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HomeMy WebLinkAbout02-22-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C.....-'o..t\&.-2. COUNTY, PENNSYL VANIA Estate of 1)6"" ~ n.. 1-\: \ \U File Number ~/- 02(XJg - () J CJ 5' also known as , Deceased Social Security Number ~ Petitioner(J), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) G;r' A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the f:~eCl4.~ last Will of the Decedent dated J",,''1 1 S I ,""'i t. and codicil(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 bom 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: :-._....,;"'1 '.::':"' ~~._- ) c::"';' o B. Grant of Letters of Administration;: (l :::; (lfapplicable, e11ler: c.t.a.; d.b.n.c.t.a.; pende11le lite; dural1le absentia; duran4?~lOritate) ry. . . '":^j O::l Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spo~ ttfny) ~heirs:_ (If AdnlllllstratlOll, c.t.a. or d.b.n.c.t.a., enter date of Will In SectIOn A above and complete lzst of heirs.) . >< Name Relationship Residenc~ .. ~ c ""'1 (COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary. Decedent was domiciled at death in C.......'oe.t \_12 County, Pennsylvania with his / her last principal residence at Z'i!>~ c:c",4w...l ..~, C~ ~aq~_. C_~\~C~ (List street address, towl/lcity. township, county, state, zip code) Decedent, then 84 years of age, died on J,..,. I~Z.,oB at ~. ~ ~:.:.\:. \.\o~'P;.t..\ I Eo. ~..."., bw. \' "'~ I yb. Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania -0 - $ $ $ $ ---0 - 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: C 1-/ Signature Ty ed or rinted name and residence J~c: H . \)o..u~ 341 ,./.It:'-\ Jo1tJw....&;", 'R.~.e Jlew,,;\I~1 PA \12.4\ Form RW-02 rev. 10.13.06 Page 1 0[2 Oath of Personal Representative COMMONWEAL TH OF PENNSYLVANIA ss COUNTY OF ClA."",b..A~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con.ect to the best of the knowledge and beliefofPetitioner(s) and that, as perso 1 representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Signature of Personal Representative Signature of Personal Representative File Number: ~ / 'uloOf - 0/95 , ') :;:0 . -~C) ,~ ~-=- -n :L. Date of Death: od\4b.oot; .r:::- AND NOW, b2 ,~8 , in consideration of the foregoing Petition, satisfaclny proof having been presented before me, IT I ECREED that Letters le~~-,-.b,..1 are hereby granted to ~d.h-e,\ n. 1>~~ Estate of "D",;~ J-1. f1; Ilu :_,; ?;i:l P-I OJ r''') N , DeceagiQi,.:.-:: ;,_,";';1 in the above estate and that the instrument(s) dated J",,\'1 15. '1t1'i t.. described in the Petition be admitted to probate and filed of rec IS. 00 la.co Of at) ~y FEES Letters ~ 41, ~~ Attomey Signature: Short Certificate(s) . . . . . . . . Renunclation(s) .......... $ =-W...~ -~$ $ .. . $ $ $ $ ... $ cf TOTAL .............. $!::) , (J.J Attomey Name: 0', cul(:.r Supreme Court I.D. No.: 441'11 UH3 ,J. 5<<t)~ Q ~ . .\.-\w-, ~ ~ b ~-.J \?A 11 ,,0 Address: Telephone: h \1 \ 1..\ ~ - (..1.53 Form RW-IJ2 rev 10.13.06 Page 2 of2 HI()5.~1l5 REV r01107) os-tqS LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14120354 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. ~ J1; ~'". JiN 17/z008 Local Registrar Date Issued ::0 'J] ~) r~',,' c::~ C..;:;:l c.3 -~; r'"~ c;o r-) N '.1 -n .1;.- co iEV 1112006 PRINT IN rANENT ~KrNK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) I. Name"_(fi>sI,_,lasI,suffix) Doris M. 5. Age (Last Birthday) Un<ler 1 Miller 6. Dale 01 BIrth (Month. da , year) 84 Vrs. January 15, 1923 Williams town , PA ad, Facility Name (If no! institution, give street and number) 8b. Coonly .. Dea.h Dauphin Harrisburg Harrisburg Hospital 13. Decedent's Education (Specify only highest grade completed) Elementary I Secondary (0-12) College (1-4 or 5+) 12 12. Was Decedent ever in the U.S. Armed Forces? Dves IKINo Decedent's Aclual Resider1C9 17;l.. Stale most of work' lile. Do nol slale retired Kind of Business/Industry Secretar Clerical 16. Oecedenfs Mailing Address (Slreet, city flown, state, zip code) 2830 Central Avenue Camp Hill, PA 17011 18. Father's Name (First, middle, Iasl, suffix) Frank Shuttlesworth Pennsylvania Cumberland 170. Co<mty o NursimJ Home 0 Residence 9. Was Decedent of Hispanic Origin? KI No 0 Yes (If yes, specify Cuban, Mexican, Puerto Rican, etc.) DOl"'" 0 Specil'f. 10. Race: American Indian, Black, White, etc. (Spec;fy\ white 14. Marital 8mtus: Married, Nevel Married, Widowed, Divorced (Specify) Married Charles R. Miller Did Decedenl Livalna Township? 17c. 0 Yes, Decedent Lived in l7d. KJ No, Decedent Uved within I\ctual limits 01 Twp. Camp Hill City I Bore 20a. Informant's Name (Type I Prlnt) 19. Molher's Name (First, middle, maiden sumame) Sadie M. Fry 201:1. Informant's Mailing Address (Street, city I town, state, zip code) 2830 Central Avenue, Camp Hill, PA 17011 21e. Place 01 Oisposltion {Name 01 cemetery, crematory or other place} Rolling Green Cemetery 21d. Location (City ftown, stale, zip code) Lower Allen Twp.,PA 17011 22c. Name and Address of Facility Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 ~~~A:~n~S: ~1\~se~ ..., ,', a ( (It rr\ltct L Due: to (or as a consequence yt): b L C' ( 6 lila..,." '1 Due to {or as a coosequence of): ) g. ("'< c;+ A 1 ,~ ('1 j)( ~c....-,..L \ Sequentially list conditions, if any, ~~:o':~~~~r~ a. (disease or injury lt1at iniliatedthe events resulting In death) LAST. Que. to ler as a consequence 01): 3Oa. Was an Autopsy Performed? JOb. Were Autopsy findings Availclble Prior to Completion of Cause 01 Death? DYes ci'NO 32d, Time of Injuty 31. Manner of Dealh o Na\\JJal 0 HomIcide o Accident 0 Pending Investigation o Suicide 0 Could Not be Detennined Dyes ,. No M. : RegiStrar's S' a re and DiStrir.~ ~ O?I II ~I / 1 /1 Disposilion Permit No. r-X-' n ."*. ,'.z, q 23b, License Number. 2:k. Date Signed (Month, day, year) fLy;. (;'() r..rt; <.e (-t.... ,J,;.i \ij{L < , i S- I 'z c;.(;'S 26. Was Case Referred to Medical Examiner I Coroner 10f a Reason Other man tema~on or Donation? Dves )&NO Part II: Enler other smificant conditions contribtJlina 10 death. but not resulting in me underlying cause given in Parll. 28. Did Tobacco Use Contribute to Dea.th? DVes DProbably D No Unknown 9. If Female' o Nol pregnant within past year o Pregnant at lime of dealh o Not pregnant, bot pregnant within 42 da.ys o/death o Not pregnant, bul pregnant 43 days 10 1 year before death o Unknown it pregnant within the past year 32c. Place 01 Injury: Home, Farm, Street, Facloty, Office Building, elc. (Specify) <rv.t.. 'S~'( l2u {I(.& DI'seG C'hcS.l-\ 9'> ~ rll~.zt rI h .~j; 1--: t"l ((",of-lei\. 32g. Location of lnilJl'f {Sl~t. ~ I lemn, slale} /(j D~ - Jq S \=:CE r ~~ I -..,': IIPOUll OO'ellll Last 9Jl~~ ..A~d TestQM.e~tU3 FEG 22 Pr; 4: \ 8 of Doris M. Miller o CP\ /"v'n, ,'-,.';"'" :V11IRT ,",,:;-<,;-;,:\. \j\...JJ ,i ,~ ,I ,..... I, Doris M. Miller, a resident of Camp Hill, Pennsylvania, being of sound and disposing mind and memory and over the age of eighteen years, do hereby declare this to be my Last Will and Testament and I expressly revoke all Wills, including codicils, heretofore made by me. ARTICLE I 1.1 I hereby declare that at the time of making this Last Will and Testament that I am married to Charles R. Miller. 1.2 I declare that I have the below listed children at this time: Joanne L. Fedora ARTICLE II 2.1 I declare the entire residue of my estate be distributed to the Trustee(s) then in office under that trust designated as "The Charles and Doris Miller Living Trust" established ]"V 1 i _ ~ S 1~ (., , of which I am a grantor. I direct that the residue of my estate shall be added to, administered, and distributed as part of that trust, according to the terms of the trust and any amendment made to it before my death. To the extent permitted by law, it is not my intent to create a separate trust by this will or to subject the trust or the property added to it by this will to the jurisdiction of the probate court. 2.2 I hereby direct that my Executor or my Trustee(s) may elect to: (1) use administrative expenses as deductions either for estate tax purposes or income tax purposes; and (2) to use either date of death values or optional values for estate tax purposes, regardless of the effect thereof on any of the interests under this Will. 2.3 I further direct that my Executor or Trustee(s) shall not be required to pay any debt in advance of the due date thereof, including installment obligations, but instead may pay the same in installments as each installment comes due. However if the Trustee(s) deems it to the advantage of the estate any or all debts may be paid in advance of their required installments. 2.4 I stipulate that any asset under litigation, lien, or claim that might cause the assets of the aforementioned Trust to be compromised in any fashion, be held separate from the said Trust until it is free of any claim or threat to the integrity of the Trust. ARTICLE III 3.1 If the disposition in Article 11, above, is inoperative or is invalid for any reason, or if the trust referred to in Article 11 above, fails or is revoked, I incorporate herein by reference, the terms of that trust, as if executed on this date, without giving effect to any amendments made subsequently, and I bequeath and devise the residue of my estate to the Trustee(s) named in the trust as Trustee(s), to be held, S;gn'd~ t/Jr,. ~ Pag' 1 administered, and distributed as provided in that instrument. ARTICLE IV 4.1 I do hereby nominate the following individual(s) as the Executor(s) of this Will, to serve in the order listed: Charles R. Miller, Jeffrey M. Dows. 4.2 The Executor shall have full power and authority to carry out the provisions of the Will, including the power to manage and operate during the probate of my estate any property and any business belonging to my estate. However, the Executor should not compromise the referenced trust in any fashion by premature transfer of assets that may carry any claim or litigation into the Trust. 4.3 The Executor or Trustee(s) shall serve without bond. However, in the event that one (1) or more bonds are required for one (1) or more such individuals, in their capacities as Executors hereunder, then I request that such bonds be nominal bonds, and, my Executor shall pay any such bond premiums, as bonds premiums are due, as administration expenses of my estate, until the administration of my estate is completed. s;gn<dL (/,Ih, Q?;... tlPl.J Pag,2 IN WITNESS WHEREOF, I have hereunto subscribed my name to this document, my last Will and Testament, which consists of three (3) typewritten pages, and for the purpose of identification, I have initialed or signed each page, all in the presence of the persons who are witnessing, at my request, the execution of this, my last Will an~Testament on this 2.. 5 day of :;.J) f ' 19~, at (l--r f.h' \ \ , t'" Q.... . (~~1w Doris M. Miller Certificate of Acknowledgement of Notary Public Commonwealth of Pennsylvania) :ss. County of Cumberland ) On this 2.S day of :::r U\ i ' A.D. 19~, appeared before me Doris M. Miller personally known to me (or proved to me on the basis of satisfactory evidence) to be the person whose name is subscribed in this instrument, and acknowledged that he/she executed it. )lj~ Notary Public My Commission Expires Residing in Notarial Seal Nort~~~~'t:i ~bertc' Notary Public M C ' p., umber/and County Y ommlssion Expires May 8, 2000 NOTARY SEAL: Signed o!J~ c:J:?J. ~page 3 ATTESTATION The foregoing instrument, which consists ofthree (3) typewritten pages, was signed, sealed, published, and declared by Doris M. Miller, the testator, to be the testator's last Will and Testament, in our presence, and we, at the testator's request and in the presence of each other, have hereunto subscribed our names as witnesses, this 2 S day of .:Ju\ i ' 19~, at C'~ ^ H, I , ~ , r 0-.. . WJtJ, ';/' -@~ (Witness Signature) b~~ L~cor' 0 (Print Name) 1.?1' ('elf'-~ lAve.. (Address) 7f,~9' Date (City, State, Zip Code) (Witness Signature) ?:&~h;;; Date T. (' ... '" e l(:) In!? l I (Print Name) 3oo~ ~n \e Ave. C'-\f \-4"\ \ \ Pc... "~ l \ (Address) (City, State, Zip Code) Signed ~~,~page 4 ACKNOWLEDGEMENT OF THE EXECUTION OF THE LAST WILL AND TESTAMENT OF Doris M. Miller We, whose names are signed below, each declare under penalties of perjury: that Doris M. Miller, the testator, executed the foregoing instrument as the testator's last will and testament; that in our presence, the testator signed the testator's signature and declared that such signing was the testator's free and voluntary act for the purpose of executing the testator's last will and testament; that each of the Witnesses thereto,in the presence of the testator (and at the testator's request) and in the presence of each other, signed such instrument which the testator stated to be the testator's last will and testament; and, to the best of our knowledge, the testator was, at the time of the testator's signing and at the time of the signing of the witnesses, eighteen (18) or more years of age and of sound mind. ~~an~ Doris M. Miller ~/~S/l9 qc. w.u:#,:;t ~o- (Witness Signature) ~~ l. \)r-ocop L u (Print Name) '47 l' (' ., II\. ~C&.. , A II e.. (Address) C--r; I-l-;", e... \ '7.. \ I , . (City, Slale, Zip Code) "=~ P (Witness Signature) :r:: ('@ ~ l Q ..,. ~ l \ (Print Name) 300 g '1 CL \ -e. A ve.. (Address) C ^"-f \-h"\ \, .p - \ '10 l \ (City, State, Zip Code) ?/~9' Date ~hb , .r Date Signed ~~.~ Page 5 ,.. )2' r'.1 I ~ [' n ll: I 9 OATH OF SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~/- ~?(jJ6D\ ~ <) Estate of Doris M. Miller , Deceased Beth L. Procopio and Irene Lovell , (each) a subscribing witness to (Print Namels) the IZIWill 0 Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were present and saw the above Testator / Testatrix sign the same and that she / he / they signed the same and that she / he / they signed as a witness at the request of thl~ Testator / Testatrix III her / his presence and in the presence of each other. ~;;L~ LL~ (Signature) 2817 Central Avenue (Street Address) 435 Bethany Drive (Street Address) Camp Hill, Pennsylvania 17011 (City, State. Zip) Mechanicsburg, Pennsylvania 17055 (City, State, Zip) b~:fore me this of day Executed out of Register's Office Sworn to or affirmed and subscribed before me this c:fl[) /ld dal of !f~ ' ~OOtf. tJ?~ It ~ Notary Public V My Commission Expires: (Signature and Seal of Notary or other official quaiified to administer oaths, Show date of expiration of Notary's Commission.) ElCecuted in Register's Office Sworn to or affirmed and subscribed Deputy for Register of Wills NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy ofinstrument(s) at time of notarization. COMMONWEALTH OF PENNSYLVANIA I Notarial Seal .Rhonda L: Lang. Notary Public CIty ofH~rr~sburg. Dauphin COllllty My CommiSSion Expires Aug 9.2008 Form RW-03 rev. 10.13.06