HomeMy WebLinkAbout12-22-11PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF C U Mrt (3t12L~ A1~ 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• l~fJi//iQAt ,~ Li/b
a/k/a:
a/k/a:
a/k/a:
Date of Death•
Decedent was domiciled at death in (:U.M i~rl. Ipntd County,
principal residence at ~ 3 ,PhPns ant 5~ /1'iGC,J1AA7ic5~
Street address, Post Office and Zip Code
Decedent died at ',~ 3 /Teas a.,nf S1` /Yler/hairl i~sbK
Street address, Post Office snd Zip Code
_ (State) with his/1~ last
~.t..._~. n t_.
County
.s a Cwntbarl~ P.~
County State
Estimate of value of decedent's property at death:
sa
If domiciled in Pennsylvania ............................ All personal property $ `~ /t~OD
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ ,~~ DDD •p°
Real estate in Pennsylvania situated
(Attach additional sheets, if necessary.)
(Assigned by Register)
Social Security No: / 9 R -30 -O X9(1
Age at death• ~f~f
address, Post Office and Zip Code City, Township or Borough County
^ A. Petition for Probate and Grant of Letters Testamentary
Petitioner{ aver(s)-ite/sheLtl~ey-isle the Executor{s}named in the last Will of the Decedent, dated .TN.~I/ ~O~ ~~~ and~e~iefl(s)
thereto dated
State relevant circumstances (eg. 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(g), 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 life, durance absentia, durance minoritate
If Administration, c.t.a. or d b.n.c.t a., 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(g) 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 Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
Name Relationshi Address -Y Q ~+:. t ~~.
17 .
~
! T C7 t~
-~
:~ C~ ~=~~
~~ ~
Form Rw oz rev. loi»/zol~ Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS:
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the liest~t~e~knowl~~ge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitio r(s) w' will and truly administer%tte_::f~s"tate accoriiing to law; -~
~a! , ~ ~ Date ~~"~ ~__~
Sworn to or af~'irmed and subscribed before _ . ~ ,
me this.• ay of ~ `^'"`"`^" inn/.~fa! Date
By: t.
For the Register ,
Date
Date
BOND Required: ^ YESY M lvU
FEES:
Letters ......................
( (.~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ..............
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ••••••••
~:~1 - ` ....... .
$~C.~'~,
1L. rr
~G-(r'~
Official Use Only
To the Register of Wi[is:
Please enter my appearance by my signature below:
Attorney Signature:
~GE~CG~
Printed Name: (~?4/"~GS E d~~ el~S 1
Supreme Court 3&S/3
ID Number:
Firm Name:
Address: ~ C/euSPr -
/.Y~P1~~,.~~ic5 N.M ~ l7QC~
Automation Fee .............. .
JCS Fee .....................
TOTAL ..................... $ r7 7 ~'~''
Phone: ~/~ ~76G -~zo9
Fax: - S-7
Email: CPS %&14~~~~ •
DECREE OF THE REGISTER
Estate of L//LL~MY F LE/8 File No: ~/`~~
a/k/a:
~ °~l~ m consideration of the foregoing Petition,
/ ,_ !t_Lt ~ ~-, ~
ANDNOW,_ .~i ~ '~~l ~ ,~,.
satisfactory proof having been p e ented before me, IT IS DECREED that Letters ~ c~d/YIG~I ~/'y
are hereby granted to ,~/i TiS/ E. ~ ~~B
in the above estate and (if applicable) that
the instrument(s) dated T 0
described in the Petition be a 'tted to probate and filed of rec/ord as the last Will (end-i^tT~lie~lfs}j of Decede/nt./ , ~~
j ~---~,
Register of Wit - ~ i'~ ~ (~. t, < < l )~- ~~ -_L~(:: J''`
~' age 2 of 2
Form RW-02 rev. 10/11/2011
COUNTY OF Ck~13E12.L/~M1~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 17979000
Certification N~unber
/`y ~~1
`~BS1/3 REV 11f2006
TYPE /PRINT IN
PERMANEM
BLACK INK
`J
0
This is to certify that the information herr Siren is
correctly copied ti-uln nn original Certificate o1 Death
duly tiled with me as Local Regisu-ar. The ori~~inal
certificate will he forwarded to the State Vital
Records Office for permanent filin~~.
~~kS~~K'~b~~x~ 1/2ott
Local Registrar Date (slued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and exam lee on reverse)
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P STATE FILE NUMBER
1. Name of Decedent (Rrst middle, last, suffix) - 2. Sex 3. Social Security Number 4. Dek of Deem (Manor, day, ypr)
WILLIAM E. LEIB Male 192 _ 30 _ 0490 November 29, 2011
5. Age (Lass Bkthday) Undar 1 ar Under 1 da 8. Date of Birm Monm, da , a 7. Bid aM stale or ' n coon 8a. Place of Deem Check an one
84 Maa"' °a" "°'"' ""'"1B9 Dec. 16, 1926 Monroe Twp. PA Hospital: Other:
Yrs. ^ Inpetknt ^ ER / Ou~etient ^ DOA ^ Nursing Fiume ®Residence ^ Omar - Speciy
M1. County of Death &. Ciry, Boca, Twp. of Deem Bd. Fedlry Name (II not inelilutlon, gNe street entl number) 9. Was Oecetlent of Hispeiac Orig"? ®Np ^ ye$ to. Rau: Amencen hMian, Slack, White, alc.
Cumberland
Silver Spring Twp.
23 Pheasant St. (lf yes. spedry Cuban,
Mexlun,PUedoRipn,atc.) ISM
White
11. DecedenYS Usual lion Klntl of work tlore tl un moll of tile. Do rwt state retire 12. Was Decetlanl ever in me 13. Decedent's Education (Spedty ony highest gratle comp leted) 14. Marvel Skms: Marned, Never Married, 15. Surviving Spou se Qf wile, gWe maiden name)
KiM of Wak
Letter Carrier Kintld Business/Industry
US Postal Service US. Amad Forus?
^ Ves ~ No Flamenco I Sewn P12
---ry----`~- ~ Col
----~(~-aa~u~ -- Wed' ~~ (SP~M)
Married
Ruth Shields
18. Decedent's Mailing Address (Street, city /town, state, zip code) DecetlarKS Oitl Oecetlent gc~
Silver Spring
Pennsylvania LNema
adaal Residence n
skt
V
tk
23 Pheasant St. T,~
e
a.
na. U
ea,
cetlem Lrvedm
T01"'s';p?
Mechanicsburg, Pa 17055 ne.^Nd,Dapdeml.roedwm~in
17b. Codnry Cumberland Acbal Limds of city/Boor
18. Famers Name (First, middle, last, suXlx) 19. Mothers Nerve (Fast, middle, maiden sumarne)
John E. Leib Ruth A. Woods
20a. Informant's Name (Type / Pnm) ZBb. Informant's Mailing Admess (Street, dry I town, slate, z'q code)
Ruth Leib 23 Pheasant St. Mechanicsburg, Pa 17055
21 a. M
em
od of Disposition ^ Cremation ^ Donation 21 b. Date al Disposebn (Manor, day, year) 21c. Place of DielweMon (Name of cemetery, aemetory ar omen place) 21 d. Laotian (Ciryl sown, stale, zp code)
,q
1y
CS'BUnal ^ RemovallramSkk ~wa:~
~nAUllx,rlad^
remi~
^ 2011
Dec
3 Mt. Zion Cemetery Boiling Springs
Pa 17007
ka
m
Yaa
NO
^ omen .
, ,
22a. Signature _ neml Service (or cling as such) 22b. license Number 22c. Name antl Address of Fadllty
FD-012909-L Ronan Funeral Home 255 York Road, Carlisle, Pa 17013
Canpkte' 23ac onty when certltydrg 23a. T e bast al my krgwladge, deem eau at ma time, dale and plan stated. (Slgnalure and tltie) 7,ib. License Number 23c. to Signed (Month, day, year)
physkkn u MI avallabk 91 tlma d deem to Q (; _ yt n ~ A ~C / n
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Items 24-26 mat p candeted by person 21. Time of Daam Pranou
a
ed
D
ead
(Monm, day, year) 2fi. Was Case Relerred to Medial Examiner / Coronr for Reason Other Nan Crematron a Donation?
who prawunces deem. e 5 M. ~y~,
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n
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`~ t•laXlL ~ ~y rJ G' ~ ~ ^ Vas Q1a~
CAUSE O DEATH (See Inshuetlon and examples) , Appoximete kkrval: Pen IL Enter Omer simficent antlBbns mntdbutlno m deem. 28. DM Tabacm Uu ConmDule to Deem?
aem 27. Pan I: Enkr the diem of events -diseases, injuries, or compiptbns ~ met dredry posed me deem. DO NOT amen terminal events such as prdec anent, Onset to Deem but not resulting k dre urdenying cause given "Pan I. ^ Vas ^ Pmbebly
respkalory anent, or ventricular fmniktlon wimoul slkm"g me etlobgy. List any ono pose on each krce. [~~ ^ Unknown
IMMEDIATE CAUSE (F'na1 disease or !
r~1(,ll~ i MO~rCI~s
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Du Io (or as a consaqueae op:
Q.~..x~
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pregnan
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year
^ Pregnam at time m 4alh
pl IW owldilions, it any, b. i
'
n ~ r~~J~
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b pose I
sted on line a. Ilue to (or as a an once o
e UNDERLYING CAUSE sag O~ r
Enter
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Not pregnant, bm pregnam wimin 4z dsys
of seam
(disease or iryury mat Initiatetl the
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LAST •
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1 ![a..l ev T Y
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0lg in deem)
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evenk reu
Duero (or es a amequenu on: I Not pregnant. Om pregnant 43 tlays 101 year
Defore deem
d. ^ Unknown a
re
nant wimin the
ast
ear
p
g
p
y
30e. Waa an Autopsy 38b. Were ANOpsy Fadmgs 31. Memar of Deem 32e. Date of Inury (Honor, day, year) 32h. Descdbe lbw Injury Occurred 32c. Pkce of Injury: Hone, Farm, Street, Factory,
Penomwtl? AvetlaMa Prior to Competlan
of Cause 01 Dpm? r-n~~
L-~ Natural ^ H°rnnda Omp Buildng, etc. IS,aa'y/
^
[~
^ V
^ N ^ Aaidem ^ Peming Inyeslipa8on 320. Tone M Injury 32e. Irqury et Work? ~. If Trensponation Inryry (Spearyl 32g. Loption of injury (Saeet, dy /lows, state)
Ves as
o
Deroimined
^ S
i
ide ^ Co
W Not D
^ Vas ^ Na ^ Orluar/Opereta ^ Passenger ^ Petleshien
u
c
u
a M ^ Omar - Spea~M
33a. CeNfier (dredc arty one) 33b. Signewr nd i I Ce I,
A1M~ ~'
• CMilyirg phyaieien (Plryaican pnirying cause d deem when another phyaiden hen gomieiced deem end compktetl Item 23)
d..m ocourtad duo to IM uwe(e) end menrier es •tetsa_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To tae beat of my Nnowkdgs ~
,
• Pronouncing eM urtgying phyelclan IPhysroian bum prerpuakg deem end cenilying to puu of path)
^ 33c. Uprise Number 33tl. Dale Signed (Mon
' , py, year)
~
To tM Deal of my knowledge, deem occuned at tae lime, date, and Place, and due to tae uusa(c) and manrwr es atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Madkel Examiner/Coroner ,/F Q q.4 e ~ •.~ L
1/-' (
L l L (,( ',
On t11e baste W examinadon and / or Inveallgatlon, In my oplnbn, dam oeeumd et the tirre, date, and place, aM due to the cause(s) and manrbr n stated_ ^ 34. Name and Address d Person Who Completed Cause of Desch (Item 27) T pe I Pnnl
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35. Registrer M
,~,~D'~~,N~~k'~
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~ 36. Date Bled (Honor, day, year) ~
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Uisposil'wn Permit No. s~ ~~% `~~ Ir~~
OATI~ OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
C It m 4~~~ COUNTY, PENNSYLVANIA ~? ~ _ _1--
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Estate of GV ~LG~R'~JY F• L~/~ ~' `~ b~ceased ':
..,fit ~~ e ~ ..%~ [,
1~' ~?H ~ .. L.~ I B and
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquaintedwith ~ ALL/~4•H~ E. LE/~ and arm familiar
with the handwriting and signature of the decedent, and that the signature of ~/GG/x/11 E• LE'/~
to the foregoing instrument.purporting to be the Last Will and TestamendE~rdit~ of LtJ/~L/ ~/h
L E'/~C3
is in hisser own proper handwriting.
f ~ ~ ~
(Signs re) R ~ 7't/ E. L~/B
a3~~~r.
(Scree! Ad~d~re~s,s,), Q
(City, State, Zip)
Executed in Registet-'s Office
Sworn to or affirmed and subscribed
before me this ;,~ .~1~`~~ day
~eputy for Registe~'of Tills
(Signature)
(Street Address)
(City, State, Zip)
Form R N! 04 rev. 10.13.06
OATH OF SUBSCRIBING WITNESS(ES)
~~ = :z-,
EGISTER OF WILLS
P ~ n _ -
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~l~ /htE3l~?1,~4rU~ COUNT', PENNSYLVANIA _-`t~-c ,
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/LL/tt+~iyJ ~: L.E/$ ~r'`~1 ,t~.Dece~s~(~=
Estate of ~
~~~/(~fZLE- f' ~k,~/(~ >- subscribing witness to
(Print Name/s)
they Will ~~~;~~}presented herewith,) being duly qualified according io law, depose(s) and
say(s) that she-~-l~-l tl.~. waste present and saw the above a~e~ /Testatrix sign the same
and that she / h signed the. same and that she-L-~ay signed as a witness at the request of
the Testator / in -~/ his presence and in the presence of each other.
(Signature)
(Street Address)
(Cite, State, Zip)
Execistted in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Wills
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GOUSP.Y l/CD~
(Street Address)
i'~?ee~iics~~rq, ~,~ /7osS
(City, State, Zip)
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Ezecacted otct of Register's Office ,fir,
Sworn to or affirmed and subscribed
day ~.:
before me this 7,/
of ~•~lti , .2fll ~t,
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C.P ~ ~~
Notary Public
My Conunission Expires:
(Signature and Seal of Notan~ or other official qualified to
administer oaths. show date of eapiralion of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the oriDinal or copy of instrument(s) at time of notarization.
rornt Rhlr-p3 rev. 10.13.06
LAST WILL AND TESTAMENT OF WILLIAM E. LEIB
I, WILLIAM E. LEIB, currently of 23 Pheasant Street, Mechanicsburg, Silver Spring
Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and
making void any and all prior Wills and Codicils by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my `decease as the
same can conveniently be done. =_ - _ -.~.
v~ ~ --
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2. - U; ~ ~-
~ ,~ _~
All the rest, residue and remainder of my Estate, real, personal and mixed, whatso~er and..^; -- -~
wheresoever situate, I give, devise, and bequeath to my wife, RUTH E. LEIB, to her oc$n use and~`~: ~.~~
benefit absolutely. `~'
3.
In the event, however, that my said wife, RUTH E. LEIB, should predecease me or die at
about the same time as I die, such as from an accident or disaster common ±o both of us, I give,
devise and bequeath my said Estate to be divided and distributed as follows:
A. The sum of Ten Thousand and No/100ths ($10,000.00) Dollars is to be given to each
of my grandsons who survive me, to wit: WILLIAM GEORGE LEIB,
ANTHONY JAMES CLAY, and ANDREW DALEY CLAY.
B. The balance is to be divided equally among my three (3) children, to wit: ROBERT
E. LEIB, PATRICIA E. LEIB, and ROXANN E. CLAY.
4.
In the event my said son predeceases me then his share is to go to my said two daughters or
to the survivor of them if one of them has predeceased me. In the event both of my said daughters
have predeceased me then my said son's share is to go to the issue of my daughter ROXANN.
In the event my daughter PATRICIA predeceases me I direct that the first ten thousand and
No/100ths ($10,000.00) dollars of her share is to go in two (2) equal parts of five thousand and
No/100ths ($5,000.00) Dollars to the MT. ZION LUTHERAN CHURCH and to the now
incorporated MT. ZION CEMETERY OF CHURCHTOWN, currently located at 325 Old Stone
House Road, Boiling Springs, Cumberland County, Pennsylvania. The balance of her share shall go
to her sister ROXANN or her said sister's issue, as the case may be.
~~~ ~ c~~
Page 1
In the event my daughter ROXANN predeceases me her share is to go to her issue, per
stiff. In the event she is not survived by issue, then to her siblings who do survive her.
5.
I nominate, constitute and appoint my wife, RUTH E. LEIB, to be the Executrix of this my
Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint
my daughters, PATRICIA E. LEIB and ROXANN E. CLAY, to be Co-Executrices in her place
and stead. I further direct that they shall not be required to file bond or other security in the Office
of the Register of Wills for the purpose of administering my Estate.
I WITNESS WHEREOF, I have hereunto set my hand and seal this a0/~i day of
A.D. 2010.
(SEAL)
WILLIAM E. LEIB
Signed, sealed, published and declared by the above-named WILLIAM E. LEIB, as and for
his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the
presence of each other. have hereunto subscribed our names as witnesses.
~~
Page 2