HomeMy WebLinkAbout01-03-05 ?ETITION FOR PROBATE aad GRANT OF LETTERS
also known as To:
Register of VC/,lls for the
, Deceased. County of G~/Yi~'¢~At07/) in the
Social Security No. ~tg- ,_~.,_ ~ ~ ~--~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of a~g.e or older an the execut~/I(~<, named
in the last will of the above decedent, dated ~A ~ /5/, /~'F~ ' - - 19
and codicil(s) dated ' '"' / ' ' ~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Ct,//tt'~'~E(~/AJ./-
(list street, number ~d muncipality)
Decendent, then. ~ years ofag,, died ~C~F~
Except as ~ollows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) ~1 personal property $ /~
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Person~ property in County $
Value of real estate in Pennsylvania $.
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters 4-~'~ ~td~t'~j77~
theron. (testamentary; atlministration c.t.a.; administration d.b.n.c.t.a.)
~ ~ ~/o ,Yr. ,~ ~Zug ~/ff~W~ ~~ '~
OATH OF'PERSONAL REP~SENTATIVE ~ "
CO~ONWEALTH OF PENNSYLVANIA ) ~
COUNTY OF ff ss
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and be~ef of petitioner(s) and that as personal represen-
t ative(s) of the above decedent petitioner(s) will well.and truly ad~is~er t~ est~e according to law.
~worn to or affirm~and subscribed ~ ~ff.~~~J J/~'
before me this ff day o~ / w ~
21-'o5
'~ ~' OF PROBATE AND G~NT OF LET~RS
~ ' been vr~s~n~d
iT iS DECP~ED that the instrument(s) dated -
described therein be admitted to probate and filed ot record as the last will of -
and Letters ~
are hereby granted to ~ ~ k~ t ~
FEES
Probate, Letters, Etc ..........
Sho~ C~ificat~s( ) .......... $ A~ORNEY (Sup. Ct. I.D. No.)
Renunciation ................
$ ADD.SS
TOTAL ,. $
Filed .................... : .... .......... PHONE
~ ~ ~egi~ter n£ !~9i!!~ nf Cumh~rianb
OATH OF NON-SUBSCRIBING WITNESS
Also known as
__, Deceased
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
~ ~ familiar with the signature of ~[~-Q~J/~ ~. ~.F~qK'J ~ testatOr.tX'of
one of the subscribing wimesses to) the codicil/will presented herewith and that ~d/believes
( ..~ ~
the signature on the codicil/will is in the handwriting of O~/0]dl~ ~. /tJOP'[~t/
to the best of ~1~ i~ knowledge and belief.
(Address)
~om ~a~me~an~ubscnbed _
~_~ ~ ~ [ ~ day ot
,2005
For the Register ~' ~~ ~- (Addr~s)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
H105112 REV $/88
(FEE FORTHIS TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
CERTIFICATE S200) COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CErn. m. T 5 7 917 6 7 ~ecembe~ 19 2004
Jennie B. Hoffman
Name of Decedent
First Middle Last
Female 200-36-0495 December 16,2004
Sex_ Social Security No. Date of Death
July 19,1910 Menallen Twp., Penna.
Date of Birth Birthplace
Holy Spirit Hospital Cumberland Co. Camp Hill Pennsylvania
Place of Death
Facility Name? County City. Borough or Township
W-bite Homemaker NO
Race_ Occupation Armed Forces? (Yes or No)
Widowed Decedent's 4905 East Trindle Road, Mechanicsburg, Pa. 17050
Marital Status Mailing Address
Nurube~ Street City or Town State
Betty Adams Laura G. Rothermel
Informant Funeral Director
Name and Address of Rothermel F.H. 25 W. Pine St Palmyra, Pa. 170~_~n~
, · , 0 ~ --'~ ~"~
Funer,al Establishment r~:o c--
!~.?~_ terv~Bet~
Part h Immediate Cause i..~zj~nset and
-'-' 5~--o ~O
la) Hypoxia <~ ~ ~
Advanced Age _~ ...H --
lb)
o-~c~
Rectal Bleed , c:~
lc) '
Dementia
Part Il: Other Significant Conditions
Manner of Death Describe how injury occurred:
Natural [~( Homicide
Accident ~ Pending Investigation []
Suicide [] Could not be Determined
Steven A. Prophet
Nam(; and Title of Certfier
(M.D., D~O., '"~-^ , .....
888 Poplar Church Rd., Camp Hill, Pa.
Address
This is to certify that the information here given is correctly copied from an original certificate
of death duly filed with me as Local Registrar. The,qri~inal certificate will be forwarded to the
State Vital Records Office for permanentfiling.~~~.Z~ ~ ~,.~ 38-357
-- Local Reg~sPar of Vital Records District NO
December 19,2004 159 N. Railroad St., Palmyra, Pa. 17078
Dat~: Rece~¢ed by Loca~ Reg, 3r3~ ~lreel Address City Borough, Township
I, JENNIE B. HOFFMAN, of the Township of Lower Allen, County
of Cumberland and Commonwealth of Pennsylvania, do hereby make,
publish and declare this to be my Last Will and Testament, hereby
revoking and making void all former Wills by me at any time
heretofore made.
FIRST: I give, devise and bequeath my entire estate in equal
shares to my grandchildren per stirpes.
SECOND: I direct that all taxes which may be a~s~eac3n
consequence of my death, of whatever nature and by~._~te?~r
jurisdiction imposed, shall be paifl fz-o~a ray ~-es-,duary esta~_
part of the expense of the administration of my estate.
THIRD: I nominate, constitute and appoint BETTY H. ADAMS, and
ELIZABETH HOFFMAN, co-Executrices of this my Will. No personal
representative shall be required to post bond or furnish surety in
this or any other jurisdiction.
IN WITNESS WHEREOF, I have to this Will, hereunto set my hand
and seal this ;~,day of ~ ,
1996.
hnie-B'.' H~fman
Signed, sealed, published and declared by the above-named
Testatrix, JENNIE B. HOFFMAN, as and for her Last Will and
Testament, in the presence of us, who, at her request and in her
presence and in the presence of each other, have subscribed our
names as witnesses thereto.
/
~~/ ~/_~.~,~ residing at
-~'"~'~"/~-~~~~c~ residing at