HomeMy WebLinkAbout11-03-05
Register of Wills of Cumberland County
PETITION FOR PROBATE and GRANT OF LETTERS
No. ~'\-~S- ~\~3
To:
Register of Wills tor the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, and the execut_ named in the last will of the
above decedent, dated , 20
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
County,
Rei
Decedent,then7Lyearsofage,died:J'l,..ve /1( ,20e>.J ,at ;=;//51 ?'#/'ff' ,f>e};"m/1&/i// /Tc>~
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:
Decedent 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 last win and codicil(s) presented
herewith and the grant of letters
thereon.
tS i gn~,tprel s)% Petitioner(~
A ~ ,[;bp~1fk ?JT#4f4-
t7
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
;(dl3
, Residence12 ofPetitioner(s)
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENT A TIVE
COMMONWEALTH OF PENNSYLVANIA
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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 ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
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Swom to or affirmed and subscribed
BefoU:JP.e this to day of
S\:::VTE:m B E:K ,20 05
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Estate of ;;'11 e / y /II IS fY}" we/,' Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW ~~~"'~R ~ 20~S, 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
, described therein be admitted to probate filed of record as the last will of
; and Letters are hereby granted to -:s~~ '\:)~~\::.\.~ ~~~\~\<.
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Register of Wills ..~ X~ \
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Attomey (Sup. Ct. l.D. No.)
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FEES
Probate, Letters, Etc. .............
Will .................................
$
$
Renunciation.... .... ...... ...... .., $
Short Certificates (") ............ $
J CP . .. .. . .. . .. . .. .. .. .. . .. .. .. . . . .. .. $
Automation Fee.. .. .. .. .. .. .. .. .. . $
$
$
20~
":)..~
5
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Address
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Bond............................. ....
Total
Filed '\, - ~ -
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Phone
Register of Wills of Cumberland County
RENUNCIATION
Estate of rve/ Y;'lI 1... PlD we /'
Also known as'-.J.,1CJ r he/" () F ~ A IV
- r - J?1 " i.V' 6" /' ..5' eNS , deceased
No. "). \ ~ ~ S - '\ '\ S
;:) - /?o8er-l~
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned "JOhJl/ .DcJNI9/d /YJe; wer Sd# f
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters fill /'tc!'.;OC;>// ry - {/-S C!t//,/'<9NC! Y'
be issued to JC h ~ D,'flI./f / d . />1~ JV 6? /' ..> 0 ",/
Affirm~ and subscribed before me this (Si ature)
Lo dayof 4911.'-1' _::z.=~ gn ~ fJ,
~,~,/ ~/. / 6cJb !/}111/f>.fIlr.>rItJ., .' .n/~
~./ (Address)
)>I6l' P. tic ~7 AIIIIIoriz.<dJ_O~ ~~~
CcIdfkate No. ()0.009 ~A"
MyCommi"ionExpire'~lfpllhaf _ u~ .27
l J~ Act 1<)2 of August t 19 (Signa~)
Witness my/~and(s) this / t:J ,!i day of
Or
(Address)
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
(Address)
Deputy
(Signature and seal of Notary or other official
qualified to aciminister oaths. Show date of
expiration of Notary's commission)
. 1
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H105.905 REV (0 1104) (~ \ ; ~.~..> -<:::::\"'"\ ::3
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ (JJ. )/aJ,A
,. r -( ()~l r- 3
jJ,ut5b-':
No.
Charles Hardester
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
AUG 2 720B6
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H10S.143 Aev. 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
059540
TYPE/PRINT
IN
PERMANENT
BLACK JNK
~\
t. Evelyn E. Mower
AGE (last BirthdayJ UNDER 1 YEAR
Months Oays
SEX
,. F.elDa.le
STATe FRf ~UueEFl
SOCIAL SECURITY NUMBER
3.175 24
DATE OF DEATH ,Mcrnh. 08.,. '''earl
June 14, 2003
NAME OF DECEDENT (F'fSZ. MldcIe. ~asrJ
V<s.
UNDER 1 DAY
Houno ! MInul..
PlACE OF oeRH (Ct\edc or>ly f)l'Ift .;ee If'\SlfucloOflS on IJ(t!ef SlOe)
HOSPITAL;
IflP.CiefttO
~)D
7])
5.
COUNTV OF OE.VH
CUrrber land
RACE. An'IefJCaIIlndian, BIactl.. wtlite. etC.
tSpecWy)
White
'0.
..
DECEDENT'S USUAl OCCUp,vION
((~r:;:;~~:~d=::~~
Homemaker
SUAVIVING SPOUSE
{IfWlte.grvemaldennarn..
,71>.
l>d
-
IiW i1u
('l1mh<>rl "nn -' "d.Gi :;...""=".'.::'.. Ci'lrl isle
MOTHER'S NAME (~lI'St. Moddle. Malden Surname)
... Catherin o. Whitworth
INFQRMANrs MAlUHG ADDRESS ,SIr... CilyfTOwn. $&ale, Zip Code)
__ 67 Prospect Road, Carlisle PA 17013
PlACE OF 0ISP0SlT1ON - Naone d c.m.tery, C,..,.,a1ory LOC.....IQN. CitylT~. Stat.. rip Code
MOl'- __
...
11.
FRHER'$ NAME (Fits!. Mme. ~l
to. Russel H. Leewri
INFORMANT'S NAME (T ypelPrinI)
HL Barbara Fenicle
METHOD OF OtSPOSITK>N
....... Dc,......... 6tI
CIthef (Specify'
...,-.
21.
I Approximate
I intwnIl betwMn
1 onMt and death
:
PART II: 0Iher significant condilioM ooncributing 10 dNttI. bIIr
noItHUftingintM ~cauMgiwnin PART I
l :
DUE TO (OR AS A CONSEOUENCE Of)"
DUE TO lOA AS A CONSEQUENCE Of):
WEAE AUlOPSY FINDINGS
AVAILABlE PRIOR TO
COUPLETlON OF CAUSE
Of' OE.<rH'
MANNER Of DEATH
DATE OF INJURY
(Month, Day. ~arl
Trt.4E Of' I~~URY
INJURV /fJ WORK? DESCRIBE HOW INJURY OCCURRED.
NoD
........
___ D
Suicide D
Horn""" D
Pendi!'9anv.stigatlon 0
COOd not be delMTlined 0
\'eo D NoD
"MEDICAL EXAMINER/CORONER
On the b..is 0' examination and/or Investigation, in my opinion. dulh occurred al the time. da1., and place, And due to the cause(.) and
m.nner..st.I~............. ......... .... ._...... ..__....... ._.... .__ _,....... '" ..... _._. ___."..... _.... ......
31..
REGISTRAR'S SIGNATURE AND NU
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D
.a.. 21b. 29.
CERTJFIER lo,eck ani". Ol'\el
.CERTIFYING PHYSlClAN (PhYSOCIa" cerllfylng cause 01 death wh8('l anOlher phySoC'an has pronollt1Ced dealh ana completeo Item 23)
To"" bntot my knowtedgtl, de.th occurred due 10 the eMlM(.) and manner.. stated. .
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'PRONOUNONG AND CERTIFYING PHVSlCIAN (phys>c1a/'I bolt'l j)t:Y\OUoc~ d@athandcertlly>nglocauseotoealh\
To the tM.t of my knowledge, dnth occurred at the time, ~e. al'ld piece. and due '0 theca~I.) and mann... ...'ated.
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