HomeMy WebLinkAbout12-12-06
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of
BerV\,da..
G('~c..e.
m ()O se File Number c9l- Ole. (oqct
also known as
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~i\. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated 2. 11- Cj 1 and codicil(s) dated
named in the
(State relevant circumstances, e.g., renunciation, death 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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
o B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) apj,heirs; (if
Administration, c.t.a. or d.b.fl.c.l.a., enter date of Will in Section A above and complete /ist of heirs.) Q g
,- 0""'
Name
Relationship
~
u:>
B l~~ce.' '1
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in C l.(..""" b . County, Pennsylvania with his / her last principal residence at
hat"le I yvJr J-Iol/., 5f("II'1'f S P4 170r.:,S-
(Ust street address, town/city, township, county, state, zip code)
Decedent, then
'?z
yearsofage,diedon 11../'.0(.:, at CC>.,(""lls (e
PA
Decedent at death owned property with estimated values as follows;
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
$ to 00 . 0 (:)
$
$
$
situated as fol1ows;
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:
Signature
Ty ed or rinted name and residence
?~
P/a.,IlJc;::.'
2u
B rerz e
Wlt
/70 ,,,-
Form RW.O] rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the _I ~ day of
~ Q...,g..('/\, ~'" , &CX::A.o
~1'1(~~a/Lru'"\ l J~.ADb~"-
~, ~ [1~~'" J
:.""::L"tfZ~'C:::;i~ ~
Signature of Personal Representative
Signature of Personal Representative
File Number: d.1-(J.,o-1 Dq q
Estate of ~~(Lc.- sf:i. fY1~
, Deceased
Social Security Number: c9o;).-.;J () - 3L~OO Date of Death: \ l- ll.(>.. Ol.o
AND NOW,~..Q (\ _. \ a-.. ' O>c')(}I..o, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters \e'S"'('''-'<''<Y~",--t~
are hereby granted to F. ~("-A"_-' P \0. l\.'K
in the above estate
and that the instrument(s) dated .;:) - 1\ - C\--,
described in the Petition be admitted to probate and filed ofrecord as the last Will (and Codicil(s)) of Decedent.
~~~~,,\ ~\~'''6'''
Register of Wills
TOTAL ....
$ dO . 00
$ 4 .00
$
$
$
$
$
$
$
$
$
$
$
~~
FEES
Letters .".,
Short Certificate(s) . . . . , , . ,
Renunciation(s) ..'."....
~p
\.)0\ \ "
~c'(0 N"'CL-t, D\"'-
Attorney Signature:
\t;l . au
\ S-- 00
S.W
Attorney Name:
Supreme Court J.D. No.:
Address:
",')
V(JTeI~1?hone: ,I iV
:~ !\)0'Hd80
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62 : iI W\l' Z I :3309UOZ
FO/"lI/RW-1J2 rev/IJ/3.1J6 Page2of2
!J l05.":Ii'i RL\. il:'i
This is to cemfv that the information b:re given is '-'orreL\l~ ((,pled lrnlll an I,Jriginal certificate of death duly filed with me as
Local Registrar: The original certIficate wi(1 be forwarded to thr. SiaL' ViLl1 Records Office for permanent filing.
WARNING: It is illegal to duplicate this ccpy by photostat or photograph.
Fee fur thi, ccrl.1fi'.'J'c. S6,()()
~ ~.~~~~~v
Lucal Registrar
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P 12994987
NOV 2 0 2006
Date
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H105.1-43REV.02I2CXl8
TYPE I PRINT IN
PERMANENT
BlACK INK
1. Nane of Decedent (FIIS~ mkSdle, las~ suffix)
Bemida Moose
5. Age (Las"....,,)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
82 v~
8b.CoonlyofOoalh
~\
Cumberland outh Middleton Twp.
11. Deceder1rsUsual alIoo ndofworkdonedurl rnostof life. Oonol state retired.
Ki1dolWork Kind of Business I Industry
Clerk rocery Store
. 16. Decedeofs Mailing Address(StreeI, city/town, stale, zip code)
20 Brenely Lane
. Mt. Holly Springs, PA 17065
18. Falher'sName(FirJt,middle,lasl,suflix)
Pi
t-.....>
=
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CJ
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0--.. 000...._:
10. Rsce:AmericarlIn:liSl'l,81ack,lNhite,elc.
(SpocIfy)
White
17c. 0 Yes, 0ecedenI LiYed in fwp.
11~61~~J'Y8dwifjn Mt. Holly Springs Cityl_
~
~
PA 17065
CornpIeIe_Zl&-<:",~_ceI1Ifyh1g
physiciW1 is mlMilableilllmeofd8alhtl
C8l1fyC8Oll8otdealh
_,...,.mustt>o_bypel1Ol1
wI1opnllKUlC8Sdealh.
<<t'O
\").. (7 0 "::r c> 3& '8'
Home, Inc., Carlisle, PA 17013
Carlisle, PA
PartII:Emerother~mnditinn!tlYW'llriluhlmdealtl 28. DkITobaa::oUseConb1buleIoDealh?
butool_tII1g.....rn_ClIIlS8g11on.P...I. OVes D-
O No (31fnk.......
29.__:
IJ1lOi pnlgn""" post,...
o PIognanlalUmeof_
o :':-""but'",,""""""'42d'YS
o Not,_bul_43days.l,...
ofdeath
OUn""""lpreg~I_"'postye..
32c. P\ace of In;ury: Home, Farm, Street, Factory,
omce_,ak:. (SpocIfy)
23b.l.k:::enseNu/Ti)er
f"
M.
CAUSE OF DEATH (SMlnsbUctl0n8 and examplee)
OlIaZl. PART I: _..._. _Iljtrtls, orOlll1fKab18' ~al_Y~"'deaI\. DO HOT __"."bsucll ascOlliac;msl
I1lSpiralDry III'BSt, crvenlr'iwlw IIbriIalion wilttoulsOOwing the etiology. Ustoriy one CIlUIl8 on 8lI:h line.
==~=--+ L~' l) ILl? I" i1.1:!,/'/l1/A TCiPf f/1 iL J (:.f:-
Due to (or as . consequencs of):
b.-r;::;:."'vL .-" ,PI:!r-,NO.P,.[1 h.Y) Z t:/77'V\X'1 i u11I(1'/ (
~to(orllS.lXlnUllll8/lceof): -:;
, /I P:H.tI( -rn j I .J../t/.,,f;--
DUfI to (or as 8 consequence ot):
Approximetei1tervel:
Omel.lJealh
~Istconcilion&,ifmy,
ilcauselisildonha.
En~ UNDERLYING CAUSE
~r:ld~~~)~
d.
3Oa. WflSSI'I~Y
-,
3Ob. Were Autopsy Anclings
AvalaI*tPrior IoCoo1pletlon
of Cause of Death?
31. McmerofDeath 32a. Oateofl~ury(Month,day,year) 320, DBscribeHowlnjuryOccurred:
~-'I D-
O Aoddanl 0 Pendng__ 32rl. Tmeofl.;u<y
o s.tdda 0 CoUdHofbeOelsnnlnod
OPadesbian
329. LocaIia1~1Iljlr1(Stteet,ciy/town,sIat81
DVM ~'"
OVes 0'"
M.
33a CerUfler (check only one)
CertJlyfng physl,lon (PhysM:ian oertifying CllUS& of death _ _physml h.. pItIlOOClC8d dealh and """",1Bd Item 23)
Tothe bHtof my kMwIldge, dnth occurred due to lht~II(.)and mMllllrultalt&l_ ___.......................... __.......... --.................................
~::u~":,.::~~...~:d1::=~=:::=dmann.,...tslt<L ______ _____..... _...._..D
~:' .::'01== ,00 J 01' inveetlgltlon, In my opinion, dteth occunW at the time, dJte, and pIaCf, and due to Ihe cauae(s) and manner 1& staIt<t... ..D
. Dale Fiad (Mon~, day,"'"
. I~ 1 I 10..1 I I tJ I oc::,
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c:\wp51 \wills\moosc .wil
1K&~t mill &ttb mt!it&ttttttt
OF
BERNIDA G. MOOSE
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I BERNIDA G. MOOSE, af 204-A Lincoln Street, Carlisle,Q~mbe~~d
--,
County, Pennsylvania, being of sound and disposing mind, memory and understanct~g,
do make, publish and declare this as and for my Last Will and Testament, hereby
revoking and making void any and all former Wills, Codicils, or writings in the nature
thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor, hereinafter
named, to pay all my just debts, funeral expenses, testamentary expenses and all
Inheritance, Estate, Transfer and Succession Taxes, as soon as may be conveniently
done after my death, out of my residuary estate.
SECOND: I direct that my jewelry and antique dishes be divided equally
among my three daughters, PEGGY RICKRODE, F. JEAN PLANK and MARY
RICHWINE.
THIRD:
All the rest, reside and remainder of my estate I give to my five
children, PEGGY RICKRODE, MARY RICHWINE, F. JEAN PLANK, TERRY L. MOOSE
and TOM E. MOOSE, in equal shares, per stirpes.
(':\\41'51 \wills\mo\lslo wil
LASTL Y:
I nominate, constitute and appoint my daughter, F. JEAN
PLANK, to be the Executrix of this my Last Will and Testament. In the event that the said
F. JEAN PLANK, shall be unable to serve as Executrix for any reason, I appoint my sons,
TERRY L. MOOSE and TOM E. MOOSE, jointly, to serve as Co-Executors. No Executor
or Executrix shall be required to file bond in this or any other jurisdiction.
JlL-h
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day ofdh'Lu. CV'tJ ,1997.
.~~. '1r7~
Bernida G. Moose
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
----..
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c:\wp51 \wills\moose.wil
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, BERNIDA G. MOOSE, Testatrix, 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 or affirmed /0 and
MOOSE, the Testatrix, this I ~
acknowleggec;i before me, by
day of (deJ:}'cU- CL~ r ~
BERNIDA G.
,1997.
~/fi.m~
Bernida G. Moose, Testatrix
~.ikf~QA ~tr0W~
Notary Public
I
I
L.__
NOTARIAL SEAL
MERLENE MARHEVKA Notary Ptbli.':
Cdrli$ie. Curr.berland Countt, Pil.
My Commission Expires 6il119,Q
3
c: Iw.,Sl Iwillslmoosc. wil
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, and ~ Q,,~f bt~,C~~ {
the witnesses who ched or foregoing instrument, being
duly qualified acc ding to law, do depose an say that we were present and saw
Testatrix 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 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 or affirmed to and subscribed to before me by ( CJ(~
and ;{alUf/: J}\C' C ~ illU [ C this 1--' i-t\ day of
: L V-A C ~ :J) .-,-") ~ ( {C ,,'
Witness
_hO"
~:/~~
, v
Witness
~l
r NofARlALsrrL~-"
MERLENE MARHEVKA. Nolary Plblic
Cartisle. Cumberland Count:! PD..
My Commission Expires 61!i/9iJ
4