HomeMy WebLinkAbout09-06-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Ezekiel A. Binaaman
also known as
COUNTY, PENNSYLVANIA
File Number 21-11
,Deceased Social Security Number 180-70-9384
Audrey M. Bloom
Petitioner(s), who is/are 18 years of 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 named in the
last Will of the Decedent, dated and codicil(s) dated
Renunciation of Mikel G Binaaman natural father of the Decedent ham been filed
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 Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pedente liter durente absentia; durante minoritate)
Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the following spouse cif any) and heirs (if
Administration, c.t.a. ord.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
Bingaman Child Halifax PA
n ~.T..:
Elijah Bingaman Child ~ ~~ ~'
Halifax, PA ~ -z, ~.; ;.
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(COMPLETE /N ALL CASES:) Attach additional sheets if necessary. ~~~ ~ ~~ ,, ~,~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal r~it~ice at -,r 5~~ ;-T-r
422 South Enola Drive Enola East Pennsboro Cumberland PA 17025 ~' ~"~ ``
-~-,
(List street address, town/city, township, county, state, zip code)
Decedent, then ~_ years of age, died on 03/02/2011 at Wertzville Road. Enola, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
Total
situated as follows:
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
re Typed or printed name and residence
~/~ Audrey M. Bloom 101 East Perry Street
~!~-=~ ./~ Enota, PA 17025
rcn,n r~.r-VL K6V. 77-Z6-ZU1 U (interim form, pending action by the Court) Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1
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LOCAL. REGISI"RAR~'S CERTIFICATION O~F DE~,~,"rFl
1NA,RNING: It is illegal to duplicate this copy by photostat o~r photogrct;~h.
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REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
/PRINT IN CORONER'S CERTIFICATE OF DEATH
MANENT
4CK INK (See instructions and examples on reverse) STATE FILE NUMBER
4~ 3 2- 4 7 5 4. Date o1 Death (Month, da ear
2. Sex 3. Social Security Number y~ y )
1. Name of Decedent (Flst, middle, last, suffix)
Ezekiel A Bin amen 180 -70 ~ 9384 March 2 2011
5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Birth (Month, day, ear) 7. Binhplace (City and state a forei ceuMry) Ba. Place of Death (Check only cne)
Hospital: Other:
Mon6~s Days Hours Minulea
22 Yrs. Februar 9 1989 Harrisbur Pa ^Inpetient ^ER/Oulpatirrnt ^DOA ^NursingHome ^Residence Other-Speciry.
6b. County of Death &. City, Boro, f Death 8d. Faciliy Name (If not institution, give street and number) 9. Was Decedent of Hispanic Origin? ~No ^ Yes 10. Race American Indian, Black, White, etc
(If yes, specity Cuban, (Spearyl
~ Mexican, Puerto Rican, etc.) Whit e
Cumberland Ham den 4250 Wertzville Road
11. Decedent's Usual Occu tbn Kind of work done du' most of world life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Speuity only highest grade completed) 14. WidcwedtaDivorced ~3pecil)gr Married, 15 Surviving Spouse (II wife, give maiden name)
Kind of Work Kind of Business I Industry U.S. Armed Forces? Elementary /Secondary (0.12) College (1-4 or 5+)
Painter Pro one Co. ^Yes ~'° U k Sin le
16. Decedent's Mail' Address Street, ca /town, state, zi code) Decedent's Did Decedent
"~ ( y p Pennsylvania Liveina 17c~Yes,DecedenlLivedin Ramat- pPnnsbOrO _Twp.
Actual Residence 17a. State Township?
422 South Enola Dr. Cumberland 17d ^ No,DecedentLivedwithin
17b. County Actual Limas of Ciry I Boro
Enola Pa 17025 -
18 Father's Name (First, middle, last, suffix) 19 Mother's Name (First, middle, maiden surname)
Mikel C. Bingaman Audrey M. Schoffstall
20a. Informant's Name (Type !Print) 20b. Informant's Mailing Address (Street, city I town, state, zip tale)
Audrey M. Bloom 422 South Enola Dr., Enola, Pa 17025
21 a. Method of Disposition [Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. L°C2U°n (City I town, state, rip code)
•
^ Burial ^ Removal from State !Was Cremation or Donation Authorized
^ Other • Specify: ; by Medical Examiner I Coroner? ~ Yes ^ No Mar 4 2 01 1 Evans Cremation S E3 r V 1 C e Leo 1 a P a
~ 22a. Signet of F I Service Licensee (a person actin as such) 22b. License Number 22c. Name and Address of Facility S u l l 1 V a n F U rie r a 1 Home
~~ ~ ~ FD011897-L 51 N. Enola Dr. En.ola Pa 17025
r
Complete 23a-c only when certifying
23a. To the best of my knowledge, death occurred at the time, date and place stated. (Signature and title)
23b. Lcense Number 23c. Date Si ned Month, day, year)
9
physician is not available at time o1 death to
certify cause of death.
Wa Case Referred to Medical Examiner /Coroner
26
for a Reason Other than Cremation or Donation?
st be competed by person
24
26 m 24. Time of Death 25. Date Pronounced Dead (Month, day, year) .
Yes ^ No
u
-
Items
who pronounces death. 2 : 4 5 A . M.
A rX March 2 2011
.
CAUSE OF DEATH (See Instru ctions and examples) r Approximate interval: Part II: Enter other gjgpi(jganl conditions co
rt
in
c
d
i
th ntdbutinb to death,
iven in Part I
ause 26. Did Tobaccro Use Contribute to Death?
^ Yes ^ Probably
Item 27. Part I' Enter the chain of events -diseases, injuries, or complications -that directly caused the death. DO NOT enter lertninal events such as cardiac arrest, r
r Onset to Death .
g
g
e un
e
y
n
but not ran Iting ^ N° ^ Unknown
respiratory amest, or ventdculer libdllation without showing Me etiology. List only one cause on each Nne. r
r
r 29. It Female.
IMMEDIATE CAUSE (Final disease or r
cordftion resulting m death) .~ a. Head and Chest I n ~ tlr i e S ,
^ Not pregnant within past year
Due to (or as a consequence ol): r
r ^ Pregnant at lime of death
Sequentially Gst conditions, it any, b. MO t O r Vehicle Crash r
r ^ Not pregnant, but pregnant within 42 days
lead to the cause listed on line a.
UNDERLYING CAUSE Due to (or as a consequence of): r
h of death
e
r
Enter t
(disease a injury that initiated the c. r
^ Not pregnant, but pregnant 43 days to 1 year
events resuhirg in death) LAST. ~ ~
Due to (or as a consequence ol). before death
, ^ Unknown it pregnant within the past year
d
Occuned
H
I 32c. Place of Injury. Home, Farm, Street, Factory,
30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) ow
jury
b.
left r o adwa ,
~n~e~t e ~ operator , Y struck Office Building, etc. ($~ecity)
Pertormed? Available Prbr to Completion
^Natural ^Homicide
March 2, 201
1
tree ari
a house overturned Ru r a 1 Ro a
/ of Cause of Death?
t.,r Accident ^ Pending Investigation 32d. Time of Injury p
A rX 32e. Injury at Work? 3 2f. II Transportation Injury (Specity) 32g. Locati on of Injury (St-eeL city I town, state)
~
M Yes ^ No
,
17rt Ves ^ No
d .
Driver I Operator ^ Passenger ^F'edesuian
^ Yes No
PA
1
E
Y ] ^ Suidde ^ Could Not be Determine 2 • 45 A M. Odter - specify: Unknown We no
a
t Zv 111 a
33b. Signature and Title of C~(.~_
33a. Certifier (check Doty one)
• Certifying physician (Physician cedfijing cause of death when another physician has prorwunced death and completed Item 23)
^ ,
n
To the beat of my knowledge, death occurred due to the cause(s) and manner as afated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ License Number
33c 33d. Date Signed (Month, day year)
Pronouncing and certifying phyekian (Physxaan both pronounang death and certiytng to cause of death)
• ^ .
To tfK best of my knowledge, death occurred at the time, date, end place, end due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ March 2 2 011
• Medial Examiner 1 Coroner
On the basis of ezamination and I a Investlgetfon, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as atated_ _
34, Name,~(~d A rQss oj,Perso Its Completed C~yse of De th (Item 27) Type I Print
l r~Q l; ~CKE'nrOat? ~oroner
35. Registrar's Signatwe District Numbs / 36. Date Filed ( nth, day, year) 6 3 7 5 B a s e h o r e Rd •, z~ u i t e fr 1
~ ~ I ~ I ~ I s~ I ~ I ! I ,_3 ~~ Q j / Mechanicsburg, Pa 17050
Disposition Permit No. ~) ~`~" l \ J ~ 'g~
REGISTER OF WILLS OF
RENUNCIATION
CUMBERLAND
-~~_~~
COUNTY, PENNSYLVANIA
Deceased
Estate of Ezekiel A. Bin aman .~=.: ~,~
I'mo' ~~ t ,..~
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in my capacity/rela whip as---; ~- 'i`y'
a ""'
~~ Mikel C. Bingaman '"~
of the above Decedent, hereby renounce~fhe right to
natual father
administer the Estate of the Decedent and respectfully request that Letters be issued to
Audre M. Bloom
j~~
ignature) Mikel C. Bingaman
(Date)
11 Maple Road
(Street Address)
Mt. Pleasant Mills, PA 17853
(City, State, Zip)
Executed out of Register's Office
Executed in Register's Office Before the undersigned personally appeared the
worn to or affirmed and subscribed
S party executing this renunciation and certified
before me this day thurt oses fatedwithin on }hr ~ot dtayn for the
of - • P P
of U ~- .
Deputy for Register of Wills Notary Public a0 ~,~
~ ~ b ~
nny Commission Expires:
(Signature and seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's commission.)
~~r1j~ r~~~;i~i
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Copyright (c) 2006 form software only The Lackner Group, Inc. , x_, ~„~, ~~., v ,. ,~..~:.. .~ ~•:~ ~~ - r~~x,.==
Form ftW Os Rev. 10-13-2006
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
etitioner s) above-named swear(s) or affirm(s) that the statements in the foe De edenlt' Pet tionrer(s) will weep and trulybest of
The P
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of t
administer the estate according to law.
Sworn to or affirmed and subscribed
before me this l ~ ~ day of
' ,1 ~ <~~
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Fc~r a Re ister
~_
of Personal Representative
~~~~
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.~ ~ -~-s
21-11 - ~~ ~~ `3
File Number:
Deceased
Estate of Ezekiel A. Bin aman ------- '
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Date of Death: 0310212011
Social Security Number: 180-70-9384 roof
~~ ~ l , in consideration of the foregoing Petition, satisfactory p
AND NOW,
having been presented before me, T IS DECREED that Letters of Administration
are hereby granted to 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 Decedent.
FEES
Letters .......................................... $ ( ~ ^^v
$ ~~ ~''t/
Short Certificate(s) ....................... ~r
(if~
7
$
Renunciation(s) ............................ ~
.
$
$
$
$
$
$
$
$ ~ S~ ~ y
p
.......................
TOTAL.......... ..
X H V a l U~y~~ \ 71 IN r~ _ I "'_
Regi er of w s
,~ ~~~~,
Attorney Signature:
Attorney Name: EdvNard P Seeber
Supreme Court I.D. No.:
James, Smith, Dietterick & Connelly, LLP
Address: SuNte C-400, 555 GettYsbura Pike
Mechanicsburg, PA 17055
Telephone: 71'T-533-3280
Page 2 of 2
Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lacltner Group, Inc.
Signature of Personal Representative ~ _- ~
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