HomeMy WebLinkAbout12-01-05
PETITION FOR PROBATE and GRANT OF LETTERS
No. ~l - Os-- t oL(~
To:
Estate of . RM/,4-Ll> /F.
also known as
//PfJE 71"
Register of Wills for the
, Deceased. County of Cu.m.ber-//M1.d in the
Social Security No. ;:2oL/- 30- 8'/(/2 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 executor
in the last will of the above decedent, dated /Yti>J/eA'J/Jer /5'
and codicil(s) dated
named
, lj2Eo~
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in CLL""l:u.r-I
last fa 'ly or principal residence at 3goo
(list street, number and muncipality)
/J/~YUJl.ber /9 , yi:2bOS ,
Decendent, then 4, 'f
at CaNJIi n C~k!t/ cSIt:Ufe ~
Except as follows, decedent di 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:
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
sitated as follows: 3j{)O Gti>/IV;eaI /}r. _ /lJedJlln;C>~tt~
~ CU4~ .
f'- oS; 19{)tJ. ~D
$
$
$ r
$ ~ pt)/J . V#I
W,,~ ~./ (Y.ilMbu-/~
WHEREFORE, petitioner(s) respectfully re'l.uest(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters "k.stQ.f'i1ntlaJ')
(testamentary; administration c. La.; administration d. b.n.c. La.)
theron.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA I ss
COUNTY OF e CtJf113tF1{Uhtlj) 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 and tru dminister the estate according to law.
and
subscribed {
'M day of 7QPp /iPPE TT
eglster
en
~.
::s
l:l
-
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~
~
No. c:2105-IOWW
Estate ofhcrlO. \c\ r;;. t;ppetJ-
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW D~\.\.lX'I\\b..QA. OlrY)S- W_. 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 ,\ -I 5.. (~CJ("l5
described therein be admitted to probate and filed of record as the last will of
~bnQ\c\ G". ~ pjX.tt
and Letters \~<;\.f>..IY'It="'T""R~
are hereby granted to Icc\c\ 'f>P€.."""tt
~ ~E~S... ~ 5.00
Probate, Letters, Etc. ........... $ Cia .(j"\J
Short Certificates( )............ $ 3:;l . 00
~ 1i;)o~......... $\S.\.~
~QP $ ID ,ClO
TOTAL _ $ 15'2.00
Filed } ~ .-. ~ .-' '?? . . . . . . . . . . . . . . . . . . . . .
JUx((\~~N'\~i\Ilb~~
Register of Wills ,~t ~\.pZ}..~6
~ ~~JE
AITORNEY (Sup. Ct. I.D. No.) 3'8~/3
b C/t;VSU ;(t:I.., /JIedt4111'cSUU~ ~/f 17tJ.>S
ADDRESS
7/7- 7~~ -/!)ZtJf
PHONE
REGISTER OF WILLS OF C tlAl13EJeLA-AJ1:> COUNTY
OATH OF SUBSCRIBING WITNESS
\:1\ -o~ -IO\.lL/
\ '
/iI/CHA~L S. SCHIVOYClf(
w~~...~J
~ a sUbscribing lIIimess to tbe will presented herewith,~) being duly qualified according to
law, depose(s) and say(s) that HiE tlJlIS present and sa""
'RoNALD F T/PPE TT
the testator . sign the same and that HF signed as a witness at the
request of testaloL-- in ~ presence and (ia ihe ",!3(.,~,,- of CIl!l. Mh,,~ (in the presence of the
other subscribing ""itness(es)). ~~-'
Sworn \~.s;:2..rmed aod subscribed before .x ,,-,,I \ I .
me this . \ .:Ja..*" day of hi/ell . D
_~~. .\~'> ~. ~~. yI~ /7 E: Olin! ~T./ t!;f-nt6l~~ /70f3
- ,.' J1tJ~~,O_IY\J (Address)
AI" .N~ Co R~.JU.
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Kym M. Gritman, Notary Public
City Of Harrisburg, Dauphin County
My Commission Expires Apr. 11, 2009
Member, Pennsylvania Association of Notaries
(Name)
[SMLJ
(Address)
REGISTER OF WILLS OF COUNTY.
OATH OF NON-SUBSCRIBING WITNESS
testat_ of (one of the Subscribing witnesses to) the
that
presented herewith and
codiCIl
believes the signature 01) the will is in the handwriting of
10 the best of
knowl~dge and belief.
Sworn 10 Or affirmed and subscrlbed before
me rhis day of
19_
(Name)
(Address)
Re1:,s((!r
(Name)
(Address)
o
c.')
W
C.:)
. 1
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tTl
REGISTER OF WILLS OF C U IJ1/3QtlA-AlJ) COUNTY
OATH OF SUBSCRIBING WITNESS
J I - or:;- -/0 L/ ~
tJlI/l-lUGS e: SIi I C-U)S I!l
c(lsiei1--
..(-eachJ a subscribing witness to the will presented herewith, feaeR) being duly qualified according to
law, depose(s) and say(s) that liE t:v~ present and saw
RMI,lftJ> E". 7/~fJE TT
the testatDr , sign the same and that JIG signed as a witness at the
request of testat.et:::....- in hIS presence and ~R tl1@ pn~g@RCe of @aca other) (in the presence of the
other subscribing witness(es)). ~ Co ~ ..iJ
Charles./!:. Slie/~ ftt.
{Naine)
~ ~U~ &, /JIetJkAW~s6~~)tfJ/f /7bSS"
(Address)
(Name)
f)
(Address)
, ,
" ,
, ']
,
REGISTER OF WILLS OF COUNTYi
OATH OF NON-SUBSCRIBING WITNESS
c:)
G..>
(each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that
familiar with the signature of
codicil
will
that
presented herewith and
codicil
believes the signature on the will is in the handwriting of
testat_ of (one of the subscribing witnesses to) the
to the best of
knowledge and belief.
Sworn to or affirmed and subscribed before
me this day of
il)_
i Name)
.rlddress)
!?e~is(er
. Name)
Aadress)
j........,
-:~:~:")
'-".J
C-j
-'~']
II 1(I'iX(}'1 RI-:\' I/O'i
This is to certify that the information here given is correctly copied fron~ an original ce~~.ific<.~te of death du~r filed with
Local Registrar. The original certificate will be forwarded to the State VItal Records Office tor permanent tIling.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
p
32907
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Local RCg~
fee for this certificate, $6.00
l1C
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No.
NOV 222005
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Rev. 2187
$1- 0'5" -/oL/V
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
o
(..,.)
CERTIFICATE OF DEATH
Yrs.
SEX
2.male
PLA E OF DEATH
HOSPITAl:
~,"IO
B..
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
3.204 - 30 - 8102
DATE OF DEATH (Month. Day. Year)
.Iq. {)S
1. Ronald
AGE (Last Birthday)
ERlOutpatlllnl D
4.
ODAO
121
64
Hospi..c.e
ReaidllnceU
WAS DECEDENT OF HISPANIC ORIGIN?
NM]) Yes n If yes, specify Cuban,
MeXican, Pue~ Rican, etc.
5.
COUNTY OF DEATH
Dauphin
Bb.
Be.
DECEDENTS USUAL OCCUPATION
(~~V:;~i~~i;:~~od~~t.u~~rir~Vir~)at
lW?chinist l~promalloY/TAD
DECEDENTS MAiliNG ADDRESS (Street. CitylTown. State. Zip Code) DECEDENTS
ACTUAL
RESIDENCE
(See instructions
on other side)
KIND OF BUSINESS /INDUSTRY
MARITAl STATUS. Manied,
Never Married. Widowed,
Divorced (Specify)
14.di vorced
17e.K] Yes.dece<lentlivedin Hampden
SURVIVING SPOUSE
(lfwlfll,glv.matdllnnamll)
3800 Golfview Dr.
16. hanicsbur PA 17050
FATHER'S NAME (First. Middle. Last)
lB. William C. Tippett
INFORMANTS NAME (Type/Print)
20a. Todd A. Ti
METHOD OF DISPOSITION
Donation 0 Burial KJ Cremation ~emoval from State D
21a. Other (Specify)
SIGNFUI\E Cfi IJlNERAL SER
22a. VJ~
Compk)te items 23a-c only when certifying
physician is not available at time of death to
certify cause of death.
Cumberland
Did
decedent
live in a
township?
twp,
17b. County
17d. 0 ~f:h~e;~~~7~i~i~: of
citylboro.
ett
MOTHER'S NAME (First. Middle, Maiden Surname)
19. Kathryn Sheeley
INFORMANTS MAiliNG ADDRESS (Street. CitylTown, State, Zip Code)
20b.254 Lincoln Ave. Harrisburg,PA 17\1)11
PLACE OF DISPOS1T10N~ Name of Cemetery, Crematory LOCATION ~ CityfTown, State, Zip Code
or Other Place
~2lling Green Mem.Park
NAME AND !\DuRESS OF FAClPD
ssel.man FH&CS
Items 24~26 must be completed by
person who pronounces death.
the best of my knowledge, death occurred at the timE;, date and place sta:cd.
( ignature and Title)
23a.
TIME OF DEATH
liCENSE NUMBER
L
24.
25.
DATE PRONOUNCED DEAD (Month, Day, Year)
I l - t q - C~
23b. 23e.
WAS CASE REFERRED TO A MEDICAL EXAMINER /CORONER?
26. Yes 0 No ~
: Approximate PART II: Other significant conditions contributing to death, but
I intelVal between not resulting in the underlying cause given in PART I.
: onset and death
27. PART I: Ent.r the dl......, InJurIa. or complication. which cau.ed thll death, 00 not enter the mode of dying, luch a. cardiac or r..piratory arrlllt, .hock or heart failure.
L1.1 only one caus. on each line.
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)--Il>
~~frlOC~~V~/,r~
DUE TO (OR AS A CONSEQUENCE OF)
C/r-ft..c I rv () M A
Sequentially list conditions [ b.
if any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury c.
that initiated events
resulting on death) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DUE TO (OR AS A CONSEQUENCE OF):
DUE TO (OR AS A CONSEQUENCE OF):
MANNER OF DEATH
DATE OF INJURY
(Month. Day. Year)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
Natural
~
o
o
Homicide
o
o
o
30a. 30b. M.
PLACE OF INJURY - At home, farm, street, factory, office
building, IItC. (SpeCify)
30e.
Yes 0 No 0
30e.
Yes 0 No Ii]
Yes 0
NoD
Suicide
Pending Investigation
Could not be determined
Yl'ID
Accident
2B.. 2Bb.
CERTIFIER (Check only one)
.~~~~~F:~~tGor~~~~~~~eY'g~Sb~:rh c~Wett~~~aduJ: t"d f~;~ha~:~(~)~~jr~~X~i;~a~s h:t~fe~~~.~~~~.~ .~~~~~. ~~~ .~?~.~~~~~.~. i~~~ .~~.)...... ...... ...... 0
29.
.MEDICAL EXAMINER/CORONER
~:~~:rb::I:~:e~~~~.I.~~.t.I~~. ~~.~~~.~ .I~~~~~~~.~~~~.~: .l~. ~~. ~~l~~~.~: .~~~~ .~~~~~~~.~. ~~. ~~.~. ~.~~:. ~~~~:. ~.~~ .~~~.~~'. ~~~ .~~~. ~~ .t.~~ .~~.~~.~~.(.~~ .~~~.. 0
31a. :
REGISTRAR'S SIGNATUR. ~. D NUMBER-f.}') 1ft-
/'( /tz.-~
33. I.
l..a /b7V 1'1
DATE SIGNED (Montl)..pay. Ye~
31e. 31d. /1- "2/ - G DO,j
NAME AND ADDRESS OJ'.fERSON WHO CQMPLET~ CAUSE OF DEATH
(Item 27) Type or Print ;t.TrlOf"YJ/t':J I7YL'VIU::"-~J""O
~q/'Z.. TnI/'vOU!' ,z/~
32. ~" HN"''-I f?,q I? 0))
DATE FILED (Month. Day. Year)
.PTRoOt~~~:'~I~fG~N~;;I:~;~I~e~t~~:~~~:~ ~~~~:i~l;:,ne~~~tr~~~u;~~~~,d:~: da:ed t~e~~~~ut~e~(~)~~~ d~:~h~er as stated,..................... ~.
34.
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