HomeMy WebLinkAbout09-02-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of _ SI~GAti G,n /¢ . G~ //Q eG , Deceursed ESTATE NO: 21- - /
a/k/a:
a/k/a:
a/k/a:
SS NO: l 8'4 ~ 70 - y~SZ
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
0 A. Probate and Grant of Letters Testamentary or D Administration c.t.a., or d.b.n.c.t.a. co lete Part
and aver that Petitioner(s) !s/are entitled to the aforementioned Letters ( ~ C ~O)
the last Will of the above-named Decedent, dated ~ under
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
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated pers
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been esta
23 Pa. C.S.A. § 3323(8):
-~..,
4.rF ~_
~n oe ~ -.
was 4ot a ~-,~ .'
as d~'fimed in
1
-) _.F_I
B. Grant of Letters of Administration~ ~ ~ , ~ ~ r ,-
(If applicable, eater d.b.n., pendent lite, durante absentia, durante m' ornate) '~ G
~:
C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the
following spouse (if any) and heirs (If Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a a
proceeding wherein grounds for divorce bad been established as rovided in 23 Pa. C.S.A. 332 ~ to a pending divorce
D SPoKSE /t/o C/~//LDRFi/ Np ~rxC~p,~,~ ~ ~o ~), except as follows:
Name .SK~tilf~E p /oi~/~Eit/T,S'
_ ~ Aiiri..ai...
t0 DtCedenL
USE ADDITIONAL SHEETS IF NECESSARY
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in CumbE
~~alXer /~QS ~C6tkttd A I~enw,c:a.~•ok
,bc,;~ p~rst,~~ /~trt~vf~.
Pennsylvania, with hiss last fami
,yiY, L'an~.~i~.r'/ate ~-_ _ ~
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
J4ica//Yto~+'
or principal residence
--
Decedent, then ~S years of age, died ,1~_7, Zo// at _ 4~ //a// Shx~ p,r,~ ,A
~ija+ ~o, .pi4
(Month, Day, Year of death)
Estimated value of decedent's property at death: (C'n' and State where death occurred)
If domiciled in PA All personal property
If not domiciled in PA $ 1~ D Op • eO le a~.~
- Personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
_Value of Real Estate in Pennsylvania
Total Estimated Value $ ], d pd . o0
Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~/~
Signature(s) Name(s) & Mailing Address(es)
~ .~ ~sz~ 8 E?Sy 5. W /~ uRCF a boo k. 2 ~, ~ St,~ Camp Hilly P
_ l~o l l
Interim Form RW-02 revised 12.26.10 by
pending action by the Court
Page 1 of 2
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 Petitioners} 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
bef re me this -~ ~ ~ da of
y
L, ~. ~' /
~ ~`lL(_-~-~i ~~~~ t ~ ~ r~~1fm ,
For the Register
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DECREE OF PROBATE AND GRANT OF LETTERS
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Estate of ~~crp ~{/1 ~. w~ f 1 ~L ,Deceased File Number: 21- I ~ -
AND NOW, this ~ da of ~~ ~r in consideration of the
Y Petition on
the reverse side hereon, satisfactory proof h wing been presented before me, IT IS DECREED that Letters
Testamentary ~ of Administration are hereby granted to:
(If applicable, enter c.ta., d.b.n., d.b.n.c.tai., etc.)
~~y S. Wallace ~
the above estate and that instruments(s) dated Nli¢ described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
Glenda Farner Stras
Register of Wills
FEES: Signature of Counsel Required to Enter Appearance
Letters ....................$ /~` ~
Will ........................ -D~
C '1(s) ...............
( Short Certificates . f7~
( ~ Renunciations....... ' ,, ~ vG
Bond ............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 23.50
C11 ~, ,~~
TOTAL ................ $
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
55 ~ d
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
Page 2 of 2
.--
RENUNCIATION `~; T
~ T' s~°_
... ,_,_,,, rrZ
REGISTER OF WILLS ~''' cr_~
C ~'~~~~-
G~~1~~.4~1~ COUNTY, PENNSYLVANIA _ -.
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Estate of ~ 1-7'~F,~lij ~ ,~ ,, ~j¢~~
I, s) ~ T = ~
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w.~
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Deceased
in my capacity/relationship as
(Print Name)
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
r ~ ~:~~ .
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~ ~ r ~~ day
of /~C~ ~,~5'c' ~o t ~
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
ri
Form RW-06 rev. 10.13.06
MoMlir r~81
Mark L. 8w6esr, pto6lry Put~e
lerrx~ne Born. Cumbertarc! County
MY Comrnlasbn Expired MAr+Ch 11, 9@13
Member, Psnnsytvania Assodafion of Not~ttes
(City, State, Zip
.~-l~-~I~~
LOCAL REGISTRAR'S CERTIFI~~ATION OF DEATF~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1=ee for this certificate, $6.0~
P 17557453 _
Certification Number
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This is to certify that the information hE°re given is
a~rrectly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the `Mate Vital
Records Office for ~~errnanent filing.
/~r~ ~~~__~ `JU 0 ~1 011
Local Re~~istr~>r Date Issued
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+•144 REV ttrtaos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ ~~
rPE/PRwTIN y
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PEFSMNENT
CORONER'S CERTIFICATE OF DEATH
~
"~ ,
_____
i. Name d Decoder (FFet, nrldrle, Me4 eulPoc) _.r___ __. .~-~
2. Sex . ~~~ _.. .._.._.__...
3. SoeW Secretly Number _-..
4. Date d Death (Month, eey, yar)
STEPHEN A WALLACE E - - July 7, 2011
s. "g• that elrnrmy) tlrrder 1 under , m e. are d elrth
. day, 7. Blrprplaa and ehh a 9a. Phce d Derth CMck
Monea D>'p Floue Mrxrlw
1losppel: other. ~ 0. e Qtryl..t. a
s
25 Yn
.
^ InppaM ^ ER / outpatlern ^ DOA ^ r4raserg Home ^ Residence ®other • spedfy: l~~"CO=-
9b. Counly d Deets 8c. City, Boo, Twp. d Dsefh 9d. FaoWty Name (p not insp6NOn, 9hro Street end resrrber) 9. Wa DeaxieM d Frrspenie tAtgfrr? ~] No ^ Yes 10. Race: Amerk;err krdlarr, Black, WNn, ek.
Dauphin Middle Paxton Twp 2100 Block Route 325 (h ra, r Cuban, (~~
Mexican, Puerto Rkxn, elc.) WHITE
11. Decadence thud Khd d wok dons mast d Ne. Do nd slice 12. Wa Decedent ever M the 1 3. DecederrMa Edulapar (Spedly arty hiphert grade Cortt Nad) 14
Medhl 9teh
M
d
l4
d
M
i
IOnd d Wok
FINISHER
Khxl d &,tlnae 1 Irduatry
CABI
U.S. Amred Faces?
^
~
EM~ry / s,~„d,ry (0-12) p
College (1.4 or 5+) .
a:
ar
e
ever
,
arr
ed,
WWovrod, t>Nor~d lso~M 15. SurNving Spouse (If wpe, Give maiden name)
NET MFG Ya [ 1 NEVER MARRIID
- 1e.
) Decedern'e D1dDioidint
PENNSYLVANIA
(
Aduel Reelderrce 17a. Stale
LNe In a
17~ rwp
^
Yea, Decedent t.wad In
260 NORTH
29thSTREET
.
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17b. Count' CUMBt~u~u~L Top? 17d La No, pendent Lived wdhh
CAMP HILL PA A
CAMP HILL
ctual Lhrlte d
~,, eao
1&. Faprer'a Nems (Fiat, mklds, lest, aulAx)
19. Mopxe'a Nartre (flirt, mldde, melden eumame)
JOHN F WALLACE
20e. Infennarn's Nanw (type I Prttrf) 20b. InlameM'a Haling Addroa (Street, dty ! town, stets, zip coda)
260 NORTH 29th
~ 21 s. Mettxx! d DlepoeMm ~ Cremation ^ pory~, 21 b. Deli d DlepotMbn (March, day, year)
` lien elite 21c. Place d Dlepoeltbn (Noon d certrtlory, crematory a who place) 21d. Locatlan (Chy /town. stale, zip Dods)
O oO r
wd` I°oi""c ~,ba ^ No JULY 11 2011
~
~ HOLLINGER CRIIKATORY
MT HOLLY SPRINGS PA
22e. Servbe ( ouch 22b. License Number 22c. Name end Addrea d rrealty
- 014819 - 1903
Canpleb Ware 23ee art' when arWyFrg 23a To the bent d my krawladps, dalh occurred at d» tlme, date and plea sliced. (Signaturo and 1Me) 236. IJcerree Number 23c
Date sk
ned (Mornh
d
physkaen a roc awdebb e< this d dapr b .
l
,
aX Y~1
aspfy awe d deem.
pertx 24.26 mot be eomplehd br person 24. Time d DeaM ApprOX: 2s. Date ProrrOUnced Dad (Month, day, yar) 2&. Wa Case Refsrrod b Medeal Examiner I Coroner to a Reason Other pwrr Cremation or Dantbn?
• "4b vrararna~ ~h~ 07:00 A M. July 7, 2011 ®Ya ^ No
CAUSE OF DEATH (Sort InstrueeHoru and orzampin) r Approxkneh Intorvd:
hem 27. PaA I: Error Ilia ~11~ - dresses, injrelea, a cortrpdcedare - pod drocly prised the dalh. DO NOT enter temEnel evens ouch a Grdlec amrt, r Onset b Death
l
l
rt Part II: ryder ocher
hN not rauRig rt pre underlying arise given h Part I. 29. Db 7absoco the CadrlwM to Deapr?
^ Ya ^ Probably
rosp
ay arro
n
, a vernrtcrlar fibrllttlon wMtort ahowYq pro etlology. Lbt only are crate on sech dos. ~ ~
IYYEDIATE CAUSE FMI dieeae a r
~ ~ ^ ~
) .~ a. Gunshot Wound To Head
~°"~0" "°'~'" 29. d Primate:
Due b (a a a coneeQuerrce oA: ~ ^ Na pregtwrt wNNn pal yar
~_• N ~~ b. r
b
~ ^ Pregnern at tlrtre d dent
Due b (a as a corraequerrce of): r
EnMr
I
M
D
6ILYING CAUSE
r
^ Not progrrerd, but pregnant wiMin 42 days
i
~
W
c. r
. ree~~~
r d death
Dueb aaa
( COnaee off: r ^ Not pregrunt. but pregnant 43 days 101 year
~ d. i betas dapr
^ Unkrrowrr d pregneM wdhin the part year
30e. Wa an Arecpsy
~'"onisd7 306. Wen Aubpey Fxxlnpe
""al'"'~1or1oCoi1~ho" 31. Msrxrer d Deem
^ Nawral ^ tlanlclde 32a. Dated 1
rr(ay (March, day, year)
Jul 7, 2011
y 32b. Dseedbe How In)ury Otsurred
Gunshot Wound To Head 32e. Plecs d IMrry: liortre, Fem, StneL Faebry,
~e ~r
'~{
e A
p
d Cause d papr? Sta
a
n
ce
s
^ Ya ®No ^ res ^ No ^ Accident ^ PendFg Irrvestlgetlon 32d. Time d Irt)rry 32e. rrM,ry at Wak7 321. p Trrreporftllon MMsY (SPAY) 32g. Lorsdan d btirry (Stroe1, city /town. elate)
®S1dde ^ 0oa1d "°l ~° °eNn"k"d Apx 07:00 A M ^ Yes ®No ^ °rAro'/ Operrta ^ Pasergsr ^Pedsrtden 2100 Block Route 325, Harrisburg, PA
17018
. oprer - SpeaYy.• ,
33a. CerdfMr (check art' are) 33D. 3ignearro TiIN d Cerpfkr
Csrtllylnp phyeklen (Ptryaiderr oertifyirg aua d daepr wha~ andher physidan Irea pronounaW death and txxnplMeo hem 23)
To Ure boot d my knowNdgs, deaYr occurred dw h Urs auoo(s) and menrw a steled- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ^
• M
-
b ,
Lisa A. Potteiger, Chief Deputy
Mrq t (fin both pron0rrreerp death aril certpyirg b awes d death)
g a
~
To pre bed d ary MnowNdge, dam ocaa-ee rt pre tlme, doh, and plea, end due m the auee(s) end merrier a etahd.. - - - - - - - - - - - - - - -
^ 33c. Licerme Nrmrber 33d. Date 3gned (Monh, day. Yar)
- -
• IlladialExarrlrrarlCerorrt JUIy 8, 2011
On Ure haab d erwNrotlon end I a fnvestfpation, M my opidon, rMath oa:urrad N the tlmt, dale, and place, and due to the oauoya) and manner a sfeMd- ®
~. Nerne and Addroa d Person Wtp Canpbkd Cause d Despr (ha m 27) Type I Porn
R
t
r
d
~ Lisa A. Potteiger
-
.~
n
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s4~t
ar/ I ~ I `I p~' ! I rl
''l~ 3e. Dale ~Y. Yad
« 1271 South 28th Street
~ ~d0 HaMsbu PA 17111
rrep0mtanrrormnno. V~1V41L