HomeMy WebLinkAbout08-09-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Mary M. Barrick ESTATE NO: 21-11- ~ ~ (~ Q
also known as
ecease SS NO: 182-22-8889
Petitioner(s) who islare 18 years of age or older, apply(ies) for:
[ ] A. Probate and Grant of Letters Testamentary or _ Administration c.t.a., 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: co ct to
state re evenat circumstances, e.g. renunciation, ea o executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding:
at the time of death wherein grounds for divorce had been established as defined in 23 Pa.C.S.A. §3323(8):
No Exceiptions
[X ] B. Grant of letters of Administration
(If applicab a enter: .n.; pen ente ite; urante sentia; urante 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 db.n.c.t.a., enter date of Will in 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(8), excpect as follows: No Exceptions
ame
Betty A. Eurich X728 Forge. Road, Carlisle, PA 1701- Daughter
USE ADDITIONAL SHEETS IF NECESSARY
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her last
7 West Springville Road, Boiling Springs, PA 17007 (South Middleton Townsb
ist street address, townlcity, township, county, state, zip coae
residence
Decedent then 83 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
situated as follows:
10,000.00
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 a ro riate form to the undersi ned:
.Q„ar,,.~. vne or pnnte name an res~ ence
xoy ~. isarricx ~~
0 ~ ~s 135 Old Stonehouse Road, Carlisle, PA 17015 0 -- :1~
~~.
Betty A. Eurich ~i z n i~y
7 ,a r- v 3
F 728 Fo a Road, Carlisle, PA 17015 ,-~ :~ rn
Q tri ~°"
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Page 1 of 2~
7/30/11 at Chapel Pointe, Carlisle, PA
OATH OF PERSONAL REPRESENTATIVE
COMMONWEATLH OF PENNSYLVANIA
couNTY of CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true and corn
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 ~~ ~`t
!~ ; ~ ,~ Betty A. Eurich
~ For the Register
C O ) ~~
~~tJ 4.,
~13
File Number: ~,~ I ~~ ~ ~ - ~ ~ ~~ ~ ~ ~ ~ _
.-~ cri ~ ~°
.J ~7
Estate Of Mary M. Barrick , Deceas~ ~==~,-_~ ~-ry
~ _ ~•~ C':
-; ~
Social Security Number: 182-22-8889 Date of Death ~uly 30, 2011
AND NOW f it ~'! /+ ~:' , , 20.~in consideration of the Petition, satisfactory proof
having been presented b re e IT IS DECREED that Letters of Administration
are hereby granted to Roy E. Barrick
Betty A. Eurich in the above estate
and that the instrument(s) dated __
described in thte Petition to be admitted to probate and filed of record as the las Will (and Codicil(s) of Decedent)
~_.-
Roy E. Barrick
1
-~k -t
~.~ '
Register of
FEES
Signature
_~
Robert G. Frey
Attorney Name
Letters ~ ~L
Short Certificates .~,~' ~ Sup. Ct. LD. No
Renunciation
4~ ~ c~ ,/~ ~ , ~~', Address:
Telephone:
TOTAL... `? 7 . `~ ~
46397
5 South Hanover Street
Carlisle, Pennsylvania 17013
(717) 243-5838
Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee felt this certificate. X6.00
P X772.741
Certification Number
`Chic is to cirtit*. ?i;~a tl,h intl)I ni;il~l; ~s ~: ~iYi~l~ )~
correcli~' c~?pic11 .~~.~/):I al, uri~rin~(( C~~i11 ail-~ ctf~ Je~ttl~i
duly filed t~~ith (.,c ~i~ [.L~cai RL ~i•l~;)r. "lbc ,ri~~=n:)~
certificate ~rili !,_ I~n~:~ardcd ;.~ i~':' St~1tc 1'ha!
Rec~arcls Offil_c ,t ~;vrnr :n~.:))t fill)., .
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Local R~~~istrar i~,ltc i5:ued
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COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
lSee instructions and examples on reverse) ~..r< <„ ~ ,~~,,,
1. Name of Decedent (Frst, midde, last, suffix) 2. Sex 3. Sxial Secunry Number 4. Data of Deem (Month, day, year)
MARY M. BARRICK Female 182 - 22 - 8889 July 30, 2011
5. Age (Last Birthday) Und« 1 ar. Under 1 de 8. Date of BIM Month, da , ar 7. BIM w Ci arM state ar f«ei coon Ba. PMw of Deem Cheri om one
Monms Days Flours Mlnmes Hosplbl: O~r~mpper'
g 3 Feb . 18 , 19 28 Car 1 i s 1 e , P a ^ Impatient ^ ER / Ou~etlent ^ DOA O Nursing Home ^ Residence ^ Omer - $pedry:
Yrs.
eb. Cwnry of Deam &. City, Boro, Two. of Dwm 13d. Facility Name (ll not institutive, give street ant number) 9. Was Decedent W Hispanic Origin? [~ No ^ vas 10. Paw: Amancart Inaan, BWCk, White, etc.
Cumberland Carlisle Boro Chapel Pointe (Ilye¢, neclycm,an, (specd>7,
Maxiwn, Pwna Rkve, etc.) Whit e
• 11. DecedenYS Usual Oau eon Kind m work tlane tlun moll W weld file. Do not stale retlred 12. Was Decedent ever in the 13. Dewdent's Edtxatan ISpsdly only highest gretle completed) 14. Menial Status: Marred, Never MartieQ 15. SurvNing Space (H wife, give maitlen rams)
Widoweq DNOrcetl (Speaty)
Kind of Work Kintl m Busiws¢I Industry U.S. Armed Forces?
Elementary I Sewn (b12) College (1-4 or 5t)
d
------------- Wid
-
~
Cafeteria Worker Public Schools owe
^yes 1~No -------
-
-
• 16.DecedenYsMeilingAtldress(Street,tdyltown,sbte,ziprotle) Decedent's Pennsylvania ° 8° aura South Middleton
Decedent Lived in Twp
17c d Yes
7 W . S p r 1ng V i 11 e Road ,
Actual Resitlence 17a. stale ?
um er an Township.
Ned wimin
17tl.^
Boiling Springs, Pa 17007 170. County
CirylBaro
ACiualem~of
18. Fathers Neme (First, midde, last, suffix) 19. MotheYS Neme (Flml midde, maiden surtame)
Edward Witter Annie Garman
20a InhmnanYs Name (Tyyq / Pnnp 2C6. Inf s Mailing Atldress Street. dry /tam, state zip rode)
Pa 17015
Carlisle
72Forge )~oad
Betty Eur>.ch ,
,
21 a. Memod of DisposPove ^ Crerwdon ^ Dowtive 21 b. Date al Dispo¢ieve (MOmh, day, Year) 21 c. Place a Dispwitbn (Nana of c«wbry, creramry or omer plawl 21 d. Location (City/rown, state, ziP rode)
® Banal ^ RamovallromState ~ wnCremetlon«Donetbnaulhwhed
^
^
• Aug 8, 2011 Westminster McLrorial Gardens Carlisle, Pa 17013
No
Yes
^ ~« _ Medkel Examiner/Coroner?
t
'ry as auoh)
~ 22a. B' amre morel Service L' (or pe
-y
~
~ 22b. tiwnw Number
E1>-012909-L 22c. Name end Address al Facility
Ronan Fiuberal Hare 255 York Road Carlisle Pa 17013
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Complete ire 23a< vey when wrfityirg
n is rat available at time al deem to
phys 23a. m Oast of my kra , deem ax:u f at trio y' , data a plow stated. (Signature vetl title)
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~J 23b. Licvew Number
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W 23c. Gate S' d (Month, day, year)
C j~ ~/{ ~`/
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cerY wove of deem. C
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Items 24-25 must be canplatetl by person _
24. i Deem 25. Date Prorw cetl De (MOnm, day, year) 2fi. Wes Case Referred to MeG I Examiner I Coroner f« a Reason Omer than Crematbn or Donation?
^
who pronourxes deem. `
~ ~k.J p M. ~~~ ~~, vas No
CAUSE OF DEATH (See Inatructbns and examples) t Approximate interval: Pan IL Emar omer u~nrd •rt rondOam nnm tin t dean
iven in Pen I
in the underl
in
muse
t
lti
b
t 28. Did Tobacco Use Contribute to Oeath?
^ y
bl
^ P
b
Item 27. Pan I: Enter ea chain m event¢ - awases, Injures, or c«nplkatiow -mat directly waved me deem. W NOT enter terminal events such as wrtliac artest Orael to Daam .
y
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rw
resu
ng
u y
es
ro
a
respiratory erect, or venlricWar Ahntlatbn wdhpul showing me edobgy. List very as mouse ve each five. i ^ Unknown
IMMEDIATE CAUSE Final demo « ,~n- / 1 ~ t
candPopn resurong in ~aaml
~4sYUVW ~ V'I V VI ~ e l~ I 29. If F M'.
nant mmin past
ear
re
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ditiaa
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^ Pregmam al n,w of seam
imp 42 d
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ty, b.
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Me ' ro the mouse Gsletl ve live a. Due to (or as a consequenw al:
Emar me UNDERLYING CAUSE ays
Not pregnant, but Pm9mant w
of deem
t
(tlisease or irqury met indicted the
nant 43 da
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ear
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nant
WI
re
^ Na
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events resutling m deem) UST. t
Duero (« as a mwequence al: y
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before Beam
; ^ Unlaawn if prxaant wimin the past year
d t
•
30a. Was an ANOpsy 3W. Were Amopry Fn?rgs 37. Harmer of Deem 32a. Date of Inlury (Ma,m, day, year) 32b. Describe Haw Injury Occurted 32c. Pace of Injury: Nana, Farm, BtreeL Feaary,
Office Building, etc. (Speaty)
Pertomad? Available P,ior to Complefive Natural ^ Homicitle
' of Cause of Deem? ^ Actidem ^ Pandirg Imesligetion 32d. Time of Inlury 32a. Injury at Wo,N? 32f. II Transponatun Injury (Speatyf 32g. Locative of Inlury (Street city I town, state)
~
T,~
^ Yes pp r1o ^ Yes ^ No ^ Yes ^ No ^ Dr'werl Operetor ^ Passenger ^ PetlesMen
^ Suidtle ^ Count Nal be Delerminetl M. ^ (Hher ~ Speaty:
33a. Cemfiar (check very veal 33b, Signature and Tide of Ceniher
• Cenlying phyelclan (Physician wrttlying mouse m tlwm when another physkien has pronwrretl deem and completetl Item 23)
- ~ y
To the beetamy knowledge, death occured due to UN muuys)end manner aaeWad_________________________________
• Pronouncing ark certilylrg phyeklen IPhY~an Ood, prorouncing deem and wrtilyktg to mouse of deem)
^ 33c. License
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33tl. De 5 Month, day, year
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To tM bestamy awwledg., death oeeurtetl al the tlme,tlab, and pkm, and due to me muse(s)erW mannerm sbtetl__________________ 1"` 1
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• Medlnl hammer/Coroner
On me bNia of exeminatbn ant I a Investlgmbe, in my oplnlon, death occurred al tlse time, dab, arM pkw, arM due to 1M mass(e) end manmr as stated_ ^ 34. Neme end Adtlroas at Person Who Completed Cause of Deam (Item 271 Tvw I Pnn
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