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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: Suzann S. Staiger
a/kJa:
a/k/a:
a/kJa:
Date of Death: January 15, 2013
File No• ~ ~ - ~ ~~ - ~~~
(Assigned by Register)
Social Security No:
Age at death: 75
Decedent was domiciled at death in Cumberland County, pA (Stare) with his/her last
principal residence at 310 Glendale Drive, Shiremanstown, PA 17011 - (Lo_wer Allen Twp Annex) Cumberland County
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Holv Spirit Hospital - 503 N. 21st St., Camn Hill PA (East Pennsboro Township) Cumberland Countv
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 $ 300,000.00
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $ 225,000 00
TOTAL ESTIMATED VALUE.... $ 525.000.00
Real estate in Pennsylvania situated at: 310 Glendale Drive Shiremanstown PA 17011 (Lower Allen Twp) Cumberland Countv
(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 n = ;~,
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ O " a1 ~ C~icil(s)
thereto dated m -~. G'j ~
rn e+ n ~ :.ta
State relevant circumstances (e.g. renunciation, death of executor, etc.) ~ 3~ ~~ fF~ ~'i~'
Except as follows: after the execution of [he instrument(s) offered for probate Decedent did not marry, was no vortes~,vvas not a par~o~~ending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323)~zl9d nat. aye a'>~iTdlborn or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ .. -.l
® NO EXCEPTIONS o EXCEPTIONS ;~ t~ ~ t._- tv7
i'-
Ta W fn C7
® B. Petition for Grant of Letters of Administration (if applicablei t"'" -rl
c.t.a., d.b.n., d. b. n. c. t. a., pendente lite, durante absentia, durante minoritate
If Administration, c.t.a. or db.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 o 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):
Name Relationshi Address
Scott A. Staiger Son 628 N Front St, Wormleysburg, PA 17043
Robert M. Staiger Son 5141 Kylock Rd, Mechanicsburg, PA 17055
Jennifer A. Staiger Daughter 5524 Moreland Court, Mechanicsburg, PA 17055
Michael C. Staiger c/o Donna Munro-Mother Grandson 1459 Hillcrest Ct, Apt 509, Camp Hill, PA 17011
Form Rw-oz rev. ~nilliao» Page 1 of 2
1 ~'
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
Official Use Only
l.N
Petitioner(s) Printed Name Petitioner(s) Printed Address
Scott A. Stai er 628 North Front Street Wormle sbur PA 0 ''~~ i 1
CLEF
QRPH~i~S' ~1~;.!€~T
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 dent, the Petit' r(s) will well and truly administer the estate a'cc/ording to law.
Sworn to r affirmed and subscribed before Date 7f ~ ~
me t~~' ,,~ day of
For the Register
Date
Date
Date
BOND Required: ®YES ~ NO
FEES:
Letters ..................... .
( { ~ )Short Certificate(s)..... .
( ^~ )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond .. ......................
Comm ission ................. .
Other
7 ...,.,..
L~
`
~ ~V1 ;Y~.I ....... .
Y
E
r~ ~ ........
$ y~~~L-
l
.......
Automation Fee ............... ~-j
JCS Fee . .................... 'Z3A ~~
TOTAL ..................... S ~ 0.00
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
Estate of Suzann S. Staieer File No: ~ ~- ~ 3 - ~~a
a/k/a:
AND NOW, MQ.rC ~ 2.~ r 3 , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ,( 1 ~F~ ~('-~ '(,~~.
are hereby granted to
in th bove estate and (if applicable) that
the instrument(s) dated N W
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
IYC~ r -, i'
egister of Wills •~ f Njj,,-~~ ~1~~
Form RW-02 rev. l0/ll/2011 r'~-~ Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph„
REGORGEC OFFICE OF
Fee for this certificate. ~6.t)() REGIS { Ala OF ~rf ILLS
zul3 ~flfl 8 8~i i~ 31
This is to certify that the information here given is
cl.~rrectly copied fro(71 zm original Certificate of Death
duly filed with me as Local Registrar. The original
ci:~rtificate will he forwarded to the State Vital
Records Oflice tix- permanent tiling.
CLERK of
P 19 ~. 7 9 4 3 3 oRpHar~s~ couRT
Certification Number CUMBERLAND Co., PA
w/Font In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECOPDS
-~~!~~ ~fl~al~
Local Re~~isrrar Date Issued
I. Decedent's Legal Name (Floc, Mltltlk, last, Sukh) 2. Sex 3. SnIal Securtty Nvmber~ . • ~ Date of Death (MO/Day/Yrl )Spell Mal
Suzann Elizabeth Steiger Fpmal 175 - 30 - 9626 Jan 15, 2013
3a. Age-cast Birthday iYn) Sb. Undo l Year k. Under l0a 6. pan of Birth (MO/Day/rear) (Spell Month) Ta I~C
lp~ arb ya(e or Forclgn Country)
e
Month Days Hours Minutes , YA
75 Jul 26 1937 ]b. Blrthpkce (COUnryI
Ba. Realdence (State or Forego Country) eb. gesitlence (street and Number ~ IMhde Apt No.) Bc. Did DxeOaM Live In a TownsMp7
Penns lvania 31
l ~Yes
dxedentliveeln LbI~Z' Allen w
Bd. Resdence (Cpunryl 0 G
endale Drive ,
,p
G~unberlarld ge. Resdenc! IZIp Codel 17 11 ^ No, tllceden[ IWed wnMn IImiO of _ cIry/Mro.
9. Ever lnUSy.rmM fueesT lO Marital Sbtus at Timr pf DeaM ^Manked ^ Wbowed 11. SUrvIMng spouse's Name llf wile,gM name prior to fist marriage)
^ Yes Ct No ^ Unknown ~ ONOrcetl ^ Never Marrkd ^ Unkrgwn
1Z. FatMYS Name (First, MM1dk, Lail. SvNlxl 13. MaMer's Name Prbr[p first Marriage (First, Middle, last)
Michael J. Serluco Ala
14x. Inlprmant's Name 34b. gakMnship tp Decedent lac. Informant's MaRing Address (Stmt ant Number, Cw, Sbte, Zip Code)
o Jennifer A. Stai 5524 Moreland Court Mechanic , PA 17055
G
a ___________"' 1sa. eoDeat on pne
_______________ __-_-_- ________ ___-____
u DeaM occlarre b a H
l
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i
i
m -
:
n
~ :
osM
a
nox
e
dl DeaM Dccurree som.wn
re a
er Than a Hpspnal: d iiospke Faclnry b oecexnrs Home
^EmergerscY Rapm/OUtpatknt ^ Dead on Arrival I ^NUrsing Home/long-Term Can Faclliry ^OMer lSpxllyl
15b. Faclliry Name DfrotirwMUtbn,gM Street and number) Ik ClryorTOwn, Stan, asd Zip Code litl. COUnry of Death
Hol S irit Hospital Camp Hill, PA 17011 Cumberland
1ba. Method of dsposMOn ~BVrlal ^Crematlon 16p. Date of Dlspositbn lgc. Platt of Oliposttbn(Nama of cemetery, crcmalory, or otherplxel
8 ^ 0.emwaffrom State ^ Donaelpn
^ aner(saaN) 17 2013 Gate of Heaven Cemet
2 l6d. LOCa[bnpf Dhppskbn lCky ar Town, Stan, anO Zlpl 1]a. SI eot fgDe M)je Lkemee or Person In Charye of Interment lTb. Ucenu Number
S Mechani PA 17055 FD - 014889
E ITC Name and Complete Addrta of funeral Facllily
5 Mal zzi F13rleral Hare 8 Market Plaza Way icsburg, PA 17055
~ lg. OxadeM's Educatbn - Check tM bw that best describes tM 19. DlctdrM of Hlswnlc Orlgln - Chx4 tM Z0. Oendenth 0.xe ~ Chxk ONE OA MORF races to IMk
t
h
t
r a
e w
a
hghest depee u level of schael cpmpkted at Use time o/deaM. boa that Mrt descrbes whether tM decedent lM decedent consdered himself or herself ro be
.
^BM grade or less IsspaM3h/HkpanlUUtino. Check M!•NO' '(Q Whne
Q No elpbma,9th-31M grade box Ntlxedenth rotSpnish/Hlspank/Utlnp. ^ Black or Afrkan American ^ Vlemamese
^ Hlgh school gradwnor GED <ompkRetl W No, rant Spanish/HhPanlUla[irso ^AmManlMlan or Alaska Native ^ Other ASlan
^ Some ulkge cretlk, put no dgne ^ Yes, Mexkan, Mednn American, Cnkano ^ Askn Indian ^ Natve Hawallan
^ bsock[e depee (ag. AA, Asl ^ Yes, Puerto Pkan ^ Chlluse
^ Guamanian or [hamprro
Bachebfs depee (eg. BA, AB, 85) ^ Yes, Cuban
^ Filipino ^ Samoin
^ Martefs degree le.g. MA, MS, MErq, MEd, MSW, MBA) ^ Yes, other sWnlshMlspanlUlatlno ^ )spawn ^ Other PaclHC Islander
Q Doctort[e (e.g. phD, EdD)or Professionaldryrce (Swcdy) ^Other (zpeclryl
!.. MO DOS OVM LLB 1D
Zl. Deceeent's Single Rau $eH-pesgwdon -Check ONIY ONE to Indicate what Me decedent <onsberctl himself or heneH to M. lla. Oentlen[Y Uswl Occupation ~ IMkate type of work
Whtte ^ Japanese ^ Samwn dyne duang most of working lNe. DO NOT USE RETIgED
.
Q Blxkor Afrlnn Amerkn ^ Korean ^ OMer PacHk Islander
^AmrkanlMlan or Alaska Natve ^Vletwmese ^DOn'[Know/NOT Sure Teacher
^ Asian )Mien ^ OMer Asian ^ Refuted Zlb. Klntl of Business/Industry
^ Chbese ^ NaUVe Hawallan ^ OtMr(Speclryl
^ Mnpno ^ w,mangnprcnamorra Education
ITEMS ZSe• MUSE BE COMPLETED 23x. Dan Pronou Dead Ma ay r 13 .sgn>tvre
nProrlouMing Deaf On when ap kabkl 33c
lkense Number
.
Br vERSaFF yvNO IdtDNOUNDFZ oR
~
P
1
V
13
d. Dat
s~ d o/Dw/Yrl 24. T
ime
~aM ~ N v/Q ~ Z
~
H ZS. Was MedkalEnm or Coroner COntactedT ^ Yes No
r
CAUSE OF DEATH
~ Approximate
26. Part 1. EnlertM Chain of events--dheases, Injures, or complkrtlons--that directN [+wed the dram. DO NOT enter terminal events such as cardiac arrest nerve):
Aspiratory amlSl, or venM1kularfbrlllation without shpwing tM etlobgy. p0 ABBREVIATE. Enter onN nec se onaRne. Atltl addltlowllines if necessary. 1 Onut to Death
o au
r // ~/~ ~s/i
IMMEDIATE UUSE -- -~-~-~~~~~-a a. , _~`,'C.` ~~ f ~~[v / Q~~ ~ ~.'(_ / / l~ I
(Fiwl eiseaA or conempn Due m (pr u a crosequence nrp.
resuking in death)
b
sequeMkw cast nnanbns, Die to (or a, a ronsequence oil:
d err, leasing ro the nose
Ihtetl on Ilne a. Enter the c
UNOERLTING GUSE Oue to for as a consequence of).
(tlluase x Inlury [hat
F Inl[hted the eKnts resulting d.
Cy b aeatnl case. Due m Tor as a consequence aq.
57 ZB. Part II. Enter other I Ifk diLb tdh ^I de th but not resunlry In the untleHNnt cause given In Part 1. 2T. Was an autopsy peAormldT
~ ^ Yes
28. Werc autopy fllWlnp available
E ro romokn tM nose of eeatnT
~' ^ Yes ^ No
29. If Female:
E
~ 30. DM Tobacco Un ConMbute to DeathT 31....Ma`nner of DeaM
ATM pregnant wkhin past War ^ Yes ^ ProbaMY ly natural
^ Homkide
b' Q PAgwnt a[[kne of tlratn ^ No Q.Dnknown
^ Accident ^ Pending lnvesHgatlpn
N
t
b
^
o
prgnan[,
ut pregnant wkhln 4l days of tlea[h
Suklde Q Cpuk nptMtletermined
^ Not pennant, but pregnant 43 days to /year M/orc deaM 32. Date of Injury (MO/Oay/Yr) (Spell Month)
^ Unkrawn k Pregnant wkNn Mr past year 33. Tlm<of Injury
34. Mace of Inlury le.g. Mme: conrtrunbn ske; farm; xhool) 35. Locatbn of Injury (Stmt and Number, Cky, County, State, 21p Cods)
36.Inlury at WOM1 3). I/TrtmportatbnlMury, SpetlfY: 38. DeuHbe NOw Inlury Ocnrrctl:
Q Yes ^ Ddver/Operator ^ Pedestrian
^ No ^ Paasrryer ^ oener lspxiry)
3 9x. r ~ physlcgn, cerlRkd none pr
aR
ttbrur, metllcal examiner/coroner (Chxk wN out:
q
v
Qrtnylry onN - To tM pert of my
IedN, tleaM ouurted due to tM nusalal ant manner stated.
e !
O PromuMirq 6 Crrtnying - io f my krlowkdge, tleaM xcunetl at the time, den, antl plau, and dw to the owelsl ant manner stated
.
O MMlul Examiner/EOroM t asls of epmiwtbn and/or InvesHNtbn, In my opinion, de red at tM Hme, data and place, and Due ro tnr/ryaTUn(:) an rti fated.
~
~a
/
Sigwtlax of certlfler:
Mk of certNkr: / Ucenu Number:(/r
Y
-x:33
3 9b. me, rtss and M. Co U ~~/ofpeatA Item 161 s ~ C ` , l' 39c. Dat q ~ ( /JyY/Yr)
.•//II Lv
4 0. eglrtn s Dht Nu her 41. Reghtrar's 5 nature 42. R gis[nr File Oa[e Mp ay r
4 3. AmeMmmts
Dlsoosltlon Permtt NO 0819538 Niv O'-143
/Tot)
RENUNCIATION
Cumberland
RRC'~i~TRR OF WILLS
RECCE 1.0 ~: ~ ~ ~~°;r~ pF
.'±' i 3 ERR g ~~ . ~ v ~
CLERK ~~'
COUNTY, PENNSYLV~I~,A~S
CUMBERLANC,,~rR jRA
Estate of Suzann S. Staiger ,Deceased
1, Robert M. Staiger , in my capacity/relationship as
(Print Name)
Son
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Scott A. Staiger
(Date)
~~..
(Signature) ~ ,~' /
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 retie. lO. I3.06
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this 7 ~~ day
of ~GLI`l~ ~!~
Notary Public" ~
My Commission Expires:~j'u,Q/~ lrf~ ~/~
(Signature and Seal of Notary or other official qualified t//o
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
Gail J. Mahoney, Notary Public
Lemoyne Borough, Cumberland County
My commission expires Feb, , ruary 19, 2~I4
Cumberland
RENUNCIATION
J~13 ~iAR ~ F,i
O~R~NANS' c;!~~3_~T~
REGISTER OF WILLS CiJMgERLQ~,~ ~'t;; ~~
COUNTY, PENNSYLVANIA
Estate of Suzann S. Staiger
Deceased
I, Jennifer A. Staiger , in my capacity/relationship as
(Print Name)
Daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Scott A. Staiger
(Date)
(Sign lure)
~~ ~~ L' ~~ ~ C~
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Street Address)
(City. Stale. Zrp)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ~~~' day
of rY1 G.rG~ , a0 ~~
~~-~'J
Not y Public ~
My Commission Expires: -l~~jj~~~ (~ 116
(Signature and Seal of Notary or other official qualified to `I
administer oaths. Show date of expiration oY Notary's Commission.)
CpMN(pNWEALTH OF PENNS`fLVANIA
NOTARIAL SEAL
Gail J. Mahoney, Notary Public
Lemoyne Borough, Cumberland County
Mycommission expires February 19, 2014