HomeMy WebLinkAbout06-03-05
PETITION FOR PROBATE and GRANT OF LE TERS
Estate all!, /~-J II. tr!cz(la.-,.} /oJ No. ~ '\ - <;:) S - 5 C:l
also known as To:
Register of Wills for t
;., Deceased. . County of
Social Security No. I (PO It, - 11 d.. I Commonwealth of Pe
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older ao the execu
in the last will of the above decedent, dated - G, - '1", '7
aod codicil(s) dated
t!'",
12 15(J'T111111.,j;0~
. named
, 19~
T e
"
/L
II ~-<-
<: '"
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death irL J M Ju...v IA...Jcl County
h~ last family or pri 'pal residence at / 7
ct- / 01/
(list street, number and muncipality)
Pennsylvania, with
De endent, the~ f) 1: years of '!l:", died
at d "- <2,vTe
Except as fo lows, decedent did not marry, was not divorced and did not have a c ild born or adopted
after execution ofthe will offered for probate; was not the victim of a killing aod never adjudicated
incompetent:
~d~
..l-9:::
/
(hrC) . -
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) 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 las will aod codicil(s)
presented herewith aod the graot of letters
(testamentary; administration c.t.a.; a ministration d.b.n.c.t.a.)
theron.
~
.
b ~:~#1Ji!Jr:Jt=
='.0
-u;&
U'_
~o
;;
=
..
OJ
c......)
,r
"__ -.n
...;i.;...
:D
_.._.,--i
.'....
-'
f~,:)
o
OATH OF PERSONAL REPRESENTATI E
COMMONWEALTH OF PENNSYLVANIA '") 55
COUNTY OF <:::'l.""\' . j
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the oregoing petition are
true and correct to the best of the knowledge aod belief of petitioner(s) aod that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the es . te according to law.
Sworn to or affir~d aod subscribed
before me this " ' day of
"3"""... ~~. N
~~^" ~tl\."'~
1\'>--9..'\(,~1 ~". '\)~ Reg: e
""
00'
"
'"
~
~
~
{
c
No. J... \ - ~ S . S ~C:l
Estate of
~~L~~ 'i;>,.
V\t ~ i:\~~
. Deceased
DECREE OF PROBATE AND GRANT OF LE TERS
AND NOW -:s,,,, '<'><1. ~ . "::l.. ~\:l S , 'l:l( , in considera' n of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated . \" '\ C\\" '1
described therein be admitted to probate aod filed of record as the last will of
~""" '>.. ~,,~ \>\,,-\:j
aod Letters - 't'!"~ -<'"
are hereby granted to "t::. \ Q.Q ~ ~ ~'" "-
FEES
Probate, Letters, Etc. ......... $ 'J..\"\0
Short Certificates(S) . . . . . . . . .. $ "). '"
R.ee"--'--'-~ ~\I..."'.......... $ \5 .
:so::" ~... ~~'" ""'-l. $ ~S
TOTAL _ $ ." \ ~ ...~
Filed .. ...'-;>.-:'!;..-.~.~......... ............
~~
~~
)
PHON
.
-;
.
Register of Wills of Cumberland Co ty
OATH OF NON-SUBSCRIBING WITNESS
Estateof 1/e./e,J A rn eC""Ai".)
No.
":l...\-'\:ls.S'\l
Also known as
, Deceased
(each) a subscriber hereto, (each) being duly ';llified according to law, depose(s) a d sa:(s) that
t.<>~ familiar with the signature of e/~~ JL...p;cCA.0t0 ,te t~of(oneofthe
subscribing witnesses to) the codicil/will presented herewith and that l.t} ~e~ve elieves the signature
on the codicil/will is in the handwriting of ..;}e../e.J Ii. fri ~ C AAJ t the best of
() J (( knowledge and belief.
..... )b;) ()
We believe the handwriting of the codicil to be tha of
Helen McCann.
Sworn to or affirmed ~d subscribed
Before me this "3. ~ day of
:s..,......~ ,20 '\IS .
(Name)
fB~
(Address)
~~ ~~ "S,~ \
Register
~Q..'<.~, "d.."" ~~
Deputy
CJ
~~
tv.
(Name)
0-.
(
~<U).
~~;-
o::~o'
O~.
U
M
I
=)
. ~ JbS/~
HI05.HflS REV 11(1.~ " - ~ S - S~\)
This is to certify that the information here given is correctly copied from an original certific te of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office r permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or ph tograph.
11560074
No.
a
flJ :r-:
"
Fec for this certificate, $6.00
Local Registrar
p
JUl'i 0 1 2005
Date
"
So
;~D~Q
:~:::Q
. ;/>><
<->
C':~;;:'
c ")
(".:7,
c.....
S
..,,-
0.'
1105.143 RBV. 2J87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECOR S
CERTIFICATE OF DEATH
N
CJ
"
Sl..,lE F NUMBER
...
...
Derry Twp.
sex
2. Female
8IRTHPlACE(Cityand AT
St8leorForelgnCoutlIry) HOSPITAL:
ast Pennsboro 1..........1iU.
7. PA ,..
FACIl.ITY NAME (If not InBtltution. give slfeet and f\Ufl\ber)
M.S. Hershey Medical Center
SOCIAL SECURITY NUM R
..160 t6
7t2l
DATE OF DEATH (Month, Day, Vur)
~Ma 31, 2005
H
K
NAME OF DECEDENT (FIr8l, Middle, UlSt)
1. Helen
AGe(lut~)
84 Vrs.
..
COUNTY OF DEATH
DECEDENT'S USUAL OCCUPA nON
ol"'=:~~::~"i'
11" Sales Mana er
DECEDENrS MAIUHG AD SS (SIre.1, C
113 May Drive, Apt. 1
Camp Hill, PA 17011
...
FATHER'S NAMe (First, Mlddle.lul)
1.. Wilbert
ORIAAKT'S NAME IT
KINO OF BUSINESS I INDUSTRY
AS DECEDENT EVER IN
U.S. ARMED FORCES?
YesD Nok]
...
DECEDENT'S EDUCATION
1~"'0IIIy ..._.......,-1
E_nlatylSecondsry ~
u.10lG-UI (HC<~1
-0 ~)D
RACE-ArnlM'k;an lndllln. Blaek.WhiIe,
'_I
10. White
SURVIVING SPOUSE
\11-....-.......)
Dauphin
11b.Furniture Co.
own, &.Ie. Zip Code) DECEDENT'S
""TUAl
RESIDENCE
(SeeInstnK:tiatls
onolhersilje)
1h.Sta\8
1'A
....
...
METHOD OF OlSPOS ON
. 00I\all0n 0 Burilll 0 CIwnMion ~.movaI tom Slate 0 0
.21" l:)CI,.-(~) 21b.
SIGNA OF fUNE $E N ~()R pt;RSON -'ClING 1+3 SUCH
Wilbert Bom ardner
""
decedent
Ilvllin.
t7b. Countv Cumberland township? 17d.fl ~
MOTHER'S NAME (Fnt, Middle. MilIden Surname)
...
INFORMANT'S MAlLlNG ADDRESS (Strtlllt, CIyI1'
20b.2556 Ho e Drive ~ Erie
PlACEOfOlSP<)&\T\ON-Kaf1lIs.d~.
~~P~eCremation Society
21<:. PA C're1l1B.tor
NAME AND ADDRESS Of FACILl
22.:.Services Inc.
liCENSE NU
Iveclof Camll Rill
-.
To the bnl: 01 my knowledge. deeth oo::cumKl at the ~me. date and place slBt$d
tSignalu'aandlllle)
2S..
TIME OF DEATH
" 10'/5' A
....
Ww:.CASE REFE
,.
:App(oJdmele
'......,
:onsel.nddealh
elen Swe er
. Stal8,ZipCodSl)
1'A 16510
l...OCATION - C'lyfTawn, SUIts, Zip Code
of
21d. Harrisbur PA 17109
uer Memorial Home & Cremation
Harrisbur l' 1 10
D
(Month,o.y. Yeer)
,><.
o 10 '" lAEDICM.. EXAMINER /CORONER?
Yu No 0
PARTU: OIherslgllilicMltcondilionacontribulinQlodttelh.bul
not...sulIingWltheundelt)TlgClWHgIYen WI PART I.
Born ardner
21.PARTl: ~"'__InJu~OI_plI.-.-..llIc11_"'_III. DD~"'''''''''",''''.oftl~...,s''''~''Clrtlh.eor...plmoryamlA.''-''ot_rl''''''.,
LIaI....,__olluchl.....
..
r
,.
d.
MANNER Of DEATH
........ IE
-. 0
vnO N.Qj:. VMO NoD S-. 0
-
PendWlglnvettlgatioo
Cauldootbe.de\emlinel1
DATE OF INJURY
(UoIIlh.t!av,Yu'l
o
o
o
TIME OF INJURV
lNJU Y AT WORt<:? DESCRIBE HOW tNJURY OCCURRED.
2ta. 21b.
CERTIFIER (Cheek only one)
l~tGJ~~=~C8J.:g~c:.::~{=d~x=e:,~~~~.~.~~~~.~~.~~~.~.;,l~.~.~~).............,....
...
SOli. 30b. M.
PlACE OF INJURV .At hOlTWl. flInn, street, ladOrY. office
1luil<IIng..le(SpocIfy)
....
'f}1L)
"~~:O~~":~~~~~:~=:':J,~lhd~~C:II~.~~j~=J.r""l4ll.d.........
CATE SIGHED tMoolh, Day. 'fear)
"d. f),/3i/:2.00r
f PERSON WHO 9~~TEO CAUSE OF DEATH
(j1,--rt.., 'f1L<S~(),r
edica' Center Hershey, PA 17033
" "MEDICAL EXAMINERlCOROHER
On Ole bull of .umlnlltlon and/or InWlatlQ&llon, In my opinion, d..1t! OC;:~lIrrad at th. 11m.. date, and pla~., and duB to aha ':8II_(sl and
. rnannar..atal.d............................................................................................................................................................0
".
.....,.,.........~~.R
". ~ /C' /M~-'P-
I~ IIpj/l/l
"
WILL
OF
HELEN A. MCCANN
I, HELEN A. MCCANN, 6F the Borough of Camp Hill, Cumberland County,
made by me.
Pennsylvania, declare this to be my last will and revoke any will previously
wherever situate to my sister, MARGARET CALVERT,
Item I. I devise and bequeath all of my estate f every nature and
Item II. Should my sister, Margaret Calvert, pr decease me, I devise
Hill, Pennsylvania.
and bequeath all of my estate of every nature and wherev r situate to my brother
WILBERT D. BOMGARDNER, of Erie, Pennsylvania.
Item III. It is my wish that at the time of dea h my body be released
to the Anatomical Board of the State of Pennsylvania by y nearest of kin or
the executor of my estate for delivery to one of the cal schools of the
State of Pennsylvania, for studies in the promotion of s ientific medicine and
burial plot of the Anatomical Board.
ultimate cremation with others, and burial of the ashes ith others, in the
Item IV. I appoint my sister, MARGARET CALVERT, executrix of this my
last will. Should my sister, Margaret Calvert, fail to ualify or cease to act
as executrix, I appoint my brother, WILBERT D. BOMGARDNE , executor of this my
last will.
to give bond for the faithful performance of their dutie
Item V. I direct that my personal representativ shall not be required
IN WITNESS WHEREOF, I have hereunto set my hand
-~vO_/'.)1 , 1967.
:/ (
n/
loJ;JVV
in any jurisdiction.
/ ~ day of
/ C.. ?
'/. /{ <'- (I tI~4,v"
his
"
"
.,
\'
.'
'~\j
~.J
~)
,"-..J
\ \~
-~''''-\-
~
\
" '~
~ ,i
{-~
, \J
I
!
\'0
The preceding instrument, consisting of this an one other typewritten
page, each identified by the signature of the testatrix was on the date
thereof signed, published and declared by HELEN A. MCC , the testatrix
therein named, as and for her last will, in the presenc of us, who, at her
request, in her presence, and in the presence of each 0 er, have subscribed
our names as witnesses hereto.
~
i!
~
\,
/~tZ,
.I
^ /
\ I
'-;/
, -
~ . -7
~- ~ -/ cC-t. ...;;- ~-/ .:-~ '
,:'
/ ~}- Y' /J/}?ij h -,
C' .~ (Li't:~// ,/ / /:1 / L:e
Ldaiu ~ aiv ~
'xI~/ ~//"'IJJ}i /1.0/-
,-yt/, ,/ ~ /
"
,
<f~ If\-#;k/:>>t~
~~ 4"~~
CPM/fU .~ ~
q~k:Jt1x
~
~-AliJU-1U JI-t
.L. ,
, ,
- ~~,j~ j' />,67
~jb3- ~?~j
_ 036). 0'131
v!A/ tlt.-J
a/~d
"
^
. ,