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HomeMy WebLinkAbout10-26-091 ~~+ PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of also known as Helen E. Miller COUNTY, PENNSYLVANIA File Number 21-- ~~ l - ~~Q3 ,Deceased Social Security Number 209-12-9137 Joy M. Hamsher and Cindy M. Evans Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE `A' or `B' BELOW.) ~X A Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the last Will of the Decedent, dated 05/31/1978 and codicil(s) dated State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not many, was not 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: ~~' ~~ v~ ~l.c e ~~ i~,~~ h~+u~.~t ~,~-1~-~ ~,c.4air~.~.~:~1~ o `~ . Irt ~ ~Ci~n, 5' ~,.~ ^ ws~l~.~cu~ `° B. Grant of Letters of Administration app Ica e, enter: c.t.a.; .n.c.t.a.; pe ente rte; urante a enGa; urante mmorttate 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: (/f 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 Residence ° -: `^"'. 4`~ /'mi'l 1~1 j I,'~`.,,~ ~~~ ~ + 1 ... _ ..r...~ ,..p, `I~ 7 ~._~.3 V ~ ~- r..-.,~ -~:~ .._, ~' ,. ~ :. ~... ~„ ,, fY j .. _ ~• ~- _._ . .- . ._ . _..r} (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. -r7 "" ~ ~ ~~' °~ '~~~ ~~ Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at t„3 . ~ 1325 Oak Lane, New Cumberland, Cumberland, PA 17070 (List street address, town/city, township, county, state, zip code) Decedent, then $$ years of age, died on 09/22/2009 Claremont Nursing 8~ Rehabilitation Center, Middlesex Township, at Cumberland County, Pennsylvania Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (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: NIA 65, 000.00 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: Signature Typed or printed name and residence Joy M. Hamsher 1325 Oak Lane ` ,~ New Cumberland, PA 17070 ~/ ~ 717-774-6911 ,..-- ~.. Cindy M. Evans 9 Conover Lane \~~ Cape May Court House, NJ 08210 ~ 1 i \ ~ ~~ ~ 609-463-1330 Form RW-02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 ~~" Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumber{and } The Petitioner(s) above-named swears} 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. Swom tc~ or affirmed and subscribed before me this ~ day of .-. ~~ signar a of a on ~ Kepresenranve Joy M. Hamsher ~1 ~ tom- Signature of Personal Re~re entative Cindy M. Evans ~' I C"~ , For the Register Signature of Persona/ Representative t--'~ ~-j ~ ~.;,, ... - `_ } + y """ ~ 1 T ~.. ~ (/ . . r-,-.1 ~ -.., t ~ C I f ~ ! r ~~ File Number: 21-- ZQQ~- `~{~3 r ., ~ ~`i ~ r.-..~ ~ --~~. ~~~° ` _..F„,~ Estate of Helen E, Miller , Dec~sed ~ _ ~ ''~ .. t.t~ , ~ _ Social Security Number: 209-12-9137 Date of Death: 09/22/2009 AND NOW, 'I'Q'' U , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT S DECREED that Letters Testamentary are hereby granted to Joy M. Hamsher and Cindy M. Evans in the above estate and that the instrument(s) dated 05/31 /1978 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES ~,. Letters ............................................ $ ~ 3~ ~0 Short Certificate(s) ....................... $ 2`T. R~enu`ncia`tion(s) ............................. $ ~G~ $ ~ y. cry: TOTAL .................................... $ 1 ~ ~ - o Cj Supreme Court I.D. No.: 19475 Bogar & Hipp Law OfFices Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717-737-8761 Form RW-02 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attomey Signature: Attomey Name: ameS D. r OATH OF NON-SUBSCRIBING V~VITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNT, PENNSYL~TANIA Z 1- Z oo ~- ~ 00.3 Estate of HELEN E. MILLER ,Deceased Joy M. Hamsher and Cindy M. Evans (each) being duly qualified according to law, depose(s) and say(s) that she 1 he /they was /were well- acquainted with Helen E. Miller and am/are familiar with the handwriting and signature of the decedent, and that the signature of Helen E. Miller to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Helen E. Miller is in his/her own proper handwriting. YYl (seat e) M. Hamsher 1325 Oak Lane (Street Address) New Cumberland, PA 17070 (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ day of Da Deputy or Register of Wills (signature) C i n M. Evan s 9 Conover Lane (Street Address) Cape May Courthouse, NJ 0$210 (City, State, Zip) <~~ ~ }`...~ ,..~ ~ ,. S.y ~1 f 7 1 "~ --'' ~ '~.. .. .. 4 .: __ ~ ~ ..., ,. M rE ,! _ .'r ~ ~ 1 T=., ~ . ...,1 ~ f Form RW-04 rev. 10.13.06 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15690570 Certification Number This is to certify that the information here given correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origin certificate will be forwarded to the State Vit Records Office for permanent filing. p 20~ Local Registrar Date Issued rv C~7 '~- C `) t._ . -. ) . _... ~..: _) ~ -'~, ~ -S '' n, ;y ~ ~.: >~ a W K: aEV itr2oos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ANENT" CERTIFICATE OF DEATH ;K INK (See Instructions and examples on reverse} STATE FILE NUMBER t. Name of Decedent (First, middle, last, suffx) 2. Sex 3. Social Security Number ~ 4. Date of Death (Month, day, year) Helen E, Miller Female 209 -12 - 9137 Se tember 22 2009 5. Age (Last Birtfiday) Under t year Under 1 day 6. Date of Birth (Month, day, ear) 7.13in ace (CN and state or to ' n count } Ba. Place of Death (Check onl one) Morrihe Oays Noun Minutes Hospital; Other: 1 9 21 Enders PA ^ Ju 1 y 3 0 m ^ Re idence ^Other • S ecity ti t ^ DOA ~ N i N i ^ ER /O t 8 $ , , p , en urs ng o e s Inpat ent u pa Yrs. Bb. County of Death Bc. City, Boro, Twp. of Oealh lk1. Facility Name (It not krstNNion, give street and number) 9. Was Decedent of Hispanic Origin? [~No ^Yes tp. Race: American Indian, Black, White, etc. Cumberland Middlesex Tw p Claremont Nursin & Rehab. Ct (It yea,apecNycuban, (spa~im g Mexican, Puerto Rican, etc.) 11. Decedent's Usual tion Kind of work d one du' mast of work' Nfe. Do trot state retired l2. Was Decedent ever in the 13. Decedent's Educatron (Specify only highest grade completed) 74. Marital Status: Married, Never Manned, 15. Surviving Spouse (If wife, glue maiden name) if W Di d d d S . Kind t Work Sales Clerk Kind of Buair~ss !Industry r Bowman s De~ U.S. Armed Force? ^Yes ~No Elementary f Secondary (0.12) 12 College (1.4 or 5+) vortre y) i ( pec owe , Widowed 18. Decedent's Mailing Address (Street, city !Sown, state, zip code} Decedent's p A Did Decedent M i d d 1 e s e x Actual Residence 17a. Stale Liva in a 17c. ®Yes, Decedent Lived in Twp 1 3 2 5 Oak Lane Township? Cumberland 17d.^No,DecedenlLivedwiihin 7 C New Cumberland, PA 17070 ounty 1 b. Actual Limits of City ! Boro 18, Father's Name (First middle, last, suffix) 19. Mother's Name (First, middle, maiden surname) Llo d Wesle Enders Sr. Mar Stone 20e. Infomrant's Nema (Type i Print) 20b. informant's Mating Address (Street, city /town, state, zip code) Jo Hamsher 1325 Oak Lane New Cumberland PA 17070 21a. Method of Disposition ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21 c. Place of OisposNion (Name of rx+rttetery, crematory or other place) 21d. Location (City I town, state, zip code) Br,riat Removal from State ~ Wu Cremeuon ix t)onetbn Autfiorized ® ^ 2 0 0 9 2 8 Sept 2 n d i a n t o w n G a N a t i o n a l C e m p Annville, PA 17003 ^ Other - Specity: + by Medtcel Ex r I CoronerT ^Yes ^ No , . ~ 22a. re of Funeral a Ucensee ~~ng es s ~ 22b. Ucense Number 22c. Name and Address of FaGNty . i~ ~ o,~„~~ ;.,, FO 012342-L Stone & MurrayF.H.,408 3rd.St.,New Cumberland, PA 17070 e Ilema 23a•c only when cenitying teen is not available at time of death to 23a. knowledge, death occurred at the N place stated. (Signature and Ntle) ~ ~ ~~ /'~„ ) 23b UAcen~se Number ~ % ~ 1 ~ r~L ~!V 23c. Dale Signed (Month, d y, year) F~_ f'~~~'7"7~.y" ZZ~ artily cause of death. 1..~.-i / v '"~ , t" _ Hems 24-26 must De completed by person 24. Time of Oeeth C ~ y ~ 2 e Pronounc sad (Month, day, year) ~ ~ ~ ~ 'r Z " ` ~ ~ 26. W^es Case Refened to Medical Examiner /Coroner for a Aeason Other than Cremation or Donation? Yes No who prorrounces death. .J M. Y ~, ~'/ _ ~J CAUSE OE DEATH {See instructions end exsmpka) r Approximate interval: Part II: Enter rNher sidnlNCent condikons contributing to death, 28. Did Tobacco Use Contribute to Death? Item 27. Pan I: Enter the ~gjn of events -diseases, injuries, or rAmplications -that directty caused the death. 00 NOT enter terminal events such as cardiac arrest, r Onset to Death but riot resulting in the underlying cause given in Pant ^Yes ^ Probably respiratory arrest, or ventricular fibrillation without showing the etSology. Ust only one cause on each line. t . ^ No ^ Unknown ///+++ IMMEDIATE CAUSE (Final disease or ~ ~~" {,/ r 29. It Female: rxxtdition reauNing rn death) a. / J r -~ ^ N t t ithi r r Due to (m as a consequence of): SitquerNiaNY fist txx>dtions, if any, b. ' r pregnan w n past year o ^ Pregnant al time of death ~ ksd to 1 e cause listed on Nne a rig Due to (or as a consequence oQ: r ^ Not pregnant, but pregnant within 42 days Emer the UNDERLYMIO CAUSE r ~(~NBe~ese or injury That initiated the c. ~ of death 7 wants nesuHing rn death) LAST, r Due to (or as a consequence of): . ^ Not pregnant, but pregnant 43 days to 1 year before death .. ~ d. r ^ Unknown ii pregnant within the past year ~ 30e. Was an Autopsy 3tlb. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury gccuned 32c. Place of Injury: Home, Farm, Street, Factory, OfNce Building, etc. (Specity) ~ Penormed? ~ Available Prior to Completion of Cause of Death? ^ Natural ^ Homicide N Y ~l ^Ye '[~lo ^ AcrAdenl ^ Pending Investigation 32d. Time of Injury 32e. Injury al Work? 32t. If Transportation Injury (Specity) 32g. Location of Injury (Street, city !town, state) o ^ es . `t" s ^ Suicide ^ Could Not be Delennined ^Yes ^ No ^ Driver /Operator ^ Passenger ^Pedestrien M ^Other - Spifcity; 33a. CenNier (check only one) 33b. Signature and Tit Nis • Certifying phytieien (Physicsan certifying cause of death when arather physician has prorrounced death and completed Item 23) death occurted due to the cause(s) end manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ . To Ifie best of my knowledge ` ~J ~ - , • Pronouncing end cerlUying physician (Physipan both pronouncing death and certiying to cause o1 death) To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner ea stated,. _ _ _ _ _ _ ,. _ _ _ _ _ _ _ .. _ _ ^ 33c. License Number ~ \ r~ ^^J ~ ~~ ~' `,/ / " -' ~ 33d, to Signed (Month, day, year) ~• ~1 ~j ~ "> ~~ lI~ ` ~ 4' r"~''~ • Medieei Ezeminer f Coroner On the beats M examination end / or Inveatigetion,ln my opinion, death xcurred at the time, date, end place, and due to the cause(s) and manner as stated_ ^ ~ ~~~ A teas of Person Who Completed ~se of Death (Item 2j,);~TyQe~Pnnt~ / , ~ j JJ ~. ii SS'''- ~r~~ 4 t ;~ ~~- - ~ ~ ~ f ~ ~Si nature and Dis 35. Registrar's Year) ed (Month, da y, 36 Da te F)l ~/ // ~ r~•~'~Jf'~~,y '~ ~'' c / ~ i ` J ~ I l 7 ~ y >' rliennaitirxr Pormil Nn J ~ ~~p~~~~~,~~ ~ I, HELEN E, MILLER, a resident of the Borough of New Cumberland, Cumberland County, Pennsyl~a, nia, be-i~g of sound and disposing mind and memory, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses by paid as soon after my decease as any be found convenient. ITEM II. All the rest, residue and remainder of my estate, real or personal, which I may own or have the power to dispose of at the time of my death, I give, devise and bequeath unto my husband, Charles W. Miller. ITEM III. In the event my husband, Charles W. Miller, shall predecease me, I give, devise and bequeath my entire estate, real or personal, in equal shares, unto my children, Joy M. Hamsher and Cindy M. Evans, If either of my said children shall predecease me, her share shall go to her surviving issue, if any, in equal shares, otherwise to my surviving child. t ITEM IV. I hereby nominate, constitute and appoint my husband, Charles W. Miller, Executor of this my Last Will and Testament, with full power in his discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order of court, any real or personal property belonging to my estate, and to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could do if living. In the event that my said husband, shall predecease me, I hereby nominate, constitute and appoint my daughters, Joy M. Hamsher and Cindy M. Evans, Executrices with full powers as set forth above. IN WITNESS WHEREOF, ~ have hereunto set my hand and seal to this, my Last Will and Testament, this ~~ day of ~~~ , A. D. , 1978, ~-~ _ ~`"~~ ~'1~~ (SEAL) Signed, sealed, published and declared by the above-named Helen E. Miller, as and for her Last Will and Testament /^'~ \, ,J C,""~ .~1 in the presence of us, who, at her re uest, q ~~:;~ 7'''~ `~' ~~~ ~-=-` tTt~ _ ~ in her presence and in the presence of __4 _, C~ ..,..,.~ f E., f-w each other, we believing her to be of ` F~ ~ ~ sound and disposing mind and memory, ~ ~ %~~:~~ .. _ , t.. , t- ,~ have hereunto subscribed our names as , ~ ` '`--' ~'"` '~ witnesses this ~~ day of~:~ ~~~ _~ ~ .. ~ ~ + { . ~ ~ A. D. , 1978. ~.~ , . ,., > ~ ~,_ ,,. rN ~~ _ COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland Oath of Personal Representative } ss } 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. Swom tc~ or affrmed and subscribed before me this ~~ day of ^- Signat a of a on I Representative Joy M. Hamsher ~1 ~ ~~ Signature of Persona/Re,Qre entative Cindy M. Evans For the Register Signature of Personal Representative ~~- ~ ~~~ ~ s " `~: ..~_} •:~ File Number: 21-- ZQ~~- Io~3 ~ ,..k C _ f~~I Estate of Helen E. Miller , Dec~sed ~ ;;; ' ~ C..3 ` ~ Social Security Number: 209-12-9137 Date of Death: 09/22/2009 AND NOW, ~'" AU , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT S DECREED that Letters Testamentary are hereby granted to Joy M Hamsher and Cindy M. Evans in the above estate and that the instrument(s) dated 05/31/1978 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............................................ $ (~~ G~ Short Certificate(s) ........................ $ ~~, f~ Renunciation(s) ............................. $ ~ ~G~" $ ~ V. ~.t: $ $ $ $ $ $ TOTAL .................................... $ ~ () / - o Cj Supreme Court I.D. No.: 19475 Bogar & Hipp Law Offices Address: One West Main Street Shiremanstown, PA 17011 Telephone: 717-737-8761 Form RW-U2 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attomey Signature: 7 ~„ Attomey Name: ameS D. r OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~ - 2 0©~- ~ Do~3 Estate of HELEN E. MILLER Joy M. Hamsher and Cindy M. Evans Deceased (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with Helen E. Miller with the handwriting and signature of the decedent, and that the signature of and am/are familiar Helen E. Miller to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Helen E. Miller is in his/her own proper handwriting. YYl (sear e) M. Hamsher 1325 Oak Lane (Street Address) New Cumberland, PA 17070 (City, State, Zip) Executed in Register's Office Sworn to or affirmed' and subscribed before me this ~ day of Oa Deputy or Register of Wills ~~ ~ ~~ C~J~--~ (Signature) C i n M. Evan s 9 Conover Lane (Street Address) Cape May Courthouse, NJ 08210 (City, State, Zip) c~~ .._~_ c7 ;. t _~..~ ~i_ i -` ~ ~ ~ F~ ~ ~..~ ~ ~ i „~.i i - `. _.~' :. t ,, ~~ ~ ( ~ -7 ~~ - _. ~ :~ ~ :. .. .~ r ~ Form RW-04 rev. 10.13.06 HIUS.S(IS KEV (Of/07) Z.~ °Zaa~_ ~~ LOCAL REGISTRAR'S CERTIFICATION OF DEATFI WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15690570 Certification Number This is to certify that the information here given i. correctly copied from an original Certificate of Deatl duly filed with me as Local Registrar. The origins certificate will be forwarded to the State Vita Records Office for permanent filing. ,~/~i ~ 100 Local Registrar Date Issued ~ ~ + _. ~-w_ . __e__.______ _________~_~.___ ~ (~ ~ ~~ , , ~~ -~ ~r ____ --- _ _ , _ _- . _ __-___~ _______~____e _. ~____.__...,_.,. _..,,...,,_.,_ ., Y '~ ~ _ . 1 ~ ~ ~ .~l r t ^, -_ ~....__~. _._ ,_~_._... _._.. _.., ._..~._. _..........._. .. _ ..._.._ ._._...... _,.,,,,_- ~~ r ' " '`\ ^ ~ \J ~ ~f``-~~{ ....T r..,,,1 ,_, A'._T .; _,,~s •i.._. f.,_. rM , ,,~ 1 ~ \ ~J r F REV tt/2oo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN iANENT CERTIFICATE OF DEATH .K INK (see instructions and examples on reverse) ~r.r~ ~„ ,. ,,, ,,,,,~„ 1. Name of Decedent (Flrsl middle, last, sutlix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) ~ Helen E. Miller Female 209 -12 - 9137 Se tember 22 2009 5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, ear) 7. Birthplace (C' and state or for ' n country) 8a. Place of Death (Check only one) MonMs Oays How' Mmutee Hospital: Other: 88 Yra. July 30, 1921 Enders, PA ^ Inpatient ^ ER !Outpatient ^ DOA ~] Nursing Home ^ Residence ^Other • Specity: 6b. County of Death Sc. City, Boro, Twp, of Death 6d. Fadlity Name (If not institution, give street and number) 9. Was Decedent of Hispanic Origin? [~No ^ Yes 10. Race: American Indian, Black, While, etc. Cumberland Middlesex Twp. Ct !If yea,apecltycuben, (gp~i~ Claremont Nursing & Rehab . Mexican, Puerto Rican, etc.) 11. Decedent's Usual lion Kind of work done dtxi most d warki life, Do not stele retired 12. Wes Decedent ever in the 13. Decedent's Education (Specfy only highest grade completed) 14. Marital Status: Marred, Never Married, 15. SurvWing Spouse (If wile, give maiden name) Kind f Work Kind of Busir~ss I Industry ~, Sales Clerk Bowman $ De~~. U.S. Armed Forr(e~? Elementary /Secondary (0.12) College (1.4 or 5+) Widowed, Divorced (Specify) ^Yes ~]No 1 2 W1dOWed 16. Decedent's Mailing Address (Street, city /town, state, zip code) Decedent's p A Did Decedent M i d d 1 e s e x Li i id , 7 l R s A t 13 2 5 Oak Lane ve es n a „~, T~ ence a. tate c ua Yes, Decedent Lived in New Cumberland PA 17070 Township? ~vedwithin 17b.County Cumberland 17d. ^ q eL me j e i sol City I Boro 16 Father's Name (First, middle, last, su6iz) 19. Mother's Name (First, mkldle, maiden surname) Llo d Wesle Enders Sr. Mar Stone 20a. Informant's Name (Type /Print) 20b. Informant's Melling Address (Street, city /town, state, zip code) Jo Hamsher 1325 Oak Lane New Cumberland PA 17070 21 a. Mettwd of Disposition ~ ^ Cremetbn ^ Donation 21 b. Date of Dispositlon (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or omer place) 21d. Locaton (City /town, state, zip code) ® Burial ^ Removal from State i Wee Cromatlon or DorteUon Authorized ^ aher • speciry: by Medkel Ex ins, / Coroner? ^ vas ^ No $ e t . 2 8 2 0 0 9 p - I rid i ant own Ga Na t i one 1 Cem p A n n v i 11 e , P A 1 7 0 0 3 a. r ref a Licensee ~~ygtgon acting as suc 22b. License Number 22c. Name and Address of Facility , ~~ GTO~~'-•~` + FO 012342-L Stone & MurrayF.H.,408 3rd.St.,New Cumberland, PA 17070 C e Items 23a•c only when certifying ph icier is not avatlable al time of death to 23a. y knowledge, death occured at the tl place stated. (Sgnature and title) z.-~ ) ' 23b License Number ,~~ ~ ~L 23c. Date Signed (Month, d y, year) ~ cacti cause o1 death. ~, / " 1.~ s ~ 3 y ~~~~7 ~ ` , Z Items 24-26 must be completetl by person who praaunces death 24. Time of Death ~ ~ ~ y 2 e Pronou ad (Month, day, year) n ~ ~ ° -- ' ~ Z ~ ~ ' - b 26. Was Case Referred to Medical Examiner 1 Coroner for a Reason Other than Cremation or Donation? . . M ` ~ ~ 7 Y ~ ~ ^ Yes No CAUSE OF DEATH (See instructions end examples) r Approximate interval: Item 27. Pert I: Enter the chain of events -diseases, injuries, or compficetions -that directly caused the death. 00 NOT enter terminal events such as cardiac avast, r Onset to Death Part II: Enter other ~gnNicant conditions contnbutin91g death, but not resulting in the underlying cause given in Pan L 28. Did Tobacco Use Contribute to Death? ^ Yes ^ PrabaWy respiratory avast, or ventricular fibdllatlon without showing the efiofogy. List only one cause on each line. t ~ ; IMMEDIATE CAUSE (Final disease or ^ No ^ Unknown a ~ ~~~ condition resulting in death) ~~ 29. If Female: Due to (or as a consequence of): ~ ^ Not pregnant within past year Sogtranbe Irst catdkions, ff any, b. r leadi to a cause listed on line a. Pregnant at lime of death Due to or as a con Eller lRJDERLYING CAUSE 1 sequence of r r ^ Nol pregnant, but pregnant within 42 days ersease or injury that infliatad the c. r ants resuting in death) LAST, r of tleath Due to (or as a consequence ol): r ^ Not pregnant, but pregnant 43 days to 1 year d, ~ before death ^ Unknown N pregnant within the past year 3~. Was an Autopsy Performed? 30b. Were Autopsy Findings Available Prbr to Completion 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occuved 32c. Place of Injury: Home, Farm, Street Factory, of Cause of Death? ^ Natural ^ Homicide Otfice Building, etc. (Specify) ^ Yes ~.No ` ' ^ Yes '[~10 ^ Acddent ^ Pending Investigation 32d. Time of Injury 32e. Injury et Work? 321. If Transpodation Injury (Specify) 32g. Location of Injury (Street, city I town, state) ~ ^ Suicide ^ Could Nol be Determined ^ Yes ^ Na ^ Driver /Operates ^ Passenger ^Pedesirian M• Other- S r ^ P~ fy 33a. Certifier (check only one) 33b. Signature and Td rtifie • Certifying phyelcfen (Physican certifying cause of death when another physician has pronounced death and completed Item 23) T th b ! j o e est o my knowledge, death occurred due to the cause(s) end manner as atated_ _ _ _ _ _ _ _ _ _ ., _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ • P ~ ~--~ ronouncing end ceAltying physician (Physician both pronouncing death and ceriying to cause of death) To the Nest of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ Metlleal Ezaminer I Coroner 33c. License Number ~ ~~ ~„%~ ~ . 33d. to ~ igned (Month, day, year) t r ,/ ~ jr . On the beats of exa inat{ tl I tl I fi I ~~~ y ,~ ~ ,, ~ ~ ~,~ `-! m on an or nvea ga on, n my opinion, death occurred at the Nme, date, and place, and due to the cause(s) and manner as atated_ ^ 34 Name Ad ress of Person Who Completed {se of Death (Ite ~ m 2 T Print ~ Registrar's nature and Dis ' mhr~-~ I ~r I I ~ ~ ~I I 36. Date Fled (Month, day, year) / / ~ ", ~~~ y~~ ~ ' "~ - "` ~~'i~ r f '~ ~`- ' ~ i i r i s i r 1 rlicnncilinn Parmil Nn ti ,_,- ..~ I, HELEN E. MILLER, a resident of the Borough of New Cumberland, Cumberland County, Pennsyl~a. nia, b~i~g of sound and disposing mind and memory, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ITEM I. I direct that all my just debts and funeral expenses by paid as soon after my decease as may be found convenient. ITEM II. All the rest, residue and remainder of my estate, real or personal, which I may own or have the power to dispose of at the time of my death, I give, devise and bequeath unto my husband, Charles W. Miller. ITEM III. In the event my husband, Charles W. Miller, shall predecease me, I give, devise and bequeath my entire estate, real or personal, in equal shares, unto my children, Joy M. Hamsher and• Cindy M. Evans, If either of my said children shall predecease me, her share shall go to her surviving issue, if any, in equal shares, otherwise to my surviving child. r ITEM IV. I hereby nominate, constitute and appoint my husband, Charles W. Miller, Executor of this my Last Will and Testament, with full power in his discretion to do any and all things necessary for the complete administration of my estate, with full power to sell at public or private sale and without order of court, any real or personal property belonging to my estate, and to compound, compromise or otherwise to settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate as fully as I could do if living. In the event that my said husband, shall predecease me, I hereby nominate, constitute and appoint my daughters, Joy M. Hamsher and Cindy M. Evans, Executrices with full powers as set forth above. IN WITNESS WHEREOF, ~ have hereunto set my hand and seal to this, my Last Will and Testament, this 'Z~ day of ~~ A. D. , 1978. -•• ,. ~~.~!.~c~,~ ~`''/ V~,. G~L,~~ SEAL) Signed, sealed, published and declared by the above-named Helen E. Miller, as and for her Last Will and Testament *~°~ '~ - ti in the presence of us, who, at her request, `'ti-, ~ -~.-~ t' in her presence and in the presence of -R-~ ~ ~.Y' ~`~ ~ c ~) ---~ ~ t~7 each other, we believing her to be of ~.;...; N ~ ~, j ..~ ,,~ sound and disposing mind and memory, I. ,.; ~'' t ~ `.~ have hereunto subscribed our names as ~-~~-~•~ :...~ witnesses this ~~ day of °~' ,' ~ • ~ ~ ~~ A. D. , 1978. ~ ~ '' ~ ~,. {.`+ .....,..,...».__ ~ Y _......_...._...,/,_,~ ~i.,,~ . (~