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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 py�
Name: Marie L.Hall File No: �� '�^ � � Ov
a/Wa: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 208-38-6671
Date of Death: July 26,2013 Age at death:g9�
Decedent was domiciled at death in Cumberland County,pennsylvania (Srare)with his/her last
principal residence at 770 Vista Drive Cama Hill Cumberland
Street address,Post OfTce and Zip Code City,Township or Boroug6 County
Decedent died at Manorcare Health Services 1700 Market Street Camp Hill Cumberland PA
Street address,Post OfTice and Zip Code City,Township or Borough County State
Estimate of value of decedenPs property at death:
If domiciled in Pennsylvania............................ All personal property $ 980,100.00
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsy/vania. ....................... Personal property in Counry S
Value of real estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE. ... $ 980.100.00
Real estate in Pennsylvania situated at:770 Vista Drive Camp Hill Cumberland
(Atmch additiona!sheers,i/necessa�y.J 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 July 2, 1987 and Codicil(s)
thereto dated
State relevant circumstances(e.g.renunciallon,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.
Q NO EXCEPTIONS Q EXCEPTIONS
� B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,peiadente lite,durante absentia,durante minoritate
r-.ti
If Administration,c.t.a. or d b.n.c.�a.,enter date of Will in Section A above and aE�nplete list�heir�, �
rn
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for�'cor�had bee�5tablidped�§defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated pers�. 'i3 � � �.1
� n _.� C7
Q 1V0 EXCEPTIONS Q EXCEPTiONS � ��„� `� �
�
Petitioner(s),after a proper search has/have ascertained that Decedent left no W ill and was survived by the fct�p�QifOg g�use(if any)a�h�s(attach
additro»al sheets,ifnecessarv): p � � T.J ^rq "'r7
� _ "'01
Name Relationshi A,�d�r " [�
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Form RW-02 rev.10i11/20!! Page 1 Of 2
��
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
;n oZ i ` U. �'r i✓e .2.Z �-Z
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 Pet � ner(s)w� e�nd t ly � ster the estate according to law.
Sworn to ar affirmed subscribed before � � ��. ___ C � Date � /U�✓ ���
me i � � day o `� � � �� �ate
$y: �( r � '� Date
For the Register Date
BOtiD Required: Q YES Q NO To the Register of Wills:
FEES' Please enter my appearance by my signature below:
Letters. . . . . . . . . . . . . . . . . . . . . . $ lX�V•� Attorney Signature:
( � )ShortCertificate(s). . . . . . �O•c�
( )Renunciation(s).. . . . . . . . � ,�
( )Codicil(s). . . . . . . . . . .. .
�-..:
( )Affidavit(s).. . . . . . . . . . . �' �7
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: � `-`' '� m
Commission. . . . . . . . . . . . . . . . . . Supreme Court
� � � � �
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Other . . . . . . . . ID Number. � C U'� %�
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i� . . . . . . . �5• a ''��,�, � � �"z"E C z'�
. . . . . . . . �-�'j,{�� Firm Name: b. � -r, � � ~�
. . . . . . . . Address:
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. . . . . . Phone: � � t!) �_
Automation Fee. . . . . . . . . . . . . . . ,-��,(� Fax: � �
JCS Fee. . . . . . . . . . . . . . . . . . . . . . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . � `���i_ .
DECREE OF THE REGISTER
Estate of Norman File No: pG�'��—����
a/k/a:
AND NOW, I.:v� ,in consideration of the foregoing Petition,
satisfactory proof having b n presented before me,TT I D CREED tha Letters
are hereby granted to
i he above estate and(if applicable)that
the instrument(s)dated
described in the Petition be admit d to probate and filed of record as the last Will(and Codicil(s))of Decedent.
! ,
Register of Wills 4 -•
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For,n aw-oz ,-ev. roi�UZnll Page 2 of 2
H105.R05 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
REC4�t��.i� :;��I:;� OF
Fee for this certificate, $6.00 �--n 'i! �$ This is to certify that the information here given is
R�.G1Si�..� 4� �s�s- ��'"'p;`ZHOFpF'
a�,a'�t�, iy,y: correetly copied from an original Certificate of Death
C� � �� `,�� _ _`rG` duly filed with me as Local Registrar. The original
��(j l� ��Q� �7 f � � „� �� =_� s� certificate� will be forwarded to the State Vital
` ;o
,� -� ag Records Office for permanent filing.
� CLERK �� �* _ *,,;
P � � � ..� Q 4 � � �°_°�'.� �" ?�� JUL 2013
ORPNANS COU�i _q E.�,P~,, Z 7
,
9lMfNT� ;���'"
Certification Number CUM$ER�-A�� �`�" P� """����� Local Registrar Date Issued
5 Type/Print In COMMONWEAITH OF PENNSVLVANIA•DEPARTMENT OF HEALTH�VITAL RECORDS
Pe�ma"e"` CERTIFICATE OF DEATH
� Black Ink 5[ate File Number:
1.Decetlent's Legal Name(First,Mfddle,Last,Suffix) 2.Sex 3.Soclal Security N�mber 4.Date of Death(MO/Oaytyr)(Speli Mo)
Marie L. Hall Femal 208-38-6671 Jul 26 2013
Sa.Age-Last Birthday(Vrs) Sb.Under 1 Vear Sc.Untler 1 Da 6.Date of Birth(MO/Day/Year)(Spell Month) 7a.Birthplace(City and 5[aie or Foretgn Country)
Months Days Hours Minutes Broterode CiErC[1'dI1
9Ei D2Cember' 1 1913 76.Birthpla<e�co�„zYy
Sa.Reside�ce(SSate or For¢ign Co�ntry) 86.Residence(Streei and N�mber-Inclutle Apt No.) 8c.Did Decedent Live in a Township? . . �..
{� Pa � OYes,decedent Ilvetl in � t�yp.
/ � Sd.Residence(COUniy) 77� V1S t3 I}r1VE ryo,decedent Ilved within limits of �+ca�a�4+ E�-11
� CiUI17�Er1$L'ld 8e.Resldence(21p Cotle) 17 1 city/boro.
9.Ever in U��med Forces7 10.Marital Sfatus a[Time of Death Q Marrled Widowed 11.Surviving Spo�se's Name(If wlfe,give name prior to flrst marriage)
�ves {S]No 0 Unknown �Divorced �Never Married �Unknow
12.Father's Name(Firsl,Middle,Last,Suffiz) 13.Mother's Name Prio�to First Mar�iage(Fl�si,Middle,Last)
Gustav Ledermann So Yiie Oschmann
14a.Informant's Name 146.Relationship to Oecedent 14c.Informant's Mailing Adtlress(Street and Number,City,State,Zip Code)
p 2 2
rj . 15a.P ace o Deat C e4k p�n y one . . � .. : � �
'"""".............."""""""'"""""'""'"............ .........'""""'""....""".........�.........................""""""""..........'""' ...........""""'""..."""'""''
... '""'............"'..............."'...""""""""""""...'""'""""......."
if Death Occurred In a Hospital: Inpat{ent [If Death Occu��ed Somewhere Other Than a Hospital: C]Hospice FaciiiTy � �Decedent's Home
� 0 Emergen�cy Room/OUtpatlent � Oead on Arrlval �Nursing HomelLOng-Terrn Care Facllity �O[her(Specify) �� �
� 156.FacillSy Name(if not insi{tution,give street and nUmber; iSC.City or Town,State, d Zip Code 15d.CounLy of Death . �
Manor Care Hill Pa 17011 C�unberland
16a.Method of�ispositlon 6�rial 0 Cremailon 166.Dafe of Dispositlon 16c.Place of�ISposiclon(Name of cemetery,crematory,or other place)
� [�(tem val from State �Donatfon � . .
.� oOther(SPecify) Au ust 1 201 La.keview Cemetery
i16d.Locetlon of DlsposlUOn(City or Town,State,and Zip) of Funeral Service�I e erson In�CNarge of Interment 17b.License Number
� New Canaan Ct.06840 011654-L
E 17c_Na�me and�COmplete Address of Funeral Facility .
e m 1 O Marlcet treet '11 Pa 170 1
18.DeceAent's Educatlon-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the ZO.Decatlent'S Race-Check ONE OR MORE races to indicate what
`- highest degree or level of school completed at the time of death. box that best tlescribes whecher the decedent the decedenc considered himself or herself co be.
� 8th grode�or less ls Spanish/Hlspanic/Latino. Check the"NO" [XWhite � 0 Korean
� No diploma,9fh-12th grade box if decedent is noi Spanish/Hispanic/Latino. 0 Black or African Amertcan Q Vietnamese
� High school graduate or GEO compieted �]No,not Spanish/Hlspantc/La�ino 0 Ame�tcan Indian or Alaska Native � Other Asian
� Some college cr�dit,but no degree �Yes,Mexican,Mexlcan American,Chicano �Asian Indtan Q Native Hawailan
� Associa[e tlegree(e.g.AA,AS) �Ves,Puerto Rtcan �Chinese � Guamanian or CM1amor�o
�Bachelor's tlegree(e.g.6A,AB,BS) �Ves,Cuban 0 Filipino � Samoan
Maste�'s tlegree(e.g.MA,M5,MEng,MEd,MSW,MBA) O Yes,othe�Spanish/Hispanic/La[ino �Japanese Q Other Paciflc Islander
� DoctoraSe(e.g.PhD,EdD)or Professional tlegree (Specify) �Other(Specifyj
.MD DDS OVM LLB JD
21.Deredent's Singie Race Self-Designation-Check ONLV ONE to indicate what the decedent considered htmself or herself to be. 22a.Decedent's Usual Occ�pation-Indicate type of work
�lNhite �Japanese Q Samoan do�e d�ring most of working iife. DO NOT USE ftETIRED.
�Black or African American �Korean �Other Paclfic Islantler
�America�indian or Ataska Nafive 0 Vleinamese Q Don't Know/NOt Sure Teacher
Q Asian Indian �Other Astan 0 Refused 226.Ktntl of Business/Industry
�N O ent�ese p Nau�e Hawana., p orne�(sPec�ry)
o F���P�^a O Guamanlan or Chamorro Barnard Colle e
ITEM 23e-23d MVST BE COMPIETEO 23a.Date Prono�nced Dead(MO/Day/Vr 23b.Stgnature of Person Pronouncing Death(Only wh@n applit3�le) 23c.Lice�se N�.mber
BV PERSON WHO�PRONOUNCESOR O ?�� t +Y n- • 3� �_
CERTIFIES DEATH �� /'_ �� �� �� ���v .� p
23d.Date Signed Mo/Da /Yr) 24.Time of Death �/�� Cw� O
0 � � ( ��.�.-' �� !r��1 25.Was Medical Ezaminer o�Coroner Contacted7 0� Ves � No � �
� � CAUSE OF UEATH � � � qpp.,.ox;,,,a�e
26.Part 1. Enter the chaln of e ents--diseases,injuries,o mplicatlons-that tlirectly caused[lie death. DO NOT enter terminal events s�ch a ardiac arrest Interval:
. respiratory arrest,or ventricular fibrillation witho t showing the e logy. DO NOT ABBREVIATE. Enter only one ca�se on a ilne. Add adtlitional li�es if necessary Onset to�eath
o =
.�.A� � - 1 :
IMMEDIATE CAUSE --------------> a. � N!\v v V Q AJ ' '
(Flnal tllsaase o ontll[lon �u o(o s seq�anc�oI):
resultlnB�n death) b_ I� _\ .�� ��'��c � ���i
�-�G� \V�
Sequentialiy Iist conditions, ��,DUe to(or as a consequence of): �� � � � �
if any,leading to tfie cause � � �
Ilsted on Ilne a. Enter the c. �
UNOERlVIN6 CAUSE Due to(or as a conseq�ence of): \\ � /� � �
� (disease or injury thai �� � n A� �`� . �� � �J \.� /� � � � �
Ini[iated the evenxs resulxing d. �� JCX �t�-(�--�-��\/1
s In death)LAST. Due to(or as a consequenc o): � �
r'i
s 26.Part 11. Enter other sisnificant conditlons contributine to death but not resulting[n the underlying cause given in Part I � � 27..Was an autopsy p rtormed?
�
� Yes No
� . � 28..�Were copsy flntl��gs available
� � to compleGe the ca s of deaih?
� Yes e No
� 29.If Female: 30.DId Tobacco Use Contribute to DeathT 31.Manner eath
e �t pregnant within past year 0 Yes � Probably at�ra� 0 Homicide
� Pregnant at Hme of death � No J�-VITRnown � Accldent Q Pending Investtgation
0 NoS pregnani,but pregnani within 42 days of dea(h � Suicide 0 Could not be determined
� � Not pregnanf,but pregnant 43 days to 1 year before death 32.Date of Injury(MO/Day/Vr)(Spell Month)
� Unknown If pregnant within the past year 33.Time of Injury
34.Piace of Injury(e.g.home;constructlon site;farm;school) 35.LocaUOn of Injury(SYreet and Number,City,Stafe,Zip Code)
36.InJury at Work 37.If Transportation InJury,Specify: 38.Describe How In)ury Occurred:
0 Ves �Driver/Operator Q Pedestrian
� No 0 Passenger � Other(Speclfy)
39a.C r(Check only one):
Certifying physician-To the best of my knowledge,death o�curred tlue to the cause(s)and m r siated
Pron ncing�Certifying physician-To the best of my knowledge,death o red at[he time,date,and piace,and tlue to the c e(s)antl m sYated
� Medical Examiner/COroner-On of examination,antl/or investlgationr(n my opinion,death o r d ai the time,date,and place,and duerto th ( )a�d mann�r stated
Slgnature of certlfier. TIHe of certlfler:� License N�mber.����Y Z��� ��
39b.Nam�,Atldr¢ss a pleting Cause of�ea2h(Item 26) � 39c.Date S�grvetl M /Day/Vr) .
� � �c 8 .ro � � � fo,�i.�d C��riw llr�, ,Q:� i�b/� � a� I3
40.RegisCrar'�s Distri�ct Number 41.Registrar's nature 42 � egistr File Oate(MO DdY/'�r).
/ - ��� L?/� ..7 .�?o /
43.Amendments ' - .
O
�
H105-143
Dispositlon Permit No. �� � �(�_� REV 07/2011
Hall; 5/5/87; D40
��t k �i11 � � t�m t
� �n C�1 � Pn
I , MARIE L. HAZZ, of Camp Hill , Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make , publish and declare this as and
'! for my Last Will and Testament, hereby revoking and making void
any and all former Wills, Codicils, or writings in the nature
thereof, by me at any time heretofore made .
FIRST : I hereby order and direct my Executor ,
' hereinafter named, to pay all my just debts, funeral expenses,
' testamentary expenses and all Inheritance , Estate , Transfer and
'' Succession Taxes, as soon as may be conveniently done after my
death, out of my residuary estate .
SECOND: I give , devise and bequeath all my property
: whatsoever and wherever situate unto my husband, CHARZES S. HAI,L,
��.,
to be his absolutely. � �� � �
� ° �' � c.�
THIRD: Should my husband, CHARZES s . HAI,I,� �.� 1� �'� .�'
a �
' � j:;, t-- :�
� '"' � Q'S ,,., ��
; survive me , I give my entire estate as follows: � �, x� _
.�_ _ ,r: c>
C7 � �, -rf -t �?
a. T o my daught e r , MARGARET SUSAN HALI,, 1 Q�� -;•� =� =
c� � � c�
b. To my son, NORMAN CHRISTOPHER HAZI,, 90`�q.; � � f ��
;,
,:- ��-, �' -,�
= or to their issue if they should predecease me .
�
� FOURTH: Should any beneficiary take under the terms of
; j
.
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Hall; 5�5/87; D40
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this Will while a minor , I appoint Farmers Trust Company, of
f
' Carlisle , Pennsylvania, to be the Guardian of the estate of such �
�
�.
� minor , with full discretion to use principal as well as income '
for the benefit of such minor .
F
I,ASTLY: I nominate , constitute and appoint my husband ,
(
CHARI,ES S. HALZ, to be the Executor of this my I,ast Will and
' Testament . Should my husband , CHARLES �. HAI,L, be unable to act,
'' I appoint my son, NORMAN C. HALI,, to act as Executor . No
Executor shall be required to file bond .
IN WITNESS WHEREOF, I have hereunto set my hand and
r
! seal this � �e� day of � 1987.
� ���
� /`' t' ���j�
%�;�,�c�"�1( � �`:���._-...'(SEAL)
Marie I,. Hall
SIGNED , SEALED, PUBI,ISHED and DECZARED
' in t presence of:
/� � � � 1
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C MMONWEALTH OF PENNSYLVANIA )
ss.
': COUNTY OF CUMBERLAND )
I , Marie Z. Hall, Testatrix, whose name is signed to
' the attached or foregoing instrument, having been duly qualified
! according to law, do hereby acknowledge that I signed and
';, executed the instrument as my Last Will; that I signed it
` willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
- 2 -
Hall; 5/5/87; D40
;
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Sworn or affirmed to and acknowledged before me , by °
- Marie L. Hall, Testatrix, this �? �� day of , 1987. (
J /��� �
//J ��/y/�.py"/'} /, ` �{',/^ ��`-�����(/+/f� f
f I. �-i..+Y��'C�� r'i ( ' , „ �L"l���'i f
Testatrix
t� � .��V, -{�..,,� ,��. f l%�.
No� ary i
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COMMONWEAI,TH OF PENNSYI,VANIA )
ss.
` COUNTY OF CUMBERZAND )
W e , �.�° '�.r.-. �.%5 '�j. � c��..�.��-��- an d
,---
���C�.-YY.,.c��, ��. �- ' � � ,�1.� `�� , the witnesses whose ;
na s are signed to the atta�hed or foregoing instrument, being
` duly qualified according to law, do depose and say that we were
'; present and saw Testatrix, Marie Z. Hall, sign and execute the
instrument as her I,ast Will; that she signed willingly and that
�! she executed it as her free and voluntary act for the purposes
' therein expressed; that each of us in the hearing and sight of
' the Testatrix signed the Will as witnesses ; and that to the best
of our knowledge the Testatrix was at that time 18 or more years
of age , of sound mind and under no constraint or undue influence .
Sworn or affirmed to and subscribed to before me by
� ,T �
�--�C>..-.....-,•�:: �;� ��o�...� ��, and '����.--�.��, `�:> ,r\ c.��.��--ti ��'�
' th s � �� e', day of .,�y,� 1987• ^ �
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i ess
' W tness
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