HomeMy WebLinkAbout10-18-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
, Deceased
File Number Z 1-0'\ - q J..-t()
Social Security Number 1-1 "l- - L...(O - S '-7 )'
Estate of /'11/~~O
,0
/I"l. ENl/>
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
d A: Pcob"",d G",tof uti"" T "'1m,"",> ,ru""m ""~ p,titi,n",) j, I = th, "" u ,,.-1-. ~ f
last Will of the Decedent dated Cflz.. LL t!J :7 and COdlCll(s) dated
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 instmment(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; ,cfzlrante minorita@5
'..) c=
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the followf~~~use (ifa~ and heirs: flf
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
R"r ~
C)
0,
Decedent, then ? 0
years of age, died on /0/(,,/0 7 at
12...2-0 r'",?
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 PAl Personal property in County
Value of real estate in Pennsylvania
$ /ooa.oo
$
$
$
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:
Ty ed or rinted name and residence
m
F LO '1(J c.... /L1 C I2-12-IS
At cL VAt Il... ISd Wr ~f
Form RW-02 rev. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affim1(s) that the statements in the foregoing Petition are hue and conect to the best of
the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the \ '64-L...-
D:- ~~
C~D+
day of
ignature of Personal Representative
~/!:Y!;ePI~n~a~
,Qool
~C",,A,~ '0- '0.,...
\ or the Register ~ Signature of Personal Representative
c~
,. .....J
(._.~.,r
c=.
_....j
--I
-,. ~
.,-f'
File Number: c2. \ - 0\ - <1 y 0
Estate of (Yl; lei r- ~L P mern'.s
Social Security Number: Zr 2. - Z(P-<-~2}..fl
AND NOW, WO\:-:Qf \ P, ,fJo.::>"l , in consideration of the foregoing Petition, satisfactOlY proof
having been presented before me, IT IS DECREED that Letters \<2."--~\ ;:>"\'-'\EN\A~
are hereby granted to t\ njrl C 'f"('w An ~ ~ 0--.v-0L ~ ltr'D-- Q... ~O~-S
in the above estate
ro
-r)
, Dec.eased
i----j
,.J
Date of Death:
o
C"
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of recor
(
" ".
TOTAL
~.c>o
$ r-J() ~G""0
$
$
$
$
$
$
$
$
$
$
$ (0. 0u
Attomey Signature:
/1
/Jd,
r}
FEES
Letters
Short Certificate(s) . . . . . . . .
Renunciation(s) ..........
00. l\
i~cP
~~""-J.
lS--Cl~
((') . O-(=~
S _ ('in
Attol11ey Name:
Supreme Court 1.D. No.:
Address:
Telephone:
FO/'lll RW.O] rev IO.IJ06
Page 20f2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee tor this certificate, $6.00
P 13859336
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.
~ I? ~..L~OZ 6 ~ DO
Local Registrar Date Issued
OCT 0 9 Z007
c;
C:;n
REV 11/2006
I PRINT IN
~ANENT
.el< INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
CJ
1. Name 01 Oecedenl (First, middle. lasl, suffix)
Mildred P. Merris
5. Age (lasIBirthday)
13. Decedent's Education (Specify only highest grade completed)
Elementary I Secondary (0-12) College (1.4 or 5.;.)
12
6. Date of Birth (Month, day, year)
80 Yrs
8b. County 01 Death
Feb. 24. 1927 Morgan. KY
ad. Facility Name (If nollnsllMion, rJve street and number)
C1IIIIber land
1875 Holly Pike
11. Decedent's Usual Occ lion Kild of werle. done d
Kind of Wor1<
Retail
most 01 life. Do no! slale retired
Kind of Business/lnduslfy
Floral
12. Was Decedent ever in the
U.S. Armed Forces?
DYes ][]No
Oecedenfs
ActIJlI Residence 17a.Stale
. 16. Decedeot'a Mailing Address (Street, city I town, stale, zip code)
1875 Bolly Pike
Carlisle. PA 17015
f8. Father's Name (First, middle, last, suffix)
John W. Denny
201. Informant's Name (Type I Print)
Pennav1v.ni.A
Cumberl.And
19. Mother's Name (First, middle, maiden surname)
Ethel McCandless
.]b. Coon1y
3. Social Security Number
272 - 26 - 3274
O1her
o lopah.nl 0 EA I Outpaheol 0 DOA 0 Nursiog Horn. ][] A..",o" 001h8l. Speci~'
9. Was Decedent 01 Hispanic Otigin? !XI No 0 Yes 10. Race: American Indian. Black., 'WtIhe. elc.
(II yes. -"y Cubeo, (Specifyj
Max"'o. Puerto AIcaI1, etc,) White
14. Marital Status: Married, Never Married,
WIdowed. Divo_ (Specif;j
Widowed
17c.IXIYes.DecedenIUvedio South Middleton
17d. 0 No, Decedenl Uved with"
AcIual Umltsol
Twp.
City/Boro
2Ob. Inlormant's MaRing Address (Slreet, City I town, state, zip code)
1875 Boll Pike. Carlisle. PA 17015
21c. Place of Disposrtion (Name 01 cemetery, cremalol'y or other place) 21d. locabon (City !town, slate, zip code)
Cremation Society of PA Harrisburg. PA 17109
22c,NameandAddressoIFacillIy Auer Memorial Hoae and Cremation Services. Inc.
"ems 24.26 must be completed by person
who pronounces death
24. TIme or Death
/2"-2-0
CAUSE OF DEATH (See Instruction. 8nd eXlmples)
lIem 27. Part t: Enler the ~ -liseases, injuries, Of complicalions . that dir9ctIy caused Ihe death. 00 NOT enter terminal events such as cardiac arrest,
respiratory arrest, or ventricular fibrillation without showing the etiology. UBI onty one cause on each nne.
I'
M.
=~~~~d:a~\mse=
a. OuelO(~as~1lI::~f I
J../ i r f e ..., r:; N -'l\i N
Due to (.;, I. Joooseque",. of):' .
)'!\tS
Sequenllally list conditions, if any,
IeadI'Io to the cause listed on ~ne a.
Enter the UNDEALYfNQ CAUSE
~ser,se~l~~n~~rMr~
Due to (or as a consequence of)'
d.
308. Was an Autopsy
Per1om1ed?
3Ob. Were Autopsy Finclngs
Allailable Prior to Completion
01 Cause of Death?
DYes ONo
31. Manner of Death
)2'NalUrel 0--
o Accidenl 0 PO<lding lo,,",igetiorI
o Suicide 0 Could Not be Determined
M,
o Yea VNo
32d. lime of Injury
338. Certifier (chICk only one)
Certifying physician (Physician certifying cause 01 death when another physician has pronounced death and completed Item 23)
To the best of my knowledge, death occurred due 10 the cause(s) and manner as st.tad.- .. _ _ .. .... _ .... _ _ _.... _.. .. _.. _ _ .. _ _.. .. _ _.. _ :
Pronouncing and certifying physician (Physician both pronouncing dealh and certifying 10 cause 01 death)
To the best 01 my knowledge, death occurred at the time. date, and placl, and due to the caul8(s) and manner .1 11attd.. .. .. .. .. _ _ _ .. .. .. .. _ _ _ _ .... 0
Medical Examiner I Coroner
On the bOlll1 of eXlmtnation and J or investigation, In my opinion, death occurred al the time, date, and place, and due to the cause(s) and manner as stated_ 0
35. Registrar's Signatu
~
~ /1 ~ I, II
Disposition Permh No.
23tJ. license Number
23c. Date Signed (Month, day, year)
26. Was Case Referred 10 Medical Examiner / Coroner tor a Aeason Other than Cremation or Donalion?
Dyes ONo
Part II: Enter other slmIflcanl condition'!: contribulino to death, 28. Did Tobacco Use Contribute 10 Death?
bul not resulting in lhe underlying cause grven in Part r. 0 Yes 0 Probably
o No ..0'Uokoowo
29. II Femaio:
%~ pregnanlwithin past yaar
. 0 Pregnant al lime of death
o Not pregnant, but pregnanl within 42 days
of death
o Not pregnant, but pregnant 43 days to 1 year
beforedealh
o Unknown if pregnant within the past year
32c. = ~u\;:~~ ~~j Street, Factory,
32g.locationollnjury(Streel. city/town,slatel
-0
LAW OFFICES OF
STEPHEN]. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
WILL OF
MILDRED P. MERRIS
I, Mildred P. Merris, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A.
Upon my death, Melva R. Bowers will pay Floyd C.
Merris, III, % of $55,000 dollars or $27,500.00
within one year of my date of death.
B The remainder of my estate shall be divided
equally between Melva R. Bowers and Floyd C.
Merris, III. Should Melva R. Bowers predecease
me, her share shall be divided equally between
her children, Laurie B. Kennemore and Melissa
Bowers. Should Floyd C. Merris, III predecease
me, his share shall be divided equally between his
children Daniel A. Russell, Kenneth C. Crull and
Floyd C. Merris, IV.
4. I appoint Melva R. Bowers and Floyd C. Merris, III, jointly,
as Executors of this my last Will. If either Melva R.
Bowers or Floyd C. Merris, III predecease me, I appoint
the survivor as Executor.
5. The Executors of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
~$L
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
IN WITNESS W.HEREOF, I have hereunto set my hand this JL day
of Q~ ' 2003.
-~'f?~
Mildred P. Merris
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
LAW OFFICES OF
STEPHEN}. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
The preceding instrument consisting of this and two other pages
was on the day and date hereof signed, published and declared by
Mildred P. Merris, as and for her last Will in the presence of us, who at
her request, in her presence and in the presence of each other have
subscribed our names as witnesses hereto.
-~~~t(-Clfi'7 ~L J( dL/J-
W1TNESS . . 'WITNESS I
LAW OFFICES OF
STEPHEN}. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Mildred P. Merris, the testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
~i?~~
Mildred P. Merris
Sworn to or affirmed and~CknOwledge~L7'e by Mildred
P. Merris, the testatrix, this Jd.!:::. day of _ ' ,
, // /
NOTAlULRAL /01"'/:/
STEPHEN J. HOGG. NOTARY PUBLIC ./ t/ f /!
CARLISlE BORO. CUMBERLAND CO., PA .~'..
MYCOMMlS8ION EXPIRES SEPTEMBal3,ZOOfi N t P bl.
. 0 ary u I
AFFIDAVIT
State of Pennsylvania
ss
We and l-/~ ~ bl Jkrt-, the
witnesses wtiose names ar si ed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her last Will; that the testatrix signed willingly and
executed it as her free and voluntary act for the pUrpbses therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of
so d rnind and under no o~straint or ~ndue influeBc:, ^
'f '~~ f<. ~
MOrAlULIIAL
ITIPH8f oJ. tfOGG, NOTARY PU8Uc
e~ I8LE 8OAO. CUlllllER..ANo co PA
MY -1II8ION EXPN8 8EPTEU8EJI"1, 2008