HomeMy WebLinkAbout01-11-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUM 13E1lLA-A/.D COUNTY, PENNSYL VANIA
Estate of HEL.E/V So :J2J1/AJ',A/
also known as
File Number
c21- 07-{)D3Z
, Deceased
Social Security Number 176 - /, - 3 2 Z. ~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
18" A. Probate and Grant of Letters Testamentary and aver that Petitioner~is / _ the G- ~1L'Iri X
last Will of the Decedent dated ~ :17, 240'1 ana ellaieil(J) ddL..,d
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: ,N/Ao
o B. Grant of Letters of Administration
'"
o B
(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; dur'!fi!!<!!!!poritate) .......
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following sp~~.{iT)any) ~ heirs~iif';;
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) . :~ S:~ '.. . m
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Name
Relationship
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in
II
(List street a (tress, townlcity, township, county. state, zip code)
Decedent, then
8"'1
years of age, died on IVn~ ~s. ~t
.
1'1'(11 ~/;.,i' ~-so,ift/~ E. ~nskr# ~
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 P A) Personal property in County
Value ofreal estate in Pennsylvania
situated as follows:
9'0 ~~~r ~e.
.
$
$
$
$
Af&c) t~/c-nd ~AI//M ~)
/61 tJl)D
~.,,.. ..6
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:
T ed or rinted name and residence
8 mAYFlatJ /&');9.
n1EtJ.N A-N/~ $8uR.ti
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Form RW-02 rev. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C I.(. In tactZLAlV.l>
SS
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
administer the estate according to law.
d-1-D7-~~Y
H€l.9J/ s... ..7P#/Y.J~d
Social Security Number: /7' - / t- 3 ZZ;' Date of Death: AI~v.. 2~ ~i!XJ6
AND NOW, J~ Q \.OSl oct& \ \ .~ , in consideration of the foregoing Petition, satisfactory proOf.
having been presented before me, IT IS DE ED that Letters T8rs;rAAlI!?iIII T~Y .
are hereby granted to tJ/'YO~ ME ~#- ~. ExlFt'.brA!/K
.
File Number:
Estate of
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Signature of Personal Representative
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Signature of Personal Representative
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, Deceased
in the above estate
and that the instrument(s) dated /17AY 27~ 4!,~,,~
described in the Petition be admitted to probate and filed of recor
FEES
Letters .......... _ . . . _ $ qo -
Short Certificate(s) . .I.b. . ..$ 40"-
Renu\1ciation(s) .......... $
JJ)I LI d~~
~ ...$
1:lu..tDmo. tiQY). . . $ . -
.. . $
.. - $
.. . $
.. . $
.., $
.. . $
TOTAL. .. .. .... .. .. . $~lo() ~
Forl/l RW-02 rev. 10.13.06
GtIy
Attorney Signature:
Attorney Name:
t!H~ ~ .s,y/~.2F
335/3
, CLOI1SB'{ A?,I} .
/)/E&/A#/(!S J!lu/f!G" PA-
/7tJSS'
Supreme Court LD. No.:
Address:
Telephone:
7/7- 7'" ~02,~r
Page 2 of2
HJ05.805 R'OV '10<
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 filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
No.
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Local Registrar U 0"
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12934877
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H105 143 REI/ 02J2006
TYPE / PRINT IN
PERMANENT
BlACl< INK
1 Nane 01 Oecedenc (fist. midde, laM, SUlb)
Helen S. Johnson
5 Age (lao;' Bilhd.,1
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH . VITAL RECORDS
CERTIFICATE OF DEATH
6. DaealBilll~.
STATE FilE NUMBER
. Dale of 0.... 1_ ..,.....1
Novem bet' ~ S;. 10 of:,
84
.. CounIy of 0....
,,,
Sept. 9, 1922
Cumberalnd
II Decedents Usual
Kind of Work
Registered Nur
Tw
mosl 01 IIIIIOB' We. 00001 Slate retired
....,,-.,-
Education
la. FabI(,Name {First.middIt. Iast,suffixl
Jack O'Shea
2lla_l......IT....'PIp'
LUlCla Jonnson
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AcwalResidence 17a Stale P A
170 C"",,~ CUmherlanrl
19 MoIher'SNiWlle(First.mddle,maideflsumame)
17e Iii Yes, Oec8OerHived Il'l T L'lWPr A. 11 ~n
17d 0 :~~iWld'Mhn
To.
90 Poplar Ave.
C",_
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1
2Il:l. Inlon1la1t's Mailing Adchu 15net. c:iIy IloMl, stale, lip code)
8 Mayfield Rd., Mechanicsbur ,
21c Place 01 Oisposilioo{Name c1cemekwy. CI8fINlIOry 01' oIher IiarAI
PA
2006 Holli
22c: Name a1d Address of FdIy
M. J. Malpezzi Funeral
ComplOto ..... 230< """
ph1sician is no! avaUble aI
celtifyCilU&e 01 deall
1tems2426tllU$lbecompletedbypefSOfl
:' who pronounces deaIh
2. T...ofo.~ Ctf: L{ S ~ 25 O'FJOVem'T/€t '2 '3 f
CAUSE OF DEA. TH (See lnatrucdone and .umpln)
I6em 27 PARr I. Enl8f Ihi Y!i!ll Iolf'venll- dl9Uase$, ....leS, OJ complJCalion$ -Ihaldlrecly cau!ie41he deatl 00 NOT enIfJ( IelmN t:'11!fl1$ slJdl as CdldlClC arresl
respiralor) anest Of venilCuIar k1rillilbon wilhoul showng'" titIology lISt only one cause on eadlline
'200G
or ""'-'1
: ApproXimate inlefllal
: OnsetlOOei:llh
No
PM It Enlef of)er I!IllIkan1Wll11Km~-ll~.
but no! fesulllng III the und6r1"ing cause gwen III PiW11
28 OidTobaccoUseCooantkMIOOeIll?
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ON<> Du"""""
29 If Female
o Not PfegoaM Wl\hln pail ~
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oIdeall
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of_
o Unknown If j)ftiglant WIIIwl tle pail '/f!at
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EtiIr '*DERI. 'ftNG CAUSE
(dI5Hse Of I'ljlM"f I\aI M*d!he
even.. rewlllng III deai'l J LAST.
Due to (or H. CClnaequence of)
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Due 10 (or 1M it CORaequenc.e of)
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OOIlvt!r/Qvtn"alor DPd!>$en!ItH
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331 C..oo.lchedlOfllyooe) 33b SignalUfeandTi1Ieor
~pbWSidMl~~lIlgl;ilJWloIdBaflwhenanolhefph.,.iIOaflh~plonoutlUldl;\eathaodUllllJllfJLadIk.1n:l31 ~ ')..
TDlhe....oIlnyknowMdge,....DUWRd..toltMicaua~al.ndlMNlef......est___ _ ___ _.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _..D _ .._--- -"
. PronouftClnt MIl ceRiIy.....pfar*ilin (Ph,sioan boll prClrlOullcing oealh .n.tceAlfylO9 to cause ofoeitdll ....... ik. license 33d Date Signed (Monlh. day. 18M)
. :.::.."::'..:::=......OC<..,.....,........-,...._..nd........'~OO(.I.................ld__________________ IV\\) 0 ]CJ. 13 E Il - -.15 - JUG (.
On Ibe _Ie of~ WMtI or InVdtiption, In my opnkln, dNth occurred Ilthe lime, dalt,.oo pa.c., and due 10 1M cluHjatMld tMnMf.. aWlft _..D 34 Name andMjreas 01 Person Who Completed Cause or o.aIh (Itllm21J T~/PrinI
35 ~ .Sogn.o......OoslrdN...... 16 DaleF...t.........,.,.>1 K<.~h,~A r"~"L..l,, NU
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(See Instructions and exa~ple. on reverse)
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REGISTER OF WILLS
C U JJt ~iJ COUNTY, PENNSYLVANIA
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OATH OF SUBSCRIBING WITNESS(ES)
c21-D 7 - (5038
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Estate of
I-I€Z~ S,
.:n;I;/NSP/V'
en
, Deceased
eHM.u:=s E: ~/~ '7lI
, ~) a subscribing witness to
(Print Name/s)
the a Will a C8ffieil(~ presented herewith,~ being duly qualified according to law, depose(s) and
say(s) that ~ / he /~
and that . ~~
was ~ present and saw the above Testatef I Testatrix sign the same
signed the same and that .-afte./ he / ~ signed as a witness at the request of
In her /-AH;.. presence and in the presence of each other.
the 'f G3tatef" / Testatrix
.~g~-
(Signature) a/rt'/l-AUES If: SN/~s or
(Signature)
~ ~"gR!"/'l ,f!J>.
(Street Address)
(Street Address)
(City. State. Zip)
1J1E'(!,.It'A-/II/CS" BUJE?(;,;OA /745r
(City. State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ~ day
o(j~'Uf-' ;;ml .
"\)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this
day
of
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.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy ofinstrument(s) at time of notarization.
Form RW-03 rev. /0./3.06
REGISTER OF WILLS
e l{JI1~1IJ.i) COUNTY, PENNSYL VANIA
C)
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OATH OF SUBSCRIBING WITNESS(ES)
JJ -07- 0033
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Estate of
J..i a.~AI.f'. ~#;IJ{f~ /II
, Deceased
L/I\VJA- ~AE . ~t'h-'~A" - 8t;<.
,~) a subscribing witness to
(Print Name/s)
the 0 Will B-CeElisil(s) presented herewith, ~ being duly qualified according to law, depose(s) and
say(s) that she J he / th~ was ~ present and saw the above l'eEtator-l Testatrix sign the same
and that she / he / th~ signed the same and that she / h€l / th~ signed as a witness at the request of
the festffiw / Testatrix III her ~ presence and in the presence of each other.
"'---
(Signature)
c/t//,I'4.Jt:)/fJ ~ex
(Street Address)
(Street Address)
(City, State. Zip)
/J/Et!NA-A/ICS~t{R.G... ~A- 17tJS$"'
(Cily, State. Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this -LIt\') day
Of~I1110~16 ,c-'W7.
)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this
day
of
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.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy ofinstrument(s) at time of notarization.
Form RW-03 rev. 10./3.06