Loading...
HomeMy WebLinkAbout10-19-11Reset Form PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Thomas M. Richards also known as N/A File Number ~ I - l 1 I ~ ~'~~ Deceased Social Security Number 196-14-4993 Petitioner(s), who is/are 13 years of age or older, apply(ies) for: (COMPLETE 'A' or B' BELOW.) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is !are the last Will of the Decedent dated and codicil(s) dated (State relevant circumstances, e.g., renu~aciation, death ojerecutor, etc.) named in the Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of`~lr~i iu~tnunent(s)-0ffered i_ r for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~:~~ ~ ` i ri )) 1:/ ~~Grant of Letters of Administrafion -. _.; (Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente /rte; durarate nGsentia; durmTte mut~ztatej, ~:~ :" Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (~i~tty) and he~ijs: (If __ i `r` Administrafion, c.t.a. or d. b.n.c.t.a., eater date of Will in Section A above and complete list of heirs.) `~ - -t `: , ~~ ,; -•~ t (COMPLETE Decedent, then 85 years of age, died on 10/1/2011 at Carolyn Croxton Slane Hospice Residence, Dauphin Cty. 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 Pemtsylvania (If not domiciled in PA} Personal property in County Value of real estate in Pennsylvania $__ 20,000.00 g 50,000.00 sintated as follows: 4719 E. Trindle Rd., Mechanicsburg, Hampden Township, PA 17050 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Si anise T ed or Tinted name and residence i :~ Ruth P_ Richards, 4719 E. Trindle Rd.,Mechanicsburq, PA17050 Fonn Rlr! 02 rev. 10.13.06 Page 1 of 2 ~'~: Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 4719 E_ Trindle Rd., Mechanicsburg, Hampden Township, PA 17050 (List street address, town/city, township, county, state, zip code) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COi1N"I~' OF CUMBERLAND SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hue 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 the estate according to Iaw. Sworn to or affirmed and subscribed before one Mine ~ ~ day of '~ ~ y - !~ ~ ~~ For the Register Sigrrature~fPersonalRepresentAtive ~ T -.x--r _U ~ ~_ SignatureafPersonalRepres•entntive ~_~ t_ ~--~ ` ~' 1 r-- ~Tt --- Signature of Personal Representative ' r '; r'~ T _ i .... File Number: .~~-` ~ ~ - ~~(~ Estate of Thomas M. Richards Deceased Social Security Number: 196-14-4993 Date of Death: 10/1/2011 AND NOW, October 19 2011 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Ruth P. Richards and that the instrument(s) dated N/A described in the Petition be admitted to probate and filed of FEES Letters ............... $ Short Certificate(s) . ~ ..... $ Renunciation(s) .......... $ ~`f~MA--11Gti ... $ S O --. $ ... $ ... $ ... $ --- $ .. $ -- $ TOTAL .............. $ h~~_ 5G~-80~ Attorney Signature: Attorney Name: Marvin Beshore, Esquire Supreme Court LD. No.: 31979 Address: 130 State Street, P.O. Box 946 Harrisburg, PA 17108-0946 Telephone: (717) 236-0781 in the above estate q ~~, Form Rir! 02 rev. 10.13.06 Page 2 of 2 OCAL REGISTRAR'S CERTIFICATION OF DEA'~'HI WARNING: It is illegal to duplicate this copy by photostat or photograph. ,. tree tln thts cerhtlcare, wf,_UIl ;;, ~lhl~ I~ t!1 rln?,. ~F: i I!u u~li~rm ttion hue ulven i~ Ill''~~SH OFPf; ~%~~F.,~ iy'~ rl Irc'ctlti~ 11,~?ieci 1 ~r,nl •ln+I)i ~inul CcrtitiLrtte ol~l)ralh y ,k~/ ~ ~`rr ~ lhlly iilc~a ltiilh t Ir •, i lrai Rcglstr,u~. The ~~n~~uiul L lr~, ~ i,~ :•~ til~iralL ~x,ai ~ =r. u~Eli,•~i tt~ the Stutz b~(tal ~ca°.~~ a-~ a;~ Rr•~(~rc,O~f)~r' 1 ,crnllr~~rll I~ilint~. ~~ ~, x .t _, ! f ., - __ ~~~IMENT OE~~`~' % _~ ~~--, Certification NumhL'r ~:-~ a ,,, -h~ueLl ti -~ c~_~ 7 - .r_7 v~: :rl ~,, ;~ T- .- ;, _. .'T:t Asa :. .._ ,[T)r Hms~~,i Rev COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS I' `'"" ~ ~,. TYPE PRINT ~IN~ uERHANE"' CERTIFICATE OF DEATH &ACK INN (See instructions and examples on reverse) STATE FILE NUMBER l Y S~ I Narra at Detecen, IFirsl, mi0dle, lass suttisl 2. $Bx J. $ocW $acuhN Nrarrper a Dale of OeaVi IHa,m, daY. Year) Z~Lh(a( ~qlp - ly -4~1~13 October 1, 2011 ~ s Age iLasl a,nnoayl under I rear under , da s. Dale of &nn Monln. m . B ~. a e cr aw wte a laei ea. Place a Deem mace Monlns Days murr Hrx,ln nosvnal. Omer ' `i5 ws C~ a3 ae Ashtabula, OH ^Inpal.enl ^ER/oalpanBnt ^DOA N~rx~ngr,ara C.1Readente ^ Omer speap. fl 6o CtUnIY 01 Deal! & ~iN dao, Twp d Dedln Bd FatJity NarnB III not inseNna, qne street aM nlarEer ~ ~ 9. Was DBCemnl 01 MiSpa'rC Orign~ L' Np ~~ ve s _ _ _ 10 Race 0.m dnenC iMar'. 3idcx. rYrv,e x"~ pl yea. ap.city awn, a M Heax:an, Puerto Rlcan, arc.) ~ 1 t e I I. Dececenrs Jsual lax, Kn0 01 work da,e d un most d Me. DO not slate reared 12. Wag Deprcenl ever 'n Vw IJ. Decedents Edralion ISpeaN a'e'/ teglwet grace con,pl eled) la Hartle $lalus. Mar/retl Never Marred, 16 Sunrvlrg Spo use III wAa grve rtraioen nanwl Ketla Work Kirbd BusIrMUIIMUSVy US. Nmeo Faces? Elamanury! $BLVrxlary (P72) Cdlege IId a' SB) Waiowq Oi-~rted () Sales Self-Em to ed ~ vB: ^ Na 12 Never Married _ - ,6 Dekeom's Malinq Address IStreel. ary i IOwn. sole, np code) Decedents Did Decadent Pennsylvania ova ina n A t l R id v r l ^r e ~ro a s D 4719 Trindle Rd. c ua es erce d. B la C Bnl ~n_ _ .,p BCe B t ea. T°"""'ip' .rd®NODecedallLrvBdw~lhn ~''-comics urn g mb nd l Mechanicsbur PA 17050 u nb.cWrnN er a AdaalUnJlsa ~ IB Fa:hzr> Name IFirsl coddle, last, sudlxi tq. Homer's Name IFirsl, mtlde, mlgan wmame) Ruth N. Shetron 20a Inlamanfs Name (Type! Prnl) __ lob Inlomanrs Maierg Adhev (SIMI, dry r bwn. sole. xp code) Ruth P. Richards 4719 E. Trindle Rd. Mechanicsburg, PA 17050 ~ z I a. Medved of PspoMf r ^ Cremaf ^ Donaf 210. Dal. a asposlGOn (Mmm, day, veer) 21c. PMCa a DiePOVUOn (Name d wmetery. Wemawry a otlwr pace) 210. toCdli[n IGN! sown. wle, iG cWe C~e~na ^ Rprovailromslale waacr«n,twnWDW,.danAw,odaed 10/6/2011 East Harrisburg Cemetery Harrisburg, PA ^ aner .SpBtr I by Mama Ex,min«ICWen.r ^ ves^ No zza. sgndlwB of Fa,aa sB l,te Ice persm dCWq a: such) zzb. utena. Nunroer 1 zx. Name and Adhass a FadaN e s s e e i g e u n e r a om e - - FD-014404-1 2100 Li nglestown Rd. Harrisburg, PA 17110 I CanplBle hems 23a< oaY wnert ceruMrq zza Tome asst a my ledge. dBdm attuned al ale lime. and pa[f staled. I$gnalae and YdB) Z1b. Lx:eme Helder 2Jc Dale srg',Bd (Room. ear. rear) Wryvoen a nc, avanalWe al tune d dean to n / P -~ 1 ~ -f- b temty canna al dean. i 9 / ~ p r ( a o i ~ Oc nan,s 2a~,6 must ce cm,plelM W pervert 2a Tune d Deam 26. Dale Prmanceo Dead (Mmm, day, year) ___ 26. Was Casa RNaned Mean Exarrurrw~ i r;aroner to a Reasm Omer awn Cre. lion a Canatm I woo an,awxe= dean. p 3 ~~ 1 ~ o ~ ~ ^ Yee '~ CAUSE OF DEATH (Sea inslruetlons antl asamplea) r Approxanala dlerval' Pin II'. Enter Weer yurlifica^I mnl9mrw mntriMn~ L Deal i 28. Did Tobacco UsB Con1MWe Ic Dealn' Item 2' Pan I' Enter N¢ cAdN1.41.eYCL115 - aeeases, vyunes, a corr,pldeAdru ~ coal era 1ty cdusBd the deem. DO NOT solar terminal evenm such as Grdx ar rBSl, Dnsel to Daam Wl rot resulting n IM ,ntlErlyv,g cause gven n Pan I. I, ^ yes ^ Prooaay resprdlay artesl. a venlKUldr IIDrillana wttlqul SlUwinq m¢ efgbgy 1151 aJY Or18 Huse M Ball tine. ! _ ^ ~ ^ U IMMEDIATE CAUSEFinal dsease cr /~ ~ I,, ( `n/"~ ''' J /~,~ / r I/~'^ I~ /~ ~ uvWnrw, resull~ng .n ~eaNl ' ( ~ h r, L{(/ ( yE J J " O ~ ~~ 29 ur Femak _~ e ~ y W ~ l~•~ ~ ! V ~ k Jae w Ice as a consepuence oq ____ - ^ Not Dregnan w~m,n past rar ^ P ' c $aa ,al NISI mrdbons, it any. o IeaLnq Ito N rue N led m kre d rBgnanl dl BrtrP a dadm 7u1 yeq-~ar,l •im~n J2 ]a+s I --'I ^ Na preryam p,~ It la as a _ uerce a) e UNDERLYING CAUSE bn~Q . f d ln d58dse w inryry Inal IniaalBO V,e vents resulting n de6lnt U$i o ed ^ NW pregrWnl. WI pregndnl Si airs '.D I ,~ Jae 10 for as a ca'ISBgUenCO ol) I. a210re dedln d - ^ JrrNwwn it paq~dn, wimp Ve fat: yeei Ida was an awepsy Job Were Autopsy Fnangs 31 Manner d deem J2a Date d,nryry (Monet. day, year) J2D. Dewnne How Iryury Occwrad 72c Place d Iryury Horrid =a m, Suez,. =ac;u~ nedormBd~ Availao4 Prwr to Canaelrn n ~auS¢ W Deafnr t ^ L-] Natural ^ Momrcide Oda;e Ruildrq, etc. 'Spdolyl T, ^ Acodenl ^ PeM~n investi ation J2d Time of Intury 72e. Iryury al Wax? 121. II TransportaGOn Injury (Spe6y) _-_~ J2g loaf of injury iStreel cm i town sla;el , r ._ es ~, r'o ~ r.: Yes ~ '+r. q g ^ S a N l rm n d ^ Co D l d ^ Yes ^ No ^ Onver!Operala ^ Passenger ^ ''eaaslnan - uw ~ e u o x e e e __. M ^ Omer ~ $pecily. JJa cen,l,dr Icnecx unN y I ni i n i N r n c i f d h l 2J S'gname role a c/9inner ~ I--- -- ~'t ~ ry nq p ys an ( y ry~ng cause o s~a . te • e c eem w en anomer pity prprwaKBd seam and canp elad hem ) ' w ,Ala) Ana mann.rnas vaed _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ To Ins best of m knowkd dean occurred d to Ins tau _ _ _ _ _ _ _ _ -' _ _ _ _ _ ® - /-1 n Y ~ /~ C / y- J - I ~.(l.~ W L~ VVV ~~- • Pronouncing and certifying physician (Pnysrcan nom wawlevvy ceaM arb canityinq to cause a ceaml To Ins best a my ImawMOge, xaln occurrea al lne nine, eels. Ana Plata, aw aue to the cavsatsl Ana manner a: slalee_ _ _ _ _ _ _ _ _ ^ 7Jt. License N Osr /'-{ ~ (~ ~ Sl ~ 6 _ L 3Jd Dalelsrg^ad IMmin. day. Pearl ~~I / ~ l~ Z ~ // I • MedrUl EaaminerlCwona On me wsia a examination Ana I or rnresugallon. in my opinion, ceam occurred at me lime, date, and plsca, and due la Ne causgsl and manner as sated_ ^ Ja N rd AOM a Person Wno CorrglelM Cause d De m Ilea 2]) Type; Vml ~ a , ~'+ /~ ~ '- ~/V'T ~ ~ a ~ ,~ J~ 1 ~ eJ ~~ ~V ,an,re Js w omeF m. r, rear) ~/ / `l Dispasngn Permit No O~ I ~/ N-'