HomeMy WebLinkAbout08-23-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
Estate of Jose h C GRIBB
also known as
COUNTY, PENNSYLVAcNIA
File Number 21-11 ~ ~ D
Deceased Social Security Number 031-22-9755
Jeffre H Gribb
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE `A' or `8' BELOW.)
® named in the
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor
last Will of the Decedent, dated 10/2912001 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 did not have a child bom o~ dopted; was n t the victim/ o
wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 (g);
a killing; and was never adjudicated an incapacitated person, except as follows:
B. Grant of Letters of Administratio
(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 cif 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
nrovided in 23 Pa. C.S.A. § 3323 (g), except as follows: .-, -_
Decedent at death owned property with estimated values as follows: 49,000.00
(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 $
$ 310,000.00
Value of real estate in Pennsylvania
situated as follows: 715 Arlington Road, Camp Hill Borough, Cumberland County, PA
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:
S' nat Typed or printed name and residence
<,• Jeffrey H Gribb 914 Drexel Hills Blvd.
` ,~'"-~ New Cumberland, PA 17070
~_
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Page 1 of 2
Form RW-OZ Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2006 form software only The Lackner C3roup, Inc.
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
715 Arlin ton Road Cam Hill Borou h Cumberland Coun Penns Ivania 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then _ 98 years of age, died on 08/01/2011 at 265 Ailanthus Lane, Arden Courts, Susquehanna Twp, Dauphin Co, 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. ~~~ A A //
A ~
Sworn to or affirmed and subscribed
before me this ~J day of
~ '~ ^ A
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~~~
For the Register
File Number:
~,
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Sign_ ~ A
21-11 ~ Q ~~
Signature of Personal Representative
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Signature of Personal Representative :L ~ C~-'~ •
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Estate of Joseph C GRIBB ,Deceased
Social Security Number: 0 31- 2 2 - 9 7 5 5 Date of Death: 01/01/2010
1 I , in consideration of the foregoing Petition, satisfactory proof
AND NOW, '
having been presented before me, IT IS DECREED that Letters Testamenta
are hereby granted to in the above estate
and that the instrument(s) dated 10129/2001
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters .......................................... $ ~ U • ~~ _
./
Short Certificate(s)...~.1/....•••••••• $ ~U • Ut~~
Renunciation(s) ............................ $
~.~~I~I $ ~5~t~
BLS $ ~ ~ ~
~.~
~1 •~`lC:~ ~~ C~ ~ $
$
$
$
$
$
TOTAL ................................... $ ~ ~ . ~~
Attorney Signature:
Attorney Name:
Jeffrey H Gribb
. ~ ,~ ~`7r~~F
RICHARD W. STEWART
Supreme Court I.D. No.: 18039
Johnson Duffie
Address: 301 Market St.
PO Box 109
Lemoyne, PA 17043-0109
Telephone: (717) 761-4540
Copyright (c) 2006 form software only The Lackner C3roup, Inc. Page 2 of 2
Form RW-02 Rev. ~o-~s-loos
LClCAL REGISTRAR'S CERTIFICATION CIF DEATH
'WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
~ 1755x18.0__
Certification Number
'T'his is to certify that the information here given ~s
correctly co~~ied trorn an original Certificate of Death
duly filed with n~le as (..ocal Registrar. The original
certific~rtc ~~~ill t~~c forwarded to the State Vital
Records Office f1rr permanent filing.
~y~ ~ AUG 0 2 201
Local F:egislrar~~~~ Date Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
3 REV 111'1006
PRINT IN CERTIFICATE OF DEATH
ACNK (See instructions and examples On reverse) STATE FILE NUMBER
2. Sex 3. Soda) Ssauny Number 4. Deb of Dath (Monts, day, Year)
t. Name d Decedent) (Kral, middle, lest, suffix) - 22 -- 9755 A ust 1 2011
e
5. Age (leaf Bktltday) Under i r Under 1 6. Data d &rlh 7. BI ertd slate a 1 8a. Plea of Death Check ate
HoaPnat: Other.
.
- ~~ Haun Mrxna March 6 1913 Nanticoke Pa ^ InpatbM ^ ER I a,tpetlem ^ DOA C~Nursing Hans ^ Residence ^ Other • Spedly.
98 Yom. Was Decederd d Hispanic Origin
9 ? No ^ Yes 10. Rex: Amedcxrt Irxlien, Black, Whne, etc.
D
h Ci
6c Twp
Boro
ty . of Death 6d. Fac6My Name (n not ktetltlrtlan, gkre street end number) . (sP•dM
• eat
6b. Coudy of
u in
D ,
,
.
Sus uehanna
Arden Courts (n yes, epecny Cuban,
Mezban, Puerto Rkxn, etc.) 1 to
m
iden name)
h
II
if
a
Decerlertt's Uaud tlon Kaxl d work do
11 ne du moat of pie. Do not state 12. Wes Deadertt ever In the 13. Decedents Educatbn (Spedly ony higfxet grade tbntpletattJ 14. Marna) Status: Married, Never Married,
~~' DNOroed (N1 re
a
w
e, g
15. Surviving Spouse (
.
rand of Business l Indtutry
land d work U.S. Amted Fatxs? E~~r ! SecaMery (0.12) Cotlege (1d or 5+) d
d
W
Yes ^ NO 5+ OWe
1
- 18. Decedents Address (Street, dry I town, state, zip code)
ton Road
715 in Decederd's Did Decedent
Actual Realdentce 17a. Slate PA live in a 17c. Yes, Decedent Lived in T'^~
TOYw'~~?
g ,
D
17d. No
ltfcede~t~ edwnhin Cali1A Hlll cnyfBoro
f`,~,n},cY~At'1f~
- Camp Hill, Pa 17011 "b ~°""~ ~
t
a
19. Mttthefa Name (First, mkldk, maiden aumame)
i6. Fatltefs Name (First, midde, last, stdfix) to nix Krasion
20x. ktfortrtartts Name (Type I Print) 20b. Informant's MaNkq Atidrees (Street, dy I town, state, zip code)
914 Drexel Hills Blvd. New Cumberland,Pa 17070
Jeffre H. Cribb crematory a other pl~e)
mete
d
N
itl 21 d. Locatbn (City I town, state, ap code)
tbn ^ Donation
osttlat
f pi
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M
tl
d 21b. Date of Disposition (Month, day, year) ry,
ame
ce
ort (
21 c. Plsce of Dlepos
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sp
reme
to
o
21 a.
e
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^ Bartel ^ Remove"re"state ; ~
^ Y
^ No A ust 3 2011 Hollin er Crematory MrHolly Springs,Pa
,
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ea en., us.....,.~ AArrre •e ~ FnrAHv
22a Signature of F as such) 22b. License Number
~ 011654
ibrtts 23ac any when ceANylrg 23a. To the best d my krav+l•d9•, death occurred at the tl , drite end stated. (Signature and title)
/
pftyeldant k nd evaGebb at tlme of death to //~^s `/
-
certly aauee d death.
`ter Ti
Items 24-26 must ba completed by person
rortotxtces death
h 24. Time d Death
'~ ~ US P M. 25. Date Prono (Montlt, day, year)
~' '~ (- oZ C7
.
w
o p CAUSE OF DEATH (Soo Inatructlons and •xannplss) r Approxhnete ~~~'
that tiredly caused the death. DO NOT amen terminal events such as cerdac aneaL
Part 1: Ender the drain of everds - dmeasa, inJunies, a campAcetlonta -
Ibm 27 t Onset to Death
t
.
reepkatory anest or ventrkxrler ibrNbtbn witlwut showing .List ony one cause on line.
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in death) 9sease a a/ ~7r / ! vY.~ / 1i[ I ~ v / ,
ltln
d6 r 1~L_
g
on resu
con
Due to (or as a consequence ofJ: r
tlst crortdltlona, it arty, b,
a~ Due ~ (a as a consequence af):
S
A
E
~ r
E
U
ul YING C
Mer
(dhease a IrrJury that kdfiated the c i
events reetdtlrtg in death) LAST. Due to (a es a consequence of):
t
d. t
30e. Wes en Autopsy 30b. Were Autopsy FkMirgs 31. Manner of bath 32x. Date d IntPxxy (Momh, day, Year) 32b. Describe How Inury OawtTed
PeAartted? Aveaeble Prbr to Completbn ~ Natural ^ Homidde
lme Inc. 1903 Market St Hill Pa 17011
23b. License Number 23c. Date Signed (Month, day, year)
RN ~~7/?(n L G~" O I ~o//
26. Was Case Ref to Medical Examiner I Corone r to a Reason Other than Cremation or Danatbn?
^ Yee No
art II: Ender other '
but not reetAlhtg in the undedyktg cause given In Pad I. 28. Did Tobacco Use Contribute to Death?
^ Yes ^ Probably
No ^ Unknown
29. 11 Female:
^ Not pregnant wnhln past year
^ Pregnant et time of death
^ Nd pre~tan6 but pregnant within 42 days
of death
^ Not pregneni, but pregnant 43 days to 1 year
before death
^ Unknown if pregnant within the past year
32c. Place of Injury: Name, Farm, Street, Factory,
01fice Building, etc. (Specify)
of Cause d Death? 32 Locetbn o1 m u 3treel, ctty I town, state)
~•1_ ^ Accident ^ PendMg Investlgetlan 32d• Tkrre of Injury 32e. InJury at Work? 321. It Trerteportatbn Injury (Specfy) g• J ry
^ Yes ~`~° ^ Yes ^ No ^ Yes ^ No ^ Driver/Operetor ^ Passenger ^ Pedestrlen
^ Suidde ^ Could Not be Determined M. ^ Ogxr - g~/j,,' / ~ (~,//)
33x. Certlfier (tirade ony one) 33b. Signature and Title of Certlfier /~ I"'~'
• C•~YkW PhY•kb^ Ian c•~YbB cause d death when araMa phyekktiaen has pronounced death end completed item 23) yr
To fife bat of my knowbdga, lath otxur-ed due to the puaa(a) and manner a shred - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ® 33c. Licence Number / Q' / 33d. D to Signed (Month, day, Year)
• Praaundng ad aAllYing ( ~, P9 loth and aertnying m awes d loth) OS o o ~~(~Q ,r(~
To the bat of my btowladP, Oats occurtsd n tlta time, dab, and P~•, and dw to ttta txuaa(s) and manner a stated- - - - - - - - - - - - - - - - - - ^
• Medial EramYtarlCaonsr y~//p
On 1M bash of axaminatlort and / a lavaatigation, b my oplnbn, tiatlt otxurrod N the thna, dab, and place, and due to 1M atri(a) and manner a sated_ 34. Naras a v~~ ~ / ,~Cauee of Death (Item 27) T I Print
'GL~ ~ L`>7 I ~ ~a I l I ~ ~~~~Y // S ~ ~ .~/ ~ S ~ l~ ~l .~ ~ ~J//
. Diepoeitlon Pennn No. /~ r /'t'/ a~~~