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AMQ�IDID
PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUA�BERLAND COUNTI',PENNSYLVANIA
Petitioner(s) named belov�-, who is/are 18 years of a�e 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 l�To: ��� �� �
a/1:/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,pennsvlvania (srare) with his/her last
principal residence at 801 North Hanover Street,Cariisle,PA 17013 Carlisle Cumberland
Street address,Post OfTice and Zip Code City,ToH nship or Borough County
Decedent died at Hershev Medical Center.501 Universitv Drive Hershev P A 17033 Derrv To�unshio Dauohin PA
Street address,Post Office and Zip Code Cit�•,Township or Borough Count�• 5tate
Estiruate of value of decedent's property at death:
/f do�niciled i�:Pe�rr:s��/vania..... . ... ... .... . ... . . . . ... . All personal property $ 90,000.00
If�eo�dorniciled in Pe�msylvm:ia. . .. ... . .... .... ... ... . . Personal property in Pennsylvania $
If rxot do�nici[ed irt Per:ns}�h�ania. . . .. . ... . .. .. . . . .. ..... Personal property in County $
Value of r•eal estate in Peirns��h�ania.. ... . ....... . . . . . . . . .. . ...... ... . ... . .. ... . .... . ... ..... $
TOTAL ESTIA'IATED VALUE. .. . $_ 90.000.00
Real estate in Pennsylvania situated at: N/A
(.9ttaclv additional sheets,if necessaryJ Street address,Post Of6ce and Zip Code City,To��nship or Borough Count}•
0 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 May 24, 1999 and Codicil(s)
thereto dated
State relevant circumstances(e.g.renunciation,deativ of exeeutor,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�rounds 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 victim of a killiiig vor ever adjudicated an ivcapacitated person.
Q NO EXCEPTIONS Q EXCEPTIONS
0 B. Petition for Grant of Letters of Administration (Ifapplioable)
c.t.a.,d.b.n., d.b.,�.c.t.a.,pe�adente lite,durante absentia,dz�rar:te miiloritate
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 divorce had been established as defined
in 23 Pa.C.S.§3323(')and was neither the victun of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTiONS �EXCEPTIONS
0
Petitioner(s),after a proper search has/have ascertained that Decedent]eft no Will and was survived by the fo�wing spouse�ny)a�t�ts(attach
additional slzeets, if necessart-�): G t`�
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Name Relationship Ad�re3fi � ""; �
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Form Rrr-o� ,-�,�.��i�v�ol� Page 1 of 2
Oath of Personal Representative O�cial Use Onl}
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COMMONWEALTH OF PENNSYLVANIA , G �
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COUNTY OF Cumberland ) � � � � -� �
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Petitioner(s)Printed Name Petitioner(sj Priirted Address � � %'� `='
c� o � 3 "' -=�
Denise E.Jose h 2062 South oint Drive,Hummelstown,PA 17036 —
. � � �
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Tl�e Petitioner(s)above-named swear(s)or affirm(s)tl�e statements in the foregoiog 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 the estate according to law.
Sworn to a Zed an scr b d Ue�^re � Date ✓��Jf�l'�
me this o , �(J�� Date
By: Date
r tk Re�tster Date
BOND Required: Q YES Q '.VO To t1�e Regrster of Wills:
FEES: Please enter my appearance b�� my signature below:
�,�e� o0
Letters . . . . . . . . . . . . . . . . . . . . . $ �, Attorney Signature:
( ) Sl�ort Certificate(s). . . . . .
( I ) 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 VVest Governor Road
• • • • . • � � Suite20l
. . . . . . . . Hershev,PA 17033
. . . . . . . Phone: (717)533-7113
Automation Fee. . . . . . . . . . . . . . . Fax: (7171 533-7233
� JCS Fee. . . . . . . . . . . . . . . . . . . . . Email: z etPr(g��nnPC-hPnnin�er c�m
TOTAL. . . . . . . . . . . . . . . . . . . . . $ �"8� v
�. 6 O
DECREE OF THE REGISTER
Estate of Doris L.Ders' File No: ,�� �� —^����
a/k/a: ` �!/�
Al�'D NOW, \� ' /�/�'� J � � , �CJ� , in co � tion of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Le ters �/�tQ
are hereby granted to / '
in the al�QVe estate and(if applicable)that
the instrument(s) dated G{
described in the Petition be admi d to probate and filed of ec �d as the last Will(a d odicil(s)) of Decedent.
jr
e ster of Wills
Form RiT'-0_' rev. ]O,�II,C011 P2g Of 2
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RENUNCIATION ;�� � ��
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.� c� � c�'n �y-, �°
REGISTER OF WILLS .� o
CUMBERLAND COUNTY,PENNSYLVAI�IIA �� o -� � �
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Estate of Doris L.Dersin ,Deceased
Z, Muryl E.Dersin,II , in my capacity/relationship as
(Priut Nan�e)
executor/son of the abo��e Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters Ue issued to
Denise E.Joseph
�
�/»��y . � `�
(Daie) (Sigrinnrre)
2703 Loch Haven Drive
(5n�eer Address)
Ijamsvi11e,1vID 21754
(Crly,5rale,Zip)
Executed in Register's O,ffzce Executed oret ofRegister's Office
Sworn to or affirmed ai�d suUscribed Before the undersigned personaliy appeared the
before me ehis day party executing this renunciation and certiiied
of , that he or she executed the renunciation for the
puxposes stated within on this day
of N � al
otary Pubiic
ery County, Maryland
ires 07-20-2016
Deputy for Register of Wills Notary Puhlic
My Comnlission Expires: Q'1-�0 040)�
(Signature and 5eal ofNotary or other official qualificd to
udminister oaths. Shon�Jate of eapiratiou of T�sotaq�'s Commission.)
Farn�R1Y-06 rev.10J3.06