HomeMy WebLinkAbout03-16-06
Estate of
Register of Wills of Dauphin County I Pennsylvania
PETITION FOR GRANT OF LETTERS
f./4RV JcJ 51/1-ttJf/e~
No.
ZoO&; "0233
also known as
I Deceased
Social Security No. /17'1 -//7' -.(tf't1 S-
Pelilionelllll. who i./a,e 18 yea,. 01 age or aide" applylie.) tor:
(COMPLETE "A" OR "B" BELOW:)
~
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut~ named in the last Will of the
Decedent, dated 0 q / c:i I / ? .s- and codicil(s) dated
I ' ,
St81e releV8flt circumstances, e.g., renunciation, dealh 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 incompetent:
Q
B. Grant of Letters of Administration
(C.I.II., d.b.n.c.I.II.: pendenle hie; durllOle lIbsentill; durllllle minor;llIle)
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name
Relationship
Residence
Decedent was domiciled at death in
residence at ";2. I)
(Iisl sl,eel, number 8nd municipalilyl
Decedent, then ---2-2.- years of age, died
JUn/1:?
e:;/
, 200~ at
6E1I1Ib/1/iI (), '-{If C e t 1/" F~/( 4LL ti;
/YJ EC If IJ /fileS- 81/;< C;, M T w-p.
~ Rto. t'd
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:
,.::;; R''' IJ ~ () d
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:
Typed or printed name and residence
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cen~re
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 esta~e z.::'
Sworn to and affirmed and subscribed . ~
t/
be:{k me this c20~ day of
~ 'fffrn)Y/L 2005
If!!f::t-Bieiy, 4~r ot Wills
~-
DECREE OF REGISTER
Estate of fv1ary JO StlU/'Ier
<./
also known as
Deceased
200f.LJ - 0233
No.
Date of Death: 0<0" 2 J - .2 005
Social Security No: I q4 -/4- - t+Q05
AND NOW, HarCh Ihfh , 20 ~, in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters r8i Testamentary 0 of Administration
(r..fn,. dbrll:l . JH~pder\1e hte, dUlilIne .absentia, durante rnlllfJllliJlI!j
are hereby granted to JOann I). f<OCK e.ff
in the above estate and that the instrument(s), if any, dated Jeptem her 2i I /qq5
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters.......................... .
Short Certificate(s)...... \~
Renunciation................. .
Affidavit ( ).................
Extra Pages ( ).. .. .. ......
Will
Ge€Hett...................... ....
JCP Fee........................
~& Tax Forms...
Other... ,q'.~.~?....... cJ' .'.:~.
TOTAL............... .
RW-7a
$
30.00
$
$
$
$
$
$
$
$
if. 00
5.00
/500
/0.00
1500
S, (:>0
$
ftf .l~-?
,~ ~()Aj'Lff1 ~
Regi,'e' of Will~-~
Attorney:
1.0. No:
Address:
Telephone :
-Ii-..
DATE FILED: _--VVLaAdZ /0 bl-OOfp
'1 ",-
'!hi, IS to certify that the information here given is correctly copied froI11 an original certificate of death duly filed' with me as
LlJcal Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph. /~:;
Lac
P 11770851
No.
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,'III'~~\.\H OF PE,t",,-..
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Fee for this certificate. $6.00
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Date:--
, ;
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'11:./7 e 4WC:Je k,~rt.Ve.
(.....)
r1105 ;4) Ae.. 2/81
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH '
" i?nl~T
STATE FIL! NUMBER
; - ~M//
i
SEX SOCIAL SECUAtT'f NU\l8EA , J C DATE Of DEATH ,MCIllIl. Oa.. -,
Z. ~tnA 1<.. .J!' I 'l L1 - /4 -., 10S .. :Sl.An(. ~ I
UNOER I OM DATE OF 8lRTH I BIPTHf'lACE iCJy .'\d PlACE CI' DEATH (CI-ec:k Ol1ly ""8 - ;ee "'SlruCLoni on ~., iIOel
HoUlS Minwl.. ,Monlll.o.y .....1 SweOl fCtlloQll CounuYJ HOSPITAL
Jan 25,1913 i;'Yronel PA :~tlMl iJ ERlOulDallent 0
FA::rUTY ..AM( i" Ml 'csNIi/lOil_ ~Ml s;re-..I ~nll nUll'l)e(,
Cumberland Bethany village
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I)ECEOOr--T"S.USU.;["(>::CUFfliCN ~KINO "" !Il!~ l'II;!':SiINDU!>TR't WAS OECECE~IE-oE. CEDE;;T~:> ':DUCAr:ON
--TG.;.~naCi;o;kdQt.;,rM~~-- ---------~_.. U,S, AfiME/)fOACeS7 __...i?~.!!(!..: t,e$!, r~~L
C'WOfk;'>QlllfI:dOOOI.oa: edl Retail Clothing '!IoaD NoIXl Eleme"l~cZ;~;","nCl~'Y "C."~,~,
· '1a. Sales AsSOClate l1b. ,"" _ 1~. l~. 12 '
OECt""OEN~AI~ESi(Si;;;'. CilyfT'uw; ~e~-' _CEDENT'S - iJ
Bethany- Village ~~~~~E l1a.~_-EA____ ~e.3ent Hc Y...oec_~lNedin__
5225 Wllson Lane ,S.IU.$!IU:SoVoa Iio,Ula
1'. ur PA 17055 cnOIl'l"tilOe. 17b.Counly 1O..."s/lip7 17dD :~-::'=CI
fATHER'S NAME lfolst, Middle l.ISI) MOTHER'~Nc~raE ,F"J4._ .Mod<OlQ-aM4lCmee" Sur'namel
II. Ernest G. Sawyer ". Cot" U.
iNFORMANT'S NAME (T y,*Pnnl) INFOAMANT"S MAiliNG AOOAESS (Sueel. C1l'tl1lr"' SlaIe, l:D Coce)
2ClLJo Ann Rockey 2J.170 Centre St., Be.1efonte, PA 16823
METHOD OF o.spc.smON OATE OF OISPOSlT.QN -- PLACE Of' OISPOSITION - Name ol Ce_lery. Ct""~ LOCATION. City(T~. SUI., Zio Code
8urqJ 0 CtematioA ~ RemovalltORl Sla'e 0 IMo/lIl'l, Day. Yll3t1 Of 0ttHN PIK.
. ~O OlNqSI*:lIYI 0 21~une 23, 2005 Harrisburg Crematory
SIGHAT~R'~ ~UNEAAl.~RV E LICENSEE OR PERSON ~~s SUCH lICENse NUMBER r.
~ -c.t ;;:1 A-I. 22b. 0/ () 4- II - ER-WI EDEMAN
Complete 01..... ~ onIV when c;ertlfVin9 To IIIe lleII 01 my k""lIWle<lg.. clealh OCC:Ulte<l ~llhe lime. cl&le _ pIKe Mated. lICENSE NUM8ER
pl\ysiclan. not available aalilne of dealh to (SigN....._ T>lIo)
~_ olc:lNtn_
9~
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UNOER I yEAR
~. 1 D:~
Assi5t~lvlng
1'1....._ 0 ,Spec;.lyl Kl
. AkEIlfT
I. ~ :':K lNK
NAME 0F DECEOENT \F~Sl, /.I'lllll.. ~~l
t. rnAR.
SAv.J\{er
2.0:)5
AGE (l~S1 B><1t>aay)
Y",
5.
o cOlJN 1'1 O.:QEAr I~
RACE - Amonc:.ll1lt1C11an. aJac:lL. Wh.. .'e
(Spec:4o,)
"AflITA~ STI.TUS . M.",.d
Na.et Ma"'e<l. Wiao...a.
"NOIee<l'Sp,-;"",
1... Never Married
U~'per Allen
10. White
SURVIVING SPOuSE
III "".. ~,.. "'-' l\MT\.'
:wp
ClIY/boto
, PAl71CX
~~2~
i~~i
~~~g
H_ 24.2. mUll be CIlmpleled by
penon whC) pronQWlC" de.th.
21&.
TIME OF OEATH
24. J.'3A,
21. MAT I: Eruarlll. elisea.... ;IlIUn.s Of corn~ uhid'o ca~Cl.~lh 0.:.
Lilt onlY one ca.- on eKlt 1iM_
OATE PRONOU"lCEO OEAO (MOt1\fI. Oay, )eall
15. June 21, 2005
e.1Iet 1/1. mod. 0' Clyit1g. IUCh as carCliac: Of ,espi,aIO'''I1''.S1. snaCk '" /..art !&II",.
23b. 23c.
WAS CASE REFEARE~lO ,.EOICAL EXAMINERlCOROHER?
~il NoD
H.
I ApptOxim&:.'
:=-=:
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P.RTII:
OIhfll Slgtllllc:anl c:cncliIions c:anuobulitlg 10 _, llul
110I ,eslAing Ift:he ~ _ giveft in PART I,
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a__~~ ~\\\ 1\~ __~r~'\L.kt\ _____
c..OO~-() A crJNSf~NCe OFI:
\ b__ oUEm(ciiAS~O\.'n.ceOi'): - ---------
C-_ ~ Ct.:ETOiOAASAC~J~~------- ---
G,.______ _______
WERE AUTOPSV'FiN5iW3S- MAHNER OF OUT... -.-- DATE OF INJURY
AWlAiIlE f'nlOP. TO lMontt\. Day. "W)
COMPLETION 0tF CAUSE
OF OEAJH1
TIME OF INJURY
INJURY ,(f 'NCRK7
OeSCRlBE HOIN INJURY OCCURREO.
NllIuraI
Ga
o
o
Hom~
o
o
o i>L'CE OF INJURY. AI home. Parm. SIl..t. fadO/'t. olliu M.
IluiIding. 1tC. ISpecM
308_
Y.. 0 NoD
Accidanl
P....d.ng '".eall9allOtl
'1M 0 No [1
Y" 0
NoD
S4lIciae
Could noc be d.llIfRlined
, 0.." 'fNt,
o ~
2... 2....
CUlTlflEA iO>Kll rriy oneI
'CERTlFYING PHYSICIAN (PhySlC,.r1 c"I~1"Il9 CAusa 01 <leath ...,.." ~.. pnys.c.." has pronoo"",,,,, <lealrl ana corngl<lted Ilem 231
To the De" 01 my knowledV.. death OCCURlIG due 10 _ c....Ml.) and "'.""., a. .'Illld. . _ . . ' . . . , . . . . . . . , . . . . . . . . . . , . . .
21.
a:iG
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~ .5' ~
... -..
a:-3.c
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'PRONOUNCING AND CERTIFYING PHYSICIAN (PhySIC"" bOltI ;ltono...'-';"'9 .:.alll ana CertllyonglO cao... 01 <leathl
To the beel 01 lilY kno....ed4... "...U\occ",," al UIe lime, d.... and IlIK., aIId due 10 UIe cau..(I) ~nd ma"n.t.. .talld.. . .. . ... . . . ,
'MEDICAL EXAMINER/COAONIA
On lh. b..i. 0' e.aminellon and/or Inv..Ugalion.ln my Olllnioll, de.th occ:un.d at Ihellme. dat.. and plece. .,,4 GUllo Ihe cause(s) ~nd
menn., aa ..atad; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . , . . ; , . , . .
31..
REGISTRAR-S SIGNATUI'lE AND N~
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(.::J.J 6.. ).\ ~ \.L ~ (\
trL2~~1
23 -b'...s-
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....
....
I . '
I
LAST WILL AND TESTAMENT
OJ'
MARY JO SAWYER
I, MARY JO SAWYER, of 434 Hale Avenue, Harrisburg, Dauphin
County, Pennsylvania, being of sound mind, memory and understand-
ing, do make and publish this, my Last Will and Testament, hereby
revoking all former wills by me at any time heretofore made.
ITEM I.
I direct that all inheritance and estate taxes
becoming due by reason of my death, whether such taxes may be
payable by my estate or by any recipient of any property shall be
paid by my Co-Executors out of the property passing under ITEM II
of this Will, as an expense and cost of administration of my
estate. My Co-Executors shall have no duty or obligation to obtain
reimbursement of any such tax so paid, even though on proceeds of
insurance or other property not passing under this Will. In the
absolute discretion of my Co-Executors, such taxes may be paid
immediately, or the Co-Executors may postpone the payment of taxes
on future or remainder interests until the time possession thereof
accrues to the beneficiaries.
.' i:/
i ,/1. 1 \. / ///;,. .~_
/ )'j/4A-tr ...~..-'~ C4,u ~r~
Ma Jo ~~r ./
, t..
Page 1 of 2 pages
.
).
~"
:ITEM :I:I.
I give, devise and bequeath all the rest,
residue and remainder of my estate, of whatsoever nature and
wheresoever situate at the time of my death, to my niece, JoAnn D.
Rockey, of Bellefonte, Pennsylvania, and my nephew, Marlin E.
Sawyer, of Pittsburgh , Pennsylvania, in equal shares. In the event
JoAnn D. Rockey or Marlin E. Sawyer should predecease me, then the
share that she or he would have received shall be distributed to
Barbara Sawyer.
:ITEM :III.
I nominate, constitute and appoint my niece,
JoAnn D. Rockey, and my nephew, Marlin E. Sawyer, or the survivor
of them, as Co-Executors of this, my Last will and Testament. It
is my desire that my Co-Executors serve without bond.
:IN W:ITNESS WHEREOF, I have set my hand and seal to this, my
Last Will and Testament, typewritten on one (1) other page, this
21st day of September, 1995.
witness:
c4bJJih)';/1iY-
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/ :----- ,,~-..;:;.-,-- '
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---- ----- ---
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C01Ol0~Tll OF pElD1S~L~1Jo
coUNT~ OF DJoUP1l1-
I, MARY .10 SAwYER, testatriX 1,rlhOse name is signed to the
attached or foregoing instrument, having been dulY qualified
according to la1,rl, do herebY ackno1,rlledge that I signed and executed
the instrument as my Last Will and Testall\ent; that I signed it
1,rlillin91Y; and that I signed it as mY free and voluntary act for
the purposes therein contained.
S1,rlOrn or affirmed to and ackno1,rlledged before me, bY MARY .10
SAwYER, testatriX, this 2~st da~of septemb~~' ~995.
/1 \}
"""....._/'7l ..
: ss
.
.
C01Ol0)19fBllLTll OF pElD1S"lL~1Jo
coUNT"l OF DJouP1l1-
.
.
we, .JameS fl. Turner and Alison J. FOX, the witnesses, respect-
ively, 1,rlhose names are signed to the attached or foregoing
instrument, being duly qualified according to la1,rl, do depose and
say that 1,rle 1,rlere present and sa1,rl the testatriX sign and execute the
instrU1l\ent as her Last Will and Testament; that MARY .10 SAwYER sig-
ned 1,rlillin91Y and that she executed it as her free and voluntary
act for the purposes therein expressed; that each of uS in the
hearing and sight of the testatriX 1,rlas at that time eighteen or
more years of age, of sound mind and under no constraint or undue
influence.
: SS
.
.
S1,rlorn or affirmed to and subScribed to before me bY
.JameS fl. Turner and Alison .1. FoX, the 1,rlitnesses, this 2~st day of
september, ~995.
3
..
Register of Wills of Dauphin County, Pennsylvania
Estate of
RENUNCIA TION
(Y] fJ-t(t/ ...J, .s;,4-uJt(e~ No. J..OOir0233
also known as
I Deceased
The undersigned, rYlltI:.LJI/) E:-::;4u)f/e~J (1- ExecL/T2J/?.
(Relationship) (Capacity)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters -r;--.;rA-/.Jlen/riT~ V be issued to .)0 4/IJ //J j). ~ C/O? f(
I~Of~O~
f. 7lJ~'~~,,~~
(Signature)
~c3~ /771//('.;1 A#l1tFH. 1211. R 1S-D23/;
(Address)
Witness
hand this
(Signature)
(Address)
(Signature)
(Address)
~:,-'~."~;'
;. .J
l, ".
-
.;..-.
NOTE: Renunciations executed outside the Ulll\;~ VI 11V~.~w. .)f
Wills are required in some counties to be notarized.
RW-13 (Rvsd 9/92)
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....................."...........................,.,..........,.... '~\" 'o'<S;""'" dO AlNflO:J
~:._H'~\:j VHJV^'l I ~}IH~d dO 3lVlS
~OlV~lSINIWOV ~O ~Olfl:J3:X3: dO lIAVOlddV
INVENTORY
of all real and personal estate of ........tJ1./:1.&. Y....J..o....5./t<.!,.? .~..~.I\.... ........... .......... .... .... ........... .... ................ ........... ...... ....... ....... ...... ........................ ........... .... ....
deceased, late of.. S. tOlflft1l/l U t)'.~LfJ. .t;;.t..... .mU. Street $~ ,;i,ff... 4t!, l~s. c>rz!!t!/J1:;CitYu!lJCCII/fl11lcS.13tt ~t::;, .l~
L /J'-' 116$"S"'
Bora. ....... .................. ......... .... ....... ..... ........... ...... .... ........... ........ ...... ...... .... ...... ..... .... ...... .... ...... ...... .... ..Twp .... ().w..EI{.,...Er~/J!..../~........ .... ....... .................. ....... .......
PERSONAL ESTATE SCHEDULE
Dollars Cents
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
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23
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