HomeMy WebLinkAbout03-28-12i ~
PETITION FOR GRANT OF LETTERS ~~,, ~~
REGISTER OF WILLS OF ,~Aml~~~_~i~1til~, ~1~'~~A1VT'A
Petitioner(sj Warned below, who is; are 18 years of age or older, apply(ies) for IG~tt~e~{a<51 specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Lett~{~-{ap~t~ form:
Decedent's Information CUh~R ~R' ~a~`~!'.`.: i ,~ PA
Name: ° l~-ll~m~ Ili ~j ~'/7~(
a/k/a:
a/k/a:
a/k/a:
Date of Death: l h ~ 3 J ~ 11
Decedent was domiciled at death in
principal residence at 33 (~,
Decedent died at
Street addr//ess, Post Office and Zip Code
Street address, Post Office and Zip Code
File No: t:~ ~ ! ~ ~ --~ ~a'
(Assigned by Register)
Social Security No: ~
Age at death: ~/
LCtntal wick hic/har last
City, Township or Borough
City, Township ar Borough
Estimate of value of decedent's property at death:
If domiciled in Pennsy!vania ............................ All personal property
If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania
If not domiciled in Pennsy!vania ........................ Personal property in County
Value of real estate in Pennsy!vania ............................................. .
TOTAL ESTIMATED VALUE... .
County State
Real estate in Pennsylvania situated at: ~~ lr /G~/'/~(~~~" ~/~-yrj~p !7/~
(Attach additional sheets, ijnecessary.) Street address,~-Post~Offi~ce and Zip Code City, Township or Borough
^ 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
thereto dated
State relevant circumstances (eg. renunciation, death ojexecutor, etc.)
~•
Counly
and Codicil(s)
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 (tf applicable)
c•.t.u., d.b.tr., d.b.n.c.t.u., pendente life, durunte absentia, durance minoritute
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 parry 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 Will and was survived by thE; following spouse (ifany) and heirs (uttuc•h
additional sheets, iJ7tecessury):
Name Relationshi Address
~ / f l~~
~4 ~ ,~ !~ 13f rQr ~~ Ctc~ ~ ~~/~G
~ v ~ ,' S~ 3i~ ~~Z ~;aJ fi
/
;~
t
Form RW-02 rev. tnituznlt ~~L~ S ~ ~S Zj jG1i0~0.~ Ch
~~~~~~~ ~i~~U~
Page I of 2
J~j
Oath of Personal Representative
COMMONWEALTI~[ OF PENNSYLVANIA }
I } SS:
COLNTY OF Plt h(111V !I n ~ nV ,
Petitioner() Printed Name
The Petitioner(s) above-n~med 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, a~s Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to r ~ffirmed'an subscr'bed before c
me this ~ day of!~ (~ Date~-
~ Date
By:
Date
r he Register
Date
BOND Required: ~ YES ~NO
FEES:
Letters ............ ...... .... $ lJ`O
(~' ~) Short Certific$ te(s).. .... (~
( 3 )Renunciation( )..... .... _~_j
( ) Codicil(s)... ~ ..... ... .
( ) Affidavit(s)., l ..... ... .
Bond ..............',..... ....
Commission....... .
Other
Automation Fee ..... ..... . . .
....... ... v? 3. 'Z~-"
TOTAL ...........
....... ... $ Iti„~3. 5~7~
To the Register of Wii7s:
Please enter my appearance by my signature below:
I Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
--.-----
Estate of C~ \ File No• c~ 1 - i ~ ` 3 ~~
a/k/a:
~~
AND NOW,
satisfactory proo
,~ (JI ~ ~ ~~ ~ ~ in
been presented before me, IT I~ DECREED that Letter
are hereby granted to _ r u ,4 _ ~1~
the instrument(s) date ~'`
described in the Petitidn be
Form RW-02 rev. (D/!1/Z01!
F~~ ~! .,; ~~f~at u~~,q~y..
'~Fi2~AR2~ ~~~1Ii~ 4
of the foregoing Petition,
J _ _ t
in the above estate and (if applicable) that
to prorate and riled
i as the la t W'll (and Codicils
of ill
Pagl~ f 2
~f (;r~j:7, ~ ~~ - - .. `~ Ole
'; ~4
{ ~,•~ J
IV-~ -~ '
RENUNCIATION
REGISTER OF WILLS
Cumberland
°iI.~2 +~t~R 2$ ~{~~ ! t ~ 4 F
CLERJ~ Or
CtORPyA.,~~N L;0~1R PA,
COUNTY, PENNSYLVANIA
Estate of Tammy Geraci ,Deceased
I, Tami Sausser Mull
(Print Name)
half-sister
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Jerry Mattern, Jr.
~~
3 ~ ., ~,,
,~'' ~
// ~ ~ t~ ~ , ~
(Date `~.
(Signature)
4 25 Indian Court
(Street Address)
Executed in Register's Office
Swont to or affirmed and subscrined
before e this _ ~9 day
of Q 2. , .
Deputy for Register of Wills
Form RW-06 rev. ]0.13.06
Gainesville, GA 30506
(City, State, Ztp)
Executed out of Register's Office
Before the undersigned personaily appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes sta,te,,d~'~'>thin on this ~ day
_ J
~~ ~~
Notary Public
My Commission Expires: ~- ~ f -- ~ ~
(Signature and Seal of Notary or other
administer oaths. Show date of exoid'
-~' ~Y'T--- -~~ i
Q"j
y`°
~`
.
J
y
y ~~
~
~
l
J' ~ r
~.• ~ :'ri
~ : ~a ~,~C ~ ° iL
.G i
' •s,~~
•.,
• ...
N~,~
r nn ~j, ,
a~2fhr~R28 i~~~~~'~~
RENUNCIATION CLERK 0
REGISTER OF WILLS CII;MP"~I ~1^~1' ~~ pp
COUNTY, PENNSYLVANIA
Estate of ~~m`'j ~ ~ ~f~i -~ /
Deceased
I, J~~~ ~- }~~ ~ 7F ~'?~; S!~ _, in my capacity/relationship as
G _ (Pant Name)
(~` /~~~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
J~~12~ ,~- ~~ ~ 7~j2iv
(Da
(Si atwe)
~~~ ~~
~~
(Street Addre.u)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of 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
purpo ess ted within on this _ ,~~ day
of IZ
Notary Public /
Myn~+lp~t~~b~r~}~i~~[va ire ~ t
MSignat ~nd T~~l@~t3~}~r other ofricial ualified to
dmin' t'df ~h~~~~a{1~~3+d~xpq~t~'on of tary's Commission.)
amp Hill Coro, Cumberland County
My Commission Expires Seote~mber 19, 2013
Form RW-06 rev. 10.13.06
. ~.~~~
RENUNCIATION
REGISTER OF WILLS
~'~~~7~iAR 2$ ~~i l1= 4
CLERK nF
ORPMAi~1'~ CJ~ lg r
COUNTY, PENNSYLVANIA
Estate of ~mm l~ {~r CJf/~- i Deceased
I, ~~'~'~~~ ~~~}~~~w _, in my capacity/relationship as
~n~ / (Print Name)
'" `O ~L t r°R of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
(Signature) ('
(Street Address)
`~ ~- t ~
(City, State, Zip
Executed in Register's Office
Sworn to or affirmed and subscribed
before a this _ ~ day
of , ~(~,
Deputy for Register of 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 within on this day
OMMONWEALTH
A
of „ ~P ~- ~.~ -.
5 ILLE o Public
.(~ ~ ip it B r C e d ounty
Notary Publi ...~ .w,.w er , 203
My Commission Expires: ~~~-
l4-l~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date ofexpiration of Notary's Commission.)
Form RW-06 rev. !0.13.06
LOCAL. REGISTRAR'S CERTIFICATION OF DEATH
r~ - ~ •1r
WARNRCFa~li~li~Feg~~p(y~tlplicate this copy by photostat or photograph.
,,;~, -;, , ,~r, r
Fee for this certificate, $6.00
Hif
S
P
Certification Number
t'~!Z t~AR 28 A~ I i ~ 48
CLERK OF
ORPHAN'S COIJRr
Cl1MB~"~?i ANA (;~).. PA
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
certificate will be forwarded to the State Vital
Records Office for permanent filing.
Local Registrar Date Issued
s.ue l2EV „rz2od ~~~ • x~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
Dude ~ (See ItIBLtUCII0i18 and examples Ott revtirse) STATE FILE eAlA1BER
#33-134
1. Nanw d DeOedwa (Pict. nianB, laei sold) 2 Sea 3. SOad
4. Deb d Dxri IMcOMt. EsY. Ywl
17T- ~ 838.E
Tamm M Geraci Female October 31 2011
5. Ape (taq SirnMYl tAdar t lhda 1 8. Dda d 9M ) 7. and dde a ik nea d Dees one
"°a" ° js "°"' '""`° YVllllamsport, PA "0Aa'" °""`
45 Yn. November 17 1965 ^ ^eN~aaPrima ^~A ^N~nF~• R.ban. ^~-
a,. cae~h d Dorn &. City, Twp. Daat, M. FadNy Nanw (N nd irrutlon, ghw eaed and nmhar) n. Yyee Deoedan d HYprib OdpnT ~
No ^ Yee f0. Hea: Ambkwl Sbn, ebck YYlste, eb.
.
(n yes, epadM CWn, (3P•dY)
Cumberland East P nnsboro 33 Heidi Terrace "'b"~a"•P'""Df°°'"d~) White
1,. Dendefe Ihal ~ ,DMd ask Q oro mod d 11e Do M able 12. Was Deaden ever w tlw 13. Deadae'e Eaia:etlon (Spedly atly hIpIW Srede aarip bba) 1t. MrW Seem: ibnb4 Neva AWded, ,5. SurvNeg 3po ue (M wte, nba mddms rsm)
H6MIIIrhaker ~d d~ u.s Amwd Fa~ayeT E~,,,m„a,y ~ seamary (ate) caen• U~~ s') '
^Yee LINO Divorced
%.°~"Fi~I118i1PT'""""•,bFa.ma°')
G~ DeaOerre PA udDeceeea Eaat PennsbOro
Actual Ruidma t7a Sub flue b a 17c. ~a, DeaMre tMa b Tap.
Camp Hill, PA 17011 v+edwa,w
Cumberland T°""'"'PT nd
^
~d
.
,n ~,
~ lsoro
te. FaMe Name (Fad, midae, rd, auSW Jerry Mattem Sr. tt. Alatax's lwrrw (FYaL mmb, mdMn aumw) Sandra Schooley
20a. bbnnrWe Naa (Typell'rM) Jerry Mattern p'~`~~e~A~e"~'`~
0
p
o
12
4 Ca
it
l St Harrisburg, PA 17102
21a. McBwd d DeDodea CmnYlen ^ Damwn 2iD. Dde a Dbpaba t MY. Y••0 21e. Pba a D4poeltlan (None d amdmy aemdaP a dlwrpea) 21a Laatlon (CYy I ewm, Yb, ap cads)
~ ,ransre °
°~
"'""~id November 8, 2011 Hoffman Crematory Carlisle
PA 17013
^ t aeaE~
e~
caa~rz
^r..^ra ,
Furwrtl Senors liorwee la Pbea ec"uae auai) 22b. tlanw Number 22c. Name andAMr«ed r-rary
- FD-13845-L Sullivan Funeral Home 51 N. Enola Dr. Enola, PA 17025
Compete Serm23ac odywtan aMlYg 23a. To be Dad d nq luwab02e, deem oaured d tw ems, deb and Pba emud. (Slpbaae end INeI 230. tbeae Naha 230. Deb Spwd Iww,a,, My, year)
pyaeden's rot mtaela dune d amts b
adlll emseddeaN.
temc 2428 must a oonplWd M Dwaon 24. Tma d Dana 25. Dab Pmwnced Dead (ederN, MKY«rl 28. YYae Cave MbmW b Medcd Fsadrbr! Coroner br a Hagen Dtlser Men CranaMn a DoatlonT
'"°P'"°"iss°eBtli A rx. 7:15 A. "'~ October 1 w` ^"°
CAUSE OF DEATH (See Inetr3selwm aaW antepFas) , ApprauraW Yaervd: Ph S: Fnir aSr 28. Did Tdroro Use CaepM b DaeOiT
Ibm 27. Pen 1: Enerbe ~a8,d,@aa1-deamms, i~aba, a mryncelinb-tlW array dosed IM deals. llO NOT ~~ur,wnerul evade eucn n aNec xreet. s Oad b OeaM Dd M reeuNnp b IM uMarybg oauee pNal b PM 1. ^ Yee ^ Rdrgp
napireby ate, a redrbYr NaWYSn wabd dbebg tie eedopr. tkt day aro aae a eatl, bor. s
' ^ ~ ^ ~~
YII®UTE CAUSE IFnd 6aeae a
cpldfa, rsaAtlrgb _~ a. Acute Peritonitis ~
Adverse Effects of 23. n FertW:
^
am b (a.e a areap»na an: a
~edw,dian,nanr. n.Gastric Bypass Surgery ;
b
d
d
i Morphine Net getnbe wa,o i•d yw
^ Pregrnd,eaaMen
taw
a
a
ns e. Due b (a as a mreequenee d): ~
Enm 111
0
91LYSxi CAUSE ^ Na preprud, W pspmd wihw 12 days
~
~u
~as"reeubrg~e d~wi"j A~" a.Morbid Obesity. . dMdn
Dud b (a se a ooneegarcw dl: ~ ^ Na PaSrud• ed Pr•PW, ~ MY• b, Y•m
n. ~ hewn d..n
^ lMWbmlilxgwewphb lM Ped year
9De. Yoe enAdopey
P
d
R! 30e. YAweAubpsy Finags
Avanehb Prbrb C
ldi 31. Aiermer d Dedh 31a. Dtle d iMy (elorYls, dry, year) 32e. Deeruwe How eQtey Oedarsd 32c. Pba al wMay: Forme. Femt.30ea4 FadaY~
Olla ddNn
M
(S
d
)
a
ame ang
a ~ Ndad ^ ~~ 7.
c.
ee
y
a case a DmmT
kiya ^ No
J!~ t~ yp ^ ,~
l'~ ^ Aoptlent ^ perianp ueeatpeYOn 320. rme d lorry 32e. lNuy al WOrAT 321. nrirmpoiWion wlay (~edyl 325. itteNa a wFuy Istnel, dy i Mm, Nu)
^ Sddda ^ Dauu Nd ba Ddemwse0 ^ Yee ^ No ^ DMw, CpweW ^ P~~ ^Petleehun
µ odor - Spsciy
srcwniw(awdcayaw) 32asgn.ae
• cnnw°w"da.rat"~m.nawr"°`aa.daeanenenanodwrPnrru.nn.apaw~.~ed°airand°a°ldedn.mr.~ _
To tlM held m/lowwwdpe, Mad acatalad dlu btlb aauete)endmwwaetabd._______________________________ ^ ~~~~
- Chief De ut Coroner
• aM artllyeq glyaww (Plryewbri sob paa~q M.a and areyip a dies a aedn>
Th b
e
d
w
l
d
O
a
d
tl
W
M
M
b
d
^ 33e txaree Nunbx 33a Dar SiROd liwdn My. y.d
m
al
rp
bw
e
pe,
ee
oOnen
al
r
a,
b,a
p
a, an
dabtlm wwe(sl eml mamardxea__________________
• aeaadEaa~ae,.lcaa. kkyy
On tlw Orltd umdnatlat ardla hveetlpatlm,bmy apbbn, Mau aaurad attM terr,Mb,mtl pba
and daum.ume(e)aM ardor ae aubd.. W Januar 25 2012
,
'` s'~~`~NeS":i11D.~°~'o`n°~°r'r
a~i~e~~eputy Coroner
35. Hepigrlra gprus sod ~ Numaar day
yeert
Dale Red (Mar
38 ,
6375 Basehore Road
Suite ~~1
- ~ I~ L~- I~- l y I ,
,
.
p ~/Z„ ,
Mechanicsbuz•g, pa. 17050
r
Dbpanbn Peme, No.