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HomeMy WebLinkAbout05-17-12i- PETITION FOR GRANT OF LETTERS ~~~' '_ ~ ' ~; .~ REGISTER OF WILLS OF CUMBERLAND COUNTtY~.~?~f~~ISY~~/AaIA 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) tie following and respectfully requests the grant of Letters in the appropriate form: Maretta K Schmidt ~_ Decedent's Information ~~~vfiL;i~ ~t~t) , ,('~ Name: Rita Helene Krantz File No: 2 - ~"/~~ a/kla: (Assigned by Register) a/kla: a!k/a: Social Security No: Date of Death: 03/12/2012 Age at Death: 84 Decedent was domiciled at death in Cumberland County, pA (State) with his/her last principal residence at 824 Lisburn Rd., Camp Hill 17011 Lower Allen Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at The Woods at Cedar Run, 824 Lisburn Rd. 17011 Lower Allen Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ...................... All personal property $ 75,000.00 If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ TOTAL ESTIMATED VALUE $ 75,000.00 Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ^ A. Petition for Probate and Grant of Letters Testamental Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated and Codicil(s) thereto dated State relevant circumstances (e.g., renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did riot have a child born 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 Admini r^tion (If applicable) c. t. a., d. b. n., d. b. n. c. t. a., pedente iite, duranDs absentia. durance minoritate If Administration, c.t.a or d.b.n.c.t.a., enter date of Will in Spr•tinn o annvn ~.,.+ .,.,, torn tt~r .,f t,ot~~ Except as follows: Decedent was not a party to pending divorce proceedin wherein the grounds for divorce had been e:>tablished as defined in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated 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): Name Relationship Address Gina Krantz Child PO Box 338 Manala an NJ 07726 Maretta Krantr Schmidt Child 950 Donmar Dr. Dau hin PA 17018 Form RW O2 rev. f0-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 ''\ ~~C ~'~~~ ~- ~t f 71- Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } COUNTY OF Cumberland ~';_ ; ' ~ 'Offlclal tlsep"lr i _ :_~l Petitioner(s) Printed Name Petitioner(s) Printed Address Maretta KSchmidt 950 Donmar Drive `ff iu'~ r ` f ~iT Dauphin, PA 17018 ~ ~ The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the Deist of the Knowleage aria belief of Petitioner(s) and that, as Personal Representative the Decedent, P I n ( will well and truly administer thie estate accordi g to la Sworn to or affirmed and subscribed before - Date ~ r r ~~,' I'~, Date me this day of ~ t - - By: \'~,..~ 1 ~ ~ L t ` ) ~ ~ ~ (,~ ( ~' ~ .~ ~ Data For the Register Date BOND Required? ~ YES ~ NO FEES: Letters ...................................... .... $ 135.00 ( 5 )Short Certificate(s)...... ... 20.00 ( [ )Renunciation(s) ........... ... ~ ), ('~ ( )Codicil(s) ..................... ... ( )Affidavit(s) ................... ... Bond ......................................... .... Commission ............................. ..... Other Automation Fee ....................... ..... 5.00 JCS Fee ................................... .... 23.50 TOTAL ..................................... .... $ ~ ~.` ~~ 183:50-- Please enter my appearance by my signature below: To the Register of Wills: Attorney Si nature: ~ ~~ (.~ ~~ Printed Name: Linda J. Olsen, Esq. Supreme Court ID Number: 92858 Firm Name: Hazen Elder Law Address: 2000 Linglestown Rd. Suite 202 Harrisburg, PA 17110 Phone: 717-540-4332 Fax: T17-540-4313 E-mail: DECREE OF THE REGISTER Date of Death: 03/12/2012 Social Security No: Estate of Rita Helene Krantz File No: 21-12 a/k/a: AND NOW, i ` ~ ~_ , in consideration of the foregoing Petition, satisfactory proof having been' resented before me, IT IS DECREED that Letters of Administration are hereby granted to Maretta K Schmidt _ in the above estate and (if applicable) that the instrument(s) dated _ described in the Petition be admitted to probate and filed of record as last Will (and Codicil(s) of Decedent. Register of Wills ~ f ( J/' ~ / 1 (/ /,J Copyright (c) 2011 form software only The Lackner Group, rc.~~` i ~ '~~- ` ~ ~ r~-l ~ ~^- Pale 2 Of ~ ` ~, °l~tA~'~I;~It~is~ ~ileg~~-~~ ~ldig:~S~~of~tf~ ~~r . ,- ~)d)~4~,;;~ . ~', lilt, ,. t'J~!tl: ~I~'w '7. ~ .{ 1.~ ~I7~ ! ~ ! Yl~'~ ~ ~ C.U I F :~~~ ~~ r j CU~I~E~ERI 4;v~ ~~ . PA ~<L~ , ~ ..~ P 1833.573 Type/Print In Permanent Black Ink T_ r/ ~\ _\,~ 3 etYidF 9 t ~~ v~.) ` \•.'' C 1 ~~~ 3 ~ 7 °~Vr 1 / . COMMONWEALTH OF PENNSYLVANIA • OEPARTM ENT OF HEALTH VITAL 0.ECORDS f FRTIGIC'ATF AF I7FOTH r _. _. 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Secu ri[y Number 4. Date of Death (MO/Day/Vr) (Spell Mo) Female 317-20-7790 March 12, 2012 K Sa. Age-Las[ Birthday (Yrs) Sb. Under 1 Year Sc. Vnder 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) Ja. Birthplace (CI[y and Efate or I oreign Country) Months Days Houn Minutes Al3Y0Ye IL 84 March 29 , 1927 76. Birthplace (County) Kane 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apf No.) 8c. Did Decedent Live in a Townshfpi Penns lvania ®ves, decedent used in Lower Allen __ twp. Bd. Residence (councyl 824 Lisburn Road Cumberland se. Residence (Zip code) 17011 ONO, aecedeni eyed wltnin bmrcs pf _ city/born. 9. Ever In US Armed Forces? 10. Mar ital Status at Time of Death Q Marrietl Q Widowed 11. Surviving Spouse's Name (If wife, giv¢ name! prior So first marriage] Q Ves ®No Q Unknown ® Di vorced Q Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother s Name Prior to First Marriage (First, Middle, Lasi) Robert H. Lanham Dorothy Wittry 14a. informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, Scale, 21p Cotlej Mrs. Maretta K. Schmidt Dau hter 950 Dortmar Drive, Dauphin, PA 17018 G ace o on one ............ ........ ........ ... ......... .... ....... ....... ..... ¢ _ _ If Death Occurred in a Hospital: ~ Inpatient ; a pi pice Faclli ~( Decedent's Home If Death Occurred Somewhere Other Than Hos [al: C] Hos ry S Q Emergency ROOM/Outpatient Q Dead on Arrival ® Nursing Home/long-Term Cate Facility Q Other (Specify) 16b. Fac eme (If not Insfltution, g e s[reat and number, i c. City or own, a e, and 21p Coda 16d. Caun[y of Death ST 1 Ru n PA 17011 Cumberland Cam Hill 16a. Method of Disposition Q Burial ® Cremation 16b. Dale of Disposition 16c. Place of Disposition (Name of cemetery, cremator. or other place) $ Q Removal from State ~ Donation .€ Other (specify) Mar h 14, 2012 Cremation So nie ty of PA ~ 16tl. Location of Dlspositlpn (City or Town, State, antl Zlp) 17a. Sig Cure of Funeral Service Licensee n Charge of Interment SZb. License Number Harrisburg, PA 17109 ',L'L. FD-1.3B753 0 17 Name and Complete Adtlress o1 Funeral Facility Auer Cremation Services of Pennsylvania, Inc., 4100 Jonesto oad, Harrisburg, PA 17109 i 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what highest degree or level of school completed at the time of death, box that best describes whether the decedent the decedent consitlered himself or herself to be. Q Hih grade or less is Spanish/Hispanic/Latino. Check the "NO" $] White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese ® High school gratluate or GED completetl ®No, not Spanish/Hispanic/LatlnO Q American Intlian or Alaska Nafiye Q Other Asian Q Some college credit, but no tlegree Oyes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Associate tlegree (e.g. AA, AS) Q Ves, Puerto Rican ~ Chinese Q Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, BS) Q Ves, Cuban Q Filipino Q Sarnoan Q Master's tlegree (e.g. MA, MS, MEng, MEtl, MS W, MBA) Q Yes, other Spanish/Hispanic/Latino ~ laps nese Q Other Pacific Islander Q Doctorate (e.g. PhD, EtlD) or Professional degree (Specify) Q Ocher (Speclry) __ . MD DDS, DVM LLB, JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE fo indicate what the tlecetlent consitlered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work ~( White Q Japanese Q Samoan tlone during most of working life. DO NOT USE RETIRED. Q Black or African American ~ Korean Q Other pacific Islander American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure Public Relations Q Asian Intlian Q Other Asian Q Refused 22 b. Kind of Business/Intlus[ry Q Chinese Q Native Hawaiian Q Other (Specify) Q Filipino p Guamanian or cnamorro Bell of Penns.ylYan is ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronouncetl Dead (MO Day r) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR t'~ CERTIFIES DEATH I , ~ ~ 23d. Date Signetl (MO/Day/Yr) 24. Time of Death ./y 2 ~ 2z /"~~) 26. Was Medical Examiner or Coroner Contacted? O Yes- No CAUSE OF DEATH Approximate 26. Part 1. Enter the cha'n of a enis--diseases, in uries, or complications--that tlirecily caused the death. 00 NOT enter terminal events such as cardiac arrest Interval: ABBREVIATE. Enter only one cause on a line. Atltl atltlitional Iinev- if necessary Onset to Death etio logy. 00 NOT respiratory arrest, or ventricular fibrillation without showing the '' 11 1I i IMMEDIATE CAUSF ------- -- - -> a. Cl,yr+r~.~ O J~A 7~/1v.r.c r~Qr>_~`G2~..-- ____ (Final disease or contlition Due to (or a:: a consequence resulting In death) b. -_- 6equentlally Ilst condiTions, Due to (or as a consequence of): if any, leading to the c e listed on line a. Enter the --- UNDERLYING CAUSE Due to (or as a consequence of): (dis injury that o he events resulting d. -_ Initiated t c t m deem) LAST. DOe o (or as a consequence Of): ~ 26. Part II. Enter ocher signif"can[ conditions contributing to death but not resulting in The underlying cause gWen in Part I 27. Was an autopsy performedT Q Ves GI-l~ ~ /~T Av l~ ~~.tlvw_. '7~- T~nw~ 28. Were autopsy fintlings available to plete the taus of death? a co O Ves No 4 29. If Female: 30. Oid Tobacco Use Contribute to Death? 31. Manner of Death c [~}~IQbt pregnant within past year Q Ves Q Probably ~aCll rat [J Homicitle Q Pregnant at time of death Q No [a}Onknown Q Accltlent [, Pentling Investigation ~' Q Not pregnant, but pregnanT within 42 tlays of death Q Suicitle [] Could not be determined but pregnant 43 days io 1 year before tleaih Q NoT pregnant 32. Dale of Injury (MO/Day/Yr) (Spell Month) , Q Unknown ii pregnant within the pasT year 33. Time of Injury 34. Place o1 Injury (e.g. home; construction sit¢; farm; school) 35. Location of Injury (Street and Number, City, State, Zlp Code) 36. Injury at Work 37. If Transportation Injury, SpeciTy: 38. Describe How Injury Otcu rred: ~ Yes Q Driver/Operator Q Pedestrian ~ No Q Passenger Q Other (Specify) 39a. Cyy''ttifler (Check only one): ~~Certifying physician - To the best of my knowledge, death occurred tlue o the cause(s) and m tetl Q Pronouncing 8. Ce rtifying physician -TO the best of my knowledge, death occurretl a<the time, date Sa nd place, and due to She cause(s) antl manner stated ion, and/or investigation, In my opinion, tleaih occurred at fhe time, tlate, and place, and due [o the cause(s) antl manner stated Q Metlical Examiner/Coroner - A basi s of x a min at ~ the e ( 1 ~ ~ ) ~~ ~ , ,. y ~ Signature of certifier: t`Q+~~t 'C--2 ~..+--~L~-- Title of certifier: ~ ~ License Number: M~Q [~~J ~ L't~ 3 b. Name. Atldress antl Zip Code of Person Completing Cause of Death (Item 26) A ~ 39c. Date Sigr~etl (MO/Day/Yr) ) -e..-~...lle- P/i-tZ'C9.J3 bw-~ (C h[t~[ya.t~ MIS +-I TS r-i Wer.~64_..Sk ~ 3 11~--~i2_ 40. Registrar's DlstNCt Number 41. Registrar's Signat 42. Registrar File Oat (MO Day r) It 2 43. Amendments oisposi[ion permiT No. 0725744 H1O5-143 REV 07/2011 RENUNCIATION Estate of Rita Helene Krantz REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ,Deceased ~' Gina Krantz in my capacity/relatioinship as daughter of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Maretta K. Schmidt ~~ (Date) ts_ `~ ~ Z i_: -- a.. - .-- , -- _.._ ..;.. _ _. ~ _ _ ..~. ... , t . _ _, . -, `C.J t"~ , ' ~ T- c'C "~- _ ~u ~~_ ~wJ ~ ~ t U Executed in Register's Office Sworn to or affirmed and subscribed before me this day of~ Deputy for Register of Wills ~~ rsigr, ure) Gina Krantz PO Box 338 (Street Address) Manalapan, NJ 07726 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party exe g this renunciation and certified that he sh xecuted the renunciation for the purposes ed within on tkus~~ lay of PR/G , ?Q/ _...~_.. No ary Public L~ ~ ZO/Z My Commission Expires / 7/ (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's comn~ussion.) DAVID N. BERGERON NOTARY PUBLIC NEW JERSEY MY COMMISSION EXPIRES 10.25.2012 Form RW-OB Rev. 10-13-2006 Copyright (c) 2W6 form software only The Lackner Group, Inc.