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Home My WebLink About02-14-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully requests the grant of Letters in the appropriate form: Emma K. Weitzel Decedent's Information Name: Emma C. Wentzel-Toth a/k/a: Emma W. Toth a/k/a: File No: 21-12 ~ ~ 'T (Assigned by Register) a/k/a: Social Security No: Date of Death: 01/01/2012 Age at Death: 99 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 1000 W. South Street, Carlisle 17013 Carlisle Cumberland Street address, Post Office and Zip Code City, 'township or Borough County Decedent died at 1000 W. South Street, CaNisle 17013 Carlisle Cumberland PA Street address, Poat Office arW Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: Hdomlciled in Pennsylvanla ...................... All personal property $ 965,000.00 ff not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ Knot domiciled in Pennsylvania ................ Personal property in County $ Value of real estate !n Pennsylvania ................................................................... $ 3,000.00 TOTAL ESTIMATED VALUE $ 968,000.00 Real estate in Pennsylvania situated at Southampton Township, Franklin Co., PA Southampton Township Franklin (Attach additana/ sheets, it necessary.) Street address, Post Office and Zip Code City, Township or Borough County ^ A. Petition for Probate and Grant of Cellars Teatamentarv Petitioner(s) aver(s) that he/shetthey is/are the Executor(s) named in the Last Will of the Decedent, dated and Codicil(s) thereto dated State relevant circumstar>ces (e.g., renunciation, death o/execufor, etc.) Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not mar was not divorced, was not a pa to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. ~8323(g), and did not have a child bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ^ NO EXCEPTIONS ^ EXCEPTIONS ® B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.ta~., pedente life, durante absentia. durante minoritate If Administration, c.t.a or d.b.n.c.t.a., enter date of Will in Section A above and comoleta list of heirs. Except as follows: Decedent was not a party to pending divorce proceedingg wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adudiceted an incapacitated person. ® NO EXCEPTIONS ^ EXCEPTIONS 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 (attach additional sheets, if necessary): {-7 ~' ~ ~ tv "X3 Name Relationship Address -T; `° r''~ ~% CJ Emma K. Weitzel Daughter 61 G reenfietd Drive ~~ ~ ~ { ~ s"t 01 ~ ~ .. 7 Q ~ sa. ~~ ~ ~ rn --+ Q ~ t..~ Form RW-02 rev. faf ~-2of ~ Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2~ \~ rfcr~flJf~:LI'` ,`~,~:~ii~~ (~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Cumberland } SS. ' ' ~ 'Ri~~~ ~{~~~'~ r1 ~~p ~ 4 ~~ ~' fl Petitioner(s) Printed Name Petitioner(s) Printed Address Emma K. Weitzel 67 Greenfield Drive Carlisle, PA 17015 Q~~.~~~rJ ~id~~r The Petitioner(s) above-named swear(s) or affirm(s) 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 Decedent, Petltione (s) w II well and truly administer the estate acco ing to taw. Swom to or affirmed and subscribed before pace ~' Y °7D1O~ me thi d of ,c~Q~ Dace gy; Date ~ Reglstar Date BOND Required? ~ YES ~ NO FEES: To the Register of Wlls: Please enter my appearance by my signature below: Attorney Signature: ~ C Printed Name: George F Douglas, III Esq. Supreme Court ID Number: 61686 Firm Name: Salzmann Hughes, P.C. Address: 354 Alexander Spring Road, Suite 1 Carlisle, PA 17015 Phone: 717-249-8333 Fax: E-mail: gdouglas~salzmannhughes.com Letters .......................................... $ 660.00 ( 4 )Short Certificate(s)......... 16.00 ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ............................................. Commission .................................. Other JCP 23.50 Automation Fee 5.00 Automation Fee ............................ JCS Fee ....................................... TOTAL ......................................... $ 704.50 DECREE OF THE REGISTER Date of Death: 01/01/2012 Social Security No: Estate of Emma C. Wentzei-Toth File No: 21-12 Iq} a/k/a: Emma W. Toth AND NOW ~1 oZ _ , in consideration of the foregoing Petition, satisfactory pr of ing been pre nt before me, IT IS DECREED that Letters of Administration are hereby granted to Emma K. Weitzel in the above estate and (ff applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of record a last Will (and C icil(s)) of Decedent. Register of Will I _ / J/~ Copyright (c) 2011 form eoRwa The Lackner Group, Inc. /'~ ,~l ///J/ l',•9,''- / age 2 of 2 LOCAL RE,GIST,RAR'S CERTIFICATION i0F DEATH WARNING: I~~~~ .this copy by photostat or photograph. Fee for this certificate, $6.00 P 1~11~322 Certification Number _~ TYPe/Prln[In Permanent Lo H 3 ~_ ,,,il~~~~~~~~~~~--,., This is to certify that the information here given is II'.' p~~N OF pE~; :: correctly copied from an original Certificate of Death ~tll2 DEB 14 AM 9~,;o tis~:- r~, duly filed with me as Local Registrar. The original ~,~ ~ ~ '_ z certificate will be forwarded to the State Vital ~i~.~RE( Q~ °v ~ ~ ~ a Records Office for permanent filing. orvf~ cou ' o ~ ~ ~ ~~ ~ *,~~ ClJMRFpI A.NI7 C -- ~~ IIjl1 IL- ,~_ q~_jFP~~~''~ ~~t_Q`~^~~e~~t~l~ies~Dext~" JAM 6 ~2Q12 '~- IMENT OF~;III """""'ill Local Registrar Date [sued COMMONWEALTH OF PENNSYLVANIA -DEPARTMENT OF HEALTH -VITAL RECORDS f_FRTI FI ['ATF AF 1'fFAT1a 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number' ry4. Date of Death (MO/Day/Vr) (Spell Mo) - C/H~4• lit/ Tp t`l Female 174-OS-2448 .Janus o~ ~a/~ Sa. Age-last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) I 99 Months Days Hours Minutes Feb 19 r 1912 7b. Birthplace (County) Per ga. Residence (State or Foreign Country) Bb. Residence (street and Number -Include Apt No.) 8c. Did Decedent Llve In a Township? PA 1000 W . $071th Street Q Yes decedent lived In , _ p,yP. Bd. Residence (ca„ntY) Carl isle Cun)l~erland 8e. Residence (Zip Code) ~ No, decedent INed wlthlni limits of city/boro. 9. Ever in US Armed Forces? 30. Marital Status at Time of Death Q Married ~ Widowed 11. SurvWing Spouse's Name (If wife, give name prior to first marriage) Q Ves ~ No Q Unknown Q Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First ~Aerrlage (First, Middle, Lest) John Calvin Weitzel F of i 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's M (ling Address I;Street and Number, City, State, Zip Codel F n i l .c fna We tze daughter 67 Greenfield Dr., Carlisle, PA 17015 .................• ---................----- t~+t ......°--•--•----............--°-------r-..........-a-'-- rsss..,,«t--, Pn y, ens ....-......................... _ _ _ _ If Death Occurred In a Hosplfal: I-_I Inpatient ;If Death Occurred Somewhere Other Than a Hospital: ~(~HOSpice Facility --~- -~ Decedent's Home Q Emergency Room/OUtpatleni Dead on Arrival _ Nursing Mome/Long-Term Care Facility Other (specify) a~~. lSb- Faelllty Name (If not Institution, give street and number; lSC. City or Town, State, and Zlp Gode 16d. County of Death' ' Cumberland ~, 16a. Method of Dlsposltion Q Burial Cremation 16b. Date of Dlsposltion 16c. Place of Disposition (Name of cemetery, crematory, or other place) pRemovalfrom scare Donation other (sPetlfy) Q Htmlanit Gifts R is ry J 4 r 2012 Y eg ' t 16d. Location of Dlsposltion (City or Town, State, and Zip) 1 . 5 ature of Funeral Service or Person In Charge of Interment 17b. License Number Philadelphia, PA 19107 013144E 37c. Name and Complete Address of Funeral Facility ' ~ 18. Decedent's Education -Check [he box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what F- highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. Q Bth grade or less Is Spe nish/Hispanlc/Latino. Check the "NO" ~ White Q Korean Q No diploma, 9th - 12th Srade box if decedent Is not Spanish/Hlspanlc/Latino. Q Black or African American ~ Vietnamese Q High school graduate or GED completed ®No, not Spanish/Hlspanlc/Latino Q American Indian or Alaska Native Q Other Asian Q Some colle e credit but no de ree [] g , g Ves, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawallan Q Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese Q Guamanian or Chamorro ' Bachelor s degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino Q Samoan ' Q Master s degree (e.g. MA, MS, MEng, MEd, MS W, MBA) Q Yes, ocher Spanish/Hlspanlc/Latino Q Japanese ~ Other Paclflc Islander Q Doctorate (e.g. PhD, EdD) or Professional de gree (SPecHy) Q Ocher(`-:Pacify) . MD DDS DVM LLB JO 21. Decedent's Single Race Self-Designation -Check ONLY ONE [o indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work White Q Japanese Q Samoan done during most of working Ilfe. DO NOT USE RETIRED. Black r Afri A i o can mer can Q Korean Q Other Paclflc Islander HOmema]cer Q AmeNCan Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese ~ Native Hawallan Q Other (Specify) OWn Halle Q Filipino Q Guamanian or Chamorro ITEMS 23a - 3 MVST BE COMPLETED 23a. Date Pronounce Dead (MO Day 23b. Signature o Person Pronouncing Dea'[h (On y when app Ica a 23c Ucense Number r . BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH ~-/G7ULL O ~ oZ ~ ~dt // / ~ ~ ~ ~ o 73~~ ~ /~<~ ~~ `/~5 p 0 L- 23d. Det Signed (Mo/Day/Vr) 24. Time of D th + 2~z % `i~ r i.S// ~ ~/ Of o7~/at ~)(/IS'r~~~ (~~~•~ 25. Was Medical Examiner or Coroner COn[acted7 Q Yes ~ No CAUSE OF DEATH ~ ApProximace 26. Part 1. Enter the chain of events--diseases, Inju rtes, or complications-that dlrecYly roused the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular flbriliatfon without showing the etiolog y. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Ilnez If necessary Onset to Death /I ~-- IMMEDIATE CAUSE ---------------> a. f ~ ~! /TS ~ N Iyl e•L/7-L+J (Final disease or condition Due [o (or as a consequ nce of): res~iting In death) b. (7~lYV1F/l!T'1 A 1/~/Kksc= r ~,>tgtz- `f ~r4i2 lr c Sequentially list conditions, Due to (or as a consequence f): If any, leading to the cause listed on Ilne a. Enter the i UNDERLYING CAUSE Due to (or as a consequence of): f (disease or InJury that F eG initiated [he events resulting d. in death) LAST. Due to (or as a consequence of): 26. P.K 11- Enter other si Ifl t dirt t Ib tl t d th but not resulting in the underlying cause given In Par[ 1 27. Was an autopsy performed? O ve: ~-T~o 2a. were autopav flndmga ayanam. ~ to tpmplete the ta.,ae of seam? Q Ves No , E 29. If Fema~: 30. Old Tobacco Vse Contribute to Death? 31. Manner of Death jyNOt pregnant within ast ear s p y Q Ye s Q Probably .~-NatV ral Q Homicide n nt Q Pre t ti /d th o g . a a me o ea Q N known Q Accident Q Pending investigation N t b m Q o pregnant, ut pregnant within 42 days of death Q Suicide Q Could not be determined Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place ollnjury (e.g. home; construction site; farm; school) 35. location of InJury (Street and Number, Clty, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 3B. Describe How Injury Occurred: Q Ves Q Driver/Operator 0 Pedestrian 17 No Q Passenger Q Other (Specify) 39a. Ce er (Check only one): ertifying physlclan - To the best of my knowledge, death o<c red due to the cause(s) and manner stated Q Pronouncing 8. Certiying physlclan - To the best of my knowledge, death occurred at the time, data, and place, and due to the cause(s) and manner stated Q Medical Examiner/Coroner - pn the bal ~at~ nd/pr Investigation, In mY oPlnlon, death occurred a[ the time, da1:e, and Place, and due to the cause(s) and manner stated / l ~~\` Signature of certifier: ( A/ Title of certifier: ~ p _ License Number: ~~~Q 448S4~L 396. Name, Address and Zip Code of Parson Completing Cause of Death (Item 26) 39c. Date SI ed (MO/Day/Yr) w l[..L_t 6. 1<~rtw~cPRn z V CA~K~c-+rLE L -~o R 3 1 JZ 40. Registrar's District Num er 41. Registrar nature ~ 42. Registrar FI a Dale Mo Day r O ~ ~ 43. Amendmen ~~ ` ~~ //~~ H105-143 Disposition Permit No. to ~ ~~ REV 07/2011