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HomeMy WebLinkAbout06-25-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of MITZI WINTERS MORONES File Number 21 10 (1(11 ~.~ also known as MITZI MORONES Deceased Social Security Number 191-46-0330 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 Testamentaryand aver that Petitioner(s) is 1 are the Executor named in the last Will of the Decedent dated and codicil(s) dated none (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 (If applicable, enter: c. t. a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate) 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. ord. b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal residence at 21 North Middleton Road Carlisle PA 17013 North Middleton Twp. (List street address, town/city, township, county, state, zip code) Decedent, then 54 years of age, died on 3/3110 at 328 S. Railroad Street Palm ra Lebanon Coun PA 17078 Decedent at death owned property with estimated values as follows: rv (If domiciled in PA) All personal property $ C7 ° 1,000_ QO (If not domiciled in PA) Personal property in Pennsylvania $ ~' Q ~ ~:A ~ ' ` (If not domiciled in PA) Personal property in County $ ~ ~ G ~ ~:--' ~~~~' Value of real estate in Pennsylvania $ -~ r- ~ ' c n ~,.~ ~' _.:' ~: ~ ~ ~~ c. ~ ~: -v ..:. _ situated as follows: ,~~ ~ ~' °=---~- Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant o~,etters in the ~ypropriaxe'6ar'r~7to the undersigned: ~ ~'' Signature Typed or printed name and residence ' Michelle Winters 622 Woodlawn Avenue Mt. Holl S rin s PA 17065 Page 1 of 2 Form RW-02 rev. 10.13.06 ~ ''=+~ (COMPLETE INALL CASES:) Attach additional sheets if necessary. 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 ntiily administer the estate according to law. Sworn to or affirmed and subscribed before me the ~~~ day of .-_ n~ n l ~ ' _~~.. For the Register Signatur ersonal Representative Michelle Winters ~ ~ Signature of Personal Representative '~ ~ ~ ~_" ~ '~~" " '~ Signature of Personal Representative ;;:~- ,~-~ ~ ~ --, r~ -,-, '~ ~~~ ~:~ _ _ o ~, ~ ~ ~, File Number: 21 - ~ ~ _ ""' Estate of MITZI WINTERS MORONES ,Deceased k_~ ''1 E • i '''2 _•__ f _.;_; - _~~ .;_` . •°.~ c"~`~i Social Security Number:191-46-0330 Date of Death: 3/3/10 AND NOW, __S ~ ~ ~~ t~ ~ , 2010 , in consideration of the foregoing Petition, satisfactory proof' having been presented before me, IT IS DECREED that Letters Administration are hereby granted to Michelle Winters 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 Decedent. ~~ FEES $ Register of Wills ~Q ~' ~ ~ ~~ Letters ............................. ~-- `~ " Short Certificate(s) $ Attorney Signature: Renunciation(s) •••••••••••••••• $ ~ . ~ _ . $ ~~ ,~~ Attorney Name: Seth T 1Vlosebey ;1 • • • • _ $ `-~ r ~, Supreme Court I.D. No.. 203046 .... $ $ Address: 10 East High Street • • • • $ Carlisle .... $ •••. $ PA 17013 .... $ Telephone: 717-243-3341 $ _ _ ~ ;~ ~ (~ TOTAL ............................. $ Form RW-02 rev. 10.13.06 Yag~ Z Of Z 105.905 REV.(3/09) r _ This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. Linda A. Caniglia State Registrar ~~ H105-143 REV 11(2006 TYPE /PRINT IN PERMANENT BLACK INK a W ~ ~ 4 4 • :n +7J V ~~ V 0 5500167 No. Date r X P STATE FILE NUMBER MAR 242010 , COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH • VITAL RECORDS CERTfFICATE OF DEATH See inst uctions and a am les on reverse) 1. Name of Decedent (First. middle, last. suffix) 2. Sex 3. Sosial~$ecuriry Nlxnber46 0330 4. Oats of Death (Month, day, year) l~ l1 - - March 3, 2010 Mitzi Winters Morones female 5. Age (Last Birthday) Under 1 year Under t day 6. Date of Birth (Month, day, year) 7. Bidhplace (City and slate or lorei n country) 6a. Place or Death (Check only one) 54 ~°"'n~ ~s "°"`~ "~"Iaa May 22, 1955 Carlisle, PA Hospital: Other: Yrs. ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home g] Residence ^Other -Specify: fib. County of Death Bc. Cay, Boro, Twp. of Death Bd. Facility Name (It not instiiutbn, give street and number) 9. Was Decedem of Hispanic Odgin? No ^ Yes 10. Race: American Indian, Black, White, etc. Lebanon Palmyra 328 5. Railroad St . ar yea. =pacify Cuban, (spera(y~ White Mexican, Puerto Rican, etc.) 71. Decedent's Usual Occ lion (Kind of work done B urin most of worldn Gfe. Oo rat stale retired 12. Was Decedent ever kt ttte t3. Decedenfs Education (Specify onty highest grade comp leted) 14. Marital Status: Married, Never Married, 15. Surviving Spo use (If wife, give maiden name) King of Work Kind of Business I Industry U.S. Armed Forces? Elementary / Secontlary (0-t L) College (1-4 or 5+) Widowetl. Divorced (Speci/7~ Food Store ]Yea ^NO 12 Divorced 16.~ede nt's MaNI Address (y~e~ city/town, eta zrp cube) th Mldp`1 eLOn ~Oaq N Decedent's Did Decedent PA Live in a t 7 N Middleton Tw Y D d t Liv d i l R id n sl A L1 or PA 17013 Carl isle _ en p. ctua es ence a. ate c. es. ece e n Cumberland Township? t 7tl. ^ No, Decedent Lived within 17b Count , . y Actual Limits of City! Born 7fi. Father's Name (First. mitldle, last, suffix) Gerald Winters 19. Marher's Name (First, middle, maitlen surname) P McElro ~J9Y Y 20a. Informant's Name (Type !Print) 20b. Informant's Mailing Address (Street, pry ;town, state, zp code) Michelle Winters 622 Woodland Avenue, Mt. Holly Springs, PA 17065 21a. Method of Disposidon ^ Cremation ^ tbrtatan 21b. Date of Dispositbn (Month, day. year) 21 c. Place of Disposition (Name o1 cemetery, crematory or other place) 21d. Location (Gty /town, state, zip code) ® Bunal ^ Removal !Was Crodtetbn or Donator Authorized March 8, 2010 Cumberland Valley Memorial Garde s 17013 P l i l ^ Other - Spea'ry: by MedkN Examiner f Coroner9 ^ Yes ^ Ntl s e , A Car 22a. Signature neral Servic Lic person cling as such) Number 22c. Name and Address ar Facility Hof fman-Roth FUneral Rome & Crematory, Inc . - 138504 v Street Carlisle, PA 17013 Co a Items 3e 3a. To Ina Desl of my knowledge, death occurred at the time. dare and place stated. (Signature and tole) 23b. License Number 23c. Date Signed (Mon th , day, year) phy ry an w not of death to ~i' V A ~ {~ L ~ ~~ yy C~ ~ - C~ 3 - G ( ~ rxarti cause of ih. • ~ ~ - - ; F- o EC Items 24-26 must be completed by person 24. Time of Dee _ 25. Date Pronounced Dead {Month, day, yr) 26. Was Case Referred to Medical Examiner !Coroner for a Reason Otner dtan Cremation or Donation? who pronounces death. ~ : 3Gy (in M. m A,T ~ 3~f C'I ~ ~ ~ l~ ^ Yes ~No CAUSE OF DEATH (Sae InstruMlons and examples) r Approximate interval: Pan II: Enter othersjgnifk "1 condlions contdbudnq to deadr, 28. Did Tottacco Use Contribute to Death? Item 27. Part I: Enter the chain of events -diseases, iryuries, or cortpiicetbns -that directly caused the deatlt DO NOT enter termktal evens such as caMiac arrest, I Onset to Death but not resulting in the undenying cause given in Part I. ^ Yes ^ Probably respiratory anesL or ventricular fitxiilaaon without showing the eddogy. List only one cetue on each fine. ~ ^ No ^ Unknown IMMEDIATE CAUSE (Final disease or r ~ Q~~ ~~ sy, '~ ~M ~~ i conditron resulting in death) _~ a fv~ jpyt, f ~ 1~ 4~ 29. If Female: ^ N ithi t n Due to (or as a consequence o : r ot pregnant w n pas year ^ Pregnant ai tlrne of death Sequantielty Xst caWitions, it anY. b. i leading b the cause Ns[ed on Hne a. Due to (or as a consequence o t Enter the UNDERLYING CAUSE ~~ t ^ Not pregnant, but pregnant within 42 days (disease or injurytfrat irutiated the o. t t ltin n death) LAST eve ts r s of death u g i . n e Due to (or as a consequence of): r ^ Not pregnant, but pregnant 43 days to t year d ; ttefore death ^ Unknown it pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Deatn 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, Pedormetl? Available Prior !o Completbn of Cause o1 Death? p~ NaWral ^ Haridde J°~ Office Buildirg, etc. (Specify) ^ Yes ~ No ^ Yes [] No ^ A~zdent ^ Pending Investigatbn 32d. Time of Injury 32e. Injury at Work? 32f. If Transpodation Injury (Specify) 32g. Location of Injury (street, dry /sown, stale) ^ Suicide ^ Caltl Not be Determined ^ Yes ^ No ^ Driver! Operator ^ Passenger ^ PedesMan M ^ Other - Specity: 33a. Certifier (check only one) 33b. Signature and Title of r - • CeRitying physkkn (Physician certifying cause of death when another physician has pronanced death and completed Item 23) To the best of my knowledge, death occurred due to the cause(s) end msnrter as atafer!_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~ - • PronounNng and certifying physcian iPhysiaan both pronouncing dash and certifying to cause of death) ^ h 33c. License Num 330. Date Signed ( onth, da year) e cause(s) end manner ea sfafad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ To the best of my knowledge, rieath occurrctl at the lima, date, and place, and due to t • Medicel Examiner 1 Coroner ) ~ C~ 6 On the basis of exeminetlon end ! or investigetlon, In my opinion, death occurred at the time, date, and place, and due to the cause(sj and manner as stated_ ^ 34. Name and A~ddress of Person Wfa Completed Cause of Deat Item 27) Type /Print ~ Registrar's I and Disl er 35 ` r' 36. Date Filed (Month, day, year) ,( LIS~ t~ vnl G~ ~'ft ~ ~~SG . ~ea,c~,~ - ~ . De-`~~ I,` ~. 11 I ~ I t I C I ' 1~! v P~ b . _ 5 ./ ~s r• - 7 r Disposition Permit Na. v `t.,J ~~(p i~ Q P'~.1 C"""Y G1 '`'1 -l.s "~ .. C!~ ~ U1 r~ r ° _I_~ ~ , (_.r ~ ,~ .. -, ~`- ; :, ~~© ~ _ -.` --1 fy y- ~`Y""i ' ~ ~,.<~ ...r 05!17/2010 10:21 717-243-1850 MARTSON LAS PAGE 02!02 RE~LTNCIATI~N - ''' '~ -:~ c ~ ~- -r, REGtS'x'1/R OF WILLS -:r~ ~ r ~ ~ ~' ~ ,~~ c COUNTY, PENNSYI:.V,~NIA ,- ~" i-r-t ,- ~= ~ i;J? ~ (V cn ~ ~ ~ ` ' -: . ,.._ ~ .. ,i -..~ ~ rv ; " .T ~~i ~.. -; i Estate O.f M1."I'~'I ~)Y -S A/K1A 1:~IIT~I h'S P. , .1~CCCascu ~, SHEILA R. WINTERS , in my capacity/relationship as (1'riKf Name) DAUGHTE>E~___. of the abarre Decedent, hereby .renounce the right to aclmini.stcr t11e Estate of the Decedent and respectfully request that ~.etters be issued to 1VIICHELLE WIN7 ~.RS s rnR,p1 Rxecuted. in Register's Qce Sworn to or affirmed and subscniheci befv:e me this d.av of (Sigrrnlure) 473 Wa nc Avenue (Street Address) C~arr~hcrcbur~--.-- PA t 72~ 1 FGirv. Sialc, Zip) .~acecuited nut ~f,~'egfster's Uffee Before the undersigned personally appeared 'the p~rti e:~ecvtirr<g *.;his renunci.atioia arld certified that tae ~or she executed the rcntar~riatinn for the pu~st~d. within on th.' ~~~ day af. ~ ._..~ , z . ~~ Deputy folr Registor of Wills Forr~t RW-06 rcru J0.13.OG Alotary Public My Carnmi ssi on Expires: ~~`~ d /~ `CS (Sign~luYt ttncl Scal a~l' Notary or other nfi"icial gtii~liFCd 14 administer aathn. Shrrwdat~ ~1'cxpirati0n of Nuta~'y's C'ommistir~~n.l ~tiOMMONWEALTH OF PENNSYLVANIA NOTARIAL Sl:AL Victoria L. Otto, Notary Public Carlisle Borough, Cumberland County M commission ex ins December 20, 2010