HomeMy WebLinkAbout06-27-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF L k M !fir"rQ A n.lQ 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 request(s) the grant of Letters in the appropriate form:
Decedent's Information _ h ~ ' ~~/ ~ n/~
Name: GE2,4 t_rf _ Il,~ r <' ~! File No: CY ,/
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ,gyp/ - 30 -/5/7
Date of Death: ~o a ~ /a a ~ a Age at death: 75
Decedent was domiciled at death in Ct. ,... Q FQ i q,v d County, pt aN s vc v a,vrR-(ware) with his/her last
principal residence at 3 ~ I~f.4sS1 ~~~~ lLQ Ncc..'1~r.2!' A,a /~ayi NdpF r~C[. Can.,Q,
Street address, Port Onlce and Zip Code Clty, Township or Borough County
Decedent died at 3' Sfo w
Street address, Poat Ofilce and Zip Code Clty, Townahlp or Borough
Estimate of value of decedent's property at death
Ijdomiciled In Pennrylvania ............................ All persoPalpro~erty sy
!f no[ domkiled in Pennsy(vanla ........................ Personat ro er to Penn Ivania
If not donsiciled in Pennrylvania ........................ Personal property in County
Value of real estate in Pennsylvania .........................................................
TOTAL ESTIMATED VALUE... .
Real estate in Pennsylvania situated at:
(Attach additional sheers, ijnecessary.) Street address, Post Otnce and Zip Code
State
S /P! f 1~4D. ~
S
S
S /(LD , 000
CIty, Towoship or Borough Connty
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/shdthey is/arc the Executor(s) named in the last Will of the Decedent, dated,g~ ~ eo y and Codicil(s)
thereto dated
Sate relevant circumstanca (eg. renanclatlon, deatAr ojerecator, etaJ
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not many, was not divorced, was not a party to~ up.pe~nding
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and tot have a cNt'&tbom or
adopted; and Decedrnt was neither the victim of a killing nor ever adjudicated an incapacitated person, r~ ,~
® NO EXCEPTIONS ^ EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
c.r.u., d.b.n., d.b.n.c.t.a., pendente life, durance ~
If Administration, ct.a or db.n.c.t:a., enter date of Will in Section A above and complete
Except as follows: Decedent was not a parry to a pending divorce proceeding wherein the grounds for divorce had
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^NO EXCEPTIONS ^ EXCEPTIONS
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fe defin~j
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Petitioner(s), afters proper search has/have ascertained that Decedent left no Will and was survivedby the following spouse (ifany) and heirs (attach
additional sheets, it necessary):
Fornr RW-02 r~~, roi~liaou Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Official Usc Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
I~,a,~ ~ .1 3 ~ ~ s; ~ ~~ ~ ~ , 1~A ~~a y
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 the Decedent, the Petitioner(s) will well and truly administer the estate according ro law.
Sworn t r firmed an subscribed before ,~~,~ ~ ~ Date L~a27-/a2
me th' d y o DI Dace
BY~ Date
or the Regist lute
fV
BOND Required: Q YES NO ~ To the Register ojWilla: ~' _
N
FEES: JO Please enter my appearance by my signs t1~J slow: ~ ~ ,
Letters ...................... S _
~l '
1i5 )Short Certificate(s)
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commissio ............
Other ~t ........
........
Automation Fee ............... ~~.
JCS Fee ..................... 'Z7i'T"~~
TOTAL ..................... S
Attorney Signature: ~-- x
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Cr
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Printed Name• -+ .. t'-^
Supreme Court -
~
ID Number: '
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~ e.(-t-~-{ ~ l: ~ I ~l,(, ~ L~! File No: ~~ ~ ~ c~ ' ~ ~>/~
a/k/a: _
AND NOW, `~ (~~~ ~ ~ , ~ ~a , in considerati n of the f regoing Petition,
satisfactory proof having been presented before me, IT IS D CREED that Letters
are hereby granted to CJ)') ~ , ~ p /
in the above estate and (if applicable) that
the instrument(s) dated GL
described in the Petition be admitted probate and filed of record as the
Fonn RW-02 rev. 10111/2011
of Wills
(and
Page 2 of 2
urng.Rps say Iq)+I1
LOCAL R CERTIFICATION OF DEATH
WARNING: I ate this copy by photostat or photograph.
i ~ 1 t
Fee for this certificate, $6.00
P 18626456
2011 Jl~l 27 PM 2t 3 """"~""" °"" This is to certif that the information here even is
II~~p~TH llF pE~'ytr correctly copied from an original Certificate of Death
o~ _ ~`; - duly filed with me as Local Registrar. The original
'~~. ~ ~ ~ ~ `.° i; certificate will be forwarded to the State Vital
IS ~V ~ y * ~ Records Office for permanent filing.
Y` ~R~ ~
'~ ~~ [~u~4 21/zo~z
~gTMENT OE„~~%'''~
"'""'"~ Local Registrar Date Issued
GOMMONWEALTN OF PENNSYLVANIA • DEPAgTMENi OF HEALTH _ VITAL RECORDS
Certification Number
>,~
TYPe/PNnl In
Permanent
g39
i
--------~~-.~v• rrr~r ~r $t.N FIIR Number:
1. pecadent s LR{al Neme (Phil Mlddle, 14x, SUMS) 1
R
3
.
Re
. Soel41 Securrcy NumbRr 4. pBN Dea< M pq ri (^p•N Mo)
Gerald E_ Miller ale 344-30-1517 Jun
2
y, e
, 2012
Se. A{e-Lest Blr! day IVra . Under S Yeer Sc. ntler 1 Oa 6. Date oI glRh Me/DRy/YRer) SpR Month) ie. BlMplece (Clry a lt
.<R or FoNI{n Country)
M°nttls D•rt NOYn Mlnlltb '
Q~ T
Bg 1 Q 1 ~. W y
75 February 4, 1937
ib, el,ehP,e~(eq°ntrJ oc
ge. RRaldenca Ste<R or FeNlgn Gauntry) eb. Residence !tract end Number-Include APt N0.1 {c. DI DKedent Llw In a Tewnahip>
Parma lvani
37
a
Haeainger Rd Vo
tlKatlem ll
dl
HODa
li
,
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wa
b. Ruldenca County) twp.
Cumber 1 a n d {e. RRSldenu (Zlp Code) 1 4 Q O No, decadent Ilwtl wthln Ilmltf of
9. Ewr In US Armetl FertesT 10. Merrcel SNWS et Tlme oT peeM MerrMd WI owe 11. Survivin 5 clty/bero.
Yr Yet Q NO Q Unknown ~ OHOrcetl Q Nawr Merrlad 0 Unknown { P°ui!'i Neme (IT wHa, {Ne namR prlOr t0 RrK mPMe{RJ
11. Feth4r's NemR (F Nt. Mlddle, Les[, Suffla) 13. Methar's Name PHOr to Flrrt Ha R (FI Mldd
Gordon Chariels M111er Helen `~','o 1Fe tea g's`~t)r um
1M. Infermen<'f Neme 14b. Reletlonf ip to DRcadant 14c. Infermam's Melling AddNSS (SINN end Num er, Grcy, Sete, 21 Cede
A_ Matthew M111er S
on 37 Ha6Efinger Rd_ Newburg, F4A 7240
... .. .Fnw . .... .............................. ........ ......................... ...
If peNh Occuried M • NosPINi: r~ InPedRn[ ~
R ...........~....Ke.... ...},..... ..!5...°.:J. ..one _
IF Death Oaurrod 9omRwheN DMK Then a HOSPrceI: C7 Neipice Feclll<y-~~-~~~~~~~~~~p
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n
oo Oui lam Dead on Arrival
ISb. Fed11H NRme not Ins< on, gIW rtreet entl nom a
r e0edene
s Home
Nursln HOmN1Pn -Term GN Feell Other (Spat 1
lSC. CIH or Tewn
State
an ZI
Code
Life Care ,
,
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SS . Ceun[y OT t
Mechanicsburg PA 17050
lga. McMOd plspesRlen guH41 Nmrtlon
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6/22/2012 H
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nger Crematory
P°sltle Crcy Town, Stele, 21P
Mt. Holly ~pr~ngs, ~, )t7065 Sie. 51gne F nerel Service Llwnsee Or Person In Cherry IntRrmam Sib. Ucame Number
~- FD 13695 L
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ral Home
i nC 15 Big Spring Ave ewvilla PA 17241
~ 1g. pery cot's E ucatlon - C eck the bOK Me[ besi defcribee Me 19. Decadent of N4pinle Orlgin - ChK t . 20. pecedenf'a Race - c ONE OR MORE Ncas <q Indicate what
hl{hart degNe v level qT ached compbted at Ma time oT tl
h
b
eet
.
as that best descrlbas whether LM detedRM tM decadent eOnflderad hlmaeM or MnaN to be.
Q BM grRde or IRU
li Spenlsh/Hlfpenlc/l4tino. CMck tha'NO" hhe
0 No tllPleme, 9th - 11th {rode box if decadent b not SPenUh/Hla Q Korean
Penlc/l4tl^°. 0 {lack or AMcan American ~ Vletnemese
NI{h school [Nduata Of 6ED rom lated
P
a
,not SPadsh/NlsPanlc/Letine ~ 4marlcan Indlen or Aleske Netlw 0 Other Alien
Q Reme tulle{e cretlil but no dagroe Yes, McKlcan, McKleen American, Chicano ~ Asian Ind
a^ ~ NKNe Hawellan
~ NsocleN dHNe le.{. AA, ARI ~ Yes, Puerto Rlcen
~ Chinese
B
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~ Vat, Cuban 0 Filipino
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e{Ne (e.{- MA, M3, MEnF MEtl, MEW, MBA) Q Vef, °M.r 9PanlFh/NIFPenlUletln° 0 J.Penese O Other PKlflc Islander
O DOLSeNN le.{. PhD, EdD) pr Prohulpnel degNe
(Spedfy) ~ Other (9pauTyl
• M pD5 DVM LLB Jp
21. ORcadent'f Sln{le gory Self-peal{nation -Check ONLY ONE N IndICNR whet the ecaden< consldeNd hlmfelT or hROeH to be. 221. Oecatlent's Usua Occupation - Ind1caN ty
][J WhIN 0 lePeneN
e
k
p
wor
~ Samoan done during mOR oT werkln IIN. DO NOT UEE RETIRED.
0 gleek Or Ahleen American 0 Korean ~ Other Paclflt Islantlv g
O AmRHcanlndlan or Alafka Ne[Ne J~VIRtnamesR ~DenY Know/Not SUN Truck Driver
Q AFLn Indl.n a ptl,.r Alen O R.h,F.d
~ Chlnery ~ Natlw NewalMn ~ OMer IRPRCIfy) 23b. Kln of {ualnefs Intlurt
Q FIII
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unse
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23d. p.N n Mq o.v a p..< O ,.~ ~.t 5
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rCaron nt d Yes ~ No
CAUSE OF DEATH
ApProzlmata
36. Part 1. Emer the chin-~I.vany.-dis.asea, InJurlef, or tompllcatlons--that dlr.ctly ceusatl the death. DO NOT.nNr terminal even s such as cardiac Brryst In<Rrvel:
resplrrtory erns[, Pr wntriculy flbrlllaN°n
wi<houL s
h
owln{ [ha etlOle{y
DO NOT ABBREVIATE
.
. Enter only one cause on • Ilne. Add eddrclonal Ilnes H nacauery
Onset to DeHh
/
~
/
~
IMMEDIATE GUSE -------> L B P-.~
(Final dll.esR Or cpndlNPn Due to (°r of a conawquenca on.
Nsultin{ In deethJ
b.
Sequent1e11Y Ilat rondl<lons, Due <o (or ei a cOnsequenca On: (
IT anY. leadln{ t0 the qwe
i
IIRNd on Ilne e. Enter the c,
UND{RLy1Ngi CUBE Due to (or es • wnsaquenee ef):
(dINRN qr Inlury that
Inltlabd the events resulfln{ d.
(
In tleeth) TART, DuR f° (or as a wnsRquenee Off:
~ 36
PRR 11
EnNr other
y
g .
.
but nM rRSURIn{ in the untlerlVln{ cause Biwn In Part 1
9 3i. Wes en cola
car p. rmedi
~' yea Ne
ze. weN eutoPir n Inn awneble
to complRN tna cause of deethi
29. If Fema R- 30. Dltl TObKCO UsR ContrlbuN t0 Deethi Yei NO
Q Not PNfnenf withln Pest War 31. Manner o/ Death
~ Q Pregnant K time o1 tleeth Q N° Q V nknown 0 Natural ~ Nemlcltle
~ NOt PNgnanl but PNryent withln 42 tlew of tleeth ~ Aetldent 0 Pandln{ Inwrtlrydon
Nd: N nanl but N ys y ~ Suk:lde ~ Could not lta tlverminW
0 P ^ p gnanf 49 tle [° 1 Rar bafON death 32. DatR o InJury (MO/Oay/Vr) (Spell Mom
~ unknown H pN{nant withln the Pas[ war
3 . Tlma of Injury
34. Plep °T In ury e.g. home, Wm<rucLlOn aRe; Hrm; is oo) 33. LON[lon °f Injury Is[Net entl Number, Gity, State, Zlp COtle)
3g. Injury a< Work 3>. If TrenapprtatlPn Injury, Specify: 3{. Describe How InJury Occurred:
Q ~'.f 0 Drlwr/OPere<er Q P.d.strlRn
gNq Q Parsenpr p otMr(SpKINJ
99R. c~RLLttlnv fOheck only oneL'
tlT
l
•~
h
wi
y
n{ p
yal<lan - TP the best of my knewl.dg., tleeth eccurNd due to the cause(s) and manner stated
Q Prorwuncin{ t Grtlryln{ phwlclan _ TO the best oT m
kne
l
d
tl
y
w
e
ry,
eeth occurred a[ the time, date, entl place, end due M the ousels) and manner atetetl
O Medical Eseminar/Coroner - O the basis °( Rseml etion tl/or Inwstl{a<len, In my opinion, tleeth oeeumtl a[ the time
d
l
d
i
,
e
., an
p
ece, entl due to thR causR(s) entl manner rt4t4d
Slgn4tuN of wrtlRRr:
TI<le °I canMer: rp LIt.nN Numb.r: /lJ'J Dais 7YSF
39 . Neme, A Nss entl Zlp Gotle OT Person CemplRtin{ Ge ys Deets them 26) 38
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Rev oi/SO11
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LAST WILL AND TESTAMENT
~5e
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~~
I, GERALD E. MILER, presently residing at 37 Hassinger Road, Newburg, Cumberland
County, Pennsylvania, 17240 being of sound mind, memory and disposition, do hereby make,
publish and declare this my Last Will and Testament, hereby revoking and making void all Wills
by me at any time heretofore made.
FIRST. I order and direct the payment of all my legally enforceable debts and
funeral expenses as soon as may be convenient after my decease.
SECOND. I give, devise and bequeath all my estate, real, personal and mixed,
whatsoever and wheresoever situate to my children, namely, JULIE A. DRABENSTADT,
AARON M. MILLER, and ANGEI.IA M. MILLER also known as ANGELA M. MILLER,
in equal shares, on a per stirpes distribution basis.
THIRD. I nominate, constitute and appoint my son, AARON M. MILLER to be
the Executor of this my Last Will and Testament. In the event that he be unable to fulfill the
duties of Executor, I then nominate, constitute and appoint JULIE A. DRABENSTADT to be the
Executrix of this my Last Will and Testament.
FOURTH. I direct that my personal representatives shall not be required to give bond
for the faithful performance of their duties in any jurisdiction.
FIFTH. I direct that any and all death taxes which become due and payable upon my
death be borne equally by all of the beneficiaries named under this my Last Will and Testament
including any charitable beneficiaries named herein.
IN WITNESS WHEREOF, I, GERALD E. MILLER, have hereunto set my and seal
to 's my Las Will and Testament, written on one (1) page, on this _~_ day of
2007.
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(SEAL)
WEIGLE & ASSOCIATES. P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
This instrument was by the Testator on the date hereof, signed, published and declared by him to
be his Last Will and Testament, in our presence, who at his request and in the presence of each
other, we believing him to be of sound and disposing mind and memory, have hereunto subscribed
our names as witnesses.
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, GERALD E. MILLER, the person 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; that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
~%~~
Sworn or affirmed to and acknowledged before
me by G RALD E. LER, Testator,
' day of ~ 2007
~ r
X ;~/~ •~- `~~
-~
`~ ~`"~' ~~" Jerry A. Weigte, Notary Ilc
.~ s "~ '~ Shippensburg, PA Cumber) d County
:.
;y~,, ,,,.: My Commission F~cpires October 7, 2010
~; _ ,
I
r'w'7 f f ~ , ,a
WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 726 EAST KING STREET - SHIPPENSBURG, PA 17257-1397
~,l~ '/~1,s~t1/
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLA AND :
and ~ Gu!)._Kd~ J - C~e~~ ~ ,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 GERALD E. MILLER, the Testator, sign and execute the instrument as his Last
Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as
witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more
years of age and of sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me
by 1 fe
1
and /~ ~C4~~t~ta
wit~SS~, this day of
"~: ~ y/`'
fyr~ 1 /
~ i' ~Y '.
~;~
+0 r
.,,
• f'..
r-
Jerry A. Weigle,(Notary Public
Shippensburg, PA Cumberland Courrty
Av Commrseion F~cpires October 7, 2010
WEIGLE & ASSOCIATES, P. C. - ATTORNEYS AT LAW - 726 EAST KING STREET - SHIPPENSBU RG, PA 17257-1397
~~~~~ta (~ ~~~