HomeMy WebLinkAbout12-22-05
.
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Joyce Gustafson Case
also known as
No. -:l., \ - ~ S - \ \ '\::J ~
To:
, Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 043-24-2086
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ies
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with h~ last family or principal
residence at 118 Holly Drive, Mechanicsburg, PA 17055
(list street, number and municipality)
Decedent, then 74 years of age, died October 17
Cumberland County, Pennsylvania
,2005
, at
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:
$ 14,000.00
$
$
$ 143,430.00
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name
Jeffrey T. Case
Lisa J. Case
Relationshi
Son
Dau hter
Residence
6404 Terrace Court, Harrisbur!=!, PA 17111
126 Crosstimber Way, Frederick, Maryland 21702
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
'^
Residence(s) ofPetitioner(s)
126 Crosstimber Way, Frederick, Maryland 21702
- ".' , .~I
z Z : II !Jl T~ ::;2 S.~L
.
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMBERLAND
COMMONWEAL TH OF PENNSYLVANIA
SS:
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 accorzrrrding aw.
Sworn to or affirmec~ ~~dJ~scribed {><- ~
Before me this " '^' day of
~~~~~ ,20 ~'5
~~~~ ~~~....,..~ \
Register ~~
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Estate of Joyce Gustafson Case , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW "0~", '\l~~' '"::L ~ 20~, in consideration of the petition on the reverse
side hereof, satisfactory proof having been pr~sented before me,
IT IS DECREED that Lisa J. Case
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Lisa J. Case
in the estate of Joyce Gustafson Case.
FEES
Probate, Letters, Etc. .............
Will ............................. ....
Renunciation.............. .........
Short Certificates (.3) ............
JCP.. . . .. . . ... . . .. .. . .. . .. . . . . ... .. ..
Automation Fee...................
Bond............................. ....
Total
Filed '\~- "'),,~ 20~
$ ~<O\J
$
$ ..s
$ '\~
$ \~
$ S
$ \S
$ ~~"\ .~
~~, ~~~ ~&~ ~
Register of Wills ~ .\(:~\ ~...~ ~
Yoffe & Yoffe, P.C. by Jeffrey N. Yoffe, Esq. (52933)
A (S C ID N) ~ ~,'\)\ tJ~ ~ 1f\~~
ttorney up. t. . . o. " _,
214 Senate Avenue, Suite 203
Camp Hill, PA 17011
Address
(717)975-1838
L_~.:
Phone
~.... ,.'::'
r<:'
P",;
1"-:
.
Register of Wills of Cumberland County
RENUNCIATION
Estate of Joyce Gustafson Case
Also known as
No. '1 \ - ~ S - \ \ \j )...
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned Jeffrey Thomas Case, son
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce( s) the right to administer the estate and respectfully request( s) that
Letters of Administration
be issued to Lisa J. Case
Witness my/our hand(s) this;;),;;). day of ~~.btr- /~ , 20~.
Affrrmed and subscribed before me this
"l.1..~ day of ~~ '\.\~')J\.
~.
~A
(Signature)
Jeffrey Thomas Case
Notary Public
(Address)
6404 Terrace Court, Harrisburg, PA 17111
My Commission Expires:
(Signature)
Or
(Address)
Affirmed and subscribed before me this
J:l:..'<.....y day of '\:)~,~....... ~'\
':t......~.
(Signature)
~~ ~'~ ~~<\'..~_.~
Register of WiIls- . - -~~ \
~,<-~ .'<..~ z">~ ~
Deputy \
(Address)
i_. ")
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
f-,,::'
r--....)
N
Fin"", pr.\ ").. '\ _ "J S _ \ \ <:J ~
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 permanenf'filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
No.
p
12064651
rJ t: tiJ..u/v ~. (). -,2 () (') ,;;-
I
Date
Z 1'f.hl~3S~~udd'_~tZ.. ~~3c""'~.....tc~
If./(
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Hl05144Aev 1/91
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
i')
r"',...~-
TYPE/PfijNT
IN
PERMANENT
BLACK iNK
o
w
'"
:>
'"
<(
~
A
Ie.
UNDER 1 DAY
Hours Minut..
Case
DATE OF BIRTH
(Moulh. Day, Yea,!
SEX
2. Female
& October 17, 2005
BIRTHPLACE (Clly and
SlaleorFOfl7lgnCuunlfY)
CITY, BOR
="'1"10
RACE - Amet4can Indian, BIaca. WhilIe, *
(Spoc"Whi te
DEC(OENT'S USUAL OCCUPATION
{~t:)~t~01~~k ~l::::'J!.:1f
11 Client Service l1b.Direct
DECEDENT'S MAILING ADDRESS (Sl:reel. CityfTo.....n. Slale, Zip Code)
10.
118 Holly Drive
Mechanicsburg, PA 17055
Mail
DECEDENT'S
ACTUAl
RESIDENCE
(See UlStrucliOlls
OflOlhersMJe)
11..5Iale PA
0",
_n'
live in a
Cllllll'Pr land township? 17d.D :::::~:i~OI
MOTHER'S NAME (fll'st, Middle, Maiden Surname)
11. Alma Larson
INFORMANT'S ""AILING ADDRESS (SIreet, CilyfTown. State. lip Code)
2Gb. 6404 Terrace ct. Harrisbur PA 17111
PlACE OF DISPOSITION - Name of Cemetery. Crematory LOCATION. CitylJOwo. Stale, Zip coo.
()( Other Place
MARITAL STRUS - Married
tMvar Manied. Widowed.
""",,oed (Spec",)
"pivorced
17c.OQ Y&S,CleC&deJtllivec:lin. r~r
/
SURVIVING SPOUSE
(II WIfe, gllle maideo name)
A llpn
Iwp
11.
f.,.HEA.SN....EHeh':lin~j") Gus tafson
11.
INfORMANT'S j~ffrey T. Case
METHOD OF DISPOSITION
BunalXJ Cremation [J Romollatfrom SlateD
Olher(Speclty~
1lb. COOn!
cifyJboro
LICENSE NUMBER
23.0.
TIME OF DEATH DATE PRONOUNCED DEAD (Month, Day, Yearl
'4. 11: 45 p.. n. October i 7, 2005
21. PART J: Em., 1M dIee.....ln)Ul'ie. Of compfIcatlons which caU88d the defl.th. 00 root enlef lhe mode of dying. such as cardiac or respiratory amN", Shock or hElarl lailUl8
liW onty one cause on each line
,
lMonI:h, Day. 'ft!ar)
23b. 23c:.
~S CASE REFERRED 10 MEDICAL EXAMlNERICORONER7
"" ~ HorJ
Metastatic Carcinoma of the Breast
---~--~--~-
I.
:~O.Ilimale
I 1lll8rval between
: onset ana death
i
PART It; Other litgnificant conclitiOM contflbuting 10 ciMln, buI
not resulting in the underlying cause giNn In PART I
DUE ro (OR AS A CONSEQUENCE Of)'
b.~___~~.____~_~__.____.~_,_._____.__.__~~_..____
DUE 10 (00 AS A CONSEQUENCE OF) I
J
c.-------Ouewi'ji-AS'ACONSEQUENCE OF): ~~,-----~ -~--~---'--_..---'--1--~
d
WERE AUTOPSY FINDINGS
"'-"llABLE PRIOR ro
COMPLETION Of CAUSE::
OF DEATH?
Natural
I)ll
[J
rJ
Homicide
MANNER OF DE./liTH
OATE Of INJURY
(Month, Day. Yedr)
"" []
No []
Auident
Pending Inllesligalion
...
~
[iJ
&:
o
is
w
"
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Z
u.. 21b.
aRTlFlER (Chad<. only Ofltl)
.CERTIFYING PHYSICIAN (I't.ySILIaII ';ClIolYlllY (:<lU:;U 01 <i.MIII whOrl dl'Olhtlr pt.ys.cian lid:; pr'Jll<J"'lCffiJ tJOdlh w.d u:)fllJ-!loloo lI..ll. 23)
To U. be'sI or m)' knowtedga, death occurred due to the c.auH(.) and menhfi a. .tated. .
SIUCide
20.
Could nol b6 delermined
".<.f,fJ})~
I~ [IC).;, II dJ..
1 Coroner
JDATE SW3NED (Monlh, Day, Year)
[] "C. 31d. Oc tober 18. 2005
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(Item 27) Type 0< P/int Michael L. Norris, Coroner
1'\1'1 6375 Basehore Road, Suite (Jl
II'( 32. Mechanicsburg, Pa. 17050
DATE FILED (Month, Day, Year)
34. (9
'PRONOUNCING AND CERTIfYING PHYSK:CAN (t-'hy~ian WIt! pIOlK..mung dedltl <1",1 cUltllYIIIU 10 Law>e 01 titmltl)
To Ihe beat 01 m)' knowledge, dIIath occurred al ~ Um., dale, and ptKe, and due to Ihec&UM(a) and manner .aataled
.MeOICAl EXAMINER/CORONER
On the baalaof e.aminatlon and/or InweaUgatlon, In my Oplnlon, de.lh occurred at theUme, dale. and place. and due 10 lhe cau.e(a) and
ma.lI'''''' ata-.d . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
31a.
REGIST A'S SIG':'IATURE AND NUMBER
. Register of Wills of Cumberland County
,
Estate of Joyce Case
BOND AND SURETY FOR PERSONAL REPRESENTATIVE
"'::l..\-~~-\\~l.
No. 25652871
Also known as
, Deceased
KNOW ALL BY THESE PRESENTS, that Lisa J. Case As principal(s) and
Wes tern Surety Companls surety (sureties) are held and firmly bound unto
the Commonwealth of Pennsylvania in the sum of Twenty Five Thousand dollars
($ 25,000.00 ) to be paid to the Commonwealth, for which payment we do bind ourselves, jointly and severally, our
heirs, executors, administrators and successors, the condition of this obligation being that if
Lisa J. Case
fiduciary capacity)
Joyce Case
Administratrix
as (state
of the estate of
, deceased, or any of them, shall well and truly administer the estate
according to law, then this obligation shall be void as to the personal representative or representatives who shall so
administer the estate and his or their surety or sureties; but otherwise it shall remain in full force.
Signed and sealed this 15th
be legally bound hereby.
day of December 20 05 h t d t
, _, eac in en ing 0
Signa~sentative .-
Lisa J. Case
Signature of Personal Representative
(Seal)
Signature of Personal Representative
g;fI#~
s#a f ding Agency
Jeffrey L. Scott
Attorney-Tn-Fact
r'-..)
c;;
POWER OF ATTORNEY
Know All Men by These Presents:
25652871
... ...
That this Power of Attorney is not valid or in effect unless attached to the bond which it authorizes executed, but may be detached by the
approving officer if desired. That Western Surety Company, a corporation, does hereby make, constitute and appoint the following
F 0 U R I 4 I authorized individuals:
AUTHORIZED INDIVIDUALS
E HOCKLEY
COSBY
(Irrevocable)
BOND No. R-
CHARLES
DIANE E
AUTHORIZED INDIVIDUALS
DAWN M WEYANDT
JEFFREY L SCOTT
CARLISLE
in the City of , State of
lawful Attomey( s) in fact with full power and authority hereby conferred, to sign,
one of the following bonds.
An ORIGINAL bond required by Statute, Decree of Court or Ordinance for:
(A) ADMINISTRATOR REFEREE IN PARTITION
EXECUTOR COMMISSIONER TO SELL REAL ESTATE
PERSONAL REPRESENTATIVE TRUSTEE OR RECEIVER - In Bankruptcy (Excluding Chapter II)
GUARDIAN OF INCOMPETENT CURATOR
CONSERVATOR OF INCOMPETENT/CONSERVATEE
COMMITTEE OF INCOMPETENT
SALE OF REAL OR PERSONAL PROPERTY - When this company has qualifying bond or wben it is a separate
bond for accounting of proceeds of sale only.
PENNSYLVANIA
, with limited authority, its true and
execute, acknowledge and deliver for and on its behalf as Surety,
MAXIMUM PENALTY
$ 500,000
(B)
(C)
(D)
GUARDIAN OF MINOR OR CONSERVATOR OF MINOR
NOTARY PUBLIC RECEIVER - (In State Court Ooly)
PUBLIC OFFICIAL AND DEPUTIES TRUSTEE - (Testamentary Only)
PLAINTIFF'S COURT BOND - Banks, Savings & Loan, and Trust Companies
(Except Restraining
Order and In'unction - All Others, exec t bonds rohibited b ;'!'\OTE" below
(G)
STATE LICENSE AND PERMIT - Thc following
(EXCLUDING OPEN PENALTY, STAY, SUPERSEDEAS OR GUARANTEE OF A JUDGMENT)
$ 10,000
$ 50,000
$ 100,000
$ 20 000
$ 2,000
$ 25,000
(E)
(F)
COST ON APPEAL
bonds are authorized where the state of
PENNSYLVANIA
is the obligee (other state required bonds not authorized).
AUCTIONEER AND APPRENTICE AUCTIONEER ************
AUCTION COMPANY AND AUCTION HOUSE ***************
PRIVATE DETECTIVE *******************************
*************************************************
*************************************************
*************************************************
$ 25,000
SPECIAL FUEL USERS
ANY BOND OR INDEMNITY provided there is attached to this Power of Attorney, written authority in the form of an endorsement, letter or telegram. signed
~f te:s%~e&:~~t~~~~\~~~f~~inat~~%i~~tis ~~~~=~i.n~~p~~~}\~~~~e~~r~:~~~~~t~j~~~:~~~:ty~~i~=tc~~~~~~~'d~~~' br:;=~~~ ~sii~JOO~1jl~~
(339..()O(1ll in South Dakota).
'\OTE:SllPl::RSf;DEAS, OR OPEI\ I'ENALTY OR STAY BONDS ON APPEAL OR GUARANTEE OF H'I>GME'Vr OR BAIL BONI>S OR CONSTRlJCTlO'\ Bill OR CO'HRACI
BOrmS OR BONDS FOR I>EFE'\DANTS OR UTlI.ITY DEPOSIT BONDS OR SITE IMPROVEME'iT BO"'DS ARE '\OT AUTHORIZED BY THIS POWER OF ATTORNEY,
eXcept as pro\idt'din H).
WESTERN SURETY, Y further certifies that the following is a true and exact copy of Section 7 of the By-Laws of Western Surety Company, duly
adopted an!inow ill force, to-WIt:, "Section 7. All bonds, policies, undertakings, Powers of Attorney, or other obligations of the corporation shall be executed in the
COIJloratename of theCOlnP3Ilyby the President, Secretary, any Assistant Secretary, Treasurer, or any Vice President, or by such other officers as the Board of
Directors ,may authorize. The P~esident, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall
have authority to issue bonds,policies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies,
undertakings, Powers of Attorney oZ[oth r obligations f th~ corporation. The signature of any such office~n~h; c;rp;a; S;f21 may be ~n;d;y ;a~mtle." COM PAN Y
Dated this 1st day ofJuly, 2005.
ATTEST ---f.fr--
Assistant Secretary By.---""'" / I
STATE OF SOUTH DAKOTA } ~ .
COUNTY OF MINNEHAHA SS Senior Vice President
On this I st day of July, 2005, before me, S. Petrik, the undersigned officer, personally appeared PAUL T. BRUFLAT and A. VIETOR who acknowledged themselves to be the Senior Vice President and
Assistant Secretary, respectively, of Western Surety Company, a corporation, and that they, as such officers being authorized to do so, executed the foregoing instrument for the purposes therein contained, by
signing the name of the corporation by themselves as such officers. J n
In witv-!..:'l.!i~!S.~llbs...~tv set my hand and official seal. ~
$ S. PETRIK $
~==:=~ .
:..............................................: ----------- -.------
My Commiallion Ellpirea August 11, 2010 Notary Public, South Dakota
I, the undersigned officer of Western Surety Company, a stock corporation of the State of South Dakota, do hereby certify that the attached Power of Attorney is in full force and effect
and is irrevocable; and furthermore, that Section 7 of the By-Laws of the company as set forth in the Power of Attorney, is now in f!cS t h
In testimony whereof, I have hereunto set my hand and the seal of the Western Surety Company this .
$
2,000
(H)
*IMPORTANT: This date must be f'IUed in before it is attached
to the bond and it must be the same date as the bond.
:EIZ
~ofDecember 2005
SURETY COMPANY