HomeMy WebLinkAbout03-09-09PETITION FOR PROOBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF 13~4LX'n~;'~Y.~M`(.)` COUNTY, PENNSYLVANIA
Estate of /{I~~f3 ~- /~~ ~L~~
also known as
Deceased
File Number ~ ~ ~ 1 ~~~
Social Security Number ~~t r ' L~ _ ~5~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COftilPLETE 'A' or 'B' BELOW:) ~ ~-~
` ~/A~Q <~~ ~~/LLC~'~ named in the
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated ~ ~N o~ CO (v and codicil(s) dated
(Stare relevant circu,nstnnces, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was no[ 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:
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^ B. Grant of Letters of Administration ~,o -
(Ifnpplicn6le, enter: c.t.a.; d. b. n. c. t. n.; pendentelite; durmztenbsentin; dur~t~e~toritntej ~ ~
7 ',.~
hens- (!
Petitioner(s) after a proper search has /have ascertained that Decedent ]eft no Will and was survived by the following spouse any) 3R$ f
Administration, c. t. n. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) _ ~
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(COiY1PLETE h'V ALL CASES:) Attach additia/tal shheets if necessary.
Decedent was domiciled a~eath in G6Q. `~~ County, Pennsylvania with his /her last principal residence at
~~~ ~t/L~+pL s~ s'!a ~ P ~n/s u2C3 Fr~NA e 7~ s ~
(List street address, lawn/city, township, count), state, up code) /~ J ~C~`~ / /r~7
Decedent, then ~_ years of age, died on
Decedent at death owned property with estimated values as follows: $ c1 y G, G~
(If domiciled in PA) All personal property 7
Personal property in Pennsylvania ~
(If not domiciled in PA) $
Qf not domiciled in PA) Personal property in County
$ ~-~ o oG~
Value of real estate in Pennsylvania
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~.~~.1 s ~. .~H i P~'~~s ~3u2G ;t~~,r~.t~A
situated as follows: ~`~~ /U
Wherefore, Petitioner(s) respectfully request(s) the probate of the last W ill and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form ro
the undersigned:
Sig>nature Ty ed or tinted name and residence
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Page 1 of 2
Furm RW-02 rev. 10.13.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named sweat(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect 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 /~ ~d
Q
before me the 1 day of t afore oJPersona! Representative
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Signature oJPersona! Representative =
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For the Register Signature oJPersona! Representative ~
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FileMNumber: ~ ~ b~ Va~~ r
Estate of _ 1 ~ 11~,P'~ ~~a L ,Deceased
Social Security Number: ~~0 ~~ a ~~ Date of Death:~,l((~(~ ~ Z~
AND NOW, ,~~rL~ ~ ~ , o`kks~ ill consid ration of die foregoing Petition, satisfactory proof
having been presented before n e, IT IS DE REED that Letters
are hereby granted to _ __ ~ ~p~ Q~'
and that the instrument(s) dated `~ ~\ t
described in the Petition be admitted to probate and
FEES
F
Letters .....
W ~.
.. .
$ ~~
TT
Short Certificate(s) .. (l..'.. .. $~_
Renunciation(s) ......... . $
_ .. . $ 1~
.. . $~
_ -
.. . $
-
.. . $
_
_ .. . $
.. $
_ .
.. $
_ .
.. . $
_
TOTAL ......... ... . $
2 Zo ~~
Furor RW-0_' rev. !0.13.0(
in the above estate
the last Weil (and Codicil(s~ of Decedent.
Register of Wills
Attorney Signature:
Attorney Name:
Supreme Court LD. No
Address:
Telephone:
Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARMNIG: ft is illegal to duplicate this copy by photostat or photograph.
l=ee Ct1 1hi. ''crt:l;; ate tit~.lll)
- -~. 5 2 _~ ~ 3_~_
This i:, to ~ rti±r, teat the i))Srrn'~a(i~>n ht)r~ r~iY:~n i
rt,rrectl=, copl~'d i~n~rO :In original C'~rtif;ratt~ ol` Death
duly filed with 1T1c .I `+ Local Izegi~tr;u~. Tl)e ~~ri~~ina1
certificate will he 1~)rwardc~i t+? (hc State Vital
Records Ofiioc ;;?s permanent ~iling
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -A - ;''.-1
CERTIFICATE OF DEATH ~ ,,,,_
repo Instructions and examples on reverse) STATE FILE NUMBER '
H705~143 REV 1120W
TYPE /PRIM IN
PERMANENT
BLACK INK
SI
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85 Yrs.
County of Death
Cumberland
t. Name of Decedanl (Fmt middle, lest. ss
Nina L. Miller
5. Age (Leaf Bidtdey) Untlr
rte retiretl 12. Was Decedent ever in the 13. Decedent's EducaDm (Speaty only highest prat
Mustry U.S. Amrad Forces? Elementary / Secondary (012) College i
Verslty ^Yes ®NO 8 years
Decedent's PA
Actual Residence t7a. Sete
1 ^ ER /Outpatient (J DOA U Nursing Home LJ Residence LJDlher -Specify:
9. Was Decedent of Nispank Origin? ®No ^Yes 10. Race: American IMian, Black, Whae, etc.
pf yes, specity Cuban, (~M
Mexican, Puerto Rcen, etc.) White
neat 14. Marital Salus: Martied, Never Mertied, 15. Surviving Spouse (If wife, give maitlen name)
) widowed. Divorced (Sped!))
widowed
pfd Decadent
Live in e 17c. ^Yes, Decedent Lwed in Twp.
TownsNp? 17d. ®No, Decedent Lived walrin
fro. County Cumberland Aauel L;narom Shippensburg Day/ewo
21a. Method at Dsposilbn j ^ Crematwn ^ Doplan 27D. Dale d Disppamn
® Burro) ^ Removal tram Sate ~ p aMMEwnlrrponetioCcen~ rizM ^Yes ^ No 3 - 7 -09
^ ghor-Specify
22e. Sigra~yry d Fu ( ce~ acan9 as wbe) 71b. License NurMer
~ FD-012984-L
rote Items 23ec ony when codifying 23a. To dre best of my knowledge. death axurted at the time. date ant Die slated. (Sign
2. Sex 3. Social SecuMy Number 4. Dale of Death (MOnm, day, year)
Female 301 - 18 - 2554 March 4, 2009
~ raWrt M Mee
11-30-23 Petroleum, WV
i1c. CaY, Born, Twp. of DeaM Bd. Fadldy Name Qf rrot inslamion, gNe weer and number)
S. Middleton Twp. Carlisle Regional Medical Center
KiM MWak Kind of Business I I
Union President ~~~~~)'TMgTi^'
16. Decedent's Meiling Address lSir~• ceY /town. Grote. zip code)
448 North Earl Street
Shippensburg, PA 17257
18. Fedrer's Name (First mtldk, lest, Mdib)
Oliver Varner
20a. Inlarrent's Name (TYDe / PnM)
H. Alan Miller
o Medpl Examiner /Coroner for a Reason Other then Cramatbn a Daratbn?
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26. Was Case Refe
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^Yes LM'°
ad II: Emer miter slgnifxenl cp6lions contdbutino b death, 26. Ditl Tobacco Use Caanhme to Death?
but not rewlting in the undedying pose gNen in Pan I. ^Yes ^ Prd>eNy
^ No ^ DnMawrr
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G 29.NFemale:
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/ ^ Nil pregnant within pest year
^ Pregnant al Dme d death
^ NM pregrtanl, bW pregnant within 42 days
of death
^ Na pregnant, but pregnan143 days to t year
before death
^ Unkrrown it pnymam within the past year
32c. Race of Injury: Hare, Farm, Street, Faaory,
ORme Builtlmg, etc. (Specity)
of Cause of Death.
,., / ^ Acddenl ^ Penang Irnestigation 32tl. Tmre d Injury 32e. Injuy al Work? 321. If TnnsporroNon Iryury (Bpecnyl
Yes ^Yes l.'JT10 ^ ^Dm~a/Operates ^Passerrger ^Pedestrian
^ ^ Suicitle ^ Cold Nil be Determined M ^Yes No l)ther ~ Specify:
33a. Ced'aier (dteck only ore) 33b. S' natur~ Tak of Ce 1
Cerlitying phyakron (Physician cenayirg pose of death when erwlher physkdan has pronourwed tleaM end axrpleled Gem 23) , v
Tothe best of my krrowkdge, death occurred due to the ceuse(s)aM rnemeru prated--------------------------------- ^ icense NuMer
Pronouncing and prlltying physicron (Physcian both pronourmirg death arM cedilylrg to cause of death)
To Me best of my krawletlge, death occurred at the lime,date, and Droce, and due to the ceuse(a)and manner as sletetl------------------ Mrs- ~3 [~G~L
Medkal Examiner I C i] 6 ~
On the basis of hmtion I or Imesdgation oplni death occunetl at the tMne, dme, and place, end due to the pose(s) entl manner as staled_ 3a. Name arM ass of Person Wh C I
I .~ ~ ~ 36. to FNed (Month. daY. Yprl ~ / ~ ~C+K k
35. tieglstrar's S~gnat trio Number UI-(/ I `~T I •~ 0 D
( f ~Lr
M:alion of Injury (Street, illy I Ism, state)
~~
33d. Dale Signed (Monti, day, year)
3~y~~
se of Death plem 27) Type I Prin
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,5~p.eti.1 a~
19. MoMer's Name (Fill. midde, maiden wmame)
Elizabeth Harris
20b. IMorment's McOing Address (Boast wY / bwn, slate, zip code)
43g Pmlbext~m Blvd. , Browns Mills, NJ 08015
Mash, day, year) 21c. Place of Disposaion (Nance a cemetery, cremerory a other place) 21tl. Locatbn (Coy /town, slate, zip cetle)
Ctmberlarkd Valley Msmerial Gardens Carlisle, PA 17013
22c. Name and Atldress of FadNly
Fogelsanger-Bricker Funeral Home Inc., Shippensburg, PA 17257
,re and tak) 236. License Numar 23c. Date Signed (Homo. daY Y~r)
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physiden is rrot available al ame of deem to
cerdly pose of tleath.
24. Tme o1 Deem 26. Date Pronamced lMonm, day, year)
Items 2426 must be completed by Dersar
who pronaxx;es deaN. ~ Z Y (~ p M. 3
CAUSE OF DEATH (See Inelructlons entl examp s) , Approximate iaerval
W X~T enter terminal events such es pNiac arteal,
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hem 27
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IMMEDIATE CAUSE1Final disease or
condaan resuNng in Beam) _~ a. ~[a ~ia.~ /~ [~ n W S J n r~l rO MC° V
i ---y-
Due to (or es a consequence~/9Q- ~ ` ~~
r`~ ar ~4 r(-'
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SequaMiaay list conditbns, a arty, b,
leeGnp to the pose I'stetl on qne a. Due to (a es a consegpnca M):
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Enter tM UNDENLYING CAUSE
G L r r lit
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(disease or injury that inaroled the g, u
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events resWlug m death) LABT. Due to (a es a conseprertce MI: i
tl.
ear)
M
nth
da
f I Desaib
32b e How Injury Occurted
30a. Was en Auopsy :30b. Ware Autopsy Fillings 31. Manner I Death ryury (
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32e. Date o ,
Performed? Avairode Prior to Conpletwn
0 Natural ^ Fiondcide m
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LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, NINA L. MILLER of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all
prior wills and codicils by me at any time heretofore made. ~ _;` ,.,.
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FIRST: I direct the payment of all my legal debts, funeral expenses , -r ~,
,:
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including my grave marker and all expenses of my last illness, state, fe~ ~I~`' -._
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estate and inheritance taxes and administration costs shall be paid as soon as ..
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath all my property, be it real, mixed
or personal whatsoever and wheresoever situate to my son, Harold Alan Miller,
per stirpes.
THIRD: I nominate and appoint my son, Harold Alan Miller, as the
Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I, NINA L. MILLER to this my Last Will and
Testament set my hand and official seal, this ~ day of 2006.
G~ ~i- (SEAL)
Nina L. Miller
Sworn to and subscribed, declared and
Published by Nina L. Miller, as
her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
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COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
I, Nina L. Miller, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I
signed it willingly; and that I signed it as my free and voluntary act for the
purpose therein expressed.
Nina L. Miller
Sworn to and acknowledged, before me,
By Nina L. Miller, the Testatrix,
This °~ ~ day of ~~ A~ 2006.
Notary Public
Notaries Sens
H. Anthony Adams, Notary Pubic
Shippensburg Bcrro, Curnbertand Connky
My Come ;fission Fixpires b3ay IS, 29f;6
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that he signed willingly and that he
executed it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the Will as
witnesses, and that to the best of our knowledge and belief the Testatrix was at
the time at least eighteen (18) or more years of age and of sound mind and
under no constraint or undue influence.
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Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams
The witnesses, this ~ day of 2006.
Notary Public
Notarial Seal
H. Anthony Adams, Notary 3'ublic
Shippensburg Boro, C~mherland County
My Commission Expires May i_5, 2006
Merrbf.~ ~ennSUivani~aASS~,ciati;;notf~otarieS
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