HomeMy WebLinkAbout06-11-08 (2)PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Rachel H. Gray
also known as
,Deceased
reuuoner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE A' or B' BELOW.)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
last Will of the Decedent, dated and codicil(s) dated
named in the
State relevant crcumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not many, was not divorced, and did not have a child bom or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
Clarene Gray (spouse) died 8H2/07
^X B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
AdministYat~on, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Ray Smallen Son 229 Winding Way _y0 ~ -
Camp Hill, PA 17011 ; ~'-« ~
v>~ - -
~~ ~
-;
-T-; ~ _~
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. --f _ , , =,
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
C~
940 Walnut Bottom Road, Carlisle, South Middleton, Cumberland, PA 17013
(List street address, town/city, township, county, state, zip code)
Decedent, then 90 years of age, died on 04/17/2008 at Manor Care Health Services, Carlisle, PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(If not domiciled in PA 3,300.00
Personal property in Pennsylvania $
(If not domiciled in PA) Personal 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 with this Petition and the grant of Letters in the appropriate form to
the undersigned:
- I ypeo or punted name and residence
Ray Smallen 229 Winding Way
Camp Hill, PA 17011
`'~-~~11./ 717-761-6914
Form RW-02 Rev.
Copyright (c) 2006 form software only The Lackner Group, Inc.
COUNTY, PENNSYLVANIA
File Number 21-08- ~(y '~ 7
Social Security Number 412-48-7824
Page 1 of 2
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(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Swom to or affirmeid,(a~n1d subscribed
before me this I I!_Vl day of
F the Register
.~...~ v.nouQ~i
Signature of Personal Representative
Signature of Persona/ Representative
File Number: _ 21_08_ D~D
r-.a
Estate of Rachel H. Gray ,Dec C~~ ~c
Social Security Number: 412-48-7824 ,~ ~ rte-- "~` `
Date of Death: 04/17/2008 T m -
.- _ ~t
AND NOW, rn ~2yQ ~ , in consideration of the for oin Pe{ifi J
e9 9 _ . ~itisfag~ry proof
~._
having been presented before me, IT IS D REED that Letters of Administration _ _ ~ ' '
are hereby granted to Ra Smallen -T7 y
~ r/a
and that the instrument(s) dated in t bove estate
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
FEES Q~
Letters ............................................ $
Short Certificate(s) ........................ $ ~.
Reln/u~ncyi~ation(s) ............................. $
7""'
Attorney Signature:
Attorney Name: Ward P. Seeber
Supreme Court I.D. N .: 76084
James, Smith, Dietterick & Connelly, LLP
Address: Suite C-400, 555 Gettysburg Pike
Telephone:
TOTAL .................................... $ `. "J ~O
Form l?tH-02 Rev. 10.132008
Mechanicsburg, PA 17055
717/533-3280
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 2 of 2
tO5,Rp5 RFV ml/nT~ _. - _ - _ -
o~i~ ~~'G'CPx 7
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 ['his is to certify that the information here given is
orrectly copied from an original Certificate of Death
July filed with me as Local Registrar. The original
ertificate will be forwarded to the State Vital
records Office for permanent filing.
P 14528248 ~.F~~ P 2 Zooe
Certification Number
Local Registrar Date Issued
-_____ r~
..t ,
'~~ C" _~
~, :ate ~ J
-~. -
~ ~D W --
U'i
TYPE / PRIM IN
N10Str3 REV 1U1006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
PEFWiWEN!
B'A~"* CERTIFICATE OF DEATH
(See Instructions end examples on reverse)
,. Name a Dscaawn (Rrr, piddle, hµ erfp) STATE FILE NUMBER
Ra(~' lei H. Gray 2. SeM 3. $ocW $oaaNy NwMer 4. Delo d Death (MonM~ dry, ynr)
s. AS.(LrBellaey) tAgr, F 412 - 48 - 7824 ril 17r 2008
under, s. oar a Bab Moak, ,rear) ~. ( uia etw a cum) ea Place a Deeb (check r pro)
Mwew ~ rbwe ry„M
90 vra. 10/27/1917 Michigan °_tlix//
• m. cawiy a oath ee cly, Bom, rrry. a Drm ^ mPanem ^ ER / Dulpeaenl ^ DDA ISO Nora. ^ Rrklenoe ^omw
Btl. Fualry Nunn PI nd YNtlhnbn, pw east and aeroer) B. Wee DeoedwM d Hbpenk: Odyn7 No SD~Y
Ctimlber'land m yr, apetlfy caeen, ~ ^ rr m. Race: Anrdcen ei6en, BhM, wire, ab.
uth Middl ton (~+»
,,. oerdem'. llwrl Mann H g Mexben, Puwb Rkan, eb.) White
Io~~yr wul~ a wah acne mr a ~ s.. ro rpI w,e ~ ,z. wr Derdwit per h me ,a pandwd'e Eaurtlr (5pealy oar Newt pads
Sales C;1P,rK Iwaaaw~nerl~uuty u.s.AmrdFOroeer El,,,~,p/secanm u,z u.MedwsmwcMenrd.NeverM.aed. ,e.su~,~h*w~owlrcwn•.eh+m.a.nname)
Ladies T ^ vac ®~ 12 n ( ) cawoe (,~ w k) wbawed, okome es,«,r»
,a D•rwaerea MeiN Ad6en (straw, aey/ bwm, erg, m ooee) Widowed _
Derdnt's pp as D.oeaea
940 Walnut Bohan Road ''~ Rridwc. na sere z ira. ®Yae, oerawd Urea b South Middleton T
~P
PA ne. carbrr Clmlberland na. ^ Na, Decrwa Iwaa wsMn
,a FeMer'elbnie (RnL mMdle, let. eW4) Acw.i t>mlm a car / Bwo
William - Hull 1B. MalrYe Noma (Flrr, mbAs, meldr waneme)
Elva Fern Yarnell
2Da. momwN'e Name (Type! Pdm)
Ra Smalleri zro. bramemS MreN Amen (seee6 tray! raven, ear, zp mw)
z,aMwnodaolaprron ^crrwar 229 Winding Wa ,Came Hill, PA 17011
BuW L f Rarrp.N hom Sure ^ Dorrtlm 21h. Dab a D4poeitlan ~Mpilh~ day. year) 21a PWz a IXepoelYon (Name d pmatay. uemalay ar dher
• ^ Othar - Spxiy Wr Crwrrtbn ar Banetlwrr Aahrlad Macs) 21d. Locetlon (CM /town. rte, rb cade)
arll.aarEarabw/mar ^rr^NO 4/22/2008 Oak Ridge Marorial Park
2zda Lirreelw euai Oak Ridge, TN 37830
22D, lkww NuMw 22c. Nuns elr AtlSen d Family
~ ~ FD 012633 L Dwing Brothers Funeral Hare, Inc., Carlisle, PA 17013
crvbr Iwn 27ec pay w,rtri arsytq zaa. To uw er a my ocurM tM ran., are rid place eabd. (Bpnrus end tee)
Mgrdr w na arW6b n tlme d dsab b zb. Lkaras Numeer
awsy aredael. ~ ~ ~ RA!l~ 72 L ~C~.:G/~ ~cs~
.' wn~o ponrmw d 4O"caed M P.aon z4. nme a Dram . D.b Pmrwrrwa ors pdonm, der, r~ 2s. wn can Rel«~ea
M. _ `~ ~ Q m~ ^ m ~Alsrral Bwanerl Canmx br a Reeeon qhu yiu~ CrenWbn a Danetlon7
CAUSE OF DEATH (See Imtructlone entl plea) C/, ~jo
INm 27. Pert I: FiArr as ~L~OY-dlaenee, k~wir, w oonplratlme-br ~~, rimer yy yeye ~ NOT wear tram enM euM r rrdlec enr, i AOOrorYrM ~: Pad II: Eau otlrr 2e. gtlTd.wv the CaMbas b orm
raeliabry emr, w wrWw Ibrietlan wNiW ehoeMp a. stldopy. live pay ar mw r path Ina. artist b DeaX, eul rol rerAlFp b the wreayeq rw gNen h Pan I. ^ Yee ^ Praoeety
CAUSE derv a ``rr ,( C~
"ew"t°"} ---> a. <~tir9 <Y `l ~C? ~C2~ -- I ~C-~ ~ ~.SZ e ^ uamawn
29. M Femur:
Dr b (or n mnaequuce d). r
b oeus ~ r i~ie a e' ~ ^ Nd preprre wpNn pew yeu
Eax UNDERLYNp CAlIBE Due b (or n a mirprenr d): ~ ^ Pregre u Isr d drM
`~•y Irerna~elwaut~byd me
eaww deebt) LABT. c. i ^ Na Drewa. da paprm wmih e2 dsya
as w.ro(wr.mreque,m•a): ~ aaem
a. '
r ^ erw.~.nMw.~aaomyaa,yrr
30a.WrrAlAapy aae.wwa '
~~ cr.. a oeae~ 31~ mgr ^ non:owe aze. oere a Ir{uy IMadn, mv. r•~) a'm. orub• Nw. m)wy ouawred ~ of I,pwy; ~NUna Seer, Faday,
s, ^ ~'« ^ Yea ^ No ^ Actltlers ^ PeMeN Immlgrbn aza. Thne a lr{ury dze. Iryuy r wade sa. n rrwwpM.Iw, eVcn (SA•~i9 ~. lauar a bey (prat, dr / rum. aura)
::z ^ eases p coved Na w Dermire M ^ yr ^ No ^ omw r oPwetw ^ PerNipw ^PadrbYn
x+e. cwlnw (awA ore ar) omw ~ ~i'
~~ - --_
' ~rbY M,yeleir IPhrrden Gruylr5 owe a am when ananrr a'm. sigwAr ,
"~ To tM ant d mr bwwbtlps, arb amen dw to lhs DhYeirien hae Prwiaua'sd drh er mripMae kam 23) ~ O
P1OA^~'9•nda«,NrlrgMtlelcYnlPhYatirbah ~a)rdmemrrnwubrL-------------°---------------- ~ ..
r a» er a ray bbwbaps, Been, amnrad r the nm~e,"w"r0 drb wr aenayinp b seise d aerie ax.I.kenee N ,
deb.raPl.r..ra.rotn.nreta)ammwar.rn.bra.------ ^ ava.oresgnedP.bmh.my.
• MsaplEwnewlCawrr -------~ ^
on m. ere a sxamwtlon rr / or+nwgiprbn, b my opmon, pram oauma r the una aw, wr Mar, am ar b ms C~e7 ~ ~ 15' - ~. [f l r (fj
cswe(s) erM nmrsr n 3r, Nems erg Adders d Pwam Who
~ ~, _ ... SlpneMe D'ut Canpletr Cewe d DnM (Item Z>) Type /Print
~ ~ I I I ~ I I I ~ I ~ o~F"'d(h~'~~dry''°") Darryl Guistwite, Carlisle, PA 17013
•0
/7
DiaPaeeian Ponnq No. ~ ~ q ~' 1