HomeMy WebLinkAbout07-22-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of George C. Bennewitz
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number ~ 1 ~ V 1 ~~
Social Security Number 073-44-8810
Petitioner(s), who is/are 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
last Will of the Decedent dated and codicil(s) dated
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) ~:~ r ~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiori-ef~trum~(s) oftisred_'~
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: t...~ H _ - _
' ~ O -n z'°"
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~/ B. Grant of Letters of Administration „
(lfapplicable, enter: c.t.a.; d. b. n. c. t. a.; pendente life; durante absentia; du~rte minoritateJ n
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any and 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.)
Leonore D. Oyler ~ sister ~ 217 Neil Road, Shippensburg, PA 17257
named in the
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
109 Shippensburg Mobile Estate Shippensburt; Shippensburg Township Cumberland County Pennsylvania
(List street address, town/city, township, county, state, zip code)
Decedent, then 58 years of age, died on July 14, 2009 at Harrisburg, Dauphin County, Pennsylvania
Decedent at death owned property with estimated values as follows:
([f domiciled in PA) All personal property $ 5,000.00
(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: None
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:
Si nature T ed or rinted name and residence
Leonore D. Oyler, 217 Neil Road, Shippensburg, PA 17257
Form RW-02 rev. 10.13.06 Page 1 of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
~`,_.~ box : SS
COUNTY OF ~
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 sybscribed
b~'ore me the ~/l+ day of
~, o~..
Signature of Persona! Representative
Signature of Persona! Representative n d
For the gister Signature of Personal Representative ':.~
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File Number:_~~~ ~ ~~D ! / ~ ~ n
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Estate of George C. Bennewitz ,Deceased
Social Secunrity Number: 073-44-8810 Date of Death: July 14, 2009
AND NOW, I ~ Q , ~~~, in consideration of the foregoing Petition, satisfactory proof
having been presented before m , IT IS D REED that Letters of Administration
are hereby granted to Leonore D. Oyler
in the above. estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of De edent.
FEES
Letters $ ,~~~ ~ Re ster of wills
............... .
Short Certificate(s) ........ $ y Attorney Signature:
Renu ciation(s) .......... $
... $~~
,~
... $~~_•
... $
... $
... $
... $
... $
... $
... $,~-9.96'
TOTAL .............. $
Attorney Name: H.Anthony Adams
Supreme Court I.D. No.: 25502
Address: 49 West Orange Street
Shippensburg,PA 17257
Telephone: 717-532-3270
Form RW-02 rev. !0.13.06 Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00 rms )s u, cerudy uru LIIC ltliVllllLLLlVtr ,n.r~. br~~r, r.~
correctly copied from an ori~7inal Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
. Records for pe n~ t f 'ng.
P 15664057 °~ ~
Certification Number ~ Local ~trar Date Issued
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HtOS143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS `~ ~ ~ Sae
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TYPE /PRINT IN
PERMANENT CERTIFICATE OF DEATH ~G r-
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BLACK INN (See instructions and examples on reverse) STATE FILE Rl1MB~ CO ~ t
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1. Name d Deadem (First, ntldrle, bcl, sutlu) 2. Sex 3. Socbl SecuMy Nurber le of ath (Month ar)
/
Gea a C. Bennew.etz MaX.e 073 -44 - 8810
5. Age (Led Binldey) l)rder 1 r Under 1 daY 6. Date o18iM (Momh, day, year) 7. Bidhpbo (Ctly and stele w cauMry) Po. Place d Deets (CMdc on one)
M~pa tyw,s Noce ayy„, Hocptlel; gher.
58 rya. 8-30-50 $naoFLe. n NY plnpetlem ^ER /Oulpelbnt ^DOA ^NUrsing Hane ^Reskence ^gher'~Specify:
•
8h CouMY d Death &. Cky, 8oro, Twp. d Death 8d. Fadiy Name (II not irelsNiay gNe street end number) S. Wes Decedent d Hispanic Ongn? ~ No ^ Yea 10. Race: Ammon nAan, Black. While, ek.
Dauphin Hannibbwig (N yes, apedty Cuban,
Hct~.i,66ung Ho.apita.~ Mexicen,PUenoRicen,etc.) (SDec/M
tUhi.#e
11. Decetlem's Usual Lion its d wodc done most d weld Ne. Do rot able reti 12. Was Deodem ever In IDs 13. Decedent's Education (Speciy only highest grede mntpldetl) 14. Meribl 9relus: Martied, Never Martled, 15. SumNirg Spouse (tl wile, gWe rtaNen name)
~~ (BP~M
Wed
Kent d Work Kntl d Buwaes / alduary
Manageh Y Tnanb.(~ Auth. .
U.S. Ametl Fwas?
Avy Elementary / Secondary (P72) Cdlega (id or 54)
r~,Yea ^No 12 sane even Mwvu.ed
. t6.DeodenyaMeikgAddress(Srem,dy/kwm,able,ripcade) Deotlem's DktDecadenl ,K Shippenbbww TWp. T
PA Live n a 17c
Decedent LNetl In w9
Ye
Ee~atea
109 Shippenebwcq Mob~e . Ey
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a
Actual Reeitlence 17a Slab
lmdwitlkn G
County Cumbeh,Pa.nd T°""'"'D? nd.^ ~D ~
,7b
/Bwa
7
S ppenb ung, PAA d
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16. FaMer's Name (FireL middle, led, suMb) 1B. Mothers Name (Fled, midde, maiden wmvne)
G
d
P
it~~
Unh.nawn ~.a
yb S.
.
,
20a. IMOrmanl's Name (TYDe /Print) ~ 20b. InbmaM's McYnp Atlaess (Basel. dA' /loon, stale, zlp code)
Leonone D. ~y.Ze~c 217 Ne.i,e Road, Sh,ippen66ung, PA 17257
21a. MetMtl d Disposskn i ^ Cramason ^ Donetkn 21D. Dale d D'sposllbn (Mats, dry, year) 21c. Pace d Dispoenion (Name d cemetery, warelory a oNer place) 21tl. Laotbn (City / town, date, a4 code)
Burial ^ Removal iron Stele ' w.a cromnknal3aretlon Authodatl
• 7-20-09 an~awn Gap Na~iona.C Ceme~eny
Indi Hanovvc Townehi,p
^ Oyer . ~py~ W Medkal ExmnMer / Cworer7 ^Yes ^ No ,
~ 22a. Sgretus unerel (or pe acing es such) 22b. license NuMer 22c, Noma eM Address d Fedkly
. ~ PD-012984-L Fa ¢,P,ban eh.-Bni,chen funena.2 Flame Inc., Sh,i, penbbung, PA 17257
CargMe hems 23ee eery when o tlYng 23a. To the bast d my knowledge, 0eelh oaurted a the tare, dale eM place dMed. (Sigatwa antl title) 23b. License Number 23c. Date Sigatl (Month, day, year)
ptrysidan b not evadable al lima d tleaM to
cerlilY ease d d6elh.
dame 24-26 mat be coniplded Dy person 24. Tana d Death 25. Dead (Monts, as year) 28. Was Case Refemtl to Metlnal Examiner /Coroner for a Reawn qMr Ihen Crematbn a Donation?
who prorouw:as death. ~ Nt, Da ^Yes ^No
CAUSE OF DEATH (Sae Inatruetlona nd atu s) , Appmximale nlerva: Pon II: Enla dMr ' 23. Did Tobeao lke Conlrtule k Death?
Kem 27. Pen 1: Enter the 9YS015 -diseases, iryudes, a contplkedora -that diroulky caused tla h. DO NO enler terminal evems such as oMiac amsl, n Onsm to Deets bd not resupkg k the undenyiiry cause given n Pen L ^Yes ^ Probably
respiratory arted, a veMMxAer fbrtllsllen w4hatl strowkg dw etidogy. list ady as a on each lens. r
Ne ^ Unlmown
r
ME~TE CAUS~~n~l
W
Aseasea S 29. if Female:
j
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9 -~ e. ~
`S
i ear
^ Nd
re
nant within
est
pppp
nee
Due ~~_~ ~, ` ~~~~~V~~`•, n
$ep~M' W candilkm, N airy, b, Je tea- -' ,~.~ p
g
p
y
^ Prep~ant et time d death
leading k the rates kaetl o Ins a. i ^ Nd gegnaM, hd pmgneM wnMn 42 days
Enter me UNDERLYING CAUSE Due to (a es a ronsequence d): r d death
(6sease a I M'W Mel hoist the c
~
eveMS reaANgSn d~thl
T•
Due k (or as a uronseQuance oQ: t ^ Nd pregrenl, bn prepnenl43 days k 1 year
bekre death
d. ^ Unkmsm X ixepaM wi1Nn the past year
90e. Was an Aukpsy 30b. Were Ainepsy Fndngs 31. Manner d Death 32e. Date d Injury (Abnth, day, year) 32b. Desenbe How Injury Occurted 32c. Place d Injury: Home, Fero, Street, Feday,
plies Butldbg, ek. (Spayly)
PedomaU? Avelbble Prior to Coripletion
d Cerra d Deets, lIqo~
pu Neturel ^ Haricide
I.pt
No
^ Yes
^Yes ^ No ^ Awkem ^ Pen6ng Investipelion 32tl. Time d Inpny 32e. Injury d Work? 321. N Trensponalkn hgwy (Spedryl 32g. Location of Injury (Sireel, dty /town, sole)
~1 ^ Suidde ^ Cculd Nd be Delemined ^Yes ^ No ^ ~! Opereta ^ Passenger ^P iron
M OOar-Spedy:
33s. CMtlier (deck Dory me) ~ 33b. Sigotu tle d Cenitler
• CernBVk9 phyelcian (Pliysicbn cenilykg cause d death when another physkbn has proriainced death antl cempleletl Item 23)
death ouurted due to the Dose(s) antl manner as steled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To the hest of my hnawkdge ,
,
• Praaundng arts rxHlynng phyakWn (Plryskien Odh pronourwmg death end cenilyng k reuse d tleaM)
To the best d my knowledge, death occurtetl el the time, dab, end place, and due to the ceusgs) end manner a eteterL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
mner I Corona
l E
• M
tlk 33c. License Number
t ~ 33tl. a Sgrred (Month, day, yeerl
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a
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On the Basle d exemkrslion antl / or kwegigalbn m Ion, death oaurred at the Thos, dale, mtl place, and due to the oase(s) ant manner es ebled_ ^ ,%.'`,,,,,, ~ d P Wl/g1 C,gnn7ple)ed ayyc~ath Ple
„ice,,
~"' y I
35. Regislrer's Si ore ~ Dvmdd tuber
-I d~l ~ I ~I / ICI 36. Dale se0lMonth, day, Year)
oo (
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v (/
,V , V
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~ ~ z ,Pel
Q Cl7
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Disposition Permit No.