HomeMy WebLinkAbout08-24-05
Register of Wills of ~_ Cumberland ___ County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Helen Mae Garone No. 21-05- 07 ~1
also known as
, Deceased
Social Security No. 267-40-7845
Mary M. Lentz
Petitioner(s), who isfare 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated 03/06/1998 and codicils dated
none
Executrix
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
none
o B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante minoritate)
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:
Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
C)
or principal residence at 820 Lisburn Road, Camp Hill, Lower Allen Township
(list street, number, and municipality)
Decedent, then ..2L years of age, died 08/06/2005 at Carolyn Croxton Slane Hospice Residence
(Location)
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 Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
24,000.00
$
$
$
$
situated as follows: none
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:
~
Mary M, Lentz
yped or printed name and resl ence
42 Longwood Drive
Mechanicsburg, PA 17050
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 ~orm software ornv The Lackner Group, Inc.
Fo"" RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Pemioner(s) above-named swear(s) or affirm(s) that the statements In the foregoing Pemion 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 a~rding to law. ~
Sworn to or affirmed anI subscribed "D1"-CtA-u.~A -
I ('41( Mary M. Lentz ?
before me this E day of \,
No.
21-05-
Estate of
Helen Mae Garone
, Deceased
also known as
Social Security 71. 267-40-7845 Date of Death:
AND NOW, ~3 ~i~r f1;~-1-
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters ~ Testamentary D of Administration
08/06/2005
, ;;2..CXJ )- ,in consideration
(c.I.a.; d.b.n.c.l.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Mary M. Lentz, Executrix
in the above estate and that the instrument(s) dated
3/6/1998
Short Certificate(s)...................... $
75.00
FEES
Letters.......................................... $
8.00
Renunciation............................... $
Attorney:
Extra Pages ( )......................$
I.D. No: 21458
Said is, uff, Flower & Lindsay
Address: 2109 Market Street
Affidavits ( )...........................$
CodiciL....................... .................. $
JCP Fee.......................................$
15.00
Camp Hill, PA 17011
Telephone1 (717) 737-3405
Inventory.. ....................... ............. $
E-Mail:
Other............................................$
TOT AL............................ $
98.00
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 fomn software only The Lackner Group. Inc.
Form RW-1(1991)
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Notaciai Seal
Pamcia A. Wh;;ler, NOlai}' t-ublc
..l~~ovn<c 80ro. Cumberiand County
,,1, Comml9Slon Expires No\!. 15, 1900
Membe~lvanill Assocr.tlion of NIltsries
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Thi, IS 10 certify that the information here given is correctly copied frolll an original cer~ificate of death dqly. filed with
Loctl Registmr. The original certificate will be forwarded to the State Vital Records Oftlce tor permanent tIlmg.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p
J,'1.878
No.
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Lo 'al Registrar
Fee for this certificate. 56.00
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
TYPE/PRINT
'N
PERMANENT
BLACK INK
CERTIFICATE OF DEATH
STATE FilE NUIwIBfR
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COLJNIYOF DEATH
78 Yr~
SEX SOCIAL SECURITY NUMBER
,. Female 3. 267 40
BIRTHPlAC~(Cilyand PI ACE OF DEATH Cn ckonl n clion Ofl
Statl.lOfForelgnCountly) ttOSPIT.....
IIIP.u6nlO 00.0.0
..
FACILITY NAME (If not institution, give iilnlel and number)
1
AGE (l.ilSl Bilthday)
NAME OF DECEDENT (first. Middle, L.nt)
Helen Mae Garone
..
white
SURVIVING SPOUSE
(II...,., g''''' maldallflf,m.j
twp
l1b Courllv
Cumberland
citylboro
t 8 2005 '"
LICENSE NUMBER
".. FD 014889
PA
To the best 011111' knowledge, dealh o<:<:lJrn~d allt,e time, dale anu pld"", =ot,.teu
(SI9nalur~a"d T'lltl)
23.
TIME OF OEA TH
" /1:"I?i' PM
2B.
\,
21. PART I' ~"I.. th. dl......, ....J..,t.. I>< c""'I'I'c"uu". ..hl~h C.....tllh. tluVl. 00 "r,1 ."1.. the m..d. of d~ln~, ...<h.. c.rdla<.... '..plr.tn't arr..l, .h<H;k '" M.rt f.ll..,.. . Approximale
U.t n"lt 0'" c.......n."ch 10,.. : intufVill between
. onset i1nddeilth
l:
Olhflr iiiunilk:ant conditions I,.-unlril>uling 10 death, but
not resulling in the underlying cause given in PART I
out.: ro ({)f{ AS A CONSEOUENCE OF)
WERE AUTOPSY ~INlJINGS
AVAilABLE PRIOR TO
COMPLE1ION OF CAUSE
OF PEA TtO
MANNER OF DEATH
t~illU(af
..l:'!l..
o
o
DATE OF lNJUHY
(1wI""Ih,D"y,YU'1
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Humicide
o
o -D~D
JOa _ JOb M JOt.
o PLACE OF INJURY. At home, farm, streel, factoI)', office
1""'<1"'11,'''<' (Sp'K,ly>
...
ACCldllrll
PunJlnglnyu:iIIoJ"lIon
(;,,,,ldnul La delermined
Ye~ D NlJ 121
'GNATURE AND NUMBER~. 0
.~" I) l-fA /1 ~ < L ,~L 4.41
~;2J Ilal \ bl-I
DATE SIGNED (Monlh, Day, YUdr)
Yes 0
N"D
SUII;;i<lu
28. 26b
CERTIFIER (Check only ono)
.~ ~~~F:~~IGOr~~~~~~~.1F~h:,S~'.::~~ c~~~~~nr~S'du.:: I':: thb:~a~~':~\I:i'~~drJ.'~A~~~'I~~t~I~I~d::~~~~~~,~ .~~~~~'. ~','~ .:~:~t.~~~~,~. i!~.~~ .~~.). .
2B
.PtlONOUNCING AND CERTIFYING PHYSICIAN (phys-id..n (mlt. jX')fl(.lUn';IIl!,l dtl<dh ..nd "e/lity"'9 1" ,-,<<use of d""lh)
To Ih. ~.t ot mr knowl",dg"" dUlh OCCUfflld II thll lima, date, and plllce, and dua to the c;lu.e'('land manner a. .t,ded,
'MEDiCAL EXAMINERlCOHONER
~~.~:::rb::~:t'.~~~mlnalh;m ana/or fnye.tlllatlon, In my opinion, d"ilth occurro.u at tll... time, dille, and placl, .anti dUllo Ihl c;au""11 .and. 0
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