HomeMy WebLinkAbout10-25-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of 1ir11T.T)RFT) FT.i7.ARFTH HANN ,Deceased ESTATE NO: 21- ~ ~- 'I
a/k/a: MILDRED E_ HANN
a/k/a:
a/k/a:
SS NO:
Petitioner(s) who is/atr,-~ 8 yrs of age or older, apply(ies} for: COMPLETE SECTION `A' or `B' AND "C" as
applicable:
^A. Probate and Grant of Letters Testamentary orpAdministration c.t.a., or d.b.n.c.t.a. (complete Part Calso)
and 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 N/A
(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 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 party to a pending divorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except asfollows:-
h1o Exceptions ,-,
Name Address
Honey Grove, PA 17035
'. A-1
~__
USE ADDITIONAL SHEETS IF NECESSARY ~ `-a~ ~ '
__ ~~.. C.
THIS SECTION MUST BE COMPLETED: `
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence
At 9 East Simpson Street, Mechanicsburg, A~ 17 055 _ _
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City)
Decedent, then 83 years of age, died 10/01/2011 at Mifflin, PA
(Month, Day, Year of death) (City and State where death occurred)
Estimated value of decedent's property at death
If domiciled in PA All personal property $ 25,000.00
If not domiciled in PA Personal property in Pennsylvani;i $ __
_If not domiciled in PA Personal property in County $
-Value of Real Estate in Pennsylvania $ 1_~1~000 00
Total Estimated Value $ _~4(~~~_
Location of Real Estate in Pennsylvania: (Provide full address if possible.) 9 East SiimpsOn Street, Mechanicsburg, PA 17055
Signature(s)
Name(s) & Mailing Address(es)
_' ..f5c~- <<~:. ~ . ~ :,Y- `-- Richard L. Hann
1495 Willow Run Road
Hone v P 17
Intenm Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 1 oft
-->
- ~ , :_';
OATH OF PERSONAL REPRESENTATIVE - _ ~:
--~~
',-,
~_..
Commonwealth of Pennsylvania " '~'
County of Cumberland SS __~
.>
c,
~) ~ ~ ..'
The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petitfon are true 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 law.
Sworn to or affirmed and subscribed
before me this ~FJ day of ichard L. Hann
October 2011
For the Register
DECREE OF PROBATE AND GRANT OF LETTERS
Estate of MILDRF.n Fr.T~ARETH HANN ,Deceased File Number: 21- F~L ~ ~ - i ;
AND NOW, this ~_ day of (~'(`: ~ (',~fj.-F i~ 2011 , in consideration of the Petition on
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters
-Testamentary ~ of Administration _ are hereby granted to:
(If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.)
RICHARD L. HANN
the above estate and that instruments(s) dated 1J/A described in the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
m
~~t~ `~ C~~, - ~ r. _ _
Glenda Farner Strasbaugh, ~ ~ • ~r_~~~<(',~ ,~ a~~_y ~,~, i
Register of Wills
FEES:
Letters ....................$ -~ Q~` CYO
Will ........................
Codicil(s) .................
(_~j) Short Certificates •~ - ~iJ
( )Renunciations.......
Bond .............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 23.50
„ „ ~~
TOTAL ................ $ < ~ ~ , .
~tgnature of Lounset tc~gt~rea to
Atty's Signature
PRINTED Name: Marlin R McCaleb
Supreme Court ID No.: 0635 3
Address: 219 East Ma in Street
1Nechani c s bt~g, PA 1705
Phone: 717 ~i91- 7 770 _
Fax: 717- 69 1- 7772
Interim Form RW-02 revised 12.26.10 by Qimherland County pending action by the Court Page 2 of 2
OCAL REGISTRAR'S CERTIFICATIIOIU (~F DEA~~'H
WARNING: It is illegal to duplicate this copy key photlost~=lt or photog~~~p
f~rc j~~Yr th;.- ~_rrtifiL~atL:, ~;(,-lu:. ll ,,
I
~.-
~~kt JF A I_~ I II r'. ~:~ n)f(uln.Atilm hoc. ~i~rn 15
~
'
F,~
-
„~~~
;,
~~ I . i ,, , . ll~, , crtifi~ 1(~ Oi
Leath
l ~int(l C
~
~
:c_
,`'~'
~ JL I, ~c tl . 1 I~ hc 1yn~Inal
,(i l~,°~uU;n_
l
`;~~~ ~
G
)
9
,. ~ I ° It '~
1 ~I', ~
1 lii'CI ICt ~hL' ~IaIC ~ t<<LI
~
o m Z
.tom= n
' K. ,i~~ `? ~ ~ r,'nt tilui ~.
* - -
;;
~L
`~°
~
!
~
'
P 17 6 4 5 4
1
6 q,~,. ~~ ~~ ~ ~
~
t;~t 1`? ~
r
1
i~
.
..
.
--_--- -----
MFNr~E. , ._
_
-- -
____
Certlfu.atilu~ Numl>~~r - w. ~'! 1?; „t ~I L)ute (~su~Ll
';7 ~~~
O _ T.
-,
~~~
-
._;
,
-. t
;„
rte.
- ~' ~
_ t
~7 _. ,-r:
T> • r I
S' "
H105~163 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE /PRIM IN
PERMANENT CERTIFICATE OF DEATH
BLACK INK See instructions and exam les on reverse
P ~ STATE FILE NUMBER
0
z
1. Nerve d Decetlenl (First, mitldle. 1851, SuXix) 2. Sax 3. Social Security Number 4. Date of Ik4m (Monet, tley, year)
~~
z3
7
lClr?CSI ~lizabetl
n F
7`~
%'I?
~
c~
~
-
n
~
ro i avi
ig
-
5. Age ILast &MtlaY) Under t err under 1 der 6. Date of BiM Mmm, m . 7. Bi and slate or forei coon /re. Pface d Deam ChecN on are
}~~ Monllrs Odys Hoars WnWas ~// ~ / / ~~~ ~ Hospital: 1Oct~hrer:
(U( Yrs. (~ ~ n 7 ~~ ^ Inpatient ^ ER ! ONpaaent ^ DOA ld Numng Home ^ Residence ^ OUrer - Specify:
fib. County of Deam &. CM. Roro. Twp. of Death Bd- Facdily Name (H not irwtiMtim, gb<streel and number) 9. Waz Decedent of Hispanic Origin? ~ Np ^ Yes
' 10. Race: Amerkan IM ,Black, Whhe, etc.
'S°e°"'
.1U11ICctL( ~1`1i~Iir1 L~uSt ~ruv~ i~ll~rsinJ ~;1n~ MK~n~ ~~oA~~.elp) j,~h~-~~
11. DecerknYS Usual lion Kind of work done dxin most d w Ise. Do not state mtlred 12. Waz Decedent ever in the /3. DecetlenYS Education (Specify Dory nignest grade comp leted) 14. Marilaf Status: Married, Never Mamied.
' t 5. Surviving Spo use (n wife, gNe maiden name)
KiM d Work
)Illnc- ltiM W Busirx:ss/Industry }.
elzccmm nlCull(iYtS U.S. Armed Fol~rms?
^veSlaNO Elementary I Secondary (0-12)
iv- College (1 ~d or 5+) zy)
Wd0'"wd. Divoyrc~ed (Spec
/~CV~/ II~QVVI~C~
16. Decedent's ' rg Address (Slreel, ary' town, state. zip code) Decedents 13~d Decedent
PQ I
Ne in a
v
i
P
l R
itl
7
D
d
L
T
^
~'A 1105
~' tQS~ Sim
xcT'~ S-r i~1~C!- _
ctua
es
1
es,
ece
ent
rved
wp.
ence 17x. Slate /~
c. ~0
n I
1
IAY~'lb?l~~laq'xG Townsnrp+ 17d ILVNO,I~cetlemLivadwnhin Yu~7
~
1
; 1
{
Y 17o.CounyS
7rYlunics
I~Y6
AcNal Limned I'I ~ ciry/BOm
1 B. FameYS Name (First, mitldle, last, wfhx) y ~
~ 19. Mothefs Name (First mkktie, maiden wmamel
rlarrc'~K
EI)z~~befi
uE~n
~I~ct' ~
20x. Informant's Name (Type I Print)
f~iCl1c~rc~ ~ µci.d1~'1 20b. InlormanYS Mailing Adtlress (Street, cM / town, s re, zq code)
i~f`15 ~vlilcw /~d. ~re~;e r ~ i~o35
21 a. Methotl of Dlsposbion ®Cremation ^ Donation 21 b. Date of Disposidm (MOMh, day, year) 21 c. Place of Disposition (Name of cemabry, crematory a r place) 21d. Lcptlon (City/ NYwn, stale, zip wde)
^ Burial ^ Renwval hen SUte r Was Crematlon or Donatlon Aulhor'vatl
i /
'~' -
/~
~ ~LL ~lr1C. ~
i'f~2' lS2
X
'
y`C~''
C
I~ ~ -7
'Tti ~ a-5 1
IA
S
'
S ~
~
JQ
^ Omer- by Medical Examiner/Coroner? ^ves^ No l.'
1 .
rY;
v
Y~
Ir1i.Yc
y ~~ r
1
i
t
V
~(
f F
$e~
~ pe ass )
°
'/
~ 22b. Lirense Number
I~I't$1
~'D 22c. Name and Atldress of Fadliry
rvuuv~ ST
C4t
~a'~
3~l E
l~ ~
N
~ ~711~~
m
,k +~
rzrvw~,y~
~~4
~
h
=
g
jA-'
'a'~'
C
j
,r
a, ~
C .
-
-
.
-
k
v
.
ye~
",,.;.ti.
r
k
c
~,
CompleR Gems 23at oMy when ceNtyin9 23x. Tome bell of knowledge, death oawrad at are ame, sate erd plate stated. (Signatwe antl line) 23x. License Number 23c. Dare Sigwd (Monet, day. year)
physican is rx11 avaiabk al time m tleam la
piny pass d seam.
Items 242fi must be conipletetl by person 24. Tme d Death 37 25. Date Pronounpd OBHtl (MOnm, daY, year( 26. Was Case Retertetl to MBtlKaI Examiner I Coroner for a Reason Omer than Cremation or Dmatlon?
wM prorlPUnCeS dean. ~ Q'~-M_ ~
~ ^ Vas ^ No
, Approz to Interval:
CAUSE OF DEATH (See Instructions antl examples)
Injurws
or corr
litatiort5 -mat Oiredl
caused der deem
DO NOT enter terminal events wch as prAac aneri
Item 27
Pan 1: Enter the Gant of events - tlispses
Onset b Death Part IL. Emer Omer sim'fkanl cardil'pns canMhut'm to dean
t n
t raz
llu
in the underyin
cause
iven In Part I
b 26. Ditl Tabacro~U CanlrlDute to DeaM?
^
p
,
.
,
,
Y
.
resgretory artest, or ventriwWr fibrillation wimad stowing rile etrokxJy. LW only one pose on eatlr line. g
g
g
.
u
o
u Yes lL]l.ProbaMy
^ No ^ Unkrowt
IMMEDLITE CAS ~ IFnW disea~ '/ , ~(l ' r , ~ r
toMPoan resraa th a .- 4. (~~ ^ ` ,
1,~ r . ~ l , J ~"( 7f
29. M~Flemale:
iNn
l
Na
Due m as a con rice oft: ~' t^..z ~~~~~
l
'
" '~My ~ pregan
w
past ypr
,~.x
^ Pregrent at tlme of death
.
l
$$aapp tiely list contlNms, B any, b ` ~ ^
leading b the lisletl on line a.
EnW IM UNDERLYING CAUSE Due to for as a crosequance oft'. Nd P• Jnanl but pregrant wimin 42 days
(disease or'vyary met initiated de
ln
re
d
m
LAST
c
- fir. f .3}~ ~ ~
(~ li ' ~ ,.-J~ ~~~'~ Qd~~~' -"' ' of tlaam
^
eve
msu
rrg in
ee
(
.
Oua to for as a rmsequence og. Nd pregranl, but pregranf 43 daYS to 1 year
afore dpm
e.
^ Unknown it pregnant w,mn ea past year
30x. Was an ANOpry 30b. Were ANOpsy Frbirgs 31. Manner d Deam 328. Date of Injury (MOnm, day, year) 32b. Describe How Injury Occurred 32c. Place b Injury: Herne, Fartn, Street. Factory,
PeAOmletl? AvaiMbre Poor N Completion
of waae of Deam? 1,.~ NaNral ^ Momkide Off &,ildirg, etc (SpecilyJ
^ Yes No
^ Yes ^~NO ^ Accident ^ Pentling InveStigalion ~' Time d Injury 32e. Injury at Work? 32f If Trareponatbn Injury /SPedzY1
^ DMer/O
erator ^ P
r ^ P
tn
n
tl 32g. Lop(n o1 injury ISlreet, cM /town. sblal
^ Suicitle ^ Could Nd De Detertrkned M' ^ Yes ^ No p
assenge
e
as
a
^War-Spealy
33x. CeNf r (Nleck any one) 33b. S'yaWre and one of taro' r
• Certeying physkfan (Physkan certirying pose of tleath when another physican has gorauncetl deem aM wmpleteo Item 23)
To 1M best d my ktwwletlge, death occurred tlue to the tau
ee(s)aM manner as stated_________________________________
~ ~ ~ ~~~ r~ L
• Praauneing and certlying physician (Physician bom gorpurKing dpm and pnMing to cause d tleam)
To [fw beat b m
knowed
and due to the puee(e) antl manner az atnted
e
tlath o¢urretl a! the li
^
d
t
d
lace 3.3c. Uprise Nummr / `
~~ C
' 33d. ]ate Si9nae ( onm, Y. Year)
~~ 3 ~ ~
y
g
,
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
me.
a
a an
p
.
• Medkal Examined Coroner r
~ l) J ~-~{ Z~
r ~ (
(
On tM bash d examinelbn arM / or investigation, in my opinion, death oecunetl al Ih! time, tlete, and plop, antl tlrw 1o the ewN(at arM manner n atatad_ ^ 34. Name antl Atltlmss of Person Who Gomplet~etl(Cause of Deam (I(em 27) Type I Pri
nt
~z
~
~
I
i
'1
!
" a Fil
%
tl
~ `
,
~
~y'ci'T-+/y
""r,
\ _!~~
typ antl D
r
ot I
I
I
7 I I I ~ I
.ny c71 t ./1 .C
e
l
y +~t71f ^
/
-z c
y ~Y ~
Y z t. ( l h / 1 f ~i ~l
Disposition Permit No. v) / r..L ~ `+c ~ l