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Home My WebLink About02-19-13Reset 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 specixied 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: Charles M. Fisher File No: ~ ~1 ~ ' - { . ~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 01/31/2013 Age at death: 59 Decedent was domiciled at death in Cumberland County, pennsylyania (Scare) with his/her last principal residence at 2415 Arcona Road Upper Allen Two Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 2415 Arcona Road Upper Allen Twp 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 $ 100,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ...................... ................................... $ 5,000.00 TOTAL ESTIMATED VALUE.... $ 105,000.00 Real estate in Pennsylvania situated at: Arcona Road Lot 4D Upper Allen Twp 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 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 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 applicabte) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durance absentia, durance 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. O 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 (attach additional sheets, if necessary): r~~ Name Relationshi Ades w ~ f7'1 Margaret W. Fisher Spouse 2415 Arcona Road ~ ~ rn ~ ~ Mechanicsbur PA 17055 ~' Daniel Fisher Son ~ D r` I--. ' ~ ~ :°rl rrl r- ~ rn cn - ~ _ c7 ~ _~ - r D- _r.: ~ o c.o '*f and Codicil(s) Form RW-02 rev. 10/I1/20I1 Page 1 of 2 L®~AL REGISTRAR'S +~ERTII° I~A~TIOIV QI° ~EL~~wI-~ 11U'ApNING. li is illegal to dupli~ratE this ropy, fair t-l~atostat or photoq!°api1. .;~~, RECORDED OFE~CE OF - i i 1 ~„ r~ ,l . {=` , ,~i.~rnllrlol~ ~ur,c ~~I~~(~ ~~ Fcc ,~ r thi>. celtii~k:atc . , l ~ - REGISTER Ofi ~~ ~ ~ ~ S,ra~~~~" ~~~ ~ : . r~ ~ I : ~ ~ .II,<1~ < ~1r,t;v ~IL~ X11 ~r_:~1n ~ ~, t (I: ~ i u ~ 1r ~.~~ ~1 Rc~.~sriar- 'Tf11~ ori~rnal t I~ ~ Ldy ?~13 FEB 15 ~'(~ 1 ~~ ~ '~ ~ . I r ~I ~ ~ I,i~~~ ~~, r9,~r ~~tt,1C' e 11 I~ CLERK OF "~ P 19179944 ORPFIANS' couR~ ~''M~~TnI~" '~-~~'`- _- --~_1 #I~ r ~1__ (~Plltl'_dS1U11 'tiltill~~Ct `/~~ a{~'/gr{aFr /`E -{/-~' ~]~ ~~, •~~':~'~' tU rit'z i :_ ~!aic 3~,lECLi /Print In y ~ `.1 y g.. R L /1 N D ~^V'ONy/E~1!(gF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAI RECORDS m'"e"' CERTIFICATE OF DEATH 1. Decetlmt's LeBRI Name IFirsl, Mltldk, last, Suffla} 2. SeK 3. Sala) Security Number d. Date of Oeath IMO/Day/Yrl (Spell Mol C'haxles M. Fisher Male 162-46-4346 January 31, 2013 Sa. Age-last Birthday IYr51 Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/O ay/Year) (Spell Mon[hl ]a. Birthplace (thy and State or Foreign Country] ' Cj (3 Months DAYS Hours Minutes I1arr15b71T [~ July 17, 1953 )b. Birtholace (County( ea. Resideree IStat or foreign Country) i eb. Residence (Street and Number- Include Apt Np.) ec. Old Oecetlen[ Uve In a Townships Penrvsy vania 241 5 Arcond Road rea, ae[edem Iroee m [ln-~nar Al n ea. Residence (fqunryl Curtlberland ee. Residence (Zip Code) ^NO, decedent Ilved within limits of city/born. 9. Ever in US Armed Forces) 10. Marital SUtus at Time of Death z] Married ^ WMgwetl 11 SurvNing Spouu's Name IH wise, glue name prior [o first mardagel ^V< ~Np ^Unknown ^DMprcee ^NeverMarried ^Unknown Margaret Welder 12. Father's Name (First, Miedle, Last, SufRal 13. Mother's Name Orlor [o First Marriage (first. Mldtlle, last) Charles Fisher Maxine Glenn 14a. Informant's Name Sdb. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Chy, State, Zip Cade', O MarcJaret Fisher 2415 Axcve R3. Nf33alic~tffg, f'A 17055 G . . .. ..... ...... . ....... i..a.. P ace o, Oeat... ... eck on .one ........_.................... ................... .............. ............. .. .. r ......................................:................YY .................... . . patient I it Deam DaNrr<d in a Hoamtal: y~ln ry l Death Oaurred Somewhere Other Thane Noapltal. ~I HOZpke Frill r~Decedent's Home ^ Emerg<nry Room/OUtpetlen[ ^ Dead qn Arrival ~ ^ Nursing Home/Long-Term fare Facility ^ ana (spxlryl S 15 b. Fatlliry Name (If no[ instkutlon, glue street and number; SC. Gry or Town, State, and Zlp Code 15d. County of Death 2415 Arcona Road Mechanicsbur , PA 17055 y 16a. Methoe of Oisposkion ^ Burial ~ Cremation 1 6b. Date of Oisposl[ion 16c. Place pl Disposition (Name of cemetery, Crematory, or other place E - ^ Rempyanrpmstat< ^ Dgnaugn Other lSpeciryl 2/3/2013 Cumberland Crematory LI,C 2 16d. Laatlon of Disposition IClty or Town, State, and Zip 1 )a. afore F rat SeMCe Licensee or Person In Charge of Interment 1]b. License Number ~ Carlisle, PA 17013 „~ ,< ~, /~S yo a n[. H,me and complete Aeereaa Pr wnoel Fagih<y Mechani csbur PA 17055 1B. Decedent's Education -Check the bow that best dexrlbes the 19. Decedent of Hlspanit Agin ~ Check the 2 0. Decedent's Race -Check ONE OR MORE races to Intllcate what highest dgree or level of school completed at the time ql tlea[h. boa that best tlescribes whether the eeced<m t he decedent considered himself or herulf to be. ^ 8th grade or less Is Spanish/Hispanic/labno. Check the "NO" ®Whl[e ^ Korean ^ No diploma, 9th - 12th grade boa Hdecedent ii not Spanish/Hispanic/latino. ^ Black or African American ^ Vietnamese ~Fllgh school gratluate IX GED Completed [ZNp, not Spanish/Nispenic/Latlnq ^ Amerl[an Indian or Alaska Na[IVe ^ Other giian ^ SOm<colllge credll, but no degre[ ^ Y<s, Mealcan, McKi[..i American, Chicano ^ Asian Intllan ^ Native Hawaiian ^ Assalate degree (e.g. M, A51 ^ Yes, Puerto Rican ^ Chinese ^ Guamanian or Chamorro ^ Bachelor's degree Ie.g. BA, AB. BSI ^ Yes, Cuban ^ Filipino ^ Samoan ^ Master's eegree Ie.g. MA, MS, MEng, MEd, MSW, MBA) ^ Yes, other Spanish/Hispanic/Latino ^lapanese ^ Other Pacific Islander ^ Doctorate (e.g. PhD, EdDI or pro/esslonal degree ISpxlhl __- __ ^ Other (Specify) .. MD DDS DVM LL0 10 2l. Decedent's Single Race Sell-Designation -ChecF ONLY ONE to Indicate what [he decedent considered himself or hersel! tp be. 22a. Decetlent's Usual Occupation.lndicate type of woM1 }QWhite ^lapanese ^Samoan doneduring most of working life. DO NOT USE RETIRED. ^ Black pr African American ^ Korean ^ Other Paci}ic Islander rev-,.•~vter ^ AmeNCan Indian or Alaska Native ^ Vietnamese ^ Don'[ Know/Not Sure `^~ [^-'~ ^ Asian lndlan ^ 13ther Asian ^ Refused 22b. Kind of Business/Industry ^ Chinese ^ Naive Hawaiian ^ Other (SpeclHl ALmy UeFIOt ^ Filipino ^ Guamanian or Chartiorro ITEMS 2L-23d MUST BE COMPLFTEO 23a. Dale Pronounced Oead IMO Day/yr) 236. Signature of Perron Pronouncing Death (Only when applicable) 23c. Litenu Number BY PERSON WHO PRONOUNCES OR CERTIFIES DfATH 23d. Oate Signed (MO/Day/Yr) 2d. Time qt Death OX. 11:00 AM 25. Wai Meelcal Examiner or Coroner Contacted) Yes ^ No CAUSE OF DEATH Approaimate Z6. pan 1. Enter the chain of events--tliuases, inlunes, or complications--[het elrectly caused the tleaM. 00 NOT enter terminal events such as cardiac arrest rval. respiratory arrest, or ventricular flbnlla[ion without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Imes if necessary Onset to Death IMMEDIATE UUSE ------~---..~a a. ~_ (T'Y •' J~ ~// t(• L/~ :, ~rl L.i• vv/! l (Final dluau or cgneition Due to Ior as a consequence ofj: resulting in death) D. Sequen[lally list conditions, Due to Ior as a consequence ofl- i!any, leading to the cauu listed on Ilne a. Enter the -.. UNDERLYING CAUSE Due t" Ior as a Consequence pf): ~elsease or injury that -_ mhlatee me events reswung e. _ _. m aeatnl LAST. Due to Ior as a consequence ot). Lg 26. Part II. Enter other slaniflanl colMi[lons contrlbutln¢ td death but not resulting In the underlying reuse given in Part I 2). Was an autopsy periormedl I I // I ~ • ^Yes ~Nq ~ [ r ('!21n [•. /. fl N!• .: I A'It~IAS 1 ~ ," S -t l ~ j•~s' I l,r'I r -~ Cl~ l ~Ir -1 iii /~ h S Y 2g. Were auto findin I bee psy gs avaia to o ple[e Me cause of deathP t ^ Yes ^ No 29. If Female: 30. Did Tobacco Use Contribute [o Death) 31. Manner of Death E ^NOl pregnant within past year ^Yes m'Drobably ^Natural ^HOmlciee ^ Pregnant at time of death ^ No ^ Unknown ^ Accitlent ^ Pentling Investigation ^ Nat pregnant, but pregnant within d2 days pf tleath ^ Suicide ^ Could not be determined ^ Not pregnant, but pregnant d3 days to 1 year belore death 32. Date pl Inlury IMO/Day/Yr) (Spell Month) Unkrgwn 1/ pregnant wlMin [he past year 33. Time of Injury 30. Place of Injury le.g. home; construc[lon site; /arm; school) 35 Location of Injury (Street antl Number, Ciry, State, Lip Cpdel 3fi. Injury at WOrF 3).If Traniponatlon Injury, Specify: 3B. Describe HOw Injury Otturretl ^ ve s ^ Oriver/Operator ^ Pedestrian ^ No ^ Passenger ^ Other (Sootily) 39a. Certifier (Check only ore): ~Certllying phVSician To the best of mY knowletlge, death occurred due to the cauxels) and manner stated ^ Pronouncing & Certifying physician -TO the best of my kiwwledge, dea[F occurred at the time, tlate, and place, and tlue to the cause(s) antl manner stated r stated ^ Metli<al Examiner/Corpner.On the basis of eaamination,3nd/or Investigatlpn, In my opinion, death occurred at the bme, date, antl place, and due to the cause(s) and mann e / a Signa eglcertiPer: - ,1~ <2 ~/~itle ofcertifier 1~1 ~] se Number: ~')1~)CtZ~3,7 ~_ con 39b. Name Atltlres antl Zip Code of Persolr Corti ting Caus of a[h (Item 26I ~ 39c. Date SlBnetl IMO/Day/Yr) ( nom. 6~ ~r~ ! -~4ntE5 ~~ (C tr~l< ' aw„ / I a~ '~,7 00. Registrar's District Number 61. RM r s Igna[urc d2. Registrar Flle Date Mo Day rl d3. Amendments _.-_ M105-143 Dlsooahlon vermlt No. 0819582 REV Dnzau