HomeMy WebLinkAbout08-26-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of Lena Dahl
also known as Lena F. Dahl
CUMBERLAND
COUNTY, PENNSYLVANIA
File Number 21 - ~~ ~ ~ 9p 7
Deceased Social Security Number 187-12-7879
Charles R. Dahl
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 named in the
last Will of the Decedent dated 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 mar ,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 pted; was n(t.the victim of
a killing; and was never adjudicated an incapacitated person, except as follows: ,,,^ ~~.
^X B. Grant of Letters of Administration =-`- .c._ r'r't rv a 1 , ,: ; .:.
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app Ica e, en er c..a.; .n.c..a.; pe en e i e; uran e a sen ~a; uran a mmon a e
Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the following spotaCs~ ffif~any) awl heirs: (if
Administration, c. t. a. ord.b.n.c.t.a., enter date of Will on Section A above and complete list of heirs); was not the victim'b1?~&iltitrg; wa~never
adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce ~en established a~-_- ,-`~-;
provided in 23 Pa. C.S.A. § 3323 (g), except as follows: _.
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Name Relationshi Residence ~ a
Charles R. Dahl Son 317 Fifth Avenue
New Cumberland, PA 17070
Edwin F. Dahl Husband died 10/09/1966
Margaret Susan Dahl Daughter died without issue 4/10/1993
~c;vmr~t / t fIV HLL c;ASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
317 Fifth Avenue, New Cumberland Borough, Cumberland County, PA 17070
(List street address, town/city, township, county, state, zip code)
Decedent, then 90 years of age, died on 05/26/2011 at Holy Spirit Hospital, East Pennsboro Township, Cumberland County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 2,600.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 133,800.00
situated as follows: 317 Fifth Avenue, New Cumberland 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:
Signature Typed or printed name and residence
~~ L ~i '/~G~ ~ /~ Charles R. Dahl 317 Fifth Avenue
New Cumberland, PA 17070
Form
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Page 1 of 2
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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 subscribed ~
~, -~ /,, th ~~ Signature of Personal Representative Charles R. Dahl
efor me this tY (~ day cf
For the Register
File Number:
Estate of Lena Dahl
Signature of Personal Representative
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Signature of Personal Representative T't --~
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Deceased C°'
Soci curity Number: 1f8~7-12-7879 Date of Death: 05/26/2011
AND NO c!f , in consideration of the foregoing Petition, satisfactory proof
having been presented efore me, IT IS DECREED that Letters of Administration
are hereby granted to Charles R. Dahl
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
in the above estate
FEES G~ , ~ c
Letters ............................................$
ro /s ~ `~
Short Certificate(s) .............~......... $ ~ . ~ O
Renunciation(s) ............................. $ Attorney Signature: ~~
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$ ~.~ Attorney Name: Robert P Kline
(~(, $ , ~a
Supreme Court I.D. No.: 58798
Kline Law Office
$ Address: 714 Bridge Street
$ P.O. Box 461
$ New Cumberland, PA 17070
$ Telephone: 717/770-2540
$
$
TOTAL .................................... $ ''
Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATIOIN OF DEA~~`~1-I
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, `.>~.0~
P 17556380
Certification Number
This is to ceriifv that (ht~ ilion~ii;i ion here giv ct~~rrectly cr~rpied from ,, ~ on •~i nai C": rtificate of D
duly filed with me as ~~oc~ l Re:~i~trar. The ori~
certificate will he ft~~~warat~d tt~ the State `
Records C)i~fic~~ 1tn° pc)~manrnt filing.
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- MAY 2 8 20~
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Local Registrar llate lssued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~
143 REV 11/2006 ~'
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ERMArENr" CERTIFICATE OF DEATH .
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BLACK INK (See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decsderd (Brat, midAe, lest, sudhc) 2. Sez 3. Sodel Security Number 4. Deb of DeaM (Month, de/, year)
Female 187 __12 - 7879 May 26, 2011
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bce of Death Check one
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6. Age (last Bktlday) Under 1 ar Unrler 1 de 8. Deb of Birth Morhh de , 7.81 and Meta a rare 8e.
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Other:
~reit l)aya Hours Mkzzea
9 0 Yrs Jan . 19 , 1 9 21 Phi 1 a d e 1 ph i a , P A ^ ,,,~„e„t ^ ER I orApetlent ^ DOA ^ Nursing Home ^ Reaklence ^ Other - Specfy _-
- lib, County of Death 8c. CNy, Bono, Twp. of Death >3d. Feddty Name (If nd ks6drtlort, give street end number) 9. Was Decedent of Hbpenfc Origin? ~ ~ ^ Yes 10. Race: American In~an, Black, Whfte, ate
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' Cumberland East Pennsborg' R~,a~a White
Holy Spirit Hospital ~
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• 11.Oecedertts Usud Kind of work d are moat oI INe. Do not Mete retr -
12. Wes Decadent ever n Ihs 13. Decedents Edrxztron (Specdy only hlglbM grede cortpleted) 14. M Sd'ta~ ) r Married, 15. Surviving Spouse Qf wife, give maldan name)
ofWOrk KlndolBuMneasllrzhretry
Homemaker Own Home U.S. Amred Forces?
^ y, ~j Nd Elementgry~Secondary (0.12) College (1-4 or 5+)
Widowed
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1 s. Decedents Mai6rp Address (Street, pN /town, state, zip code) Decedents P A Did Decederd
State Live in a 17c. ^ Yes, Decedent Lived in Tv+P
Actual Residence 17a
317 Fifth Avenue .
Cumberland T0'rp~ 17d.®No,DecedentLivedwithinNew Cumberland
' New Cumberland, PA 17070 "~•~""ty ActualLimftsof CitylBoro
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1 Glda (RF 1i zfesumeme)
Name R ! PdntJ
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~~arf 20b. Inromrerita Meiling Aadreaa (street, city I town, Mate, ziP code)
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es 31 7 Fifth Avenue New Cumberland PA 1 7-070 _-
21 a. Method d DispoMUOn r ^ Cematon ^ Donelbn 21b. Date of Dispositldn (Month, day, year) 21c. Place o1 Dbpositbn (Name of cememry, txematay a other place) 21 d. locatlon (City I town, state, zip code)
^
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DonetlonAWrorleed^
CnrYtlon
Budd ^ taernwalfromstMe ~ ~
' June 1 , 2011 Mt. Olivet Cemetery New Cumberland,PA1 70
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' 22a of Ftrsral licewee (a actlnA u such) 22b. t.iceroe Number 22c. Name and Address d FadlNy
1
7070_
land,PA
FO 012342-L Stone & MurrayF.H., 408 3rd.St.,New Cumber
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llama 23ec only when rxrtMylrrg 23a. Ta , death oavned et the tlme, date end staled. (Signature and title) 23b. r .Date Month, dary,/y~(r)
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' b not evalMble M tkne d death ro ~~ ~
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pdNy arse of death. ~
~ Naas 24.26 ~ ~ ~ngbbd ~ ~~ 24 n of 25 (M~, dsy, r) I 26. as Referred to Mer9cel Exeminer /Coroner for a Re on Other th Cremation or Danetbnl
~ wino P deatlr ' J r~ (~jJl•) M Yea ^ No
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CAUSE OF DEATH (See Instructlons end eze pbs) r Approzimete Interval: Part II: Enter other ' 26. Did Tobacco Use Contribute to Death?
a Has ~ 1hM drerxly caused ds death. DO NOT enter temrnal events such u cerdlac arreM, ~ Onset to Death but not reautting in the undertying cause given in Part I. ^ Yes ^ Probably
njurbe
Pert I: Eller Us then of svanb - d'eeasea
Item 27
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respiratory anent, a wxWicuuler ibritletron witlaut showing the etlobgy. List ardy one terse on each line. r ^ No ^ Unknown
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MMIEDUITE CAUSE (FM~I deasse or ~~ ~G ~~~ 1 ~~'~ r 29. It Female:
n deem)
, ^ Not pre
nant within pant year
r~lion restdhn
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~~~ ~ r Jr, l:~ ~ ~ I _ / r ^ Pregnant et time of death
Due ~r
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- i ^ Not pregnant, but pregnant within 42 days
1. (,
1tyy Yst candllorrs, tl vry, b. p
ro dre cause kabd on Nrs a. Duero (a as a ~ i of death
Ertbr t1NDERLYNI(i CAl13E ~~,- ^ „ ~~°"CB o E! nG~ ..-i-~-~ ~ V
- (disease a injury tltal nitrated the c C,l:.rvac ~ ^ Not pregnant, but pregnant 43 days to 1 year
event reerltlrg m death) LAST.
• Due to (a as a corsegrsrrce ot): , before death
i ^ Unknown fi pregnant within the past year
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30e. Wes en Autopsy 30b. Were Autopsy Endings 31. Manner of Death 32e. Date of Injury (Month, day, year) 32b. Descrtbe How Injury Occurred 32c. Place of Injury: Home, Ferm, Street, Faetory,
Office Building, etc. (Specify)
_ Perfomred? Ava6ebb Prbr to Completion ^ Natural ^ Homkdde
^ Yes ~ No of Cause of Death?
^ Yes ^ No
^ Aaddent ^ Pending Inveetlgatron
32d. Tkne of Injury
32e. Injury at Work?
^ Y
^ No
321. 6 Transportation njury (SyedlyJ
^ DrlverlOpereror ^ Passenger ^ Pedestrian
32g. Locatbn of kriury (Street, city /town, state)
^ Suktide ^ Could Not be DMermined M, ea ^ 0~
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33a. Certltler (check only one) 33b. ~of Certlfier t
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• Certllylnp phyNcbrr (Physician certllykrg teats of death when anodrer phyelden hoe prorqunced death end corrgrleted hem 23)
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To tM bent of my IororeMdga, death occurre
• PronormcNg and artllYMg PMs~ (fin botlr Pig death and certliying to cause of death)
To the bast of my knowMdgs, death occurred M the time, dste, and pbee, and due to the ease(s) end manner a afabd - - - - - - - - - - - - - - - - - -~ 33c. Urxmae Number
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l~~ 33d. De Signed (Month, day, year)
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• Wdlal ExsmlrNr/Cororw
On 1M bob of eaemhation end / a Investlgallon, In my opinbn, death occurred M the Ume, date, and pbce, and due to fhe awe(s) end manner o stebd_ ^
34._ ame~ ~ P` erg Who Oanplet00Gpusth (hem 27) T P t
35. Regbtrats end / ~- P~ I ~ ~ °CI / I ~I
- _ ~~jd 0 ' ~D / ~ ~G(„ C li! QCL l l~7 ~~`~ ~ f I ~.1.( l 1 ' r ' / ~+ ~ l ~ R~
Disposltbn Permit No. O ~ /~ ^~