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HomeMy WebLinkAbout02-23-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~(,tJ~I~ty~ ~ Q y~~ COUNTY', PENNSYLVANIA Petitioner(sj 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: ~ C, o ~ l0. ~`~ M iV~ -'t` a/k/a: 2 a/k/a: Date of Death: ~ 2 Z S ~ Z O~ l Decedent was domiciled at death in c-~ County, principal residence at ~ Z- 8 S 1 S -~ ~ o,,fv.J1 FileNo:~~ _ ~~ -"~~~ (Assigned by Register) Social Security No: ~ $2. -2Z - S q 0-( Age at death„ ~ $ (scare) with his/her last o L 1 ~.tt,tv.~/' Street address, Post Office and Zip Code t City, Township or Borough Colunty p Decedent died at C-~A{`~1sn0~~ (~ ~~t'S 1V~q ~ ~ ~g t \b0 0 C~C~ 1''~OY~ T ~ Co, r `~S,e P 1~ Street address, Post Office and Zip Code City, Township or Borough County `~ ~St`at~ ~ O , Estitnate of value of decedent's property at death: U Ijdomiciled in Pennsylvania ............................ All personal property $ ~ 6~, Q~Q ,--- Ifnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ Ijnot domiciled in Pennsy!vania ....................... .Personal property in County $ Value ojreal estate in Pennsylvania ......................................................... $_ ,` TOTAL ESTIMATED VALU:E.... $ ~~p p Q --~ Real estate in Pennsylvania situated at: 1~ C(1Q, (Attach additional sheets, ijnecessary.) Street address, Post Ottlce 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) n-a-llned in the last Will o thereto dated F' e~1n l 6 2O l Z H n r r r a C 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 life, durance absentia, durante 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^NO EXCEPTIONS ^ EXCEPTIONS r^.s Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following S,p'~ttse (if any) anli~eirs (uttac~ additional sheets, i/'necessary): ~---(~ rv Name Relationshi Address!` r" t~ ~~ T' J C ~ -- A „ ~.~. ~ ~7 -h i Fnrnr RW-O2 ,-~~. lniilnnlt Page 1 of 2 State relevant circumstances (eg. renunciation, death ojexectrtor, etc.) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } ss: COliNTY OF ~FGG~r~-_L` ~ `~-~-~,~ D~ ~,, L-~ , Offieia 'Use Oa ~1 ?~!2 ~ EB 23 P~ i2~ 54 R Petitioner(s) Perinted Name 1~~11~ ~ J1 C Petitioner(s) Prinnted ~ r; ,, 31~ J~ O S~ rte t ~~OUI~ ~ X11 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 tnily administer the estate according to law. Sworn to or affirmed an subscribed before ~ Dace Z 2 me this da o c~12 Date By. Date Fort a Register Date BOND Required: Q YES ~NO To the Register ojWii[s: FEES: Please enter my appearance by my signature below: Letters .............. ...... $-.cz~ ~J..__ ( G )Short Certificate(s)..... . ( 1 )Renunciation(s)......... ,~ ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ~`~'~ , , , , .. I S- Attorney Signature: Printed Name: Supreme Court ID Number: Automation Fee ............... _~ a JCS Fee . .................... ,~,'S. 5T1" TOTAL ..................... $ ~?~Z• STJ' Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate o ~(~ ~ (e/~(Yl,i/LLp ~ File No• _ ~ ` l a/k/a: ~ , AND NOW, , ~~ a--; in con; ideration of the foregoing Petition, satisfactory proo ' ng been pr sent before me, IT, ECREED at Letters ~ - re hereby granted to in the above state and (if applicable) that the instrument(s) dated ~ ®l ~oZ / ! c.`~ described in the Petition be admitted to probate and filed of record as the last Will (anti Codicil(s)) of Decedent of Fonn RW-02 rev. !0/1!/20(( !, l PaQL 2 Of 2 OATH OF NON-SUBSCRIBh,TG `~~ITNESS(ES) REGISTER OF WILLS ~i.~cv~.be ~ 1 a -n ~ COUIv'TY, PENNSYLVANIA Estate of ~ ~ a-h ~-- o lA e- ~ l o~. ~ ct ~M 1w ~- ~ ,Deceased ~J o ~ ll- . K ,.~ c~ ~ ~ and (each) being duly qualified according to law, depose(s) and say(s) that she he: /they was were well- acquainted with ~--2.C~1n ~ o ~ e_1 ~ a +~ H,n,.~rv.e ~ and ain re familiar with the handwriting and signature of the decedent, and that the signature of L e; a (~ L.o ti e_ 1 ~ a. t'~ c.~r"n~e to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Le.c~.ln ~o u~l ~ a. l~ ~w~ tM,e 1 is in hi er wn proper handwriting. (Signatu ) ~ g 13 e,~.~ ~ Z 7'1'1. ,1.1 a~ (Street Address) 1,~e1~SV~~1~ ~f1 I-I~La.S (City, State, Zip) } Execctted iii Register's Office me this c~~ day y for Register of 1~'ills (Signature) (Street Address) (City, Stnle, ZipJ r.a ~ ~ _ r :-+1 ~ ~ r~ . a J ' fT7 N s --'s ; 'r :±~ cn ~ W .'.~ t r'~ :7 -z !;.~ ;";` in ~~ ~n Farm RW-04 rev. 10.13.0( Sworn to or aff rmed and subscribed OATH OF NON-SUBSCRIBING "'ITNE;SS(ES) / REGISTER OF WILLS ~--y,M. ~~e~' I ocy~ ~. COUNTY, PENNSYLVAN:[A Estate of ~- ~ ~~ ,-- ©~~~ ~ ~- 1°~' ~` t""r'~e ~ ,Deceased ~~ yJ rJ \ E ~ ~Iy t. \1 \ ~e~/ and (each) being duly qua1lified according to law, depose('s)Iand say(s) that(1 she lie /they wa /were well- acquainted with L.,~p~`n Lc~u.e~.LO`. t~7~lm m 2.~. land a~m~are fam'il'iar (~ with the handwriting and signature of the decedent, and that the signature of LL2.`n 1~t.ig.~,~-0.- ~t~.VYIYYI P~ j'to the foregoling instrume'nitpurport,,ihng to be the Last Will and Testament/Codicil of L-20.-~ ~-o~ ~. ~ t1~- YV~I'Y~.~t is in his er wn proper handwriting. .-- (Signature) ~'-~- ~cl C~In 2S~-r~i ~~ (Street Address) ~~~~ ~a- X701 (City, State, Zi Executed in Register's Office Sworn to or affirmed ame~nd subscribed before me this .~05 ~ day for Re~[ster of Wills r, ~~ ~ z ~ S cm It~ ~ c.-~ ~: r C%) W :. 3 ...~ ~ ~~~ ~ © -ry r , ~, b C.li ~'`~ Form RW-04 rev. 10.13.06 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA RENUNCIATION Estate of LEAH LOUELLA HUMMEL No. also known as Deceased The undersigned, Nephew and Executor of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters Testamentary/Administration be issued to RONALD SIEG Witness my hand this f ~° ~'¢lay of Febru~, X012 HARRY HAFNER (signature) (Signature) (Address) Sworn to or affirmed and subscribed before me this ~ ~ day of Notary Pubti~ My Commission Expires: ~- ~ ~- - OMMONWEALTH OF' PENNSYLVA(~ NOTARIAL SEAL GINA UgAtDI, Notary Public Camp Hill Boro, Cumberland County My Commission Expires February 12, 2014 ~y dd UJ ~Nu t~~~W(l~ ~~no~ s,~v (signature and seal of Notary or other Renunaations executed outside the gffice of Register of Wills are orficial qualified to administer oaths. Show ~~ ~~~ required in some counties to be notarized. date of expiretion of Notary's commission.) ~5 ~Z4 bid EZ 83.E ll ~l ,~-,~-ie ~ a,`~~'~~~'~~. ~ 411I'g ~ ~~q W~.:~ ~.r 1 RW-3 ~ av~~~ 14J~~1~~~3~ filO~.ROS RFb' ((,I10't LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING~Ft ~~~~~aa~ J#Q~`~p~cate this copy by photostat or photograph. Fee for this certificate, $6.00 P 17990974 Certification Number i3 i 2 ~ rB 23 P~ IZ CORK ~F ORPHAN'S COUR C~JMR~4f ~~' CC This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certifa3te will be forwarded to the State Vital Records Office for permanent filing. Local Regis ar Date Issued nD5-,47 REV nrzooo COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE ~ PRINT IN PERMANE"' CERTIFICATE OF DEATH BLaCn INa (See Instructions and examples on reverse) STATE FILE NUMBER ' "~'""°°"°°""~''"'°°° ~' "''"" Leah Louella Hummel 2 female 7 soaels~y~Nlaro.r 22_ 8907 a DaraD.amp7aRm,c~}T1Der 25, 2011 5 Age (Lass BinndaYl Ur,Oer I yer l1Ma 1 daY 6. Dab d BNn (MaWI, dry, 1 7. Birdpate ICily and war « wlaa7l 6.. Plan a Onm (CMA aay aw) 13$ ~+~• DaY• laws uasrs July 27, 1926 Marysville, PA om.c rrs. ^ lrpaaenl ^ EN / wroaa«n ^ DOA Nu rang Namr ^ Ruimnte ^Omer ~ spadly: m ca,nn ~pU m be rla nd 8c GN. egrq, r~.,y Daam I eS@X Twp. fie F,axY na baunao., ale nil s. w,a Daaam a wwrl~ o~q~rl' ®No ^ Y.: w Raa: Amo~;oa e,ea,. eras, wlxa. ee ~~aremol~l~uarsmg & Rehab Ctr p e a etll wn c . y , p y a . ~~+ White 1Maian, PIrM Flinn, ea.) t I. DecedaYS llsur Kvq d oara tarty most d ib. Do rld srr rarW 12. was Decedent ewN n me 17. OeaMxa's Edxation (SPecily aay IigMa1 grape t/. Y rc l S a a hlw: MarrrA~ Nawr MarnaO. 15. Savmrg Spouu III vile. qNa maiew, na,nal 8ec1"etary '~11-phtfh~e"CO. I tl ~a ~ r E U.S.Aml Face? EIMMntery/St~wary (612) Carpe 11-ea5.1 W IV~Ve~Ed ^Ye ®No pa.a~~IS~~1~lnapq~~t~$aN,c~c~~rv~ • 16. JU IYVflrl IJafl JIrCC[ 'uar. >:V Catla) OacaOnYS DW D.eadwa Camp Hill PA 17011 ~ Izasl. I7c. ^ Ve, DenprM Uvad b Twp. u n T~+eP? , I7p. Da,nly am I t 7p. ®No. Dacedra IiveO .itlrl P Acbel tmr d City I Bono 'fi f"a.`a"'m'(FI'a' n.°°a.'az' =wwtal John Lawrence Hummel 19 A~'a"+^r(F~n~ nil Mary Bertha Rinehart . ZOa. la«rrenfa Name (TYpa,Pmt) Harry H. Sieg 2m. wamanr`wlip Aptrealstie~•'~TIfI•~Olfi Street Camp Hill, PA 17011 21 a. rell,od d D~a«I ®Cranrdm ^ Dania, ^ Bund ^ Rara.almmsrt. ~ WazG,,,,,p,,,apa,rgoiAUtlarfie 21 b. Wle d D.Paiuon (raw,. pay, yefj December 29, 2011 214 Place d Dgpoailm (Name d oamrry tmri«y a tNw ) Cremation Society o~PA 210. Loptlpi (Ctly l lave, atYe, aD merl Harrisbur PA 17110 ^ Omar ~ SOe«h~ i M ArdlW Eaardrr I Caener7 ~ Ye ^ No g, ~ 22a. Square a Fawal a amgazrKn) ~e X125-L ~`'"~in°A0°'a1~fL~ael J. Shalonis Funeral Hclme 206 Maple Avenue Marysville PA 17053 _ - , Cariaele Nems 27a< owldYinq 27a. To tlN OeN d my Ivauia09a, ewm axare al ar Mr, mr and Plata rand, (Siquaua and aWl ~~ lipnsa Nunbw 27c. Date Sgr,sd Iraan, EaY Y+a) OMsK a^ r nd availaaa d deem b orrY CawedOem. ,~. R tiv ~7~v i ~.3 9 9 / ~ ,~~,>~ ~ s Irma 24-26 mull a mrplrsd M Parson 24. Trrr a Deem ,Y dn 26. Dr. Hmoau.a Da.e (~nM. der. rar) 26. Wsa Casa Nahnsc a r.Qa.l Eaam:rr 1 Carver ar a Raasm olnsr man crw,utim « ua,7 wno pranu,te Osrn. / M. `~ J -J ~j O / / x ^ Yss ^ Na CAUSE OF DEATH (Sty Inetr,sctlons and .:unpas) Appoamra ia«W: uem 2] Pan r 6aer Or pWO d ever,r - dsetaa. ajaies. a ampica0ar -Yir de~P weed ar da0t DO NDT Isar WmiW wags wU u ardac rmL Orrr b Dam I Pan M: Enrr aYw ~ ~ ~ W na sewRap n tM «grlyiq was g^'en r Pan L 28. DiC To6aoco Use Cagi6da a pean> ^ Vat ^ ProEeOYY ErYdon rrlala sNOwrg pr edobgy. Lis4aay ar we on earn rr. raapt(eFlorWy arrer. a varYnlar a r • ^ NO ^ UMUbrm loam) _~ m,64on A ~• - ~ C ~ ~ A ( I C `~ ,. I 1 , ~ 1 C a_ "~/ e / i 29 11 Famar: . . 1 ~I Y lA K ~ Due a (a as a carrepuaKe dp. ^ Nd pragnad vM,n Out Yev Sagbalaay m mrloaons, a amY. C ~ ^ Prgnra w rre a dnm . a Or cause WM an fne a. Due m la u a Erna UNDERLYrIG CAUSE a o9: ~ ^ N« prgua, W pragiura wAM 42 Oats lOiseue a ry«y aw.waled me c. _ aswxs rewirrg n aeml UST. , a aem Due bjaaza carequenca °~: ^ Nd pragwv, od 7reg'a'a 0.1 mya a ,Year p, alwe dean ^ Ilr,baae d prsgwa awn ax tyr year 7w P ~~A~noosy goo Au ~F.bnga ~ ~I a o..m Ra. D.r a ~ww 1r«rm, ur. ran azo. D..«iw Nom m)ay ooaaaa ,~ 32c. Plea d aM+Y: Flour, Farm, Saar, f a awe a Den+ Natural HomciOa ^ Dlace Bu161q. Nc. (SpeOry1 ^ res ~ vas ^ No ^ Atndenl ^ Panting InvafagaaM 720. iarr d aWeY 72a. WaY r Wak7 721. II Tnnapalapon aMury (SWCYYI 72q. Lacaom d injury (Bluer. aN /town. srlel ^ Suitlde ^ Caad Nd M DramrW ^ Yas ^ No ^ ~~lOJMelor ^ Paaargar ^PWYNiiarl r Obrr' SpeWr 77a Can~Mr Iara oay met 37C. Spwwe era TNr d Cerali.~ • Certayinq pryakian (Pnysawn can;lyirg comae d oum wMn arolner pnyskian naz pranolaaM dnn aro mn,daM Item 271 Y o ar Lest d my arawrdgs, derv a:uwnd dw a tNe cwsa(s) and mama u alred_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ P.avwn rr l P M ~ b _ ^ ~ ~Q `~ c q a rysbrn ( 9 p nYSaan Odn praaaranq dnm and cenilyuvq b cause d peps) Y ' rleKal Exam-nerY ! ~«awr • derv oawrad a11M tuns. dale, arM plxe. and dw b ltla uufe(a) and mamer as ahled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ a~~~/ _Lll "t. `k~ N«~ / p~',~~7~ ~7 L `J ~7d. DaN SgrO (rm . 6aY Year) ~1~~ t On tM wsis d eaamwtion and / a invesdq.eon, in my opinwn, dean occurred at Ur lnM, data, ana place. and dw b lNa uuaMal and manrrr as arrd_ ^ 1 , ~_ ~„r ~a6r'r. u d ParsoP W laa Cauae d Deem Ite Iy ~~~p ~a m 271 Type I P 35. R tome awy `J~ J / ~ ~(l ~ - ~ 76. Dar FieO balm, daY. Yer) _ ` ~ 2 ~ D 1 i- ` 1 ~ \/v t y( y~-t / Y~ l7 ~ I o I i i I ~ I l.t-a L /~ l:~i $ / ~ ") 1~ (, ~ G r( rtn y r.~- yli ~1 ~Sl uC ~ ~ ~1U.1 L~Pl Diaposilan Perna No. ( / 6 `~ (~ 9~ / _ _ _ ,,_ .. ~~ ,.~ /02 ~~~~ L 6~~ ~3 d ~~~`~~~ /J ~ - 3737 ~~-.~ -~~~~~,~,1, ~ -- ~ - ~'%~-1 ~~ J apO ~ ~ ~ ~~°~ ~/[~ ~ l ~ ~ {~-~~ 7r 7'~J ~~iG ~/~~ ~O`~ A ~~ .~ , ~~~ ;~.,~ N ~ -+~ ~-,-~ r*~t ~, :. CX7 c'`~'~ W ~c .` c~3 'V - ~ -°Ti {~ ~~; cJt `~ ~-