HomeMy WebLinkAbout01-04-06
Register of Wills of Cumberland County
PETITION FOR PROBATE and GRANT OF LETTERS
Estateof ,'2AY 4, IfEL('E~
also known as
No.
To:
J'AN / , [;< 00 G , Deceased.
Social Security j,'o. ; f?Jt .- i ~ .-if.!J- S2
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 ofIhe
above decedent, dated ..j A tv' if ' 20 6 G; "
and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was d~miciled at death in Cu..m~t\. }QYtd
Pennsylvania, with h~ last family or principal residence jlt /)
5C;S '0, If? Tfu S-r: i ('~ tiLl!, /--:.{,
(list street, number and municipality)
Decedent, then .ZR. years of age, died ,JQru / , 20 C b , at t-/oh-1f t
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:
"/0
County,
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(lfnot domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value ofreal estate in Penn~ylvania f/., .
situated as follows: 7~~8' t~ ~~1 ~-r.. f1r;r' / II ,
( OY[ RI C (J. ) .
$
$
$
$
f$ 1'f:2 IOOCJ
3 cO(f)
)
WHEREFORE, petitioner(s) respectfullY request( ) the ob te of the last will and codicil(s) presented
herewith and the grant ofletters~.J ' "
(te tamentary; administration c.t.a.; administration d.b.n.c.t.a.)
thereon.
Signature( s) of Petitioner( s)
Residence( s) of Petitioner( s)
i:M;;t c:t iff ./J-J
1/2 u..JALiTJIV AVe " ('1-k>t;5>-lr, I-~
!70(~
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL V A.1\fIA
}
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 beliefofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate ac~o~~=:: #
Sworn to or affirmed and subscribed {_ ~ ~ &!~~
Befor e this L/-tA day of _ _
,,200[,
"I'Jlci'o.~Jlu . '- v1httu:k,- r,tr: !
Regi'~J. Uf!JI/ (" '6/€fiuLj
No. :2I-Ot:;'-ca57
Estate of 110.._-'1 A (Jdiey , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
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FEES ,/ Registe10f:YfY1~\)f1 )
:>robate, Letters, Etc. ............. $ () () t '-f . {9LL 5 VlU./
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Will...... ........ ..... .............. $ I ~. () D Attorney (Sup. Ct. J.D. No.)
~enunciation... . . . . . . . . . . . . . '. . .. . . $
:~;rtc~rt;"~at" 0.: ;)~ O.~B Add","
\utomation Fee................... $ "5-. () .
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30nd........... ;~~.. :3r~"CD :
;iled / /t-/J 20Q{
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12211819
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Ray A. Heller
, 8~"''''-:, E .::'L1-:;~"::" ; .:",i:"t;ij
bbcoor.iyo10aalh ~- -- &:-C;ty,Boro~r;pol-Death
Cumberland Lower Allen
;~ 11 Oeceden!'s USllal Occ lion Kind 01 work dune durin rrosl- of workinQ life, do 1101 slale retired}
Kind 01 Work Kind 01 BusmesslmduSIl)'
Plumber and Pi Federal Gov
n. 16 OlKedenfs Ma~IO\I Address (511ee1. cny,1own, stale zip Code)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
---___~r~~~-r-t8'8~": N""~l 2_
8 Bir1h Iace(ClyaodSlil~~~~~__ Sa P~cl!olOealh Chackonl cme
Hospital.
Din ahenl 0 Efl/OUlahenl
,
STATEflLE NUMBER
H105 143Aev Oll06
TYPE/PRINT lH
PEAUANENT
BLACK INK
~'-'Name-ol Otlcedent (F~sl. n;jd~~'~ ,-
18th Street
PA 17011
III Aesid~lrlce 0 C\hllr.
10, Race: American Indian. Black,WhiI.,e\C
(Specify!
White
. Dale 01 Oealll (Monlh. day, yeal)
January 1,
2006
hhest radeco led
Colle08 (1.... or 5+)
14 Martlaf Slalus MaHied, Never mallled
Widowed. DMlrced (Spttcityl
Widowed
15 SurvivinG Spouse (U wile.. Qive ma..:ien f\&ffie\
598 South
Camp Hill
Did Decooenl
llveina 17c~
Township?
Yes, Deo.:edenl lived io
Lowern Allen
Twp
17d D
No, Decitdenl lived wdhlO
Actual limits 01
_ _~ ClIYiBoro
17b County
~ Fathe/!o Name (FlfSt middle, la!>l)
19 Molher's Name (Firs!. middle. maiden Sllfname)
Andrew H. Heller
-2oa IfllOlmanl'!> Name (Typeiprint)
Anna Grace Stall
'200 Inlormanl's Malltng Address (SlIeel. cilyoown. stale. zip code)
Terry L. Hell er
112 Walton Avenue Carlisle, PA 17013
o
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2iZPiaCeOlDlSPOS1Ikln (Name 01 cemetery, clematory or olher place)
2 ill locatkln (Ctytlown. slate, Zip codel
2206 Rollin
Green Memorial Par
Camp Hill PA 17011
22c Name and Addres!> 01 Facility
FD-012662-L
MYERS FUNERAL HOME MECHANICSBURG PA 17055
24 TIIlle at Deatl\ 25 Dale PlOoounc:&I1Dead (Mull1h, day, year)
CAUSEfo:i~:,",n..oo "'mple~ ~ ;;?<<J~
IIem 27. Pari I_ Enter the ~ ~ dl!oeases, In,.mes, or conlpllCdhon~ lhal directly cal.J!oed the death DO NOT enler termillal llVtlflts sochas caldlilC alls!>\
resplta\ory arres\. Of venlrlCular ftlllllallon wAhoul showlI1g Ihe ellology DO NOl abbreviate Enter only one cause on a line
IM,.EDIATf CAUSf \hrl.ill dislldse or /--. .... ("L~ - Ll~... j r ~ l....~
Coooh::'!\lestlllflijIf\Oeath) -? a - I.Al ~s;q-~:-/~- l~n.--l-~"":.~----
S~ueOl~lIyllslconclltklns_ltany Due~ra onseq{uenceoi-~' I " -
. - r-<t1C.1. Jd;l.L"- i- &-!"""
~dll1g10lhecauselistedonllllea D"".;J\" asaconse1"""l. 0 -. -t _J
- Entellhe UNOERL YIHG CAUSE 1'"7 h
. (dlSeaS8Ofln]u'Yltlatinilldledlhe U'L'" _ ______:",{K.j{'.(l ,~__a~_
(, eVlwts re!oldllng Ul "ealh) lAST (Jue 10 (or i1~ a cOJlsequence of) J J
: "4lPlOxmale inlervaf Pari U: Enfer othel sillni!lCarll coodih:ms cootlilullna 10 dealh.
: onsellO dealh bul nol (esulll'll} in the undeltyinlil cause c;ven in Part I
/~
,<A.;
~jQa. Was al\ Au\CPSy
Pelbrmed?
DYes ~
d
JOb Wate AuIopsy Fm~
Available Priol lu CO~lel~n
o/Cause01 Dealh?
DYes 0 No
Clvn!J",-k~/L1,d/
~~1(;"'..,
""-"'J2d!~H (/IJJ1 f!A.~1.UJ2__
f'.../...._"I 1l1,*,n-.-
20 Did Tobacco Use Conkilllle 10 Death?
.tf''1es 0 Probably
o No 0 Unk/IOWfI
29 UFemale
o Notpte\lOanl....~hlllpastyeal
o Pte~J\\ill\\Il'Ilealdea\t\
a Nol prellflaOI. bul preg1anl WJtllill 42 days
oldealh
o Nol p(&gnanl, bul pregoanl 43 Gays lu 1 ye.ill
beloltldealh
o UnklWNflilpleljl)l\ntwilhWllheP9s1YIili1I
32c. Place olln/lll)', Home, Fal'nJ, Sire&!., Factor)', OIlice
Buildillg,elc(~
31 Man(lelolDealh
P"Nalural 0 HOlTllCide
o Accldenl 0 Pending Invesligillklo
o SUiCide 0 COllld Nol tie De(eunined
32a Dale 01 fnllll)' (Moolh, day, year}
32b. Describe how InJUry Occuned'
M
32g localion(Slreef.cilyilown.Slale}
32d Trmeollnju'Y
t--
~
o
w
~
o
'c
o
IiJ
::;;
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Z
-JJa Cenl'ier (chedl. only one)
Cenltyioll ph)'sk;~n (Ph:fs"':ldn cerld,lng cause of dealh ....hen arwlher phYSICian has prooounced dlldlh and COOllilJted liei'll 23)
To the besl 01 '"" knowledge. c1ulh occurred dfJlllO IN! C.lIUse{s).lInd lNnne( as suted
PronounGinll and unit)'log ph)'sic~n (physlCldn both pronour.:lllg death and cerll/)'Ifly 10 cause 01 deathl
To the besl 01111)' knowledge, death occurred .lItlhe lime, d.llle,.lIOO pl.llce. and due 10 the cause(s) and manner as s~lecL
>>ed6c.ll1 eurinerlcoroner
On In. wsls 01 .umin.iltlon .and/or 'nvesl'~tioo, in my opinion, death occurred.llt ItW lime, dale,.lInd place, .lInd due to the G.lIuse($I.and IT1iInner as 'Llled... .. 0
"'''S''''''''''''D''<<'9(; 'J...' { 1;2..1/ l.?-l I'" .O:"F"'IMoo~_""'Y'''1
A~L.V ~ ~- - -- L1 -6
g if (See instructions and examples on reversel
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M()O OO'ti:
J.t Namtl and AddftlSS 01 PerSOl1 Who Colfllleled Cause 01 Death (nem 27) TypeIPrinl
'"
Creston C. Herold Jr., M.D.
Lemoyne, PA 17043-
LAST WILL AND TESTAMENr
I, RAY A. HELLER, of the Township of Lower Allen, County of -
Cumberland and State of pennsylvania, being of sound mind, memory. and
understanding, do make, publish and declare this to be my Last Will and - '_
Testament, hereby revoking and making void all former wills, codicils and,
other testamentary dispositions by me at any time heretofore made.
1.
I direct my Executrix, hereinafter named, to pay as soon as
practicable after my decease all my legally enforceable debts and the
expenses of my last illness and burial.
2.
I order and direct that I be buried in a lot which I own situate
at the Rolling Green Memorial Park located in Camp Hill, Pennsylvania.
3.
I give, devise and bequeath all of my estate, whatsoever and
wheresoever situate, unto my dearly beloved wife, Lottie M. Heller,
providing she survives me by sixty (60) days.
4.
Should my said wife, Lottie M. Heller, predecease me or die on or
before the sixtieth (60th) day following my death, then and in that event,
I give, devise and bequeath all of my said estate unto my Children, Terry
L. Heller, Richard D. Heller, Barbara A. Wildon and Jeffrey L. Heller,
share and share alike.
5.
I hereby nominate, constitute and appoint my wife, Lottie M.
Heller, Executrix of this my Last Will and Testament. Should my said wife
fail to qualify or cease to act as Executrix, then and in that event I
hereby nominate, constitute and appoint my son, Terry L. Heller, Executor
of this my Last Will.
6.
I direct that my personal representatives shall not be required
to furnish bond for the faithful performance of their duties in any
jurisdiction.
IN WITNFSS WHF.R&>F, I, RAY A. BELLER, the Testator, have hereunto
set my hand and seal to this my Last will and Testament this ~ 9 ~ day
of ~AA./UAI/.y' , 2001.
~~
(SEAL)
Signed, sealed, published and declared by the above RAY A.
BELLER, 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 thereto.
COMMONWEALTH OF PENNSYLVANIA
.
.
ss.
COUNTY OF CUMBERLAND
.
.
I, RAY A. BELLER, 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 willingly: and that I signed it as my free and
voluntary act for the pUrPOses therein expressed.
Sworn to 91}d acknowledged before me
Testator, this Jt.CJ!1:! day of 4/.4Nutl4~y
BELLER, the
JOf2ri2! .Seal
Charfy Clu:c: :~:8, 'I:;"]:" P,'jiic
Mech2nj(;~:i'I,J'-q
My Con::'ls,
Member, l~cr~r;Syjv,:jT!ia
II""'"
COMMONWEALTH OF PENNSYLVANIA
.
.
.
.
ss.
COUNTY OF CUMBERLAND
We, WI<.t.rtfJl'iJ 1.. St.'NOA;' ,and (;YIfi41"rlll9 ,y. S'~A~
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 the Testator, RAY A. HELLER, sign and execute the
instrument as his Last Will: that he 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 that
time 18 or more years of age, of sound mind and under no constraint or
undue influence.
Sworn to and subscribed before me by Wi,(,L)tll'f 1. ~?t,J,<.!-/JI1IY
and C)".u'T IN A .AI ,.5YA ~ , witnesses, this :z f or fl day of
~JA~VAA)I , 2001.
i
nt~rI~1 ,Seel ..,
Cha, rlyn, Y, ,r,t',cr",';n" l"tl,',',I,arv,'_ P""'"II"C,J
Mechnnli:;'!IIW; ',":il'j1rl r:c,qnfv
My Cr'''''',': ' , " ,0 "",l?
, Member, peml"Yi;~i1;~ A~~;~i~ii'~:;;i' Nor~rt83
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