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Home My WebLink About07-26-12Reset PETITION 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 request(s) the grant of Letters in the appropriate form: Decedent's Information Name: Ellsworth G. Minich File No: ~ ~ - ~ ~ - ~i a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: June 25, 2012 Age at death: 76 Decedent was domiciled at death in Cumberland County, pennsylvania (stare) with his/her last principal residence at 129 Ctmberland Drive. North Middleton Townshin, Carlisle. PA 17013 Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 129 Cumberland Drive. North Middleton Townshin Carlisle 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 $ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ ,U~ t~~ , ~yJ TOTAL ESTIMATED VALUE.... $--~i1pp~.00 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated November 17, 1.987 thereto dated County and Codicil(s) State relevant circumstances (e.g. renunciation, death ojexecutor, 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 not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~10 EXCEPTIONS Q EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d. b. n.c.t.a., pendente lite, durance absentia, durance minoritate If Administration, c.~a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs. Except as follows: Decedent 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 was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (ifany) and h it (attach additional sheets, il~necessary): ~ C~ _.._ v Name Relationshi Address _ C ~~, John E. Minich son 3540 Rolo Court ~ ~ r:~ ~_.. Mechanicsbur PA 17055 r' fV C7 ~-, f- ' 17 -: C.~ . ~' GJ _~ 3 ;-*'~ t _ J !- 3 - tr art, ,_-- '_ f~r'1 7~ Form RW-02 rev. t0/I1/20!! Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } SS: 1 ~ Petitioner(s) Printed Name ~ Petitioner(s) Printed Address ~ John E. Minich _ ~ 3540 Rolo Court, Mechanicsbure. PA ] 7055 1- The Petitioner(s) above-named swear(s) or affirm(s) the statements in th oregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the cede a Petitioner(s) will we d truly administer the estate ar~ecording to law. Sworn to or affirmed and subscribed before Date l ' ~~ ~1,~ me tkr>,S ~ day of ~ , c~C1 ~" Byt. )~'{IL.~.~,~ ~ ~ ~~( ~: ~~ ~ Date Date For the Register Date BOND Required: 0 YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ......... ...... $ ( 7 )Short Certificate(s)...... ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other Attorney Signature: ~~~ Printed Name: William P. Dou las Supreme Court ID Number: 37926 Firm Name: Douglas Law Office Address: 43 W. South 4t -Carlisle, PA 170] ~ Automation Fee ............... ~ JCS Fee . .................... r TOTAL ..................... a 0.00 Phone Fax: Email: ~[J'~ OfficiallJs[e{O~nly(~ t?t_i /~ tl[_.(l ~'lt.f ~tit~ Vi ,fU~i.J (.. ... i .u1 717-243-1790 717-243-8955 hharhrn~rCcr~earthlink nPt DECREE OF THE REGISTER Estate of Ellsworth G. Minich File No: -~ ~ - ~ ~ -(~~(~ a/k/a: AND NOW -~- ~~ ~ ~ ~ ~ ) ~ ~- , in consideration of the foregoing Petition, satisfactory proof havin een presented before me, IT I ECREED that Letters are hereby granted to ~ ~ n tC 1~/t ~ _~ i C' .~'~ in the above estate and (if plicable) that the instrument(s) dated (3l'1(~(`/ ,tD descrtbed m the Pehtton be admttted to probate and filed of record as the last Will (and Codicil(s)) of L>ecedent(} Fa•m RW-02 rev. 10/11/2011 gtster or wtus _~~, f .~ Page 2 of 2 LOCQ~~~R'S CERTIFICATION OF DEATH WARN~~ fr#ec„~) I~t,~ duplicate this copy by photostat or photograph. Fee for this certificate. $6.00 P %~12 JUL 26 PM 3~ 34 ~t i,i, iti ~() ~e)-tir` ti,~(t tf)e infor.nation ne)e given is correctly copied frc~ni an rn-iginal Certificate of Death duly filed with roe .(~~ Local Registrar. 'The original ~''~`~ 1 ~I!p cert)ficate ~~ill hr forwarded to tl,e Mate Vital ~~ y~y,p~~'/~~~~,' v~Vill R.t~ords OI lice ..',oi 11ermanent tiling. ~llJ1~OCf1LJ'Y`f~ li0„ P14 Certification Number TYPa/Print In Permanent 3k Z Z_'J R G ._ ~_ Loc,.(I Registrar Date sued COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS P'F RTIC~f'ATF AC fICATU 3. Decedent's Legal Name (First, Mitldle, Last, Suffix) 2. Sex 3. Social Security Number" 4!,Da[e of Death (MO/Day/Vr) (Spell Mo) E1laworth G Minich Male 171-28-7256 June 25 2012 6a. Age-Last Birthday (Yrs) Sb. Under 3 Year Sc. Under 1 Da 6. Date of Birth (MO/Day/Vear) (Spell Month) 7a. Birthplace (City and State or Foreign Country) ` Months Days Hours Minutes 1 ' 76 June 1 1 7b. Birthplace (County) Sa. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Bc. Did Dettdent Llye in a Township] PA 129 Cumberland Dr ~ Ves, dettdent uyed in N Middy eton _ _ _ twp. 8d. Residence (County) Cumberland Se. Residence (Zip Code) 17013 ~ No, decedent Ilyed within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married Q Widowed 11. Surviving Spouse's Name (If wife, glue name prior to first marriage) Q Ves ~ No Q Unknown ~~ Divorced Q Never Married Q Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marrie ge (First, Middy, Last) John E_ Minich 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Melling Address (Street and Number, Clty, State, Zip Code) Barbara Jo Punda 100 E. Clearview Dr., C Hill PA 17011 s If Death Occurred In a Hos Ital: ........... ............................. ~+~s ........... .... ......... ..... ....... ....... ..... In b t f h - p en ; I Deat Occurred Somewhere Other Than a Hos ital: P U Hospice Facility ~ Decedent's Home 0 Emergency Room/Outpatient Q Dead on Arrival Q Nursing Home/LOn -Term Care Facility Other (Specify) ~ uu~~ 15b. Facility Name (If not institution, give street and number; lSc. City or Town, State, and 2Ip Code 15d Count of Death 129 Cumberland Drive . y Carlisle PA 17013 Cumberland ~, 16a. Method of Disposltlon ~ Burlai Q Cremation S6b. Date of Disposltlon 16c. Place of Disposltlon (Name of ttmete ry, cremafgry, or other place) Q Removal from State p Donation Other (Specify) July 6 , 2012 Di llsburg Cemetery 16d. Location of Disposition (City or Town, State, and Zlp) 1Za. 51 Lure of Funeral Servic arge of Interment 17b. License Number Dillsburg, PA 17019 138504 17 c. Name and Complete Address of Funeral Facility s ~ 18. Decedent's Education -Check the box Shat best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's ace - C eck O O M R rafts to Indicate what t- highest tlegree 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 Spanish/Hispanic/Latino. Check the "NO' [y~ White Q Korean Q No diploma 9th - 12th grade b if d d , ox ece ent is not Spanish/Hispanlc/Latino. [~ Black or African American Q Vietnamese Q High school graduate or GEO completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Natlye Q Other Asian R] Some college credit, but no degree Q Ves, Mexican, Mexi<an American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro ' Q Bachelor s degree (e.g. BA, AB, BS) Q Ves, Cuban O Filipino Q Samoan ' Q Master s degree (e.g. MA, MS, MEng, MEd, M6W, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (S ecif ) Q p y Other (Specify) . MD DDS DVM LLB, JD 21. Decedent's Single Race Self-DCSfgnation -Check OLV LY ONE to Indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occu ation -Indi t f k p ca e type o wor White Q Japanese Q Samoan done during most of working Ilfe. DO NOT USE RETIRED . Q Black or African American Q Korean Q Other PaciFlc Islander Owrier/operator Q A i I d ' mer can n ian or Alaska Native Q Vietnamese Q Don t Know/Not Sure Q Asian lndlan Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese 0 Na[Iye Hawaiian Q Other (Specify) Q FIIlpino Q Guamanian or Chamorro SerVlce Station ITEMS 23a -23 MVST BE COMPLETED 23a. Date Pronounced Dea Mo Day r) 23b. Signature of Person Pronouncing Deat (Only when applicable) 23c License Number . BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH June 29 2012 23d. Data Slgnetl (MO/Day/Vr) 24. Time of Death 17nICnOWI1 PM 26. Was MCdical Examiner or Coroner COntacted~ Yes Q No CAUSE OF DEATH Approximate 26. part 1. Enter the chain of events--diseases, injuries, or complications--that directly causetl the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrlllatlon without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a I(ne. Add additional lines If necessary Onset to Death IMMEDIATE CAUSE > Hypertensive Cardiovascular Disease (Final disease or condition Due to (or as a consequence of): resulting In death) b. Sequentially Ilst conditions, Due to (or as a consequence ofJ If any, leading to the cause listed on Ilne a. Enter the UNDERLYING CAUSE Due to (or as a consequen ce of): (disease or in)ury that initiated the events resulting d. in death) LAST. Due to (or as a consequence of): -- S s 26. Part 11. Enter other sjgniflca nt conditions contrlbutlna t d th but not resulting In the underlying cause given in Par[ 1 27. Was an auto psy performedT ~ ~ vas wo Diabetes Mellitus, Morbid Obesity zB.wereaptepsYfln Ingsayauab+e to complete the cause of death? 333 D Yes Q No 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death Q Not pregnant within past year Yes Probabl Q Q Y ~' Natural Q Homicide ~ ~ Pregnant at time of death Accident Pendin Inyestl Q No Q Unknown Q Q g gatlon No< r t b [- Q p egnan , ut pregnant within 42 days of deaS[ Q Not pregnant, but pregnant 43 days to 1 year before deatF 32. Date of In Q Suicide Q Could no[ be determined Jury (Mo/Day/Yr) (Spell Month) Q Unknown if pregnant within the past yeas 33. Tima of Injury 34. Place o£ InJury (e.g. home; consTructlon site; farm; school) 35. Location of InJury (Street and NUm ber, City, State, Zip Code) 36. Injury at Work 37. If Transportation InJury, Specify: 38. Describe How InJury Occurred: Q Ves 0 Orlver/Operator Q Pedesirlan ~ Np Q Passenger Q Other (Specify) 39a. Certifier (Check only one): ~ Certifying physician - To the best of my knowledge, death occurred due To the cause(s) and manner stated Pronouncing S Certifying physician - To She best of my knowledge, death occurred at the time, date, and place', and due to the cause(s) and manner stated Medical Exami /C ner O O basis of ex~r}Ina n and/or investigation, in my opinion, death occurretl at the' time, date, and place, and due to the cause(s) and manner stated ~%~ Signature of certifier: ~ i~~ Title of certifier: ACtinE Coroner License NUmber~ _ 39b. Name, Address and 2Ip Code of Person Completing Cause of Death (Item 26) 6375 $83 e110re Road $ilite ~ 1 39c. pate Signed (Mq/pay/Yr) , Matthew S. Stoner, Actin Coroner Mechanicabur PA 17050 Jul 2, 2012 ' 40. Registrar s District Number 41. Registrar's 51Rrratura 42 R i ~~ . eg strar Flla Date Mo Day r) 43. Amendments Disposltlon Permit No. C> t JO ~ l 1 H305-143 REV 07/201]. LAST WILL AND TESTAMENT I, Ellsworth Gernard Minich, of North Middleton Township, C~miberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, declare the following to be my last will and testament, hereby revoking and making void any and all wills heretofore made by me. I. I direct my executors to pay my debts and funeral expenses. II. I bequeath my coin collection to my son, John E. Minich. III. I bequeath my savings accounts to my daughters, Toby E. ' Schwalm and Barbara J. Panda, in equal shares. IV. I devise my cemetery lots in the Dillsburg Cemetery to my son, John E. Minich. V. All the rest, residue and remainder of my estate I devise and bequeath in equal parts to my son, John E. Minich, and my daughters, Toby E. Schwalm and Barbara J. Panda. If any of these three of my children predecease me, their share shall go to their issue, if any, and, if they die without issue, then to my surviving children. IV. I nominate, constitute and appoint my wife, Diane Minich, and my son, John E. Minich, as my executors. IN WITNESS WFIEREOF, I have hereunto set my hand and seal this the day of 1987. Ellsworth Gernard Minich Signed, sealed, published and declared by the above named testator as and for his last will and testament, who at his request, in his presence, in our presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses: ~~ ~~~ ~~~ ~'rn _~ ~-. r~- V~ xj ~"1 ~..: ~- N W _~ <- ~` `--~ C7 r~?~ ri- '.:..3 ~i s- -' ~1 ~ T7 L7 COMMONWEALTH OF PENNSYLVANIA ) COUN'T'Y OF CUMBERLAND ) We,~2~'s ~~ Sh~~~l and ~~lec y~ ~/~j~.~~.+,/ , the witnesses whose names are signed to the attached or foregoing instnmient, being duly qualified according to law, do depose and say that we were present and saw testator sign and execute the instr~:urnnt as his last will, and that he signed willingly and that he executed it as his free and voluntary act for the pur- poses therein contained; 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 that time 18 or mare years of age, of sound mind and under no constraint or undue influence. ~~~ Sworn to and subscribed before me this I •~ day of ~/~N . 198 1`1o~~OSIE M. 6UR ~ ~ - Carlisle,Cumberland Co., PA My Commission Expires May 6,1991 • ,- CC~IONWEAL~TH OF PENNSYLVANIA) COLTNI'Y OF C:[AKBERI~AND ) I, Ellsworth Gerhard Minich, whose name is signed to the attached or foregoing instnamexit, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instnunent 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. p I E swarth Gerhard Minich Sworn to and subscribed to before me this (%Z day of ~jJ~, ;~.~-~-,z,-~.~,,~ ,1987 . No Carlisle, Cumberland Co•, PA , My Commission Expires May 6, ~~~