HomeMy WebLinkAbout12-02-05
PETITION FOR GRANT OF LETTERS
Estate of Helen C. Moses
No~1 - O~ - /()L/7
also known as
, Deceased
Social Security No. 179285874
George L. Moses
Petitioner(s), who is/are 18 years of age or older. apply)ies) for'
(COMPLETE "A" OR "B" BELOW:)
o
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of the
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 incapacitated;
GJ
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.l.a.: pendente lite, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
e L. Moses
Husband
233 Woods Dr.
Mechanicsbur ,PA 17050
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. )~:::;
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her~mst famil)/,9t principa~C)
residence at 233 Woods Dr., Mechanicsburg, PA 17050 -., . . ,;(~
(list street, number and municipality) " -; ': C-)
years of age, died January 10 ,2005, at home, 233 Woods Dr., MechanrCPbur~. PA " c.!)
(Location) . " v. i:'i
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.....- -(-j
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Decedent, then 70
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 ..................................................................... $
Total......... ..................................................................... $
Real Estate situated as follows: 200 Tomko Ave., Hanover Township, PA 18706
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:
, I
...
C)
I I I
(A)
__. "'1
10,omY.00
10,000.00
C",
Typed or printed name and residence
Geor e L. Moses
233 Woods Dr., Mechanicsbur , PA 17050
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and 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
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
'. (1 c\
before me this~" day of
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DECREE OF REGISTER
Estate of Helen C. Moses
Deceased
No. ~') i- OS- -/OLII
also known as
Social Security No: 179285874 Date of Death: 1/10/2005
AND NOW,~(ly'XY"I~.-V\.. :2 ~s- , in consideration of the Petition on the
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary ~ of Administration
((c.I.a., d.b.n.c.l.; pendente lite; durante absentia; durante minoriate)
are hereby granted to George L. Moses
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
Extra Pages (
) ...............
$ 4S-co
$ r:2() , ex)
$
$
$
$
$ /0.00
$
$ S. ()()
Signature
FEES
Lette rs ....................................
Short Certificates(s) .............
Renunciation .........................
ITR.......................
TOTAL .............................$ 8() . cx..~
Attorney: R. Mark Thomas
I.D. No: 41301
Address: 101 S. Market 8t.
Mechanicsburg
Telephone: 717-796-2100
DATE FILED: fC) -d- 05
PA 17055
JCP Fee ................
Inventory................
Other ...... ......... ........ .... ...........
I J 1(J:'i~II~ RI\
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 for~arded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local R~
Fee for this certificate. $2.00
JAN 1 2 20QS
P 11063295
Date
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H10S.143Rev.V87
011 - os-- fOLI,
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (FII"II. Middle, lal
1. Helen C.
AGE (last Blrttlday) uNOEA 1 YEAR
Months Oays
SEX
.Fema 1 e
STATE FILE NUMBER
SOCIAL SECURITY NUM8ER
TYPE/PRINT
IN
PERMANENT
BLACK INK
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,.179
- 28
8IRTHPLAC6 (Ciry i1Ad
Slall or Fouwgn Countty)
~::ify)O
CumiJ.:rland .;)../
...
OECEOEN1"S USUAl.. OCCUPATION
(~V~~i~N~~~~U:';~'~
11.COsmeto ist' "..Self
DECEDENT'S MAILING ADDRESS (Str..'!. CrtylTown, Sbn, Zip Code)
223 Woods Dr.
Mechanicsburg Pa. 17055
RACE. Arn.ncan Indian. B1K1l.. Whll:.. ell:.
(Specify)
,..White
SUFWWINQ SPOUSE
(II >MI.. g,.... malO8rt name,
......
clty/borQ.
11.
FATHER'S NAME (First. Middle. Last)
...
INFORMANT'S NAME (TypefPrinl)
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18706
Parrish St. W_B1~~02
DATE SIGNED
{Monltl,Oay. '(eal)
23b. 2 .
WAS CASE AEFERRED TO MEDICAL EXAMINER/COAONER?
V.. S- NoD
liCENSE NUMBER
...
I Approximate
:Inl.,..,.~n
I onMC and death
I
:
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WEFlE AUlOPSY FINDINGS
AVAILABLE PRtC)R TO
COMPLETION OF CAUSE
OF DEATH?
" 'I"?r.
Natura!
~
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OATE OF INJURY
(Month, Day. Year)
TIME OF INJURY
MANNER OF DEATH
Homicide
o
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o PLACE OF INJURY. AI home, 'arm, st~e.4.fsctory, oftlc:e
building, elC. (Specify)
....
"" 0 NoD
"" 0 No~ v.. 0
2... 21b.
CERTifiER (Check onl\, onel
.CEJIITIFYIHG PHYSICIAN (PhYSICian c@fllfyingcauseoldeathwtlManotherpl'lySicianhaspronounceddealhan(J completed Item 23l
To the..t of my knOwteclge, d..th occurred due 101ft_ caun(s) and mann., all sta'-d. . . ... .. .
Accident
Pending Inwllligallon
,..
NoD
SuIc1do
Couklnotbtldet.rmlnlld
...
.PRONOUNCING AND CERTIFYING PHYSICIAN (Ph\'siclan both pwnounc'l'\Q Claa\tl and certifying to cause 01 death)
To Ihe bHl 01 my knowledi., dea'" occurred at ttl. lime, dale. and piau. snd dUI to the cauM(a) and msnn., a. a'atlld..
-MEDICAL EXAMINER/CORONER
On the baal. of ...mlnatlon and/or Inv..UgIUon,ln my opinion, d.lth occu,red al the lime, date, and pile., and due 10 th. CIU..(I) .nd
mlnn.r...llted........... .... ....... .............. ........ ... ... .................. .... ....... ......... .... ......
31a.
REGISTRAR'S SIGNATURE ANO l)Itl R
(A:~~~ !u:. 17',0 0~1 &t