HomeMy WebLinkAbout04-21-06
04/13/2005 08:58
71 75411527
COATES
PAGE 03/04
Register of Wills of CUmberland County, Pennsylvania
PETITION, FOR GRANT OF LETTERS
Estate of
EDIT'd CATLIN BOLLING
No.
(;~- ]'3 q
-
also known as
I Deceased
F. OONALD CATLIN
Social Security No. 173-38-5262
I"llltkxl'tfc.li. WItoCl........ 1~ ...t1,~ 01 fIIO Of Qld'IIlI'4 ..,J'lyIJep.' tor
(COMPLETE "A" OR "B" BELOW:!
Q
A. Probate and Grant of Letters and aver that Petitioner{sl is/are the execut_ named in the Last Will of the
Decedent, dated and codiciltsl dated
$t:at.. '''(ilIl1l111'1t "jfl1'Imflt.~"(1f".. ll'.II.. ',""I.fI1or;I..~I~. dIrR'h fJt t'llIlPlCl'tqt, ft~r:.
ExctlPt llS follows, Decedent did not marry, was not divorced, and did not heve a child born or adopted aftar execution of the dOcumonta offorod
fo, probete; wag not tMa vlotl.... of n killing nnd w.... 1'I0vnr "djvdle(ltod inf,:(ImpeUnt:
fiI
B. Grant of Letters of Administration
~"",llll" ~,h.r\.o..I.III.: ","n/tnftrA IH~~ 11t,'IN'o[~ Ai).M,I,.: du'....1t ol/iVJ"[~t!Jl
F'etitioner(s) after a proper search has/have ascertained that Decedent left no Will and was sl,ltvived by the following spouse
(if any) and heirs:
I Nemo Rel8tlon~hlp Rosidcnce I
F. Donald Catlin . 5236
Son Deerfiel]Cl Ave, Mechanics
"e IN ALL !";A~t::;;:l "!,ttech additlonsTshests if MOMMr .
burg
PA
y
Oecedent was domiciled at death in Cumberland _ County, Pennsylvania, with his/her last family or prinCipal
residence at 5236 Ceerfield Ave. I Mechanic~bura. PA 17050
(I~.[ .1,.Ot, ~, .."i rnlnlcll,,.tlt...,.,
Decedent. then -2L years of age, died February 16
, 20Q!L, at Mechanicsbw:q , PA
rt,nr:IltI"l'\l
OOC~d9nt at death owned property with estlmatod vellles as follows:
(If dOfT'i~llod In PAl All personsl property . , . . . . . . . . . . . . . _ _ _ , . , , . . $
!If not domic:iled in PAl Per:soMI proparty in Pennsylvllnia . _ _ _ , . . , . . . . . . . . _ _ . , . . $
(If not clomiciled in PAl Person>ll property in County. , . . . . . . . . . . . . _ _ . . . . . . , . _ . S
Vslua of rOnt 08tate in Penflsylvsnia .., _ . . . . . . . . . , . . . . _. . . . . . . . .' . _ _ . . . . . . , . . . . $
Total _.. . . . . . . . . . . _ _ . . . . . . . . . . _ _ , , . _ . . . . . , . . .. _. $
Rasl E:.Ittlte siluatod as follows: . .,...... . - , . , , , , , ,
90,000.00
90.QOO.00
Wh6r~fore, Petltlonar(5) respe~tfUlly reql,l6st(sl the probate of tho last Willllnd CodlcitlS) prBsBllted with thia Patition and the grant of letters In th~
~PPropnate form to ,he underSigned:
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printed nama and residoncB
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RPR-13-2006 07:49RM
FRX: 7175411527
ID:
PRGE: 003 R=96:<
04/13/2005 08:58
71 75411527
COATES
PAGE 04/04
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cllri'lbe:rland
Th~ Petitjoner~s) above.namQd swaar(s) and affirm(sl that the statements in the foregoing Petition are true and
correct to the best ofthe knowledce and belief o. f peti.tJ.O{1ti ...n. er(5) an.d that, as O"~' ,".p.p.' r"es tative(s) of the Decedent,
Patitioner(s) will well and truly administer th~ate(a~pOrding t,o law. (__ ,~
Sworn to and affirmed and subscribed /_~;? ..L \,-r/;/ l--",-
,d J S f
befora me this ~ deW of
{(pMJ 20~
. Jd1J!Ad a '--1 {)}JUA ~tuWf;zu ~
-1Jt\~U1i/ ~
DECREE OF REGISTER
Estat" of td1 {)v C oiW~ ~
also known as
Deceased
No.
D (; -()35'-/
Social Security No: /7 3 ~ 38' - 5.::t./P.2. Date of Death: 2- - J G7 . 0 (p
AND NOW, {~{2' 5 f , 20 Oh, in consideration of the Petition
on the reverse side hereon, satisfactory proof ha0J1g been presented before me,
IT IS DECREED that Letters 0 iestamentary g/"of Administration
are hereby granted to F DontUel to. t!J~
(11,1,11,; rt,h.".e.'-~ ~.~dtAtIt IUI~ nU'lnt~ "~...ntJ.; durllrioUr ml!1l!lHllftll
in the above estate and that the instrument(sl, if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters........................... $
~Add Lja1/uJt ~~~
R.aj.t.r"fwwl~ '-/Y~ ~y
Short Certificate(s).......... $
Renunciation.................. $
Affidavit ( )................. $
Extra Pages [ ).. .......... $
Codicil.......................... $
JCP Fee.....................,.. $
Inventory & Tax Forms... $
Other. .. .. ... .. . .. .. ........... .. $
A~~~r.~ ~(' ..M~5~V-rowalsh, Esq.
I.D. ~\08 'd.~
Add \ Fbrest Hil s Drive, suite 37
ress.
T .\1,~~~n~:d ~~2~A 17112-1099
OA TE:FIt!-~O\:,1 \\:\ \:~)~-~ . ,
) ':..c>\ -HQ (J}J:\LC-,
vl-..'
TOiAL................ $
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PAGE:004 R=96%
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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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. S6.00
~kJ"~
Local Re~
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P 12228181
No.
FES 21 2006
Date
143 Rev. 2187
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATE FilE NUMBER
NAME OF DECEDENT (First, Middle, Last)
1. Edith Catlin Bolling
AGE (Last Birthday)
SEX
2. Female
SOCIAL SECURITY NUMBER
3. 173 - 38 - 5262
BIRTHPLACE (City and PLACE OF DEATH Check ani one. see instructions on other side
State or Foreign Country) HOSPITAL: OTHER:
New Bloomfield Inpatient IKJ ERlOulpat\ent D DOA 0
7. PA 8..
FACILITY NAME (If not institution, give street and number)
96 Yrs.
5.
COUNTY OF DEATH
Bb. Cumberland
DECEDENT'S USUAL OCCUPATION
(~~v::~i~;~~~O ~;leu~~"r~Yir~'3t
Be. Mechanicsburg
KIND OF BUSINESS I INDUSTRY
MARITAL STATUS. Married.
Never Married, Widowed,
Divorced (Specify)
14.Widowed
17a. State
PA
Did
decedent
live in a
township?
17d.B ~~h~e;~t~~?~i~i~~ of
Mechanicsburg
city/bora.
He. 0 Yes. decedent lived In
17b. County
Cumberland
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DATE OF DEATH (Month. Day, Yeal)
4February 16, 2006
Residence 0 ~~:~fy) 0
RACE - American Indian, Black, White, et
(Spec;fy)
10. White
SURVIVING SPOUSE
(If wife, give maiden nl!lme)
twp.
MOTHER'S NAME (First, Middle, Maiden Surname)
19. Florence Ma ee
INFORMANT'S MAILING ADDRESS (Stree'. CilylTown. Stale, Zip Code)
20b.5236 Deerfield Avenue, Mechanicsbur , PA 17050
PLACE OF DISPOSITION. Name of Cemetery, Crematory LOCATION. CltyfTown, State, Zip Code
orOtherPiace(;remation Society of
2ie.
23b. 23e.
WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER?
26. Yes ~ No [3--
: Approximate PART II: Other significant conditions contributing to death, but
: ~~:~~:::~~~ not resulting in the under1ying cause given in PART I.
'/.\ SlJ4T p:
'/;-;':/
Items 24.26 must be completed by
person who pronounces death.
27. PART I: Enter ttte dl.e...., Injuries or complicatlona which caused the death.
list only one cau.e on each line.
IMMEDIATE CAUSE (Final
disease or condition T l,'
resulting in death)----+
Sequentially list conditions
if any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury
that initiated events
resulting on death) LAST
lb.
c.
d.
DUE TO (OR AS A CONSEQUENCE OF):
DUE TO (OR AS A CONSEQUENCE OF):
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH
PERFORMED? AVAILABLE PRIOR TO W 0
COMPLETION OF CAUSE Natural Homicide
OF DEATH? 0 0
Accident Pending Investigation
Yes 0 No Yes 0 NoD Suicide 0 Could not be determined 0
DATE OF INJURY
(Month, Day, Year)
TIME OF tNJURY
'NJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Yes 0 No 0
30a. 30b. M. 30e.
PLACE OF INJURY - At home, farm, street, factory, office
building, elc. (Specify)
28a. 28b. 29. 30e.
CERTIFIER (Check only one)
*l;~~:F~~tGor~~~;~~e~hl.S~C~:th C~~~i~~~~u~: teg fheea~a~~:~(:)~~3r~~X~i;~a~s ~t~f:~~~~~~~. ~~~~~. .~~~ .~~.~~~~~:.~ .i~~~ .~~.).................. 0
*PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying to cause of death)
To the best of my knowledge, death occurred at the time, date, and place, and due to the eauses(s) and manner as stated......................
'MEDICAL EXAMINER/CORONER
~~~~:rb::I:::e~~~~I.~~~I.~~. ~~.~~~~ ~~~.~~~:~.~~~~.~: .'.~ .~~ .~~l.~~~.~: .~~~~~ .~~~~~~~.~. ~~. ~~~. ~.~~.'. ~~~~.'. ~.~~ .~~~.~~', ~~.~ ,~.~~. ~~ .t.~~. .~~~~.~~.(.~~ .~~~.. 0
31a.
RE~R'S SIGNmE~UMBER
33. ~'< 1.;<11\ ~ -r ~