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Home My WebLink About09-12-07 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND , Deceased COUNTY, PENNSYLVANIA File Number 21 ()'l ~1:? Social Security Number 195-38-9494 Estate of Vinson F. Ertz also known as Petitioner(s), who is/are 18 years of age or older, apply(ies) fo~: (COMPLETE~' 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 dlCUmstances, e.g., renundation, 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: 00 B. Grant of Letters of Administration (If eppllCable, enter: c.t.e.; d.b.n.c.t.a.; pedente lite; durante absentia; durante mlnoritate) PetitionerEs) after a proper search has I fleve ascertained that Decedent left no Will and was survived by the following lIPllYIle (if aRW aRd heirs: (If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationship ResidenCe (") v .> . -, I " ) ,I See attached schedule (COMPLETE IN ALL CASES:) Attach additional sheets if necessary..p -~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his 1.1fter last principal residence";t 660 #13 Geneva Drive, Mechanicsbur ,PA 17055 (Ust street address, town/city, township, county, state, zip code) U1 W Decedent, then 52 years of age, died on 0.9/03/2007 at IIp/, ~i('d J.lMllt~ eMt PeAft6 l>"~ 1W4fy. C lJM. h u / ~ CtftM.d'''{ Decedent at death owned property with estimated values as follows: (If domiciled in PA) 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 $ situated as follows: 90,000.00 Wheretore, Petitioner!lij respectfully request(s) U- I IIrllll'l If lAI II""." r-t <:-;....'1"(-) p.MA.,..,.... ...,.. ...;~ D.,....__ --.... the grant of Letters in the appropriate form to the undersigned: Typed or printed name and residence Stephen E. Ertz 94 Hobart Avenue Summit, NJ 07901 Form R -02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Pege1of2 REGISTER OF WILLS OF PETITION FOR PROBATE AND GRANT OF LETTERS (Continued) CUMBERLAND COUNTY, PENNSYLVANIA tr\ O~~~ File Number 21 Estate of Vinson F. Ertz also known as , Deceased Social Security Number 195-38-9494 Name . Relationship Residence Agatha R. Ertz Mother 19588 Southwest Touchmark Way #304 Bend, OR 97702 Francis J. Ertz Father 19588 Southwest Touchmark Way #304 Bend, OR 97702 Gregory J. Ertz Brother 63175 Lookout Drive Bend, OR 97701 Jeffrey P. Ertz Brother N66 W26575 Lakeview Drive Sussex, WI 53089 Kathleen M. I!!Tt2: 7lIA..SS<'-rLl/tl Sister 6219 North Hogahn Circle Paradise Valley, AZ 85253 Stephen E. Ertz Brother 94 Hobart Avenue Summit, NJ 17901 ;........, :"J ;-11 ~J ^ (-)n ".~).:~::I ~ ~..: ~-' --j J> <.::;:. --.J C/:; ,-; ~ -u f',.) --, U1 W -.. ) COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Oath of Personal Representative } 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 of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. before me this day of Sworn to or affirmed and subscribed Signature of Personal Representative Signature of Personal Representative File Number: 21 t)"1 <{) S '? Estate of Vinson F. Ertz , Deceased Social Security Number: 195-38-9494 Date of Death: 09/03/2007 AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration r~'-o-) '_. '-J '-- are hereby granted to ::;; Cj --.l . :;:' {/1 : "-:j In the ::l!1nve eState" -, J )..." , .:':h. ~. - .-^..- ,. - {'~ _.~;,.. , /"',- i"V and that the instrument(s) dated described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent. \,), <...n ,; W ~ \000 :J860 cJSD() /~OD ~O 00 soO ~ .C~~ Richard E. Connell, Esquire Attorney Signature: Attorney Name: Supreme Court I.D. No.: 21542 Address: Ball, Murren & Connell 2303 Market Street Camp Hill, PA 17011 Telephone: 717/232-8731 TOTAL.................................... $ ~030 iJ Form RW-02 Rev. 10-13-2006 Copyright (cl 2006 form software only The Leckner Group, Inc, Page 2 of2 H105.805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Certification Number 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. P 13858043 thn- /J; ~. Local Regist~ c:; 0 (/) c" -::0 p, J -u 0 -.:; ~S; 13 1') (f) 7""'" "('-)(~ ) C) -T1 \;--. c:: '~J :!~ :;.' SEP/l,O ?C07 Pate, ~ssued , -Q .-,',.. -- ,'1 ".J c..n w lE\ll1l2OO6 'RINT IN ANENT :KINK 1131-084 1. Nameol_(Ars!, _, ~.llUllIx) Vinson 5. Agt(LaslBlltt1day) COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Instructions and axampleS on reverse) 52 March 4, 1955 Harrisburg, PA 3. SodaJ Security Number q5 -::/0 - g/fC) Sa. Plac:e 01 DeaIl1 I~ one) HospItaJ: Olhet: o Inpatient D!:I ER 1 OutpatIent O!lOA 0 Nli110lg Home 0 Residence 9. Was llocedont 01 Hispanic Origin? E9 No 0 Y.. In yea, specify Cuban, Mox'<an, Puerto RM:an, etc.) 13. Decodonl', EduCation ISpoc;fy on~ highest grade completed) 14. Marilal SIalus: Maniod, NeYer Maniod, Elementary 1 5eoonda1y 10-12) College (1-4 or 5+) W_, Divon:ed {Spec;ryl 12 Never Married Did Docedent LWein a Township? STATE FILE NUMBER ~\ Q\ t<t~~ Francis Ertz 6. Data 01 Blr1h (Month, 4. Data 01 Dealh IMonth, day, year) September 3, 2007 Yrs. ,- 7. Birlf'4>lace ICily anc!..... or Holy Spirit Hospital OOlher. Spoc;fy: 10. Raco:_ _. Blecl<, White, etc. 1Spec;ryl Bb. Coun~ 01 Death Cumberland &d. FKRy Name (It not_, giYe ~l1Oland_) white 11.Oecedent'sUsuaI most 01 IIle.Donotstate KiMelWar'< KiM 01_' Indus1ry Operator Communications 16.Docodent"MaiIIrol_{StI08t,cily/town"taIe,zip_) 660-13 Geneva Drive Mechanicsburg, PA 17055 18. Father's Name (Rrsl, mIdcIe, last, suffix) Francis J. Ertz 12. Was Decedent ever in !he U.S. Armed Foroes? DYes ~No Decedenrs Actual Rosidence 17'.5ta1e 17b. County Pennsylvania Cumberland 17c. rn Y",DocodentlOedln 170. 0 No, _ LOed wllhln ActuetLmlsol Lower Allen Twp. Cily 1 Boro 208, Inklnnant's Name {Type I Print) Francis J. Ertz 21.. MoIhodelDisposiIion I ~Cremalion OOonation , 0 Burial 0 Remov,1 tram Stale ; Was CremaIion or Donetion A_ D OtI'er.SpeciIy: ; by_e-Jner/c-? 22.. (or peBOI1lleling es ouch) ~ ~ COI\1ll8le 23a-c oriy .... cecilying physician is not avaiable at lime at death 10 certilycauseeldaalh. homo 24-26 must be """"""" by porsor wIloplOl\CllllC8l_. 19. lAolher'. Name IArs1. _, _surname) Agatha R. Ruoff 2OI>.ln_ MeillngAdd....IStI08t. cily I town, ....., zip-I 19855 SW Touchmark Way, 21c. Place of Dispo6Ition (Name of cemetery, crematory 0( other place) Apt. 304, Bend, OR 97702 210. location ICily 1 town, state. "P_I chaefferstown, PA 17088 FH & CS Inc. P.O. Box 23b. LIcense_ 24. Time of Death 1 :00 25. Data Pronounced Daad (Month, day, yearl P. M. September 3, 2007 ljlf.Y.. O'No 311>. W... "'- Frdngs A__toe-. 01 Cause 01 Oealh? -g,y.. 0 No 31. Mamer 01 Dealh ~ D- O- OP~1IMlStigelion o Suicide 0 CoUd Not be DeIe<mlned 26: Was Case Referred to Medical Examiner f Coroner tor a Fleason Other than Cremation or Donation? ~Yes ONo Approximata inteNal: PIII1I1: Enter _....-. anIllon!l_to daall1, 26. Did Tobea:o Use eon_eto Oealh? Onset to Oealh butnotreoultinglntheundellyllgcausegivenlnPartI. 0 Yes OProllebly o No 0 Unknown 29.IIFamM: o Notprognantwllhinpaslyear o Pragnentattimaoldaalh o Not prognant, but p,eg"ml wllhln 42 deys ol_ D Not _nt, but preg180t 43 days I. 1 yea, bokn _ o Unk-. n pregnant _ the pes' yea, 32<:. P1ece ellIjury: Home, F'"", StI08t, Factory. ()IIlco1loidng,alc.($pecIIy) CAUSE OF OEATH (See lnatrucllono and oumpleo) )tern 27. Part t Enter the ~ - dseases, injuries, 01' complications -1hI1 drIctIyClUlMd thedHth. DO NOT tntif' termnal events such as cardac arrest, respirat<<y BIT88L, orV'lll'lltlctJer fbrilIBIIon wIIhoul:showing the etiology. Ustonly one cause on each line. ~~=--: a. Atherosclerotic Cardiovascular Disease Due 10 {or as aconseqtllf'lC8 of): _1sI...-.s. n '''Y, IeecingtohC8Uleisledon\inea. Enter IN UNDERlYING CAUSE =-~~~nrmr b. Due to 'Of as a consequi8nCI 01): c. Due to (or as a consequence 01): d. 308. Wes an "'- - 321.IIT.._InjUry(SpeciIy) ODriYer/Ope<B1orOPassengerOP_ Olher . Specify. 330. Certifier (check on~ one) 33b. Slgnetu.. anc! ::::,==~=:::'''::lI1l11O~'''':'ancl,"=h:~_ ~:_~~ ~~ ~ ___ _ _ __ _ _ _ _ _ _ _ ___ 0 ~ Coroner Pn>oouncIng and cetlIlyIng phyoIc1en (PhysM;en boCh proIlIlUIlCing _ end cerlilying to cause 01 dealh) 33<. l<ensa Number 330. Dele Signed (Monlh, dey, veer) TOll1Obootolmyknowledgt.__..lI1O_,cIoto,andP*O.anclcluo..""'..UM(.)and..................____------------- 0 S b 4, 2007 _E.-/Coronor Iv( eptem er Onlhe_ ol_ and/orlnveellption, in my opinion, - - ..thetlme, Oala, and pIoce.endcluotolhe ceuae(')end ....nor.. stated.. \Cl. ~'H'm~,:"",~~;e"'t"b~~F Type/Pm! 35.RegiI and ..::I / .". / / 36.Da1e 1MD1,day,yean 6375 Basehore Roadl Suite 111 ~ I V"I I I 1 I 9 7/t:' 7 Mechanicsburg, PA 7050 [);sposllion Parmi! No. ~'1 (') ~ce) 32<1. Tme oIlnju~ 329.locationollnju~(StI08t,cily/t"""""tel M. RENUNCIATION ~ \ Qt ~~'S REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Vinson F. Ertz , Deceased I, Agatha R. Ertz ,in my relationship as (Print Name) Mother of the above Decedent, hereby renounce,1!:le right to administer the Estate of the Decedent and respectfully request that Letters be issued to () '~~ ~:-1 -T'() X::r-; ...::..-~....".,," " C I) 0;::': (~C) r:~) -ii c...:.;> -.j Stephen E. Ertz (/) r'1 -u N v (Date) 9 II;;"! 01 , ~ ~~-~ (Signature) Agathcf R. Ertz . "I1 "7) -.j (j "' c.n w /9 SS'J' J~tiw~ -;-7;;;.cI>>tark ~it SOli- (Street Address) IJe It" 0 Ii' 9' 7 7tJ 2- (City, State, Zip) ) Executed in Register's Office Sworn to or affirmed and subscribed before me thi~ of day Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunci~ion for the purpo stated within on this /~.. day of ~ 007 . ~.,tI.1/ Deputy for Register of Wills (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTARIAL SEAL GLORIA J. COPPfRSt~1TH, No".lry Public Clmp Hili 801"0, Cumberland COl.mty My Commission expires June 21, 2011 Form RW.06 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. ~\ Gt<i~) RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Vinson F. Ertz , Deceased I, Francis J. Ertz ,in my relationship as Father of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to o c;o .' ~jJ --;:] -,-0 "-; F;::; . ""'.".~ =-;..J [rl-'~ ',' .......". I'-..J ':::::::' <= -..J (/) p, V Stephen E. Ertz N 9//;1. /07 . (Date) - / q S ~y Sovtlwe.sT /'vc-IIt/tt.l'kl/J4y:d JtJf/. (Street Address) tJeJ. O~ , f770;Z (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me thi~ of day Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renun~tion for the pur e stated within on this I~ - day of ~ Deputy for Register of Wills (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTARIAL SEAL GLORIA J. COPPERSMITH, Notary Public Camp Hili Boro, CUmberland COUnty My Commission ExpII'II June 21, 2011 Form RW-06 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. RENUNCIATION d. \ 6\ O~~l, REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Vinson F. Ertz , Deceased I, Gregory J. Ertz ,in my relationship as (Print Name) Brother of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to r" (Date) 9/!'?/b1 , JI C) S:;O :j;g ! ::r C) J ~l:'-pr- '7fTl ;:.>;5: <= --.J Stephen E. Ertz (/) f11 U .~--~ (Signature) ~ 3/7.:) J.i>lJki>u:f /Jrit'<" (Street Address) &nJ ()~ 9770/ (City, State, Zip) ) Executed in Register's Office Sworn to or affirmed and subscribed before me thi~ of day Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renun1i!tion for the purp stated within on this I~ - day ~ 02.(}0 ~ .t:2./-/1 Deputy for Register of Wills (Signature and seal of Notary or other official qualified to "h"", nAle of eXDiration of Notarv's commission.) NOTARIAL SEAL GLORIA J. COPPERSMITH, Notary Public Camp Hili 80m, Cumberland County My Commission expires June 21, 2011 Form RW-06 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lacl<ner Group, Inc. RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Vinson F. Ertz I, Jeffrey P. Ertz ,in my relationship as (Print Name) '.l \ 0\ G<(,;:' , Deceased of the above Decedent, hereby renounce the right to Brother administer the Estate of the Decedent and respectfully request that Letters be issued to o c:: -0.0 :::0 -rl :::to J:;: r=;:; ,:>:S:J Stephen E. Ertz '7//:</01 ~,9~E~s1~ (Date) r",...,,) c::.;: = --' (/) Pl -0 N -0 -H" c...'l (....;) AI~6 to d6SJ.j-- J..~4vlW)j)T'. (Street Address) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renul'\C~ion for the pur es stated within on this /,(..... day of S.tJs~ex . to! , .53039 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me thi!': of day Deputy for Register of Wills (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) NOTAAIAL SEAL GLORIA J. COPPERSMITH, Notary Public Clmp Hili 8oro, Cumberland County My CommIssion expires June 21, 2011 Fonn RW-06 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. RENUNCIATION ~ \ <1.1 (f(,1,3 REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Vinson F. Ertz , Deceased I, Kathleen M. Ertz - r1lrt551t~f\tJO (Print Name) ,in my relationship as Stephen E. Ertz Sister 9//;1./D7 (Date) ~:< /9 l/or-rA ,J/p~dnC",!e (Street Address) "",..,.!,arr..ctse i{~,4z R.5:?-,3 before me thi~ of day Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renu,~ion for the purp stated within on this / - day of I~'. ~~:l/-/I Executed in Register's Office Sworn to or affirmed and subscribed Deputy for Register of Wills (Signature and seal of Notery or other offiCial qualified to administer oaths. Show date of expiration of Notary's commission.) NOTARIAL SEAL GLORIA J. COPPEP..si~1TH, Not.ary Public Camp Hili Boro, Cumberland County My Commission expires June 21, 2011 Form RW-06 Rev. 10-13-2006 Copyright (cl 2006 form software only The Lackner Group, Inc.