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Home My WebLink About09-13-12PETITION FOR GRANT OF LETTERS / _ -~-~ REGISTER OF WILLS OF ~ c,,c vvt {j ~r a~.- ~ c/ COUNTY PENNS~~NIA `~' _'~~ '~' Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as ~t~~d bele~v, and iil` ; =. support thereof aver(s) the following and res ectfull re nest s the rant of Letters in the a ro ~'' ~ ~-' ` p Y q O g pp ~~ form: :~~' ;~~ 4 .-,.. _ r..Y~ Decedent's Information ,~; ~ '.~'~' Name: _ ~ /a S /aft j ~ ~1r` File No: ~~"~ - ~ ~' _:~ -; rr'. C,~ r__ a/lc/a: (Assigned by ister) ~-, a/k/a: _ ~,~~ a/k/a: Date of lleath: Social Security No: ~ ~ ~2 ..~.~.5~ AgL at death: Decedent was domiciled at death in ~~~j~>,--~~~,~ County, ~ ~ principal residence at Z ~~ ~ ~,, ~ Yn h ;~, ~ v p ~, vyt Q Street address, Post Office and Zip Code City, Townshq Decedent died at _~ ~~ ~ ~~,~~~~ ~~~a,,, ~1~,~ ~,t ~ ~ ~, ~J Street address, Post Office and dip Code City, Township Estimate of value of decedent's property at death: If don:iciled itt Pennsylvania ............................All personal property If not domiciled in Pennsylvania ........................Personal property in Pennsylvania If not domiciled in Pennsyh~ania ........................ Personal property in County Value of real estate in Pennsylvania ........................................................ . TOTAL ESTIMATED VALUE... . Real estate in Pennsylvania situated at: Z ~ ~ ~!~ ,~, ~/ ~ ?d, ~ ~ f (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code ity, Township ^ 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 thereto dated County and Codicil(s) State relevant circumstances leg. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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(g), and did not 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 Administration (If applicable) c. t. u., d. b. n., d.b.n.c.t.a., pendente lite, durunte absentia, durunte minoritctte If Administration, c.t.a. ord.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(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 udditionul sheets, i~~necessury): Name Relationshi Address ~ d ~--r' pfd z7~3 Co/u~t ~J ~ ~~~ ~~ /~; //~~4 ~ ~ v: c~ /~ ~~~~' ~'1 Sd tf `' x / e ~' 1 ~ S•/ 0 v l ~ ~-1 ~ ~ Z_ Z > `~- C fir. ~n ~, .'~ E ~' ? s e7 5 ~.,,~ ~ ~ sit ~ ~- ~ ~-,-, ~ ~ y. ti~ 4% ,~ ~ ~ 9 ~~ ~s- (5cate) with his/her last I.Lsi?~ Ear' ~~ County County State $ .~.~~,.3: 00 $ l l2 5'~ 3F uC~ Fo~•n~ Rw-nz r•ev. lnill~znll Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } SS. } r,- ~ ~ `2~ ~ Jse Only ~~: - ~ ~-rr ~ ..J...f _; ~ 1,~ ~.,.r. i ~~~ ~~ '~J~ W _ Petitioner(s) Printed Name Petitioner(s) Printed Address - - .. r~ rr Q -t3 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 P;.rsonal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law. v' ., Sworn to r affirmed and' bscrib d before G~ ~ /'Ut.~~"2J Date ~J ;~-C~/~- me t i ,~'~' day of ~__~i~- '' Date Date ,,•-~`or the Re;isler Date BOND Required: ~ YES ~ NO FEES: ~~, ~ CC Letters ...................... $ ( f_) Short Certificate(s)...... , OCR ( ~) Renunciation(s)......... ~ GQ ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ,..,.,.. Automation Fee ............... ~ ;~ JCS Fee . ................... . TOTAL ..................... $ To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: //, ~ ~ ~- ~~ ~ Printed Name: ~~ ya ~t ~S' ~ ~~-- ~~y~~ Supreme Court ID N ~ ~ ~ umber: Firm Narne: ._.-- ~Lrv-tl ~ ~ `-~ G ~C~~.~ yt E' ~ f Address: ~ 7G / /1/ Frdv, ~ s~ / 7/ / ~ Phone: ~l ~ " ~ 3 Z ' `~ ~.~~/ Fax: ~~/~ -- Z ~~ - ~, //~ Email: r ~{ ~~c~~~~n~ ~(~ C~y'~ DECREE OF THE REGISTER Estate of ~ ~ /~ 1 E'~ - " l File No: a/k/a: AND NOW, ~ "" ~ '' `~ ~;~~ ~ ~ ~~ 'n consi er do of the foregoing Pe ition, satisfactor proof hfaving en presented before me, IT IS DECRE D that Letter ~~) ~~ il' / /y~~ /~~~ are hereby granted to L ~1 ~' z° in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of Form R GV-OZ rev. l n~11~2n! I as the last Will (and Codicil(s)) of De Register of Wills .~~`~ .~ . -~- 2 of 2 -'~, ~~ ), 1 ,..rr. ' 'r' ~'^ a ) I'_ ~ - . X11 Type/Print In Permanent v .~i W O z s Vt ii 1 i~'il~~ ~~ i~i./i~J~t CIJ~BrR~.~~L~ CO., ~'~ ~n~y1~%a~.dQ%t~-JAN 1 7 2012 O COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS !'CQT~C~!'ATC !lC P9C ATV 1. Decedent's Legal Name (First, Middle, Last, Suffix) e rv 2. Sex 3. Social Security Number umoer: 4. Date of Death (Mo/Day/Vr) (Spell Mo) Lila S_ Miller femal 092-22-5357 Jan_14,2012 Sa. Age-Last Birthday (Yrs) 56. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Days Hours Minutes Geneva, Indiana 9 0 Aug _ 2 2, 1 9 2 1 7b. Birthplace (county) n a 8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township? PA ~ 0 ~Q.1 l]Sil ~a AVe _ QYes decedent lived in 8d. Residence Count Y) t , am R 1 -+- 1 P , twp. Cumberland 8e. Residence (Zip Code) o, decedent lived within limits of Camp H111 city/boro. 9. Ever in US Ar yd Forces? 10. Marital Status at Time of Death Q Marred idowed il. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes o Q Unknown Q Divorced Q Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Nathan Sprunger Caroline Scheidegger 14a. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) ffi Lydia E_ Keller ddaughter 2703 Columbia Ave_,Camp Hi11,PA Ci .................... ................ .. _.._.. ....................... ................................ ,,. 15a. P ace o Deat Check onl one .._ ............................~._ . . Y z _ ° p If Death Occurred in a Hos Ital: p In atient ; . . ....._._ .................._............___.... .................................................. ............... .............. :If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility Q Decedent's Home Emer enc Room Out atient Q g Y / P Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Q Other (Specify) ~ lSb. Facility Name (If not institution, give street and number; lSc. City or Town, State, and Zip Code lSd. County of Death Hot S irit Hos ital Cam Hi11 PA 17011 Cumberland r 16a. Method of Disposition Q Burial Q Cremation QRemovalfro st t 16 b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) a m a e ovation 1 ~17~201 2 Humanity Gifts Registry Q Other (Specify) ~ 16d. Location of Disposition (City or Town, State, and Zip) 1 nat+J re of Funeral Service Licensee or Person in Charge of Interment 17b. License Number ;, Philadelphia, PA1 91 05 ~,,y~~ FD-01 31 63-L E g ~' 17c. Name and Co plate Address of Funeral F cility Mussel"'man FH&CS,324 Hummel Ava_,Lemoyne,PA 17043 ° 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent' 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 de ent considered himself or herself to be Q 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" _ hite Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed Q No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Ayecfate degree (e.g. AA, AS) ~achelor's de ree (e BA AB BS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Gha morro g .g. , , Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, Cuban Q Yes, other Spanish/Hispanic/Latino Q Filipino Q Samoan Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, EdD) or Professional degree (Specify) Q Other (Specify) e. MD, DDS, DVM, LLB, JD 21. Dace ingle Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work hate Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Paclflc Islander teacher American Indian or Alaska Native Q Q Vietnamese Q Don't Know/Not Sure Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) S Ch001 Q Filipino Q Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED BY PERSON WHO PRONOUNCES OR 23a. ate Pronounced De o Day/Yr) !~ 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number CERTIFIES DEATH m /~c I ~ ~ ~ 1 t v 1 23d. Date Signed (Mo/Day/Yr) 24./Ti~mce of D eyath~' / ! 6 - 1 1.J W~ 25. Was Medical 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 caused the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the e Qlogy. DO NOT ABBRE V I ATE. E nter only one ca u JJ se on a line. Add additional lines if necessary _ Onset to Death ^ ( ~ Q c ~ - y ~ IMMEDIATE CAUSE ---------------> a. ~-~--f ~T~ ~=- r~ S ~1 ~ 1~- t O /~ ~ 1 ~T/ 1 ~ r-- (Final disease or condition Due to (or as a consequence of): resulting In death) C~ b ~ L( L `T t 1'~~ ~y4 ~ 3 ~ mo ~ . ~ ._ ~ ! 6~ t L7r r Sequentially list conditions, r Due to (or as a co nseq uenc e of): ( T ~ l o e \ A, c7 r-T- r 7 ` listed ova ln e at E ter the c. ~'t v \ ~~ \ (' ~-/' ~ `-~~.-.,i /~'J ~ SJ (S ~-y~'-~' C~ UNDERLYING CAUSE Due to (or as a consequence of): u; (disease or injury that initiated the events resulting d. w in death) LAST. Due to (or as a consequence of): u_ 26. Part II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy perfor 2 ° ~ Q Yes No 2S. Were autopsy findings available rD ~ to complete the cause of death? °.~' Q Yes Q No a 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death E ° Q Not pregnant within past year Q Yes Q Probably Q Natural Q Homicide c ~ Q Pregnant at time of death Q No Q Unknown Q Accident Q Pending Investigation m Not re Want, but p g 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 of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes Q Driver/Operator Q Pedestrian Q No 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 Q Pronouncing 8a Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/Corone - On the basis of examination, and/or investigation, in my opinion, dea t h occu rred at the time, date, and place, and due to the cause(s) and ma n ner stat ed / ~ n G - 2 Signature of certifier: Tttle of certifier: ' ~' r rN )~ ~.1 3 -7 ~ p b License Number: 39b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (Mo/Day/Yr) ~A-Y 1~ S >•"? r~i - d2_- S' (2 'T ~ T r9-t_- b r ~ 1 ~0 1 40. Registrar's District Number 41. Registrar's - nature 42. Registrar File Date (MO/Day/Yr) oZ I'+~ ~~ ~ ~~ ~ ~~ O/-~ 43. Amendments ITEM # ~`~ ~ SHOULD READ ~l~~C-~~~ %~ ~~ 2 ~ C's ~ ~G' ~ y ~ H105-143 Disposition Permit No. REV 07/2011 RENUNCIATION (~ ~ z ,".may ~~~ =,) ~"-~~~-' r , ~-_-: --r .~ r-» - ~..;.~ _~ , - _ :. =~. - REGISTER OF WILLS • "'_"~ ~ `' c~ ~ -. r~ ~'`' , ~ "t^ ~, ' ' `-~ CUMBERLAND COUNTY, PENNSYLVANIA a~=~ ~ _ ~= D ~ ~~ C.~ ' ~ ,., ~ Estate of LILA S. MILLER ,Deceased I, MARK MILLER , in my capacity/relationship as (Print Name) SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to LYDIA KELLER / .~ ~~~ (Date) (Signah~ ~) 44 San Ramon Way (Street Address) Novato, CA 94945 (Crry. State. Zip) Lneer~tnd in Register's Office S«Terr~ to or affirmed and si.~? scri~:,u before me tha day of Deputy for Register of Wills Executed out of Register's Office ~e ure rile undesi-geed p,r5onaiiy appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this ~' day of .)u ~ ~~ i Notary Pu My Commission Expires: (Signature and Seal of Notary or other official qualitied to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 E. J. WEAVER ....., Commission # 1886998 z : ~s .~ Notary Public -California z Z ' ~ Marin County D ~' My Comm. Expires Apr 24, 2014 RENUNCIATION ~° ~ ~=r' ~= REGISTER OF WILLS .~ ~=- ~ W CUMBERLAND COUNTY, PENNSYLVANIA c~~--,~ ~' ~-~ ~ ~ . ~~ Estate of LILA S. MILLER ,Deceased I, JAMES LLEWELLYN MILLER , in my capacity/relationship as (Print Name) SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of : Deputy for Register of Wills gnatureJ ~ 540 Harrison Street (Street Address) Scranton, PA 18510 (City. State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renun~iafor the purpo es toted within on ~,s - ~ day Notary P My Commission Expires: ~ '~~ (Signature and S ~th~~i4a ~ ° AAll~1 administer oat A L A on.) CHERYL R. CARMAN, Notary Public Camp Hill Boro, Cumberland County My Commission Expires May 20, 2016 Form RW-06 rev. 10.13.06 RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA /'~ :, '..Y, ~ Y ~. '....n r~ ~~ CJ'7 , ... r...~ ~ ; ~ v ~] r ~. w ~-._ .-~ y cs L~ \~ --~ ~•~ Estate of LILA S. MILLER ,Deceased I, SARAH DAVI ES , in my capacity/relationship as (Print Name) DAUGHTER of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to LYDIA KELLER . 2p c/- 2. ~~ ~ Z- (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of l~ "/ (Signature) 222 Kit Carson Circle (Street Ada'ress) Pocono Pines, PA 18350 (City. State, Zip) Executed out of Register's OffCCe Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renuncia for the purposes s ated within on t ~~'~`-` day Deputy for Register of Wills Notary Pu~~ My Commission Expires: ~ ~ ~~ (Signature and Seal of 19(~J~t F~~fF~P~~~ LVANI administer oaths. Sh w a e A CHERYL ARMAN, Notary Public Camp Hill Boro, Cumberland County My Commission Expires May 20, 2016 Forrn RW-06 rev. 10.13.06 Gl !-''-' :---- RIJNUNCIATION ~ ~' ~-~ REGISTER OF WILLS or -- ; t - CUMBERLAND COUNTY, PENNSYLVANIA _ ~~-- ~ ~ =: c ~~~ ~~ _.~ c.~ r_.... / ~ , Estate of LILA S. MILLER ,Deceased I, DAVID MILLER , in my capacity/relationship as (Print Name SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that betters be issued to LYDIA KELLER I Y `a. (Date) °' Executed in Register's Office Sworn to or affirmed and subscribed before me this day of _ _ Deputy for Register of Wills Form RW-06 rev. 10.13.06 '~ , , ~~ ~`"~ ; ~~ 0 /, A ~ (SignalureJ 504 Colfax Avenue (Street Address) Scranton. PA 18510 (Crry, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpose, stated within on this s ~ ~ ~ day of (_~ is ri.~.t.-~/rG'. _ r"~~i~ ~ .~ i,..~ , ~~ ~~, . ti ~:~* .Z Notax~ Public My`-Commission Expires: 1'I I ~~' (Signature and Seal of Notary or other official qualitied to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jane# R. Gilroy, Notary Public City d Scranton, Lackawanna County M GAI'~t191r~8i~H ~ res Jan__i7, 2016