HomeMy WebLinkAbout10-06-06
Register of Wi lIs of Cumberland County
Estate of I-Jt?--1-A L, L(/.r.. te/'N14/1
.
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
No. d f- 0 ~- OO~ L(
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
, Deceased.
Social Security No. O:].s- - A.r- - '7 S- S 7
The petition of the undersigned respectfully represents that:
Your petitioner( s), who is/are 18 years of age or older, and the execute> r named in the last will of the
above decedent, dated (3 L h 6f"/'" t' . ,20 oJ.(
and codicil( s) dated --
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in C~ 1"'\1'1 i-..-h.-. tt. County,
Pennsylvania, with hLrlast family or principal residence at ,
COVVl6y r1ce; af,u/J) 't-q~ E. 7,.,Yv/'/'_ ~ A1~?,G;.... r~A'Ld-
(list street, n er and municipality)
Decedent, then.u years of age, died _~"'~l..r .;! r , 200' ,at 4f; f~{;-t7 ~/n I
Except as follows, decedent did not marry, was not divorced and did not have child born or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
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 of real estate in Pennsylvania
situated as follows:
$ /ac;/:9~-':;C2.jG':'..)
$ \
$
$ ~
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented
herewith and the grant of letters ?:t
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
thereon.
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Residen~e~~petitiOner(s) , '
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA
}
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 personal representative( s) of the above
decedent petitioner( s) will well and truly administer the estate according to law. ---7 /J
Sworntooraffirmed~dsubscribed . {x~ ~
Before me this tv r- day of
CGhJhtv ,20 C}p
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rv C~ ~egister
~ No. ~)-06"OfN
Estate of Ik I~Vl L Wilde" n q" ' Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW 0 C-I-. (p 20{).c, in consideration of the petition on the reverse side
hereof, sitiSf:1cto proof having been presented before me, IT IS DECREED that the instrument(s), dated
D . f () <.. , described therein be admitted to probate. filed of record as the las,t ~ll of
L. W14 ; and Letters are hereby granted to rn I {) ft:t1.,.J t!> I\-A) ~
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation........ ....... ..... ... $
Short Certificates ( (..) ............ $
JCP.. ..:...... .............. ......... $
Automation Fee................... $
Bond. .... ..... .................. ..... $
Total $
Filed~20~
1. to D .00
, 6.0 D
~df1 / JitAfLVL ~bWf1G
RegisterOfWi1lS~ U
Attorney (Sup. Ct. I.D. No.) ~!vI ~
d4~{)1)
ID.ot)
5- - () 0
Address
z..)11-(.00
Phone
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Thi, 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.
No.
· t:hn- ft; ~
Local Registrar
Fee for this certificate, $6.00
p
12839465
OCT 0 3 2006
Date
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I REV. 0212006
I PRINT IN
lMANENT
\CK INK
1 Name of Decedent (FilSt.lliddIe, last. .uffix)
Helen L. Waterman
5. Aqe (\.asl Bir1hdayl
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
95
VIS
7557
6. Date 01 Birth Monlh. da, at
6. Place 01 Dealh Chad< on one
Hospital QIhar'
29lnpalien' 0 ER' 0uIpafien\ 0 DDA 0 Nurslllg Home
9. wasOecedenlofH~panicDrlgkl?D'o DYes
(If yes, .pecify Cuban,
Mexican, Puarto Rican. 0<<:.1
14. Marital Slatus: Mlvrled, Never Married,
~, llNorced (Spedy)
Widowed
o ResdenC8 0 Other . Specify.
10. Race: A_Indian, 8Iack, While, elt.
(SpecIfy)
White
Sb. COunlyoflloatl1
Cumberland
11. Oeoedenf. Usual most of WllI1c' life. Do not stale relinld
Kind of Wcrk Kind 01 Ilusines, 'Indu'try
Clerical Federal Employee
. 16 Decede<1fs Moiling Mdress IS1ree\, ciIy 11OWn, state, zip code)
fumtry Meadows
. 4905 E. Trindle Rd. Mechanicsburg, PA 17050
16. F_, Natne (First. middle, lasl, sullix)
George Brehm
200. /nbmanr, N..., (Type' Print)
A1 ice Canerini
21.. l!j!1od of DisposiIion
~ Burial 0 RamoY8I from Slate
o 0Iher . Speafy:
223. S1gna1ur8 of F........ SerW:e
. ~
Complete Items n.c only when certifying
pIlysil:ian ~ no! available aI time of death 10
Cl!f1ify cause of death.
llems 24-26 must be a>mpieled by person
who pmnoonces death
Decedenl',
Actual Residerce 17a. Slate
17b. County
11e. ~ Yes,DecedenIUvedin Hanpden
l1d 0 ~ ~~iYed wilhkl
Twp
City' Boro
19, MoIhe(, Name (First, middle, maiden sumatne)
Louisa Engerbara
2Gb nlormanr. Mailing Adltess (Slreet, city I -., slate, zip code)
Mid Penn Bank 349 Union St. Millersburg, PA 17061
21b. Dele of Oiaposition (Monlh, day, year) 21e, Place of ~posi1ion (Natne of comelery, Ctllmatoly or other placel 21d. Location (City I IIlWn, ,\ale, zip code)
R.1. Veterans ~rial Celretery Exeter, Rhode Islam 02822
220. Natne and Address of Facilly
Richardson Funeral lbne Inc. 2:98. Enola Dr. Enola, PA 17025
place staled. (SlgnalUre and 1i1le) 23b. License Number L 2Jc. O.le Signed (Month, day, year)
M~F9* 7~~~~k~
26. W..ease Refell1!d toMedicalE_/Coronerlor a Reason Other than Cremation or Donatton?
DYes ~
=~:.uUS:~=ld_~
CAUSE OF DEATH ISH in.tructlona and... p''')
110m 1I. PART I En"" !he ~~. diseases, Injuries, or compllClllions . Iha1 direcUy caused the deall1 DO NOT enlet Ienninal events such as cardiac ",,",I,
_\Illy anast, or WlI11ricu1at rMlalion wilhaul showing lhe eliology. Ust only one cau,. on each line
C'e:;rn 'J (???;1Ve *'ff T ;::;:,., ( ~ e
Due 10 (Df a. a consequence...,,: I ~I
/'~4'_ vYR
Due to (or as a conseqUflnce of)' ,
Part II: Enler other siclnlflcanl conditiJns cnntrlbutlno In rlRath
bul nol ,"lUning in \he undertyilg cause gNen in Pari I
2B. Did Tobecco Use Conlribule 10 Dealh?
DYes 0 Probably
DNo~
29, If Female:
~nant within past yaM
o P1ognanlallimeoldealh
o Not pregnanl, bul ptegnant wilhin 42 days
ofdealh
o Not QMgl"'~ but preg_ 43 days Ie I '10"
ofd.ath
o Unknown If ptegnant wi1h..the pasl yeat
32c. f'laceoflnJUlY: Home, Film, Street. FactoIy,
Office Building, ele (Specify)
~1iaIy list condlions, If any,
~ler1:~v.:~uk
(disease or iriutY lhaI_the
. ...ms IOSUlting in ileath ) LAST,
Due to (or as a consequence of)
321. If Transportalion Injury (Specify)
o Driver , Operalor 0 P....nger
M o Other . Specify:
330. CoIlIIlor (checIl onfy one) Jab Signature and Title of
. C<<tlIyIng phyoIc;lon (Physician certifying cause 01 d.ath when another physician has pronounced death and compIelad l!em 231 ~
To the bosI of myknowlodgf, dolllll DCCUrnd duolotllo cauHls) .nd man"....s ....011_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _..D .
Pronouncing .nd wtlIylng physIclan (Physician both pIOflouncing death and cerIlfy;ng In CllJM o! dealh\ . .
Tathe _ of my 1<noooItdgt, doath aceu""" II tIIo lime, dat...nd pIoco,.nd dot to tIIo ClUN('land mannor. .ta.... "" 330. License Number ./ / JJd. Dale SIgned (Month, day, year)
. .......1 Eumlnat I Corontt' '&.... - - - -- -- - - - - -- -- - - ~ m /J C/ .s 71 ~L.- 'r
On.1M baa. of _nation and I or illYftllgotJon, In my opinion, - occurracl II tIIo -, dalo,.nd p1oct, and d.-to the caUH(l) and manner.. otalf'I. _..D 34. N_'-p _ 01_ Who ~ r Dealh II1em 1I) lype I Print
35. Regis.....S~andDisltdN~ d-' ., 36. DaleFiIed(Mon ,day,year) 57 t?c/.P1 ;<J/lJ//" < ~ .
~ ~ /'( ~ . I ~I " '-t II (I Iii 3 ~(")t i'j'? ,I'7~/-fr dJ-?'~ ~//J/l ~4- ("fe-/,/
(See instructions and examples on reverse)
oVes ONo
8 Natural 0 Hon1icide
o Accidenl 0 Pending InvesIiga1Ion 32d. Time of Injury
o Suicide 0 Could NoI be lle1ennined
32b. Describe How Injury Occurred:
JOa, Was an AUlopSy
Performed'
n. Were Iwlopoy Findings
Available Prior In CompIeIion
of Cause of Death?
31. Mannero/Dealh
o Yes Jit No
p~
;) I - 0 0 -0 gOt-f
LAST WILL AND TESTAMENT
OF
HELEN L. WATERMAN
I, Helen L. Waterman, having my legal residence at Country
Meadows, 4905 E. Trindle Road, Mechanicsburg, Cumberland County,
Commonwealth of Pennsylvania, do hereby declare this to be my
Last Will and Testament, revoking all other Wills and Codicils
heretofore made by me. My daughter, Elaine C. Wevodau, is living
at the time of the execution of this, my Last Will and
Testament.
ITEM ONE:
I direct that the expenses of my last
illness and funeral be paid from my estate as soon as practical
after my death.
ITEM TWO:
I devise and bequeath all of the remainder
of my estate and property, of whatever r.ature and wheresoever
situate shall be distributed in the following manner:
(a) Eighty (80%) percent of my estate to my grandson,
George W. Waterman, 1000 Bonita Lane, McHenry, IL 60050.
(b) The rest and residue of my estate to Pennsylvania
, . '-1/....,
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A~~o~i~iidri~Jor the Blind.
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Helen L. Waterman
/0 .... 6 ~- /J 'r
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SSe
COUNTY OF DAUPHIN
I, Helen L. Waterman, the 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; and that I signed it
willingly and as my free and voluntary act for the purposes
therein expressed.
Sworn to or affirmed and acknowledged before me by Helen L.
Waterman, the Testator this t?~ day of CJ~~
2004.
~~l~~
Helen L. Waterman
fJJt<>ndD (l Jl:A:J~
Notary Public .
i1;,
NOTORIAl SEAL
RHONDA C. SHAFFNER, NOTARY PUBlIC
LONOONDERRYTWP., DAUPHIN COUNT'( PA
MY COMMISSION EXPIRES MAY 2001
4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
We, d,iyJ?~/s' /iJtrr~#'t'?
and
tenclro.. A I (r)oh r
the witnesses whose names are subscribed to the attached or
foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testator sign
and execute the instrument as her Last Will; that she signed it
willingly 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 signed the Will as witnesses;
and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
SWORN and subscribed to
before me, this aWl day
of ~ , 2004
iJfO/LdA f~
Notary Publ
Res: Waterman16851~Will-helen2004
5
NOTORIAL SEAL
RHONDA C. SHAFFNER, NOTARY PUBLIC
LONDONDERRYTWI!. DAUPHIN COUNT( PA
MY COMMISSION IR S MAY 5