HomeMy WebLinkAbout09-26-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
REGISTER OF WILLS ~ PENNSYLVANIA
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of Janice W. Etshied
a/k/a:
a/k/a:
a1k/a:
Deceased ESTATE NO: 21- j ~ - ~ 1C 1 ^-~
SS NO: 194-22-7525
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A'
applicable: or B AND "C" as
^ A. Probate and Grant of Letters Testaments or
and aver that Petitioner(s) is/are entitled to the aforemen^tioned1Letterson c t a., or d.b.n.c.t.a. (complete Part C also)
the last Will of the above-named Decedent, dated
- --------- _-_ a do oc dtcil(s) dated under
n
r;
Except as follows, Decedent did notam relevant circumstances, e.g. renunciation, death of executor, etc.) -C
,was not divorced, and did not have a child born or adopted after eite~
instruments offered for probate; was not the victim of a killing, was never adjudicated an inca acit ,~
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): P ated pels~p,;;
ti
~ B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent lite, durante absentia, durante minoritate) ~'
C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survi
following spouse (if any) and heirs (If Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Sectio
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not sued by the
proceeding wherein grounds for divorce had been established as rovided in 23 Pa. C.S,A. ° A and complete list of
p party to a pending divorce
Name § 3323(8), except as follows:_
Janice L. Etshied Bolton Address
483 Country Club Road, Camp Hill, PA :L7011-2113 Relationshi
Karl Jeffrey Etshied Daughter
Karl B. Etshied -deceased 03/2002 54 Westerly Road, Camp Hill, PA 17011-2957
Son
I'SE
ETS IF
use
THIS SECTION MUST BE COMPLETED: i I
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last f
At 54 Westerl Road Cam Hill PA 17011 Cam Hill Borou h
(Street address with Post Office and Zip Code, Munici ali Townshi ,Borou Cit amity or principal residence
Decedent, then 83 p ri~ P ~~ y)
years of age, died 8/21/2011
Estimated value of decedent's property at death: (Month, Day, Yeaz ofdeath) at Camp Hill, PA
_If domiciled in PA (City and State where death occurred)
_If not domiciled in PA All personal property
_If not domiciled in PA Personal property in Pennsylvania $ 1 000.00
_Value of Real Estate in Pennsylvania Personal property in County $
Total Estimated Value $ 75,000.00
Location of Real Estate in Pennsylvania: (provide full address if possible.) 54 Westerly Road Cam $ 76 000.00
Signature(s) ~ P Hill, PA 17011
Name(s) & Mailing Address(es)
~. l 1~ .! 9 ~,_
- ~ Janice L. Etshied Bolton, 483 Country Club Rd, Camp Hill, Pq
Karl Jeffrey Etshied, 54 Westerly Road, Camp Hill, PA 17011
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
Page 1
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OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania
County of Cumberland _ SS
The Petitioner(s) herein named swear or affirm that the statements
correct to the best of the knowledge and belief of Petitioner s
Decedent, Petitioner(s) will well and truly administe m the foregoing Petition are true and
()and that, as personal representative(s) of the
r the estate according to law.
Sworn to or affirmed and subscribed
' before me this ~~ ~Y~'? da of
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For the Regis-
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DECREE OF PROBATE AND GRANT OF LETT
Estate of ERS
Janice W. Etshied
Deceased File Number: 21 __ ~`
AND NOW, this ~ C_'~I day of ~ ~_-` ~~
the reverse side hereon, satisfacto ~ / 1 ~ ti-~ (-
-Testament rY proof ha ing been presented before me IT I ideration of the Petition on
m'Y x of Administration S DECREED that Letters
1 ~ L, t ~ - ( 1 ~- ~( -~ ~i~anP11e86Je, enter c.t.a., d.b.n., d.b.n.c.t.a., eie.~ are hereby an e to
e ~~~~ ~ 1~.]j~ gr t d
the above estate ' ~' ~'f t ~ I ~_)t' { }
and that instruments(s) dated { ~ -~~ 1 <'
admitted to probate and filed of record as the last Will in
and Codicil(s) of D ce edentcribed in the petition be
FEES:
Letters...........
Will........... s . ,'
Codicil(s).......
((t) Short Certificates j ~ ~ -. ~" `~
( )Renunciations.
....
Bond ............. ..
................
Other ............................
.
............ .
...............
Automation FEE
.........
JCS FEE..
5.00
.....
............ 23.50
TOTAL..
.....
$ ~C`'l `-'
2S
......... .
.,S{J.~
(~ 1~. - ,
l~
Glenda Farner Strasb u r ~ ~ t ~`s c~ C ~ t~ ~'
Register of Wills ~ g~~~(, l ~~ ~ tI 1.>1r: 1 ~,
v ,. ~ J.~ .
Signature of Counsel R
~ ed to Ente earance
Atty's Signature i
PRINTED Name: ~
Gre °ry S. Chelap
Supreme Court ID No..
78443
Address:
Phone:
Fax:
Interim Form RW-p2 revised 12.26. l0 6 ~ L_
y Cumberland County pending action by the Court
17._ South Second Street, 6th Floor
Harrisbur Pq 17101
X717) z33-.1000
(717) 233-6740
Page 2 oft
OCAL REGISTRAR'S CERTI~'ICATIOIV
WARNING: It is illegal to duplicate this co OI~ ®EATH
P1 by photostat or pr~o~c~graph.
Fey tilt this certifiratc. `~h (1(i
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ACK INK
1MANEM COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
t. Noma m Decedent (Firet mklde, lasLt. suRix)
(See 1nsERTonsCand exOamPes on reverse)
Janice W. Etsilled STATE FILE NUMBER
6. Aga (Last Btnhday) Under 1 ar 2. Sex 3. Social Security Number
Untlerl tla 6. Date of BIM Female 194 4. Date of Deem (Month, tla ,
MonW
Days Month, tla , ar 7. BIM lace Ci - 2'1 Y Yeer)
83 ~ ~kturs M"mB5 end state or torsi n court -
Ym~ 7 i Ba. Place of Death Check on one
bh_ Count' of Death JUl 17 19'18 Hospital:
~. city, Bom, rwP. or Deem We$ t (fie to other:
G~mberland ~ Pettily Nana (I/ rot instllutioq ^ Inoalient ^ ER / Outpatient ^ DOA
~P Hi 11 gk'e sheet end number) ^ Nursirg Homo
54 g. Was Decedent M Hispanic Odgin? p~ Residence ^ Other S
t1 DecedentS Usual Wes tart W.I Nc °~~~
Lion Kind of work done dun most of Road ht Yes, apeciy Cuban, ^ Yes 10. Race: American Indian, Black, White, etc.
Kind of Work tile. Do not state retired 12, Was Decadent aver in me 13. Mexican, Puerto Rican, etc.)
Housewife Kintl of Business / Indust DeceeenYa Education l bpecr
ry U.S. arced Forces? (SPecdy ory highest gretla am tat VYl l7. to
Elementary /Seconds P ad) 14. MarAal Status; Married Never Mamed, 16. Surviving Spouse pl wife,
i6. Decedent's Mailing Address (Street my /town. state, zip code) ^ Vas ~ Np N (0.12) 4College (1~4 or br) Wklowaq DNorcetl /SpenNl
54 9we maklen name)
WeLsl~terly Road °eCQd~^''a Widowed
11111 AMaal Residence 17a. State _p9
Pa 17011 Did Decadent
1 S. Famer's Name (First middle, last, suffix) 17b. County _ Ifyl}lo we in a
Y~ ^ ~(~ Township? 17c R^fVes, Decedent Lived in
Howard Weir ~-~~ t7d ~ANU, Decetleni Lved wimin ('ter,,.. ^; 71 Twp
20e. Intonnant's Name 19. Mome/s Name (First, mitltlle, maiden surname) Actual LimMS of "''+rrY ul l
(Type / Prnt) Ciry r Boro
Lillian Baxte
21a. Memod of Dis 20b, Informant's Meiling Address (Sweet cly /town, state, zip coda)
posmon fps
^ Burial ^ Removal from State ' W Cremation ^ Donation 276. Data of Di
^ t Wea Crertte6pn or Donation Aulhodrae +Posiaon (MOnm, my, Year) 21 c. Place of Di
t by trNekal Examiner/CarpneYl sposia'on (Name of cemetery, crematory or omer place)
• ~ ignature M F AU l1S 27 d. Location (Ciry/town, state. zip cotle)
re's Yea^ "° t 23 2011
~- acting as such) 22b. License Number Hollin er
22c. Hama and Address of Facility Cremator
re~23a<pnywhen ~ 0 -j, Mt Holl S tin s Pa
~ Physician u rid available at dme of death to a ~' °f "h' knowledge, des erS-Ratner Funeral Home
~rtily cause of death. a and place stated. (Signahae and tlde) Inc 19 ke
•~ Items 2446 must he wmpleted by arson 24. Time of Death r /e~J 236. License Number t
.ai wM Pronounces death. 26 ~ !~ f ~~ 23c. Date Signed (MOnm, day, Year)
r ronouncetl Deed (Monet, day, year) /e ~~L - , ~y /
/ M. a/ 26. Was Cese Referretl to Medicel Examiner r Coroner fora ~/ ZD` /
Item 27 Part I: Enter me t CAUSE OF DEATH (See Instructlona and ~~`~ ^ Yes son Omer man Cremafbn or Donatlon?
~di-.P3Y9N5 - tliseases, injures, or complications -that direcly caused Me death, DO Np7 eNer)terminal events such as cardiac anent. I ^ Ne
respiratory anent, or ventrk;ular fibrillation wahout showing the efio
IMMEDIATE CAUSE (Final disease or ~' LAM °n i APMOximate interval: Pan II: Enter other ,
d ty one cause on each line. Onset to Death ~d10n c t ~ rp paam
cmdrhon resuPong in sent) r but not resulting m me unded in ~v 26 Did Tobacco Use ConMbme to Deam?
~~ a NA (A-~ Lv~ t Y 9 cause given in Part i ~ yes
~ ^ Probably
Sequentiallyy list Due to (o as a pry i ^ No ^ Unknown
- leading to ate corMMans, it any, d i __
- Enter the UNDERUL~YIpC CAUSE a Due to (a as a consequence op: ~-~_ 28~If Fyemale.
~ eveenk resuPofury mat milieted me i ~-- ys Not a rant wilhm
pr 9 past year
n9 m tleath) LAST. ' ~---~ ^ Pregnant at time of Death
c Due to for as a consequence op: ~ ^ Nol pregnant but pregnam waNn a2 days
d ~ -~~ of deals
30a. Wes an Autopsy 30h. Were Aut i _---~- ^ NM
Performed? oPSY Findngs 31. Mannar of DeaM pregnant, but pregnan143 tlays (o f year
Available Prior (o Completion 32a. Date of Injury (Month, tle , ear ' before death
of Cause of Deatnv ^ Natural ^ Homicide Y Y ) 32b. DescMe How Injury Occurred ~- ^ Unknown it re rant wdhin the
P g past year
^ Yes o ^ Yes ^ No ^ Accident g g 32c. Place pl in
^ Pentlin Invesa aeon 32d. Time of Injury I ry' Home, Farm, Street, Factory
32e. Injury at Work? 321. HTra Office Building, etc. /SpecMl
^ Suicrtle ^ Could Not be Determined nsportadon Injury (SPea`N/
33a. Certifier (check ory one) M. ^ Yes ^ No ^ Dmrer/Operetor ^ Paesen er 32g. Location of iryury (Street, Ciry /sown, state)
^ Other-Specpy~ g ^ PedesMan
To theme ~ of me ~~ yskian certiyirg cause of loam when enomer physician has pronouncetl
Y l+ege, deatA ottumed due to the Gu deem and completed ttem 23J 336. SignaN Trcl Ce
Pronouncing one certXying pAyeklan Pn aNq and manner as HatM _ _
7o the beat of my kn ( Ystaen born pronouncin -'------- ,
owteege, death otturree H the Nma, 9 Beam and certdying to cause of deem) _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ^
kaedksl ExamAror/Coroner eau, and place, and tlue to 1M - - - - - - - 33c. License Nu bar
On the baW+ M axeminetion end / or Invest cause(s) end manner a+ etated_ _ _ _
igstlon, in my opinion, death occurred h the time, tlah, and plop, and due to the u - - - - - - - - - - - - - - ^ HO 0~ ~~`~ ~ ~ 33tl. Data Signed (Monet, day, year)
i6. Registrars Sig and Dlstnm r ~a~/ uee(s/snd manner ea etatad_ ^ ,}-
(/ 3a. Name and6ddresy of Person WA~ sled Cause t L w ~ Z r G`Q~ r
/ I ~i / ~ d ~ ~ i ~ ~ ~~re~~~~~ ~tNr (/~C_i.J/ '~-'~ ~ ~~a9r. ~T~C T SN'~ ~ 7'
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Disposition Permit No _ O