HomeMy WebLinkAbout12-16-05
Register of Wills of Cumberland County
Estate of navi a M
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No. c;{ 1-0 5.. lo~4
To:
Plll)h
, Deceased.
Social Security No. 1 81 - 3 2 - 3 4 4 0
Register of Wills for 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 executOr named in the last will ofthe
above decedent, dated August 24 ,~ 1 qR4
and codicil(s) dated
Mllrn~ 1 R Wi'll h>r!':, III I E5qllire, renO'lnces his right to administer
the e5tate to Sharon L. Pugh.
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland
Pennsylvania, with hiSast family or principal residence at
64 High R; agE'! 'T'ri'l; 1, Mpl""h;:lniC'sbll"t"l)
(list street, number and municipality)
County,
Decedent, then Jil years of age, diedSeptember3 0, 20...0..5-, at Holy Spiri t Hospi tal.
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:
marr; E'!a Shi'lrnn T. Taylor on OctnhE'!r 4, 1 q96
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:
$ 78,000.00
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters 1- P!': t (;I me 'l t a t'y
(testamentary; administration c.t.a.; administration d.b.n.c.l.a.)
thereo . 7 /)
. natur titioner(s)
x
64 High
Residence(s) of Petitioner(s) ("-,)
Ridge Trail, Mec~8icsb~g,
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
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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 ersonal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate accordi law.
Sworn to or affirmed and ~cribed {
Before n1f'\his_ ~ . day of
~~ ,2005
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Estate ~~ ~. \)\)..j-- , Deceased ~
DECREE OF PROBATE AND GRANT OF LETTERS Ul
AND NOW ~ \:l;4 ~ \r....2A... \ lo 20 OS, 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
S - d. L.\ - ~ 1.\ , described therein be admitted to pr , te filed of rrcor s th last will of
~~ ~ \=>~ ; and Letters are hereby granted to L
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Register of WIlls I U
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to(l..-l..-{IJ.M L Il.-cLC.Jj 5 t (3
Attorney (Sup. Ct. 1.0. No.)
II C!(,t' I..R Il./J We)' 0 )J /J<?
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FEES
Probate,Letters,Etc. ............. $dlD oD
Will................................. $ 1S- - oD
Renunciation...... .. .... .. .. .. ..... $
Short Certificates ( )............ $
JCP.. .. ............... ... .... .. .... .. $
Automation Fee................... $
Bond................................. $
Total ~ ~LA ,tJO
Filed ) J. - J L~ 200.$
Address
{." A ~ P /--I (L L- i (? F-J I 701 I
7/7 I~I IGoo
Phone
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.
TYPE/PRINT
IN
PERMANENT
BLACK INK
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WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
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1'1826170
No.
16
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H105. 143 Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATE FilE NUMBER
1.
AGE (Last Birthday)
city/VOlO
NAME OF DECEDENT (First, Middle, Last)
SE:X
2. I'vtIle
SOCIAL SECURITY NUMBER
3. 181 - 32 -3440
DATE OF DEATH (Month, Day, Year)
4..512 rem ber 3) dVU)-
BIRTHPLACE (Cily and
Slate or FOfeign COllOtry)
PA
PLACE or DEATH Check ani one
HOS.PITAL
lnpallettl [If
Sa.
63
y"
Rf'~ldto"r.e 0 ~~::;IIY) 0
RACE - Amcrit:anlndi.ln, Black. While, (:t
(Specify)
5.
COUNTY OF DEATH
8b.
Cumberland
East PennsborD
White
8e.
10.
DECEDENT'S USUAL OCCUPA liON
(GIV" kmd 01 wotk Quilt, dunng mOlol
t~oiTlpanY"l're~j(jent
11a. 11b.
DECEDENT'S MAILING ADDRESS (Street, CityfTown, State, lip Code)
64 High Ridge Trail
Mechanicsburg, PA 17055
KIND OF BUSINESS I INDUSTRY
SURVIVING SPOUSE
(lfw.....g'vtI rnaid(lnniirf1t!)
Computer Network
Sharon Taylor
DECEDENT'S
ACTUAL
RESIDENCE
(See instructions
on other side)
17... Slate
Iwp
17d. 0 ~~hi~e~~I~~7:i~i~~ of
Cumberland
17b. Countv
16.
FATHER'S NAME (FIrst, Middle, Last)
18.
INFORMANTS NAME (Type/Print)
20a.
METHOD OF DISPOSITION
Donation 0 Burial 0 Cremation ~emoval from State 0
. 21.. Otl~ (Specify)
. S~TURE_OF FUNERAL SE~VICE ENSE
-i2..~ ~
Complete items 23a.c only when certifying
physician is not available at time of death to
cer1ify cause ot death
Albert Pugh
Sharon Pugh
MOTHER'S NAME (First, Middle. Maiden Surnaqle)
19. JUne Erdossy
~~~~RMA~ ~gl~'WFJg~s~~~eet, CilyfTown, Stiile, Zip Code)
PLACE OF DlsposmON. Name of Cemetery, Crematory LOCATION
or Other Place
Hoover Crematory
Harrisburg, PA 17112
. CilyfTown, State, lip Code
o
21c.
21d.
LICENSE NUMBE't=O_13845_L
22b.
NAME AND ADDRESS OF FACILITY
22e. Gilbert L. Dailey Funeral Home 650 South 28th SI. Harrisburg, PA 17103
To tile oost of my knowledge. death occurred alltw time, dale and plal,;e staleu
(Signature and Tille)
Items 24-26 must be compl~ted by
person who pronounces death
DATE SIGNED
(Month, Day, Year)
23b. 23c.
WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER?
26. Yo, ~ ~fl No D
LICENSE NUMBER
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)-+
: Approximate
. interval between
; on~et and death
PART II: Other significant conditions conlnbuting 10 dealh. but
not resulting in the underlying cause gi....en in PART I
C AQ.QIQ PUI..""~IJ IFf..,
f\o{f-'&'
G<Z.Jert Ole VIQ J'1y()VIf1IiY
(ff-,'t..</yQ
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Sequentially list conditions b
it any, leading to immediate t' e.
cause. Enter UNDERLYING
CAUSE (Disease or injury
that initiated events
resulling on death) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAIlABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
l.-.}O ~l..
IVl'10L ,Ifl.j) ,'I....
J.vFH.:ruJ;
MANNER OF DEATH
0'
D
D
DATE OF INJURY
(Monln.Dlly. V..arJ
TIME OF INJURY
INJUHY AT WORK? DESCRIBE HOW INJURY OCCURRED.
Natural
Homicide
o
D
D
30a. 30b. M
PLACE OF INJURY - AI tlOlTIe, farm, street, factory, office
ou,lding. elC, (Sp.Il(O,lyJ
30B.
Ye, D No D
30e. 30d.
LOCATION (Street, CityfTown, Stale)
Accident
Pending Investigation
Ye, D No D
Ye'D
NoD
Suicide
Could not be determined
28a. 28b.
CERTIFIER (Check only one)
.f~~~:F';~~tGor~~S~~~~~.~hl.S~~:rh C:~~~i:;'~~~~: t~ ~eea~ar:~:~(:r~~rr!?~X~i;~a~s h:t~r~~~~~~~~~,~ .~~~~~._~~~ .~~.~~~:~~~. i~~~ .:~~ .,.......... ... 0
29.
.PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and cer1ifying 10 cause of death)
To the beat of my knowledge, death occurred at the time, date, and place, and due to the causes(s) and manner as stated.
.~
.MEOICAL EXAMINERJCORONER
~:~~:rb::I:t:tfe:~~~I.~~~lon and/or Invest~~~~~~.~:.I.~.~~.~~I.~~~n, death occurred. at t~~.~~~~.'.~~~~.'.~~~.~.l~.~e, and due to the causes(s) and. 0
31a.
REGISTRAR'S SIGNATURE ANO NUMBER N .
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Estate of David M. Pugh
Also known as
Register of Wills of Cumberland County
RENUNCIATION
No.~ 1-05 ./()"{t{
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned Murrel R. Walters, III, Attorney ~ecutor
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters
be issued to Sharon L. Pu h his wife
Witness my/our hand(s) this r) oJJ.. day of
Affirmed and subscribed before me this
1'7 #.... day of n'fJJ.e.~
Z-6>D <j
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My Commission Expires:
&/1; /0 t,
Or
Affirmed and subscribed before me this
_ day of
Register of Wills
Deputy
(Signature)
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( Address)
NOTARIAL SEAL
DEBORAH l. RYAN u__ n, ..... ._
CITY OF MECHAN/CSBURG, CUMBERLAND COUNTY (Signature)
I MY COMMISSION EXPIRES JUNE 11, 2006
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
(Address)
(Signature)
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LAST WILL AND TESTAMENT
I, DAVID M. PUGH, a resident of 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 any and all wills and Codicils
previously made by me.
I
I direct that all my just debts and funeral expenses shall be
paid from my residuary estate as soon as practicable after my
decease.
II
I direct that all taxes that may be assessed in consequence of
my death, of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
III
I give, devise and bequeath all my property, whether real or
personal, wherever situate, including any property over which I may
have a power of appointment, to my fiance, SHARON L. TAYLOR, per
stirpes.
IV
I nominate, constitute and appoint MURREL R. WALTERS, III,
ESQUIRE, as Executor of this LAST WILL, to serve without bond.
IN WITNESS WHEREOF, I, DAVID M. PUGH, have set my hand to
this LAST WILL this ..?yA day of ~ ' 1994.
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'D7Wrb M. PUGH '~20
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Signed, sealed, published and declared by the above-named
DAVID M. PUGH, as and for his Last Will and Testament, in the
presence of us, who, at his request and in his presence, and in the
presence of each other, have hereunto subscribed our names as
witnesses.
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
I, DAVID M. PUGH, Testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
~/~~~
DAVID M. PUGH ~
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Sworn or affirmed to and acknowledged before me by DAVID M. PUGH,
Testator, this 0IJ.j TN day of C~~ ' 1994.
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF CUMBERLAND
We, ;? /nl1t2/.:.: Tf!OrJJI7S and lJ//l~'E In. S/'!7/TIf ,
the witnesses whose names are signed to the attached or foregoing
instrument being duly qualified according to law, do depose and say
that we were present and saw Testator sign and execute the
instrument as his LAST WILL; that DAVID M. PUGH signed willingly
and that he executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and
sight of the Testator signed the Will as witnesses; and that to the
best of our knowledge, the Testator was at the time 18 years of age
or more, of sound mind and under no constraint or undue influence.
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Sworn or affirmed to and acknowledged before me
this ~'i- Tl'f day of ~_d ' 1994.
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