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HomeMy WebLinkAbout01-08-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of also known as __ COUNTY, PENNSYLVANIA File Number 21-10- pU- ~ ,Deceased Social Security Number 185-22-0910 Wayne M. Minich Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE `A' or `B' BELOW.•) QX A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the last Will of the Decedent, dated 08/27/2006 and codicil(s) dated 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 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: B. Grant of Letters of Administration app Ica e, en er: c..a.; ..n.c..a.; en e i e; uran e a sen ia; uran a m~non a e Petitioner(s~ after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) anirs: (if Administrat-on, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list ofheirs.) C'? _.... Name Relationship Residence ~_; ~ C7 ;~ ~ ~. ~_. , ,rte -~ -, t. _ . ; .. ~ . F f ~ .. _ t'_ J 1.... ~~ ~ ~~ ~~ 'r+f (COMPLETE /N ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 104 W. Green Street, Shiremanstown, Shiremanstown Borough, Cumberland, PA 17011 (List street address, town/city, township, county, state, zip code) Decedent, then years of age, died on 12/17/2009 at 104 W. Green Street, Shiremanstown, PA 17011 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: 104 W. Green Street, Shiremanstown, PA 17011 11,000.00 160,000.00 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 Wayne M. Minich 52 Skyline Drive ~ , , ~ ~ ~ _ "'r7 ~ Mechanicsburg, PA 1705 i Geraldine M. Minich Form KW-Ul Rev. 10-i3-2006 Copvrighi (c) 2006 form software only The Lackner Group, Inc. Page ' 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. 4 Sworn to or affirmed and subscribed ~~ before me this ~ day of , DIU For the Register < < Signature of Personal F~jepresentative "~yayne M. Minich ~,.:, U ~ ~ ; ~ ~ ~-:_~ :.:y •-r•y C... i . Signature of Personal Representative ~,;;.. ""C'7 _~? "1"' 1'1'1 1 ~ - , 4 r~ ~~ Signature of Personal Representative ~--~ ~'> ~^: ~,,, y , ^ © _' ~ `~- -..! File Number: 21-10- (~ ~ ~.} Estate of Geraldine M. Minich ,Deceased Social Security Number: 18Q5--22-0910 Date of Death: 12/17/2009 AND NOW, O ~~1 ~ , in consideration of the foregoing Petition, satisfactory proof having been presen d efore me, IT I DECREED that Letters Testamentary are hereby granted to Wayne M. Minich in the above estate and that the instrument(s) dated 08/27/2006 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............................................ $ a~D~ • C~ C~ Short Certificate(s) ........................ $ ' (D . ~~> Renunciation(s) .......... .................. $ ~ ,J , L-~ $ l S-- O~ ~ ~S $c~~.SZ~ $ $ $ $ $ $ TOTAL .................................... $ ~ ~~ •~ lJ A~ Al Aaaress: 429 South 18th Street Camp Hill, PA 17011 Telephone: 717/730-7310 Firm RW-OZ Rev. f0-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Supreme Court I.D. No.: 41263 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. F'ee for this certificate, $6.00 P 15934186 Certification Number REV 11/2006 /PRINT IN MANENT tCK INK 1. Name of Decedent (Prat, middle, last, suffix) 5. Age (Last Birthday) Under 1 year Under 1 day 8 ~ Months Days Hours Minulas Yrs. 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. ~Gr,~.n.- ~~ ~ DEC 12 9 Local Registrar Date Issued C7 t'v '~' ~~ ~ ~ S C`~ /,_rc-•rn I ~-' ~' -~~ ~:~ ~~~ C~C3 -LLB ~ _ ~ 2~ r)~ -:.~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS - ~ 00 CERTIFICATE OF DEATH ;~~. C7 (See instructions and examples on reverse) STATE FILE NUMBER +•..~ 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) fe 185 - 22~~- 0910 Dec. 17 2009 6. Dale of Bidh (Month, day, year) 7. Binhplace (CNy and state or foreign country) 6a. Place of Death (Check only onel May 8b. County of Death 6c. Ciy, Boro, Twp. of Death Dauphin Co. Susquehanna Tw 11. Decedent's Usual Occ Non (Kind of work done dur' most of world Irfe. Do not state retired Kind of Work Kind of Business /Industry beautician dept. store 16. Decedent's Mailing Address (Street, city /town, state, zip code) 104 W. Green St. Shiremanstown, PA 17011 16. Father's Name (First, middle, last, suffix) Leitheiser 20a. Informant's Name (Type I Print) Wayne M. Minich 21 M thod r ,r ~ r' , , ~. J .f >==~ r . ~ --- - ,.. ) .-i. j (-,.( . _.:?, - ,...,,.,,o,. vmer: Q ~~ ~ -- 2 8 , 19 21 Columbia , P A ^,npatient ^ ER /Outpatient ^ DOA r~~ S ^ Nursing Home ^ Residence l~tnner - Specity. fid. Facility Name (II not institution, gNe street and number) 9. Was Decedent of Hispanic Origin? ~ No ^ Ves 10 Race: American Indian, Black, White. etc. p (If yes, speciy Cuban, (Specify) C . C . Slane HO S p l c e Residence Mexican, Puerto Rican, etc.) whit e 12. Was Decedent ever in the 13. Decedent's Education (Seedy ony highest grade completed) 14. Marital Status: Married, Never Married, 15. Surviving Spouse (If wife, give maiden name) .__... U.S. Armed Forces? Elei 2tary /Secondary (0.12) College (1-4 or 5+) Widowed. Divorced (Specify) ^Yea No 1 widowed Decedent's Did Decedent ••--- Actual Residence 17a. Slate -P e ri n S ~7-_ 1 S>• Q n i F, Townshi ~ 17c. ^ Yes, Decedent Lived in p Tw . 17b. County Cumber 1 a n d p 17d. ~ No, Decedent LNed wit Actual Limits of ___ ~ } 1 1 Y P Tyl a n C f n Stir T'1 City !Boro 19. Mother's Name (First, middle, maiden surname) • Fannie 2pb, Inlonnant's Mailing Address (Street, city 1 town, state, zip code) 52 Skyline Dr., Mechanicsburg, PA 17050 a. a of Disposttan I Cremation U Donation 21b. Date of Disposition (Month, day, year) 21c. Place of Di Burial Removal from State ~ sposAbn (Name of cemetery, crematory or other place) 21 d. Location (City I town. stale, zip code) ^ ^ Wsa Crematbn or Donation Authorized 17 O 6 5 ^ Other -specify: by Medksl Examiner / CoronerT ~•~Yea ^ No Dec . 21 , 2 0 0 9 H o 11 i n g e r Crematory M t . H o 11 y Springs , P A lure of Fun Service Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Fadliy FD-013163-L Musselman FH~rCS,32 e Hems 23ac ony when cenitying 23a. Te the best of my edge, death occurred a1 the time, date and place staled. (Signature and tiNe) physician is rat available at lime of death to ~ ~ .~ certify cause of deaM. ~-~-~--• L- Items 24-26 must be completed by person 24. Time of Death _ 25. Dale Pronounced Dead (Month, day, year) who pronouraes death. ~ C~~ ~ M. (1~~~_V~ 1•,. ~ ~ ~ ~ ~~ ~~ CAUSE OF DEATH (See instructions and examples) J i Approximate interval: Item 27. Pan I: Enter the Chain of events -diseases, injuries, or complications -that directy caused the death. DO NOT enter terminal events such as cardiac arrest, r Onset to Death respiratory arrest or ventricular fibriNation without showing the etiology. Ust only one cause on each line. r IMMEDIATE CAUSE (Final disease or r condition resulting in death) -~ a "' r r Due to (or as a consequence ol): r SequemiaNy list conditions, if any, t leading fo the cause listed on line a. b ~ Enter the UNDERLYING CAUSE Due to (or as a consequence of): r Sdsease or injury that initiated the r vents resulting m deaM) LAST. c~ r Due to (or as a consequence of): r d. r r 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month, day, year) 32b. Describe How Injury Occurred Penormed? Available Prior to Completion of Cause of Death? Natural ^ Homicide 4 Hummel Ave.,Lemoyne,PA 17043 23b. License Number 23c. Date Signed (Month, day, year) 26. Was Case Referred to Medical Examiner !Coroner for a Reason Other than Cremation or Donation? ^ Yes No Part II: Enter other significant caditbn~ conMbuting to death, but not resulting in the underying cause given in Pan I. 26. Did Tobacco Use Contribute to Deafh? ^ Yes ^ Probably ^ No ^ Unknown 29. If Female: ^ Not pregnant within past year ^ Pregnant al time of death ^ Not pregnant but pregnant within 42 days of death ^ Not pregnant, but pregnant 43 days a t year before death ^ Unknown it pregnant within the past year 32c. PWce of Injury: Home, Farm, Street, Factory, ONice Building, etc fSpecrfv/ ^ Yes ~ No ^ Yes ^ No ^ Accdent ^ Pending Investigation 32d. Time o1 Inury 32e. Injury at Work? 32f. II Transportation Injury (Specity) 32g. Location of Injury (Street city /town, state) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Dnver /Operator ^ Passenger ^PedesMan M' ^ Other - Specity: 33a. Ceniker (check onty one) 33b. Signature a of Certifier ~--•- '~ i • CertNying physician (Physician certifying cause of deaM when another physician has pronounced death and completed Item 23) To the best of my knowledge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ i- • Pronounelrg and certifying phyelden (Physician both pronouncirg death and certiying to cause of death) 33c. License Number '- To the best of my knowledge, death occurred at the time, date, and place, and due to the carlse(s) and manner as sfetad_ _ _ _ _ _ _ _ _ _ _ _ ^ 33d. Date Signed nth, day, year) • Medical Examiner I Coroner """""" M 1 ~~~ ~ r ~ (~ / l~~ On the basis of examination and 1 or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ ^ 1 , ` Cl V 34. Na and A(d~dress of Person Who Completed Catise of Death (Item 27) Type /Print 36 Registrar' store and Dis 36. Date Fi (Mon day, year ~ ~ 1J E'~ ~ - ~ v S Z ~ v ,S r f ~ ' ~L~.- L _'~I ~ I vt I ~ i ~ I ~d~ ~~~ no~ Zo`Z ~'~~~ ~ ~, . ._ l Disposition Permit No. O ~ o~ O ~~~ (?~,~ ~,.~ ~ ~~ ~~ ~Q , ~ t_ .,..A~ ~~I`j~ ~~ 1 ! !~ r ^ f 1 _ - I, GERALDINE M. MINICH, of the Borough of Shiremanstown, Cumberla~rd County ° ~~`' Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my death as a part of the expense of the administration of my estate. ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all other articles of household and personal use, equipment and ornament, together with all insurance thereon and relating thereto, to my son, WAYNE M. MINICH provided he survives my death by thirty (30) days. Should my son predecease me or be deceased on the thirty-first day after my death, I give and bequeath all such items and insurance thereon to my daughter-in- law, BARBARA A. MINICH, provided she survives my death by thirty (30) days. ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate to my son WAYNE M. MINICH provided he survives my death by thirty (30) days. Should my son predecease me or be deceased on the thirty-first day after my death, I give, devise, and bequeath all the rest, residue, and remainder of my possessions and estate of every nature and wherever situate to my daughter-in- law BARBARA A. MINICH, provided she survives my death by thirty (30) days. .~ ,- .~ 1 ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my son WAYNE M. MINICH executor of this my last will. Should my son predecease me or otherwise fail to qualify or cease to serve as executor of this my last will, I appoint my daughter-in-law BARBARA A. MINICH executrix of this my last will. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ~ri ``. 2 ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~ day of q ~~ ~5 ~ , 2009. s . GERALDINE M. MINICH 3 The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by GERALDINE M. MINICH, the testatrix herein named, as and for her last will, in the presence of us, who at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ,-, Q. {7Lm-B, 4 COMMONWEALTH OF PENNSYLVANIA ( SS: COUNTY OF CUMBERLAND ) The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expresse . r • ~ ERALDINE M. MINICH Sworn or affirmed to and acknowledged before me by the t atrix name above r i ay of , 2009. ~ -~ pF ~~~ tVc~rlel Seed VV'erxfy K Sba~~b, NoM1ery Pubi~a Notary Pub c ~' Two., Cixr~beitand County My won fires May 10, 201 ~ ~ennsyt~enia ~SSOClation of Nviarie~ COMMONWEALTH OF PENNSYLVANIA ) ( SS: COUNTY OF CUMBERLAND ) WE, ~ i ~~~~ L ,~H is and ~ ~ r~ ~ /' ~ /~`~ /~/ ~~~ ~ ~ _ / ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified !according to law, do depose and say that we were present and saw the testatrix sign and execute the instrument as her last will; that she signed it willingly and that she 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, the testatrix was at that time 18 or more years of age, of sound mind, and under no constraint or undue i fl ence. a affirmed acknowledged h' day of 2006. Nod c~v Public Rtota~el Seel Wendy K 3't~ab, Nosy PubNc lvr+tir Allen Tw{a., Cumbe-land County My Ccxnmiss+on E May 10, 2011 Asso~datlon of Notad~s