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HomeMy WebLinkAbout11-17-11PETITI~nO"'N FOR GRANT OF LETTERS REGISTER OF WILLS OF ~tN'~-l~Le~ts~~~.~ COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name• ~v~o a,a 1"~~- ~~~ File No• -~ ~ _ ~ ~ ~- ~ a ~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: ~o~ - ao - ~o~-t3 Date of Death: (o a3 I I Age at death: ~a Decedent was domiciled at death in C.~-ti t~=12~ County, (ware) with his/her last principal residence at I ~u a ~w.~v~-~ ~f ~ I~ ~ Q ~ 1~ o I ~ ~tiA-v~.~ Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 5b3 1V~Y-f1., a-Isr `~ , ~'~rv~L P-~ I~10~~ ~'~.n-~.e.~-Q~r.ol Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ ~ 3 ~y(r , $ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ ' - Ifnot domiciled in Pennsylvania ........................ Personal property in County $ - Value of real estate in Pennsylvania ......................................................... $ (j TOTAL ESTIMATED VALUE.... $ 13 13t~ . X ~ Real estate in Pennsylvania situated at: ~~ ~ !~ (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ~] A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ ~~/ I~ and Codicil(s) thereto dated State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. [~NO EXCEPTIONS ^ EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d. b. n., d.b.n.c.t.a., pendente lite, durante absentia, duranteminoritate If Administration, c.t.a. or d.b.n.c.za., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach adcitional sheets, iJ necessary): ~ Name Relationshi Address ; -:~ '` _"~ . ~' , ,; '~ ~ "- -~ _, :~ -. ~' ... _ C~ Farm R W-02 rev. f0/I1/1011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } f ` ~p try } SS: COUNTY OF ~V ryl~~ ~Wt zC~ } n - _- (-~ _:_~ --~ OfficiaRJse.Odij% •" ~ - -~ ~~ _ ~~ Petitioner(s) Printed Name Petitioner(s) Printed Address ~- -C-ter--S c- ~~l'~_r~ ~ ~S Lc l~t-r 1~-l,v ~~ ~ ~~ The Petitioner(s) above-named swear(s) or affirm(s) 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, the Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before ~~ ~ ~ Date I t ~ (~ I _ me ' ' ~_ day of Y 1~ ~~~ Date ! By: l ~,k 4~1,~ ~o k~ ' ~' ~Y/ / )~'~ Date For the Register Date BOND Required: Q YES ~NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ (~ ~ UG ( 02 )Short Certificate(s)...... `~ C)CJ ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Automation Fee ............... ~ (;O JCS Fee . .................... ~.~ `.7G TOTAL ..................... $ 1 II.:7G Phone: Fax: Email: DECREE OF THE REGISTER Estate of ~GY Yl(; y 1G ~~ . ~~~.~n File No: ~. ~ - 1 t -~ Z, ~x a/k/a: AND NOW, `fJG vL~ ~`>-~ ~~~ 1' 1 "~~ ~' ~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters '~S-•~~tu ~_ y~ Ica r,~ are hereby granted to I-c' Y Q~c; ~Lti'1(~ X in the above estate and (if apr~licable} -that the instrument(s) dated Z described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)} of Decedent ~J~ V~ZCe-C~ ~, it.e.~'ti~~l ~ _l ,~ ~~'fr~ t ~1 f~,~, ~) ~~ ~~~ - Register of Wills Forrn RW-O2 rev. 10111/20]1 Paige 2 Of 2 H 105.905 REV.(Sf11) This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. 6443664 No. ~ ©'~-~`~ Marina O'Reilly Matthew State Registrar ~~~ SGT ~ 5 2a~ ~~, _ . ~ ,, z , ~di~ C7 _. _ _ , _ "' V} 11• ~ • ~ r ` ) -_ .% ~ l '"7 H1~-143 Ntv 11rmBB COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _~:a ~.i TYPE 1 PRIM W sr~ CERTIFICATE OF DEATH ~ ;~1ti3~~4~1~ (See instructions and examples on reverse) srATF FILE r4uAleFa r' a~ 0 .r 0 w w 0 i. Name d Decedad (rreL mode, lest, sulfa) 2. Ses 3. Sodal Seamy Nudla 4. Dale d Ikab (IAortlr, day, yeaz} - - June 23 2011 5. Aga Na18is9Asryj Urda 7 Under 1 6. Deis d BirBI 7, Bi end stele a Be. Place d DeeBi ae Montle pays Hues Afnks Hoapltal: Other. 82 yrs. 10/29/1928 LewiStawnt PA Irpetient ^ERloripeberd ^DOn ^Nuaipibma ^Hesidaae ^olha~speuy 8b. Ceaa1' d Drelh Bu CBy, 8°ro, Twp. d DreBi 8d r-ea31y Name @ nd natitltia, give street and nuriber) 9. Wes Deaden! d ~b r)rign? [~ No ^ Yes 10. Race: Mlabm h~den, Sleds. WNk, eb • Ctmlberland E. Pennsboro Hol S irit ital "~'°m' '~ °'~) Wlte 11.Oeadarl'sUsuM dwakd one mat d Ye.OD ndelate 12 Wes Deoedai ever M tle 13. Deadwi's EdreeBm (Seedy any highest grade anp lelad) 14. Matld Slda: Married, Never Married, 15. Suninng Spa re (0 wie, give maiden refire) 1Cgd ~-' re II S F U.S. Mad Faas? rlenenmry / sa~t~ry (o-iz) C,aBa9e (tA a 5+) Widarad~ ~~ (SAS Seams _ S xY ^ Yes ^(140 1 L Widowed • 1A.D°adad'SMeingMde~(Streat,ayrla•n,81e1~~e,aappad~) 352 Springs house K(l. peadenP6 D'dDeaderd Adual aesidence na Stab Pennsylvania _ lT.rre na ? ne. ^ tea, Deaala~ Llvea in Twp Nar'?"isburg, PA 17111 ,~.~Y ~ nd.~~L,~ad ""~" Haz'risburg cMyrAoro 1B. FaBer's Name (Fvst, midde, teal, auBoc) 19. Motlrefs None ~ milde, makkrl serene) Jose William PenneBaker 20a Inbmenfs Name (type I Roi) 20h Inbmem's Meag Pddlere (Sped, dy r town, stab, a4 code) Theresa Knox . 352 in 21aMdhodd0iepaitim r yl,ICremaba IA,~OOretia 21h.DatedDepatlbn(MOdh,day,)~ 21c.PbcedDispaiBOn(Namedcermbry,aaneloryaMerplace) 21dLaraBm(CflY/bwn,afaM,:pade) • ^ o^ber~ ~"'~ ~ n"Maa`''~ °E,~ana c "'wed®r«^ Na 6/28/2011 Science Care .Aurora, CA 22a sgrmue d Fwerel Liamea is parser ecbq re ash) 22h. Dame Mmba 22c. Name and addrere d Facliy e 1 - 1 er era - - FD-014404-L 3125 Walnut St. Iiarrisburg, PA 17109 Canrlbbtlam when 23a.T°tlebeadmyheMedge,dreMowrredetBetfine,deleandpl°cestaled(Sgieaaeandfilb) ~ 23 b .UcaiaeMmber °M h,dr(, earl Sign°d( IA Y 23c.~t e plyaidenisaiaaiaMeettinaddadhb /J +SQ ~ ~ ( ~ / ~ / - / } Q ` ~ ~ ~ o stay sure d dean. Y , 1\ p ry d J du - gems 24-26must be caryblad b/person 24 . Tme ot .pe alh 25. Dale Pmnaawed Deed (M°Ni, deY, Peer) 2A. Was Case Flderred to Med'cal Fxemimr / Caner fa a Reesm OBIa tlt°n Crematim a Daatim? ~ ^ ~ tMaprarYaiceedeafA. ( ~ ~ (J y~ ~ j 1 r 0~ 1 1/ l M• 3 ~ Yes No . CAUSE OF UEA1H (See instruelfons end examples} r fppmrjmle i~el: ast i O a to D th h d b i d d O Pad N:Emar otkr ' n n Pad I hd rat ra in tl d i M i 2& DidTobeca Ure Cabbala b DNIh? ^ ^ P , eve s suc as cer rac m ns ea nn v T aier Item 27. Part l: Eaar the 1 -direerea, iqudes, a ampBaeam • Bet Erectly eased the dead4 W N raspiebry artesL a ventriahr IBxSetion xBhart showing Be etidogY. lie ay ae ease m each ins. ; . g y s n e u lg ease give e Yea ^ No daaxm alfaiDU1TECAUSEIFrelds~se~ a t~ .. /~ l~y~Af~y,`•~p~ ~r~~V„C` ~ m~dlbnrealNrgM ) ~j'{rlillf~- 111--- "'~"~+s 29.BFemalr~ P%~ •er ( ~••Pe ~,1~- n Ln~ ~ P i ' fist andYOm, i ery, h S ~ ~ ((~ ,~M ~ /" S f I r41~ "l I ~/1^'~"`~°'1 ~ i Y d death egiad al ^ r Bi 4 d i ~ , b sure Ysbd on fie °. ~ ~ n ays v i 2 pregmd, pregant bdx Ix40EDLYMG CAUBE Due b a re s d): i ' d deatll (dseree a i~ Bat ie3eed tla ~~(/U-l.T'T / f I ~ a e d 43 da b 1 r dd ^ Nd - _ i evems reciting n dreBt) LAST. ge ys yre prePen4 pr Dua b a re s eq: r bBbre dreM • d ~ ^ lldulam B pregred xitlin Be peat Year . 90e. Was an Autopsy ' 30h. Wee Aubpay Fndwgs 31. Meurer 32e. Date d Iqury piaBt ~y, Year) 32b. Desabe How MNY Occurred 32a O aces , ~ ,( F)Sheet, Faday, Palamed t AvaBable Pier b Carpbtion Cnree d Drelh? NeWrol ^ Hadcide ^ ^ ^ ^ Aaxled ^ P~9lmestigatlm 32d Tea d Imay 32e. iluP al Work? 321. B Trempaetion iMaY (Sperry) 32g lacetbn of bINY (Sheet, cry I bwn, slag) Yes Yes No - ^ Sukdde ^ CwH Nd he DebnNaed ^ Yea ^ No ^ DdverlOparebr ^ Pass nse gar ^ Pedearen M, , 33a. CedBer idr°dc aiY ae) 33h. SgnaWre endTtlb d ~ n ! ! • CMNYIngplryabW(PhyaiciencedByingauaddaMhslienaalhapliysbenhespmromaddaeMmdampleadltan23J Tede bepdmy blowMdpe death oaurted duebtlewwi°)nd mrrnerutltebd ' -------'--'----'--' ' / A __----'--- --- , 93c.liameNU~m Nr'dry'yaart 33d.Da~Sigrad{Mar • ~en~ge~WT~(PlA'e~hatlrpmaun9igdre6andaeNlyirgbra~eedda0r) Totlebetdrrykarew4edgtl,deYhoensndetlMtlme,dtle,mdphce,ndduelolheawata)endmwlere°sWed--'--------------- ^ O 2 ~~ ,/'},/1 /1 ~ C~.. ~/J `, • Y dlgllEnmMxlcaorer ~ T e babdexrnkrtlm Iamrostlgtltbrl,hnyopkdon,deethoceurredetlhelkrc,d°Ee,edplea,ardduetotleceure{°)endnwawaaetelerL ^ 34.NameandAdAaSSdPasonWho CaaedDrelh(1am27)iypelPma d 3A D r ~ . ee ~ ` ry, Y•erl ~O S f ~ ~ / _ M ~l / ~V ( / ©(~ ~--~ ~ ~ 41,..E Oisposiion Pemd No. WILL OF RAMONA M. WEAVER I, Ramona M. Weaver, of Cumberland County Enola, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows. A. I direct that my entire estate go to Teresa Knox. B. Should Teresa Knox predecease me, I direct that my entire estate go to Christy J. Ward. 4. I appoint Teresa Knox as Executrix of this my last Will. Should Teresa Knox predecease me or cease to act in such capacity, I appoint Christy J. Ward as alternate. 5. The Executrix of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 1 IN WITNESS W REOF, I have hereunto set my hand this day of , 2011. ._ ~ _ _~ _ -a., Ramona M. Weaver :~: `'? -_ ~...... ~J ,: '~~. s-- __. _ --, ~ LAW OFFICES OF STEPHEN J. NOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Ramona M. Weaver as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. ~~ WITNESS WITNESS State of Pennsylvania County of Cumberland ACKNOWLEDGMENT ss I, Ramona M. Weaver, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Ramona M. Weaver Sworn to or affirmed an~,acknowl~dged More me by Ramona M. 'r,~~;'~~this ~: ~y of ~~ ~ , 2011. n ,~. t~r ~ ~'t+bNc J ~~ Carilalm ~reeW ~~u+nbe~ncl Co. PA ~- ~~s Notary. ublic/Attorn s, ~o,I~ LAW OFFICES OF STEPHEN J. NOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 State of Pennsylvania County of Cumberland AFFIDAVIT ss We, 1~-c~.~~2 ~v~V~ and ~ t ~ ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. ~~ orn to or affi d sub ribed t efore me by witnesses, this ~ day of __ /f , 2011. .. Mee J. H~~, ~~ry P ~ Cer'1Fs8e s°''©9 ~~rtan~ ~~„ ~~I of ry Pub I IYIp C~raml~ra~ ~~ "member ~, ~99~ .._... . _ ..__.,..r_