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PETITION F4R GRANT OF LETTERS ��
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s)named below,who isJare 18 years of age or older,apply(ies}for Letters as specified below,and in support thereof aver(s)the `
following and respectfully requests the grant of Letters in the appropriate farm: �
Richard W.Tomlinson
DecedenYs Information f��"
Name: Rhoda 1.Tomlinson File No: 21 `� �3' �11�113�
a/k/a: (Assigned by Register)
alkta: `
a/kJa: Social Security No: 177-10-0804
Date of Death: 06/07/2013 Age at Death: 97
Decedent was domiciled at death in Cumberland County, pA (Stare)with hislher la
principal residence at 100 Mt.Allen Drive,Mechanicsburg 17055 Upper Allen Township Cumberland
Street address,Post Office and 2ip Code Ciry,Township or 6orough County
Decedent died at 100 Mt.Ailen Drive,Mechanicsbur 17055 Upper Allen Township Cumberiand PA
Street address,Post Office and Zip Code City,Township or Borough Counry State
Estimate of value of decedenYs property at death:
!f domiciled in Pennsy/vania...................... Ail personal property $ 700 000.0
lfnof domiciled in Pennsy/vania................ Personal property in Pennsylvania $
!f not domiciled in Pennsytvania................ Perso�al property in County $
Va/ue of reai estate in Pennsylvania................................................................... $
TOTAL ESTIMATED VALUE � 7Q0,000.00 {
Real estate in Pennsylvania situated at 1
I
(Attach additiona�sheets,i/necessary.)
Street address,Post Otfice and Zip Code City,Township or Borough County `
{
�A. Petition for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)that helshe/they is/are the Executor(s)named in the Last Will of the Decedent,dated 02/0612009 and Codicil(s)
thereto dated
- ;
State relevant circumstances re.g.,renunciaCan,death of executor,etc.) � �.p.J
Except as follows:after the execution of the instrument(s)offered for probate,Decedent did not marry,wa�A1 rvorced,�s notc&rp to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§332�tj) �cjid n .p�_ave�h�om or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. r,,,, 1,. �-- � ._, �;r
� f't"'3 :-r; ;`�p ��
�NO EXCEPTIONS� EXCEPTIONS A �� � .-C ,��.�
� � C� �
❑ B. Petition for Grant of Letters of Administration Uf applicable) � t� �, -� �
c.t.a.,d.b.n.,d.b.n.c.t.a., r�o-lite, uran seniia.d�nte mirtoritate
If Administration,c.ta ord.b.n.c.t.a., ' ' ' ' ` ...,�.,{ � �n�` �
Except as follows:Decedent was not a party to pending divorce proceeding wherein the grounds for div had been�blis�'d�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(attach
additiona!sheets,if necessary):
i
Name Relationship Address !
Form f��N-QZ rev.10-11-2011 Copyright(c)2D11 form software only The Lackner Group,Ine. Page 1 of 2
Oath of Personal Representative �ciai Use Only
GOMMONWEALTH OF PENNSYLVANIA } -...
:�
} ss: � m �
COUNTY OF Cumberland } C'�
Petitioner(s)Printed Name Petitioner(s)Printed Address � � `� �
Richard W.Tomlinson 899 Hawthom Avenue rn � r— r-' ;:�, '��
Mechanicsburg,PA 17055 � � t"� --� '`Y r�
y N � 717-7�.�831
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The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and cor ect to the best of the knowledge and
belief of Petftioner(s)and that,as Personal Representative(s)of the Decede Pe'tion r(s)�w�i/ll weli �d t�r ,,a��drr�inister the estate according la .
Swom to or ffirmed an bscribed before �J� /���7�,�i�yy��""`,,' ��e � I'yL�
me this � t�day of ,/L�/I� Date
By: - Date
e egrster Date
BOND Required? � YES �O To the Register of Witls:
FEES: (� �°�J�
Please enter my appearance by my signature below:
Letters.......................................... � V�vV Attorney � ture:
( CC )Short Certificate(s)......... `�'jL.
( )Renunciation(s)..............
( )Codicil(s)........................
( )A�davit(s)...................... Printed Name: James D. o ar
Bond............................................. Supreme Court
Commission.................................. ID Number: 19475
Other
� C � Firm Name: Boqar 8�Hipp Law Offices
��4���ti���e, A G '�Y� �h• Address: One West Main Street
l�t�1� 1'�:D1)
Shiremanstow�,PA 17011
Phone: (717)737-8761
Automation Fee............................
�� Fax:
JCS Fee....................................... �3,�7
TOTAL......................................... $ (�1�j•"� E-mail: jbogar�bogarlaw.com
DECREE OF THE REGISTER
Date of Death: 06f07/2013
Social Security No: 177-10-0804
Estate of Rhoda i.Tomlinson File No: 21 --13- ��tP 7
a/k/a:
AND NOW, �' , � G ,in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentarv
are hereby granted to Richard W.Tomlinson
in the above estate and(if applicable)that the instrument(s)dated 02/06/2009
described in the Petition be admitted to probate and filed of record as th last Will(and Co icil(s))of Deced
I� )
R gister of Wills ��r "1��� ((,1'�,J,�
Copyright(c)2011 form software only The Lackner Gr p,Inc. � "f'�'v g of 2
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LOCAL REGISTRAR'S CERTIFICATION QF DEATH
WARNING: tt is illegal to dupiicate this copy by photostat or photograph.
�EGOR�}�f� O�F10E Ofi
Fee for this certificate, $6.00 R��',)5�~�� �jt: �rfi�,�,$ u�"",�ZH�Fp�""'�-._ This is to certify thst the information given i
���,���y�E.a FrYy�,� correctly c�pied froit� an original Certifi of Deat,
�J���3 ��� �� ��� �� ' r; duly fi•led with me as Local Registrar. origina
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'� 1zi �ertificate will t�e forwarded to the te Vita
� i�l ,'a3 Records Oftice for �ermanent filing.
C����t �t' `=_*p � . ,��*,,
P �. 9 � � � 356 �oRP�taNS� cou�T �`���9r � � �a`�� ��� � � -�U �ot3
Certification Number �,'(JMB��
�--._,MENT,aE,,,,,�� -
�.�N�} (;Q,, PA ' Local Registrar Date � ed
� Type/Prl�t In COMMONWEALTH OF VENNSY�VANIA.DEPARTMENT OG HEALTN.VITAI RECORDS
vermanent
Blacklnk CERTIFICATE OF �EATH StateF'IeN�mber:
1.DacadenYS Leasl Name(Firzt,Middle,Lest,Sufflx) 2.Sex 3.Soclal Sacurify Number 4.Date of Death(Mo/Day/Vr)( o)
om inson F. 177-10-8411 June 7 2013
�� Sa.Age-Last BlrthdaY(Yrs) Sb.Vnder 1 VNr Sc.Under 1 Da 6.Date of Birth(MO/Day/Vaar}(Spell MonLh) 7a,BiRhplace(Gity and Stacew,or�r�ForNgn Co�ntry)
Months Days Hours Mlnutes f�3 erS tOS�7I1 •-1y
`-�7 Januar 8 1916 7h,Birthplace{COUnYy) Was ton
Sa.R@sidenC!(State Or ForNgn Country) Hb.Resldence(Strtet snd Number-inclutle Api Na.) Hc.Did Oecedent Llve In a TOwnship7
Ves,decedent lived In r Allen
Btl.Ctan�er�.8nd P.
He.qesld�nce(21p Code) 7Q 0 No,dGCetlRnt Iiv�d wlthin IimiYS of
9.Ever In US Armetl FprcesT 10.Marital Stafus a[Tima of Oeath {] Merrlep [x Widowed 11.Survlving Spouse's Name(If wife.give namR prior fo first marrl?ga)
�Yes [�NO C�Unknown � Divorced Q Never Mar�letl �Unknow
12.Fath�r's Name(Fi�at,Midtlle,�as�,SuHix) 13.Mo[her's Name Prio�Co Flrst Mar�lage(First,Middle,Last)
Flo d Potter Maude I. Leatherwood
14a.MSOrmanc`s NamE 14b.Relatlonzhip fo D�ced��t 14c.I�TOrmant's Malling Adtlress(SCre�t and Number,City,State,Zip Code�
� Richard W. Tomlinson Son 899 Hawthorna Ave. Mechanicsbur PA 17
� _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _i.. aae o eac ee o e
a If Oeath Oceu�red{n s Nospitrl: ❑InpaHeeK �If DeaYh Occur�ed SqmeWhere OLfierThan a Hospltal: + []Hosplce Facility �Decedent's Ho
� � Emar sne Room/OUtpatlent � Daad on Arrival 1 Nur6�t� HOma/LOng-Term Grg Facllity Q Other(SpscHy)
15b.Facility Name(If not InstlCUtlon,eive sTreet antl�umber) i5c.CISy orTOwn,Stats,and 2Ip Code SStl.County of Oeafh
� Messiah Lifewa s Mechanicsbur PA 17055 Q.unberland
lba.MNhod of Olsposiilon � Burlal Crematlon 16b.DaCe of Dis
�' O posltion 16c.Place of DispostSlon(Name of cemefery,crematory,or other place)
� Rempvai from Stat� � Donation
p ome� so.��+�,i 06 10 2013 Holli er Cremator
� 16d.LocatlOn of Olsposiiion SCity or Town,Sfata,and Zip) i�a, nature o Fune`I Servl Ice�se r Per Charge_ollnterment 17b.Ucense Number
Mt. Holl S ri s PA 17065 Q14819
��lF'�NerSna„o...ole:er aC1111Hralc ��cy
y ci�rr�e �ome Inc. 1903 Marlce t S t., Ca�r►p Hi 11, PA 17011
� 18.�eCedenYS Educatlon-Check the box the!best tl�scrlbes the 19.Derodent of Hlspanlc Origln-Check tHe 20.Deced�nYS Race-Check ONE OR MOFE races to indlcate w
r- higM1ss[degrwe o�I�vel of scnool comO�tted aC the[ime ot death. box that best describes whethwr xhe dec�dent ilie daeed�n[considered hlmsslf o�hcrs�if to be. F
� Hth grade or less b Spanish/Hispanlc/Latino. CHeck the"NO" hitc� � Korean
0 Nn tliploma,9th-12c1i gratls box if tlecetleni is not 5
� High school grad�ate or GED com leted Penish/Hispan5c/Latlno. Black or African American O Vletnamese
Some college crotlit�bUt no de n No,noY Spanish/Hispanlc/Latino �America�Indlan or Alaska Native
O Other Asian
gree O Yes,Mexican,M@xican American,Chicano []Astsn Indlan O Native Nawa110n
O Associste tlegreE(e.g.AA,AS) O�'es,Puerto RI<an �Chin�sc
O Bachelor'a degree(e.g.BA,Ag,g5) 0 Ves,Guban O F���P��p � Guamanfan or Cham
O Master'e degr�e{e.g.MA,M5,MEng,MEd�MSW,MBA) � Yaz,otherSpanish/Hlspanlc/Latlno O lapanese O O�Fer PaclFlc Islander
0 DocforaYe{e.g.PhD�EdD)or Profcssivnal degree (Speclfy) C� OtFar(Speclfy)
.Mp DDS DVM LLB!O
21.O�cedenYS Single Race Selt-Oesignatlon-Check ONLY ONE to Intlicate whaC fhe decedeni ronsideretl himself or M1enelf to be. 23a.Decedent's Uzual OccupeNon-lndfcaYe type of
x] White O lapanesc O Samoan done durin
0 Black or African American H most of working Iife. DO NOT VSE RETIR
O Korean O Other Pacific Islander
� Q American Indian or Alaska Native O Vletnamese Q Don'i Know/NOt Sure Horricmaker
�Ch;„Q'�d�a^ C]OthGr Asian 0 Refusatl 226.Kirtd of B�siness/Ind�stry
� � 0 Native Hswailan � Other(Specify)
O F{Ilpino 0 Gu�manfan or Chamo�ro QV�l H«n�
ITEMS 29�-2 M S !CO PL EO a.Date Pronouncad Dea Mo Oay 23b.S�gnatur�o PersOn Gronoundng DBatH Only w e�app7fcable c.License Num e
BV PERSON WHO ONONOUNCES OR r
C6RTIFIES DEATH J vr-�..._ ''� 2-�L 3
23`d,.D`�e SI` g_�gd(MO/Day/Vr) �4.Tlme Of Deeth ��_ ��
� �- l 3 O'--�Z S 25.Was Medlcal Examiner or Corone�contacted7 � ves No
CAUSE OF DEATW �
26.Vart 1. Enter the cF�ain Of events--diseases,InJurfes,or com Ilcatiana--thai dlrecN � Approxtmat
V y caused the deaCh. DO NoT enter terminel evencs such as cardiac arrest, � interval:
respiraiory arrest,or ventricular flbrillarion without showing the etiology. DO NOT ABBREVIA7E. Enter only one cause on a Iln¢. Add adtlltlonal Iines if neces5ary. 1 Onsef to Dea
IMMEOIATECAVSE a. /YA1��Q�.��f�'- lI'1 F.`a�i�- ��1,u I�r �
_'_'__'�_"_"� '
(Flnal dlsease ar cond121on Du to(or ons quence of�:
.e:uiiin¢�n aeacn� b �O/E'ON�Q►2 ��t L �/� S,p �
seaucnt�a��y��st conatt�ona. � i"t/P"7'F�(' vJ 1'�G 4�..:tG _
Due Yo(or as a consequence of): ;
IT any,IeaAing to th¢cauze
liated on Iine a. Enter the �
UNDERLYING CAUSE Due to o �
(disaase or InJury thaC ( r as a consequence Of�: �
� initieSed the events resuliing d.
� in death)IAST. Due to(or as a ronsequenc�of): �
� � 26.Pir1!11. Enter otHer sbn�f��ant cuntlltl ns ib�ti t d th�but not resulting in Che underiying causG given In Part 1. 27.Was an au(opsy p Ormetl?
� y� S. (��'T��i�/A�. #"\�/PI���Q.`liZ►N �ues No
ao � 26-Wa�e copsy flndings availablG
� � C d�t�C O�9 3�'�Ite�'Ry7vF rS(��4�►1 e N 0�s4�'Y� !�t:S`f4;Sf co coOpYes the ca�se of tleatA7
29.If Female: 30.Did Tobecco Use Cont�lbute to Deaih? 31.Mann�r of D�ath No
'� � �NOC pregnsnt wlthin pasY year .
}/ s � Cragnant it time oF tleath �I Yss O Probably �NAf��ai 0 Homicltle
[7 � O Not Pregnanc,but prcanant within 42 days o£deaih � NO �Unknown � AcNdent � Pending Inveztlgatian
pregnant,but pYegnant 43 Aays to 1 year before d.eath 32.Date of In u � Sulcide � Co�ld noc be tlet¢rm{ned
_ � Unknown If pregnant within cM�pasY yaar 1 �Y(MO/Day/Yr)(Spell MonYh)
33.Time of InJury
34.Plsc�of InJury(e.g.home;construction site;ferm;school) 35.Location of In�ury(S�reeY antl Number,City,County,Sia[<.Zip Code)
� 36.Injury ai Work 37.If Transportatlon InJury,SpeclH: 38.pescriba How InJury Occurred:
� � Yes � Orlver/pperator � PedesYrian
- �No � Passengc� � pther(Specify)
39a.CeKiflp�-phyalclan,certifl�d nurse p�acHt{oner,medicsl examiner/�o�an�r(Check only one):
�:CerNTying only-To the best of my knowledQe,tleath occurred due io the<ause(s)antl manner stated.
� Pronouncing&Cer[ifying-TO the best of my knowledge,death occurretl a!the tim�,dafe,anA place,and d�e to the caus�(s)antl manner sfated.
0 Medlcal Examl�er/COroner-On the ba is f Ex Inatlon�s\d�j r InvestigaYlon,in my opinion,deaih o�c/c�urre/d��at the ilm6,tla[e,and place,and d�e co the causa(s)andr m`anner stat�d.
Slgnaturs of certifle�: �/�i��)�l� e�[A/�A�� Ttle Of certifler:_ �.l 1 lf '� LiCenaa Number:_QSs O d`y O���
396.Nam! Adtlress and 2Ip Code of P�rson CompleHng Cause of Daath(liem 26) 39c�ate Slgned(MO�Day/Y)
tA-►MS ,t9. db �- � V)1'Pr�►� . 1M�ti�'i �cs1�u ►l�a- lAd ie t3
40.Regiit�at'g OISSr{ct Num6er 41.0.egistrar's Sign 4 .R 1 ar Filc Pwte( ay
/ . o
- 43.Amendm�nit / ��i' �JG"r�
��x"oMVi�x��n 1 � � /a o�a s�
Dispos�tlon Permit No. OHS721H H105-163
- REV O]12012
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LAST WILL AND TESTAMENT c�; � , � ,_,,.� c' c:�
r, c.� ,'�
OF � ..- .. ._..
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� .,...t C_' � �`�
RHODA I. TOMLINSON �' � �% � i
o �
I, RHODA I. TOMLINSON, of Borough of Camp Hill
Count � Curr►berlan
Y. Pennsylvania, declare this to be my Last
Testament, hereby revokin an W111 an
9 y will �
previously made by me .
I • I bequeath certain �
items of my tangible personal :
property in accordance with a
written list made by me in my
lifetime. In absence of a
list or designation on the list,
then I bequeath my tangible personal
RICHAI2D W. property to mY son, !
TOMLINSON and ANN L,TI1�p,gHE �
NKA to be divided between
them as they mutually agree.
�
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II • Al1 the rest residue and remainder of m
whatever nature and wherever situate, y estate of !
I devise and '
unto my children bequeath
, RICHARD y�, TpM�,rNSON and �
in eaual shares, �N L' TIMASHENKp,, i
per stirpes � (
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SAIDIS, III . I aPPoint my son, RICHARD W.
�D��Bi this m TOMLINSON, Executor of
y Last Will and Testament . Should my son fail
� to qualify
2109 Mazket Street �r c e a s e t O
act as such then I
Camp Hill,rn appoint my daughter, A�
TIMASHFNKA to act in L.
this capacity. Neither of my personal
representatives shall be required to post bond '
jurisdiction. ln this or any
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IN WITNESS WHEREOF, I have hereunto set my hand and se I�
�
on this, the ��
day of , 2009 . '; I
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�-�_�-g��4�-D.�_..��..,-,.—� �S EAL) '; �,,
RHODA I. TOMLINSON il
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Signed, sealed, published and declared by RHODA I. TOMLINSO II
herein named, on this and one (1) other sheet of paper as an '�
tor ner Last hill and Tes�amer.t, in our �rAser_c�, :a��, in hP
presence, at her request, and in the presence of each other, �
have hereunto subscribed our names as attesting witnesses .
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. Name Address �
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`J�'ah�.-- � �-�.c,,� ,�,, � Bo� 'I �
Name �ddress'
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SAIDIS, I,
I1IVDSA� I
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2109 Market Street � I
Camp Hill>PA � ��
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COMMONWEALTH OF PENNSYLVANIA }
;
COUNTY OF CUMBERLAND �'�
}
WE, the undersigned, the Testatrix and the witnesses `
respectively, whose names are signed to the foregoin
instrument, being first duly sworn, do hereby declare to th
undersigned authority that the Testatrix signed and execute
the instrument as her Last Will and Testament and that sh
signed willingly (or willingly directed another to sign fo
her) , and that she executed it as her free will and voluntar
act for the purposes therein expressed, and that each of th
witnesses, in the presence and hearing of the Testatrix signe
the will as witnesses and that to the best of their knowledge ,
the Testatiix ;n��s a� �hat time Ei�h��en y��r� of �g� �� �1 �e.r, '
of sound mind, and under no constraint or undue influence . �
��`�`-,�--�- 9. �.�,...,�.a.,-+--�
DA I. TOMLI�SON, Testat.rix �i
; � f
� -�' �
W tness
;`�_�� � i� ���
Wltness
Subscribed, sworn to and acknowledged before me by the
Testatrix, and subscribed and sworn to before me by both
witnesses, this (,;�h day of
i , 2009 .
�
�
� a�
Notary Public
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COMMONWEALTH OF PENNSYLVANIA
SAIDIS� Y�or�e��y�k
�wER � Camp HiN Boro.CumbeASnd
�D TS� MY Commlaabn ExPiros Feb.1,�2p12
Membe►.Pr�nn�,e„�n+a Assocl�tbn NotaAes
;109 Market 3treet
Camp Hill,PA �
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