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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: Sarah Louise Ord
a/k/a:
a/k/a:
a/k/a:
Date of Death: March 28, 2012
File No: ;;t (- (.; _ G~~~~~ ~~
(Assigned by Register)
Social Security No:
Age at death: 98
Decedent was domiciled at death in Richmond County, Virginia (State) with his/her last
principal residence at 20 Delfae Drive. Apartment 39 Warsaw VA 22572 Richmond
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 20 Delfae Drive. Apartment 39 Warsaw VA 22572 Richmond Virginia
Street address, Post Office and Zip Code City, Township or Borough County Stste
Estimate of value of decedent's property at death:
Ijdomiciled in Pennsylvania ............................ All personal property $
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ n nn
If not domiciled in Pennsylvania ........................ Personal property in County $ 0 00
Value of real estate in Pennsylvania ...................... ................................... $ 00 fi fi fi
32 fi
TOTAL ESTIMATED VALUE.... $ ~
320.000.00
Real estate in Pennsylvania situated at: 45 Alters Road, Carlisle, PA 17015-8969 West Pennsboro Cumberland
(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
thereto dated
10/5/1989
and Codicil(s)
I31e are the ¢ncceccnr execntnrc named in the will Priman~ exPCntnr nrPd cPaS d
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 lite, durante 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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS 0 EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) attd heirs (att~~h
additional sheets, if necessary): ~ ~ ._, _,
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Name Relationshi Address ~' --<
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Form RW-02 rev. l0/11/2011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
Official Use Only
~~ -, - ,..
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Petitioner(s) Printed Name -,~ ..t t
Petitioner(s) Printed Address
Jean S. Do tis - - ~ , ....
802 Coan Haven Road Lottsbur VA 22511-2653 , -
Lei h E. Do tis 11- i ~ ,={,. `. L 1, ~/ v' ~ i
802 Coan Haven Road, Lottsbur , VA 22511-26 ~f = ,f ~'~ ~ -
The Petitioner(s) above-named swear(s) or affirm(s) the statements ' Pet r correc to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the cede t, the etitio er( wil ell a tru a ier the estate accor in to a
Sworn to or affirmed a uescribed before Date
me thi,&--~ ~ d o~ , a Date y Z. ~-
_ Date
the Register Date
BOND Required: Q YES ~NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters ..................... .
( .,.! )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
$ ~ ~J
or',
Other ,..,,,,,
~.XF: il,i~I~ h~ct;,c.~~...... Cr
........
Automation Fee . .............. `.> ~'~
JCS Fee . .................... _ ...~ .~~'
TOTAL ..................... $ 7C7 ~ `~~ 0.00
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of Sarah Louise Ord File No: sL~ _ ~ ~ -(` ~ (; ~.
a/k/a:
AND NOW, .: i_;1~,r ~-. ~ r n , . ; -~
. _,~ ~~~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Ti~~-1C2t1 y t,-}~,; t~ f_}mil ~ ((~~
~ C are hereby granted tot 1 ~ .5 i ~-T 3, S ~1 F' lC1
~, ~ in the above estate and (if applicable) that
the insti't~ment(s) dated iii - `j - ~ G~ ~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
register of Wills ~ C
Forne RW-02 rev. 10/11/2011 Page 2 of 2
COMMONWEALTH OF VIRGINIA -CERTIFICATE OF DEATH
COPY A DEPARTMENT OF HEALTH -DIVISION OF VITAL RECORDS -RICHMOND
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FOR DIVISION OF REGISTRATION
AREA NUMBE
f./ CERTIFICATE
NUMBER STATE FILE
VITAL RECORDS R
~
~ L/ ~ ~ NUMBER
DECEDENT 1. FULL NAME (lirst) (midtlle) (last) 2. SEX male female
OF DECEDENT
Sarah Louise Ord
^
3 DEAT OF (mo.) (day) (year) 4. AGE IF UNDER 1 YEAR IF UNDER 1 DAY 5. DATE OF (mc.) (day) (year) 6. WAS DE
CEDENV~
I
March 28 2012 98 _ ~ ~ - r - - - BIRTH EVER IN U.S. Yes o
months I days ~ hours
minutes A
y'Sd
il 18 1913 ARMED FORCES7
years I
^
pr
~L?
PLACE OF 7. NAME OF HOSPITAL OR INSTITUTION OF DEATH (i( none, so slate) I Out Pat. 6. COUNTY OF DEATH (if independent city
leave blank)
DEATH
Magnolia Manor Riverside I DOA Emer Rm In t
I
` ,
Richmond
~ ^
I
9. CiTV OR TOWN OF DEATH Inside city or town limits? t0. STREET ADDRESS OR RT. NO. OF PLACE OF DEATH
Warsaw ~ 0 20 Delfae Dr
USUAL 11. STATE (OR FOREIGN COUNTRY) OF DECEDENT'S RESIDENCE 12. COUNTY OF DECEDENT'S RESIDENCE (if Intlependenl city
leave blank)
RESIDENCE
OF DECEDENT
Virginia ,
Richmond
13. CITY OR TOWN OF RESIDENCE inside city or town limits? 14. STREET ADDRESS OR RT. NO. OF RESIDENCE I ZIP CODE
Warsaw es no
^
20 Delfae Dr 22572
PERSONAL 75. NAME OF DECEDENT'S FATHER 16. MAIDEN NAME OF DECEDENT'S MOTHER
DATA OF
DECEDENT Charles Jackson Isler Harriet Small Greenhalgh
17. RACE OF DECEDENT 16. OF HISPANIC ORIGIN? II yes, specify Cuban, Mexican, 19. EDUCATION (Specify only highest grade completed)
White Puerto Rican, etc. ~,}q
L71y no ^
yes
4
Elementary/Secontlary (0-12) College (1-0 or 5 +)
20. CITIZEN OF WHAT COUNTRY 21. BIRTHPLACE (state or country) 22. NEVER MARRIED ^ DIVORCED ^ 23. IF MARRIED OR WIDOWED, NAME OF SPOUSE
USA Pennsylvania (if divorced leave blank)
~
MARRIED ^ WIDOWEIYYLII John A Ord
24. SOCIAL SECURITY NUMBER 25. USUAL OR LAST OCCUPATION 26. KIND OF BUSINESS OR INDUSTRY 27. INFORMANT - OR SOURCE OF INFORMATION -RELATIONSHIP
501-12-3489 Homemaker Own Home J
a
D
ti
=
e
n
o
s
Dau er
CAUSE OF DEATH 26. PART I. Enter the tliseases, injuries, or complications that caused the death. D o not enter the mode of dying, such as cardiac or respiratory anest. sh d failure 1 BETIVEEN
List only one rouse on each line. .
~~-yy~~ ~' ~ r ON w1ND DEATH
. ll~ 't_. ~ _
/ _ -
TO IMMEDIATE CAUSE (Final disease or q
i
-• O 1 ..,~
rT"7 a.
PHYSICIAN: cond
tion restating in death)
DUE TO (OR AS A CONSEQUENCE O :
~ y~
' R)
? ~.-7
~
Complete and Sequentially list conditions, if any, leading (g) {/ -
sign medical to immediate cause. Enter UNDERLYING DUE TO (OR AS A CONSEQUENCE OF): -
--
)
CAU
E
certification
(item 26
d S
(Disease or injury that initiated
events r
lti
i
tl
h
-~
,
-
~~ ~ 7
) an
return both
' esu
ng
n
eat
) LAST
C
_ _J...
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- .:-
cop
es to funeral
director as soon =
O pART II. Other significant conditions contributing to death Dul not resulting In
-- the untlerlying cause given in Part I.
_ 28a.~q OPSY? ~ y s no
as possible after
determination of
U D A
THORIZF~~ ^
cause. ~
LL
~' pgb. IF FEMALE, WAS THERE A PREGNANCY
IN PAST 3 MONTHS? 28c. IF EXTERNAL CAUSE, IT WAS 26d. DESCRIBE HOW INJURY RELATING TO DEATH OCCURRED
W RPIMARY ^ ar CONTRIBUTING
NOTE: if
Pending" must U
~
Yes no ^ unknown ^ TO CAUSE OF DEATH
be indicated, so V 28e. TIME OF INJURY (mo.) (tlay) (year) 28f. INJURY OCCURRED 2Bg. PLACE OF INJURY (home, farm, I pgh. (city or town) (county) (state)
state in part 1 p factory, street, office bldg., etc.) I
and noti
ry W
~ A.M.
P while
^
not while
I
registrar of final .M. at work al work ^ I
decision as soon
as passible. 28i. +t 3 , 1
~Y
To the best of my k owledge, death occurred at \ ~ ~ ~
I ~ 1 +
__________ _______ _________ __
_ _
(a.m.) (p.m.) on the date antl place antl from the cause(s) stated.
_ __ _ _ __ _
_ _ _ _ _ _ ________
ACTUAL r _
SIGNATURE -
~ ____________________ _
I DATE SIGNED: - -
I -
~-
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_ _ - - _ _ _ _N
~ - - - - - - - - - - - - - - - - - - -
N`~°F ATTENDIN PHY ICIAN (Type or nt
fIIC,~'t+'i'l'!-~ «- I ~t`N1..~ -
-
- - - - - - - - - - i _ - - . _ - .. _ .... 1 . ~ _ _ _ _ _ _ _ _
ADDRESS O TTENDIN PHYSICu~ - -
f~~~ ~?~~'.~-~: 6J~. ~.'~'~~t'L~ ~L/,~2Z~~rL
FUNERAL
DIRECTOR 29. BURIAL REMOVAL CREMATION 30. PLACE
OF BURI (name of cemetery or crematory) (city or county) (state)
AL,
^ ^ ~ REMOVAL, ETC. Westmoreland SerVlceS Inc Richmond VA
31. (Signature of funeral director or person legally tiling this certificate)
~~,; ~~~/ ,~J
1
~G NAME OF FUNERAL AVe~. Cremation SerVlceS
t` HOME AND ~.1 L.. A
.
FUNERAL SERVICE LICENSEE /NEXT OF KIN
^ 's'
A°°REB5:4100 Jonetown Rd Harrisbur PA 1710
REGISTRAR 32. (si ture of registrar)
DATE RECOfjD'
~' /
FILED: L
,' `
`
RESERVED R -
T
! _
II REGISTRAR'S USE U
This is t~ certify that this is a true and correct reproduction of the original record filed with the
Richrnona County He/alth Department, P. O. Box boo, Warsaw, Virginia 225 2.
mate Issued' Zy~ / /~~aa/~
REGISTRAR OR DE
!SEAL.)
ANY R]3PRODUCTION OF THIS DOCUMENT IS PROHIBITED BY STATUTE. DO NOT ACCEPT UNLESS IT BEARS
THE IMPRESSED SEAL OF THE RICHMOND COUNTY DEPARTMENT OF HEALTH CLEARLY AFFIXED.
Section 32.i-272, Code of Virginia, as Amended