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HomeMy WebLinkAbout10-24-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Cheryl A. Wisner-Gardner File Number ~ ~ - ~ ` _ ~ ~ ~~~~ also known as Cheryl A. Wisner- Gardner Deceased Social Security Number 193-52-2996 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) ^ A. Probate aed Grant of Letters Tesbmentary and aver that Petitioner(s) is /are the _ ~ named in tJxa last Will of the Decedent dated and codicil(s) dated ,, ~ ~ -- -, _ ~: ., (State relevant circumstances, e.g., renunciation, death of executor, etc.) T' -~ ~ , Except as follows, Decedent did not m ~ - arty, was not divorced, and did not have a child born or adopted after execution of thg-tr3itumerit(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: . ~ ~~° - - - .:•~ ~__ -.... B. Grant of Letters of Administntiop ~ ' ' (/Jappticabte, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate) 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: (lf Administration, c.t.a. or d.b.n.c.t.a., enter date of R'i11 in Section A above acrd complete list of heirs.) Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 35 Cleversburn Road Shippensbur¢ South Hampton. Cumberland PA 17257 (Lrst street address town/crly township, county, state, np code) Decedent, then 54 years of age, died on 9/24/11 at Decedent at death owned property with estimated values as follows: (If domiciled in PA) Ail personal property S ~~ ~ ~ C C t ~) C1 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County ~ Value of real estate in Pennsylvania a 2~C ~ C) ; ~ C : t ~ ~~ situated as follows: "),J ,1~ ' ~S IOt U ~ .t~ ~~ ~ ~ ~~S ,~• . ._ Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the gent of Letters in the a ro riate form to the undersigned: PP P ~Zi `~ (COMPLETE INALL CASES:) Attach additional sheets ijnecessary. Form RW-02 rev. /0.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA , SS COUNTY OF The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition 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 r:~e the L +, ~' day of ~~ ,~ r For the Register Stgnaua• ofPersonal R sentatrve __ - " _~~ - : _ _, , ~ -cl . . Signature of Persona! Representative _ :; ~~, '~ - . . _, Signature of Personal Representative -,~ ~ ' ..~ -' > U File Number: .~ ~ - ~ ~ - ` ~ ~ L fi Estate of Cheryl A. Wisner-Gazdner Deceased Social Sec/u~rity Number: 193-52-2996 Date of Death:9/24/11 AND NOW, ~ 7C-~ ({; ~ ~~_, ,,~ j ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters _ ~ (~ ~ ~ (_S -f (i ~ are hereby granted to ~a_ ll~~;~ t in the above estate and that the instnunent(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. r Letters ............... $ .~1~; L~ Register of Wills ~C ~ ,; -~~~~,~ :,,,r~,;~~ Short Certificate(s) . ~.~.... $ ~~ ~3 ~ Attorney Signature: C /~ Renunciation(s) . !........ $ .`7 •UC) $ Attorney Name: • • • $ Supreme Court I.D. No.: ... $ ... $ Address: ... $ ... $ ... $ ' ' ' $ Telephone: TOTAL .............. $ "~~ Form RW-02 rev. 10.13.06 Page 2 of 2 ~~(~~. fW~ ~ ~7'l •~.~t y~~ rr/IffiAk~ ~ ~~~ 9~~i~~" 1. -,X~il~ ~.st~~c e c jl-''3~' '1~jAi^'"' "tom / r ~' 1r '~'~11~'~_-`s. ,~ ~~~ ..r~,~ ... ~!a/ ~'a Q.,... _ .~ r / us; r xr ,,aq ~ ~, ,,,' ~ ~ ~ STATE Off' NOR~FM C:M~~-R'C;)LN~V~~ ~~ ~"~ GF~A.VEN COINNT`~' - . " _ lM1f ~, OFFICE OF= F~EGISTEI~ Of= C)E:EC>' -, =r~. - _ ~~ CQPY 1 NORTH CARCLIiVA DEPARTMENT OF HEALTH f;ND Hl1MP,N SI_RVIC i' S ~ ~ ~~ STATE COPY NC VITAL RcCORDS _ ` • ,( MEC)ICAL F.;k:J1MINEtt',~ Cl:I?"irERI::l.T"~ OF DEAT"H ~~~~ ~~ ~ Registration ~~//~~ ~ , Distract No ~~^t,Jl,a LOCeI No, -~ ~~ ,< '~ 8 ~ Of~°(;}`f' rrsf rddM, Last) -.. r ^'~ I `_.~ G , AT H (HOntn 4.. ~ n t' C•-, f 1~~~ ~ l~th~ W t ~Y~Q~r l]'CJ~/CA 1"'~ Vir TS- ~ I 0 f7- ' DE:AT y ea 1 ~. - I _ _ _ o + 4~-r1~ SECURI N R AGE~~-Last B~rihday ', UNDcR' VEA tTN~F~: 1 DAY _ DATE: OF BIg7H {Month, 3. ~ ~~ !F 1 ~ ------~ s r, 1 HP~_ ( pirnly and 5;ale~ ~.` v q©Q (Years) J' Morthe Days flours Minules~Year l y .- 1, 1 J „' S'L- Z. f 1 ~ Sa. ? ~ 54. ...... 5c )~G cr Forcicln G nlry4 +, p ~~ 6 I : $ ~ lT/' A QED NT VER IN U. _ _I __ ~--' ~ ~~y{~~~1"~ ~ I 8a. PlA E~F"O~A H~ieck oralyore: see lr st uchoas on o7Fer sr"da) ~ ,:. N 5 ARMED FORCES?{Yes or NO/ ~ - -- __... ..i. ,.~ ~_I ~" ~ m N 9. NO HOSPITAL ^ Inpatlant U FRfOutpatient ^ DOA OTHtR. [7 Nu-sing Home ,l Readence QJler (Spe'Ny~ i'"{ p A )H r 7 ~ /` '. g PACII~ (ton, grve street and number) CITY, TO'NN, OR LOCATION OF DEATH N I I Y _ dl ~ ~ f" _'-'--`- ~L ' ~ ' `' u. Yes or No r ~_ ~ MARITAL S 1 TU -Married, Never SURVIVING SPOUSE +1 wife we maidar name DECEDENT / { - ' ~ (° 8b. W ~ I S• YCi„'f~pp'(4 ~ ~ ) V~~ S~U,,SLIAL OCCUFATiON rC~e9k+ndo/wor+9aKINDVV~Uv,S1eNfSS~I NDtJSTRY~ ' .r Martied Wklowetl D,v rose (Spea:yj _J _____ nY ~ ~ (~ Q ~ ~ y1 ~ do na dunng r~ost~oj/ workrnq l,le of use rt~Lred + ,~ f ~(:-- c E 70. t ~t'1'i ~, CS 11. fA-~ Il~r ~C~f ~Er 12a. r_'.4 Th ! L n ~~._ -__C -'-_ r't ~ r' i2b. i~ F.C. ~~ a 5 ~ RESIDENCE-STATE i'C~ry7Y ~ i~Y 70~N. OR L~~ I~ ~ ~ _' -- STREET AND; ~~1 ~~ ~ ~~ vs' ~ 8 ~ ,3a. _ /~ 5 w ,3d. 3 ~ ,~ f'- " ~ E ~YASD~~ jY LIMITSn LIP CODE Wes Decedont of Mspanic Origin? (Spacrfy Yes a -American Ind,an, DECEDENT'S EDUCATION (Speu7y only highrsf grade <` l ~ ~ ~y No-1/ yes, spe-ll$ Cuban, Mexkaq Punrto Rican Black, Wh la, Etc (Spac;fyj competed) Ekrr~erxary/SeoorWar7r (612) Cglege {t8-17~}' ~ - ~"' - ~ ~ 7r~.~~ etc) ^ Yes P~No (Speoity) =. ~` o ~ ' n g tae. ~ 131. 14. 13. ~)'1r},f~ 15 ~~~ ' w .iA FATHER'S NAME (First, MiUdle. Las!) ~ MOTHER' NAME (first, Mrrldte, Maiden 5uraarr+e) -" ~- " ~~" ~~ fir., l ~ n, ~ci~ef-~ ~,. ~(e~}a!1 ta. ~u.c~i'~"~ L, Cue+~1c'_S ~` ~ r '' I FORMANT'S NAME (TypePnM) .MAILING ADDRES Street and Num ~ ~~~ 6i1TE AMENDFO ( ~`':. "+ ` I bcv or Rural Route Number -- \ { ~ ~ ~ tla, ~ ' ` ~'l t~ ~~~ , ~ 1't ~ r ~ I C iy W Town Sfata lip Code) 1 v 1~. Z.oo'7'S "'SA~~ (fit! l.3 a ~ES~j(til' ~ r~ t4c, ~ Part 1. Enter the diseases, injuries, or cunbtiUtwrls dat caused the dealn Do not enter tM moos ni I v '~ 'x dy.nq, soon as cudiac a re If appopnate, enter tobacco, alcM+al, or drop use. List oMy one cause on each line. (PRINT or TYPE) zpirarory arrea, rxxk or lurart'ailure Approtllmate trterval 13elWeen OnSel aril "~ ~. ~ ~ tNMED1ATE CAVSE ~ Deem ~ - ~ ~ (Flnadseasaa a.~UVC(nLL .~~t~?.YSL 1~ C31r4Q Y'Ya e ~, ~ .a emdnion rnstrlting DUE TO (--~L~R AS A C-ONSEQUENCE OFI. ~~~ ' ' - `° in dear^) ~ ;' ~r I o • Sequent;ally irat crxtddlms h ,; ~~ Aany, leadirq to immediate pUE T ( R AS A CONSEQUENCE OF): - ( ~' R `" ~ ,~ ~ caua8 Enter UNDERLYING $ ~ • CAUSE (Disease a irtpsy c. ~€ I r:. ;~ ttW initialed events DUE TO (OR AS A CONSEQUENCE OFj~ -~-_..___ .___ __._,. ____...._....-_ "' a $ ~ resulting in tleaMr} LAST. - --- -.-. , _ t r 0 3& $, PART il. Otnzr sipnificanl conditions contribNing :o death but na resulcng in Ene underying ta.rso gi~,ron in Pan I, WAS AN AUTOPSY PER- Were ~ L' Y ~ := surr, as tobacco, skohoi, or drug uae; dlabatea, e:c Autopsy Flndings Avatlabia prar T, g 2t1b. FORMED (Yes w Nn) to Cortlptetpn dr DeethCenlfwfac ~ ` ~i 1 p o ro MANN OF DEAT 21; ~ 21b, (Yes W Nb) N~ ~ ' 'E $ DATE OF INJURY TIME OF INJURY INJURY AT N)ORK? DESCRIBE NOW INIVR'! QCCURRED I x7 . I - _ ~ ro ^ Nature 'dent U Suicido dy (Mon~y Aay, Y-ar~ (Yes a ryoJ 'v r< 21c. ^ Homicide Q Pandirtg (..:1 Not Determined 22a. ~{'2, ~ 23b. M. 22c. 27.d. Mss1.t3 Ct+n colt fSitl/`L f - PLACE OF INJURY - A! rains, farm, street. factory, office LOCATION (Street aral Number or Rural Route Number, Ci a Town, Stain r ' ~~ ~'. $ ~ ~ ~ buildxtg, etc (Specify) {{,~~ ~ b ) - - ~ TIME OF DEATH ~ ;,, ~ ne. rti ~ r ~. ;~~' YGi+1c.L~E3rty 1 +' o ~ n ~ To the tmst ct my kriowlecEga, death ocwrred al dta time. date and ?ace sta_t' W ~ ~ ~ ~g• ~~53 M... .( ., ~ ~ ..r, P ed, ( ~~nalwe and ilfe d CartiF•ar} DA1E{S7GNE0 (kfanth Qay;Year) _ `£ ° s m .'3~ ~„~~`~')^VY-Cw 1~+5•f•~y~ 234. `r ~ '~"'~r' (~ „~ ~. ~ < NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (I'TEM 20) (Typo w Pri.nf) r ` ~ h ~ ``,~~l ( n i ' ` ____ DATE PRONOUNCED DEAD ~--~- ( \ ?.. >~ ?Aa. ~C~V\N14. ~'~,~„~, ~U(~ /`~VaC, f31t/d f.}u/J ~seV~/ J3~ (Mantn~t°~' tear) t~g 1 r -. x o ~ M~TH p OF DISPOSI f tON PLACE OF DfSPOSITION (Name ofttmeMry LOCATION- Crty or Town, State, Zr~ pods ~~ ( I r ~ wial ^ Crematiat ^ Rertgval from Stale Q Donation Crematory, or other place) .$ k $c ti r h t f! rl ~.. %s y~ ~ p. • 21Sa. ^ Dthtx (Specify) 23b. Yd h,C ~~' ~ ~ ~ 0 ~. ' ~ -i ~ NAMEi ND ADDijESS pF FUNERAL HOME ~ r+ 0 h r r' ~ ~ q (~L q S 25c r "- K 3 f- , Yarn of Fur.Enu urc+tcrai oR aerisorJ nctiric as suer .... L IC.EN"aE NVM ER ~ 0~~ • r ntr:tq 1r~m6rfcSGrr SthVIGtJr.tt~. 1 ^~-1 ~ µ ~ 5 'r. / .jfrcel' Wr%nlirt tom yds. Td'Slo7 ~. ~ir~t (~.'. [>L~~~1t1" zx.~-G151~"7 ~' _ GES7 ' 'IGNA RE ~ DATE f ILEU (Hoorn, flay, Year) NAME OF EMBALMER • t] ~}R11i C~ ,f, , ]/] Tr~ LICFtN'SENUMpBER~ ..~. 1Revrseo d/CS) IA OHHS ilea 2 ~ ~~~ 4'! ~ G.Uf I J '.l ~ `J. ~' lCr t~ i f'r 26a. r~"S~ ` t ~~ I \`;`' 1xTAl RECOR 2fid.' L 1 ~ t ~~ Volume ~~ Page r ~~;; This is to certify that this is a true and correct reproduction or abstract of the official record filed in this office. -- '.'} ' Sherri B. Richard `~~...~~~uxutiatttt O '} 5 ~ V ~ 5 3 ~ O Register of Deeds -~ f ~, I _~ ubbpplh~,. L U Craven County _.~°•..~,~~~~»t~t~autuw.. I ``\~' Witness my hand and official se~ ~...~. k-..~~ ~~~ / 1 / 1 ~r this the -~- day of -~L-- 2p ~ ~ gy_ ~ ~SL~CJCJLe W I~LJQr~ c DHHS 3914 (REV[SBD 5/09) NC VITAL RECORDS Deputy/f)rSSfS{8gt Registei Of DCedS Any alteration or erasure voids this certificate. Do not aces t unless on securit P y piper with Register of Deeds seal clearly embossed in left comer. ~jrr a ((_~ i_'. ~flE 'mil ~~~i[ ~'la'~'~-Y1.~ c~ ~. ~ _ .._ ,_r` ~ :_ .RENUNCIATION ~~ ~ - r REGISTER OF WILLS -. -~' u ~'''' hi=,(~a r~1~ COUNTY, PENNSYLVANIA T -=~ _ ~= ~ c-~ --~-; Estate of ~~Y y~ ~ L ~' Deceased I, - ~Gt ~1 ~tti~ `~ ~ y c~ /t ~ ~ I^ nntName) , in my capacity/relationship as (~ `~ WQV1 G~ of the above Decedent, hereb renounce the ' Y right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ ~~ ~ ~ ~ ~~ (Date) ~ ~/ ~ (Street Address) 7 F~~'iSvJ~C~ ~. (ctry, star . tp) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ ~-l day of ~ '~ ,~ Deputy for Register o_f Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06