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Home My WebLink About08-28-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~iy,~,~~Pr~/~-~/ ~ COUNTY, PENNSYLVANIA Petitioner(s) named below, wh~/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: _1~~•~ /~ ~ c y~/2/~G= a/lc/a: a/k/a: Date of Ueath: mss- ~.p/ Z Decedent was domiciled at death in ~Ge fir, ~,~rl ~,/ County, principal residence at 3 2 2 it/'. f3~1~~~-.o_~ _~r Street address, Past Office and Zip Code File No: ~4~ ~ - ~ ,~., - .~~' (.~~ (Assigned by Register) Social Security No: _ ~~G% '`~~,~'~' 1 ~~~ ~J _ Age at death: ~ ~ (State) with his/her last ;Township or ~--LC C~i7 tyv~21'Y~'N C Decedent died at cS/~/~7Z~' ~¢~ o-/~" 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 $~jx~~J G•~~.:' If not domiciled in Penttsy!vania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsyh~ania ........................Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.. . Real estate in Pennsylvania situated at: :~ ~ _ S' ~ G' ~ ~ `~ (Attach additional sheets, if necessary.) Street address, Post Office and Zip ode ity, Township or Borough County / ,~ a ition for Pro ate and Grant of Letters Testamentar Petitioner(s) aver(s) h she ere the Executor(s) named in the last Will of the Decedent, dated "!f -~~ and Codicil(s) thereto dated N/,¢ State relevant circumstances (e.g. renu~icintion, 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 parry 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. u., d. b. n., d.b.n.c.t.u., pendente lite, durance ~entiu, durunte~inoritate ~-~ If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete ~ heirs. ~"" ~~_ t~ . _. "'T'2 t - ~ G') r ~;~ - Z 1 Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce hadtt~e`~yestablishe~sa defined m 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~ ~- ~ ~-_- ; :-=-- C' NO EXCEPTIONS ~ EXCEPTIONS ~ ~ ~-• ~ ~-~ ~; - ~-i Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following sp~e~tf any) and eirs (uttah~ ~~", udditional sheets, if necessary): _._, ~Y.: tt . ~ .. `~ a ~ -~, Name Relationshi Address Fo„» Rw-nz ~•ev. Inilli1n11 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } COUNTY OF ~ '77 (Y } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address /~E~-'~ ,~ ~ ~r~ ,~ v~ ~ L~~'CG/y /~/ 1/E ~ tea- ~`s ~ G ~ ~ 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 D.~cedent, the Petitioner(s) will well and truly administer the estate according to law. ,- , ~' p Sworn to or, ~~f rmed an subscribed before ~ ~ Dates =Z~ "' 2'~sZ met ~ ' ~ y of -~ , ~-~' ~ --~-- - [., 1~ ryr ~ Date t ;~ By: (.f ~ '~ ~ l(L J f > L.i' i Date _ ,.~ For the Register Date BOND Required: NO To the Register of Wi11s: FEES: Please enter my appearance by my signature belo Letters ...................... $ +~1,' •~~~~ Attorney Signature: ( } )Short Certificate(s)...... ( )Renunciation(s)......... ~ ; ~'' ~ ~- ~ " ~ ~ -' %~ ?'~ L ~ ( )Codicil(s) ............. -~C G G t ( )Affidavit(s)............ y ' ~~ ~ '' ~ Bond ........................ ~/ / Printed Name: • ~/.,: ~ !J Commission .................. Other ....... . Supreme Court ID Number: 4 ~ ~;,`y ~ ~:; ~ -•~ -~? ~ --'~. j ' ~ ~./ yam. ~ ~ ~ { ~ ....... • Firm Narne: ~~ / - ; ~ 1 - = ....... Address: ; , ., -,~ ' . . *"'° :, -,_ r r ....... Phone: G *'7 ~ " ~.~ Automation Fee ............... JCS Fee . .................... C ~, -~~ : C Fax: Emaii: ~/ r. TOTAL ..................... $ (..~~ DECREE OF THE REGISTER G=L/~ Estate of __ ~/.~ ~ ~ -- ~ ~ /J7 ~,Q/ ~~' File No: ~~ ) ~ - ~ `7 -- (,`~ ~ `~C ~.;' .- ..~- l (~ AND NOW, ri~~~(1 \ t~ ~~~,~~~ ~ `~`~ ~'~" , in consideration of the foregoing Petition, satisfactory proof having been presented be~o tne, IT IS DECREED that Letters 7`L~'zS'1`/~ ~ ENV t'~-~4/ are hereby granted to ~J'sG~Lif - ~~ M C ~ ~/,,~C in the above estate and (if applicable) that the instrument(s) dated - ..~-'~~ described in the Petition be admitted to probate and tied of record as the last Will (and Codicil(s)) of Decedent. n r ~~ Register of Wills L~ . ~ ~ ~ ~~ ~^~ ~~ ~ • For»r RW-0? rcv. loilti1n11 ` Page ~ of 2 ~~ ~~~ ~:. > t :. J :.i., _ t.. . -_ QF?~r~Pt, , ' ` ' .. ~, _ -- , ~~~''1~1C,t~itlt'1 "li.li?y"'.a Type/Pant In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent CERTIFICATE OF DEATH .._._..,_..._~__ 0 ~_ I 0 0 O 1. Decedent's legal Name (first, Middle, last, Suffix) Z. Sex 3. Social Security Number <. Date of Death (MO/Day/Yr) (Spell Mo) isela R.I. McBride Femal August 17, 2012 Sa. Age-Last Birthday (Yrs) Sb. Under 1 year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) 86 Months Days Hours Minutes D cember 21 1925 e Berlin German , 7b. Birthplace lCounty) ~ennsylV`ania reign Country) g ( 8b. R~jd¢pcvLS.reRte d pluO bef IaKJ°de Apl NO.) &. Did Decedent live In a Township? Z LL LL 11VV DD aZ a .J~rt. ^Yes, decedent lived In twp. ed. Residence (County) Cumberland Be. ResidencelZipCOde) ONO, decedentllvedwithinlimltsof Carlisle city/born. 9. Ever in US Armed Forces? 30. Marital Status al Time of Death ^ Married ® Widowed 11. Surviving Spouses Name (1(wlfe, give name prior to first marriage) ^ Yes (3 No ^ Unknown ^ Divorced ^ Nevel Mirrled ~ ^ Unknown 31. Father's Name (First, Middle, last, Suf(ixl Unknown 13. Mother's Name Prior to First Marriage (First. Middl¢, Ust) hertha Untermann lea. Informant's Name 14b. Relationship to Decedent lac. Informant's Malling Address (Street and Number, Clry, Stale, Zlp Codel g 1 V M Br'd D h r 0 Bea n r Ha ri bur PA 17112 ~ ~ lSa. P ace o Deat ec on one ........................................................ ..........................................,....................................................Y..................................... .................................... ................................... ~ a Decedent's Home II Death Occurred in a Hospital: . I~ Inpatient ;If Death Occurred Somewhere Other Than a Hospital: [(Hosplu Facility ~ ~ ^ Emergency Room/Outpatient ^ D¢ad on Arrival ^ Nursing Home/Long-Term Care Facility Other (Specify) . z lSc. City or Town, State, and 21p Code lSd. County of Death 116. Facility Name Ilf not institution, give street and number; ~ 16a. Method of Disposition ^ Burial ® Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) ^Removal from State ^Ddnatipn 8/20/2012 Bitner Crematory, LLC .k Other lSpe<ify) Z 16d. Location of Disposition (City or Town, State, and Zipj 17a. Si tore of Funeral Serv~ a Licensee or Person in Charge of Interment 17b. License Number $ 4 arrisburg„PA ~ li FD-013592-L e 17c. Name antl Complete Address of Funeral Facility Hetrick Cremation Services 3125 Walnut St. Harrisbur PA 17109 ~ 18. Decedent's Education -Check the box chat best describes the 19. Decedent of Hispanic Origin ~ Check the Z0. Decedent's Race ~ Check ONE OR MORE races to indicate what ~ highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. ^ 8th grade or less is Spanish/HispaniUUtina. Check the "NO" (~ White ^ Korean ^ No diploma, 9th - 12th grade box it decedent is not Spanish/Hispanic/Latino. ^ Black or African American ^ Vietnamese ^ High school graduate or GED completetl [~ No, no[ Spanish/Hizpanic/Latind ^ American Indian or Alaska Native ^ Other Asian ^ Som college credit, but no degree ^Yes, Mexican, Mexican American, Chicano ^ Asian Indian ^ Native Hawaiian p Associate degree le.g. AA, A51 ^Yei, Puerto Rican ^ Chinese ^ Guamanian or Chamorro ^ Bachelor's degree (e.g. BA, AB, BS) ^Yes, Cuban ^ Filipino ^ Samoan ^ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ^ Yas, other Spanish/Hispanic/Latino ^ Japanese ^ Other Pacific Islander ^ Doctorate (e.g. PhD, EdD) or Professional degree e.. MD, DDS, DVM, LLB, 10 (Specify) ^ Other (Specify] 21. Decedent's Single Race Sell-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 1^ White ^ Japanese ^ Samoan 22a. Decedent's Usual Occupation -Indicate type of work done during most ofworking life. DO NOT USE RETIRED. ^Black or African American ^Korean ^Other Pacific Islander Writer-Artist ^ American Indian or Alaska Native ^ Vietnamese ^ Don't Know/Not Sure ^ Asian radian ^ Other Asian ^ Refused 22b. Kind of Business/Industry ^ Chinese ^ NativeHawaiian ^ OtherlSpe<ify) Self-Employed ^ Filipino ^ Guamanian or Chamorro ITEMS 23a ~ 23d MUST BE COMDIETED 2 3a. Date Pronounced Dead (MO Day/Yr) 23b. Si Lure o/ Pers r auncing Death (Only when applicable) Z3c. license Number BY PFRSON WHO PRONOUNCES SIR CE0.TIFIES DEATH rip ~ Z Vo I~\S~`/ ZI /.Il. ' isd. oat signed IMO/oav/s'•1 z Q ( Z,(j Z a. nmt~Moar ~f n --- - - - In ~ Zq -__ ZS. as Mt al Examiner or Coroner Cantacud7 ^ Yes Y rte" •'~' HY Q No CAUSE OF DEATH avvroximate Interval l h di . events suc as Car ac arrest 26. Part I. Enter the main of events-~diseazes, Injuries, or complicationt--that directly caused the death. DO NOT enter termina ' respiratory arrest, or venfncular librilla[lon rw1yitnhout showing [he etiologyTyO~~IjO NO7 AAB~BRE~7V~IATE. E/nter only/!on~e~causpe on a line. Add a ditilonal Irm-es it necessary Onset to Death L ~ ~~ ~I ` ~ ~~~ ~t ~ ~ ~~ - ~ ( 1. y S I ' \( 1 1 I /L Wl IMMEDIATE CAUSE _ .............> a. " I `i Ill IFinal disease or condition '!! Due [o (or as a consequence o(): resulting in death) b. Sequentially list <ondi[ionL Oue to (or as a consequence of): leadin to the cause if an y, g listed on line ~. Enter the -_ VNOERLYING MUSE Oue [o (or az a consequence off: (disease or injury that initialed the events resulting d. in dea[hl LAST. Due to (or as a consequence o(): ,g 26. Part II. Enter other sie~nificanl conditions contributlne to death but not resulting in the underlying cause given in Part I 27. Was an autopsy Deri ed7 o ^Yes No ~ Ze. Were autopsy findings available to complete the cause of death? ^ Yes ^ No Y o 29. II Female: ^ Not pregnant within past year 30. Did Tobacco Use Contribute to Death? ^Yes ^ Probably 31. Manner o/Death ®Natural ^ Homicide ~ ^ Pregnant at ume of death ^ Not pregnant, but pregnant within a2 days of death ^ No ^ Unknown ^ Accident ^ Pending Investigation ^ Suicide ^ Could not be deurmined ~ Not pregnant, but pregnant a3 days to 1 year before death 31. Date of Injury (Mo/Day/Yr) lSpell Month) ^ Unknown it pregnan; within the past Year 33. Time of Injury 34. Place of Inlury le.g. home; con. traction site; farm; school) 35. location of Injury (Street and Number, City, State, Zip Code) 36 Inlury at work Q Yes 37. If Transportation Injury, Specify: ^ Ortver/Operator ^ Pedestrian 38. Describe How Injury Occurred. ^ No ^ Passenger ^ Other lipecify) 39a. niher lCheck only oriel Certdy~ng physician - To the best of my knowledge, death occurred duo to the cause(s) and manner sated ^ Pronouncing & Certifying physician ~ To the best of my knowledge, death occurred a[ [he lime, date, and place, and due to the cause(s) and manner stated se(s) and m an n e r stated ca u mination, and/or investigation, in my opinion, death ouurred at the time, date, and place, and due to the he Oasis of ex a ^ Medical Examiner/Coroner - On t ~ r ~ ~ 'y ~ ~ s ( ` / l ~L1.L ((\ ~. VV~ ~~ Title of certifier: L ( Ucense Number: Fly ~~~> ~T V Signature of <ertilier (AA/ 3 b. Name, ddress and Zip Code of Person Comp ling Cause of Death (Item 26) > 3 1~ U ~` 9c. Date Sig ed (M /Day/Yrl r, Z, ~ ~1 2 ?Akaw ~ ~tMIS ~ ~ 2U z~o)z 's Di stri ct Number d0. Registr ar a a1. Re ar's Signature tc IMO/Day Yr) 2. Registry ~ ~ s l ` W Y'Rp ~+ ~js~ ~C/' F ~ Cp7r/J rJG /~-' -'ndments -. 43° A~ ' j ~ ^ ~ - .. .'y ~ 'S rt ~ ~~ 'Y - '.~ ~'~ 1. lY` . 07 ~/ 8 1 1 Hlos-la3 Disposition Permit No. 1 J REV 07/2011 e ~,~ ®® ~~Ll~ 1 ~li~.y1- .:" ~ ~ ~,~ a `, E:.~ t F. jR J l7 G E3 ~ t i G • t„~i1~'~,'t~~,i`,,4 '~l.i' cu~~~~~~ ~ca., Pa I, GISELA R. McBRIDE, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and revoke any will previously made by me. L I give, devise and bequeath all of my estate of every nature and wherever situate in equal shares to my adult children, GISELA V. McBRIDE and THOMAS C. McBRIDE, or to the survivor of them living on the thirty-first day following my death. II. I make no provisions herein for my grandsons, MICHAEL and IAN, not from any lack of love and affection, but because they are otherwise provided for. III. All federal, state and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether or not passing under this will, including any interest or penalty imposed in connection with such F~ tax, shall be considered a part of the expense of the administration of my estate and shall be paid out of the principal of my estate without apportionment or right of reimbursement. IV. I appoint my daughter, GISELA V. McBRIDE, executrix of this my Last Will. Should my daughter, Gisela V. McBride, fail to qualify or cease to act as executrix, I appoint my son, THOMAS C. McBRIDE, executor of this my Last ~t ~ J Will. V. I direct that my executrix or klec successor executor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. r~.- IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~day of February, 2009. ~~~ ~ • ~~~(SEAL) ELA R. McBRIDE The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, GISELA R. McBRIDE, was on the day and date thereof signed, published and declared by GISELA R. McBRIDE, the testatrix therein named, as and f`or her last will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. ~~ ~ 1 ~~ r ~if~~v N~~ ~/~/~-3 zs- ,.~ ~3~~ OATH OF N01~T-SUBSCRIBING WITNESS(ES) REGIS ER OF WILLS C~~1r/ COUNTY, PENNSYLVANIA Estate of ~ / s ~"f e~-~ !-~~ ,Deceased (each) being duly qualified according to law, depose(s) and say(s) that ~ he /they was /' ere well- acquainted with ,r ~? ~r C!s'G-L '~ c 2/ ..'and air are familiar with the handwriting and signature of the decedent, and that the signature of / ~ /-e~' 'r to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~f`~~~- r-____ ~Z ~ ~ ~ ~/ ~C is in his/ er- wn proper handwriting. ~~ (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and su'~oscribed a l.~ befor me this ~ day ~,• ~ =, ~ t +~ r .1f /// ~'' Deputy for Register of VV'~~ is 111... lll... l ~ l~ r ~' ~~` ~` (Si nature) ~~ S~L~ ~ ~ ~~~ ~G ~ ~ ~r'~,r~J ~ I?~ V,E (Street Address) /~~~ is u /~~ (City, State, Zip) ipsiz Form R W-04 rev. 10.13.06 OATH OF SUBSCRIBI~,TG WITNESS(ES) L,~ > REGISTER OF ~~ ILLS ~/~'!/~~ C / COUNTY, PENNSYLVANIA Estate of y ~s E ~ ~ 1 ~ C- ,Deceased ~, ~~i /~ /~ r~ `'-~ , ~~i ~~' , (each) a subscribing witness to (Print Name/s) the Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that sh he- they wa /were present and saw the above Testato / Testatri sign the same and that she / e they signed the same and that sh / he /they signed as a witness at the re_c.~,uest of the -, ~'~ % Testato Testat ~ ' in ~/ his presence and in the presence of each other. ~_ ~ • Vii" C t„ ~,~~- ~ ~~ ~~~ (Signature) (Signature) ~ ~ /,2~/~~s (Sd-eet Address) (City, State, Zip) Execccted in Register's Office Sworn to or affirmed and subscribed before me this day ' ~~ <~, t 1 _ Deputy for Register of,~7Vill -~- (Street Address) c~~iz~ is~ . ~~- ~~-~~ (City, State, Zip) Execicted oict of Register's Office Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Fonr~ RW-03 rev. 10.13.06