HomeMy WebLinkAbout11-28-05
Register of Wills of Cumberland County
Estate of George D. Roth
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No. a I . 0 s: - I OeJ 9
To:
, Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 716-09-4403
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, and the execut ors named in the last will of the
above decedent, dated May 27 ,20 05
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland
Pennsylvania, with h~ last family or principal residence at
5 Todd Circle, Apt. E, Carlisle
County,
(list street, number and municipality)
Decedent, then ~ years of age, died November 14 , 20~, at Carlisle Regional Medical Center
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: 602 Landsvale Street Marvsville PA 17053
$
$
$
$ 94,900.00
j
':1
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(sIpresente4.-'
herewith and the grant of letters testamentary .,
(testamentary; administration c.t.a.; administration' d.b.n:c.!.a.)
j".'-,.'
thereon.
Signature(s) ofPetitioner(s)
Residence(s) of Petitioner($)
C.i
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is 121 Ridge Road, Carlisle, PA 17013
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is 15 Kemrer Drive, Marysville, PA 17053
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA
}
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 above
decedent petitioner(s) will well and truly administer the estate according to law.
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Sworn to or affirme.sl an-fi-.s~bscribed
Before me this C) 8" . day of
i\lD\.\ ~ {y\ \:.., Q " , 20 05
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Estate of George D. Roth
, Deceased
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AND NOW t\k\J-fmh.M ():>( 20~, in consideration of the petition on the revers-;side
hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s), dated
May 27, 2005 , described therein be admitted to probate filed of record as the last will of
George D. Roth ; and Letters are hereby granted to
Carol L. Hoke and George A. Roth, Sr.
DECREE OF PROBATE AND GRANT OF LETTERS-:
FEES
Probate, Letters, Etc. .............
Will .................................
l}it:x~~, "~,, ~~"~~~-ryr.
~isterofWills: .
/ -.:..J..... v ,
tvilli C. Dissinger 10#27737 ...-.-.... J
$ 021000
$ I~.co
Renunciation....................... $
Short Certificates ( ). .. .. .. .. .. . $
J CP .. .. .. .. . . .. .. .. .. .. .. . .. .. .. .. ... $
Automation Fee................... $
$
$ cJ 5<..0 -cD
20 05
1 u . CD
IC). CD
5.00
Attorney (Sup. Ct. J.D. No.)
400 South State Road
Marysville, PA 17053
Address
Bond............................. ....
Total
Filed \ l.~"ir'
(717) 957-3474
Phone
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HIO:;SO) REV ]/I)~
This is to certify that the information here given is correctly copied from an original cert.ific~te of death du~t filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office tor permanent fIling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fee for this certificate, $6.00
p
12D26160
11//tf,/tJS-
Date
5. 96 VB.
COUNTY OF DEATH
HouB
~
-IXI
I.OCt 12, 1909 7. Marysville, PA ...
CITY, BORO, TWP OF 0EATl-t FACILITY NAME (If noIlMUtutlon, give snet and number)
BIRTHPlACE (CiIy one!
S1a1o ... ForoIgn Counlly)
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c;
'1'05.'43 Rev 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
--,.,
TYPEJPRlNT
IH .
PE.........EHT
BlACK INK
CERTIFICATE OF DEATH
NM4E OF DECEDENT (Firot. Middle. L.ot)
I.
AGE (loot Binhd.y)
SEX
ST4T1 f"U NUIrotetR
SOCIAL SECURITY NUMBER
.......
D. Roth
DATE OF BIRTH
(Monlll. Doy. V_)
2.
Male
3.716
09
-0
"",,0
Ib.
Cumberland
Ie.
Carlisle
Cut Rate Store
Carlisle Regional Medical Center
AS OECEDENT EVER IN
U.S. ARMED FORCES?
V..O NolKl
12.
17L$late
White
DECEDENTS USUAL OCCUPATION
(C:--=:~c:i~
II.. Co-OWner lIb.
DECEOENT'S MAILING ADORESS (_ CUylTown. S..t.. ZIp~)
KINO Of BUSINESS 'INDUSTRV
10.
MARITAL STATUS. Momod.
__. WIdowod.
Divot<:od (SpodIy)
Married
SURVMNG SPOUSE
11"-, p.r. .......... 1'IamI)
Rosella M. Skivington
"
I'
5 Todd Circle, Apt. E
II. Carlisle, PA 17013
FATHER'S NM4E (Fnl. ........ Loot)
II.
INFORMANl'S NM4E (TypoIPmt)
200.
METHOD OF DISPOSITION
IlutIol I:8l ClomoIIon o.omovol from S.... 0
0Ih<< (SpodIy)
FU E C
DECEOENrS
ACT\JAL
RESIDENCE
(SooInolNc:llono
""--)
I 7b. CouI1Iv
DId
--
..... .
Cumberland -.Np? I7d.lKI ~~=oI Carlisle
MOTHER'S NM4E lFirot. t.lidd... Molden S.....mo)
II. Hattie Hess
INFORMANl'S IoIAJUNG ADORESS IS'-. C!<Yfl:own 51010. ~ Code)
20b. 121 Ridge Road Carlisle, PA 17013
PlACE OF DISPOSITI(lN. Nome oIComo1o<y. CtomoIoo\o LOCATION. ClIyITown. SIoIo. ZIp ~
... 0Ih<< ......
Union Cemetery
17c. 0 v.., IMcedent ~ In
.....
dty-...
Thomas Roth
Carollo Hoke
~.
<II
:>
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0(
o
21c.
21d.
Duncannon, PA 17020
NM4E N/O ADDRESS OF FACILITY
22.. MicI1ael J. Shalonis Fune,al HomB 206 Maple Avenue Marysville. PA 17053
LICENSE NUMBER OA TE StGNED
(Month, o.y, v....)
23b. 23c.
WAS CASE REFERRED TO A MEDiCAl EXAAAINER ICORONER?
21. Ve. 0 No I8J
27. PART I: bW Ih. 4......... '"Jw&.. w _pAladoN wHeh ~'"" 1tM...... De nol-.nw'" ",MI. .,ctylno,.YCtI.. c.anM" w"."rIIloty ."..... .n.ctwhMn...._ ;ApproximIIte PART U: Oth. signiI'icanl c:ondilX::w'IS tontribu*1g to d4lath, bul
u.t..wy -- u.... - -.ch 11M. . interval between not re:tlAng in !he ~ cause given in PAAT I.
: on.. and death
LICENSE NUMBER
22b,
To 1M besl 01 my knorMedge. duth ~ .1 the time. dIIt. 8nd p'Ke stated,
(SigNlur. and Title)
230.
TIME OF DEATH
20. ~ l~
011825-L
OATE PRONOUNCED DEAD (Month, D.y, V.ar)
eo.... 25. ~~~..... \ 'i. ~~~
Sequenti.aly at conditions b,
it any. lNding to Invnedillte
.. cau... Ent. UNDERL Y1NG [
CAUSE (Di..... Of injury c.
.. thIIIiniCialIld..,."l.I
~ on dNth ) LAST d.
WAS N4 AUTOPSV WERE AUTOPSV FINDINGS
PERFORMED? AVAllA8LE PRIOR TO
COMPlETION OF CAUSE
OF DEATH?
:.......
:\J"'-I~
DUE TO lOA 4S A. COHSEOUENCE OF);
Y.. 0 No ~
Ve.o
MANNER OF DE-' TH
Natural ia Homicide 0
Ac:ddent 0 Pending Inyestigation 0
Suicide 0 Coukt not be detemWled 0
DATE OF INJURV
(........, o.y, v....,
TIME OF INJURV
INJURV AT WORK? DESCRIBE HOW INJURV OCCURRED.
Ii
W
o
W
U
'W
o
~
~
z
V.. 0 No 0
:W.. 30b. M. 30c.
PlACE OF INJURY - AI home. 'ann, stTMt. ractory, otftce
building. ~ (SP4d'y)
21.. 21b. 2.. 30..
CERTIFIER (Check onty one) SIGNA
.CERTIfYlNG PHYSlCIAN (Ph~ cettnying l;8UM oi death when another physician has pronounced death and cornp&.ted il..-n 23) ~
To the ~.t of ""I knowl.ctg., d..th OCCU~ due to th. cau..ata' WId rnann.,.. .lated..,,,....,,......,........,,......,...........................,,, ~ 31b.
"PRONOUNCING JlHD CERTIFYING PHVSICIAN (Phyoicion both p<onouncing de.th one! "_0 to cou.. 01 deoth) lIC~~UM~l \, ';t Co{ l~ DATE SIGNED (Mont lh. D:x.- V..~
To the be.t 01 my knowl4KIg., d..th QCcurr.d.. the time. d.t.,."d pl.ce, and due to the cau..s(s) and m.nner.. .tat.d.................,.... 0 31c. 31d. ~ Y ~
NM4E AND ADDRESS OF PERSON WHO COMPlETED CAUSE OF DE-' TH
"llEDICAL EXAMIHER/CORONER (I~ ~ Type... Print ~. ~ I"'eo.t)
~,:b::~::~~~~~~~I.~..-::.~~.I~~,~~~t~~.~~~:.I.~.~~.~~I.~~~:.~~~.~.~~.~~~.~.~.~~.~.~~:,~~~:.~~.~~~~',~.~.~.~~,~~,~~.,~..~~.(,~~.~.. 0 or O.~ "" ( .~ ~, ~ ~ ~ ~ U>~ n~" C;~ N """ _
3h.. , ~ 32. ~Q --., ~ .' -......J. ....)J....
RE ',SIGNA R&.,A BE OATEFIL~(M","" ._Oay;.Y *)"
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LAST WILL AND TESTAMENT
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OF
, .
GEORGE D. ROTH
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I, George D. Roth, of 5 Todd Circle, Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my Last Will
and Testament, hereby revoking all Wills and Codicils heretofore
ade by me.
funeral expenses,
all expenses of my
estate as soon as
ITEM I. I direct that all my debts and
including my cemetery lot and grave marker and
last illness, shall be paid from my residuary
racticable after my death as part of the
administration of my estate.
of
the
expense
ITEM II. I devise and bequeath all of my estate
ature and wherever situate equally to my children, George
Sr. and Carol L. Hoke, and their issue per stirpies.
of every
A. Roth,
ITEM III. I direct that any and all Inheritance, Estate and
ransfer taxes imposed upon my estate passing under my Will or
therwise, shall be paid out of the principal of my residual estate.
ITEM IV. I appoint my children, George A. Roth, Sr. and Carol
Hoke, or their survivors, Co-Executors of this my Last Will and
estament. I relieve my Executors from the necessity of posting
..
security in connection with their duties as such in any jurisdiction
in which they may be called upon to act.
IN WITNESS WHEREOF, I have hereunto set my hand to this my Last
Will and Testament, which consists of ~ pages, to each of which
I have affixed my signature this j./7 day of Af.lt V two
thousand five (2005). /
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. .
OMMONWEALTH OF PENNSYLVANIA
ss
OUNTY OF I~~
George D. Roth,
'::::-1~ .
and 't-~ \\ '. ". (\,,, \- ,
the testator and the
and
witnesses
J
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testator signed and executed the
instrument as his Last Will and that he had signed willingly, and
that he executed it as his free and voluntary act for the purposes
therein expressed, and that each of the witnesses, in the presence
and hearing of the testator, signed the Will as witness and that to
the best of their knowledge the testator was at that time eighteen
years of age or older, of sound mind and under no constraint or
undue influence.
Geo ge
~tP. ~
Witness
~~C(~>t~ ~.
Wi tne -
Subscribed and sworn to and acknowledged
before me by George D. Roth, Testator
and subscribed and sworn to and acknowledged
before me by "-\0.....\..\ A.. <f-..o~ , and
C1J~\.~)f -1\ -\2.o-~ ~r. ,witnesses this
~J ,'_ day ofrv\;:..'u..-I , 2005.
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I NOTAf'.{IAL SE/-IL- ..
. TlNA MAR,If: YOUNG, Notary Public
MarysVllla 60/'0. Peny County
My Commlssion Expiros Oct 31, 2005