HomeMy WebLinkAbout01-04-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~wn\\~"'~~ ~ COUNTY, PENNSYLVANIA
Estate of ~ aJ.. 'r"" lL '^". ~ ~ t( ~ Q 0 I"'l..
also known as 0
. Deceased
File Number 8./- (J 7- / 2-
Social Security Number \,~ 1..\- \ 1.. -l.\ ~, \
Petitioner(s), who is/are 18 years of age or older, apI'ly(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
c( A. Pr~ba" and G..n' of L"~T~.,...n"ry and aver that Petitioner(s) is I "" the ~ - e<l&:J-~,$
last Wi1I of the Decedent dated :3 ~/ If41 and codicil(s) dated J/'DIJ.{...
,
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) ,.....,
('") C;::)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spoYi~any) andSrs:
Administration, c.t.a. or d.b.n.c.t.a.. enter date of Will in Section A above and complete list of heirs.) :~:J :0 C-
:,~ :>
Name
Relationshi
~, --j
:i>
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
.,
Decedent, then 1 '1
years of age, died on '\>~,,~. '-\
at \'\S"5' \~ ~ f
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
$
~ A-u K ~es-
$
$
o
3 I '"14~. qc.f
CJ
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
T ed or rinted name and residence
ff.Ctfl';f;
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTYOF ~..~\.~~
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) ofthe Decedent, Petitioner(s) will well and truly
SS
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~-+\----'
~
day of
Signat of Personal Representative
~~"-~. UH:~~1A.)
Signa re of Personal Representative
Signature of Personal Representative
File Number: J.J - 0'1. - I d-
Estate of ---rte k A... /J1', ~ ~~ /'~ ~ , Deceased
Social Security Number: ) RtI- / ~ - ~ tr~ ( Date of Death: ]}i7. L.. 4) .:2(> 0 ~
AND NOW, 1..\ ,,"00"1 . in consideration of the foregoing Petition, satisfactory proof
having been presen d before me, IT IS DECREED that Letters \-OS
are hereby granted to ~ I(UJ~
in the above estate
FEES
Letters ............... $30 . 00
Short Certificate(s) . . . . . . . . $ I ~ . c:xJ
Renunciation(s) .......... $
10~LL ... $ (S-. 00
~ p . . . $ 10. () 0
~~~ ...$ S-'lJ0
...$
.. . $
... $
... $
.. . $
...$
TOTAL.............. $ Ii" .00
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Attorney Name:
Address:
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Telephone:
Form RW.02 rev. 10.13.06
Page 2 of2
,( 1105
; to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
~=-_~=' 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, $6.00
~I?r
Local R~
Date
p
12842121
DEe 0 7 2006
No.
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JIUIIlM ..
ERIIANENT
Il.ACKIIl(
1. Homo 01 DocodonI (First. niddlo.1ut)
Thelma M. Gutierrez
5. Ago (lasI"'-"
8 7 VIS.
a.. Counly 01 Doolh
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
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3. SociIl SecurIy NurnbIr
.184 12
STATE FILE NUMBER
4. DaloofOoatll(Montl.dly.yeo')
December 4, 2006
7. ll.t..'1IIrth
. II'
9/11/1919
<lutler land .'
Carlisle
11. llocedooI's UIIIII 01 WOIl< dono _ 01 II' do nalslelo rotnd
Clerk KlndolWartl Penn Mofllusilossllndus
16. IlIcIdonl's -.g _ (SlrooI.~.""', zip COdII)
442 Walmt Battan Pd.
carl~sle, PA 17013
14. lIattaI SlItus: ....rriId. NIYII IIIIrri1d.
nt~~~(~
13. llocodonI's Education
EIomonta~(O-12)
PA
CoIIogo (1-4 or 5+)
Did llocodonl
lJvo ill
T.........1
17e. 0 VIS. Docodont Uv..l'in
17d. I No.llocodonl LivId_
oldual LimIIs of
17a. S1a1o
17b. County Q.uberlaOO
18. F_s N8IM (First. niddlo.1ut)
Charles M. Fry
2lIL InIonNnt'.NoIIII(T~
"'.__ 19. Mol""". Homo (First. niddlo. lIIIi1onsumollll)
~le Bretz
2Ob. lnfonnsnI'. Molng -... ($IrooI.~.""'. zip COdII)
7949. Slepian Street .~isburg, PA 17112
21d. lllcalion (~....... zip codol
Silver Spring'lWp. PA 17025
~.
eon.-. _ 23lI-c only - C8Iflying
physi:ion Is naI........ at'" 01_10
C*lIfy...... 01_.
_24.26_bo~by_
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2.t)~ k..
. Apprvximato~.
: onHI to deIth .
i l..A\~
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Portl~EnIor_IianiIicanI__IIl_.
but naI,lIUIlIng il \110 undorIytng C8U11 gIvon il Port I.
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lluolo(orua_oQ:
~Ii&tClllldilions.Wlny.
Ioodilg 10 lho _iliad ooliMl a.
EnIor lho UlIlERI. V1NG CAUSE
..... or iljury lhot InIiatICIlho
_roouIIngil_lLAST.
b.
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e.
lluelll(or..._oQ:
301. _.nAi*lpsy
Porlormod?
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3lIb. W.. Ai*lpsy FildIngs
Avo""" PrIlr 10 Con1Ilation
of CoUll 01 Doolh?
o VIS D No
321. ~T'alllJlOllolion~(SjJociI'yl
o llriVorqlIrolor 0 Po_
D ~ 0 Cllhor - SjlIcOy.
33b. ~ ond llte 01
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31. _ of lloolh
"'il Natural D HonIcido
o Accidont 0 PIIdng InvoaIigaIion
o Suicido D COUld Not Be !leIonrNcl
3:11. DatI 0I1ftjIry (MonI!I, day. yeor) .
3211. DoocrIlllIlow IftjIry Occunod:
o Y.~ No
32d. r... oIlnjJry
M.
33&. ~(_onIyona)
c.utyIng phytlcIIn (Physicion CII1ifying CIUII 01_ _.nolhor phrsicion has pronouncod _ .nd COfl1Ilolod Itom 23)
To lhI.....of my........... ___ duo to lhICllUII(.).... _ II __.______.._...._...__._.__.._._.___.___._._._._.__0
"""-tclng l1li CIIIlIytng phytlcIIn (Physician both pIOI1OUI1Cirl\J dOl'" ond CIl1lfyiIg 10 COUll of dIIth)
To lhI.....ofmy......... _ occ...... II lhI-, -'l1li pIaca.1ftd duato lhIuUll(.) l1li_ u _____._.__._._._.___._._0
1IIIIcII~1'_k-~~
On lhI~ of......... andlpr InwalIgoUoft, In my opinion, _ __ at lhItln, dale, and pIaca,.... dua to the uUll(a) and _ II _ __0
35. Ragisnr'. . lliItricI 36. Dall Flod (Mo!lIh. day, yoat)
I ~ I I "2-t 'I I I 17-"1. ?-eJ (J G
(See Instructions and examples on reverse)
10. RIca: AmorIcan Indlan. BIoctl. WIllI. lie.
(SpsdM
\<bite
15. SUNMng Spousa (K wifa. give moidl. IlImol
Twp.
Carlisle
Cily4lora
28. Did T obocco IJso ContrIlut. III Doo"'?
o VIS 0 Probobly
o No "I;l U'*'-t
29. "FIIIIIII:
D Not plagnalll Wlhil post year
o Prognanl at limo ot dOIlh
o Not plagnant, IlIf plagnant wiIhin 42 days
01 doalh
o NoI pragnant. but proonanl43 dlyo III 1 year
_. dlllI1
o Unler-. Iplagnant _ \110 put yII'
321:. PIoco oflnjury; Homo. Fann. Stroet. FacIory. 0IIIc0
1luIdirIg.1Ie.(~
32g. lllcalion (SneI. cIyJ1own. .talo)
330. Li:.... N..- 33d. Dalo SIgnod (_. dly. yur)
~'b eJ l "".t\ ; 1)~ c:.. I' ~~(.
34.. NoIIII Ind -... 01 Person Who ~ Cue of lloolh (1Iom 27) Type/Prinl J ~
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Ros~ Ann M. Mull
Notary Publ'ic
Notarial Seal
o . ~
emoyne, B?ro, Cumber/and County
~ CommissIon Expires Oct, 25, 1999
r.'lemi,P.t p~~, , IOn 0 tar/IS
OATH OF NON-SUBSCRIBING WITNESS(ES)
RE~ISTER OF WILLS
e..v..J""'~ ~OJ\k.tt COUNTY, PENNSYLVANIA
Estate of
~~O-
/It r;;;.. -j,< el"1'E -z--
. Deceased
n
and
(each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were well-
acquainted with --;X~6' /t1 ~:';;t>/r-~~ and am/are fami~r .
with the handwriting and signature of the decedent, and that the signature or--a k ,hi c::::'c:f/i!!v<r'e C-.
to the foregoing instrument purporting to be the Last Will and Testament/Codicil or-;;;:,~~ ~ ~ '*e,.........r- -c..----
is in his/her own proper handwriting.
\,\~ '~f Q (A., \r \ II \-z..
(City, State, ~
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(. ignature)
.3~\G, ~\'C2A..\(\.. ~~~~
(Street Address) .
(\ ~~Pt\~ \X \\\ ~ L)... \. "/ t> L \
(City, tate. \.
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this Icr-u day
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puly for egister of Wills
Form RW-04 rev. 10.13.06