HomeMy WebLinkAbout07-08-11•
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
/ _,,
Estate of ~~t? /' C~.-~ ~?'~i~~l~ /G~/G%~1C.~~o%(.r.Deceased ESTATE NO: 21-
alk/a:
a/k/a:
a/k/a: SS NO:
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 '~ ~ Z ~~~/ and codicil(s) dated _~_ __
~.,.,
t7.~~
(State relevant circumstances, e.g. renunciation, death of executor, etc.) ? C~ C~..
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted a£r~tion~the : =:=' `~
-: r.,,
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated p~s~~t~r`,nd wad not ~ -j ; ~:.',
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been e~~d as~finedld "_:_~
23 Pa. C.S.A. § 3323(8): .-_~ _~e1--~ c`~: _-
~~ -~ ...~+ r..
B. Grant of Letters of Administration ~ ?~_ ':~? ~ = ~~"~
(If applicable, enter d.b.n., pendent life, durante absentia, durant inoritate) ~~" -Yi
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(8), except as follows:
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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
(Stffre~~etaddress with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then ~~-~"L years of age, died ~ ~ r1/ / at ,/'U ;3~
( onth, y, Year of death) (Gifu and State here death occurred)
Es~i`mated value of decedent's property at death:
_ f domiciled in PA All personal property $ ~d/j, l'~(1,
_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 $ G' ~~ ~.
Location of Real Estate in Pennsylvania: (Provide full address if possible.) .~Z"1 ~ 6U Ls /1~ 5 ~` C'' L.~,.t,~~~/ ~ ,,~
Signat eW ~~ ~ Name(cl R~ M~~~~no e.~.~.-p«~o~~
~
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Interim Form RW-02 revised 12 2~ ~n by C`I~mhPr~anc~ r~lln.., .,N,,,~,.,,, .,,..,,,., ti.. .we ~,.....
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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
~~ GC.-~. ~~. -. ~ ~~`c~ ~-' C -
bef re me this _ ,; day of -
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For the Register ~ `'`"' ~~ 'C=
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DECREE OF PROBATE AND GRANT OF LETTERS ,~.:,; ~~:~ ~~ ?~
ate of ~ ~~ ~, :~_.:.
Est ~ ~C~~ ~r~; I~~C:~(~ nn w
- 1~-1 ~ 4~C~(cI~C`>~eceased File Number: 21- ~ ~ ~ ~-~ ~ , .~
AND NOW, this ~ day of ~L ~ _"-~
the reverse side hereo>;satisfactory proof having een presented before me IT IS DECRE f tl-1e Petition on
Testamentary ~,.r' of Administration ~ ED that Letters
are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
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 pel;ition be
FEES:
Letters ....................$ ~, ~ ~
Will .......................
Codicil(s) ............... _
(~) Short Certificates ~ (;~ . (~
(~) Renunciations....... ~~: 5~}
Bond ............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
`~~ ~ ~c
TOTAL ................ $ -fie'-~0
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lenda Farner ~ ~ ~'~' % ~~
trasbaugh, ~~ ~.~PC~1,~.(a ~~L~ ~ ~~,~~
Register of Wills
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
RENUNCIATION
~„ REGISTER OF WILLS
~~~~~' \a~ ~ COUNTY, PENNSYLVANIA
Estate of ~ ~ n~ ~;~, ~ cs'~ ~ _ C~:
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Dec eased
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(Print Name) _, in my capacity/relationship as
~~~~
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~: `1v.~yur~ C"
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(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ~ -----_._____
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
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(Signature) _
~J t ~::i'T' Q ~~ ~r1 ~' S' 2'•i
(Street Address)
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personall'.y appeared the
party executing this renunciation ar>d certified
that he or she executed the renunciation. for the
purpose stated within on this __~~_ day
of , --~~1 ~
Notary A~rb~~-5- ~""
1V1y Commission Expires:
(Signature and Seal of Notary or other official qualified to
administe a ~r ~1=.r[~,taw~l~
bY~CV~( ommission.)
Id1~'t'ARIAL SEAL
CARMEN NEWTOiV, Notary Public
S. Middleton Twp., Cumberland County
My Commission Expires September 21, 2014
~.Ca~AL REGISTRAR'S C~RTi~'I~A~'I~-!~ +~~ ~~~~'Y~
ir'~I;l~1RN1NG; 1t is illegal to duplicate this copra by K~hr~tc~~tat ~~r ~,~h®toera~l'~I,
Fey f(n- this c~rtiticatL~. ~,t,.s)t
P 17451792
C trti~~i~~adiun ;~~jlill'~')
1105.143 REV 11/2006
TYPE /PRINT IN
PERMANENT
BLACK INK
1. Name of Decedent (First, middle, lest, su6ix)
Ionia Marie Richardson
5. Age (Last Birthday) Under 1 er UMer 1 da
Months Deys Hours Mlnules
46 yre.
eb. County of Death 6c. City, Boro, Twp. of DeaM
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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 Death (Month, day, year)
Female 187 - 44 - 8193 June 29, 2011
8. Date of BiM Month, da ar 7. Bi lace Ci and state or forei coon lie. Place of Death Check on one
1/31/1965 Carlisle, PA Hospital: Other:
® Inpatlent ^ ER / OtApatlent ^ DOA ^ Nursing Hoene ^ Residence ^ Other -Specify:
6d. Facility Name (If rat inagtution, give street and number) 9. Was Decedent of Hispanic 0 ' in?
n9 ^ No ~~ Yes 10. Race: American Inrian, Black, Whde, etc.
(If yes, sprrcily Cuban, (SPe~M
Mexican, Puerto Rican, etc.) Black
N state refired 12. Was Decedent ever M the 13 recede t' Educe
Kind of Work KiM of Business/Indus U.S. Amted Forces? n s tlon (Spedly ony hghest grade completed) 14. Marital Status: Marred, Never
Widowed, Divorced
Elementary /Secondary (0.12) College (1.4 or 5+) (SP~y1
Secretary U. S Army War Co~le
e Married, 15. ;surviving Spouse If wife,
( give maiden name)
g
~ Yea
^"° 12 Married
16. Decedent's Mailing Address (Street, city 1 town, state, zip code) Decedents Lin xl Richardson. Jr
327 W. North St . Actual Residence 17e. State PA Did Decedent
Live in a 17c
^ y~ Decedent Li
d i
,
ve
n __
Carlisle, PA 17013 ,7b.County ~~rland Township? Twp.
17d. ®No, Decedent Lived within Carlisle
16. Fathers Nerre (Frst, middle, last, suffix) Actual Limits of
' City/Born
19. Mother
s Name (First, middle, maiden surname)
Curtis - Smitz
Wanda B. Gobantes
20a. InfornanYS Name (Type /Print)
20b. InfortnanYs Mailing Address (Street, city /town, state, rip code)
Linwood Richardson , Jr
.
327 W. North St., Carlisle, PA
21a. Method of Disposition ,
• ^ Cremati
^
21b
1'7013
on
Donation
. Date of Di ry, ry p )
o , sposition (Month, day, year) 21 c. Place of Dispositon (Name of tamale cremeto or other lace
y ~ Burial ^ Removal from State i Was Cremation or Donation Authorized
^ 21d. I_ocegca (City/town, state, zip code)
~ •
Deter - S ~ by Medical Examiner/CoronerT ^ Yea^ N° 7 7 2011 IndiantcxAm Ga National C~riete
a 22a. Signature of Fune ~ ensee (or person acgn 22b
Li Ani-tville
PA
'
.
cense Number
22c. Name and Address of Facility
a ~ - ,
012633 L Fkvin Brothers Funeral Home, Inc., Carlisle
Compl s 23a-c ony when certif)dng 23a. To the best of my knowledge
des t
PA 17013
n
d
t th
,
u
e
a
e time, date and place stated. (Signature and gtle)
PhY keen is not available at time of death to 23b. License Number ,
cad cause of death. ~23c. Date Si
fined (Monet, day, year)
Items 24-26 must be completed by person 24. Time of Death 25. Date Pronounced Dead (Month, day, year)
who pronounces death, ' ~ ~ a O P M. ~V ~ 26. Was Case Referred to Medical Examiner / Coroner for a Reason Omer then Cremation a Donation?
OZ~ ~
~
"
~~ ^Yas ^No
CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Pan II: Enter other similicent condigon-c ~„r,id ~u Q t~~lt, 2g. Did Tobacco Use Contdbute to Death?
Item 27. Part I: Enter d,e chain of events -diseases, injuries, ar wrnWkations • mat directly caused the death. DO NOT enter terminal events such as cardiac arrest
respiratory anesl or ve
r
t
i
l
fib
l
,
n
r
cu
ar
ri
lation without shows qte etio Onset to Death but not resulting in the undedying cause giv
ng logy. List only one cause on each line. r en in Part I. ^ Yes ^ Probably
IMMEDIATE CAUSE (Float disease or ~
corbgion resulting in death) r
L
Cn /~L~ r
-~
1
-
( ^ No
Unknown
.
a.
4 G
~ ^(Y.S-y
,
Due to (or as a consequence of): ' 29. If F k:
$a~uentiegy list candibons, q arty, /^ '
leading to the cause Nsted on line a. b' ~-'~ rim (^ `~ p J K i G /~ S /Ji ^u ~!~ y +"~, , ~/ nL ; Not pregnant within past year
^
Enter q,e UNDERLYING CAUSE Due to (or as a consequence of). '-~1 i
- (disease or injury that initiated the /1 r
events resulting in death) LAST. c. (/ U I ll.~ aJn k ~ ,,~ ~,~ ~~., ^ ~ ~ ~~ , Pregnant at time of death
-' ^ Not pregnant, but pregnant within 42 days
Due to (or as a consequence oq. '
i
r r
d. ~ ` ~ ~ M ~ ~ `~ ~ ~ ~ +~" `~ of death
Nol pregnant, but pregnant 43 days to 1 year
b
f
30a. Was an Aut r
~Y 30b. Were Autopsy Findings 31. Manner d Death 32
' e
ore death
^ Unknown if pregnant within the past year
a. Date of In
u Month, de ,
Penorrtred? Available Prior 1o Canpletion 1 ry ( Y Year) 32b. Descdbe How Injury Occurred
of Cause of Death? ~NaNral ^ Homkide
;i2c. Place of In'u
Street
Fadory
~
,
,
Office Building, et
(Specilyl
LLL~~~...
^ Yes ~ No ^ Yes ^ No ^ Accident ^ Pending Investigegon 32d. Txne of Inlury 32e. Injury et Work? 321. If Transportation Injury (Specify) 32g. Location of inju ry (Streit
city /town
state)
^ Suidde ^ Could Not be Determined
^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestdan ,
,
M
33e. Certgkr (check Doty one) ^ Other - Specily~
• Certllykg phyekian (Physkan certifykg cause of death when another 33b. Signature and Tito Cengier
To tM best of m kn ~~^ ~ Ixarouraed death and completed Item 23)
\ Y owbdgs, death oxuned due to the oase(s) and
,
msnrrx ss stated _ _ _
• Pronouneln and '--------------------
9 cert„Ykr9 Phyakian (Physician both pronoundng death and cergtykg W cause of death) - - - - - - - - - ~~ M ~'
To the best o1 my knowbd 33c. License Number
gs
~
death oceurtsd ffi th
N
t~
,
_
e
me, date, arM place, and due to tM pose(s) and manner as stated- _ _ _ _ _ ^
~ fdedkal Examiner/Coroner •/~ .rte/ ! [ , ~/S
w ------------ / 7
~ On the basis of examM
tl 33d. Gale Sil7ned (Month, day, year)
~ "
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a
~('
7 ZiJ (
on and / or Investigation, In my oplMon, death occurred at the time, date, and place, and due to the cause(s) end manner ae ete4ti
^
~ 34
N
d
_
.
ame an
Address of Person Who Completed Cause of Death (Ite
36. Registrars a and ~l~r~ f~- ~n i'G L+ ~ C l ,.( tt S:~a .~-A
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~
36. Date Filed (Month
daY
Year) m 27) Type / F'dnt
..
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C
~ ~ I ~ I ~ I ~ I
,
,
Z " ` Dd.S. Hershey Medical Ctr.
Di
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sposibon Pennfl No
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