Loading...
HomeMy WebLinkAbout07-26-11PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Erika R. Anderson also known as COUNTY, PENNSYLVANIA File Number 21-11 'D ~~ ,Deceased Social Security Number 209-28-9620 Donald H. Anderson Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE `A' or `8' BELOW.) © A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor named in the last Will of the Decedent, dated 07/07/2004 and codicil(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; 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); did not have a child born or adopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pedente liter durante absentia; durante minoritate) 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 on Section A above 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: Name Relationship Residence ~p ~- ~-~ t-~ ` J r~ ~ ~~`' ZJ See attached schedule ~~'~ =~ ~ ~~~- m rv r... , -;. .-.... } ... ~* J ;^~ (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. V ~ ~;.~ CAF ; Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal~sidence at ~ ~ ~.~ >~ Bethany Towers, Mechanicsburg, Lower Allen, Cumberland, PA 17055 ~_ (List street address, town/city, township, county, state, zip code) Decedent, then ~~ years of age, died on 07/17/2011 at Manor Care, Camp Hill, PA 17011 Decedent at death owned property with estimated values as follows: $ q7, soo . REGISTER OF WILLS OF CUMBERLAND (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Signature Typed or printed name and residence ~ Donald H. Anderson 7325 Fishing Creek Valley Road Harrisburg, PA 17112 All personal property Personal property in Pennsylvania Personal property in County Form RW-U2 Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 PETITION FOR PROBATE AND GRANT OF LETTERS (Continued) REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Erika R. Anderson File Number 21-11 also known as Name Relationship American Society for the Prevention of Charity Cruelty to Animals Donald H. Anderson Son Gisela Rank Antonuk Daughter Greenpeace, USA Charity 209-28-9620 Deceased Social Security Number Residence PA 7325 Fishing Creek Valley Road Harrisburg, PA 17112 PA PA The Humane Society Charity PA Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } The Petitioner(s) above-named swear(s) or affirm(s) 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 sub~Gribed _~'~~ before me this ~ day of oI . - ~ _Fo~the egister rS~/N c~c_~ Signature of Personal Representative Donald H. Anderson ~ ~ : ` ~w ~ ' ~~-~, L._ 4 7 - Signature of Personal Representative r-~-~ -p T ~ ~ ~ i - --. ~~ rn ~-~, rya _= t..... ~-~p ..~ r,.,.4_ t / ~ Signature of Personal Representative C`a ~ Q -,n --~- ~ '=-:, '~ _..~.~ --~-- ~ ^ " ' ~ ~ n J ~. .~. f :D ..~.. '~'~ 0 File Number: 21-11 "- a ~a,,~ Estate of Erika R. Anderson ,Deceased Social Security Number: 209-28-9620 ~? Date of Death: 07/17/2011 AND NOW, v ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Donald H Anderson in the above estate and that the instrument(s) dated 07/07/2004 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters .......................................... $ ~./ O Short Certificate(s)............... $ ~ ~ Renu iation(s) ............................ $ ~f/~ $ ~~ /~ /- TOTAL ................................... ~J J~ V Supreme Court I.D. No.: 25444 Boswell, Tintner & Plccola Address: 315 N. Front Street Harrisburg, PA 17101 Telephone: 717-236-9377 Form RIN-02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attorney Signature: Attorney Name: Jeffrey R. Boswell, Esquire i l (1>.;{n5 RE\' 101 /(1' I 'w ~-i- i ~ - o ~ ~-- r LOCAL REGISTRAR'S CERTIFICATION OF DEATH ..WARNING: It is illegal to duplicate this copy by photostat or' photograph. 5 Fee for this certificate, $6.00 ,,rr~~^'""'~---- This is to certify that the information here gi~'tn is ~' ~,TN OF p~' ,ttt~~,P fy~;=: correctly copied from an original Certificate of Death ~~,~~'~~o~ `~~~ duly filed with me as Local Registrar. The original g = ~ ~ certificate will be forwarded to the State Vital o .ale Z ~ y 3 a Records Office- for permanent filing. * ~ * ~~. P 1767254 °° _ - ~~,,~, -., ~'1ENt OF rrt Certification Number ~~ '"~~~~~~~~"""~ g -~ Local Re istrar ~;~ ed t~ ~ 3 ': `~ ~,tt-~'. - - _- -~ c_C!j t 1 ~~ ,"' ~ (~ ._ -,-, •. ~, _n C ~" .~ _ w.. ..~_ ~ ._., ~•~ :tos-t43 REV ttrtoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ,~,,,_ TYPE PRWT W PERMANENT CERTIFICATE OF DEATH 3LaCK INK (Sea instructions and examples on reverse) STATE FILE NUMBER t tisrtt• d Decedre (F•A nttdde, lael, sulks) 2. Ses 3. Sacwl Seauey WtntD•r 4. Date d DeMlt (siren. aY• Y•srl Erika Rank Anderson Female 209 - 28 - 9620 Jul 17, 2011 5. Aqe (last Biretdayj lktder t Under 1 ds 8. Dew d Buret Monet, dt , earl 7 and stew a t« 8a. Place a D•aet Chedr orr Mann Days Hours tlrkn•s Hospital: OtMr: 9 5 its. July 6 , 1916 Germany ^ ,roakent ^ ER / Oulpak•rtt ^ DoA ®Ntnsng Monty ^ Ra•rderta ^ oew • Sp•ellr eD. Courey d OsaN &. City, B«o. Twp a D•aN fW. FacrYly Wma (lt not wkWkort. qNe str•W arM nunt0er) 9. Was Decedent d hispanic Ortgn? ®~ ^ Ye6 10. Raoa: Mtarir~n In0ar4 Bisd~ YMia. etc Cumberland Camp Hill Manor Care Camp Hill (hA. Kan CR ~;, etc.) ISM White t 1 D•c•d•re's Usual Knd a work d one dui most d var M•. Do not slat. retired 12. Was Oec•a•m ever n dt• 13. DecederN's Educa•on (Sp•aty ardy hgMat gr>d• cantp ktWl 14. Mantel $ta1W: Mant•d. Never LAant•d. t 5. Survnvtg Spo uw (H wd•, yn• madrt nem•1 KiMawon Cpa/~t~,}d U S. Amt•d Fortes? Elementary 7 Secondary (D-t2) CoUe9e (1.4 «5+) Widow W. Divorced f$Oe~'~N) Analyst of Penns lvania O ve• ®hw 12 Divorced tfi. D•oed•rtYs Maiirtq Address lSaeel aty I town, stale, z1p code) 7325 Fishing Creek Valley Road Decederx's Did Decedent "~' 17a.su" PA `T""na, nt.^res.DscedsMl.aedm rwp. Harrisburg, PA 17112 „~.~, Cumberland p 17d ®, ~ d~""k't Camp Hill cy/Bona 1d. faet•IS Name (Fxal mddle. last sulkx) t9. Moewls Name (First, mddw, ntaan :amain.) Heinrick Pasch Frieda Heiniecke 20a. ktlortrtarN's hWw (Type r Pmq 200. tnlortnanYs Matkrtq Address IStreel tM ! lowt, stew, zp ~) Mr. Donald Anderson 7325 Fishing Creek Valley Road, Harrisburg, PA 17112 21a Msetod d Oispavkort r ®Cremstton ^ Oortatnn 21 b. Dew d OispasiOort (Monet, day, year) 21c. Place a DispoWbrt INarrw a cemetery, crematory a aster plea( 2 td. location (Cdy r bsw, stall, rep cads) ^ Brnw ^ R•movalhomSUw i WaeCremetlort«DertMlortAuMoriaed 7-20-2011 Cremation Society of PA Harrisburg, PA 17109 ^ Oew . ' 0Y Meekal EnentYter/Cotawft ~ Yes^ No 22s Sigrukrn uneral (« as 1 22b.LiarwWtnrtOer z2t.wrn.ardAddr.aaFaadyAuer Cremation Services of Pennsylvania, Inc. - _ FD 138312 4100 Jonestown Road, Harrisburg, PA 17109 Cartplsw esrrts 23ac oNy vnt•n 23a. To et. b•a a my krtowwdge, dean occurred at ew orrw, daN artd play stawd. jSiynsttr• and tdw) 23b. Ltcnse Nuntbsr 23c. Dew Sigrwd (-~, dsy, year) pnystcian it not ava40w at ante d b t~rnynr,e.aae.rt. Vincent Olawale Bello RN RN 622367 July 17, 2011 e•nte 2448 must be c«rtpwt•o M person 24. Tine d 0•aet ~ - 5 25. Dew Prartoraved Dead (Monet, day, year) 28. was Caa R.t.rrw Jp.~adicr Esartrt•r / cor«ur l« a Rgfon on.r nwt G.mYOn ar osnWn? ^ who prortotrtae deatlt. ~' A M• J t,~.I ~ ~ 7 ~ o I t Ya Ne CAUSE OF DEATH (Sew Inatructlona and axampMa) r Approswnaw nwnal: Part II: Enwr Deter 29. Dd Tobacco lbw b Deeet? twin 27. Part I: Enter tM {gyp - diseeas, , «compkcaOons - tttat dMectly reused the d•atlt. DO NOT enW wmtrtal events such as cardiac arrecl ~ Onset to Dean tin rtot resulkrtg n ttta urtd•rlyktq tetra grvrt n Part I. ^ Y•s ^ PreO arw on each kn•. r respiratory arrest a ventricular wNtae sttowng eeology No tyeto•n ~ ralED1ATE CAUSE ((FeW diaase a ~ 29. tt F t«tdkon reMYYtq n twsMt) _~ a ' ~ e tvlte r ~ ow b 1 as a cate.atr.rta al: D ~ ~ Y ^ Pregwre at km. a deeet tip oortdllorts, ~ any. b, r ^ i Due b (« as a consegwrtw oQ: ~ Not pr•gwM, bu p•gtw wrtn 12 dsys d deaet Idi•ess• « irytrp et•1 rtaawd er t r LA T b t y t t q d ^ N O •vnw reMYWg n deeetj . ~ S Dtw b (« as a coraepuanw oQ: r ye• ptgtr ot prgwe. rys u before 0•etlt d. ; ^ UNOtoevt l preywe wan ew peM yete 3oa was an Autopsy Sob. Wr• Auropcy Fndrtgs 31. a D•aet 32a. Dew a Injury (Monet, day, year) 320. D•s«t0e How I rqury Oauned Sar••t, atbry. ~~ 32c. O w ~ P•AorrttW'! AvarlaW Prtor b Contpwlion a caws. a owth? Natwal ^ htomcide , r/ ,,,---,,,/// ^ Y•i I(J No ^ Yp No ^ ~~ ^ PMedirg ~ 32d. Time a Irtpny 32e. Irytvy al Walt? 321. It Transportation Irqury (Specryl 32g. lotatbn a injury ISenel tM !town, stew) ^ ^ Drnnr I Op•wt« ^ Pawnger Pedaskwn ^ / ^ Suicge ^ CotrW Na b• D•t•rrrwNd M ~ Yes Del•f ~ Syealy' 33a. Carew (r1t•crt any aril 33b. Signala• and Title a • ~Yd9 pttyaicien tPnysctan c•mNtn9 taus. a dsaN when artoewr phystaan has prortotwtc•d deaM and canpletw Iwm 23) deetlt oecumd atr to ttw cause(s) and tn•rwter a staMd To the l1eY a •M knowwdy _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . • 33c. litena Number 33d !kWnet, aey, ~j Pronorrtcirty and c•r-iyin! physician 1Physician boll prortotrtcvg deaet and c•nAykg b roue a deatn{ eys- end rewriter a staled T n t a w d at th time and nd d e b W wd d t e ^ l ~ ' _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ t• my gw t oatrr e , o ee q, e w o w w •c•. a P • teedhw Ettatstirter/Cororw , ~ ` On tlN Oeei• a and I a invstlyetion, in , death aaurrd st tlw twits, dew, and plat., and dw to tM aueNs) and rnamwr u stawQ. ^ m 27) r P Name and Address a Person Wh o Camp• te D•a mt N • 3< d Cause a . 1 w / 35 Regstrar s • ~ 38. aw Filed IMonm, day, ywl A ' ' ` 1 r ' ,1 ` ~ ~, - - ~ ~/ ~ ~.1 L / ! ' ~ L~~ ~ ~ ~ __ ~ , - yy~~...ff.. 11" iI Il «<IIIVVV VVV111W/WWW l/ / Dispatitwn Parent Pb l_lllJ li/ / ~ ( D 1