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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CiA rl\ e6 ~ LPiV t) COUNTY, PENNSYLVANIA
, Deceased
File Numberd \ () " D6L\ ~
Social Security Number i 8 b - 3i- - L 7 2..L{
Estate of P t> R.o \\.4 ( E . ~JJ I.J G-
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
if A. Probate and Grant of Letters Testame
last Will of the Decedent dated U t.: ,., I
ry and aver that Petitioner(s) is / are the
and codicil(s) dated
G 1 c etA!l?-J x'
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, el1ler: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minori/ate)
Petitioner(s) after a proper search has / have ascertai.ned that Decedent left no Will and was survived by the followinHPouse (if anY~d heirs: (If
AdmilllstratlOll, c.t.a. or d.b.n.c.t.a., enter date of WllI /fl SectIOn A above and complete itS! of heirs.) .--' C) ::::::.
R"~l~ ~
~
Name
Relationship
':1
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Q
Decedent, then "l Lf
yearsofage,diedonOI-OY-o7at ~:'i5.An1 IN ~€\OCt.-- fk~W2.JAL }i;;fITA(,-
M r;c/l L. N lC-~ iJ "1 tl.G P ~
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 PA) Personal property in County
Value of real estate in Pennsylvania
$ I () OJ ODt> ~ 00
$
$
$
situated as follows: 7c}'! JI,II~rJ (3'-IIP. . f/CJV uUMRlIl.LAt...rc fA
, I
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:
\ OD ) DDl)o <"0
/7tJ70
T ed or rinted name and residence
OD~-GUJ b ~ f:e
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
~<<\~<\Dc\
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
tbe knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer tbe estate according to law.
Sworn to or affirn1ed and subscribe,J
c;
before me tbe
day of
Signature of Personal Representative
Signature of Personal Representative
File Number:
d \ 0'1 OO~~
t)\)~~ E. ~\\x-Gj
\ ~ ~ ol.\; \ '1~'i
, Deceased
Estate of
Social Security Number:
AND NOW, ~'{\OOX\j \.~ ' d-.(j)l
baving been presented before me, It IS DECREED that Letters
are hereby granted to \Jsrwn E ~b-i
\
'6
Date of Death:
in the above estate
FEES
Letters
d loO .CD
~.ci)
Attorney Signature:
$
Short Certificate( s) . . . " . " $
Renunciation(s) .......... $
~\\ \ $
~C? $
~~ $
$
$
$
$
$
$
$
I S- cJ:)
\0 ,Of;
S- .co
Attorney Name:
Supreme Court LD. No.:
Address:
TOTAL
c'} qb.cQ
,\
80 :CJt
f' UJOl
Form RW-02 rev. jO.J3.06
Page 2 of2
{IOS.80S REV 1105
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.
No.
'f~
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t..LAVn..~,( /cv~~
Local Registrar
Fee for this certificate. $6.00
P 13104792
, t,\ ~.!
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vrC., ,
11 2007
Date
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o
REV 1112006
. PRINT IN
JANENT
CK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
8b. County of Death
ad. Facffity Name (!f not ;~itiJljOfl, give street anO numbet)
a
co
STATEFILE NUMBER d. \ D" CX) <-\ '3
1. Name of Decedent (Firsl. middle, last, suffix)
Dorothy
E.
Ebeling
6. Date 01 BIrth (Month, day, year)
- 34
1724
2007
Yr,;.
July 2, 1912
Wheatland, PA
Other:
o Nursing Home 0 Residel'lCe DOther - Specify:
9. Wa:5'Decedent of Hispanic Origin? 00 No 0 Yes 10. Race: American Jndien, Blaclt, Whrte, ete
(If.yes, specify Cubalt, {Specify)
Mexican, Puerto Rican, etc.) whi te
5. Age (Last Birthdayl
94
Cumberland
Mechanicsburg
Seidle Memorial Hospital
17b. County
Pennsylvania
Cumberland
Did Decedent
Uveina
Township?
,7c. 0 Yes, Decedent Lived in
17d. !.Kl No, Decedent lived Within
ActualUmitsol
Twp.
11. Oeced8nfs Usual lion Kind of wm1l. done du' most of world life. Do not state retired
Kind of Worl<. Kind of Business /lncIustry
Clerk Publishin
. 16. Deceden(s Mailing Address (street, city I town, state, lip code)
709 Haldeman Blvd.
New Cumberland, PA 17070
18. Father's Name (FffSt, middle, last, suffix)
Lewis Jones
20a. lnfonnanfs Name (Type f Print)
Doreen E. Eb
12. Was Decedent ever in me
U.S. Aml8d Forces?
Dyes OONo
Decedent's
Actual Residence 17a. Stale
13. Decadent's Education ISpecify only highest grade completed)
Elementary I Secondary (0-12) College (1-4 or 5....)
12
14. Marital Status: Married, Never Married,
Widowed, Divorced {S,aeciM
widowed
New Cumberland
City/Bow
Items 24.26 must be cornpkrted by person
who pronounces death.
19. MoIher's Name (F'llSt, middle, 11l8kien surname)
Eugenia Elson
2Gb. Informant's Malting Address {Street, clty (lown, state, zip codel
254 Ewe Road, Mechanicsburg, PA 17055
21c. Placeof~(Nameof cemetety, ~~OTotherplace) 2td.location (City/town, state, zip code)
Evans C-r'e=t~ry . Schaefferstown, PA 17088
CS, Inc., P.O. Box,431, New Cumberland, PA 17070
23c. Date Signed (Month, day, year)
IH () 9/2.{)() 7
26. Was Case Referred to Medical Examiner I Coroner tor a Reason Othef than Cremation or Donation?
Dyes IBNo
CAUSE OF OEATH (See instruetlons and examples)
Item 27. Part l: Enter the ~ - diseases, ~Ties, or complications -Ihat directly caused the d&ath. 00 NOT enter terminal events such as cardiac arrest
respiraloly arrest, or ventricular fibrination wlIhout showing the etiology. List only one cause Ofl eacl1 Une.
~~t~f~Si~~dlsea~
a.
ReLilE
1Y1'1 VU~ il.O I f\ (..
Approximate interval: Part 11: Enter other skmiflCMl condition!'; contrihutino to death, 28. Did Tobacco Use Contribute 10 Death?
Onset fa Death l:lvt not resulting in the underlying cause ~en in Part I. 0 Yes 0 Probably
D No \B'Gnknown
Seq~n:uth:~~~~,~~: a.
~ UNDERLYING CA.USE
~~~~~~~frST~
Due to (Of as a consequence oQ:
b Coi~O r-J A R 'f
DtJe to {or as a consequence on:
1\ R, E R. '-I
iNfARCTiON
OISE.f.\Se
I dnc.\
29.~~
lB""""Not pregnant MIron past year
o Pregnant at lTme at death
o Not pregnant. but pregnant w1tI1in 42 days
of death
o Not pregnant, bUl pregnant 43 days to 1 year
before death
o Unknown if Pf89Ila1lt within the pasl year
32c. Place 01 (njury: Home, Farm, Street, Factofy,
0IfIa1 Buildmg. .". (SpedIy)
I Ol...t~'''V;
Due to (Of as a consequence 01):
d.
3Oa. Was an Autopsy
Peftormed?
JOb. Wer& Autopsy Fmrlings
Available Prior to Completion
of Cause of Death?
31. Manner 01 Death
32a. Date of Injury (Month, day, year)
32f.1fTransportation Injury (Specify)
o Driver I Operator 0 Passenger OPedestrian
OOthe,. Sp8d~'
33b. Signature and Tille of Certifier
;.... Cl-",-" t/"~ fe, Ifv'
..
32g.location of Injury {Sreet, CIty /loWn, state}
DYes ~
oy" 0""
DNa"'" 0_.
D -, D Pending Inv.~lgalloo
o SWci<le D Cook! Not be O".""'n'"
32d. Time of Iniury
M.
33a.CertffierlduK:l<oroyonel
CertIfying physicIan (Pnys.iclan certifying cause 01 death wt\en 8l101her physician has pronounced death and oornplete<ll1em 23)
To the best of my~, death occurred due to thecause(s) and manner as stated.- _... _... _ _ _.. _... _ _ _.. _ _.. _... _ _...... _ _ __ _ _....._
~~:u=~:: =~:::'7:~~a~::= :htf=:~ni~e;,~~ a:~~1:~=~: manner as stated_ _ ...... ...... _.. _ _ _ ....... .. _ _ _ 0
:o=~~~m~n:~~':t: and I or inve8tlgatlon, In my oplnJon, death occurred at the time, date, anc:l place, and due to the cause(sJ and manner as stated.- 0
l"nf)
35. Registrar's Signature
..~
1"",,1 1"""1/ ,r' I
36. Dale r::ir (Month, ,y, year)
/ // /t::'/?
33c. License Number 33d, Date Signed (Month, day, year)
m 0 '!-'21 "1<;SV JL~,.n'ory /I 1-1,
34. Name and Address of Person Who Completed Cause ol Death (l1em 27) Type! Prim
r-J"m......,....'. V. t+Z'!.Jd.'I?qt
'3"( <;G "~'ndle Ko c>.l1
C" 1-n'1I /h, '10 l\
2<.'" 7
ni.."^,,iti^1'I P"rmit Nn
of 7S'5"O'<-,
JEct6t JIltll ctttb Qrt6tctUttttt
OF
DOROTHY E. EBELING
I, DOROTHY E. EBELING, of New Cumberland, Cumberland County, Pennsylvania, do
ake, publish and declare this to be my Last Will and Testament, hereby revoking and making
'oid any and all fOimer Wilis made by me.
ARTICLE I
-----
r.,)
7;'
I direct that all my legal debts and funeral expenses including my graveni~rker ana all
'.. ':"l '';'~'
xpenses of my last illness that my Executrix is obligated to pay, shall be paid from my resi<iuary
c=.'
state as soon as practicable after my decease as a part of the expense of the administration of
y estate.
ARTICLE \I
I direct my Executrix to pay all inheritance, transfer, estate and similar taxes (including
nterest and penalties) assessed or payable by reason of my death on any property or interest in
roperty which is included in my estate for the purpose of computing taxes. My Executrix shall
ot require any beneficiary to reimburse my estate for taxes paid on property passing under the
erms of this Will or otherwise.
ARTICLE III
I bequeath my automobile, household and personal effects and other tangible property of
like nature (not including cash and securities) together with any existing insurance thereon, to
y children, RICHARD A. EBELING, DOREEN E. EBY and EDWARD A. EBELING, to be divided
between them by my Executrix in as nearly equal shares as practical.
ARTICLE IV
I give, devise and bequeath all the rest, residue and remainder of my estate of every
nature and wherever situate to my three children, RICHARD A. EBELING, DOREEN E. EBY and
EDWARD A. EBELING, in equal shares. Should any such child predecease me, then his or her
share shall pass per stirpes to any issue of that child in equal shares. If my predeceased child
has no living issue, the portion of my estate otherwise reserved for that child shall be divided
equally among my surviving children.
ARTICLE V
I nominate and appoint my daughter, DOREEN E. EBY, Executrix of this my Last Will and
Testament, and require that said Executrix serve without bond.
IN WITNESS WHEREOF, I hereunto set my hand and seal this ~ \ -~ay of ~'tS:'-'
1997.
iJ ~~. &~'-'4
Doroth E. Ebeling I
(SEAL)
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence of us, who, at her request, in her presence and in the
presence of each other have hereunto subscribed our names as witnesses.
(j)~ ~
77(;.--tDc ~f?'
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
I, DOROTHY E. EBELING, Testatrix, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as
my free and voluntary act for the purposes therein expressed.
,O~ t. &~~q.
· Dorot E. Ebeling :J
Sworn or affirmed to and acknowledged before me, by Dorothy E. Ebeling, the Testatrix,
this '~\~day of ~~ ,1997.
,-
'''-.
'~~r~ ~
Notary p~ "(S'
NOTARIAL SEAL
DIANNE LENiG. Notary Public
Lemoyne Borough Cumbarland Co.
My Commission ErairE'S Dec. 21.1997 .
___"..""~.".,,.,..._ o,_..="..."'._,.___;......-'..,....~._~'
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
:ss:
COUNTY OF CUMBERLAND
and '~'kk ~ \.k'~ the witnesses
Ing instrument, being duly qualified ac ordlng to law, do
depose and say that we were present and saw the Testatrix sign and execute the foregoing
instrument as her Last Will and Testament; that she signed willingly and that she executed it as
her free and voluntary act for the purposes therein expressed; that each of us in the hearing and
We,
sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the
Testatrix was at that time at least 18 years of age, of sound mind and under no constraint or
undue influence.
~bt~ ~
Sworn to or affirmed to and subscribed to before meby ~......~ ~ . ~ ~
and~'~ ~~ ' witnesses, this ~ \ ~ay of ~ ,199.
~ ~
~~ ~
Notary Pu ~c ~
._..~~
NOTARIAL SEAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
, ,Mx~~~mmi~~~~~:D~r:.:.~ec~~ 1997
:65528