HomeMy WebLinkAbout08-25-11 (2)PETITION FOR PROBA
TE AND GRANT ()F LETT
REGISTER OF WILLS OF CUMBERLANp ERS
COUNTY, PENNSYLVANIA
Estate of Ruth H. Davidson t
also known as File Number _ 1 `~ ~ ~ -
arol Ann Ne le and Har J. Davidson Jr. ~ Deceased Social Security Number 1
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 Testamentar
last Will of the Decedent dated 2/1 /1987 y and aver that Petitioner(s) is /are the X r
and codicils dated named in the
Har J. Davidson redeceased the decedent on Janua o s
~a 2009
(State relevant circumstances e.
Except as follows, Decedent did not m ~ g ~ renunciation, death of executor, etc.,l
arty, was not divorced, and did not have a child born or adopted after execution of the in
for probate, was not the victim of a killing, was never adjudicated inca acitated
of death wherein grounds for divorce had been established as provided in 23 PA and was not a strument(s) offered
party to a pending divorce proceeding at the time
none C.S. section 3323
(g)~
r1
U -~. Grant of Letters of Administration
(Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate
Petitioner(s) after a proper search has /have ascertained that Decedent left no W' ~
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and co
ill and was survived by the fi~llowing spouse (if any) and heirs: (If
mplete list of heirs.)
Name
- i9
G7
rn ^ , : ~ .
(COMPLETE INALL CASES.) Attach additional sheets if necessary. '
~`.._~ ~ ~ ~ ,s
Decedent was domiciled at death in Cumberland ~~~~-` -
S rin Red County, Pennsylvania, with his /her last rinci --~ ~ ^.„ .
Newville ~ ~ ~ ~'
(List street address, town/city, township, county, state, zip code) PA 17241 p pal r~didence at 210 BI ~`-' `~
W. Pennsboro Tw . C mberla ~~ noun
Decedent, then 92 ~
West Pennsboro Tw .Cumberland Co Hied on 8/10/2011 at Green Rid a Vill a 210 Bi ri
Newville n Road
Decedent at death owned property with estimated values as follows: PA 17241
(If domiciled in PA)
(If not domiciled in PA) All personal property
Personal property in Pennsylvania $ 208 000.00
(If not domiciled in PA) $
Value of real estate in Pennsylvania Personal property in County
no real estate ~
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicils rese
the undersigned: () p nted with this Petition and the
Signature grant of Letters in the appropriate form to
Typed or printed name and residence
Carol Ann Negley 1 McDermond Road
~ Newville
. Harry J. Davidson, Jr. PA 17241
Shi ensbur 676 Walnut Bottom Road
PA 17257
Form RW-02 rev. 10.13.06
Page 1 of 2
t• orm x w-ut rev. t u.13. vo
OCAL REGISTRAR'S
CERTIFICATIO~J OF D
WARNING: It is illegal to duplicate this cop b EATH
Y y photostat or photograph.
Fee for this certificate, $6.00
P 17694628
Certification Numt~t~
H1r)3.143 REV 11/20pg
TYPE /PRINT IN
PERMANENT
SLACK INK
1. Name of Deaderd (Firel, rnidds,
Ruth Fi , bd, suffix)
Davidson
5. Age (Lest Birthday) Under f r
This, is to certify that the information here given .
correctly copied from an original Certificate of Deat
duly filed with me as Local Registrar. The on ins.
certificate will be forwarded to the State Vita
R ~~ Office for e)- ,
P ant filing,
,..~ ~ ~~
Deal Registrar C7
.;~: Date ~ ued
-~. ._._.
~~,.. O
_x"rte ~ ;'-r,
.-~ ~ ~ '~' r 1 1 ~- .,
r V .. 1 ~;
_~
:~C7~ _
COMMONWEALTH OF PENNSYLVANIA . '--~ ~- ~-.1
DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~ ~,,~ M1-W ~~
(See i^strRTlonsCa^d e>°mplDes on reverse) ~ , ,~R. +
i;>~ ~
2 sax STATE FILE NUMBER „~"' `i"'I
9. Social Security Nartber
t4aame -. ~° a• Dab d einn Monet da , F e m a 1 e 17 9
• 9 2 ~ ~"` ^.. Mkxnee r 7• BI lace C' and state o
r - 1 CI -- 3 8 5 2 a Dora or Deem (Monet, day, year)
r
Yrs. COUM 8a. Place d Death Check on one
eb. COwrY of Deem December 3 , 1918 S h i Hosptel:
e~. city, Bore, Twp. or Deem P p e n s b u r
p
an
g,
A
er:
~ Fadgty Name (M not Irrstiprtipr ~ d,~ snd number) ^ ~~nt ^ ER / t~prlbM ^ DOA ~ Nu
Cumber 1 a n d W . P e n n s b o r o T
~9 Ftorr
^
re
w p ,
Residence ^ Other • Specity:
9• Wes Decedent of
,,. Decedent's UerrW dare 7r ~ ~i d e V t,1 C~ It HiePanic Drain? ®Na
KkM d work ~ (Yes, epectly Cuban
most d life. Do rat stat
^ Yes 10
Race
KkM d W
A
,
ork
e ran Mexican, Prbno Rk;an, etc.)
Self Employed 12 was Decadent ever m Ina 1a DewdeM~s EducaMat
Kind dBusine~s / Induct (Specify an
. Farmer ry U.S. Anrod Forws?
N highest grade com
b .
:
merican Indian, Black,
(S~qY) White, etc.
p
Elementary /Seconds
red) 14. Madbl Status: Married, Whit e
16. DewdeM's Melling Address (mil ~, /town, state, zi ^ Yes Never Married, 15. Survivi
®No 9 years ry (0.12) College (1.4 or ~.) Wkknved, Divorced (Specilyj ng Spouse (M calla, give rrolden name)
210 B i p cede) Dead
M'
S
e
s
g
pring Road Actual Residence 17a. state P A W i ci o w e d
N e w v i 11 a P A
Did D
ecadent
1 7 2 4 1
18. FaOrer's Name First, 17b ~~ Live in a , ®Yes,
( meddle, lest, srdTuc) Cumber 1 a n d Township? 17c Decedent Lived
Isaac Rich
in
W. P e n n s b o r o T w p
,
ardson 17d. ^ No, Decedent Lived Twp.
within
Actual Limits of
20a. Informants Name (TYPe /Print) 19. MWher's Name (First, midrib, maiden sumeme)
Car
l
o
A. Mary Hock
Negley c~'/B0f0
w
`
' 21a. Method of Disposition ~. lMarrrent's Melling Address (Street,
• GrY /town, state, zgi cede)
' 1 M C D e r m o n d Road
®~riat ^ Removd from stal
^b
;
iw anon 21b
D
^
~ e
.
ate d D
w,.
, N e w v x:11 e, P A
n
Other . A~Irodzed rspoaition (Monet, day, ywr) 21c. Place of DrapoaMian (Warne of
22a. Signature d Funs
cemetery, crematory a other
/Cororbr? ^ Yes^
l
17 2 4 1
~
p
ace)
rose (a rson ecti~
No 8 - 15 - 1 1
22b.uanaeNumber Westminster Cemeter
~` ' 22c
N
21d. Location (C1ty/town, state, zip code)
y
.
ame and Address of Fadlity
~Pbteibms23a.cp~,w~ng 23arad,e d FD-012984-L Fogelsanger-B
Mien b rat evdlabb atlkro of deed, b my , death acaxred
i
Car 1 i s 1 e , P A 17 013
r
d me time, dale end
' woes of deem. Plea stated. (signature and title)
cker Funeral Home Inc
$ h
.
.
Marro 24-26 mud be 23b. ~~ Number
~ comWeted by person 24. Torre of , V
praarsass death.
25
1
P P e n s b u r , P A 17 2 5 7
23c.
D
ate Signed (M
~ ~ ~ (
./JD~ate P ounwd Deed (Mach, day, Yaar)
, (g' ~
A M.
onth, )
day, Yeer
[/,
~
t , C
r ! ~
/~•~
' " "'~ t ~ a, v 26. Wes Case Referred to ~t t ~ ,
Item 27. Part I: Enbr the CAUSE OF DEATH (See Instruotfone and a Medaal Examiner /Coroner for a Reason
,~~ -diseases, iryuries, a cengMcetioro .mat metes) ^ Yea ^ No SM r than Cremation or Dorotion?
Dry arrest, a ventria4ar tibri9etion witt
N caused the deem
DO
O .
aul showi
NOT enter terminal events such es wrdbc arrest,
n9 Mae ' r Approximate Interval: Pad II: Eller other
A~CAUSE (Fyel use a t10I091'. Lest only one cause on eacn line. r Onset b .
mrg m deem) r Deem
b
t
8
. ^
~' /
r
u
. Did Tobacco Use Contribute to Deem?
rat resulting in the undenyinp rouse given M Pan I.
-~ a. r ^ Yes ^ Probabl
D
t
.rT
v
• .~
ue
o (a as a r /
kst conditions, M any, 09~ r
M cause Meted on kro a. b r
Enter UNDERLYING CA
r y
^ No ~~
29
USE Due 1a (or as a co ~
~-~
(evens a Injury met initiated the nsequence ~: ~ /Q ,~
resuMing n death) LAST. c.
N . M Female:
~t Megn~f within past
ear
•
p r
~
Due to (or as a r -~------
carsequence op: r
d. r •---- y
^ Pregnant at time W deem
^ Not pregnant, but
Pregnant wMhi
4
-.__
' ----~_
30a. enonned?t~ Sob. ware r
AMY Furdin~ 31. Manner M Death r
Avaibpb Prior to Com
bti
r ~ n
2 days
d deem
^ Not pregnant, but pregnant 43 da
s t
1
S
p
on 32a. Date of In'
-
d cause a Deatn? ~alurai !ury (Madh, ~Y~ Pearl 32b. Describe Haw Injury occurred
.lam-- ^ Homicide
^ Pro U ~ y
o
year
before deem
^ Unknown if
pregnant wdhin the past year
/ ^ Yes ~ ^ Accident
^ Pendkrg Im~estigation 32d. Time of Injury -
32e. Injury al Work? 321. II Trenaponetian I '
Suicide ^ Count Nol be Determined ^ ~xI' (~'N)
33a. Certifier (de
k 32c. Place of I
Mary: Hone, Farm, Street, Factory,
Office ~~g, eta (Spear/yJ
c
wN are) M. Yes ^ No ^ Driver/operebr ^ Passen r ~. Location of irryury (Street, city /town, stale)
GrtHying PhYelclen ^ Other • Spep/y,• ~ ^ r'edestrien
7o the pest of my ~ ~h ~~ use of death whenaaan(ao~ndnr see r~ need death and co ) 33b. Si a ~br
• ned due to the wu mpleled Item 23 9roture a
7o die ~ a~ Ing Wryaklan (Physician both pronouraing death and can.. - - - - - - - - - - - - - - - - - -
Medial Examkre / , drrMh occurred d the time, rime, and plea, and due otthe err of death) -' - - - - - - - - -~
On the bads of exemyrdlon end / a a(s) end manner ae Meled_ _ _ _ _ - - ^ '
Inwetlg•tkxr, In my oplnbn, death oaurred d the time, dale, end - - - - - - - - - - - ~~ w 33d. Date SigrQad (Momh, daY, yam)
Repdrers Signatue r place, and due to the cause(s) and manner n etdad_ ^ 34. Nerve and~~+V~ ~'~ ~ `• v ~Q ~r~
Address d Person Competed Cause d
' Z I ' ISI 96. ate Filed (Month, day, year) J~yLC, S-~ Deem (Item 27) Type ! Print
Disposition Pennil No. Q ~ R ~ 7 ~-r `~ =-=~~ ~~} /'7 i
Oath of Personal RepresentatiV
CONIl~ON~ALTH OF PENNSYLVANIA e
COUNTY OF CUMBERLANp ~ SS
The Petitioner(s) above-named swears or
() affirm(s) that the statements in the foregoing Petition
the knowledge and belief of Petitioner(s) and that, as erson
P al representative(s) of the Decedent, .Petit oe true and correct to the best of
administer the estate according to law.
ner(s) will well and truly
Sworn to or affirmed and subscribed
before nie the ~~1
day of
For the Re is C~r~
g ter
Signature of Personal Representative Carol Ann N
~~
Signature ers 1 Representative
Harry J. av.
Signature of Personal Representative
File Number: ~ ~ '_ ~ I - Q~
n. tJ-jr.
CJ
'!'T -~ ~ G`7~
~, ("'-
.~'" '~~ '~ rv
Estate of Ruth H. Davidson -r '
;t>
:_
i
Social Securi N - ,Deceased ~~
ty umber:179103852
AND NOW, Au ust ,~J ~ Date of Death: 8/10 ~ 1
having been presented before me, IT IS DECREED th ' 2011 , in consideration of the foregoing Petition
are hereby granted to Carol Ann Ne le and Har at Letters Testamenta ,satisfactory proof
J. Davidson Jr.
and that the instrument(s) dated Februa 13 1987
described in the petition be admitted to probate and filed o ~ the above estate
f record as the last Will (and Codicil(s)) of :Decedent.
FFFC ~ ,
Letters ............................. $ 10 0~
Short Certificate(s) ....
......
Renunciation(s) .. $
00
Will
JCS fe " " ~ 15 00
Auto ~~~
mation ~ ~
$
5 00
.... $
.... $
.... $
.... $
.... $
....
TOTAL ............................. $
$
361.50
°orm RW-02 rev. 10.13.06
egister of ~
Attorney Signature:
Attorney Name: I R. Zullin er
Supreme Court I.D. No.: 17516
Address: 14 North Main Street Suite 200
Chambersbura
PA '_.-~ 17201
Telephone: (717)264-6029
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