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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND 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: RENA V. GRISSINGER
a/k/a:
a/k/a:
a/k/a:
Date of Death: 03/15/2012
File No: _ ~~ ~ ~ ~ ~ s ~ (.t? C,
(Assigned by Register)
Social Security No:
Age at death: 92
Decedent was domiciled at death in CUMBERLAND County, pA (ware) with his/her last
principal residence at 40 Melron Court, Carlisle. PA 17015 Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 40 Melron Court Carlisle PA 17015 Cumberland
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 $ ~ ~ pnO, cfl~
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.. .. $ /~ Gam, p ~ 0.00
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 March 2, 201 1 and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death of executor, etc) `- Q ~;
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced' d~oDa p a perfdtl3~"; j
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and~~~ave~ild botn;'ur~?
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. = c~ ~ ~„t ~ ~ r-r,
Q NO EXCEPTIONS o EXCEPTIONS -~ `-'<~
_'" _ -r
B. Petition for Grant of Letters of Administration (If applicable) ~ ~- y -v <== c"J
c. t. a., d. b. n., d. b. n. c. t. a., pendente life, durance absentia, dugttgte mirtoP3t
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.
Q NO EXCEPTIONS Q 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
FormRW-01 rev. t0/I!/201! pag8 1 Of
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND
Petitioner(s) Printed Name Petitioner(s) Printed Address
MARY F. GRUBER 100 KENT CIRCLE LADSON SC 29456 (,~.~RK Qh
v~
7 r as ~ ~
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the f regoing Petition are a and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, a Petitione s wi elt~ d truly administer the estate according to law.
Sworn to or affirmed and subscribed~fr~ "' +ll--~c Date - J~
me this ay f Vl Date
By' ~ ~ ~ ~ Date
Fo the Register <' L>
Date
BOND Required: Q YES Q,f NO
FEES:
Letters ...................... $ ~I
( f~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ....... ,
Automation Fee ............... :(~ _
JCS Fee . .................... `_ ..
TOTAL ..................... $ 0
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: SUS J. HARTMAN
Supreme Court
ID Number: 65184
Firm Name
Address:
DUNCAN &HARTMAN, PC
Phone: 717-249-7780
Fax: 717-249-7800
Email: snsan~ldnncanha manlaw nom
DECREE OF THE REGISTER
Estate of RENA V. GRISSINGER File No: ~ -(~C.'/~ ~,'`/~
a/k/a:
^, ~',~ --
AND NOW, ~ -' ~ , ~ , in consideration of the foregoing Petition,
satisfactory woof havin een presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to MARY F. GRUBER
in the above estate and (if applicable) that
the instrument(s) dated MARCH 2, 2011
described in the Petition be admitted to probate and filed of record as the last V~ill (and Co~l'eil(s)) of Deced t.
'" ,
R tster of Wills j ; ~ _ )''
Form RW-02 rev. !0//!/20/ I Page 2 of 2
Official Use Only
~, - ~,,.~ f {~
l i~
LOCAL REGI TRAR'S CERTIFICATION OF' DEATH
,~
WARNING: It is it ~~i'~l~+p.~ ~~ copy by photostat or photograph.
_.._~~
Fee for this certificate, $6.00
-- P ~~211.C~5-----
Certification Numhel~
;•.
TVPe/Print In
Permanent
d
.~
O
V
O
~J
Rena V _ Grissinger
6a. Age-Last Birthday (Vrs) Sb. Under 1 Year
(j 2 Months Days
~~ "Phis is to certify tfs;u the information he re given is
~~~Z+f~R corrcrtly copied fr(v(j ~)n original Certifl~t('e of Death
duly filed «lith me <(> local Registrar. 'T~e original
C~ER~ ~crtificate ~~~ill he forwarded to the ~~tate Vial
~RPI-iA,~p~ Necords Otfice f~)r tl(-rnranent filing.
~ ~~~~ ,~
- ------- - ~a 2~_20~2
Loral Registrar - Date .issued.
COMMONWEALTH OF PENNSYLVANIA ~ pEPARTM ENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH
State File Number:
2. Sez 3. Social Security Number 4. Date of Death (MO Day/Yr (Sp 1 Mo)
- ^J__. ^- _ _ - emal 1 84-1 2-4532 March 1 ~, 2b'1
I .,~..r~ I rylmp2es 1 6/ 5, 1 9 1 9
_ ~ e tstate or Foreign Country) 8b. Residence (Street and Number -Include Apt Nc
Penns 1Vania 40 Mel-Ron CT_
ad. Resldenc (copn )
Cum~er~and ge. Resldenc¢ (zip cede)
9. Ever In Us Armed Forces? 10. Marital Status at Tlme of Death ~ Married
Q Yes ~ Na Q Unknown Q Divorced Q Never Marrfetl f1 I r.. r........
"•" "° n hitt
~j ves, decedent uYed Ina pw Mi
~ No, decedent Iiyed within limits o
unryl t„L1mD0r 1anC1
]ddlesex
twp.
f city/bor
wife, give name prior to first marNao~l
Mary LouiseLehman ~~~~~~~`"~
hip [o Decedent 14c. Informant's Mailin s~ddress Street and bar, Cit
hter '100 Kent ~a.rc~e La~son,
15 F .......T ~ .................Y.......1.............................. _
>eath Occurred So ewhere Other Than a Hospital: ~f+++rr ~~~~~ ~~"~~~~~"""""'
Q Nursing Home/Long-Term Care Facility Other 5 Hospice Facllfty
c. City or Town, State, and 21p Code ( Pecify)
Carlisle, PA 1 70'1 3 lsd.cp°.
Cum
~. Date of Disposition 16<. Place of Disposition (Name of cemetery, crematpr
3/20/20"12 Hollinger Crematory
6
rland
3 Ho ngerFH&~rema~ory 50'1 N. Baltimore Ave_ M~_ Holly Springs,PA17065
'ro' 16. Decedent's Education -Check the box that best describ¢s the 19. Decedent of Nispa nic Origin -Check the
~ highest de r o I I
12. Father's Name (First, Middle, Last, Suffix
Samuel C_ Kitzmi~ler
14a. Informant's Name 1
o Mary Gruber ~
¢_ If Death Occurred in a Hospital: ~" In "" ~~"~~~~~~"'"""""
Emer --Patient
~ Q genry Room/Outpatient Q Dead on Arrival
a~ lSb. FacilltY Name (If not institution, give street and number;
4 O Ma 1 -Ron CT _
- 16a. Method of Disposition ~ Burial Crematlor
-$ Q Removal from State ~ ppnatl rr
omer s
Z 16d. Location of Dlsposii on (City or Town, State, and Zip)
~ Mt_ Ho11y Springs
E 1]c. rJ~nl¢ and Complete Addre s of Funera Facility
F
S-
s
g r eve of school completed at the time of death.
8th grade pr less box chat best describes whether The decedent to Indicate what
the d
d
O
O
No di 1 grade
~
oma, 9th - 12th is Spanish/Hispanic/Latino. Check the "NO" ece
ent cons dared h m
self or hers
elf to be.
White
s
High hoot graduate or GED completed
box if decedent is not Spanish/Hispanic/Latino. ~ Korean
~ Black or African American
Q Some collage credit, but no degree ~ No, not Spanish/Hispanic/Latino ~ Vietnamese
~ American Indian or Alaska Nativ
Q Associate de
gree (e
g. AA; AS)
Q Yes, Mexican, Mexlran American, Chicano e Q Other Asian
~ Asian Indian
~
~ Bachelor's degree ( .g. BA, AB, BS)
O Yes, Puerto Rican 0 Native Hawaiian
0 Chinese
Q Master's degree (e.g. MA, MS, MEng, MEd, M6W
MBA) ~ Yes, Cuban
0 V ~ Guamanian or Chamorro
~ Filipino J> S
,
Doctorate (e.g. PhD, EdD) or Professional de
r es, other Spanish/His
Panic/Latino amoan
~ Japanese Q O
g
ee
. MD DDS DVM LLB l0
(Specify) ther Pacific Islander
~ Other (Specify)
L. Decedent's Single Race Self-DesignaUOn -Check ONLY ONE to Indicate what the decedent considered himself or herself to be.
White Q Ja
anes 22a
Decedent'
U
p
e
Black or African American 0 Korean
A
i
0 Samoan
Q Other Pacific Islander .
s
sual Occu
Patton -Indicate type of wor
done during most of working Ilfe. DO NOT USE RETIRED
mer
can Indian or Alaska Native ~Vietnam¢se
~ Asian Indian ~ O
h
Don't Know/NOt SUre. ~ .
Cooking & Baking
t
er Asian
Q Chinese ~ Refused
2
y
~ Native Hawaiian
Q FIIIPino
~ Other (SPeclfy) 2
x1~d f~g ip~ Indust
Ca L~r~ll~ ry
~ Gu nlan or Chamorro
EMS 23a - 23d MUST BE COMPLETED
f PERSON WHO PRONOVNCES OR 23a. Dat¢ Pronounced Dead Mo Day r) 23b. Signature of Person Pron
:RTiF1E5 DEATH
March 1 5
2 0 7 2 o uncing Death (Only when appllcableJ 23c. license Number
id. Date Signed (MO Day/Yr) ~ 24. Time of Death
1 0 = ~ O PM 25
W
.
as Medical Examiner or Coroner Contacted] Q Yes
N
26
Part 1
E CAUSE OF DEATH O
.
.
nter the chain of eV¢nts--diseases, Injuries, or compli
respirato
arre
t cations--that directly caused the death
DO NOT 'a'PProximate
ry
s
, or ventricular fibrillation without
s
howing .
en
the etiology. DO NOT
ABBREVIATE
Enter o
l ter terminal events such as cardiac arrest
~
)
IMMEDIATE CAUSE ______________> a
( ~ ( ~ .
n
y one
n
~
' caus¢orq~ a Iin¢. Add additional lines If necessary OnseT to D¢atF
"
.
(Final disease or condition ~
/~.~Y / /~
~ A~ C//-) _ i d'
^ ~ ~F,i ~
resulting In death) V
D t ( quence of) J
Sequentially list conditions,
if any, loading to the cause `+`t qTJ~
listed on line a. Enter the c ~A _
~
UNDERLYING CAVSE ~
(disease or Injury that Due to (or as a consequence of):
Initiated the events resulting d.
in death)LAST.
Due to (or as a consequence of):
26. Part 11. Enter other s~niflcant c ditl T ib tl t d h but not resulting In the und¢rl i
"•
n
Y g cause given In P art I 27. Was an autoosv n~rf......_w~
F F¢ to co plate the cause of death?
Not pregnant within past year 30. Did Tobacco Use Contribute to Death? ~ Yes ryp
31. Mai ~r of Death
Q Pregnant at time of death 0 ~~ O Probably ~Nattirel ~ Homicide
Q Not pregnant, but pregnant within 42 days of deatf (wry ~ Unknown Q Accident ~ P¢nding Investigation
Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Q Suicide Q Could not be determined
~ Unknown if pregnant within the past year Jury (MO/Day/Yr) (Spell Month)
~ Ves ~ Driver/Operator 0 Pedestrian vescrro¢ now Injury Occurred:
~ No ~ Passenger Q Other (6peci
(Gh k ly ) fV)
Ce Kifying physician - To the best of my knowledge, death o red due to the cause(s) and manner stated
Q Pronouncing 8< Certifying physician - To the best of my knowledge, death v red at the time, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/Coroner - the b f examination, st d/ investigations In my opinion, death ot~ccurred at the time, date, and place, and due to the cause(s) and manner stated
Slgnatu re of certifier:------'~ Title of c¢rtifler: ~ U
b. Name, Address and Zip Code of Person Completing Copse of Death (Item 261 Vicense Number: rAjl X358 •7 2~
Disposition Perm t2 No. ~~ • I ~ ~~ L~.-~ ~` H305-143
REV O]/2011
f~- ~ cam`
~~(~ ~~~,~ ~ ; ~=r=s~~ QF
LAST WILL ~ ` ~'-~-~~
TESTAMENT ~n t2 P9~R ~ ~ ~~ 2' ` C
I, RENA V. GRISSINGER, of40 Melron Court, Carlisle, Cumberl~~~i~~~,~', r ylvania,
being of sound and disposing mind, memory and understanding, do herek~f~(~ declare
this as and for my Last Will and Testament, hereby revoking any and all other wills'ari~~odicils
heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred beside my husband Ted in our burial plot
located at Westminister Cemetery.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath all of my estate of whatever nature, be it real,
personal or mixed, and wherever situate unto my daughter, MARY F. GRUBER, provided she
survives me by thirty (30) days. In the event she fails to survive me by thirty (30) days, I give,
devise and bequeath all of my estate unto SAFE HARBOUR of Carlisle, Pennsylvania..
FIFTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SIXTH I hereby nominate, constitute and appoint MARY F. GRUBER as Executrix of
this my Last Will and Testament. In the event of renunciation, death, resignation or inability to
act for any reason whatsoever of MARY F. GRUBER, I nominate, constitute and appoint
SUSAN J. HARTMAN as Executrix of this my Last Will and Testament. I hereby relieve my
Executrix from the necessity of posting security in connection with her duties, as such, in any
jurisdiction in which she may be called upon to act insofar as I am able by law to do so. In
addition to the powers conferred by law, I authorize my Executrix, in her absolute discretion, to
retain in the form received, and to sell either at public or private sale any real or personal
property owned by me at the time of my death.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of one typewritten page this ~ ~ da of
2011. y ~a~
,~' ~
NA V. GRISSINGER
Signed, sealed published and declared by the above named Testatrix RENA V. GRISSINGER as
and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
. SS.
I, RENA V. GRISSINGER, 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 that I signed it as my
free and voluntary act for the purposes therein expressed.
Sworn or affirmed to and
acknowledged before me, by
RENA V. GRISSINGER this ~n~ day
of ./j/~ ~ rc~ , 2011.
i~~~ ~
Notary P lic
COMMONWEALTH OF PENNSYLVANfA
U
RENA V. GRISSINGER
NOTARIAL SEAL
JOAN D. AD,~''~lS, Notary Public
Cariisia Sora., Cum~i~;iand County
My Commission ~x iras March 7, 2011
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
:SS.
We, ~1~~7~ Al 1/~,/-~A~/l/tA N and G , l~v/S~ 1J G~ ~
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 RENA V.
GRISSINGER sign and execute the instrument as her Last Will; that she signed willingly and
that she executed as her free and voluntary act for the purposes therein expressed; that each of us
in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our
knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and
under no constraint or undue influence.
~r
~~ o ~~
Sworn or affirmed to and
subscribed before me b
~ v~A ~t) ~I. Ll-~-i~"-u-~ N and
witnesses,
this ~Nd day of ~~ , 2011.
K/
Notary P lic
CEi~~rr1Ur#'vv'~,a.i_~`i°~. car' ~'~Pd°*!~YLWATJIA
NOTARIAL SEAL
JOAPJ U. AD:0.P~iS; Rotary ?ubiic
Carlisle Boro., Cum"~erlanci County
My Commission Expires Marv. ch 7,?011