HomeMy WebLinkAbout08-22-05PETITION FOR PROBATE and GRANT OF LETTERS
' ~' ~ Estate of LILA T. JOHNSON No.
also known as n/a To:
Deceased.
Social Security No. 196-26-7754
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the execut rix named
in the last will of the above decedent, dated ~~ ~
and codicil(s) dated n/a
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
her last family or principal residence at 951 Hummel Avenue. Lemoyne. PA 17043
(list street, number and municipality)
Decedent, then 70 years of age, died 8/9/2005 ,
at Holy Spirit Hospital Camp Hill Cumberland County Pennsylvania
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: n/a
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
21.000.00
WHEREFORE, petitioner(s)
presented he with and the gray
thereon. ~ /,
b
Judy L.
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ectfully request(s) the probate of the last will and codicil(s)
letters T~itabv LE?TE~~ oQ ~M~N?,r 7(f/t rTZQN
{'~ (testam ntary; administration c.t.a.; administration d.b.n.c.t.a.)
51 Hummel Avenue
Lemoyne PA 17043
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA t
COUNTY OF Cumberland J ss
The petitioner(s) above-named swear(s) or affirm(s) that statements in th oregoing petition are
true and correct to the best of the knowledge and belie etitioner(s) and t as personal represen-
tative(s) of the above decedent petitioner(s) will an , ly adm fitis estate according to law/.
Sworn to or affirmed and subscribed
before me this 22nd day of ~
Au ust 2005
~„~~ ~~ egister ~
_.
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Estate of LILA T. JOHNSON ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated 6/14/2004
described therein be admitted to probate and filed of record as the last will of LILA T. JOHNSON
and Letters 1'I~ZK L ~ (? L-' ~ K' ~~ 1fii0~12/Y,,T- ~?'~/i~ 'l',~-N
are hereby granted to
JUDY JOHNSON-WARD
FEES
Probate, Letters, Etc.. $
Short Certificates ( } . $
Renunciation . $
TOTAL $
Filed . .
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Register of Wills
Harrv M. Baturin. Esouire (I.D. No. 83006
ATTORNEY (Sup. Ct. LD. No.)
2604 North Second Street
Harrisburo _ PA 17110
ADDRESS
(717) 234-2427
PHONE
'l\ - <::lS .'Ilalo
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
H105.S05 REV lIOS
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
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11698561
No.
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Local Registrar
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COMMONWEALTH OF PENNSYLVANIA.. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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8b. Cumberland a~ast pennsboro ~
OECEDENT'S USUAL OCCUPATION K!tID OF BUSINESS I!NDUSTRY AS DE R fI j DECEDENT'S EOVCA liON MArtlT AI.. STA 'f1JS . M8ni8d,
( _01 "'__tIllmoAl V.S.AAMEOF~$? (Sp..::lI)tOfl l1lgh.ot~com~_ NeIIeJMarried,WIdowed,
o/:"~InQI~....Mt_'~) 0 - ..,.,..,<IIIry Col. 0lv0rw;I{$pedfy)
11., data entry clerk1.jQilling service 12.Y8S No 13. 1?1~) (1-40<5+) lpivorced
EC.EDENT'S MAILING ADDRESS (Street, CityfTO'M'!, Slate. Zip Co1e) OECEOEl'frS 7 P l' l>ll '
ACTUAl. 1..Slale P-tln,o:;;y V?:l111 a Did l1~.~Yef.,deceQan\Ilved\n
208 Senate Ave. ,Apt.204 RES(UE.Io.'CE diKlldenl
16. Cam Hill, PA 17011 ~%e)B 17b. COunlV Cumberland =~~p~ 11d.O ~=~~~of
FATHER'S NAME (R...t, Middle, lest) MOTHER'S NAME (Rrst, Middltl. MIl1d8l'1 Sumeme)
18. victor C. Thomas \111. Ruth Marie Scott
INfORMANT'S NAME (Type/Print) INFORMANiS MA\L\HG ADDRESS (Street, CltyfTOWll, SIllIe, Zip Code)
"L Judy Ward "b.951 Hummel Ave. Lemo ne,PA 17043
METHOD OF DISPOSITION DATE OF OI.;:;POSITION "'LACE OF DISPOSITION- Name of Cemetery, CfemalQry LOCATlON - Cily{Tl:Nffl. Slale. ~ COOe
'OooellonD BUfiel Crernatiol".~cvallromStaleO D (1oIoMl>.Da1,VU'I'O 2005 OJO\h&!P\~ L't C t "h ff t170SSA
. " 0 ''''''''> ""Aug. , flpn-",- 1 e- rema ory ",Ii' ae ers own, P
$I OF FIJ RVICE liCENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADORESS OF FA.Cll...lTY Le.moyne , PAl
22b. F -013163-L lWsselman FH&CS,324 Hummel Ave.
()(leU/red ellh" lime. date end pls~ $laleo. LICENse NUMBER DATE SIGNED
(Mol1th,Dey.Ye;\r)
NAME Of DECEDENT (Firs!, Middle. last)
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AGE (last Birthday)
SEX
5. 70 Yrs
COUNTY OF DEATH
CITY, BORD. TWP OF DEATH
2_female
F
HOSPITAL;
I"PM."11:z:l
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I'ACLLIT'< NAME (11 001 insIitution, give ~lr8.,teM num~r)
BIRTHPLACE (City and
Stab.!.O\"F~CO\.lntry)
,l'lashington,P
DATE OF 81RTH
(Monlh, Day. Year)
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Minutas
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Days
e~lD
Itemll24.26 must be eompllll8d by
person who pronounces dellth.
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27. PARt I; Enterltl.dl.......lnJurln<Wcompll_""....I"~"_ltdltl....lltI. llonolln....lIIe'ltOdeol
LlltOOlly_"_.......cIlhnl,
IMMEDlAn CA.USE (Filial
dlselSSllorcondilion
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Seqll8nt1;11l1yllsteo~ditlol!S b
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Cllll5ll. Enter VNDERL YING
CAUSE{OIMlIseorlnjoly { o.
lhelinllllltede'Jenll
resulting ondlJalh) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
peRFORMED? AVAILABLE PRIOR TO
COMPl!ITlON OF CAUSE
OF DEATH?
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RACE-A.mcricenlndian,BIacI<.,White.e\
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SURVIVING SPOUSE
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Efist. Pennsboro
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cltylboto.
23b. 23e.
WAS CAse REFERRED T~~ WJ1~E~ORONERi'
2'. Yes R9-""- I (}C'''1(f".v NO ~
: Appro.w:imale PART II: Olher signllleanl c:ondillons contributing to Oelltll. bill
.\n_1 nol resulllng in the under!ying causegivan In PART I
:ooselWt:tdelllh
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Homicide
Pe(ldinglnVllsligll~on
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D 301. 3Gb. 1.4_
PlACE 01' INJURY - At home. rillTTl. slreel. factory, office
b<JlIGlnj;J..l<(S~1
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CER1IFlER IChedo: only one)
'~~'=tGJ~~~ltif':~C:C~~J:I~~.~~(:r.mr~=~"':c.c..~~.~~~,~~~.~~~~.i.~'::.~~~.
NoD
Could not bll delerrnined
Suicide
29.
'PRONOUNCING AND CERTIFYING PHYSICIAN (Phytlcial1 both pronOlmcing death and eertiIying to CQ\l$8 ofdealh}
To tM blat of my k~p, dMIh ~,l th.tlme, dlJle, ~ pl_, end dUll to the l.'IlIa"(a) and I"I'IIIIMru .t.tM... ..................
'MEDICAL EXAMlNERJCORONeR
On.... ~.I. of .llaft'dnatlon andlor In_tigat\ol1, In my opInlOfl, dIat\'I occurred at the tlmll, d.te, and plK., and dUll to jh. eaUNS(') llnd
m.nnar..atated"............... ..........,.........................'.....m...m..'. .................................
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REGISTRAR~NATURE~U~
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