HomeMy WebLinkAbout12-21-06
Estate of
Ruth Marie Apa
PETITION FOR GRANT OF LETTERS
c9/- 00 --- (137'
No.
also known as
Ruth M. Apa
.i
, Deceased
Social Security No.
Petitioner(s), who islare 18 years of age or older, apply)ies) for:
(COMPLETE "A" OR "B" BELOW:)
o
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of 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 documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
[R]
B. Grant of Letters of Administration
(c.I.a., d.b.n.c.t.a.: pendent r t ebsentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left n ill and was survived by the following spouse
(if any) and heirs:
I Name Relationship Residence I
Franklvn G. Aoa Son 131 E. Lisburn Road,
Mechanicsburg, PA 17055
Glori A. Apa Daughter 4 Reservoir Road
Mechanicsburg, PA 17055
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumber land County, Pennsylvania, with his/her last family or principal
residence at 4 Reservoir Road, Mechanicsburq, PA 17055
(list street, number and municipality)
Decedent, then 68 years of age, died 12/7 , ~,at Holy Spirit Hospital
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA All personal property......................................... $ 2, 000 . 00
(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 ..................................................................................................................... $ 2 . 000 . 00
Real Estate situated as follows:
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
Franklyn G. Apa 17055
131 East Lisburn Road, Mechanicsburg, PA
Glori A. Apa
4 Reservoir Road, Mechanicsburg, PA 17055
RW-1
Oath of Personal Representative
Commonwealth of Pennsylvania
County of
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 estate according to law. ~
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DECREE OF REGISTER
Estate of Ruth Marie Apa
Deceased
No.
0&- //3?
,
also known as
Ruth Mo Apa
Social Security No:
Dateof Death: December 7, 2006
AND NOW,
reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentarytl of Administration
, in consideration of the Petition on the
arnheffibygffi~ed~ Franklyn Go Apa and Glori Ao Apa
in the above estate and that the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the Last Will of Decedent.
FEES
.~.on
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>& R~~' ,~
Letters ..... ................... ............
Short Certificates(s) .....:t......
$
ti)) (J)
61': I
Extra Pages (
) ...............
$
$
$
$
$
$
Renunciation ......... ........ .........
/OJOJ
1k~ ~flUv '
Signature ~
Attorney: Melanie Walz Scaringi
I.T.R.......................................
JCP Fee .................................
Inventory ................................ $
Other ...............................~ $
1.0. No:
88347
Scar1ng1 & Scaring1, PoCo
2000 Linglestown Road, Suite 106
Harrisburg, PA 17110
s~ "D
Address:
TOTAL ... ....................... ...$
[:; ie/D
Telephone:
717-657-7770
DA TE FILED:
IQ.-al~
Hl05.R05 REV llf)~
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 filin~ _ //3:1"
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
No.
~~.duA~
. Local Reg. strar
p
13215322
S~ /1, ;}. 06(,
I
Date
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til05144 REV 02J2006
TYPE I PRINT IN
~:T 1130-405
1. Nane d OecedenI(Fifsl.lfidtIe, last. suffix)
RUTH
5"'(taIl~1
68
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH . VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
Holy Spirit Hospital
C'milla.a
STATE FilE NUMBER
< OaIeolDe""(llorlh,clayreO'I
December 7. 2006
M
APA
8b Co.nIy 01 Oealh
31. 1938 Harri sburg PA
&d. F~ Nane (If not 1tsIiIu1ion. give snet IIId number)
12 w. 0ecedenI ever in !he
US Aimed 1'orC8>'
OVes IXlNo
_.
AdualResidence 17a. SIa&e
17bCoooly
14. MarilalSIaius: Manied. Never Married,
_. 0Mllted(~
1. F....s NarN (Fnt. middle. 1aiI. sufh)
Boyd E. Diller
PA
Cumberland
llid~
liYeiu
Town"",'
17c Kl Yes. OecedenIlNed in
17dO~~oI--
IIpppr Allpn
Top
201 Inbmanrs Nnt (Type/Print)
Glori A.
19. MoIher',Nlmll(F...,middle. maidrefISOOIa'ne)
Sara E. Myers
2\1). -.MilIing........ISO',tiy/..."_,,.,_,
4 Reservoir Road Mechanicsbur
21b DaM of Disposition (Month, day. yell') 21c. Place d Disposition (Na'nll of cemelery, cntmab'y at olher place)
COy/Dew
~
~
ast Harrisbur
22t. NiIhe If1d Address 01 Facily
PA 17055
PA 17109
FUNERAL HOME E MAIN ST MECHANICSBURG PA 17055
23b Uconse N....... 23c. Oale Signed lllonlh, clay, '"'")
24. Time 01 Death 25. O_Pronounced Dead (MontI. dar. year)
7: 30 P. M December 7. 2006
I~I f 1..;2. I I I.J.I
26. Was Case Relerred 10 UedicaI E~ f Caoner for a Reason 0Iher.. Cremaeioft Of 00nIIi0n?
J( Ves 0 No .
Approximate inlefval P.tll: EnIef oIMlr sD'Iiic::n ~ mrtill.1Iim kl d8Mh 28. Oid Tobacco Use ContrDJit 10 Dealt?
Onset 10 Oeall b.llnolresuMingintheundertyWlgcausegivenllPa1t. 0 Ves DProbably
DNa OU""""""
Diabetes Mellitus 29 HomIIo
o NoIp<egnanI."""...._
o I'<eg:>anlallimeol.....
o Not,....., bul"""'.... _<2 days
01.....
o Not_,,,,,,,,,,,,,"""'3dljS"',","
01.....
o Unknown if plegnanl Wlhn f1e pall ye.
31< Plaatollnjwy_,F....._F.uy.
Olb B"""Il. 8l< fs..otyl
CAUSE OF DEATH elM "'.trucaOM .nd .omp''')
_27. PART I Ef'llerlhe~Qftlrlllli . di$eases. inJunes, atoompllCatioos -lhildirecllycausedhedealtJ. 00 NOT enlef Ierminalevenls such ascaJdlaC alnt,
respwaloly arresl. or venh:ulaf ftlrillalion wiIKlul showng!he ebology. list only Ole cause on each line
~~~~~~ Atherosclerotic Cardiovascular Disease
Due to (or'I' conMquenCe of)
~ listaJOdlbls,. Illy.
10 cause bted on koe a
Enter lJIC)ERL. YING CAUse
flksealeor~lh~iri\Jaed1he
.vents resufWlg... dealtlllAST.
Due to (or.. a conaeq...enc:e of)
Due 10 lor.. . COIlMquance of)'
301. W. an Autopsy
Perbmed?
n Were Autopsy Findings
Available Prior 10 CompIelloo
of Cause of Death?
OVes ~No
DYes ONo
31. M~l'IllfolOeath
~NatlJral DI10rncije
0- OPendoog__:W T...oI"".....
OS,,,,,,, 0 Cook> Not be De_
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lJlI CMlIlot l<hecI.onIy one,
. Cettirylng phyticiln (Ptly5IClan certlfY\ll9 cause of dealll when another phySlClafl has pronounced dealh and completed IIem 23)
To lh,btlt 01 my kno...... dHIb oceurrH due 10 "" CIIL1H(.) and martfttr II tUtljl_.._................................................................... jJ
PronoullCklg and ctftdyklg phPM:ian (Physician both prOl"lOU"lClOg deach and certllytng 10 cause 01 death)
To 1M bill of mw knowMdge. ..th occur,"" the u.n.. ca." end.., and dIM to tht tluH(I' and mannw n It.ttct _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ..D
IIIeGcaJ Euminw I Coronw
On the bull of.umIMtioR and, or mvntigltion,... my opinion, dulh occu.rred It 1M lime, cUte,.nd pAIce,'nd dw to tfte CI~I) lAd mIMW lllIatft _
Coroner
33d. OaIeSigned tMcx1f\, day. yeW)
December 8. 2006
34 N~~n"E'~b"m~~ll~~Vype/-
6375 Basehore Roadl Suite #1
Mechanicsburg. PA 7050