HomeMy WebLinkAbout07-20-05
PETITION FOR PROBATE and GRANT OF LETTERS
~1-D5-0lD53
Estate of' :J)oi';'oT7f1'
also known as
fY/ f}-r LL .0
No.
To:
Register of Wills for the
Deceased. . County of Cl.{mBE'rLM 0 in the
Social Security No. 16 L; - (:) 1- 77 // Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut
in the last will of the above decedent, dated
and codicil(s) dated
named
,19_
{state relevant circumstances, e.g. renunciation, death of exeCiltor, etc.)
Deeendent was domiciled at death in
h last family or principal residence at
County, Pennsylvania, with
(l1st street, number and m~IPahtYlJ- J tj..
Decendent, then 'i5 '5 years of ag?- died L1 ~. u , )oQ .2 0 0 'i ,
at thLy5f"r"lf;!< y>/oM->- l?~ J-h LCY /l- '.
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:
Deeendent 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:
o
o -
~~
--,j::O ~
-, -i~ C) f=:
',~;~ ~.~ ~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last Will)~odi~s)
presented herewith and the grant of letter< . "_.0 1'1 ::K
(testamentary; administration c.t.a.; administra.tlCm d.b.n.~.)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA 1-;:IS
COUNTY OF J
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 represen-
tative(s) of the above decedent petitioner(s) will well truly minister the estate according to law.
Sworn to or affir~~ and subscribed
before me this ~ '>l day of
~\>,-,-\ .:.~ 'S;~ ~
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~""Ol.'l..~,~"'" \:)~ Reg ler
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HIO~H05 REV 9!Hfl
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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
thn... /~ ~~1A--'
Local Registrar '7
Fec for this certificate, $2.00
p
10530568
SEP 0 82004--
Date
HHlb 143 Re~_ 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATI: fIlENI.IMBER
'RaNT
83
..
COUNTY Of DEATH
Yo
BlRTHPLACE (City lWld
SUlleorForeignCooolry)
fhiladelphia,P
~......O
NENT
"INK
NAME
SOCIAL SECURITY NUMBER
,155 01 7717
"",,0
~~lD
.Al1IllIican IndIan, 6lack While,el
(SpeciIy)
1o~ite
SURVIVING SPOUSE
IIl...to.lJI......'_.._l
. CUmberland Co.
...
East Pennsboro
...
DECEDENT'S USUAl OCCUPATION
lGiw1_oI__ _t
.........~~.." ..,
reta.l.l C.lerK
11..
DE NT'S MAl11~ ADORESS (SIfHl., CityfTown, Slalt. lip coo.)
AS DECEDENT EVER IN
US.ARMEDF~S?
YesD No~ 12 (o-12~
12. u.
17a. State Pennsylvania
C....ge
(1.4...~.)
MARITAL STATUS - Mameoj
NtI\'erM~. IMdOwllCl
~d (Speoty)
1Jfiidowed
308 N. Market street
,lJuncannon, PA 17020
FATHER'S NAME (FII'SL Middla. Last)
11. George Warne
INFORMANT'S NAME (TypeJPMt) T' th A Ell
20a. uoc> y. er
METHODOFOlSPO$l~
. OonatillnO Bu~Acr.m.tion~ernovallromstalllD
, )
EOF L UCE Sf PE~ L
To....butotmyknow\edgll,delllhoc<:lXlWdallhalllTMl,daleandplacealated
(SignallDa-IdTiI\e}
,,,.
TlMEOF
DECEDENT'S
ACTUAL
RESIDENCE
(Sllllinalruclions
on OIher aidll)
Cllvlt>Oro
17b, Count_
CUmber land
D"
-
heina Elf No,de<:edenl~veoj Camp Hill
to.wnahip? 17d.... withinllC1"*llITlilsal
MOTHER'S NAME (FIrst, Middle. Maiden SumalTltl)
11. Charlotte Reschard
Jtl.f..~MNlT'S MAILI~ ADDRESS (Slfeet, OtyfTown. State, ZipCOll&l
~.~ N. Market St.,Duncannon PA17020
~~O~SPOSITION- Name of C8<fIIIliN)', CfemalOry LOCATION -CJty-fTown, Slale, lip Code
Jington Nati. Cemetery ~lington,VA 22211
W,UE AtJD AOORESS OF fACiLITY
.selman FH&CS 324 Hum:nel Ave. Lema e PA
LICENSE NUMBER OA EO IGNED
(Month. Day. Year)
17c.D Yes.ojecedenl~vedm
.,
2T.PARTI: _...._,iIlju.......c......
liM...."'_...........__.
Uta. 23c.
WAS CASE REfERRED TO A MEQjCAL EXAMINER /CORONER?
H. Yea 0 Nog
PART II: QlherllgOiflcantcondibonsconlnblAJnglodeath b"l
rnukinglnlheunaenl'ngcausego~eninPARTI
~
Sequentially ~s\ conditions
ifWl)',leadingloimlTllllliale
cause, Enter UNDERLYING
CAUSE {Oiseue or ifljury
lhatirlillalede'lElnlS
reSllling on dealh I LAST
WAS AN AUTOPSY INERE AUTOPSY FINDINGS
PERfORMED? AVAILA8LE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
L
A ONSEQIJENCEOI')
~"
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QUENC Cll'l
YOISD
NoD
SUICIde
'S
o
o
DATE OF INJURY
(l.l""th.OoV.".")
TIME OF INJURY
INJURY AT WORK? DESCRIBE HQWINJURV OCCURRED
MANNER OF DEATH
Nalural
HomicH:le
o
o
o
veaD NoD
A""""'
P"""'n5lIn\l8S~51allon
CooIdnolbedelamuned
...
PLACEOFINJURV
WWng,"" (Svoclfy)
,...
30b.
_Alhoma,larm,5Ireel.l
"
1a., 2Ib.
CERTIFIER (Check only Oflll)
.~~~~OJ~~=e~':l.S~~~~rd'':t~='f':=:r'=~~=':sn~f:~~~.~.~~~.~~.~~~~'_l~_~~l.
...
.PRONOUNCING ANO CERTIFYING PHYSICIAN (PnlsiDan bOll't prono.n:lng deall't and certl~'l1\llo cause 0( dealhl
To 1M tanl of my knowledge. dOIlIth CKcurTed It thlllllNl, date, OInd p1aee, and dUIIO the cMlMl5(al.nd manner.. at.ted,.._. .
"MEOlCAL EXAMINER/CORONeR
On the bula or a.amlnatlon andlor In''aallgatlon. In m, opinion, de.lhCKcurr.d.tlhallrne,dete ,and p1aca, OInd dua to the ca...ei(aj and
mIIMtfll",ed
".
RE
u
b,( IIoUt' I
Estate of
No. JI-05-- ~53
DOROT~ m~ww-
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
)if[) 5
AND NOW ~. l.l.P )K-, 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 (588 ~ bE:CRf::E)
described therein be admitted to probate and filed of record as the last will of
(SEE- I>E:CRE:E-)
and Letters 6F AbW/,/NlsrRItTIDN
are hereby granted to TII'Y\.-o TiJ'-{ A. Et..Ll21<..
FEES
Probate, Letters, Etc. ......... $ 11J. tJD
. 1-4 ()[)
Short Certificates( ).......... $ .
l>pnnne;otian q 1WPp.N . . . .. $ 20. (1)
:ru> '- kF $ J':l.lJD
TOTAL _ s.1q .O-D
ATTORNEY (Sup. Ct. 1.0. No.)
ADDRESS
Filed
PHONE