HomeMy WebLinkAbout08-29-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Zacha O. Bond
also known as
COUNTY, PENNSYLVANIA
File Number 21 ~ / " d /~
,Deceased Social Security Number 167-40-17fi7
Susan F. Woska-Bond
Petitioner(s), who is/are 18 years of age or older, appiy(ies) for: .
(COMPLE7E 'A' or 'B' BELOW )
A. Probate and Grant of t.ettsrs Testamentary and aver that Petitioner(s) istare the named in the
last Wit of the Decedent, dated and codicil(s) dated
Stafe relevant dretrrr-atanoea, e. p., rer-unciaGon, death of executor, etc.
After the execution of the documents offered for probate: Decedent dkl not marry; 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 adopted; was not the victim of
a killing; and was never ad)udicated an incapacitated person, except as follows:
B. Grant of Letters of Administratto
(Kapp&cabte, err~leer. at.e.; d.b.n.at.a.; pedente 11fe; duranh absentM; chnante m)noritate)
Petitianer(s~, after a proper search, has/have ascertained that Decedent left no Wilt and was survived by the following spouse (if any) and heirs (if
Administrabon, c. t. a. or d b.n. c. t a., enter date of X11 on Section A ebova and camplete.list of heirs); was not the victim of a kiilrng; was never
aro) v Bred in 23 Pa~C.S A t§ 3323 (g), except as fot{ows~ to a pending divorce proceeding wherein grounds for divorce had been established as
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(COMPLETE 1N ALL CASES:) Attach additional sheets if necessary. ''~ `_` ``rte
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t"_»mh~rland County, Pennsylvania with his /her last principal residence of ~~ `
Decedent was domiciled at death in
4 Ardmore Clrcie New Cumberland Cumberland PA 17070
(Ctrl sireef address, town/city, township, County, state, zip code) ,t.
Decedent, then ~_ years of age, died on 07127!2011 at M S Hershey Medical Center
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) Ali personal property $ 15 000.00
(!f not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ ~ 150,000.00
Total 1 fi5,000.~)t~
situated as follows: 4 Ardmore Clrcie New Cumberland, PA 17070
respectfully request(s) the probate of the last W41t and Codiei!(s) presented with this Petition and the grant of Letters in the appropriate form to
Si nature T ped or printed name and residence
Susan F. Woska-t3ond 4 Ardmore Circle
~-, New Cumberland, PA 17070
Form RW-02 Rev. 12-2&2010 (interim ha'm, pending action by fhe Court) Copyright (c) 2006 torm software only The Ledcner Group, inc. Pegs 1•.ot 2
PETITION FOR PROBATE AND GRANT OF LETTERS
(Continued)
REGISTER OF WILLS O~ CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Zachary O. Bond File Number 21
also known as
,Deceased Social Security Number 167-40-1767
~~
Leola Bond Reiationshin
Mother Residence
VA
Tyler A. Bond Son 353 Old Stage Road
Lewisberry, PA 17339
Miles R. Holt Grandson c/o Robert and Vanessa Holt
South Riding, VA 20152
Vanessa L Holt Daughter 25597 America Square
South Riding, VA 20152
Susan F. Woska-Bond Spouse 4 Ardmore Circle
New Cumberland, PA 17070
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named swear or affirm 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 ~~ie estate according to law.
Sworn to or affirmed and subscribed
before me this ~-Uk-~ day of
(~~1 f~ ~:~ ~~~1,~~X ~-
For the
DECREE OF PROBATE AND GRANT OF LETTERS
Estate
Deceased File Number: 21- -
AND OW, this day of , in consideration of the Petition on
the reverse side reon, satisfactory proof having been presented before me, IT IS DECREED that Letters
-Testamentary of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., e[c.)
the above estate and that in ruments(s) dated described in the petition be
admitted to probate and filed record as the last Will and Codicil(s) of Decedent.
Glenda Farner Strasbaugh,
Register of Wills
FEES:
Letters .................... $
Will ........................
Codicil(s) .................
( )Short Certificates
( )Renunciations......
Bond .............................
Other .............................
................................._
Automation FEE......... _ 5.00
JCS FEE ................... 23.50
TOTAL ................$
m
Signature of Counsel Required t6~nter Appearance ~,
Atty's Signature ;,-~ r- -
_ :. r
_ -=? ~.,'
=~~~`
P TED Name:
~~ -
Supre e Court ID No.: - '
-1 ~=_
Address: z' - "~ ~+
Phone:
Fax:
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
Page 2 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
-named swear(s) or affirm(s) that the statements in the foregoing dPeni~i Pet tlonrer(s) will well and trulybest of
The Petitioner(s) above
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the ece ,
administer the estate according to law.
Sworn to or affirmed and subscribed Signature of Personal Representative Susan F. Woska-Bond
before me this day of
Signature of Personal Representative
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Signature of Personal Representative _.,_..
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ister ~`' '
For the Reg ~" ~~°~'" -~
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File Number:
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Estate of Zacha O. Bond ,~, ~ --~
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Social Security Number: 167-40-1767
A~,~ ~~ s7"" ~
AND NOW,
having been presented before me, IT IS DECREED that Letters
are hereby granted to Sr~san F WO kid
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of reco
FEES ~~O` ~~
Letters .......................................... $
v
Short Certificate(s) ......... ............ $
n , G ~`
unciation(s)......... °~-••••••••••••• $ ~
c S $ °~3• ~
~ufy $ .oo
$
$
$
$
$
Date of Death: 0712712011
~~ ~~ , in consideration of the foregoing Petition, satisfactory proof
,
of Administration
in the above estat=
rd as the last Will (and Codicil(s)) of Decedent.
Af
At
Hummelstown, PA 17036
Telephone: 7171533-3280
E-Mail: QII(a'~dC COm
......................... $ 0
TOTAL.......... . ~~
i Page
Form RVV-U2 Rev. 10-13-2006 / Copyright (c) 2006 form software only The Lackner Group, Inc.
Supreme Court I.D. No.:
James, Smith, Dietterick & Connelly, LL.`
Address: 134 Si a Avenue
REGISTER OF WILLS OF
RENUNCIATION
CUMBER=
COUNTY, PENNSYLVANIA
Deceased
~ -== ~~--
Estate of Zacha O. Bond .- -- :-~,
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FTI -~ L. J VI I C_ . - - ''i
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in my capacity/~~fanship a~ ~;~ ~~
~~ Tyler A. Bond ~ ~="`
of the above Decedent, hereby renounce the right to
Son
to of the Decedent and respectfully request that Letters be issued to
administer the Esta
Susan F. Woska-Bond
<~j
J /
~ ~ ~~ - I ~ (Signature) Tyler A. and
(Date)
353 Old Sta a Road
(Street Address)
Lewisberry, PA 17339
(City, State, Zip)
ice Executed out of Register's Offic eared the
Executed in Register s Off Before the undersigned personally app
Sworn to or affirmed and subscribed party executing this renunciation and certified
day that he or s aced within otn a ren ~ciatayn for the
before me thi purposes st
6GlJ ,~/~ -
of ~ ~ of
Notary Public
Deputy for Register of Wills IVIy Commission Expires:
(Signature and seal of Notary or other official qual~ed to
admirnster oaths. Show date of expiration of Notary's co~~ iTM ~ V
00 Notarial Seal
DeNse M. Long, No~Y ~~`
Dgry TWp., Dauphin
MEM~R W-N~A ~*Ti9N EIF
Copyright (c) 2006 form software only The Lackner Group, Inc.
Form RW-O6 Rev. 10-13-2006
REGISTER OF WILLS OF
O. Bond
COUNTY, PENNSYLVANIA
,Deceased
Estate of Zac
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in my capacitylr.~71
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~~ Vanessa L. Holt --~`~- `^'
renounc° they h'~to
of the above Decedent, hey ~~
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Dau hter
he Decedent and respectfully request that Letters be issued to
administer the Estate of t
Susan F. Wosrca-a~~~u
(Date)
' ~~ti
~,~jZZe~2/lG~
(Signa e) Vaness .Holt
25597 America S uare
(Street Address)
South Riding, VA 20152
(City, State, Zip)
Executed in Rm9a and/su~b~r bed
Sworn to or affir
before me thi day
of
Deputy for Register of Wills
RENUNCIATION
CUMBERL_
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Executed out of Reg ~ of sonalOly appeared the
Before the undersign p
party executing this renu heateon nciat on faethe
thu t h ses fated within on tk day
p u~s-1- ~ ~ ( • /~
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No Public a0 f ~~
My Commission Expires: ~~ - 3 ~
(Signature and seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's commission.)
Copyright (c) 2006 form software only The Lackner Group, Inc.
Form RW-06 Rey. ~o-~3-zoos
H105.~U5 R}rV tOllO7r
' ERTI~ICATIOIN OF DEATH
LOCAL REGISTRAR S C hotostat or photograph.
WARNING: It is illegal to dluplicate this copy by p
Fee for this certificate, ~~6•UO
P 17558=
(Certification Number
3 REV 11x2006
f PRINT IN
aMANENT
ACK INK
MENt 4.,,..,i;
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Tl,lis is to certify that the infon~ation here g)ve
correctly copied fro-TT an original Certsfica`_e of D dl_)ly riled with n)e as Local Registrar. Thy ori certificate ~~i]l ht torwarded to the State ~
Records Office frn- permanent filing.
JUL;2
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Loci-I Registrar
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HEALTH • VITAL RECORDS
LTH OF PENNSYLVANIA • DEP
COMMONWEA
OF DEATH
CERTIFICATE
NUM
8
(See Instruct)ons and examples on reverse) STATE FILE
4. Data of Death (Month, dey, year)
2. Sez 3. Sodal SelxMty Nlrmber
7
2(11 1
,-, - i.n .- 1 7h7 7
_ Tuly
t. Name d Decedent (First, middle, Isst, satiric)
ZSChar 0 • On a~ state «fo coun 8e. Plea of Death check o «ta
7 Bl Other:
Under 1 de 6. Date of BiM Month, da , Hospital:
"~ Days April 5 , 1950 Clarksburg, ~ ~ Inpatlent ^ ER 1 Outpatient ^ DOA ^ Nursing Home ^ Residence Other • Specify:
5. Aga (~ Birtiday) Under 1 r
Hours Minutes 10. Race: gmedcan Indian, Bieck, White
61 g. Was Decedent of Hlspank Origin? ~ No ^ Yes (SpeciM
Yrs. gd. FacNky Name (If not IneNbrtion, gNe Idreet end number) (It yea, specNy Cuban, Whit e
6b. County d Death 6c. Ciry, Boro, Twp. of Death Mexican, Puedo Rican, etc.)
' 15. Surviving Spouse (It wHe, give maiden name)
14. Markel Status: Married, Never Married,
• 12. Was Decedent ever In the 13. pecadent'a Education (Speldly °nlY Mglteat r;orrtpletad) Widowed, Divorced (Specify)
tton IGrld d wok date du ~ most d INe. Do not state Elementary 1 ~ndary (a12) collaga2ll-a or 5+) ~r r i e d Susan F . Wo s ka
11. pacedtx8s Usual U.S. Armed Forces? 1 L,
~ d Biuhtesa I Iridl
Kind d Work ~] No Did pecedent
Real Estate Manager Real Estate evel ^Yea I.iveina 17c.^Yes,DecedantLNedin
pecedenYs ~2..^.a ;'1 ,Apia Township? New Cumberland
16. pecederiCs MaNing Address (Street' tiry I town, state, zip coda) Actual Residence 17a. State 17d. ~ ~, pacedent Lived within Ciry 1
4 Ardmore Circle „~ ~„r,,,, Cumberland Actual Limitsot
New Cumberland, PA 17070
1e. Fathers Name (Flrsl, midda, last. suffix) Robert Bond
20a. IntomtanYs Name (Type 1 Print)
n F Woska
t9. Mdhel's Name (First, middle, maiden surname) Leo la Van Horn
* ,
~:
lob. IntomienYs Meiling Address (Street, sty /town, state, zip coda)
4 Ardmore Circle, New Cumberland x,dPLolA~at lac oo7wrlOatata zip coda)
Sus a . Match, may, Yea<) 21 c. Place of Diapositbn INama al cemetery, crematory «other place) PA 17 0 8
21b. Date of Dlspositbn ( Sche a f f e r s t own ,
21a. Method of Dispositbn 1 ~Crematbn ^ Donatbn Evans Crematory
^ Burial ^ Renloveltrom stela ; ~ ~Cn~ ~I~ C~rutjt'0r~ Yes^ No July 29 , 2011
22 Name ene Address of FacNiry N W Cumberland , PA 17 07 0-04.
22e.5gteN r ~"` --
Complete ibms h centAing
PhYs~n ~ ~ a at rime of death lr
22b. tkenee Number °~ Inc . , PO Box 431, e
(°t~`S0n °~~ as ~) FS 012 849 L Parthemore FH&C$ , 23c. Data Signed (Month, day, rear)
23b. License Number
. To the best of my knowledge, death occurred at the tlme, date and plare stated. (Signature and title)
the Crematbn or Donetk_
certky cause of death. 25. Date Praaurxad Dead (Month, dey, Year)
Nertla 24-26 must be c«ripleted by person 24. Time of Death f /
~ ~ ~ (J M. ~ l a 7 ~/ / 1 gpproxhrleta kitarvel:
wtlo prorlouraes death. +
CAUSE OF DEATH (See Instructbns s examples) i Onset to Death
tltat ~recdy caused the death. DO NOT enter terminal events such as cardiac arrest, ,
tt
ts • 1
a
r1,4y1 d 8Ver115 - daoeases, IrljUdfiS, Or complica
Item 27. Pan I: Enier the d,e 81~y, List sty one cause on each fine. 1
ular flbdllatbn wNltoul showing ,
ri
c
respiratory arrest, or vent
ase a
di / 1
se
NNAEDUTE CAUSE (Final
dklon resulting m death) 1
e. i
a
_~
con ,
t{aMy Nat canditians, N any,
~to file calm Irotad on tine a. b. ~ c C'~ 1
uenca on:
Due to (or as a conseq 1
Enter UNDERLYING CAUSE
(~BB88 « kl(uryry tltat Irtlbated the
avsrws resuldngin death) LAST. 1
c. 1
Due to (« as a consequence oQ: '
1
,
~ d.
32a. Date d Injury lMonth, day, year) 32b. pesaibe How Injury Occu
30b Were Autopsy Flrxkngs 31. Manner of Death
28. Wes Case Retened to Medical Examiner 1 Coroner for a Reason Other n
^ Yes ^ No _ .., ._ ._ r,_„«.o
ur n. cnw, ,.,, A, ~,,...~.----
m the undeltying cause given in Pert I. Yas + ro
but not resulting' ^ No ^ Unknown
29. If Female:
t l'fr ~-~~ ~~I? r.[~ f~~lx ^ Not pregnant within past year
^ pregnant at time of death
~'' ^ Nd pregnant, but pregnant within 42
d death
^ Not pregnant, but pregnant 43 days
before leant
^ Unknown N pregnant wNhin the past
32c. PO~e Bu~Mi g, e~tcme(SFPeci~'I~t, Fe+
Spa. Was an Autopsy 32g. Locatbn of injury (Street, city I town, state)
Perlomted? Avalieble Prbr to Completion ~ Natural ^ Homicide on In u
of Cause of Death? 32d. Time of Injury 32e. Inury et WorKt 32f. k Tranaportati j rrry-~~(S1 ^ Pedeshien
^ Accident ^ Pending Investigaaon ~ Vas [~ No ^ Driver/ Opereta LJ Passenger
^ Yes ~ ~ ^ Yes ^ No M, ^ Other • SpeciN:
^ Suicide ^ Could Not be Ilatennlned ~b $Ignature, of Ce1tlNer '' •
r~
~ - , - ...~.r-u
33a. CartlNer (check only one) need death and completed Item 23) 33d. Date
CertMYing physldat (Physician certifying cause of death when another physician has pralou ~. ~n,e Number _/
• To tM best of my Wtowlsdge, dsMtl occurred due to the ceuas(a) end manner es stated - - - - - - - - - - - - - - ' ' - - - - - - - - - - - - - - - - - 1I ~ ~ ~
kMri (physiasn both proraundng death and cartkyktg to cause ddeath) - - - - _ _ -~
• Pronouncing and certMying phya and manner es stated- _ _ - - - - - - - -
To the beat d my krgwbdge, deetlt occurred at the Nme, data, end place, end due to the cause(s)
' NNedkal Etulmhtar I Coster trio, in m o inlon, death occurred el the time, date, and plea, and dw to the cause(s) end malxler as stated- ^ 34. Name and Address of Person Who Completed Cause of Death (Item 27) Type
On tM besb of axamination end 1 or investiga Y P ~, Date H.iepd ( M, dey, year)
35. Registrars and District N bar ~ I ~I ~ ~ ~ ~ / ~ ~~ ~ / 6 //
- -- d~1045
Disposkion Pertnk No.
.~
M.S. Hershey Medical