.b.n.c.t.a. (complete Part C alsol and aver that Petitioner(s) is/are entitled to the aforementioned Letters __=_ tnider_ _" ~~ the last Will of the above-named Decedent, dated and codicil(s) dated ~ ~- T~, ~: `' 1r..,. i l l~r :T -~v- ~..~ r._ _;~~m ~ (State relevant circumstances, e.g. renunciation, death of executor, etc.) _=- tr~~ ~ o Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after'" Ttionafithe ' instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated p~~~and was not a_;-~ -~ party to a pending divorce proceeding at the time of death wherein grounds for divorce had been est~l~hed as ~fine~l 23 Pa. C.S.A. § 3323(8):_ .`~ ` ' -ri .. D B. Grant of Letters of Administration RENUNCIATION FOR NATHANIEL L. LIBERATOR ATTACHED HERETO (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.~.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(8), except as follows: N/A Address Relationship to Decedenx NATHANIEL L LIBERATOR `PO sox loon, HOUTZDALE, PA iSON JEREMIAH R. LIBERATOR 170 E. PENN STREET, CARLISLE, PA 17013 SON PORTIA A. LIBERATOR 27 N. PITT STREET, CARLISLE, PA 17013 (DAUGHTER ~ IALICIA A. LIBERATOR (AGE 16) 170 E. PENN STREET, CARLISLE, PA 17013 DAUGHTER l SE ADDITlON:1t, SHEETS IP NECESSARY TH[S SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At 170 E, PENN STREET CARLISLE BOROUGH CUMBERLAND COUNTY PENNSYLVANIA 17013 {Street address with Post Office and Zip Code, Municipality: Township, Borough, Cityl Decedent, then 54 years of age, died 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 5/29/2011 SS NO: 204-46-5831 CARLISLE, PENNSYLVANIA (Month, Day, Year of death) (City and State where death occurred} All personal property $ ___ 261500_00 Personal property in Pennsylvania $ Personal property in County $ $ __ 68,500.00 Total Estimated Value $ - 95,000.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) 170 E. PENN STREET, CARLISLE, PA 17013 Name(s) & Mailing Address(es) .-~. ~/~~ ~ ,~ ,%`~, `~ '~~ ~JEREMIAH R. LIBERATOR, 170 E. PENN ST., CARLISLE, PA 17013 PORTIA A. LIBERATOR, 427 N. PITT ST., CARLISLE, PA 17013 ~ lid p~ Pa~~e ~ of2 Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court - ~ y Deceased ESTATE NO: 21- 't ~ ~ _ OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania = SS County of Cumberland ~~ ~'- Estate of DIANNE K. LIBERATOR ,Deceased File Number: 21- - ;. _ :~,; ~.. ~ c, _V, AND NOW, this day of , in consideration of the Petition on tree reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary x of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) JEREMIAH R. LIBERATOR AND PORTIA A. LIBERATOR _ 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. Glenda Farner Strasbaugh, Register of Wills 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 FF,F.S• Signature of Counsel Required to Enter Appearance ~.etters ....................$ 210.00 W'ill ........................ t"odicil(s) ................. (2 )Short Certificates 8.00 (1 )Renunciations....... 5.00 Bond ............................. Other ............................. Automation FEE......... 5.00 JCS FEE ................... 23.50 TO"hAL ................$ 251.50 Atty's Signature PRINTED Name: DOUGLAS G. MILLER Supreme Court ID No.: 83776 Address: 60 WEST POMFRET STREET CARLISLE, PA 17013 Phone: (717)249-2353 Fax: (717) 249-6354 Intenm Farm RU'-U2 revised 1226.10 by Cumberland County pending action by the Court Page 2 of Z DECREE OF PROBATE AND GRANT OF LETTERS 105.905 REV,t 17111 This is to certify that this is a True copy of the record which is nn file in the Pennsylvania Department of 1-Iealth, in accorcianc~ with the Viral Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. r.~ O c.~ _, r' 2¢ t ' r c _ -- J ~- ' ~ _L ~ 6 5 4 ~ ~ _ ; _ ' _ c t .__. U Marina IJ'Rcilly Matthec~~ Actim~ .`Mate Registrar JUN 1 fi 2011 1~ ate ~~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS O4~~705 H106.144 REV 11f2006 V ? TYPEIPRINnN - CORONER'S CERTIFICATE OF DEATH PERMANENT BLACK INK (See instructions and examples on reverse) STATE FILE NUMBER 1P33-03~ 2. Sez 3. Social Secudty Number 4. Date of Death (Month, day, year) ',. Name of Decedent (First, middle, last. su~zl Ma 2 9 , 2 ~ 11 Dianne K Liberator Female 204 -46 - 5831 Y 5. Age (Last Bldhday! Under 1 year Under 1 day fi. Date of Bldh (Month, day, year) 1. Bldhplace (City and state or foreign country) Ba. Place of Death (Check only one) Hospital. Other. Nunths gays Nours Minutes 54 Yrs. November 26 1956 Harrisburg, PA ^Inpatient ^ERIOulpatienl ^DOA ^Nursing Home Residence ^Other-Specity. • Bb. County of Death 8c. City Boro Twp. of Death Bd. Facility Name Qt riot insEaufion, give street and number) 9. Was Decedent of Hispanic Odgin? [,~ No ^Yes 10. Race: Amedcan Indian, Btack, WhAe, etc. Qt yes, specity Cuban, ri (Specily~ ` • 170 E. Penn Street Mezican,PuedoRican,etc.) White 1 Cumberland Carlisle 11. Decedent's Usual Oceucafion Kind of wok done Burin most of wodeing life. Do not stale refired 12. Was Decedent ever in the 13. Decedents Education (Specify Doty highest grade completed) 14. Wi owed, D vorced (Specd}~r Marred tE. Surviving Spouse pt wife, gore maiden name) Kind of Work Kmtl of Business I Industry U.S. Armed Forces? Elementary 1 Secondary (012) College (1-0 or Sr) Disabled Disabled ^Yes ~Nq 12 Divorced Decedent's Ditl Decedent • tE. Decedent's Mailing Atlgress (Street, city I town, state, zip code] pA Live in a 17c. ^Yes, Decedent Lived in T'ro~ 170 East Penn Street Actual Resitlerrce tla. Slate Township? PA 17013 ty Cumberland 17d~Nq,Decetlentuvetlwanin Carlisle Carl i s 1 e , 11b. Coun Actual limbs of CAy I Bom • 18. Fathers Name (Firs; middle, last. suffix) 19. Mothers Name (First, middle, maiden surname) Annamay Bullock John V. Shoemaker III 20a. Informants Name (i rpe 1 Pdnq 20h. Informants Mailing Address (Street, city I town, state, zip cede) Jeremiah Liberator 170 East Penn Street, Carlisle, PA 17013 2t a. Method of Disposition ~' ^ Cremation ^ Donation 21h. Date of DisposNdn (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Loafon (City !town. state, zip code) o~ Burial ^ RemovaltromSrste j WasCremationorponationAuthorized June 4, 2011 Prospect Hill Cemetery Newville, PA 17241 • ^ Other - eciry~ '~, by Medic r I Coroner? ^Yes ^ Nq pylaay~ae a a ~ 22a.Signa ofF neralServ~ceLice a cfingassuch) 226, License Number OLLR1dR `~Ot~h"Funerdl Home and Crematory Inc. 219 N. Hanover St. • ~ 138504 ' 23b. Ucense Number 23c. Date Signed (Month, day, year] Co lele Items 23a- nl+ when ceditying 23a. To the best of my knowledge, death occurred at the time, date and place stated (Signature and title) physician is not avaiWble at time of death to cediry cause o'. death. 24. Tme of Death 2E. Dale Pronounced Deatl (Month, day, year) 2E. Was Case Refered to Medical Examiner I Coroner for a Reason Other than Cremation or Donatign? • Items 24-2E must be completed by Derspn ~ Yes ^ No • whoprarognceatleatd. A rx. 4: CC A:^ Ma 29, 2011 CAUSE OF DEATH (See instructions and examples) i Approximate interval: Pad II: Enter other significant conditions contributing to death, 2E. Did Tobacco Use Contdome to Death? r Onset to Death but not resultin in the unded in cause iven in Pad I Yes ^ Pmbahiy hem 21. Pad I Enter the chain of events -diseases, injuries, or complications - Ihaf directly roused the death. DO NOT enter terminal events such as pNiac arrest, r g y g 9 ^^ No ^ Unknown respiratory arte5. or ventricular fibrillation wAhou! showing the etiology. List only one cause on each line. r r IMMEDIATE CAUSE IFinal disease or r 29. II Female: conddion resorting indeathj ~ a. Pending Investigation i ^ Not pregnant wtlhin past year Due fo for as a consequence ol): i ^ Pregnant al time of death Sequentially list conditions, if any. 6, r ^ Not pregnant but pregnam wtlhm 42 days leading to the cause listed on line a. r Enter the UNDERLYING CAUSE Due to (or as a consequence op: r of death !disease gr inNry that indicted the c. r events resulting in dealt! LAST. r ^ Not pregnant, but preonan143 days tg 1 year Due to (or as a consequence oq~. r before death r d , ^ Unknown if pregnant with'm Ne past yea! 32a. Date of In u Month, tla ear 32h. Describe How In u Occurred 32c. Place of Injury: Home, Farm. Street, Factory, 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death I ry ( Y. Y 1 I ry 09ice Building, etc. (SpecifJl Performed? Available Prior tp Completwn of Cause of Death? ^ Natural ^ Homicide 32d. Line of In u 32e. Injury at Work? 32f. If Tmnsponation Injury (SpedryJ 32g. Location o! Injury (Street, city 1 town, stale) ^ Accident ~ Pending Invesllgatian ! ry Yes ^ No '^ Yes ~ No ^ Driver! Operator ^ Passenger ^Petlesidan ^ Suicide ^ Could Not be Determined M ^Yes ^ No ^Other ~ Specity' r 33a. Cedifier (check piny one) 336. Signature and Title at CerMR~-', Certitying physician Physician cedifying cause of death when another physician has pronounced death and wmpleled Item 23) ' ~ •lll/l••Yl(/_r( one r To the best of my knowledge, death occurred due to the cause(s)and manner as stater~________________________________ ^ Pronouncing and cedih/ing physician (Physician both pronoundng death and cediMng to cause of death) 33c. License Number ,~ 3stl. Doty igned (M' nth, day, year) To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ Ma 31 2 ~ 11 z o ~ Medical Examiner I Coroner On the basis of examination and I ar investigation, In my opinion, death occurred at the time, dale, and plarn, and due to the causef s) and manner as stated_ 3q Name and Address of Person Who Completed Cause of Death ptem 27i Type I Pdnt Todd C. Eckenrode, Coroner 35. Re arasignatareandD dc~ mbe~ 3EDteFaed(Mgmn.~y,yea<I 6375 Basehore Rd., Suite ~`1 w ~ ~ "9- ,~ ,(1. ~ t_91! 1.,71 I l~ I -~ __ ~nfl „--,-----_t_--- „_ „~~r, z /j ~/7' , Disposition PermO Nq. O (LY 1 "®~ 05-31-2011 14:42 FROl~hIRWIN & f~IcKNIGHT LAW OFFICES +7172496354 T-936 P.002/002 F-954 RENUNCIATION ~'o ~-~ _.. ~~. ` - - ~ _ ~ -;, ~=_s REGISTER OF WILLS z, v m ~ ~-;~ ? .,~ `J'i -~ CUMBERLAND COUNTY, PENNSYLVANIA --, ~~ T - _ --i `~ ~; ' t D _ . Estate of DIANrdE K. LIBERATOR ,Deceased 1, NkTI7.~.NIEI_. L. ,LIaER<:TOR , i:Z my caraciry/rc1_ati^^ship as (Prin! Na+heJ ADMINISTRAT~JR of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to PORTIA A. LIBIF'RATOR AND JEREMIAH R. LIBERATOR ;' (Dalel Executed in Regi'ster's Office Sworn to or affirrt1ed and subscribed before me this _, day of Deputy for Register of WiILs (SlgnarureJ ~ ''~ PO BOX 1000 (So-eel RddressJ HOUTZDALE,PA (Crry, Sale, ZipJ Executed out of Register's Offtre 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 /, Notary Public My Commission Expires: (Signuturn :utd Seal of Notary orothcr official quulifed to admittistof oaths. Show date ofexpiration ofNotary's C;nmmissiUn.) COMMONWEALTH Ot` PENNSYLVANIA NOTARIAL SEAL ROBERT W. PARKS, 111, NOTARY PUBLIC 1~'orm RW-06 rev. 10.13.~7G WOODWARD TWP.. CLEARfIELD COUPITY MY COMMISSION EXPIRES DEC. 1, 2G12