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HomeMy WebLinkAbout06-30-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of John Beecher Miller also known as John B. Miller COUNTY, PENNSYLVANIA File Number 1211 ~ ~I - U ~; J~.Q Deceased Social Security Number 175-52-5184 Shannon N. Miller Petitioner(s), who is/are 18 years of age or older, apply(ies) for: ~- (COMPLETE A' or `B' BELOW) OX A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Al~iw~~l+ie4~e4ia,r named in the last Will of the Decedent, dated 08/01/2010 and codicil(s) dated -~° The Will does not list an Executor The decedent had two children Shannon N Miller and Jessie Miller See attached Renunciation sinned by Jessie Miller. - State relevant circumstances, e.g., renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 (g); did not have a child born or aldopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: Decedent was married to Ellen Bear Miller. The marriage ended in divorce on April 16, 1992. B. Grant of Letters of Administration c.t.a. (If applicable, enter. c.t.a.; d.b.n.c.t.a.; pedente 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. or d. b. n. c. t. a., enter date of Will on Section A above and complete list of heirs); was not the victim of a killing; was never adjudicated an Incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323 (g), except as follows: Name Relationship Residence -~ J~sar~-M~ler Son 176 Carroll Street t~SSF~ p~~, ~ Pittston, PA 18640? ` Shannon N. Miller Daughter 490 Shed Road ~ ~ ~. ;~ c-.~ N wvill PA 1724 ~-''~~.°7 ~ ~~ -' r~ :~ _~ ; , (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~~-~, ~~ -.~ "? ` ;~; :_~i =,~ '° ~~c Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal- esC~` nce at ==:'~`- 490 Shed Road Newville Lower Mifflin Cumberland PA 17241 ~' ~-, ~.~ (List street address, town/city, township, county, state, zip code) --~:r--- Decedent, then _~_ years of age, died on 09/04/2010 at 490 Shed Road, Newville, Cumberland County, Pennsylvania 17241 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 $ _ 94,000.00 situated as follows: Real estate situate in Lower MifFlin Township, Cumberland County, PA, containing 2.2532 acres and known as 490 Shed Road, Newville, PA 17241 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 -~ 1 / j .` Shannon N. Miller 490 Shed Road ,1~ ,, „ ,; ~~. _ / ,~ Newville, PA- 17241 Form RW-02 Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2006 form software only The Lackner Group, Inc. Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } 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 this -, ~ day of A For the Register of Personal Shannon N: Miller signature or personal Representative signarure or persona/ Representative File Number: 21 - ~ ~ - (~ ~] ~~ Estate of John Beecher Miller Deceased Social Security Number: 175-52-5184 r i Date of Death: 09/04/2010 _ AND NOW, _~ i ; ~ ~) r c,~ 1~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~w4 , ~ '~i /", are hereby granted to Shannon N. Miller in the above estate and that the instrument(s) dated 08/01/2010 t7 ``''' ~~ -- ... described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. --~ ~i- ~„_ ~~ `C2 ~~ r- ~~ ; -, , ~-=f= ~~ w ''" G~ ~. FEES //~~ ~~ :~~ .:~!~,; ~- Letters .......................................... $ ~ ~ V ~ ~' n "' "~~ '° °- ' ~~-~ ~r'i CSC ~ ~:~ .~ r ~~,~~ 1 ~--- fi'e,ester of Wi1ls~ _ y / ~, ,~~'- , Short Certificate(s) ....................... $ ~f'r~ ~ ~ j}--~ =- Ir (/-Cd~~ ,~ ,~`~ Renunciation(s) ............................ $ ~L ~~ Attorney Signature: l,/ ~ C., ~~~-~'" (.~;'~ << $ ~ ~ ' ~~ Attorney Name: Richard L. Webber. Jr. Es uire Supreme Court I.D. No.: 49634 Weigle & Associates, P.~C. $ Address: 126 East King Street $ Shippensburg, PA 17257 $ Telephone: 717-532-7388 $ - $ nG TOTAL ................................... $ _ ~/ O,~c~C Form RW-02 Rey. ~0-13-loos Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 OCAL REGISTRAR'S CERTIFICATION OF DEA•~'hI yll'ARNING: It is illegal to duplicate this copy by photostat or photogralahl.. Fee 1~U-' this certit~icatc•, '~f~.(s(> P ~6774~_9~_7 C~ertific~ttion N(tn~)hi`~-- H105-143 REV 11/2006 TYPE /PRINT IN PERMANENT BLACK INK 1. Name of Decedem (FbaL middle. last, sulliz) John B. Miller 5. Aga (Leaf Birthday) under 1 veer l~~irr~rrr~1~'~~p ~ l ills lti 1C) CCi'tlt~ ~~]~(i C~11.' ICltOrlTl~ltlOil flCr~ '~Id'e11 IS ,,f;1y~ ~` ---- Fy~y-,, <<)rre~~tlti ~'<~pictl )rt~->> ;I~) ;~I-ir~tnal C'ertitic~~te t~f lleath s -_, - :~~~`~~' ~,,r~-~ ~l((1~' tile( ~~~itr- trt~ ~)~, (ttcar~ Re~;istra--. ~hhe c)ri~~ii~~ll ~r ~ - ~~ ~ ~ ~r-tit)I~~(tc r~ili t.,t~ t~l)I~a„O'r`1e~1 tt~ tuft Stifle ~%ital Oj ~ ty wl ;~ ~'' ~a.ti~ k~c't)rc.ls ~fi~f~ ?~~~-~r)t filil~~~. Yb~ \~ O '~ ~ ~ ,~ t j ~/ 11,, / t.t)~'ti-1 }:c'~`i`"t-~<if r~>~O.;. ts~„-t~~l_i .- f __ -- - i"'"" D C,.,. r--t„~ C J (~ w0 :.L? ~y ~n ~ cu. •~ t :.~ +, '~' tl :+ ->ti Q k :~:~~: - a COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~~ ~~ ~.,. ~ •:.v: m CERTIFICATE OF DEATH '~ ~'- (See instructions and examples on reverse) ~ ~°--- ~~ STATE FILE NUMBER -^r7 2. Sex 3. Sotaal Security Number 4. Date of Death (Month, day, year) c^ Male 175 _ 52 _ 5184 September 4, 2010 MorYhc a - - - _.~---- •-.., _.._ _~._ ... „„.,.y~~,,,,,,,,,,,, on. rwtxi or Vealn (1~f18CK Only Ona) -_ Yg Fiourc Minura6 Hospital: Other. -- 51 Yrs. 4-19-59 Carlisle, PA 8b. Count of Deelh ^ Inpallent ^ ER / Outpatient ^ DOA ^ Nursing Hone ~+~ Residence ^Other - Specify: Y Bc. City, Boro, Twp. of Death 8d. Fatality Name (If not insliluliorl, give sbeel and rxrmber) 8. Was Decedent of Hispanic Origin? ®No [~ Yes 10. Race: American Indian, Bladc, White, etc. Cumberland Lower Mifflin Twp. 490 Shed Road (If yes,specilyCuba"' (specryq Mexican, PuerioRican, etc.) White 11. Decedent's Usual Occ Ibn Knd of work done duri nest of vro INe. Do not stale retired 12. Waa Decedent ever In the 13. Decedemk Educagon (Specgy onty highest grade completed) 14. Marital Staters: Married, Never Manied, 15. ;iurvivin Kind of Work Kind q Buskress /Indus U.S. Armed Forces? g Spouse (II wile, give maiden name) r~4 Elementary /Secondary (0-12) College (1.4 or 5+) Widowed, Divorced (Speciyy) Laborer Boarders Discs' ^Yes L_1No 8 years divorced 16. Decedent's Mailing Address (Street, aty /town, slate, zip code) Decedents 490 Shed Road AaualResider~e t7a Sala PA DklDacedent Live le a 17c. ®Yes, Decedent Uved m_ Lower Miff 1 l ri T W p. Newvi.lle, PA 17241 17b.Coum Cumberland T0N1"~0p? Twp. Y 17d. ^ No, Decedent Uved within Adual Umlts of City! Boro 1B. Father's Name (First, middle, lest, suffix) 19. Mother's Name (First, middle, maiden surname) Robert B. Miller Vesta P. Thomas 20a. Informant's Name (Type / Pdnq 20b. Intormenfs Mailing Address (SUeel, city /town, stale, zip txWe) Vesta P. Bear 528 Shed Road, Newville, PA 17241 21a. Method of Dispositfon ) ®Cremation ^ Donation 21b. Date of Disposition (Month, day, year) 21c. Place of Disposllion (Name q cemetery, crematory or other place) 21 d. Location (Cdy /town, slate, zip code) 17 0 6 5 ^ Burial ^ Removal from Slate i Was Crometion or Donation Authorized ^ Olher•Specity: r byMrdicalExaminer/Coroner? Wes^No 9-8-10 Hollinger Crematorium P1t. Holly Springs, PA a. Signatur~ ~,w parson aging as such) 22b. Ucense Number 22c. Name and Address of Facility FD-012984-L Fogelsanger-Bricker F.H. Inc., Shippensburg, PA 17257 Complete Items 23a•c only when certifying 23a. To the best of mY knox4edga, death xcuned at Ux time, date and place staled. (Sprewre and tills) physkaan is not available at time of death to ,~~, 23b. Ucense Number 23c. Dal Signed (Month, day,ye/ar) ceniry cause of death. J v l ")' ~ ~ ~ a ~) 2rI ~ ~ Items 24-26 mull be completed by person 24. Time of Death 25. Dal Pronounced Dead (Month, day ear) who pronoura:es death. 26. Was Case Reiened to Medical Examiner !Coroner for a Reason 0 r than Cremelion or Donation i' ~7~M. ~ Q ^Yes ~No CAUSE OF DEATH (See Instructions and a mples) Item 27. Pan I: Enter tl>e chain of events - dseeses, injuries, or complications -that duegly caused tho death. DO NOT enter terminal events such as cardac anent, ~ Approxbnale interval: Pan 11: Enter other t10, 28. Did Tobatxo Use Contribge to Death? respiratory arrest a ventricular fibrilleGon without showing the etiology. Usl only one cause on each tine. r Onset to Death but nq resultirp in the urxledying cause given in Pan I. ^Yes ^ Probably IMMEDIATE CAUSE (Final disease or r ^ No ~/ "jlnknown conditbn resulting kr death) _~ a. f ~~~ ~ ~ ~~' (, / / ~ i t 0 ~ y ~Yl o ~' ~ ((G" r t !'17 !t1 t/ 29. If Female: Due to (or as a conseque ce ol): r Sequentially list conditions, d any, b. ~ ,[~ ~(~ r/ r - ^ Not pregnant within past year leading to the cause Gsled on line a. r=te/ "` r ` `~ ~M ~G ~ l L ~'1 ~ +-lc w ~ 1~ ,r,~yy~-~> ~ r1~~~ ,ter f~ S ^ Pregnant at Gme of death Enter the UNDERLYING CAUSE Due to (or as a consequence ol): T , (twenls resulting mtdela h)letAST a c• ~ ^ Not pregnant, but pregnant within 42 days of death Due to (or as a consequence oq: r d, l - ^ Nol pregnant, but pregnant 43 days to t year r before death 30a. Wes an Agopsy 30b. Were Aul ^ Unknown q pregnant within the pall year opsy Findings 31. Manner of Death 32a. Dale q I u y y ) Performed? Ava9able Prior w Canpleliar r~~ nl ry (Month, da , ear 32b. Describe How Injury lkcuned ~ 32c. Place of In'u Home, Farm, Street, Fagory, of Cause,q Death? l~vatural ^ Homicide I ry' Office Building, etc. (Specify) ^ Yes [~'No ^Yes ^ No ^ Accident ^ pending Irrvesligalwn 32d. Time of Injury 32e. Injury at Work? 321. II Transponation Injury (Specify) 32g. Locelbn of Injury (Street, oily ; town, stale) ^ Suicide ^ Could Nol be Dgermined n Yas (~ u„ ^ Driver /Operator n Passen"er (-lPadr,arri,~ - Uumer • speedy: 33a. Ceniller (dreck only one) Certll In h ciclan Ph 33b. Si nature and TNeyi-Candler • A ~ Y 9 P Y ( ysx:ian certifying cause d death when anodx3r physician has pronow iced deadr and completed Item 23) ~- ? ~ To the beet of my knowledge, death orxurred due to the cause(s) and manner ae alated_ _ _ _ _ _ ~ ' ,~ - Pronouncin andcertif in h siclan P ----~--------------- ~j`~ ~~ , '~~ G~~~~---- ~ ~~ ' 9 Y 9 P Y l Sian bqh ronou "' - - - - '~ p hang death and ceNtying to cause of death) 33c. License Number ~' / +' i To the best of my knowledge, death occurred at ttro time, date, and place, end due to the cause(s) and manner es stated_ _ _ _ _ _ _ _ _ _ _ ^ 33d. safe Srlned (Month, day, year) o Medical Examlrrer /Coroner - - - - - - - ~ ~ ~~ ~ ~ ~~ ~ ~ / / ? `~ ~ / O o On the basis of examination an vacligalion, y pinion, d wecurred sl Ilre time, dale, end place, and due to the cause(s) and manner as stated_ ^ _,e. LL 34. Name and Address of Person Who Completed Cause of Death Q1em 27) type /Print 0 35. Registrar's Signatu end D' umber -.*y } ~ ~~~ (~ ~`~C~ ~ ~ ~ ' 36. Date Fi (Month, ,Year) I t- Z 2.1 ~~ ~ 2~Lf.~~ O 20 d gip,-;:., rca- ~ ~c,..~'~~~t / ~'i~, tz cs 13 Dispoailbn Pemut No. ~ J .l 4 ~ ~ G:, ~ J • ~` ~ .~~ ~; 1,~ r ~ II~~ ,,jj ~~~ .- = ~--~ '~ ~~ ., ~ ,~} r~ Y ti~ ~~ . ~' ~ '~ -; -,~ ,~ ~.~ ~ ~ ~~ r ~ ~.~~ ~~ ~, ~~.;' c ~ C'2 ~g ..z,, r: . (~ "~~ ~ _ -- ., `~~ { '~~~ ~ ~~ ~~ ~~ ~~~~ OATH OF SUBSCRIBING WITNESS(ES) REGISTER OF WILLS OF CUMBERLAND Estate of John Beecher Miller Pastor Donald C. Snyder Scott Thrush ~rnnt rvame/s) COUNTY, PENNSYLVANIA n tip.: C ~ , Desease~ ; ;~' r I~ , ...,~ C ~ ,~ !~ ~ ~~ ~ '... . 7 ~~ ',_f (each) a subsc~bing wi tne~~ to ~ O .~ . .. _.z. ~ the 0 ~/~/ill ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same and that she / he /they signed the same and that she / he /they signed as a witness at the request of the Testator /Testatrix in his /her presence and in the presence of each other. ~s~G~~ ? (Signature) Pastor Donald C. Sny er (Street Address) r C~ ~. ro~~ r ~ 12c~ ~ (City, State, Zip) S.- ~/~~ (Signature) Scott Thrush (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of . Deputy for Register of Wills Executed out of Register's Office Sworn to or affirmed and subscribed ~~ % s -: before me this day .~`~l ~ r2 Notary Public My Commission Expires: ~>4- ~s ` s ~l ~ ~ ~©/~/ (Signature and seal of Notary or other official qualified to J administer oaths. Show date of expiration of Notary's commission.) ~~.~~... NOTARIAL SEAL RICHARD L, WEBBER JR., NOTARY PUBLIC SHIPPENSBURG BORO, CUMBERLAND COIJNTY NOTE: To be taken by Officer authorized to administer oaths. Please have present the or g n~aMorlcopo of ns trumenGs Sa 27 ~~014 Y () t time of notarizatlon. Form RW O3 Rev. 70-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. ~{ cF C4M•i o Register of Wills of Cumberland County V O 7 RENUNCIATION Estate of John B Mi l l Pr Also known as John Beacher Miller deceased No. To the Register of Wills of Cumberland County, Pennsylvania The undersigned Jessie Mille (Name) (Relationship) (Capacity) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters of administration c. t . a. be issued to Shannon Miller Witness my/our hand(s) this ~ day of Affirmed and subscribed before me this ~ ~''' day of ~ c~r~ ~..~L_t_ ota Pu is My Commission Expires: C~ 02 /v~. ~f ~ I r. Or Affirmed and subscribed before me this day of Register of Wills Deputy (Signature and seal of Notary or other official qualified to administer oaths. S1-iow date of expiration of Notary~~s commission) r-- (Address) ~'~ ~~~~~ (Signature} C'7 ., ~--: - (Address) ~ ~ ...~ ` ---- t~... ~.. ~ -r~ c--3 t~ ~~ ~r~ ~? ~ _ '.yam. ~ ~? ~ r.~ ~ ~- .Y _ ! ~ , s ~ . ' (Signature) ~.:a.- ` .' ~~ ~ ~i (Address) `~=` `'~ ~: I Notarial3eal ---` Jason Joseph Oliver, Notary public City of Edwardsville, Luzerne County MY Commission Expires February 24, 2015 RENUNCIAi'ION REGISTER OF WILLS OF CUMBERLAND _ COUNTY, PENNSYLVANIA Estate of John Beecher Miller A/wA John B. Miller _ ,Deceased ~~ Rawn E. Shunk nn ame in my capacity/relation;;hip as Residual beneficiary of the above Decedent, hereby renounce the ri ght to administer the Estate of the Decedent and respectfully request that Letters be issued to Shannon N. Miller (Date) (Signature) - Rawn E. Shunk 490 Shed Road (Street Address) -- Executed in Register's Office Sworn to or affirmed and subscribed before me this--~~` ~ ~ ~ ~aY ~,, , _ ~A~~ eputy for Register of Wills n Newville, PA 17241 ~ f~ >- ._.:::: (City, State, Zip) - ~-.1 1 ~ ~~ ~7 . ~ ~~~~ ._ ~.. y> .~_ ~ W _~ ~~'t ~ ~> ~' Executed out of Register's Otte =~• Before the undersigned personally appeared th~~ party executing this renunciation and certified that he or she executed the renunciation far the purposes stated within on tgis__ 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. ) Form RW 06 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. ~~ c ~t-t __ ... } {t ~1 - - ~~ --~,