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HomeMy WebLinkAbout08-13-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C.~,t,1v~~P ~ ~ G fyti ~ _ COUNTY, PENNSYLVANIA 1,, c ,.~ Estate of ':~~ Qt ~' ~ Vl C~_ ~~ ~ y ~~ ~'- _ _ File Number _ -~ 1-41~;~ "" ~~--~ ~C also known as ~ J' +~Z ~ 1 S~~ 1 rr eased Social Security Number Z ~ ~~ - O ~ ~ ~ r ~ ~O Petitioner(s), wllo is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) A. Probate and Grant of Lett rs Testamentary and aver that Petitioner(s) is /are the ~ t7 ~ G , ~ •~ ie named in the last Will of the Decedent dated ~ C7 (~ ~ and codicil(s) dated (State relevm,t 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; instntment(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 life; durante absentia; durante nzino,-itate) 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 Adtrtitzistration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationship _ Residence ~ (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in L. ~ C~ ~ C~County, Pennsylvania ~ r ~ ~ ~ L. (List street address', tow„/city, township, count), state, zip code) his /her last prir}~ip~residence at Decedent, then ~_ years of age, died on ~ Q_ at ( ~^ L~ ~ ~ ~ Q1 l~. ~~T C~ '~~- Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ Z~6 ~'`~ O ~ (If not domiciled in PA) Personal property in Pennsylvania $__Z.~,__T O c~ (~ (If not domiciled in PA) Personal property in County $___,;~~ ~ o ~ Value of real estate in Pennsylvania $` C~ ~ situated as follows: 9~ O ~J~.~ _ 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 appro~i~ate form to the undersigned: _ Signature Ty ed or Tinted name and residence ~_ ~ C~_~ ~ - j ,~~ ~ .~, V, c~ ; _ ~ > ;>~; r . ' _, ~~ ~ , -_.._ - j ,_ .. -~ ~~-~, Form RbV-0? r~,-. ro.l3.oh Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF 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, Sworn to or affirmed and subscribed before me the _~~~ day of ~, r ,~,.~...,_,r- For the Register ~~52. ` Signature of Personal Representative Signature of Personal Representative Signature of Persona! Representative ~p ~ ~ File Number: ~ ~ -` ~ l.• ' " ~ ~ ~~~ ~` -- Estate of ~ ~r~-' 7 1~ `~-~'C~~ ,Deceased Social Security Number: Date of Death: ~ I ~-~' ~ U_ AND NOW, ~ ~~~ ~~~~'Ll~ ~ ~~ 1 ~ ~~~-' ~ h'~ , in coLnsideration of the foregoing Petition, satisfactory proof having been presented before,_me, IT IS DECREED that Letters ~L_ ~ 1~.:.~1~-~-~ (~.~~ ,~- ~_ . are hereby granted to ~ ~L~ ~G~ ~ ~ ~ ~~~ ~~~~~'-~~ ~ '--'~ ~7 ~- \ in the above estate and that the instrument(s) dated ") 13L> ~ l described in the Petition be admitted to probate and filed of record as the last Will FEES :~ l.~ ~ ~" Letters ............... $ ' Short Certificate(s) ........ $ r ~ ~ ~ ~ Renunciation(s) ......... , $ ~_ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL ........ e ..... $ L~ ~ r~, rJ I"or~rt RW-D? rev. 1U.13.Dt Attorney Signature: Attoi7~ey Name: Supreme Court I.D. No.: .Codicil(s)) of Decedent. ~:,t,~~-L~'~t.r_~ ~, Regtsterof Wil ~, ~ ~ ,ll l C t_ ~- ~ Address: ~....~ ~ -~ :~ __ r l;_> ~' Telephone: M1 J~ir ~ ~~ c--~ ~-- ---- - -- - --, tv ~ _~ „ ~ --c~ -` ' :~,: _T -; ~ - :,a _ ~ ~~ _~ © ,~ ~^? Page 2 of 2 s~~ ..~. (~ t{' S~af~~~~ )'%~ t,.l~?~1~:'"~~ti °~•aw~ .t•~,~, ~f' ~xlt~~~t;)..:;~t~ (?~" p:~9~7+i~~t~~~1~'~I ;. .,~. 4~ ~ ~.. ~6 awl w.t! ;, ; I,' b~~N ilt- ¢J _ t. y ~~1~ r ~.. k A n ~ c ~ :' "~li, t ,);~' ,f~tll-'Tirl(la'~I1 (1~'1~~ ::1`~~Lll ]ti r~s~.. r •, ~. ,~:~ -1:• )~ t~,~ , ~lujl t ~ 'litlc.)ih t)1. Oeatlt I~"' ~,_" ~. {~7 '~, g.i1,' ~~i''i~i,'-;lt~. ~~lt' ty1'it't]]~ .i. ~' Irt.:i_)~~1O 1~~1~1~~~. 7 /J a ,~ t~ ~ =' s _ ~ C~ ,:. ,., `~ : ~ _ -rl . x~ I- _..~y) ~~ , , i "~"~ .,..... t T , .. ... ..- '~' 1 i, y. I COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ CERTIFICATE OF DEATH -- ~ - ~~ (See instructions and examples on reverse) STATE FILE NUMBER C~} ~ ~~ R105rt~HE'v 11;2006 TYPE ~ PRINT IN PERMANENT BLACK INK 0 i .~i Z 0 W U 0 I Name d Decedent (Post, mdde. last. SuhiKl 2. Sex 3. $ociW $eCUhty NtartDer 4. Odle a Death (Hpnlh, da . r) Martha L. Sieg emale 204 -03 - 4156 August 4, 2010 5. Age ILasl &rtMayl Under t year Under t day 6. Date a &rtn (tAOrutt. day. year) 7. t3uthplate (City and rote a la t country) Bor. Place d Deam (Checx Dray one) 9 0 rrs owns Days thus AY~Wes 1 0 / 1 1 / 1 91 9 M a r y s v i 11 e , P A Hosplal: ^ IrpatierN ^ ER , Outpatwiru ^ DoA otter. g}~„<=.n~ trans ^ Residence ^Omer Specrfv 8b County of Death & Ciry. Sao. Trop a Death 8d. Facility Name (II rtot vtsululwn, give erred artd rxxttper) 9 Was Deeedatt of Hispanic Ortgrn? (v1 No ^ves 10 Race'. Amencan IN~an. Blac:w vwvla arc Cumberland Carlisle Thornwald Home („ Y„ ~;N c,,,an. ~r~c (~,rM (y~~n,ptpytpR~n,Np.) White I t. Decedent's Usual Occ Uon Kind a wpAt d ate most d Ne. Do nor slate reared 12. Was Decedent ever b rase 13. Decetfenl's Ettucation (Specify arty NgMst grade contp Nled) 14. Harear 9atus: Married. Never Marred. 15. Surviving Spo use (II wile, give maden rumt~ Knd d work Knd d Buswss r itdusvy U.S. AmtW Faces? Eterrtsntery / SecorWary (U•t2) Ct>I1eye (1•{ a 5+) Wdowed, Divorced (SpxiM Hairdresser Beauty ^v.: ~w g 0 Widow ---------- - 16. Decetienl's Mailrtg Address (Basel city /town, rota, :q cads) Decederu's Did Decedent 3 0 North 1 5th Street ACtuil Rgsidertce ' 7a sale P A ~• ~ a l 7c. ^ Yss, Decederu Lased n _ _ Twp Hill P A 1 7 01 1 Cam , 7p Oppryty Cumberland r°w'""ip' , 7d,A~no, Decedersa W witlwr Carlisle p , y ry ~J 18. Faeter's Name (Fvst, middle. Wsl suaia) 19. Modter's Name (First, middle, maiden slanwrte) John L. Hummel Mar B. Rinehart 20a. Infortnartt's Name (Type /Paul 2gb. InfprtrlWY'a Miilirty Address (S1reN, ar /town. rote, iq code) Ronald P. Sieg 3737 Sharon St., Harrisbur , PA 17111 2ta. Hr;thod d Disposhiort ^ Crenwim ^ ppyyppn Ztb. Date d Diywsieon (MOntlL day, year) 21c. Place d Disposition (Name d cemeMry, atMway a atrr place) 21d. Ltxation (city /town, sole. ip code) ~ t~ ^ Removal rrpm sate ;was cr«nwiort ,, oerretlort Aud,pr~ed g/ g/ 1 0 Ever r e e n C e m e t e r D u n c a n n o n, P A 1 7 0 2 0 ^ otr>er -speak: w rtMdical Eaatrwrer / Coraxrt ^ Yes ^ No g Y 22a Sigrtatae a Funeral ice see ( Pe as such) 22D. Linrtse NtaMer 22c. Name and Adllreu d Faddy - ~ 011825-L Shalonis FH, 206 Maple Ave., Marysville, PA 17053 Cmtptete hems 23at auy when c 23a. To ere txu d my krgwkdge. deem attuned ar me Ime. date and place stated. (Signaltwe an0 t,N) 23b. License Ntanber 23c Date Stcyted (Hoorn. day. Year, physician tt rot availa0ie at time m b /j r / ( ~ certify ttuse d Beam. l ..• ~,.~,~- ~ ~ ~ ~ ~ I 0 9 L, u ~L . ;~ 0 0 hems 24-26 rtwst De canpleted bl person 24. 7me d Death 25. Date Ptprtoiatced Dsed (Mash. day, Year) 26. Was Case Reletred b Hedical Examiner i Coroner br a RO Olfter man Crematan a Doratan' woo prortoatces Deem. % ;~ S'J. M. (,( ~ Cj 4 Q ^ Yes No CAUSE OF DEATH (See Instrtaetioess d examples) i Approamale rMervtY: Part II: Eller otlrr z~eatp. 28 Dd Tobacco Use Cawioute to Deam~ Item 27. Part I Enter ere rltaul a events - dlsaasas, InjUrleS. a COrtpNCalions -mat directly caused V1e deem. DO NOT en4r IsrtttvW wisrus strlt ss Cardiac amst, i Dnset b Deem out nq reculap n eie trtdeAyirg cause given n Pan I. ^ves ^ Prooabry respiratory anent. a ventricular librhafon wieiotl showing die etiokigy. LW aNy on cause m each ire. i i WMEDIATE CAUSE Fi t ~ No ^ Unknown ( nal dsease a condition rssuhvtg in deem) _~ a. ~ V a, i D h r~ 29. If Female-. ^ Due b (a as a WnsequenC! off: ~ Nd We9nars wi7xn past year Sequertoasy 4st cortdltiont. it arty. t lea6rtq to ttte cause fisted m ire a 0 ^ Pregraru at time d Beam Error the UNOERIYING CAUSE Due b (a as a consequence d): ~ ^ Nd pegnant. flea pregnant wurvn s2 days (dsease a ryury Thal rotated me c , events resiafatg n death) LAST. , a dean Due to la as a cortsequertce tit) I ^ Not precywtt txA pregwtl 43 aay<, :o t year d. ~ before roam ^ Unknown if pregrtaN widxn rase past year 30a Was an Autopsy 300. Were Autopsy Firtdvtgs 31. Hamer d Deam 32a Date d IMurv (Mach, day. year) 32b. DesaiOe How Iryury Oawed 12c. Placed 4ytuy ybme. Farm. SVeet. Fapory. Pertained' AvaiWDb Prgr to Cartptetbn ~Nattra ^ liorracide (Mice 8tril6rtq, etc. (Speayyl a Case a Deam~ ^ Yes (d No ^res ~ No ^ Acadent ^ Pendrtg Investigatan 320. Time a lryury 32e iMWY az Wax? 321. u Transportation Injury (spealyl 32g. Lrxation of IrWry ISUeH. city ~ town. sutel "[ ^ Suicbe ^ Could Nd be Determined ^res ^ No ^ Drvsr; Operator ^ Passenger ^PtMeslnan M. Odor . ~: 13a Canuwr Icnecx tiny a>el ]3b. Signa 7itle d ceRAler • Certifying physician IPnys~can cerofvmg twee d deem wren ananer physiclart has pmrtounced deem orb oorttWeted hem 23) ~ ~` . ~ To the best of my knowledge. death oecared due to the eause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ " ~ 1 • ' y ` V L~ • Pronouncing arW ttnitying physician (Physinarl IYNh proroaring uea'n a~~d cemtyvtq to cause a deaml To Uie best of my knowled e daHh occurred a1 the time l date nd d d t th M ^ 33c. Lw:artse NurtiWr 30d. Dale Signee (Morin day. veal ' , g . , a p sce. an ue o e cause(s) s maruser as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • tiMdical Examiner /Coroner (` ~~ ~ ~ ~a ~ ~ ~ C 1, V y ~ ~ 0 I On tfte 's d exami tion a investi ion. ~'~tty opinion. death occurred at tM time, dale. and place. and due to the cause(s) and marvix as stated_ ^ t ~, Name and Atlases d Person Yrno Carpleted e~m (Item 27~ Type Pant se d D C~alu ~ 35 eostra n,re ~ D~su / 36 ¢krm y eah / ~. ~ ~ y ~ G O ~ ~' ~ ~+, ~ L'~ ~) ~ n'' ~ ^ D / . . . y ~~/ ~~ Disposition Pe; ^v; No ~ y Y ! `~ L~_ LAS T W ILL AND TESTAMENT -~ ~.~ ~ y~ r•,~ ~--~, ~ -. ^ OF . ,~, ...__ , . ! . ~µ__ / _. ~ 'T'1 .. . ---. MARTHA S IEG T i . ~..`~ ~':~ - , ,_.~ :'~' I, Martha Sieg, ..~ _; ~ ~ of 110 June Drive, Camp Hill:: ~~umbe`~``land f Q . c_ > County, Pennsylvania, being of sound and disposing mind, M~nory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and C odicils heretofore made by me . ITEM I. I direct that all my debts and funeral expenses, including my cemetery lot and grave marker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death as part of the expense of the administration of my estate. ITEM II. I devise and bequeath the sum of one thousand ($1,000.00) dollars to Holy Spirit Hospital as an unrestricted gift. ITEM III. I devise and bequeath the sum of i:ive thousand ($5,000.00) to my sister, Julia Melvina Sprenkle, and five -~ thousand ($5, 000.00) dollars to my sister, Leah Hummel . ~I ^~ ITEM IV. I devise and bequeath all of the rest, residue and `~.:. +'`~ remainder of my estate of every nature and wherever situate to my five (5) sons, Harry Hafner Sieg, Jr., Donald Carl Sieg, Ronald Paul Sieg, David Lee Sieg, Dennis James Sieg, and their issue, per stirpes. ,.~ ITEM V. I direct that any and all Inheritance,, Estate and Transfer taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residual estate. ITEM VI. I appoint my son, Ronald Sieg, Executor of this my .last Will and Testament. In the event of his renunciation, death, 'resignation or inability to act for any reason whatsoever, I appoint my son, Harry Hafner Sieg, Jr., Executor of this my Last ,Will and Testament. I relieve my Executor from the necessity of !,posting security in connection with his duties as such in any jurisdiction in which he may be called upon to act. IN WITNESS WHEREOF, I have hereunto set my hand to this my 'Last Will and Testament, which consists of Z pages, to each of which I have affixed my signature this 3 ~~`~~'""day of ~^1 ~~, vL ~ , two thousand and one (2001). ~~. ~=7- ~ 7 artha Sieg i~' ., COMMONWEALTH OF PENNSYLVANIA .. .. COUNTY OF Cumberland .w., ~y ~ Vie, Martha Sie,g, and .~,~~ ~% ~ ` ~ ~~;c .~~~1r-ri', and `j ~ ~ ~ c ~ ) c _ , ~,'~ , y, , ~~~" ~-~ ~ _..- ~..~ ~ , the testatrix and the witnesses respectively, w-ose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby de~~lare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witness and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness ~~ Witness Subscribed and sworn to and acknowledged ,before me by Martha Sieg, Testatrix and '; subscribed and __ worn Ftpf; and ac wledged before ,fie by ,~'~' ;~ ~ , ~, ~ and A~0 ~;-~~~~,~~~.,~ ~ . ,~~withesses ~!, j thi s e, day o f ,,-= / ~.. .~ 2001. f I I L _ \.,~ 1. ,r ~e otary Public ~~ .. -. ~` d~ ,~ ~. 1 __ ~a ,,,,:_ Martha S ' eg, = Te '~~trix r ~,_ ~-. ~~._ .i ~ .L~