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AN�3�IDID
PETITION FOR GRANT OF LETTERS
REGISTER OF WLLLS OF CUMBERLAND COUNTI',PENNSYLVANIA
Petitioner(s) named belov�-, 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 / � , `�
l�Tame: Doris L.Dersin File 1�To: �� �� ��7
a/l�/a: Doris Louis Dersin (Assigned by Register)
a/1Ja:
a/k/a: Social Security No:
Date of Death: October 2, '013 Age at death:90
Decedent was domiciled at death in Cumberland County,pennsylvania (srare) with his/her last
principal residence at 801 North Hanover Street.Carlisle.PA 17013 Carlisle Cumberland
Street address,Post Office and Zip Code City,ToN nship or Borough County
Decedent died at Hershev Medical Center.501 Uni��ersitv Drive,Hershev,PA 17033 Derrv Township Dauphin PA
Street address,Post Office and Zip Code Cih•,Township or Borough Count�• State
Estunate of value of decedent's property at death:
/f dnmiciled in Perens��lvania..... . ... ... .... . ... . .. . ... . All personal property $ 90,000.00
If�ro1 domiciJed in Pe�r�rsylvmeia. ... ... . .... .... ... ... . . Personal property in Pennsylvania $
If�:ot domiciled in PennspJi�ania. ... ... . .... .... ... ... . . Personal property in County $
Value of r•eal estate in Penns}�Zrania.. . .. . ..... ... ... . .... . . . . . . .. ... . ... ... ... . ........ .... . $
TOTAL ESTIMATED VALUE. . . . $ 90,000.00
Real estate in Pennsylvania situated at: N/A
(.9ttnclv additional sheets,ifnecessa�y.) Street address,Post Otfice and Zip Code City,Toa nship or Borough Counh
Q A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)he/sbe/they is/are the Executor(s)named in the last Will of tbe Decedent,dated May 24, 1999 and Codicil(s)
thereto dated
State relevant circumstances(e.g.rer:unciatio�i,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 apending
di�orce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. 5 3323(g),and did not have a child born or
adopted;and Decedent was neither the victun of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS Q EXCEPTIONS
0 B. Petition for Grant of Letters of Administration (If applicable)
e.t.cz.,d.b.»., d.b.n.c.t.a.,pendente]ite,durmtte abserrtia,duratite mir�oritnte
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 di��orce 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.
Q NO EXCEPTIONS �EXCEPTIONS
ca
Petitioner(s),after a proper search has/have ascertained that Decedent]eft no Will and was sun�ived by the fo�wing spouse�e�y)ar�t�Fs(attach
additioi�al slieets, i�'necessan): � p � � �
� 7p � -
Name Relationship A/'6�rEit �' ""� �
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Form RiP-o� ����.�oir�i�o» Page 1 of 2
Oath of Personal Representative Official Use Onl}�
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COMMONWEALTH OF PENNSYLVANtA } � O � � �
} S S: €s3 -.�o -- °
COUNTY OF Cumberland � �� �
} -��'r. � r-�— rv °`� °
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Petitioner(s)Printed Name Petitioner(s)Printed Address -�"-' � %'� `-'
C'� Q � � `" "T�
Denise E. Jose h 2062 Soutli oint Drive,Huminelsto�vn,PA 17036
. � G`� tP'—'
� �
The Petitioner(s)above-named swear(s)or affirm(s)tl�e statements in the fore�oing Petition are true and correct to the best of the knowledge a�d belief
of Petitioner(s)and that,as Personal Representati�e(s)of the D edent,tl etitioner(s)will well and truly administer tl�e estate according to law.
Sworn to a �ed an scr b d be�^re � Date ✓��J'���
me this o , �(J�� Date
By: Date
r t!i Register Date
BOND Required: Q YES (Q NO To the Register of WiAs:
FEES: Please enter m�� appearance by my signature below:
aQ� �/� 00
Letters . . . . .��. . . . . . . . . . . . $ o�J, Attorney Signature:
( ) Short Certificate(s). . . . . .
( f ) Renunciation(s).. . . . . . . . 'd D
( ) Codicil(s). . . . . . . . . . . . .
( )Affida�it(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: Peter R.Henninger,Jr.
Commission. . . . . . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . 1D Number: 44873
. . . . . . . Firm Name: Jones&Henninger,P.C.
. . . . . . . . Address: 339 West Governor Road
. . . . . . . . St�ite?Ol
. . . . . . . . Hershey,PA 17033
. . . . . . . Phone: (717)533-7113
Automation Fee. . . . . . . . . . . . . . . Fax: (7171 533-7233
�. JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: etPr �nnPC-hP.nningPr r.nin
TOTAL. . . . . . . . . . . . . . . . . . . . . $ $b$'
�. 6 O
DECREE OF THE REGISTER
Estate of Doris L.Dersin File No:
alk/a:
Al�'D NOW, , , in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to
in the above estate and(if applicable)that
the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills
Form RiT=O_' rev. 10,�11!'011 Page 2 of 2
� 0
RENUNCIATION �� � �h
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R�GISTER OF WILLS .� � �� �n _r� o
CUMBERLAND COUNTY,PENNSYLVANIA � � o -D ��;; Q
o e `n � _`� �r
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Estate of Doris L.Dersin ,Deceased
I, Muryl E. Dersin, II , in my capacity/relationship as
(Priiit Nanee)
executor/son of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Denise E. Joseph
�/��J�� . ��%,��'' �
(Date) (SignahrreJ
2703 Loch Haven Di-ive
(Streer Addirss)
Ijatusville,NID 21754
(clry,srare,zipj
Executed i�t Register's�f,fice Execiited otrt ofRegister's Office
Sworn to or af�rmed and subscribed Before the undersia ed personally appeared the
before me tliis day party executing this renuiiciation and certii`ied
of , that he or she executed the renunciation for the
purposes stated within on this day
of N � al
otary Public
ery County, Maryland
ires 07-20-2016
Deputy for Register of Wills Notary Public
My Commission Expires: Q"1-�0 04�)6
(Siguslure and Seul ofNotary or other official qualifieJ to
administer oaths. Sho��'Jate of eapiraliou of TQotaq�'s Commission.)
FarmRli!06 rev.1D.J3.06