HomeMy WebLinkAbout09-26-12PETITIOV FOR GRa~iT OF LETTERS
REGISTER OF WILLS OF ~~r rn rE' ~Q y~~~ COL7NTY, PE~1~tSYL~ ANIA
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Decedent's Information f
aka:
a/k/a:
a/k/a:
Date of Death: q -j(d --:gip/~.
File vo: ~~~ ~~' / C/,J,~,
(Assigned by Register)
Social Security No: %'7?-/(~ -%(y (o (~
Age at death: qd
Decedent was domiciled at death in
principal residence at ~/ ~~,,~~(,°
Street address, Post Office and rLip Code
~ L~2,e. emo~l f- /U ~ ~ ~~+ ~ H cam
Decedent died at laao C' I ~ p r,,, nn -1- ~ ~ ~ .~., ! /'
Street address, Post Office and Zip
County,
City, Township or Borough
City, Township or Borough
(store) with his/her last
County
County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ ~ p~U
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If trot domiciled in Pennsylvania ........................ Personal property in County $
[~akte of real estate in Pennsylvania ......................................................... $ Q
TOTAL ESTIMATED VALUE.... $ ~-~ y ~ GJ
Real estate in Pennsylvania situated at: ___~~ {}
(Attach additional sheets, i/'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 n?/~ y o79, ~C1Q~ and Codicil(s)
thereto dated
State relevant circumstances (e.g. rentu:ciatiott, 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, cktrunte absentia, durunte 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.
^ NO EXCEPTIONS [] 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 (uttuch
additional sheets, if ~necessury): Cj
Name
Relationshi ~ i.._c:t
Address "'C7 -
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Form RW-OZ rev. 10/!1/1011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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Petitioner(s) Printed Name Petitioner
(
s) Printed Address
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Tl~e 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 truly administer the estate according to law.
Sworn to r oyf~armed an ub crib b fo~~/'~~ ~ ~ -~ _ ; ~ Date ~~.- ~~ - / ~
met is ~' day of ~~~~~%t;~ ~ Date
By: Date
Fo t e Register Date
BOND Required: ~ YES ~ NO
FEES:
Letters ...................... $ ~~; ~~
( ~ )Short Certificate(s)...... G' G-
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission .................. _
Oth~r . ....... ` ~jL~
Automation Fee ............... ~
JCS Fee . .................... _.
TOTAL ............... ...... $
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
l~.state of C!/~ /~' ~' ~~ ~~-'/ /f~~~/`°7 File No: ~ ~ - ~%
/1 ,~~' ~~
a/k/a:
AND NOW, _,~
satisfactory proof having
the instrument(s) dated
described in the Petition be admitted
obate and filed of record a~ the last Wild, (and Codicil(s)y~f Decedent.
t'~
gister of Wills
..C~f~~,.~~~~ ~~ ~~ , in conside ation of the foregoing Petition,
presented before me, IT IS D REED that Letters P~~ ~ //fir/~ ff
_ are hereby granted to (:-~ ) /~t C' r .~
in he ab v estate and (if applicable) that
Fir,,, Rw-n? rev. tnil~iznl! ~/ ' ~ gage ~of 2
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1 .~ . , ~ ... '.~~ SAP 26 F~ 2~ ~1
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Type/Print In
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COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH VITAL RECORDS
rG~T~L~/"ATC sir ear-w~•
- - - State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Yr) (Spell Mo)
Charlotte I_ Lehman emale 177-16-1666 eptember 16,201
Sa. Age-Last Birthday (Yrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Count
)
ry
90 Months Days Hours Minutes
Newville, Pennsylvania
April 8, 1922
76. Birthplace (county) Cumber 1 a n d
8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Sc. Oid Decedent Live in a Township?
v 91 Doubling Gap Rd ~j Ye s, decedent lived in North Newton
iwp
Sd. Residence (County) A 2 0
d Se. Residence (Zip Code) 1 7 2 4 1 Q No, decedent lived within limits of ctty/boro.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married Widowed 11. Surviving Spouse's Name (If wife
give name
rior to fir
t
i
,
p
s
marr
age)
Q Ves No Q Unknown Q Divorced Q Never Married [~ Unknown
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
W' lam M_ Dunbar Clara E_ Gutshall
14a. Informant's Name 14b
Rel
ti
hi
D
'
.
a
ons
p to
ecedent
Connie Youn
D
h 14c. Informant
s Mailing Address (CStreet and Number, City, State, Zip o e)
hi
~~
o
~ g
aug
ter 574 S
ppensburg Newville
17241
+
~ .......................................................... ............................................. .... 15a P ace o Death C ec on Y o
.. ........:....................... .............. ... ne............................... . ....................................
If Death Occurred in a Hos ital: ...................
.
p~ ~j Inpatient
:If
e
_
° ~
..
................
~
D
ath Occurred Somewhere Other Than a Hospital: ~ Hospice Facility Decedent's Home
Q Emergency Room/Outpatient D
d
l
Q
w ea
on Arriva
ffi] Nursing Home/Long-Term Care Facility Q Other (Specify)
Facilit Name (I no stitution ive sire t a nu b r' 15 1 T t te, an Co lSd
County of Death
~'~ar~mon~ ~ursi~l
~ "l~e`F
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,
7013 Cumberland
~;,, 16a. Method of Disposition ~ Burial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory
or other place)
v ,
Q Removal from state Q Donation 9/ 1 9/ 2 0 1 2 Prospect H i 1 1 C e m e t e r y
Q Other (Specify)
v 16d. Location of Disposition (City or Town State, and Zip) 17a.
Si~ re Fune 1 Service licensee or Person in Charge of Interment 17h 11cen~e Jy 0cn2ae~ L
Newville, PA 17241 Y'
-
LJ 3t5~
E 17c. Name and Complete Address of Funeral Facility
E er Funeral Home Inc 15 Big Spring Av Newville, PA 17241
m
f=- 18. Decedent's Education -Check the box that best describes the 19. Decedent of His anic Ori
p gin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what
hi
hest d
l
l
f
h
l
g
egree or
eve
o
sc
oo
completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be.
Q 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" ~ White Q Korean
d
l
Q No
ip
oma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese
Hi
h
h
g
sc
ool graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian
Q Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hawaiian
A
i
d
Q
ssoc
ate
egree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro
Q Bachelor's degree (e
g
BA
AB
BS)
.
.
,
,
~ Yes, Cuban Q Filipino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Oth
P
ifi
I
l
d
er
ac
c
s
an
er
Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) Q
Other (Specify)
e. MD, DDS, DVM, LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a
Decedent's Usual Oc
ti
I
di
.
cupa
on -
n
cate type of work
$] White Q Japanese Q Samoan don
d
i
f
e
ur
ng most o
working life. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
L a b o r e r
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure
0 Asian Indian ~ Other Asian ~ Refused 226. Kind of Business/Industry
Chinese Q Native Hawaiian Q Other (Specify)
Q Filipino Q Guamanian or Chamorro Dress Factor y
ITEMS 23a - 23d MUST BE COMPLETED 23 Dam Jro n~ync=d Dead Mo/Day/Yr) 23b. SI nat of Pers n Pronoun g Death (Only whe p ica ble) 23c. License Number
BY PERSON WHO PRONOUNCES OR u
/
! (
Q
~ '
CERTIFIES DEATH
23
te Sig d (
ay/Vr) 24. Time t
~
~~
~~
~ ,
.i F
25. s Me c I xa finer or Coroner Contacted?
Q Yes No
CAUSE OFD AT
Approximate
26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest
interval:
,
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. ter only one cause on a line. Add additional Tines if necessary Onset to Death
IMMEDIATE CAUSE ---------------> a. C y
~
-- t~1 ~e
(Final disease or condition Due to (or as a consequence of).
resulting in death)
b.
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on line a. Enter the c.
UNDERLYING CAUSE
Due to (or as a consequence of):
_
._ (disease or injury that
initiated the events resulting d.
~
u in death) LAST.
Due to (or as a consequence of):
S
0 26. Part 11. Enter other s~niflca nt conditions contributive to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed?
~ Q Yes No
28. Were autopsy findings available
to complete the cause of death?
~
a 29. If Female: Q Yes Q No
3
,
E
° 0. Did Tobacco Use Contribute to Death? 31. Manner of Death
>~ Not pregnant within past year Q Yes Q probably [~-Natural Q Homicide
u
m Q Pregnant at time of death Q No ~- Unknown Q Accident Q Pending Investigation
o ~ Not pregnant, but pregnant within 42 days of deatF
~ Suicide Q Could not be determined
~- Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In'ur
1 Y (MO/Day/Vr) (Spell Month)
~ Unknown if pregnant within the
past year 33. Time of Injury
34. Place of Injury (e.g, home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
Q Yes Q Driver/Operator Q Pedestrian
~ No Q Passenger Q Other (Specify)
39a. Certifier (Check only one):
{$-Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated
Q Pronouncing gr Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/Coroner - O the basis o examination, and/or investigation, in my opinion, death o urred at the time, date, and place, and due to th
e
c
a
use(s) an
d m
ann
er stated
~~
((
~~
,,~~
Q
4
g
Signature of certifier. Title of certifier ~ License Number !v`t`J O I / / / ~>~
39b. Name, Address and Zip Code of Pers n Completing Cause of Death Item 26) 39c. Date Sigged (Mo/Day/Yr)
14Gb G/ i V~ (
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1 J7112
9
40. Registrar's District Number 41. Regis rar's ~at~u~r~e _ (. 42. Registrar Fife Date (Mo/D('ay~ r)
~
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43. Amendments
~~~~~/ H105-143
Disposition Permit No. !J REV 07/2011
LAST WILL AND TESTAMENT
OF
CHARLOTTE I. LEHMAN
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I, CHARLOTTE I. LEHMAN, of 91 Doubling Gap Road, Apartment 204, Newville,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
Ui~GCi~~ti~! ~:.a`ily, oili i IC1~C, N`ublijr i c~~l'u UCI:IAre ll ~iJ G!5 C11 1U ~Ui I ~ iy LaSi it v iii ci i+..~ 9 ~~id it,
hereby revoking and making void any and all former Wills, Codicils, or writings in the
nature thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executrix, hereinafter named, to pay all
my just debts, funeral expenses, testamentary expenses and all Inheritance, Estate,
Transfer and Succession Taxes, as soon as may be conveniently done after my death,
out of my residuary estate.
SECOND: I give my entire estate, both real and personal, to my daughters,
PHYLLIS E. BARD and CONNIE L. YOUNG, in equal shares, per stirpes.
THIRD: I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personai property to specric; pe~~5u~ ~s. i urge
my Executor and beneficiaries to respect these wishes. Such a memorandum, if made,
shall be stored in conjunction with this Will.
LASTLY: I nominate, constitute and appoint my daughter, CONNIE L.
YOUNG, to be the Executrix of this my Last Will and Testament. In the event that the
said CONNIE L. YOUNG shall be unable to serve as Executrix for any reason, I appoint
my granddaughter, WENDY J. ARMOLD, as Executrix. No Executrix shall be required to
file bond in this or any other jurisdiction.
v la
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~-~ day
of ~ , 2008.
Charlotte I. Lehman
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
~- ~~_
2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
I, CHARLOTTE I. LEHMAN, 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 o a ~ d acknowledged before me, by C ~ARLOTTE I. LEHMAN,
the Testatrix, this ~ day of 008
Charlotte I. Lehman, Testatrix
3
1~TARIAl. SEAL
[II.EpE J. MARHEVKA,1-~TARY Pt~.iC
GARLISl.E, CUMBERlAI~ ~OUNT1~ PA
MY GOII~MISSION EXPIRES JUNE 8, 2010
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
We. CSEG~~;E ~. ~ou~~-44s ~ and 1 `/~y~ ~ L~~~~%
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
Charlotte I. Lehman, Testatrix, sign and execute the instrument as her Last Will; that she
signed willingly and that she executed it 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 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by Cs~eZF~c ~ ~oU~(=U4~ ~ and
~~y~ L ~ ~1 ~' this
2.~ ? ~
day of , 2008
L~:
Witness
a
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r .-C'C.~-~.-
Witness
4
NOTARIAL SEAL
MERLENF J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 2010