HomeMy WebLinkAbout04-12-05
PETITION FOR PROBATE & GRANT OF LETTERS
Estate of KATHRYN F. SURFIELD
also known as
, deceased.
No. 21-05- 33'[(
To: Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
Social Security No. 196-14-3170
The Petition of the undersigned respectfully represents that:
Your Petitioners, who are 18 years of age or older and the Co-Executors named in the Last Will of the
above decedent dated N/ A , and codicils dated none . The Executor named ...D.Q!]g
died . Renunciations for none attached hereto.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal
residence at 544 Mohawk Road. Upper Frankford Township. Cumberland Countv. Pennsvlvania
Decedent, then ~ years of age, died
Newville. Pennsvlvania .
Februarv 21
, 2005, at Swaim Health Center.
Except as follows, 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: N/A
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in PA
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania, situated as follows:
544 Mohawk Road. Upper Frankford Township
Cumberland Countv. Pennsvlvania
$
$
$
$163.360.00
WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented
herewith and the grant of letters of administration thereon.
Signature(s) and Residence ) of Petitioner(s):
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
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 belief of Petitioner(s) and that as personal representative of
the above decedent, petitioner(s) will well and truly administer the estate according aw.
Sworn to or affirmed and subscribed A- II
before me this ~ day of Robe L. Surfield, Sr
April, 2005.
J;tQrndCA ~n0\\ },ltt(jf)\rv-., ;j-/
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No. 21-05-33Z
Estate of
KATHRYN F. SURFIELD
, deceased.
DECREE OF PROBATE & GRANT OF LETTERS
AND NOW, Aoril12 , 2005, in consideration of the Petition on the reverse
side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated
N/A described therein be admitted to probate and tiied of record as the Last Will of
N/A ; and Letters Administration are hereby granted to Robert L. Surfield, Sr.
IRWIN & McKNIGH
\
FEES
Probate, Letters, Etc. . . . . . . . $260.00
Short Certificates(-1-). . . . . . . $ 4.00
Renunciation(s) ..... . . . . . . $
JCP ... .. . .. . . . . .. . ... . . $ 10.00
Automation Fee............$ 5.00
Other Will .. . .... .... $ 15.00
Filed .11.1.~.05.~:.~~:. : : : : ~~9~:~~ .
Marcus A. McKniahl. III. Esauire (25476)
ATTORNEY (Sup. Ct. 1.0. No.)
60 West Pomfret St.. Carlisle. PA 17013
ADDRESS
717-249-2353
PHONE
1I111<yr'< 1<:\ 1/1)"
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 original certificate will be forwarded to the State Vital Records Office for permanent filing.
~
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WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
IL.~:~~~~
p
1133004L
No.
FFA 11 2005
Date
Hl()5,143 Rev. 2187
dl-05- 33'6
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPEIf'flINT
'"
PERMANENT
BLACK INK
STATl'-FILENUMfIEIt
I<lAMEOFDECEDENT(Flfst.MlcldIe.lelll)
1. Kathryn F. Surfield
AGE (l.osl BOihllft)')
SOCIAl SECURITY NUMBER
" 196 14
3170
o.o.TEOFDEATH(Month,o.Y.Y8erj
.. 2/21/2005
R""'_O ;;"~)O
RA E. Amer1am lrollen, Black. WUte, ft\
(Spee/lyl
10. White
BlRTHPLACE (Cll\I lWld
St'teorForelgoCOmtry)
Newville, PA
7. Ill.
FACllITYNAME(lfnollnllliluUon.g!v.otrw.e!lWldrJJll1ber)
5. 90 Yrs
COUNTY OF DEATH
01\
8b. Cumberland Swaim Health Center
DECEDENT'S USUAlOCCUPAOON KIND OF BUSINESS IINDUSTRY MARITAL STATUS _ M8ITIed.
(':r~~"='':~J.:\'' 0" Ne~'=d'"fS=ed,
111. Not available 11J.<inney Shoe Co. (Hod.1 14. Married
DECEDENT'S liNG A (StreeI,Cill'/Town. Old 11c.~y".oecedenIlivl<jln
544 Mohawk Rd. =1 INed
11. Newville, FA 17241 17b.Ccll'llY Cmnberland towoltlip? 1.7cLO :'liw=:rIlmllaOl
FATHER'S I<lAME (FIrst. MkldIl. laet) MOTHER'S NAME (F1I'1~ MId<Ie. Mill"'" SUmllma)
la. Orrie C. Neidi h 11. Ma C. Wa er
INFOR NT'S NAM (ypd'rtnl) INFORMANT'S MAIliNG ADDRESS (Sllftl. CIIy/Towo, Sin, Zip Code)
2\llI. Robert L. Surfield, Sr. 2OD.544 Mohawk Road; NewvJ.lle, PA 17241
METHOO OF DISPOSITION PLACE OF DlSPOSITIDN- Name oICemelery. CIwI1atnry lOCATION -Cll\IfT.-,. Slate. ZIpCode
. DonIllJQnO Burlll [1I.Cremdon ~emCIYallfomSt.a 0 0 """"",.~.Y-I/ o<ou...~1lCII
.21a. OUw{SpecIfy) 21b.2;25 2005 21c.NE:!WVille Canetery 21d.NE:!WVille, PA
SIGNA EOF SERVlCElIC RP~AC1INGASSUCH liCENSE NUMBER NAME,ANDADDRESSOFFACllITY
.-J ~ 22b. PO 012633 L ii1m Brothers Funeral Hane, Inc., Carlisle, P
CompIlIla 11m. 3a-Grrltwflencerttfy Tolhot mykncM1~.dutl1~lIlll1e~ma,_aOdpl"""~. liCENSE NUMBER DATE IGNED
physlcilWll.noI...aHablaal dme 01 dealll to (5lgnaM1l lWld TiIlal L'i' C rJ t'J ,_/LI 3' 19- L (MorltIJtOn, Ye.) -"I
""mfyCll<llaOldaBlh na. c""'~ .'lA.~ 23b.f1it TO l(\ 23c.~ J,.J Oleo:
l1em. 24-26 rTIU8l~ CQIl1p1_ bv TIME OF DEATH DATE PRONOUNCED DEAD (Monlh, 011\'. Year) WAS CASE REFERREDTOA MEDICAL EXAMINER /CORONER?
parson who pron""''''''deatll. 24. :JOfM, 25. OO.s- 28. Ye. 0 No
27.PART1: Entor1lM4_,.....Iloo.............-.__....d_, 110 ""'.............."'dyIog.........canll .........,.nwt,......k.._III111... :I\pprmdmele PART II: Otrler.lgnlftcanloon<ltiO/lloontr1blJlo,glod
eelh.bul
U.._.......H...__.j( :=and...... ~truuIllr1g101heUT1dertyIIlgCIIU.eglvenIflPARTI
IMMEDIATECAUSE(F1nal n J,L /1 /1 A I
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SURVlIIINGSPOUSE
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Surfield
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WAS AN AIJTOPSY ~RE AlJTOPSY FINDlNGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETKlN OF CAUSE
OF DEATH?
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MANNER OF DEATH
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DATE OF INJURY
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o PlACE OF INJURY-Alhoma."'rm.._,IIICtO'Y.oIlIco
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TIME OF INJURY
INJURY AT VIORK? DESCRIBE HOW INJURY OCCURRED
Nelural
Homlcida
PendlnglnY98llgatlon
Cculdnolba<lfl_ned
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CERTlFIER(Chackonlyona)
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