HomeMy WebLinkAbout07-06-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
Estate of
a/k,!a:
a/k ~a:
a/k.!a:
PETITION FOR PROBATE AND GRANT OF LETTERS
Arthur A. Zimmerman ,Deceased ESTATE NO: 21- 1~ ~ l ~ ~~,i
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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 e.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 r-- ~ _._ _~ , _-~r-~
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(State relevant circumstances, e.g. renunciation, death of executor, etc.) ,. Uj X Cf~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after.~~a~cat ion of the ;
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated persb'rd was--not a _ ~ ,~-;
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been estai'il~ed as defined a~~ m
23 Pa. C.S.A. § 3323(g): ~ _. ~~ Q
[] B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent life, 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 e.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:-
Relationship to llecedent
name
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USE ADDITIONAL SHEETS IF NECESSAKY
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At 1408 Carlisle Road Cam Hill PA 17011
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then 71 years of age, died 6/24/2011
(Month, Day, Year of death)
Harrisburg, PA
(City and State where death occurred)
Estimated value of decedent's property at death:
If domiciled in PA All personal property $ _ 0.00
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.) 1408 Carlisle Road, Camp Hill, PA 17011
~iomture(sl
Name(s) & Mailing Address(es)
Zachary Campbell, 3211 North Front Street, Harrisburg, PA
~~.
~~
Interim form RW-02 rerised I? 26.10 by Cumberland ('ounty penq~ng ncuon ~y me ~ pun
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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 m~ this L ~ ~ day of ~? ~ c-
r.
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For the Register ~ `~ Y• ` -- ~'
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DECREE OF PROBATE AND GRANT OF LETTERS
Estate of Arthur A. Zimmerman ,Deceased File Number: 21- " s - f f _~
AND NOW, this fit `' day of _, ~ a ~ , in consideration of the Petition on
the reverse side hereon, satisfactory proo awing een 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.)
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
r ~ ~,_
Glenda Farner Strasbaugh, ,~ a' f %~, f. ~ 1 ~ 1G_ 1
Register of Wills
~ ~
FEES:
~,
Letters ....................$
Will ........................
Codicil(s) .................
(~ ~) Short Certificates ~ i~T~°
( )Renunciations.......
Bond .............................
Other .............................
Automation FEE......... _ U
JCS FEE ................... . 0
TOTAL ................$ 28.80
Signature of Counsel Required to E,~ter ABpj~arance
Atty's Signature ~ _ /'~
_ ,'
PRINTED Name: Zachary ~. Campbell
Supreme Court ID No.: 93177
Address: 3211 North Front Street
Harrisburg, PA 17110
Phone: 717-237-8187
Fax:
Interim Form RYb"-1)? revised 12?6J 0 by Cumberland County pending action by the Court Ya~e Z of
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P 17557314
3 REV 11I200fi
/PRIM IN
3MANEM
ACK INK
JUL062011
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
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7. Name of Decadent (First, mitltlle, Ias4 suffix) 2. Sex 3. Sodal Security Number 4. of Death (Month, day y er)
Dl /
Arthur A. Zimmerman male 191 _32 ,_ 9837
5. Age (Last Birthday) Under t ear Under 1 de 6. Dale of Birth Month, de , ear 7. BiM lace Ci end state or fore) count 6a. Place of Death Check on one
MaThs Days Hours Minutes Hospital: Other'.
Jan. 24,1940 Licking Creek, PA ~l/
71
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Nuraim Hpme
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Residence
Other - Specity
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66. County of Death Bc. Clry, Boro, 7wp. of Death Bd. Facility Name (If not inslRutlon, gNe sheet and number) 9. Was Decedent of Hispenk Origin? Ne '~ Yes t0. Race. American Indian, Black. Whife, etc
Dauphin Co.
Harrisburg
Harrisburg Hospital (Ii yes, spec'rfy Cuban,
Mexican,PUerteRipan,atp) ( r(j7
w~i`ite
11. Decedent's Usual Occu tion (Kind of work d one B unn most of wondn IHe. Do rat state retired 12. Was Decedent ever in the 13. Decedents Education (SpeciTy only highest grade compl eted) 1d. Mental Status: Married, Neves Married, 15. survrvmg Spo use (If wile, give maiden name)
Kl dof Wo
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Kind of usiness/Intlustry
c~e
e us. Armed Forces?
Elements (Secondary (412)
~
College (1-4 or 5+) Widowed, Divorced (Speciry)
argaret Hall
ec
n
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a
au
o car
a
r ^ Yea Np 1 married
16. Decedents Mailing Address (Street, city I town. state, zip code) Decedent's Did Decedent
Pennsylvania
Lower Allen
QQ
1408 Carlisle Rd. Live in a „q.
vea, Decedent lived in
Actual Residerae 17a. State
Twp.
Cum er an Tpwnahro?
17d. ^ No, Decedent Lived withm.
Camp Hill, PA 17011 176, County
Actual Limits of Ciry/Bore
18. FatheYS Name (First, middle, last, suffix)
Earl H. Zimmerman 19. Mothats Name Flret, mi die, maiden surname)
Mae ~unn
20a. Informant's Name (Type / Print)
Margaret Zimmerman 20b. InlormanYS Mailirg Atldress (Sheet, city /town state, zip code)
1408 Carlisle Rcl.,Camp Hil1,PA 17011
21 a. Methotl of Disposition ^ Cremation ^ Donation 21 h. Date of D'aposition (Month, day, year) 21 c. Place of Dispostion (Name of cemetery, crematory or other place) 21 d. Location (City /town, state, zip codel
~.Bunal ^ RemovaliromState r WeeCremaNOnorDOnadonAUthortxed
^ line 29, 201 1 Tri-County Mem. Gardens ewisberr
PA1 7339
^
No
r- S ' by M•dlcal Exemlrrerl Coroner? ^ Ves y,
azure of Funere nsee for person acdng es such) 22b. License Number 22c. Name and Address of Facility
D-013163-L Musselman FH&CS,324 Hummel Ave.,Lemoyne,PA 17043
omplete Hems 23a< only when certltying
physician is not available at time pl death Io 23a. To the best of my knowledge, death owurtad at the fime, data and place stated (Signature and fide) 23b. Licensg~rrl~ ~ ~
/
^/ ~/ o 23c. to Signed IMonlh. day, y~) ~~/
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candy cause of death. l
/
Items 2426 must be completetl by person 24. Time of Death
/ i 26. Da renounced Dead (Month, ay, year)
/
D 26. Was Casa Referred to Medical Examiner /Coroner for eason Other Than Crematpn or Donation?
^
who pronounces death. O
l/1v t P M~ /
~ Yes C~YNo
CAUSE OF DEATH (Sea Instruetbna d examples) r ADProxlmate interval: Pen II: Enter other signficart mrWPoOns comnourtnq to tlea n 26. Dld Tobago Use Conmbute to Death? '
Item 27. Pan I: Enter the r,Ba10.Pf events -diseases, Injuries, or complications ~ [hat directly caused Use d DO NOT enter terminal evenfa such az cardiac artest Onset to Death but not resulting In the underlying cause given In Part I. ^Ves ^ Probably
respiratory arrest, or ventricular fibnltatlon wAhout showing the etiology. List Doty one cause on each line.
/ i ^ No ^ Unknown
,,
IMMEDIATE CAUSE !Final tlisease or ~ ~ /7 ( p ^ / r
condPoon resuMng in death) _~ / L-~UWWrv """"""
a 29. Ii Female.
^ Nat
re
ithin
nant
a
t
Due to (or as a wnsequ a op. r p
p
g
w
s
year
^ Pregnam al time of death
SeGuentialttyy list conORions, rt any.
b.
^
r
leading t° the cause listed on line a.
Enter the UNDERLYING CAUSE Due to (or as a consequence Dry. t Not pregnant but pregnant within 42 tlays
of death
(disease a injury That initiated the c
^ N
'
events resultlng In tleath) LAST.
Due to (or as a consequence pf)~. ot pregnant, but pregnant 43 days to
~ year
before death
d ^ Unknown i' pregnant within the past
ear
. y
30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occuned 32c. Place pi Injury 4pme, Farm Street FactoN.
Pedormed? Available Prior to Complefion
o! Cause of Death?
O'Fatural ^ Homidde Office Bwlding, etc. (Specilyi
,~, ~ ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 321. Ii Transportation Injury (Specify) 32g. Location pf Inj.~ry (Street, cAy /town, state)
^ Yes L-~YFJo r ^ Ves ^ No
ld Not he Determined
i
id
^ C
^ S
^ Yes ^ Ne ^ Ddverl0 ra risen er
De 9 ^ Pedestrian
ou
u
c
e M. ^ Other- ity.~
33a. Cannier (check Dory oriel 33 . igna a of Certifier
• Cedltying physician ;Physidan certifying cause of death when anoNer physcian has pronounced death and completed Item 23)
_ _
_
deeM occurred due to the cause(s) and manner as orated
knowled
t of m
e
T
th
b ,
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_
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g
,
o
e
ea
• Pronouncing and urtllying physician (Physidan boM pronoundng death end cenitying to cause of deeN) .License m 33d ate Signed (Month, day, ear
To the best of my knowledge, death occumed at the time, date, and place, and due to tM cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ O ~ ~ ~/
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On the basis of exeminetlon and I or investlgatlon, In my opinion, death oaurred et the time, date, and place, and due to the cause(s) and manner es atMed. ^
34 Name and Address of Person Who Completed Cause of Death (uem 27 ype I Print ~ y~ 0~
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Registrafs ignature and Distnd Number ,-7
36, Date IeQ~nih~~ r~ ~~n
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Disposition Pertnh No.