HomeMy WebLinkAbout05-30-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Ira C Mellinger Jr. File Number 21--
also known as
,Deceased Social Security Number 208-24-2145
Malcolm W. Hommer
Petitioner(s), who islare 18 years of age or older, apply(ies) for:
(COMPLETE A' or 'B' BELOW.•)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the
fast Will of the Decedent, dated and codicil(s) dated
State 2levant circumstances, e.g., n:nunciation, 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:
QX B. Grant of Letters of Administration
app rca e, enter. c.t.a.; ..n.c.t.a.; pe me rte; uran e a senGa; u2nte rrunontate
Petitioner(sj after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if anyj and heirs: (lf
Administration, c.t.a. ord.b.n.c.f.a., enter date of Will in Section A above and complete list ofheirs.)
Name Relationship Residence
Malcolm W. Hommer Grand Nephew 83 Magnolia Drive r~,,
Levittown, PA 19054
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(COMPLETE IN ALL CASES.) Attach additional sheets if necessary. -' <-? C> "~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal reside r ~
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409 S. Enola Drive, Enola, Cumberland, PA 17025 ~?-
(List street address, town/city, township, county, state, zip code)
Decedent, then 7$ years of age, died on 05/03/2008 at Camp Hill, Cumberland County, Pennsylvania
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA}
Value of teat estate in Pennsylvania
All personal property
Personal property in Pennsylvania
Personal property in County
17,000.00
100,000.00
situated as follows: 409 S. Enola Drive, Enola, Pennsylvania and Total $117,000.00
30 South Front Street, Wormleysburg, Pennsylvania
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:
Typed or printed name and
~~ U~ ~ Malcolm W. Hommer 83 Magnolia Drive
} Levittown, PA 19054
Form KW-02 Rev. 1413-2006
Copyright (c) 2006 form software only Tha Lackner Group, Inc.
Page 1 of 2
oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
couNTY of Cumberland }
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.
~~
Sworn to or affirmed and subscribed i
~~-{~ Signature of Persona/Representative Malcolm W. Hommer
before me this ~ll "'~ day of
Signature of Personal Representative
Signature of Personal Representative
File Number.
Estate of Ira C Mellinger Jr.
A/K,'A
Socia! Security Numbar.
208-24-2145 Date of Death: 05/03/2008
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Ma1COlm W. Hommer
in the above estate
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.
FEES
Letters .................................. .......... $ 260.00
Short Certificate(s) ............... ......... $ 20.00
Renunciation(s) .................... ......... $
JCP fee $ 10.00
Automation fee $ 5.00
$
$
$
$
$
$
TOTAL ........................... ......... $ 295.00
Register of calls
Attomey Signature: C
Attomey Name: Christian S. Daghir
Supreme Court I.D. No.: 06398
Etzweiler and Associates
Address: 105 North Front Street
Deceased
Harrisburg, PA 17101
Telephone: (717) 234-5600
21--
Form f2tN U2 Rev. 10-13-2006 Copyright (c) 2006 form software onty The Lackner Group, Inc. Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fee f11r this certificate. `~(~.Ittl
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CertificLa~tion '.~umher ~~
TIYi~ i~ to ccrlily that (hc into)-Iratir.~n h~~r.~ given is
correctly copied from an ori~~inul Cetif~c~t:: of Death
dulti tiled ~~~ith n)e as Local Re~ish~ar. "ChB original
certificate will he forte°urded jo the 'irate Vital
Rcrurd~ OI~ticc fur pcrlnanent tiling.
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REV ltrmo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN
xANENT CERTIFICATE OF DEATH
cK INK (See instructions and examples on reverse)
STATE FILE NUMBER
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1. Name a Decedent (first, mitltlle, IasL sumx) 2. Sex 3. Social Security Number 4. Dale of Death (Month, day, year)
Ira C. Mellinger Jr. Male 208 - 24 - 2145 May 3, 2008
5. Age (Lass Birthday) Under 1 year Under 1 day 6. Dale of 8idh (Month, tlay, year) 7. Birthplace (City and slate or foreign taunt j ga. PWce of Death (Check only one)
MonIIM Days Hars Mlnulex H
pital: Other'.
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7 8 yrs. h / 2 8 / 19 2 9 Harrisburg , P A <7y Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Residence ^Other -Specify:
Bb. County of DeaM Bc. qty, Boro, Twp. of Death Bd. Facility Name (II cwt inslihdpn, give sireal and number) 9. Was Decedent of Hispanic Origin? [~ No ^Ves 10. Race: Amerkan Indian. Black, White, etc.
Cumberland East Pennsboro Tw
p• Hol S irit Hos ital
Y P P (Il yes, speciry Cuban,
Mexican, Puerto Rican, arc) (Specify)
x"1171 t o
11. Decedent's Usual Occu lion Kind a work d one d un rtwsl of wpkl rile. Do nor state retired 12. Was Decetlenl ever in the 13. Decedent's Education (Specify Doty highest grade comp leletl) f 4. Marital Slalus Marnad Never Married, 1 g. Surviving Spo use pf wile, give maiden name.)
Kill a WorN
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b Kind a Bus l Industry
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C US. Armetl Fomes? Elementary /Secondary (P12)
12 College (1-0 or 5+) Widowed Divorced (Specify)
Never Married
orer
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16. Decedents MaNing Address (Strcel, city /town, state, zip code) Decedent's pA Did Decedem East P e nn s b o r o
te Uve in a n
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17b. County Adual Limits of city I Born
18. Father's Name (First mitltlle, last, suffix) 19. Maher's Noma (First, middle, maiden surname)
Ira C. Mellinger Sr. Bessie Miller
20a. Inlorrnant's Nartw (Type I Pnnp 2W. InlormanYs Mailing Address (Street, city I lawn, state, zip cone)
Mar Lou Brandt 337 Maple Lane Carlisle PA 17015
21a. Memod of Disposition i ^ Cremation ^ Donation 27 b. Date of DlspoSNW (Month, tlay, yeaQ 21c. Place of DisppNbn (Name of cemetery, crematory or other place) 27 d. Location (Gry I Town, state, ip code)
~] Banal ^ RemoeaitromSlale jwsscrematbnorDOnagonApmortzea 2008
Ma 9
Y Rollin Green Cemeter
g y Lower Allen Tw PA 17011
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^ Omer ~ Speay: i by McGCeI Examiner 1 Coroner? ^Ves ^ No ,
22a. Signanxe a Funeral Seryice Licereee (or person aaing as such) 22b. License Number 22c. Name and Address of Fadliry
~ ~-may,/~ FD 012774-L Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025
Complete ltertrs 23at Doty when certilytng 23a. To a bps(pYmy knowledge, death Deco me tune, dale and pace stated, ignalure and title) 23b. License Number 23c. Data Sigrred (MOnlh, tlay, year)
pnysidan Is not available at lime a death to ~~ 2 t7 ~ ~ ~ _n
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certgy puce d seam. (/1~ ~J () ~ 6
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Items 24-26 mull ce canlAeted by parson 2 . Tim of Deem rs~I
` 25./~Dat/e JPronounced2ead (Month, day, year) 26. Was Case Relened to Medical Examiner /Coroner for a Reason Other than Cremation or Donation?
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wtp prorwunps deem. ~ - yi / M.
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CAUSE OF EATH (See Inatructione and emplee) r Approximate inrerral. Pad II: Enter omer spnifipnl na,dniona conlrlMtine 1° deem, 28. Did Tobacco Use Contribute to Death?
Item 27. Pan I: Eller the chain oI events - dseases, agwies, or rxxnpNCations -mar dreary caused the deaM. DO NOT emer terminal events such as prdiac artesl r Onset to Deam but not resulting in the underlying pose given in Pan I. ^ Yes ^ Probably
respiratory artesl or vemncular fibrillation wnigN showing the elidogy List Doty one pose on each lime. r
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^ Nc ^ Unknown
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IMMEDIATE CAUSE (Final disease or /,, ~~~/ ~
caxlNian resulting in Beam) _' a. _I7 (/`'/~~' ~/~~~.G.(~ _ "1 ;
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29. 11 Female:
^
Due to (or as a onsepuence op: Not pregnant within past year
SeglranlieNy list carcFtions, n any, b r
r ^ Pregnant at lime a death
kadlnq to me pose listed on Noe a. Due to or as a cons
Emer the UNDERLYMG CAUSE ( equence off: r ^ Not pregnant, bW Dmgnant within 42 days
(disease or uyury mar initiated the ° I
evenu resulting n Beam) LAST.
of death
Due t0 (or es a consequence ON'. ^ Na pregnant, bur pregnan143 dalre le 1 year
tl ; belare death
^ Unknown it preg~anl wghin the past year
3Da. Waz en Autopsy 30h. Were ANOpsy Fillings 31. Manner of Deam 32a. Date of Inury (MOnm, day, year) 32h. Describe How Injury Occurred 32c. Place of Injury: Home, Farts, Slrael Factory,
Performed? Available Prior to Complefion
^ NaN21 ^ Hombide OHice Builtling, etc. (Specity)
of Cause of Deam?
^ yes
a ~•0 ^ Yes ^ No ^ Acddenl ^ Pending Investigatbn 32d. Time a Injury 32e. Injury et Wane? 321. II Transportation Injury (Specilyl 32g. Laation of Injury (Slreel, city /town, state)
4 ^ Sukide ^ Coultl Not be Determined ^ Yes ^ No ^ Dover I Operator ^ Passenger ^Pedesirian
M ^ Other ~ Speciy:
33a. Cannier (check Dory one) 33b. Signature and TNe of Camper
• Certilymg physician (Physician certitying puce of death when arrother physician has proraurx:ed death and compleletl Item 23) ,
Te tM brit a my knowledge, deaM occurted due to the cauaeLsl and manner as steterL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Pronouncing and cenflying physician (Physician both pmrouncing Beam and pnirying to cause of daelh)
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^ 33c. License Number 330. Dale goad (Month, Qay, year)
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• Medcal Examiner /Coroner ~ ~ (/ ~ ! ~ ~ ~`' ~ ~ ~y (f
C(- (/Q
On Me basis of examinatbn end I or investigmion, in my opinion, death occurretl at the time, date, and place, arM due to the ceuse(s) and manner as atetetl_ ^ 34 N
^~ and (dress of Person'LW~ho ~omplejletl Cause of Deelh'ylwm 271 Type /Print
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