HomeMy WebLinkAbout03-22-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate oI' Ann E. Minieh File Number c~t -' 1 ~ ~~I~~~)1,,,(%
also known as
.Deceased Social Security Number 184366499
Petitioner(s), who is/are 18 years o1'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 ,~-~
-~~___._.~_natncd in t11~~
last Will of the Decedent dated -- -
and codicil(s) dated ~ -- - ;-
~- _ '.,
- ^i
..: -
, ~L ~'
- ~ ,.
(Stale relei~ant circumstances, e.g., rentmcia~ion, 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 ~,e~instrum~,n~:a) offer°cd -~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~-~~'~ -~~~ ~ ~ - ~~~'-~~~
i.l
i
B. Grant of Letters of Administration
(/> applicable, enter: c. t. a.; d. b. n.c.l.a.: pendente life; duranle absenlra: durm~te r~~~in~~rrtate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (i 'any) and heir :(If
Adniinist •ation, c. t. . or d. b. n. c. t. a., enter d to of [~~il! "n S do A abo d c zplete st o~heirs.) ~ ,.,~ir.~~ ~j
~ t/h ~Z ~e ~/i' ~ Z V ~ ~
elationshi Residence
420 Telford Avenue
113 Pearl Street
(COMPLETE Ili' ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death it Cumberland County. Pennsylvania. with his /her last principal residence at 43 Pleasant
Hall Road Carlisle PA 17013
(List street aJdres~, tai+~r.!,cit}~, :etvyiship, county, state, yip code)
Decedent, then 64 years of age, died on 1/25/2011 at Cumberland County
-- Carlisle PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 300,000.00
(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:
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
~ Curtis L. Minieh
~~ ~ ,. 420 Telford Avenue
Form RW-(l? re~~. 10.13.06
Page ] of 2
,,~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA ;
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 subscribed
~ Signann•e o/Personal Representutive ~ _
before me t" ~ ~ - day of ~ r~ - = `-~
-,,
-, ~:, __
~ '
~.~,;~ Signature of Personal Representative ~_
r ~ _ , _ __
,,. _ _7
For the P.egister Signature or Personal Represenlatil~e
- ~,
_'_
File Number: ~' ~ ~~ ~ ~ -~ ~~~ '~
Estate of Ann E. Minich ,Deceased
Social Security Number:184366499 Date of Death: 1/25/2011
"~,~ (~'~~ ~ ~~ '~~ , ~ ` ti , in consideration of the foregoing Petition, satisfactory proof
AND NOW,
having been resented before me, IT IS DECREED that Letters ~~~~ ~ ~ S ~~~~ (~
P
are hereby granted to ~U ~ ~ ~ '~- ~'~ ~ r1 ~ ~'
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 T~ecedent.
FEES
Letters •••••••••••••
Short Certificate(s)
Renunciation(s)
l ~~
TOTAL •••••••••
$ ~. ~ ~
$ ~ _ '-~
$ ~~~~=
,.
$ ,t
.... $
.... $
.... $
.... $
.... $
.... $
.... $ ~ .
e
Register ~'~ 5 '~~~ ~(~ ~ c'
Attorney Signature: _
,.
Attorney Name:
Supreme Court LD. No.: 36812
Address: 19 S. Hanover Street Ste. 101
Carlisle
pq 17013
Telephone: 7172452698
Page 2 of 2
Forn7 R bl'-02 rev. 10.13.06
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H105-143 REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE !PRINT IN
BLACK INK
PERMANENT CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
1. Name of Decedent (Flrsl, middle last suffix)
• ~
Ann E. Minich 2. Sex 3. Sodal Security Number 4 ate of [kaih {Month, day, year)
Female 184 - 36 -,- 6499
y
~ !C>'j~
~,
~
5. Age (Last Birttviay) Under 1 ar Under 1 da 6. Date of Birth Month, da , ar 7.8i ace C' and state or f ' n count 6a. Place of DeaM Check on one
~~ ~'~ ~'rs ~'~
~
Yrs. ~ Oct. 15, 1946 Carlisle
~ PA Hospital: Other.
'
~. County of Death
•
rk. City, Boro, Twp. of Death Inpatient ^ ER / Outpatlent ^ DOA ^ Nursing Home ^ Resklerx~ ^ Other -Specify:
8d. Facility Name (If Trot insnntiort, give street and nurtrber)
1
Dauphin
Harrisburg
Harrisburg Hospital 9. Was Decedent of His
pent OriginT No ^ Yes 10. Race: American Indian, Black, While, etc.
u1 Yea, specly anon, (S
a~iry)
• 11. Deceden's Usual non Kard of wok done dud most d Fie. Do not state ret'
Kind of Work p
Mexican, Puerto Rken, etc.)
12 Was Decedent ever in Ne 13. Decedents Educatan Whl to
(~iy any highest grade completed) 14.
$
ta
r Herded
1 E~
S
i
i
KindotBusiness/Industry ~
d
~ ~ (~
,
.
urv
v
ng Spouse (If wHe, give maiden name)
U.S. Amted Forces? Elementary I Secondary (0.12) College (1-4 or 5+)
^ Yes ® No
i 6. Decedent's Mailing Tess (Street, city / town, state, zip code) Decedents _
43 Pleasant Hall Road
Acb,al Residence 17a. State _ p~ Did Decedent Tar
170
Y
D
N
Midd7
Carlisle, PA 17013
nb. count' CL~yn_ha ' Lp
es,
ecedent Lived in _
.
a On Twp.
Township?
rl and nil. ^ No, Decedent LivedvdMin
16. Father's Name (First, midde, last, suffix) Aqua) Limns of City I Boro
Marlin J . VanAsda lan 19. Mother's Name (Frst, middle, maiden surname) -'-
Elsie Miller
20a. InfomranYS Name (Type /Print)
Curtis Minich 20b. Informant's Mailing Address (Sheet, city I town, state, zip code)
21a. Method of Dispostron
•
r
I~ Crertra6
^ D
21b
D
t
f D 420 Telford Avenue, Readin , PA 19609
°w
Burial ^ Removal from State
^ otl on
onation
r
r Wes Crem.non or Donation Authorlied
r .
a
e o
isposltion (Montlt, day, year)
Jan . 27 2011 21c. Place of Di dbn Name of cemete crertrato or other
~ ( ry, ry Pie) 21d. Wcttion (City/town, state, zip code)
Hof flilan-Roth Funeral Home &
`~ la
.
22a Si re
f F
l byMedkelExeminer/cororbra Yea^ No Cremato Carlisle, PA 17013
~ o
unera
~ reen acting as such)
if 22b. I-icense Number 22c. Name and Address of Facility
H
ff
ate flame 23e
h
n 013144E o
man-Roth Funeral Home & Crematory
S C
li
l
c any w
en cer
tyirg
.
n is not available at time of death to 23e. To the best
nN , deaM
at the tlme, date a
a (SignaNre end title)
~
~ ar
s
e PA 17013
23b. Llrrense Number
Dppaeet
23c
Si
d
M
cause of death. ~
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gne
(
onth, day, Year)
11uI./af~ r.. /fs ~, ~ ~
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)
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•
•
flenxt 24-28 must be completed by person , _
24. Time of pea
25. Pronounced Dead (Month, day, Year) ~ ~~ t ~~
~
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~-r, /
V
V
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wfro praraurxxrs death. ,/(~ p ff// ,y / 26. Was Case Rele to Medical Examiner /Coroner for a Reason Omer than Crematbn or Donatbn?
/v 4l •.. M. Isl./~{.. +. F' ~~/i ^ Yes No '
CAUSE OF DEATH (See instruct)
Item 27. Pen L Enter the main of events -diseases, injuries, or cortrplications • that di
rrrcty caused a and examples)
th. DO NOT enter terming ants such es cardiac
r
t r Approximate interval: Part II: Enter other '
sunif~nt ~tiaru rntriY 4Lns b rlsa 28. Dq Tobaaro Use Contribute to Deem?
respiratory arrest, or ventricular fibrillation witfxxrt shovrirg trre analogy. List any one a
res
,
on each tine, r Oruet to Death
r but not resulting in tlra underying cause given in Part I
^ Y ^ Probably
IMMEDIATE CAUSE (Final disease or 1 `~~
rxxxiflion resulting in death)
} a r
,
N
r
~No ^ Unknown
.
Du (or as >rconsequerx~
off' ~
Seauennally Fat conditions, if any, b. •••• ~1 fl"
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29, if F le:
Not pregnant within past year
ae
ing W t
e cause listed on Foe a. Dyo
Enter the UNDERLYING CAUSE r" -- -
y~wyaequen a of/:
~
(disease or injury that initiated the
(/V/~( ~ r
r
r Pregnant at time or death
^ Not
pregnant
but
re
nant withi
42 d
I
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~
events resulting in death) LAST, c.
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y
,
p
g
n
a s
of death
Duet (or as ue
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f~
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~
i~ Not pregnant, but pregnant 43 days to 1 year
30e. Wes an Aut
opey 30b. Were Autopsy Fndirgs 31. Manner of Death r
r before death
^ Unkrrown if pregnant within the past year
Pedormedl Available Prior to Completion PSI 32a. Date of Injury (Month, day, year) 32b. Describ e How Injury Occurred
of Cause of Death? lot NaNral ^ FbnFcMe 32c. Place of Injury: Fbme, Farm, Street, Factory,
On'ux' Building, etc. (Specify)
^ Yes ~ No ^ Yes ^ No ^ Accident ^ Pending Investigatbn 32d. Time or Injury
^ Suicide ^ Could Not be Detertnhred 32e. Injury at Work? 32f. n Trensportatbn Injury (SPegN) 32g. Location of injury (Street, riry /town, state)
M ^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
33a. Certifrer (check any one) ^ Other - Specify
• TO the best of m I knoPhY~ cemfYing cause of death when another physkian has pronaxiced deaM and completed Item 23)
y wbdge, death occurred due to the ease(s) and manner ae stated _ _ _
-------------
• Pronoun
i
d
33b. Signs re a Tftle or Certi6e ~, - " I
'///~/~/~/J~
^
--------
rz
w
c
ng en
---------
cenllying physbian (Physician both pronouncing death and cernfyirg to cause of death) .Lice Nu r
To tM beet of my knowbdge, death otturtad ffi the time, date, and place, and due to the eauss(e) end manner as etated_ _ _ _ _ _ /) ~ ,( 33d Date Signed (Month, day, year)
MedlplExamkror/Coroner ------------ ~
/
~
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On the basis of ezaminatbn and / or Invesdgatlon, in my opinion, death oceurred at the time, date, and place, and due to the cause(s) end manner as ataterL ^
W
ho
~
,,
34. Na end Address of Person
y-,~,
~•e Cause of Death (Item Q,~
[ P
i
t (~ ~~~
w 35. Registrar lure and Di~tr~ct~erf~}~
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I 7
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36. ate Filed (Monts, day, Yeer) / , L r
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ty/pe
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Disposition Parton No: _ (~
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---
_ r--'.~ -
-- -1 ,. ,
RENUNCIATION _ ' ~-~-~
`-
-_ , , ,
. ,,
-: -,~
_, ,,' _
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA - = ~ ~ ~~ - ~~''
_ ~~~
~~~
Estate of Ann E. Minich
Deceased
I, Jessica A. Dalinskv , in my capacity/'relationship as
(Pt tnt Name)
dau4hter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Curtis L. Minich
(in ~,~i
3/22/2011
(Date)
Executed in Register's Of~re
Sworn to or affirme nd subscribed
bef th's ~,- a
of ' ~ y
_ ,. .
`~ ~'' (r'l ,~ ~' ~y' ~'~' t' G~~% <
eputy for Rc,~giste~- of Wills
'`.t.~ .
(Srgnatttre) ~~ -''``
ice:
.,
113 Pearl Street
(Street Address)
Carlisle PA 17013
(C'ity, Stale, Z/p)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation anal certified
that he or she executed the renunciation for the
purposes stated within on this day
of
_.
Notary Public
My Commission Expires:
(signature and Seal oTNotary or other official qualitied t~
administer oaths. Show date of expiration of Notary's Commission.)
f:'ornt RN'-06 rev. 10.13.06