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HomeMy WebLinkAbout07-26-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Catherine S Romig also known as COUNTY, PENNSYLVANIA File Number 21-11 - `~5:~~ Deceased Social Security Number 186-10-2900 Carol n R Romi Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or '8' BELOW:) ® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the EX@CUtrIX named in the last Will of the Decedent, dated 09/1811984 and codicil(s) dated 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 adopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: B. Grant of Letters of Administratio (lfapplicab/e, enter: c.t.a.; d. b.n.ct.a.; pedentelite; duranteabsentia; duranteminoritate) 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 n v ~, O _~ ~ -; r--°- -= rn r ~ ~ a•i -_ `~ e..i f-1 _ j_. (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. `'J ~ ~~ ; '=_ '~ i-- ~. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last princip~r`es~idence at Golden Living Nursing Home Camp Hill East Pennsboro Township Cumberland, PA 17011 ~ (List street address, town/city, township, county, state, zip code) Decedent, then ~_ years of age, died on 07/05/2011 at Holy Spirit Hospital Camp Hill East Pennsboro Twp. PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 107,055.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the last WII 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 Carolyn R Romig 4033 Caissons Court ~~ , Enola, PA 17025 ~~~~-f.~ `~~ ~ ~L Personal property in County Form RW-O? Rev. 12-26-2010 (infenm form, pending action by the Court) Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 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 truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~_ day of < , ..fit ~, 1 ` ~ For the Register of Signature of Personal Signature of Personal cri :70~ :~~ File Number: 21-11 ' ,`f,~~j ~. Estate of Catherine S Romig ,Deceased ~~ i `7"' ~ t ~. J l~ -t'T Social Security Number: 186-10-2900 Date of Death: 0710512011 AND NOW, ~ ~ ~ ~ ~-) ~ 1' - , , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to in the above estate and that the instrument(s) dated 09/1811984 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters .......................... ............. $ ~ lL~tl L~~ _ Short Certificate(s). ~~.~...•....... $ I ~ ~-'~-' Renunciation(s) ............................ $ ,~;_,_~j $ I r ) ~~ $ $ $ $ $ $ ~. r TOTAL ........................_......... $ i~ (~' ~ ~' Attorney Signature: Attorney Name: Carolyr>~ Romig ;.~~~~~N EDMUND G. MYERS Supreme Court I.D. No.: x,0558 JOHNSON DUFFIE Address: 301 MARKET STREET PO BOX 109 Lemoyne, PA 17043 Telephone: (717) 761-4540 Form RW-O2 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 O~AI_ REGISTRAR'S ~ ER°T`~~I ~~TI~~!U ~~~= ~~°H ", 1Ar`b6~I~ING: It is ~Ilegal to duplicate ~~yf", ~.e~~>~~ ra~a „~~1utl~:F~~,~ w.,r ~9~vr:^~f~,.~,. P _175.573.92. t'ertii~ik_a~ixm tiLnnr~( .. I !ia tflti:Y(9r?41 ik _ `_!~', c11 .. I~ l'ti'~( P { ~ ~, ~ t 111{~1L. l L` t~j L)Ltllll t .,~. r a, . ' , .. i s;,l±' L .aril n ~ 1~ ~ ~ ~ ~~ m n~ ,, ~o ~~ ~ v• ,.l , 7 ~. =;=. :~J CUT ~_ . ~~_ _ ^ ~ 4 ~ ~_ (~ a ~'~ Q --n c t43 REV t1r2DDs PE 1 PRIM IN 'ERMANENT &ACK INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STdTF FII F NI IMRFR 1. Name of Deatlent (First, middle, lest, sulex) 2. Sex 3. Social Sacurlly NuMer d. Date of Deelh (MOnlh, day, year) Catherine S. Romig emale 186 -10, ,2900 airy 5,2011 Age (last Bktnday) 5 Under 1 er Under 1 tla B. Dab d B1M Monts, de , 7. Bi lace C end state or tor e G. Place d Deets Check on one . 96 Days Rrere Mmes Sept.9,1914 Wellsville,PA "oapdall omar Yrs. Inpatient ^ ER / Oulpetient ^ DOA ^ Nursing Home ^ Residence ^ Omer - Spacity: 86. County d Deam &. City, Bwo, Twp. of Death ed. FecilKy Neme (If not Ins9tutbn, give street entl number) 9. Was Decedent of Hlspenk Odgin? ~ No ^Yes 10. Race. American Indian, Blad, White, etc. (tt yes, spedly Cuban, (Spedryq Cumberland E. Pennsboro Holy Spirit Hosp. Mexicen,PuenoRican,em.) bite i t. Decedents Usual lion Kind d work done d uri moll of woricin IXe. Do not stele retir 12. Wes Decedent ever in me 13. Decedents Etllratron (Specify only higGbt grade compMtad) 14. Marltel Status: Maned, Never Mertietl, d D d S a Wid 15. Surviving Spouse (It wtle, give maiden name) Kind d Work f KkM of Buslnessllndustry U.S. Armed Forces? Flem tvy {Secondary (U12) un~c College (1~4 or Sv) NOrce NJ owe , / Pe idowed e house wi ^yaz ~~ 1 B. Decedents Meiling Address (Street, ciy I town, state, zip coda) Decedents Did Decedam State PA live in a 17c. ®Yes, Decedent Lived in F. _ n n a ha ro _rwp. Actual Residence 17a 4033 Caissons Court . Cumberland Tormmlp? 17d ^No, Decedent Lived wthin Enola, PA 17025 "~c°°"y Am,al umftsd ciy/Bom 1S. Fathets Name (Frst, midtlle, last, sWAx) Luther A. Miller 19. MoMeYS Name (Frst, mitlde, maiden sumemel Edith A. Mumma 20e. Intonnent's Name (Type I Print) 206. Inloment's Mellkg Address (Street, cly /town, stele, zip code) Carol n R. Romi 4033 Caissons Court Enola,PA 17025 21 a. Method of Dispositbn 1 Cremation ^ Donakan ' ^ • 21 b. Date d Dlsposnbn (MOmh, day, year) 2011 July 11 21c. Place d Olepa'laon (Name of cemetery, crematory or other place) Rolling Green Mem. Park 21 tl Locaton IClyl town, state, zID code) Camp Hi11,PA 17emoveuromstele wasc erDOnaUOnAUthorlmd C~Bl,nd ^ ^ , Yes No ^ Omer- I lMdlee mlrlxl COroner4 ~ Service eee uW) ~ 22a. ne of F 22d. license Number 22c. Name end Address d Fedltty . ~ 011248E usselman FH&CS Inc. 324 Hummel Ave. Lemoyne,PA Camplele Items 23ec only when certrlying 23a. To the best y krwwiedge, death occurretl at me time, date entl place stated. (SlgneNre and tltle) 23b. License Number 23c. Date Signetl (Month, day. yea() phyaiden ~ n°t eva9abla et tka d eeem to arltA' cause d death. ~ ~ c ~ '~ Iv (, o3~S 3 Su-t 5 , 20 I I hems 2426 must G completed by person 24. Tirtle of Deem 25. Date Pronouncetl Dead (Monts, day, year) 26. Wes Case Rekrtad to Medical Examiner r Coroner for a Reason r than Cremation or Donation? ® ^ who promwras deem. ~. d ~ ~ M. ~~ F, Yes No CAUSE OF DEATH (Sea inatruetions entl exa pbs) 1 Approximate ilterval: t such az rardac artast t to Deam l tl th d m DO NOT m t i l O d Pen II: Emer other sionifiam mnddore centribuane t° deem Nen In Pad I bN not resultln in me undarryin awe 26, Did Tobacco Use DomrAUla to Deam? - ^Y ^ P b bl even , i nse ee . e er artn ne s rect y cause e ttem 27. Pen I: Enter the meYl d events - dseasaz, in)unes, or compliatlons ~ mat reepketory arrest, or ventricular IiMillatrm wkhout showing me etidogy. List Dory one cause on each Ilna. . g g g ro es a y ^ No ^ Unknown f IMMEDIATE CAUSE (Fnlel disease or ~" 1 ~ I~ ~ ~~ _ ^ ~ ~Y ~-~~ V ~ condition resulting In deem) _ ~ a r r' ~ ( 111 ~ 29 If Female. ^ Nol nant wAhln re ast ear Due for aY a qua on: _ (' ~~AJ~ I L O'V l $epuenaell kst condMons, A any, b ~ p p g y ^ Pregnant at time of dea(h ^ . kedi m ~ rauaz f~ on ~ e Emm me UNDEflLYING CAUSE Du W or az a~saquenc o A v Not pregnenl, but Dragnant withii d2 days of deem (deeeae or injury met InPoetetl me c {~ l v1 C~-~ - l t 43 d t 1 ^ N events resultlrlg In deem) UST. Due to (or az a consequence o~~. pregnant, but pregnan ays o year o before deem d ^ Unknown II pregnant within the past year . 30a. Was en Autopsy 30b. Ware ANapsy Flndings 31. Manner of Deam 32a. Dale d Injury (Monm, day, year) 32b. Describe Haw Injury Occurted 32c. Place of Injury: Home, Farm, Street, Factory. Pedortnetl? AvaiMble Prior to Completion °f Cause of Deam? cc~1 ICI NaNrel ^ Homidde Office Builtling, etc. (Spent') sw1 ^ Yes L.[J No ^ Ves ^ No ^ Mcldent ^ Pending Investigebon 32d. Time d Injury 32e. Injury at Work? 32f. M Tranaportefion Injury (Specify) ^ Drive I for ^ Passen r e ^ Paastnen 32g. Location of injury (Street, city l lawn, state) ^ Suicide ^ Count Not G Determired M. ^Yes ^ No 9 ^ Opay_ 33a. Certlfler (made ody one) I d ~. 4 • C•r1NYing physiekn (Physlden anirying cause of deem when another physlden has pronounced tle9ih and completed Item 23) tlaath occurred due to Me auae(e) end manner es stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ To the beet d my Imordad{p , • Pronoundng and cemttying physkMn (Physiden troth pronoundng deem and carlilykg to reuse d tleem) 33c. License Nu/n1be11r L 33d. D e S' Monm, day, Year) ~ Toth Gat of my knrx«ladge, oath oaumd at the time, data, and plea. and duo ro the ease(s) end manner a ststad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ Il`) T\ ~ I -F ( .`~ , • M•dkal Examhrr/Coroner I ' L..LL I I ; On Me Gsla d exammatlon arts I or Investigetbn, In my opinion, death oaurtetl el tG time, data, end pMa, end due to Me ease(s) end manner u ehted_ ^ ~ ~ ~ss, ,P~ ylho~{[ete~ g@pl DeaMil(em ~7) T ! PnnO~ f ' l 1 e 1r; I _ Q CV V I ~ L V I ` `(~ ~U ~ 35. Regstre/s SignaNre Disirid Nu d... ~ ~ ~ ~ 2v l ~ I ~ 38. Date onm de . y r) ~ ~'a~~~ A TH R /~/ S^ ,N tA I UL V I S ~ ~U ~ «~~ , z V Disposdion Permit No. ©`~ f ~ ` J ~~~t 3~i11 ~n~ C~TP~tttmPnY of CATHERINE S. ROMIG ~. ~o ~= -i~ ~rn ~Cn~ t~~ CT's - ,=-,' ,_ _, Jn ~ ~ ~ .._ - .._ ... : ; a . ;- A t: ~•~ O i''° 'T7 I, CATHERINE S. ROMIG, of the Borough of Lemoyne, Cumberland County, Pennsylvania, make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. L I direct the payment of my just debts and funeral expenses as soon after my ~', decease as convenient to my Executrix hereinafter named. II. If I am survived by my daughter, CAROLYN R. ROMIG, I give, devise and bequeath unto her my household goods and other items of tangible personal property. III. All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath unto my daughter, C A ROLYN R. R.OMIG, if she is living on the thirty-first (31st) day following my death. Should my daughter, CAROLYN R. ROMIG, not be living on the thirty-first (31st) day following my death, I give, devise and bequeath the residue of my estate unto JAMES K. MILLER. of Warner Robins, Georgia. rv. I name, constitute and appoint my daughter, CAROLYN R. ROMIG, to be the Executrix of this, my Will. Should my daughter, CAROLYN ~. ROMIG, fail to survive me or fail for any reason to complete the administration of my estate, I appoint CCNB BANK, N. A., to be the Executor in her stead. IN WITNESS WHEREOF, I have hereunto set my hand and seal this I ~ day of ~ ~~ -~e +,~ ~ .~--~ , 1984. < ~'~ ~7~ t,~~ (SEAL) Catherine S. Romig Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ~~ -2- ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND I, CATHERINE S. ROMIG, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. --b ~, ~ -; ~' ~~ ~ ~ J~ Catherine S. Romig Sworn or affirmed to and acknowledged before me, by CATHERINE S. ROMIG, this / $ ~ day of 1984. No t c Pub tSY C;UYta!~:i!Jti ix~IKES CEC. Zl. 1985 ~~~~~;,~~ ~~~ C:;:~7BERLAND CO. e FRm s vrm COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND W e, ~ h~ Q S / , ~~ ~ ~~ and ~~(~ ~,.-,-. c~ ~ ,~ ~~ a-S , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she 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 witnesses; 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. Sworn or affirmed to and subscribed to before me by ~ , , and EQ ,b witnesses, this / ~ day of ~~,,~,,~_ 984. Notar ublic r y C.J"fl~~'.~_'J~r icFttE3 CEC< 21. 1985 '.EIt,R: ~`: ~ r; w;1Br".RLANO CO.