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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: Loretta B. Duffy File No:~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 170322921
Date of Death: 1/1/2013 Age at death: 73
Decedent was domiciled at death in Cumberland County, Pennsylvania (State) with his/her last
principal residence at 127 Turnpike Road 17240 Newburg, Hopewell Twp. Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 127 Turnpike Road 17240 Newburg, Cumberland PA
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 $ 2,000.00
If not domiciled in Pennsylvania .............................Personal property in Pennsylvania $
If not domiciled in Pennsylvania .............................Personal property in County $
Value of real estate in Pennsylvania $ 18, 850.00
TOTAL ESTIMATED VALUE.... $ 20,850.00
Real estate in Pennsylvania situated at: 127 Turnpike Road 17240 Hopewell Township Cumberland
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
M 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 5/10/1991 and Codicil(s)
thereto dated Charles H. Duffy prede. eased on July 14, 2012
none
State relevant circumstances (e.g. 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 parry 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.
❑ 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 h5 (attach
additional sheets, if necessary): Cl>
C ; -a M
C C> M 6
Name Relationship ~Aress
Sol
Fri
C'q
Form RW-02 rev. 10'11/2011 Page 1 of 2
Oath of Personal Representative official use only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUMBERLAND } j
Petitioner(s) Printed Name Petitioner(s) Printed Address
7602 Kenya Street
Carol A. Hull Jacksonville FL 32208
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 Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed subscribed before Date
me t 'day of Date
By:_i.L_G Cjh Date
For the Register Date
BOND Required: M YES ❑ NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters $ 60.00 Attorney Signature:
(5 ) Short Certificates(s) 20.00
( ) Renunciation(s)
( ) Codicil(s) ' _kl
( ) Affidavit(s)
Bond 15.00 Pr' ed Name: Joel R. Z r
c-a Supreme Court C> C_ r7l C->
Commission
ID Number: 17516 r -
Other Will 15.00 -
Firm Name: Zullinger-Dawn, I ;Cr
14 North Mai ,
Address:
Suite 200 -
Chambersbur - PA 17101
• • • • . • • . • Phone: (717)264-6029
Fax: (717)264-1884
Automation Fee 5.00
JCS Fee . . . . . . . . . . . . . . . . . . . . . . . 23.50 Email: izullingera zullinger-davis.com
TOTAL 138.50
DECREE OF THE REGISTER
Estate of Loretta B. Duffy File No: j~
a/k/a:
AND NOW, t /~l ) 2013 , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IS DECREED that Letters Testamentary
are hereby granted to Carol A. Hull
in the above estate and (if applicable) that
the instrument(s) dated May 10, 1991
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Form RW-02 rev. 1011112011 Register of Wills
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P 19967571 CLFFA~
CUMBERLAND
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
Permanent CERTIFICATE OF DEATH
Black Ink 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)
Loretta B. Dully Female 170-32-2921 January 1, 2013
So. Age-Last Birthday (Yrs) Sb. Under 1 Year 5c. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country)
Months Days Hours Minutes Lark Township, PA
73 i I I January 22, 1939 7b. Birthplace (County) Juniata
8a. Residence (State or Foreign Country) 8b. Residence (Street and Number- Include Apt No.) ~8~cr. Did Decedent Live in a Township?
PA 127 Turnpike Road 1MYes, decedent lived In Hopewell
twp.
8d. Residence (County)
Cumberland Be. Residence (Zip Code) 17240 E3 No, decedent lived within limits of city/boro.
10. Marital Status at Time of Death 0 Married Im Widowed 11. Surviving Spouse's Name (if wife, give name prior to first marriage)
9. Ever in US Armed Forces?
E3 Yes ]M No 0 Unknown E3 Divorced Q Never Married unknown
1 13
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last)
George L. Williamson Blanche A. Rine
\ 14a. Informant's Name 4b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
a c Carol A. Hull Daughter 7602 Kenya Street Jacksonville FL 32208
rr lsa. Place o Dea[ Check only one
.................rtf D......e.....ath Occurred So...m..e...wh.....ere Other her Th an a H
c If Deatfi Occurred in a Hospital: ~Inpatient iospital: Hospice Facility Decedent's Home
° E] Emergency Room/Outpatient E3 Dead on Arrival i O Nursing Home/Long-Term Care Facility Other (Specify)
15b. Facility Name (If not Institution, give street and number) 15c. City or Town, State, and Zip Code 15d. County of Death
127 Turnpike Road Newburg, PA 17240 Cumberland
3:. 168. Method of Disposition In Burial E] Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
$ E3 Removal from State p Donation January 8, 2013 Ft. Indiantown Gap National Cemetery
rc Other (Specify)
~ 16d_ Location of Disposition (City or Town, State, and Zip) 17a. Sign atur unerai Service Licensee or Person in Charge of Interment 17b. License Number
Annville, PA 17003 - FD-014831-L
17c. Name and Complete Address of Funeral Facility .01
Fogelsanger-Bricker Funeral Home 112 W King St. PO Box 336, Shippensburg, PA 17257
X 18. Decedent's Education - Check the box that best describes the 19. Decedent of Hispanic Origin - Check the 20. Decedent's Race - Check ONE OR MORE races to indicate what
i-S 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.
E] 8th grade or less is Spanish/Hispanic/Latino. Check the "No" jgt White E] Korean
No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. E] Black or African American E3 Vietnamese
E7 High school graduate or GED completed IN No, not Spanish/Hispanic/Latino E] American Indian or Alaska Native E] Other As Ion
E] Some college credit, but no degree [:3 Yes, Mexican, Mexican American, Chicano F3 Asian Indian EJ Native Hawaiian
E] Associate degree (e.g. AA, A5) E3 Yes,. Puerto Rican E] Chinese E] Guamanian or Chamorro
E] Bachelor's degree (e-g. BA, AB, BS) E] Yes, Cuban E3 Filipino E] Samoan
E] Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) E3 Yes, other Spanish/Hisponic/Latino EJ Japanese E3 Other Pacific Islander
E3 Doctorate (e.g. PhD, EdD) or Professional degree (Specify) o Other (Specify)
(e. a. MD DDS DVM LLB JD) a
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 Occupation -Indicate type of work
White 0 Japanese E3 Samoan done during most of working life. DO NOT USE RETIRED.
0 Black or African American E] Korean E3 Other Pacific Islander - Homemaker
E] American Indian or Alaska Native E3 Vietnamese E3 Don't Know/Not Sure
E] Asian Indian _ E] Other Asian E3 Refused 22b. Kind of Business/Industry
0 Chinese E3 Native Hawaiian Q Other (Specify)
E] Filipino E3 Guamanian or Chamorro Own Home
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH
23d. Date Signed (Mo/Day/Yr) 24. Time of Death
6:23 AM 125. Was Medical Examiner or Coroner Contacted? E3 Yes Z$[ No
CAUSE OF DEATH 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. Enter only one cause on a line. Add additional lines if necessary Onset to Death
IMMEDIATE CAUSE - > 's. metastatic adenocarcinoma
i
(Final disease or condition Due to (or as a consequence of): - i
resulting In death)
b. end staged renal disease
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): /
W (disease or injury that - '
Initiated the events resulting d. i
W In death) LAST. Due to (or as a consequence of):
_u
S 26. Part II. Enter other significant conditions contributing[ to death but not resulting In the underlying cause given in Part 1 27. Was an autopsy performed?
o_
E1 Yes No
28. Were autopsy findings available
m to complete the cause of death?
Yes t5KNo
o. 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
E Eff Not pregnant within past year E] Yes E3 Probably I( Natural E] Homicide
u° C3 Pregnant at time of death = No 0 Unknown - E] Accident E] Pending Investigation
m E3 Not pregnant, but pregnant within 42 days of death E3 Suicide Could not be determined
r°- E] Not pregnant, but pregnant 43 days to 1 year before deatt- 32. Date of Injury (Mo/Day/Yr) (Spell Month)
E3 Unknown If pregnant within the past year 33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 3S. Location of Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 37. If TransportatTbn Injury, Specify: 38. Describe How Injury Occurred:
Q Yes Q Driver/Operator E] Pedestrian
E3 No E3 Passenger 0 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 0 Pronouncing & 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
E3 Medical Examiner/Coroner - On the basis of examination, and/or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated
m
Signature of certifier:-Z: ~ra,Ywr~/'it~-v Title of certifier: M•B•B•S. License Number: M0063751 L
39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (Mo/Day/Yr)
Amatul Khalid, M.B.B.S. 1988 Scotland Avenue, Chambersburg, PA 17201 January 2, 2013
40. Registrar's District Number 41. Re ar Signature 42. Registrar File Date (Mo/Day/Yr)
ze3
° 43. Amendments
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Disonsitlnn Permit Nn 0818888 -11 oS„1.,a31
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L A S T W I L L
of the Township of Fayette, County of Juniata and Ccumon-
wealth( V(~bflsylvania, declare this to be my Last Will and revoke any will
ITEM I: I direct that all my just debts, funeral expenses, gravemarker and
the costs of the administration of my estate be paid from the assets of my estate
as soon as practical after my death.
i3EM ii: i direct that all taxes that may be assessed in consequence of my
death, of whatever nature and by whatever jurisdiction imposed, shall be paid from
the assets of my estate as a part of the administration thereof, to the end that
no beneficiary hereunder, or any other person, shall be charged with or required
to pay any part of such taxes.
ITEM III: I devise and bequeath the residue of my estate of every nature and
wherever situate, including any property over which I may now have or hereafter
acquire, a power of appointment to my husband, CHARLES H. DUFT Y, provided he shall
survive me by ninety days. Should my husband, CHARLES H. DUFFY, predecease me or
die on or before the ninetieth day following my death I devise and bequeath the
residue of my estate of every nature and wherever situate, including any property
over which I may now have or hereafter acquire, a power of appointment to my
daughter, CAROL A. HULL, of 8426 Highfield Avenue, Jacksonville, Florida, provided
that the share of CAROL A. HULL should she predecease me or die on or before the
ninetieth day following my death, shall be distributed to her issue, per stirpes,
living on the ninety-first day following my death.
ITEM IV: I authorize and empower my hereinafter named Executor or alter-
native Executrix to convert any property that I may own at my death, whether real,
Page 1 of 2 Pages
personal or mixed, at either private or public sale, whichever in his or her
opinion is deemed best, hereby vesting in said Executor or alternative Executrix
full power and authority to make, execute, acknowledge and deliver good and
sufficient deeds or assurances of title therefore.
ITEM V: I appoint my husband, CHARLES H. DUFFY, Executor of this my Last
Will. Should my husband, CHARLES H. DUFFY, fail to qualify or cease to act as
Executor, I appoint my daughter, CAROL A. HULL, alternative Executrix of this my
Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this / day of Iq
1991.
LORETTA B. DUFFY
The preceding instrument, consisting of these two pages, identified by the
signature of the Testatrix, the date thereof signed, published and declared by
LORETrA B. DUFT Y, the Testatrix herein named, as and for 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.
Page 2 of 2 Pages
l 3a. V S7 T
6ATH OF SUBSCRIBING WITNESS(ES)
CLE K. :
0 RIP H A N S' C, 'Of <U -g5 REGISTER OF WILLS
CUMBERLAN-Ij V-1" P UMBERLAND COUNTY, PENNSYLVANIA
Estate of Loretta B. Duffy , Deceased
Qsjoiel F. Clark Debbie K. Clark, formerly Debbie K. , (each a subscribing witness to
(Pril) t Xame/s) 61-too
the X Will ❑ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he / they was / were present and saw the above Testator / Testatrix sign the same
and that she / he / they signed the same and that she / he / they signed as a witness at the request of
the Testat Tes trix in er / his presence and in the presence of each other.
-A 01
(Signature) (Signature)
P.O. Box 225 R P. Box 225
(Street Address) (Street Address)
Mifflint wn PA 17059 Mifflintown PA 17059
(City, State, zip) (City, State, Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed
before me this day before me this day
of of .r , aCl 1
IbJ -1 ILI . d
Deputy for Register of Wills Notary Pu lic
My Commission Expires: 5 311
(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 copye Etwop imWpNIA
Notarial Seal
Form RW-Q3 rev. 10.13.06 FAmy C. Beward, Notary Public
ker Twp., Juniata county
missio n Expires may 3, 2016
MEMBER, PENNSYLVANIA ASSOCIATION OF NOTARIES