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HomeMy WebLinkAbout06-28-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Barbara A. Miller File Number ~~' ~ ~ ~ ~ ~ Estate of '`- also known as ,Deceased Social Security Number 168267349 Patricia Ha~/wood _ 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 eXeCUtor ~ named in the last Will of the Decedent dated 2/13/2003 and codicil(s) dated Vivian Peters has renounced in favor of Patricia Haywood (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, was never adjudicated incapacitated, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): none B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d.b.n.c.t.a.; pendente liter durante absentia; durante mint>ritateJ 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. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) Name Relationship Residence ~ ,.._ t~ __.. S -T' ~ _ t -:..,., G7 ~fi r ~ _.A ~ _„ (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~{ ~_ ~j Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last principal~residence at G~ `-~ , 1051 Country Club Road Camp Hill PA 17011 Borough of Camq Hill Cumberla'itd County (List street address, town/city, township, county, state, zip code) Decedent, then 79 years of age, died on 5/26/2011 at Chambersburg Hospital _ Chambersburg _ PA 17201 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ _ 2,500.00 (If not domiciled in PA) Personal property in Pennsylvania $ _ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ _ 125.000.00 situated as follows: One-half interest as tenant in common in real estate situate at 1051 Country Club Road, Camp Hill, Cumberland County, Pennsylvania 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 ~ ~ uv ~ _ Patricia Haywood 126 Milk Wa Shi ensbur PA 17257 Page 1 of 2 Form RW-02 rev. 10.13.06 Oath of Personal Representative CONIMONWEALTH 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. Sworn to or affirmed and subscribed before me the ~ ~~ day of 2011 i ~ °' n/ ?~ For tithe Register Signature of Personal Representative P~ftricia Haywood Signature of Personal Representative Signature of Personal Representative ~'" C 3 t~ ~7 ~ "'~'1 ~C File Number: Estate of Barbara A. Miller ,Deceased __ ~' ~•'ts i _ _.1_ .~.:` t- :-r-i Social Security Number: 168267349 Date of Death: 5/26/2011 _ AND NOW, June ~-~`~~~ , 2011 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary - are hereby granted to Patricia Haywood _v1 the above estate and that the instrument(s) dated February 13. 2003 _ _ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES M~ 1t l~ (~t'~ ~ ~(~ ~~'1 ~~,~ ~~fYY~ ?~1~~ .Q )~'~~ Letters ••••••••••••• Short Certificate(s) Renunciation(s) Will JCS fee Automation fee TOTAL ...... $ 260.00 •••••• $ 20.00 ••~••• $ 5.00 ..., $ 15.00 .... $ 23.50 .... $ 5.00 .... $ .... $ .... $ .... $ .... $ .... $ ...... $ 328.50 ..~ ~~f, Attorney Signature: ~/T/`z~/L - Attorney Name: Supreme Court I.D. No.: 17516 Address: 14 North Main Street. Suite 200 Chambersburg, _ PA 17201 Telephone: (717)264-6029 _ ,~~ Form RW-02 rev. 10.13.06 Page 2 of 2 OCAL REGISTRAR'S CERTI~ICATI®~IV G~ DE~~~• WAF~NIN(a: It is illegal to duplicate this c;:ota~,d uy phr~tt:,st~~t c~i' phatogr~(~w..1 I'r„t' ~+1i' CI"lid, ~`t°rUil~`ttle, `',f`~.t)l' H105.143 REV 11/2006 TYPE/PRINTfN PERMANENT BLACK INK °w J 6 Q Q Y Q n Y Z n P ~.727~7, ~~ ~iiruu,:f~..,,~ ~, ~ #* r ,r,r Slt Of ~ r ~ 14~i'~ ;t` I.li _ , _ I 3? ~ ''lit'~!'il)~li ~ )1))1 ilC"Tr' 'Lt°t~t i` ,_ t ~ I ) r ' ~ C ~'":\ - ~tr~r _~~r t I~'t.'1(\ t_4'j '(i ! •1 y ;~~ r `~'r )~~) l t _ltll l} It ~i~ 1 l ;~°'4~~ ~,~ ~' ~ ~, t j~l~yri~ ~~ i ~~ r1€ i 1 - ~ ~E t 1 tit 9r.~'~?)^, , l ice El'at 11.1.' ~t~, °.711,11 '~ 6i f1 tit:' `wi ct~ Tai ~ ~ ~ .: ~ , , , , _ ~~t~l v l >ti`1 ~ 1~: teg'(I•. E j{ '1,1.)~'Ei l 1'.111)_ , f D~ `~ N ~ ~ y \' f / / ./ (y `,,. ~1ENT ll ~,,F -..,~_ __ _ _ _ . a ~. _ _ 1 ~ t~ c__. n ~.-7 ` .~ ~ tV : ~ ' '~ ~ . ~~ .~ • _ r .r _ . ;~ ~'" :'1'1 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ""'~ ~ • • ~ `"'~ CERTIFICATE OF DEATH c,~ (See instructions and examples on reverse) STATE FILE NUMB ER `~" 1. Name a Decedent (Post, mdde, lest, sulfur) 2. Sex 3. Sodal Security Number a. Date a Death (Month, day, year) BARBARA A MILLER Female 168-26-7349 _ May 26, 2011 5. Age (Lest Birmday) Under 1 r Under t de 6. Date of Birth (Month, day, year) 7. BetAplsce Cky end state a cored) Ba. Place a Death (Chedr ordy one) eeoaax - ~ b•Ya -~-- Hour _ _ - AAixen - - -Sh ~ b PA Hospikl: Omer. 9 Yrs. ' ry Februa 25, 1932 tpp ens urg, O Irrpetiea ^ ER / t7ulpe6ent ^ DOA ^ Nosing Haas ^ Residence ^ onrer • spedly: Bb. County o1 Death 8c. qty, l3eo, Twp. a Deem Sd. Fackity Name (k not euiiadian, glue street and number) g. Was Decedent a Hispanic Origin? ^x No ^ Yes 10. Race: American Indian, Black, White, etc. Franklin Chambersburg Chambersburg Hospital, ~~ R~icen,ete.) _ ( White 11. Decedent's Usual bn Kind a work done d most d wo kfe. Do not state re6 12. Was Decadent ever in the 13. Decedent's Education (Sbeciy ony highest grade corrrp leted) 14. Merkel Status: Monied, Never Merced, 15. Surviving Spo use (k wie, pve maiden name) Ked of Work Ked d Business I Industry U.S. Amred Forces? EbmeMery /Secondary (0.12) Calege (1-4 or 5~) Wdo~' Divorrxid (~edM Teacher Education ^Yas prro 4 Never Married 16. Decedent's Making Address (Street, sly /town, stela, zp coda) 1051 Country Club Road Decedent's Penns Iva n la Did oe~dem AdualResidence t7a.state y ~ Q? t7°.^Yes,DacederrlUved in-- Twp. Hill PA 17011 Cam n ,7b.carnty Cumberland t7d.l] +~~^ Camp Hill , p ~ ~;~,,~ 18. Father's Name (First, rtwddk, lest, sufix) 1g. Mother's Neme (Rrsl, middle, maiden armbme) William Norman Miller Anna Martha Hammond 20e. Irdoenant's Name (Type /Print) 20b. IrdonnaM's Meting Address (Street, ciy /town, state, zip code) Patricia Haywood 126 Milky Way Shippensburg PA 17257 21e. Method d Dsposkbn ^ Cremation ^ Donaton 21b. Date a Dapceinon (Mordh, day. year) 21c. Place a IlisposNion (Name d cemetery. crematory a after plaoe) 21d. location (City /tam. slate. zq Dade) x^ Burial ^ Removal from State i Ntis fkeersNon or Donatlon Autlralud ^ other-sped/y: ~ byMadlalExaminer/Cororrer't ^ves^No June 01, 2011 Spring Hill Cemetery Shippensburg, PA 17257 22a. Sg rvice ' (a ackrg az such) 22b. license Nrarber 22a Name and Address a FecAity - FD-014831-L Fogelsanger-Bricker Funeral Home 112 W King St. PO Box 336, Shippensburg, ~PA 17257 Comp) ems 23ec only 23a. To kre bell 01 rtry knowledge, deem occurred at kre kme, dab end place slated. (Signature end dtle) 23b. Ucense Number ?3c. Date Signed (Month, day, year) physkkan s na avalleMe of time a deem to cerlky ease a Beam. Items 24,26 must be completed by person 24. Time of Deem 25. Dale Praaunced Dead (MaMh, day, year) 26. Was Case Referred to Medical Examiner /Coroner la a Reason Other man Cremation or Donation? wlwprenouncesdeem. 5:40 P.M. May 26, 2011 l]Yaz ^No CAUSE OF DEATH (See tnstructlons and sxampNs) , Appro>bmate ekerval: Pad II: F1Ner other sianlficant corditions corrllrDutina_tg deed, 26. pid Tabaoco Use Cordrbute to Deem? Item 27. Pert 1: Eller me cheer a evens -diseases, eyudes, a canpkcations - mat deectly caused the deem. DO NOT enter temwnal events such az cardiac arrest, r tOrrset to Deem but na resrrUng in me rarderlying cause given n Part I. ^ Yes ^ Probably respiratory arrest, or ventricrder fibrikakon w[fbul showing the etlobgy. List arty one cause an each kne. i Q No ^ lhrWwvm IMMEDIATE CAUSE Feel dreease or ~ ~onalbonre~dnnginr~atn) ,_..~ e. Gram-negative sepsis bacteremia r heel osteomylitis 2g.IrFemele: ® Due to (e es a consequence a): ; sequemialN 1st aandi0ons, k any, b. acute g i blood loss ; - D M Not pregnant wkfwn past year ^ Pregnant et time a deem lea~r~p to a cause ksled on 6ne a. p,re ~ (e es a consequence op: ' Eller me UNDERLYING CAUSE ^ Nd pregnant, but pregnant wkhin 42 days ((maeeeeor~keuurYvmatkrimted>ne ~, stoat flbriallation with sick sinus, severe bradycardia ~ Averts resuttlA log seam) uST r adeam Due to (or as a consequence oQ: but pregnant 43 days to 7 year ^ rereg i d, UTI , - befo deam ^ Unkrrown k pregnant wtfhin me pest year 30a. Wu en Autopsy 30b. Were Autopsy Fexfrgs 31. Mars>er a Deam 32e. Dale a Injury (Month, day, year) 32b. Desrxibe How Injury Occurred 32c, Place of Injury. Home, Fann, Street, Factory, Perlomred? Avalede Prior ro Completion ~ Natuet ^ HanNdde Okice Bdltling, etc. (SpecMy) a cause a Deem? ^ Yes x^ No ^ Yes ^ No ^ Accident ^ Pending Investpaten 32d. Time a Injury 32e. Iryury al Work? 321. k Trenspodatan Injury (Specify) 32g. Location a Irgury (Snot, dty t town, state) ^ Sricrde ^ Cold Na be Detererined ^ Yes ^ No ^ Dmer /Operate ^ Passenger ^Peestrian Omer - SPecily: 33a. r;,ertitier (dtear Doty one) 33b. Sipnelrse and Tdle a Ceditier • Certllying physkWr (Ptrysidan ceryMn9 cause a death when another physician has prorpunced deem and competed Item 23) ~ To the best Ot my knowlMga, dasth occurred due re ltre petite) end manner ae ftatad- - - - - - - - - - - - - - - - - - - - - - - - - - - -. - .. - _ O O~-'~lf•.(I•D UiIT~ , i1/. tJ. - • Pronouncing and certHykg physkdarr (Physkian bah pronoundng death and oenkyerg to cause a deem) t T th D f I l d d m t th tk d t d l d d t th d d t t d ^ 33c. Llcertse Number 33d. Date Sigrretl (Month, day, year) now o e as o my e ge, ee Decante a e ne, a e, en p eee, an e ause(e) an mamer as a a - - - - - - - - - - - - - - - - - - ue o e • MadicalExsmlrrer/Coroner OS010845L May 26, 2011 On the bests of exeminsUon and 1 or Inveatlgatlon, In my opinion, death occuned M the time, dale, and place, and due to the esusga) end manner as steted_ ^ ~ ~111B and Address of Person Who Competed Cause a Deem (kem 27) Type I Print 3s. Registrar's Signature istrk:t N , ~ / ~ ~ ~ / ~ 3s. Dale Filed (Month, day, year) R. Lucas Shelly, D.O. ' I I I - I I I - ~, zo/~ 112 N 7th St, Chambersburg, PA 172:01 ' L Disposition PemM No. ~ 0608460 001 ,-• LAST WILL AND TESTAMENT OF BARBARA A. MILLER I, BARBARA A. MILLER, of Cumberland County, Pennsylvania, declaY•e this to be my Last Will, hereby revoking all prior wills and codicils. FUNERAL EXPENSES FIRST: I direct the payment of my funeral expenses, including my grav~emarker, as soon as maybe convenient after my death. PAYMENT OF DEATH TAXES SECOND: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of administration of my estate. PERSONAL PROPERTY THIRD: I bequeath all personal effects and personal property as I may s,et forth in a separate signed memorandum to the persons named in that memorandum. Any household furnishings not previously distributed by memo I bequeath to Matilda Shaub, if she shall survive me for a period of thirty (30) days. If she shall not so survive me, my household furnishings shall be added to the residue of my estate. DISTRIBUTION OF RESIDUE FOURTH: I give the entire residue of my estate to my sisters, Dorothy Daniels, Rachael O'Donald, Mary Showvaker, per stirpes and Vivian Peters, per stirpes, equally, provided that the share of any sister who does not receive her share per stirpes and who predeceases me or dies on or before the thirtieth day following my death, such share or shares shall be added to the share or shares for my remaining sisters. If none of my sisters shall survive me for a period of thirty (30) days, the entire residue shall be distributed as follows: one-half to the Shippensburg First Church of God, one-fourth to the Humane Society of Harrisburg, Inc., and one-fourth to the Humane Society of Franklin County. c~ _ ~, ' . ~. ~ -47 r r~T : ~....~~~ , : , r:' t~ri ~ ~ i - ~a -~y-,~ --... -.~ . . - - C ~ + y . 'ti..,~ ~ 7 PROTECTION OF BENEFICIARIES (Spendthrift Provision) FIFTH: No interest in income or principal shall be assignable by a beneficiary or available to anyone having a claim against a beneficiary before actual payment 1;o the beneficiary. TRUSTEE OF ESTATE OF MINORS AND INCAPACITATED BENEFICIARIES SIXTH: If any income or principal shall be payable to any person who s~,hall be a minor or who shall be incapacitated for any reason, my executor, as trustee shal]'~ hold such income and principal during minority or incapacity and shall be entitled 1;o apply such income and principal to the health, maintenance, support and education ofsuch person during minority or incapacity without the appointment of any guardian or committee or any authority of court. My trustee shall be entitled to make direct application hereunder or to make application by payment of income and principal to the parent or other person in charge of such minor or incapacitated person, or to his or her guardian or to a custodian under the Uniform Transfers to Minors Act. Trustee may, in discharge of all the Trustee's duties, pay any minor's share deemed impractical of administration to the parent or other person in charge of the minor or to his or hf;r guardian or to a custodian for the minor under the Uniform Transfers to Minors Act. Any remaining income and principal to which such person shall be entitled shall be; distributed to such person upon such person reaching the age of 18. My Trustee shall have the same powers as my executor and shall serve without bond. POWERS OF EXECUTOR SEVENTH: I confer upon my executor the right to sell or otherwise aanvert any real or personal property at public or private sale, at such time or times, in such manner, and for such price or prices, and upon such terms and conditions as my executor shall determine, and to execute and deliver good and sufficient conveyances, assignments and transfers thereof, without liability of any purchaser for the application of any consideration; to borrow money and to secure its payment by mortgage of real or personal property, pledge of investments or otherwise, without liability on the part of the lenders to see to the application thereof; to retain any investments at discretion; Ito invest and reinvest at discretion, without restriction to so-called "legal investments;" to make distribution in cash or in kind; and to do all other acts and things necessary or appropriate in the management, administration and distribution of my estate. ..• APPOINTMENT OF EXECUTOR EIGHTH: I appoint Vivian Peters, executor of my will. If Vivian Peters is unable or unwilling to qualify as executor or having qualified is unable or unwilling to act, I then appoint Patricia Haywood as executor hereof. I direct that my executor shall not be required to furnish security in any jurisdiction. INTERCHANGEABILITY OF LANGUAGE NINTH: Words used in the singular may be read to include the plural or~ the plural may be read as the singular. Similarly, the masculine form maybe read. to include the feminine and neuter; the feminine may be read to include the masculine and neuter; and the neuter may be read to include the masculine and feminine. HEADINGS TENTH: The headings used on the various paragraphs of this will are included for convenience only and shall have no legal significance. I have signed this will this /~~ day of rr ~-~~ ~y , 2003 Barbara A. Miller ~.~/ ~~ ~~ / ~...", Thomas J. Ahrens ~~ r. ~ , v -,~~~ ~ ~~ ~ ~Y ,~ _ Ashley J. Pi an ck ~_ ~ ~ ACKNOWLEDGEMENT and AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND SS. ..~ , I, Barbara A. Miller, the testatrix in, and Thomas J. Ahrens and Ashley J. Pisanick, the witnesses to the last will, the attached or foregoing instrument, who have signed the instrument, having been duly qualified according to law do depose and say: (a) that I, the testatrix, do hereby acknowledge that I signed and executed the instrument as my last will, that I signed it willingly and as my free and voluntary act for the purposes therein expressed; and (b) that we, the witnesses, were present and saw the testatrix sign and exe-cute the instrument as her last will, that she signed it willingly and 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 a witness 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 influence. ... Barbara A. Miller Witness, Thomas J. Ahrens Witness, Ashley J. Pisanick NOTAR1Al SEAL JUDD M. ANRENS, NOTARY PUBLIC ~r~` 1 ~ ~t ` c~ MECHANICSBURG BORfl., CUMBERLAND CQ ~ `/(~ ~ MY COMMISSION EXPIRES MAY 23 2005 - N tary Public r.,,s RENUNCIATIQN ~~~ ~.:.. i,:,C? "© i"'rl -- sue: ''~`• .m~... '»:'~ ~~_...) ~7 ,... ~ i,.'~: REGISTER OF WILLS ~ ~ cr`~ ~~°, ~`' ..... _- - -~ CUMBERLAND COUNTY, PENNSYLVANIA ~C.~ ~~ ~~' r- _ .. _ _: -' J., ...._: Estate of Barbara A. Miller __, Deceased I, Vivian Peters , in my capacity/relationship as (Print Name) Executor of the above Decedent, hereby renourT<ci;; the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Patricia Haywood ~ /~ ~ ~~ ~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (Signature) 5 Robin Drive _ (Street Address) Shippensburg PA 17257 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and i:;ertified that her she executed the renunciaiti ~ for the purposes s d within on this -~~? day of , .~~~=~~. . ~~ Notary Public `' My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) C©MMON4NEA9~fH C)1:- IPEIVMSYLVANW Notarial S~:al t;~rin L. Walter, Notary Public Clw~mb~rsburg Boni, Franklin County My~ Commission FJCpires nAsy 13, 2018