HomeMy WebLinkAbout10-07-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PEISYLVA~HA ~-,~-, ~~'
REGISTER OF WILLS a ~ ~ ~ "
PETITION FOR PROBATE AND GRANT OF LETTERS ~ ` ~,~ -
..._,
Estate of .~~ ,Deceased ESTATE NO: 21- ~ ,-.
_~ ~_
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a/k/a: .. `.
a/k/a: SS NO: CCU. ~-- I ~ ~~ J~~t~` r'
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Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
a plicable:
A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also)
n aver that Petitioner(s) is/are entitled to the aforementioned Letters under
the last Will of the above-named Decedent, dated _~_.~~~ __ 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 execution of the
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in
23 Pa. C.S.A. § 3323(g):
^ 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 survived by the
following spouse (if any) and heirs (If Administration c.t.a. or d.b.n.c.t.a., enter date of WiJI 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 party to a pending divorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except as follows:-
Name
Address
l.SE ADDITION:IL SHF.F.TS [L NECESSARY
THIS SECTION MUST BE COMPLETED:
Dece e~}t was domiciled at death in Cumberland Cou~ty, Pej ns~'},v~ania, with his/her last family or principal residence
At i ~' C ' ~ ~~ d~I (.~
(Str t address with Post Office and Zip Co , Municipaliity: Township, Bo ou City)
Decedent, then ~ ~ years of age, died ~ ` ~ 5-- ~ Q 1 ~ at ~'
(Month, Day, Year of death) (City and Stat where death occurred)
Estimated value of decedent's property at death:
If domiciled in PA All personal property $ ~ Q _
If not domiciled in PA Personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
-Value of Real Estate in Pennsylvania $
Total Estimated Value $ 0.00
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s) Name(s) & Mailing Address(es)
~ ~~ ~C ~ ~. C~ C ~S
~ .~~
Relationshi to Decedent
mtenm ronn Kw-U""._ revised 8.26.10 by Cumberland County pending action by the Court Page 1 oft
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania
County of Cumberland SS c7 ~- _ -~
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~~ __ ,{ _
The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petition~i-ue a•~i --
correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represetttatar~e(s).e#'the -
Decedent, Petitioner(s) will well and truly administer the estate according to law. - - --- -
Sworn to or affirmed and subscribed (()) ..
~'L~ Lam- ~' c~'~;'~Gt`~~~-L~
.~
the Kegrster
DECREE OF PROBATE AND GRANT OF LETTERS
Estate of ~ ~%?~ ~~i ~ • 1 d
(/ /~ C /~ ,Deceased File Number: 21-~_- ~~
th /
AND NOW, this ~ day of ~' ~QD~/- /~.D/~ , in consideration of the Petition on
th reverse side hereon, tisfactory proof having been presented before me, IT IS DECREED that Letters
Testamentary of Administration are hereby granted to:
(If a plicable, ent r c.t.a., b.n., b.n.c.t.a., e[c.)
E' /7 ~/' e C'r 0/Z-- _ in
the above tate and th t inst ments(s) dated
admitted fo probate and filed of record as the last Will and
1(s) of
described in the petition be
~~
Glenda Farner St
Register of Wills
FEES: _
Letters ....................$ ~,~ ~~
Will ........................ '
Come(s) .................
(~) Short Certificates
( )Renunciations.......
Bond ............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 2 .50
.\ F
TOTAL ................$ ----~-5~_.1
~~gnature of Counsel Keauired to inter Appearance
Interim Form RW-02 revised 1?26. l0 by Cumberland County pending action by the Court Paee 2 of 2
Atty's
PRINTED Name: ~l1~ba`C~ -~ Ivy Ae i' `~Or
Supreme Court ID No.: ~~~(r~jl~
Address: ~cJ ~?j ~ 1 ~,C~~- ~~~
c~cc ~ ~~ 11 I G
Phone: ~111'~7j~-~ `_~_WJ
Fax: ~ ~~ " ~ - ~ '
OCAL REGISTRAR'S CERTIIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or phr~tagraph.
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Htos t4a REV n/zoofi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE /PRINT IN t
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PERMANENT CORONER'S CERTIFICATE OF DEATH
BLADK INK _
`=~ ~'~~ -" ~'~ -
(See instructions end examples on reverse)
CTATF FII F ~~-• ~ - !"j ~.,,,,
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1-Neme of Decedent (Frsl, middle, lass, siMix) 2. Sew 3. Soda) Seeurily IVUmber 4 Death Month, tlayywm) 'T~
Chloe C. Zullinger Female 203 - 10 - 8436
5. Age (Last Blnhday) Under 7 year Under 7 tla 6. Dale of Binh Month, de , ear 7. Binh ace C and stale or forer count ) Ba. Place of Deam Check onl
Y ( Y Y I N I M 9n 7 (~ y one) ~ ~" ~t-- ----
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M
MonrAS bays Hwrs Minutes HOSPIta' y,her, l e1 - _-~-' J ~~- -
88 vra. 11-7-1922 Needmore, PA m Ilem ttrrII ~~
Pa ^ ER / Outpat enl ^ DOA ^ Nursing Home ^ Resitlerree y~Olhe ~ Specify:
Bb. Canty of Death Bc. City, Boro, ~Twp o~f D~eath
~\
lz ~" 8tl. FaciMy Name (II not InslAUlion, give street and n mbar) 9. Was Decedem of Hspenic Origin? ~NO ^Yes 10. Race. American Intl en, Black, While. etc.
(`-- ~ ,-
(It yes sDeatycuDan (ape 7»
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A,
\ \Zk (~c~ C-~-~_ ~.
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b-~-rte
Ci Y0. 1 ~~-~ -\ Mexican Puerto R can, etc.) white l
17. Decedent's Usual Occ Ik)n Kind of work tlone tlurin most of wakin Ida. Do not slate retired 12. Was Decedent ever in the 13. Decetlenl's Educelion (Speciy only highest gratle compieletl) 14. Marital SIeWS Married Never Married 15. Surviving Spouse (If wife, give maiden name)
KirW of Wak KiM of Business I Intlustry U.S. Artretl Farces? Elementary! Secontlary (0-72) College (1-4 or 5a) Wltlowetl. Divorced (Specify)
Seamstress Penn Pants ^Yes ~l0 9 years widowed
16. Decedent's Mailing AdGess (Brae), city /town. state, zip cotle) Decedent's P A Dltl Decedent H 0 ewe 11
Li
i
p
2 1 Turnpike R O a d ve
Actual Residence t7a. Sale
n a nc. ®Yes, Decetlem Lived in
Twp,
Newburg
PA 17240 Township?
nD. coum Cumber 1 a n d 17d ^ Nn, Ikcedem caved wahm
Y
, Acwetumbsd ciy/Ban
78. Father's Name (First, middle, last sNfizl 19. Maher's Name (Flrsl, middle, meklen surname)
John Weller Perthenia Mellott
20a. Inlormanl's Name (Type I Pnnll 20b. Inlormam's Mailing Atltlress ($Ireel, Pay I lows, state, zip code)
Nancy A. Swope 6802 Rice Road, Shippensbur PA 17257
2ta. Methotl of Disposition ^ Crematbn ^ Donaton 21 b. Date of Disposition (Month, day, year) 21 c. Place of Disposiion (Neme of cemetery, crematory or other place) 2t0. Location (Qty! town, state
zip cotle)
,
[~ Burial ^ Removal from Stale ;Was CrcmaNon or Dorutlon AWhorixed
^ Otner~S,xcrty: byMedlplExeminer/COroner7 ^Yes^No 9-20-2011 Ridge Cemetery Shippensbur
PA 17257
g,
22a. Si nature nerarSe~ice Lkens¢e for person aceng es slwh) 22b. License Number 22c. Name antl 0.tldress of Facility
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I~ FD 012984-L Fo elsan er-Bricker Funeral Home Inc. hi n
Cortpkle dams 23a-c only when cenitying 23a. To the best of my knowletlge. tleath oxuned et the time, date antl Dlece salted. (Signature antl title) 236. License Number 23c
Date Si
netl (MOmh
tla
IMysician is not available et time of death to .
g
,
y, year)
cenity cause of tleaM.
Items 2a-26 must be cnmpeletl by person
who Pronources tleath 2<. Time of Death
' 25. Dale Pronounced Dead (Month, day, year) 26. Was Case Referred to Metlical Examiner /Coroner for a Reason Other roan Crematron or Donation?
. r
~
~ - M. 1 ~ ^ ~ 1 1
O 1 Yes ^ No
CAUSE OF DEATH (See instruetlons and mples)
1 Approximate interval.
Item 27. Pan r. Enter the chain el evens - diseases. Irryunes, or complicalrons -that tliredly caused the tlealh. DO NOT enter lenninal events such as cardiac artesl Pan Ile En'er other s ondcanl condA Ons contrib 1 1 death,
~ 28. Did Tobacco Use Contribute to Dealh~
Onset to Death
respiratory arrest, or venlncuter Ilbr H tpn without showing the etiobgy. list Doty one cause on each line. bl,
, rwl resWing In trre underlying cause given in Pan I. ^Yes ^ ProDabty
IMMEDIATE CAUSE ((Final cheese or / ~ No ^ Unknown
s ~
aNMibon resulting in death) ~
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~ ~
29
II Female
OTe ~
Jf~ S 1 ~~r, .
.
D Ib (or 2asya..c-o nLy of;:
Se
e
l
ll
li
t
tl
L
~
/
~
~ ^ Nol pregnant within past year
qu
n
le
y
s
con
l
Ons, d any, b.
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(\ t-~,-(i~~ - 0. \;
leading to the cause listed on Gre a. r 7
~ x
5'? v ~ <~ ^ Pregnam at lime of death
Emer the UNDERLYING CAUSE Due a consequence ol), l i
L~~ //~~_
(tlisease or injury that ioAMletl the
~ 6 1 'L-
`
~
~
~
` ^ Nat pregnant, bN pregnant wAhin 42 tlays
~
events resulting in death) LAST h' ~ ~ C~
Ll-,
` n+ • i...~
~ G.J+~.'~4x~ e 1
` U ^f
c
~-rY
1~,1 r~l`•-_
w of death
Due to (or as a consequence of).
~
d
(s 1 g; ~~--.
~~ ~'V-z~ ~ ^ Na pregnant, but pregnant a3 tleys to 1 year
belae death
- r ^ Unknown A pregnant Wllhln the peal yea!
30a. Was an Autopsy 306. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month. day. year) 32b. Descri0e How I rjury Occurretl 32c. Place N Injury Hane, Ferm, Sreel Famory,
Performed? Avalleble Prrer to Completion `` 11 (( s ~ J /.\ ~W B~tllfre. etc. (puny)
of Cause of Death? ^ Natural ^ Homicide ~ G "T \~ a(j \ 1 U/1'~M.~Y. a IY~sY ~'QS Sr ,K~. \1
Yes `~[ No Yes No '~.Pccitlem. ^ Pending Invesllgatmn 32d. Time f Injury 32e. Inlury al Work? 321. II Transponalion Injury (SpecilyJ 32 . Location of In
^ T'` ^ ^ ~ 1. ~ I ry ool, dry / towq stale
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ver
pera
or
assenger ^Pttlestnan ~,/1 ~-[.Sr
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^ Suicitle ^ Cab Not be Delerminetl ~' ~~ M ^Yes ~J No
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u,y.i C~~• c5h~ -+~ t?~c~e
33a. Candler (check only care) 336. d Title of CedMer
~
ni
_
• Certiying physician (Physician cenitymg cause of death when another physician has pronounced tleelh antl completed Item 23 '-- i
To the beat of my lurowledge, death occurred due to the auaeys) ens manner es salted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~
-\. ~~ r\\ _ \~- '~ '-T• ~-~ r L ~ ~ ~-
,
• Pronouncing antl cenllying physklan (Physician both pronouncmg tleath antl cenilyirg to cause of death) 33c. L'cerse Number 330. Dale Sigretl (Month, tlay, year)
To the best of my knowledge, tleNh occurretl el the time, tlate, antl place, arM tlue to the cause(s) and manner es adted
^
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical Esamirxr/Coroner ~/
~-' ~~ 1 7 ~~ G 1 1
,
IM the buts of esaminallonend / or Investigation, In my oDlnWn, death occurretl el the time, date, antl place, antl due to the nuke(s) oral mortar ea ataled_
Z~I
,
34. Name and Address of Person Who Complmetl Cause of Death Qtem 27) Type I Pnnl
36 Repislrar's Signature Dlslrkl er 38- Dale Fi ~ (Month, tlay, Yeari --~;-Jy~ YL~ cM I \1 ~ \ ~C ` ._: C ~ ((4 T -
DiapoaAion Permit No. O 66 ~l 0 3 8
LAST WILL AND TESTAMENT
I, CHLOE C. ZULLINGER, of R. D. 1, Newburg, Cumberland County,
Pennsylvania, being of sound. mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and
making void all wills by me at any time heretofore made.
FIRST. I order and direct the payment of all my :just debts and funeral
expenses as soon as may be convenient a:Eter my decease.
SECOND. I give, devise, and bequeath al_1 my estate, real, personal, and
mixed, whatsoever and wheresoever situate, to my beloved husband, WARREN V..
ZULLINGER, absolutely.
THIRD. In the event that my said husband predeceases me or we die as the
result of a common distster, I then give, devise, and bequeath my said estate
to my daughter, SANDRA Z. ANDERSON and to my daughter, NANCY Z. SWOPE, share
and share alike.
FOURTH. I nominate, constitute and appoint my husband, WARREN V. ZULLINGER,
to be the Executor of this my Last Will and Testament; and if he be unable to
fulfill the duties of Executor, I then nominate, constitute, and appoint my
daughters, SANDRA 7.. ANDERSON and NANCY Z. SWOPE, to be my Co-Executrices.
IN idITNESS WHEREOF, I, CHLOE C. ZULLINGER, have hereunto set my
,~~
hand and seal. to this my Last Will and Testament, this %~f day of
1976,
Signed., sealed, published and .
declared by CHLOE C. ZULLINGER,
the Testatrix, as and for. her
Last Will. and Testament, in the
presence of us who have, at her
request, signed our names as .
caitnesses hereto in the presence
_~ ~ ~
~' (SEAL)
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OATH OF NON-SUBSCRIBING
REGISTER OF WILLS
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WITNESS(ES~ }
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COUNTY., PENNSYLVANIA
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Estate of _ `~~~~ ~ '~ ~ ~ .~~~~ > Deceased
~.
(,lM C.e ,{.; and _~~ ice, YI ~`C~-~`~ ,
(each) being ly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with ~ L~ and am/are familiar
with the handwriting and signature oft e decedent, d that the signature of ~ ~• ~ ryt..
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~~"_ ~ ...ems
is in his/her own proper handwriting.
~~
C~~ C~- -
Sig iaau~e)
~~ ~ 7~ tc ~- "IZ D
(Street Address)
(Qty, State, Z T--
~~ ~ti'~~l
(Sig ature)
(S1ree! Address)
(CityJStale, Zip)
Executed in Register's Office
Sworn to or affirmed~a/ d~ubscribed
befor e this __/ ~ day
of _, ~ C,' C~
~i--
uty for Register of Wills
Fa-m RW-04 rev. !0.13.06