HomeMy WebLinkAbout08-05-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Margaret E. sawn Filc Numbcr
also known as Margaret Elizabeth Bawn
Deceased Social Security Number 188-07-3211
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the CO-Executrices named in the
last Will of the Decedent dated 9/24/2008 and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of 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 instrum®ntJ(s) offered
for probate, was not the victim of a killing, was never adjudicated incapacitated, and was not a party to a pending divorceproceeding ~CCthe tines
of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): ~ ~ ~ ';"'
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B. Grant of Letters of Administration "~' ~' ~ `
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(If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendentelite; duranteabsentia; dura~~rtrrr~jtate) ~~ t.~
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spdu~any) an~ieirs: s(~
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Decedent was domiciled at death in Cumberland Count ,Pennsylvania, with his /her last princi al residence at
1814 Willow Road Camp Hill PA 17011 Lower Alen Township
(List street address, totivn/city, township, county, state, zip code)
Decedent, then
amt, Hill
92 years of age, died on 7/30/2011 at 11814 Willow Road
Lower Allen Township PA 17011
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
1814 Willow Road, Camp Hill, PA 17011
situated as follows:
$ 25,000.00
$ 149,600.00
TOTAL: $174,600.00
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 appropriate form to
the undersigned:
gnat r ' Typed or printed name and residence
Jennifer R. Lowe 9520 Ballagan Court
Bristow VA 20136
- Lisa R. Head 119 Revelation Road
North East MD 21901
Page 1 of 2
Form RW-02 rev. 10.13.06
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
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 Petitio~i 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.
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Sworn to or affirme and subscribed -
be re me the day of
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or Register
Signature of Perso 1 Represen
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Pers4tnal Representative
Signature of Personal Representative
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File Number:
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Estate of Margaret E Bawn - ,Deceased
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Social urity Nu ber:188-07-3211 Date of Death: 7/30/2011
ND NOW ~ ~ , in consideration of the foregoing Petition, satisfactory proof
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having been presented be re me, IT IS DECREED that Letters Testamentary(
are hereby granted to Jennifer R. Lowe and Lisa R. Head
in the above estate
and that the instrument(s) dated 9/24/2008
described in the Petition be admitted to probate and filed of re~c~rd as the last Vr'ill (and Co ~ici~(s)) of Dec dent. ~ ~ ~
FEES
Letters • • • • • • $ '
Short Certificate(s) ••••••••••••
Renunciatio (s) •••••••••••••••• $
.... $ 1 ~~
.... $ ~~~
.... $
TOTAL
... $
... $
.... $
.... $
.... $
.... $
.... $
Attorney Signature:
Supreme Court I.D. No.: 40486
Address: 414 Bridge Street
New Cumberland
PA 17070
Telephone: 717-774-7435
Form RW-02 rev. 10.13.06 Page 2 of 2
Attorney Name: Gerald J. Shekletski, Esquire
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LOCAL REGISTRAR'S CERTIFICATION f~F DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 17558188 _
Certification Number
This is to certify that the information here given is
correctly copied x~ro)~~ an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will he forwarded to the State Vital
Records Office for perll~anent tiling.
LGrvn.- ~ AUG 3 201
Local l;~egistrar Date Issued
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s REV n/2oos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
I PRINT IN
tMANENT CERTIFICATE OF DEATH
ACK INK (See instructions and examples on reverse) ;I
TATE FILE NUMBER
1. Name of Decedent (Frst, midtfie, last, suffix) 2. Sex 3. Sodal Security Number 4. Date of Death (Month, day, year)
Margaret Elizabeth Bawn Female 188 - 07 '- 211 Jul 2011
5. Age (Last Birthday) Under 1 ar Under 1 da 6. Date of Birth Month de r 7, Bi C and state or tor si cam 8e. Place of Death Check on one
Months Days Hours MMutes Hospital: Other:
92 y~ . September 18, 1918 Lewistown, PA ^ inpatient ^ ER I Outpatient ^ DOA ^ Nursing Home ®Resdence ^ Other • specify:
8b. Couny of Death Bc. City, Boro, Twp. of Death Bd. Fealfiy Name (If not institution, give street end number) 9. Wes Decedent of H~oenic Olg+n? ®No ^Yes 10. Race: American Indian, Black, WhAe, etc.
Cumberland Lower Allen Twp. 1814 Willow Road (MaX~ ~ nor ~~, eta.) (specrM White
11. Decedents Usual lion Kind of work d are d urt most of woldn I'rfe. Do not stale retir 12. Was Decedent ever in the 13. Decedents Educatbn (Seedy ony highest grade carrp lated) 14. Marital Status: Manied, Never Marled, 15. Surviving Spo use (I! wMe, give maiden name)
Kind of Work KindolBusiness/Industry U.S. Am>ad Forces? Elementary I Secorrdery (0-12) College (i-4 nr 5+) Widowed' DNomad ,Speaty)
Bookkee er Textiles ^ Yea ®r~ 12 Never Married
18. Decedents Matling Address (Street, pN /,own, state, zip coda) Decedents Penns lean is Dtd Decedent ~{] Y
Lower Allen T
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1814 Willow Road
PA 17 011
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Cumberland
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p Actual UmNs of Ciry / Boro
18. Father's Name (First, middle, fast, suffix) 19. MoNrei's Name (Flrsf, middle, maiden surname)
Harry Bawn Edna Clare Winegardner
20e. IrrforrtranYS Name (Type / Plnt) 20b. Informant's Melling Address (Street, dty /town, state, zip code)
Jennifer R. Lowe 9520 Ballagan Court;, Bristow, VA 20136
21a. Meltrod of Disposition r ^ Cremation ^ Donation 21 b. Date of Dispositon (March, ley, year) 21c. Place of Dispoekbn (Name of cemetery, crematory or other place) ltd. Locaton (Ciry /town, state, zip code)
® Burial ^ RemovaltromState i wuCnmatbnorponMionAutlarized
^ 0~ - t by Medbel Exemir>trlCoroMt? ^Yes^ No August 6, 2011 Mt. Rock Cemetery Lewistown, PA 17044
22a. S' of F Service Ucensee (or person ectfng es such) 22b. License Number 22c. Name end Address of FedlKy
~ FS 012 849 L Parthemo•r.e FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
(`.drlplete en CertMying . To the best of my , deatil otxured at 1h ,date and p stated. (Signature and tlYle) 23
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Number 23c. Date igned (Month, ley, year)
physican is at time of death to y
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Items 24-26 must be completed by person 24. Time of e ~
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" .Date Pronou Deed ( , ley, y
~ 26. Was Case Refe~to Medical Examiner I Coroner for eason Other an C Non or Donation?
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who pronounces death. "
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(~ Yes No
CAUSE OF DEATH (See Instructions and xsmpks) r Approximate Interval: Pen II: Enter other gjgnificent conditlans cantibutlrrc tc death 2e. Did Tobaaw Use Contribute to Death? -
Item 27. Part I: Enter the strain of events -diseases, injulas, or complications -that dredty caused the deeM. NOT enter to al events such as cardec arrest, i Onset to Death but not resulting in the undertying cause given In Part I. ^Yes ^ Probabry
respiretory arrest, a ventricular fiblllation without showing the etblogy. List Doty one cause on each line. r ^ No ^ Unknown
IMMEDIATE CAUSE (Final disease or ^ ~ Me~~L ~ v
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29. If Female:
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condition resulting in death) _~ a ^ N
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Due to (or as a consequence of): r
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^ Pregnant at time of death
enNal~ ~ ~, l any b
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ro the cause ILsted on line a. r
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Enter INIDERLYING CAUSE Ives to (a as a consequence ot): r Not pregnant, but pregnant within 42 days
of death
(disease a krjury that inPoated the t
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everds resulting m death)
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Due to (or as a consequence op: r pregnan
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30a. Was an Autopsy 30b. Were Autopsy Endings 31. Manner of Death 32a. Date o1 Injury (Month, day, year) 32b. Desclbe How Injury Occurred 32c. Place of Injury: Home, Farm, Sheet, Factory,
Pertom~ed? Available Prior to Completion
of Cause of Death? ~
~'1•latural ^ Hanicide Office Building, etc. (Speciy)
^ Y
~N
^ V
^ N ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. II Transportation Injury (Specify) 32g. Location of tn)ury (Street, city /town, state)
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^ Suicide ^ Could Not be Determined
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^Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
shat -specify:
33a. Certifier (check Doty one) 33b. Signature and TRIe of Certifier ~ ~ ,,A ~1
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• CertNying physcian (Physwtian ceAiying cause of death when another physician has pronounced death and completed Item 23)
To the hest of my knowedge, death occurred due to the eauss(s) and manner as stated _ _ _ _ _ _ _ ^ - ~.----
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• Pronouncing and csrtHying physielan (Physidan both prarouncing death and certlfyfng to cause of death)
To the best o1 my knowledge, dwttt occurred at the time, date, end place, end due to the cause(s) end manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
33c. License Number
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33d. Date Signed (Month, day, year)
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• Msdkal Examiner/Coroner ~ ` _L
On Nb basis of enminetlon and / w Inwatlgatlon, In my opinion, death occurred st the
time, dale, end place, end dw to the eauae(s) and manner ss sgtsrL ^ dre~s of Per
on
Who Completed Cause of Death
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Dispostion Pernh No. ~ ~ ~ ~ 7 S /