HomeMy WebLinkAbout12-11-06
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of TIMOTHY D. LUSH
also known as
File Number
d\
019
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, Deceased
Social Security Number 195-38-7993
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated 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:
III 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) and heirs: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date o/Will in Section A above and complete list o/heirs.)
I Name Relationship Residence I
JANET K. LUSH SPOUSE 75 RUSSELL ROAD, CARLISLE, PA 17105
SUMMER ROSE HOWARD DAUGHTER 35 WEST HIGH STREET, CARLISLE, PA 17013
SIERRA ANN LUSH DAUGHTER 1716 LINCOLN DRIVE, CAMP HILL, PA 17011
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his / her last principal residence at
75 RUSSELL ROAD, CARLISLE, LOWER FRANKFORD TWP., PA 17015
(List street address, tawn/city, township, county, state, zip code)
Decedent, then 58
COUNTY
years of age, died on NOVEMBER 17,2006
at SOUTH MIDDLETON TOWNSHIP, CUMBERLAND
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
2,500.00
$
$
$
$
situated as follows: c''''
C2 ~.5
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant or'U~ in the ap~priate.fQ~k;
the undersigned: " U ;.,., ) ()
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JANET K. LUSH, 75 RUSSELL ROAD, CARLISLE, PA 17105
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Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
: 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 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
C" G/l'-Q"*, k. ~ l )J~/~
sign6je of Personal Representative........ '
Signature of Personal Representative
Signature of Personal Representative
File Number:
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Estate of TIMOTHY D. LUSH
, Deceased
Social Security Number: 195-38-7993
Date of Death: NOVEMBER 17,2006
AND NOW, \3 ~r\\~"- ,d.tJ::~JJ) , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters OF ADMlNISTRA nON
are hereby granted to JANET LUSH
in the above estate
and that the instrument( s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
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ReglsterofWIl/s ~. 'l~
Attorney S;gnature: ~&.. (J -~~ ~
SUSAN 1 HARTMA
FEES
Letters ............... $
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Short Certificate(s) . .l ."J .. $
Renunciation(s) .......... $
1~~ ...$
') .., $
.., $
.., $
.., $
... $
.., $
... $
... $
TOTAL.............. $
30 tb
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Attorney Name:
Supreme Court LD. No.: 65184
Address:
1 IRVINE ROW C')
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Telephone:
717-249-7780
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Form RW-02 rev. 10.13.06
Page 2 of2
II Hl."l\O'" REV j'll"i
This is to ccrti ly lhat the informatIon here L:i\ en is con L'cdy cnpicd i!OIl) an original certificate of death duly filed with me as
Local Registrar. The original ccrttiicatc will oe furwarded 1', t :12 S\:ttc Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No,
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Fcc i'or this c!:rti fica!e. $GOO
P 12995045
NOV_~ 2006
Date
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H105.144 REV. 02l200O
lYPE I PRINT IN
P~ 1130-388
1. Name 01 Decedent (First, midde,lasl sulfilt)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
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D
Lush
a Date of Birth Monlh.da,
7. Birth ace Ci CIld state or
STATE FILE NUMBER
4. Date or Death {Month. day, yew)
November 17, 2006
March 10, 1948
Plainfield, NJ
ad, Fa:i6ly NM1e (II not ins~lution, give street and number)
Carlisle Regional Medical
75 Russell Rd.
Ca~lisle, PA 17015
18. Father's Name (Fi~t middle, last. sufIilt)
William G. Lush
lOa. Inlonnanl'sNorne (Type/Print)
Janet Lush
12. WasDecederlle...erinlhe
U.S. Anned Forces?
Oy" IilNo
DeceOenl's
Aclua Residence '7a, Sta!e
14. MarttalSlatus: Manied. Never Married,
W_, 0;,,,,,",, IS_I
PA
Did Decedent
Liveina
Township?
""f] y",___ Lower Frankford
17d.O~~~iYedwithl1
Twp.
17b, County
C'llllbarlilnO
19. Malfler's Name (First, middle, maiden surrnrne)
Ciy/Bool
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21b, Dale of Disposilion (Month. day, yea)
Ina Fosbre
2Qb, Inmoors Mailing Address (Street, city I town, state, zip code)
75 Russell Rd., Carlisle,
'Ho~ff=~R6th"'fu'ri~oI"H~) &
Pa 17015
21d.Localion(City/loWn,Slale.zipoodel
219 N. Hanover
Carlisle, Pa 17013
Hoffman-Roth Funeral Home & Crematory, Inc.
St., Carlisle, Pa 17013
23b. LicenseNumbef
23c_ Dale Signed (Monlh,day, year}
Complete Items 23a-c only when certifying
physician is 001 available at ~me ofdeafh kl
certify CillJSeof dealh
Ilems24..26mllSlbecompleledbypersor1
whopronooncesdealh.
24. TJ1IltlolDeath
3:35
P. M
25. Date Pronounced Deoo (Monlh, day, year)
November 17, 2006
26. Was Case Referred to Medical Examiner I Coroner for a Reason Other!han Crematioo or Donation?
)lry" 0 No
CAUSE OF DEATH (See inatructions and examples'
!\em V. PART I: Enlefthe~- ciseases, injuries, orcomplicalions.lhatdi'ec1lycaused lhedealh. 00 NOT enter lemlinal events such as cardiac CllTest,
respiralory arTe$t, or ven/rWa" fiOriI/aIion Mthout showi'lg ItIe eliologJl. List OOJl one cause on each line
=~=~=~ Pulmonary Embolism
Due to {Of as a consequence of)
Diminished Activity
3Oa. Was an Autopsy
Perlormed?
~""'" 0--
0- OPe!'d>>Qlnvestig....
Os,,,,,, Oc...~NolbeOo1em\"'"
Depression
28, Did Tooacro Use Contribute 10 Death?
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o No 0 Unknown
29. II Female:
o Notpregnant within past year
o Pnlgnanl at time of death
o Notptll9flalll,bulpregnanlwithin42days
of death
o NoI pregnant, but pregnanl 43 days to 1 year
ofdealh
o Unknown if pregnant within the past year
32c. Place or Injufy: Home, Farm, Street Factory,
Office Building, etc. (Specify)
: Approximate in/enlal: Part JI: Enter other sionificant coodilions mntribu~oo In d&aIh
: Onsello Death but not resul1J1g in the underlJling cause given in Pa-tl
=Iislcondilions,ifatlf.
Ie ' to cause isted on line a.
Enlef 'UNDERLYING CAUSE
{dlseasetXinjurylhalinilimedlhe
llYents resu4t1ng 1Il death} LAST.
Due to (Ot 8li a consequence of)
Due to (Ot a6 a consequence of)
)ty" 0 No
3/Jt), Were Autopsy findings
Av~ Prior 10 CcmpIelicfl
of Cause of Dealh?
~es ONO
31. MannerofOeath
32d. Time 01 Injury
338. Certlfktr(checkoolyone)
CertlfylllSl phyaleUIn (Phys(ian certifying cause of death when another physician has pronounced death and completed Item 23)
To thl bntof my knowitdgl.duth occurred dultoth.tlull(l) Ind I'IlInner II ltatl$f_ _ _.. _ _ _ _ _ _ _ _ _ _ -. _ _ _ _ _ _ _ _ _ _ _ _ _ _.. _ _ _..D
Pronouncing Ind eertityIng physleian (Physician both pronouncing death ald certifying \0 cause of death}
To the belt of my knowfedge, death occUlTfd arthe time, date, and pI<<e, and due 10 IhI auttf.) Ind lNInllfi as.tattct _ _ __ _ _ _ _ _... _ _ _.. _ _ _..D
Medlcll Eltamlfled Coroner
On th-f bdl, of elfammatkln and} or InvHtiplbon, in my opinion, death occurred at tM time, date, Ind pllee, and due to the ausl(s} and mln"ef" llat!q, _
Coroner
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33d,DaleSigned(Monlh,day,year)
November 20, 2006
'" m-t'!\~'l:,,!o'~1to'rm,,:''''eget'tl1Y''e'P T"",,,,,,,
6375 Basehore Roadr Suite #1
Mechanicsburg, PA 705U
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RENUNCIATION
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REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
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Estate of TIMOTHY D. LUSH
, Deceased
I SUMMER ROSE HOWARD
,
(Print Name)
DAUGHTER
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
JANET K. LUSH
IZ.////U",.
(Date)
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35 WEST HIGH STREET
(Street Address)
CARLISLE, P A 17013
(City. State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
beifte me this \ \ bY'I day
of\..J(J(' (IviliVL , )00 b .
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of
VLLL L
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form R W-06 rev. 10.13. 06