HomeMy WebLinkAbout12-06-12PETITION 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:
Decedent's Information /
Name: Janet M. Darr File No: 21 ~- tl at - ~ ~~'1
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Soeial Security No: 182-40-8299
Date of Death: 11/17f2012 Age at Death: 65
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 925 Greenspring Road, Newville 17241 North Newton Cumberland
Street atldress, Post Office and Zip Code City. Township or Borough County
Decedent died at Carlisle Regional Medical Center Carlisle Cumberland PA
Street address, Post Office and Lp Code City, Township or Borough County State
Estimate of value of decedent's property at death
/f domiciled in Pennsylvania ...................... All personal property $ 15,000.00
If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $
/f not domiciled in Pennsylvania ................ Personal property in County $
Value of real estate in Pennsylvania ................................................................... $ 90,000.00
® TOTAL ESTIMATED VALUE $ 105,000.00
Real estate in Pennsylvania situated at g25 Greenspring Road, Newville 17241 North Newton Cumberland
(Attach additional sheets, i/necessary )
Street address, Past Orice antl Zip Cotle Gty, Township or Borough County
h~
^ A. Petition for Prohate and Grant of Letters Testamentary `" ~'
d v ~ %V
Petitioner(s) aver(s) that helshe/they is/are the Executor(s) named in the Last Will of the Decedent, dated C Q and ~dicil(s)
thereto dated m ~ r=*-t ~ O
State relevant circumstances (e.g., renunciation, death Of executdG etc.) a' ~ ~ - ~ °^` '~
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not marry, was no or~ed~ntas a p pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), nd~i-ad dDt ha child botor
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ '*t __
r_.
® NO EXCEPTIONS ~ EXCEPTIONS '~~ %r1 C:~ ~~ t~v1
ra ~ ~ 0
®B. egtition for Grant of Letters of Administration (IE applicable) 7" tV " trl
c.t.a, d. b. n., d.b.n.c.t.a., pedente lite, durante absentia. durance minoritate
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.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 e/v~er adludicated an incapacitated person.
® NO EXCEPTIONS ~ EXCEPTIONS Of c e.o~e r~~' `S 'ha-~er a(~elst i ~ ~xCe S3 ~ /O vlS rs ~c~ d_n eZTT4 ~
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
Donatd L. Mixell Brother 262 West Penn Street
Newville PA 17241
Merle E. Mixell, Jr. Brother 121 Steelstown Road
Newville PA 17241
Form RtN-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA } ~ C C P?,'u~_ ~~ (,i` j r j C E Q F
COUNTY OF Cumberland } SS. EC}~ ~~ Of ~'~L~
Petitioner(s) Printed Name Petitioner(s) Printed Address i!I
Merle E. Mixell, Jr. 121 Steelstown Road
Newville, PA 17241
CLERi; C~
Donald L. Mixell 262 West Penn Street
Carlisle, PA 17013 CUMBERLAND C0.> PA
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and co ect to the best of the knowledge and
belief of Petitioner(s) and that, as Personal Representative(s) of the Deced t, Petitioner(s) wi well nd jr~administer the estate according to law.
,~ i
~ ~ ~-.t~' '~ Date ~ ` ~ ~.
Sworn t or affirmed a subscr4bed before /
me this 'day ~_4' , < lJ - Date `Z ` 6 .. ~
f _ '1, h._ Date
Y~
~~t,Ew ~ e9~ter !' ~ Date - _
BOND Required? ~ YES ~NO
FEES: ,
Letters ......................................
` ~ uJ
.... $
( `~ )Short Certificate(s)..... .... / .~`~
( )Renunciation(s) .......... ....
( )Codicil(s) .................... ....
( )Affidavit(s) .................. ....
Bond ........................................ .....
Commission ..................... ........ .....
Other
Automation Fee ....................... ..... _/ ~ _ ~f-'
JCS Fee ................................... ....
TOTAL......... "_ -
To the Register of Wills'
Please enter my appearance by my signature below:
Attorney Signa
Prim// BntCfley L Griffie
Supreme Court
ID Number: 34349
Firm Name: Griffie & Associates, P.C.
Address: 200 North Hanover Street
Carlisle, PA 17013
Phone: 717-243-5551
Fax:
E-mail: bgriffie@griffielaw.com
DECREE OF THE REGISTER
Date of Death: 11/17/2012
Social Security No: 182-40-8299
Estate of Janet M. Darr File No: 21
afk/a:
AND NOW, n -Q'~ U ~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Merle E. Mixell, Jr. and Donald L. Mixell
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 the
of
Register of Wills ( / ~~ (~,~2, ~ '~"' ' Q
Form RIN-02 rev. 10/11/2071 Copyright fy 2011 form software only The Lackner Group nc 6 " Page 2 of 2
Illni doe KI „rl 1. _ _. _. _. _ _ - - - _ - - _ - - _ _ _ - _ -
LOCAL REGISTRAR'S CERTIFICATION OF DEATF#
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee f~lr ihiti rerti~ic,i~c. 5h llil
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RECORDED ~I hip i, ti, ccr[ii~ :h;u ~}Ze infunnatio^ here [~i~~c)) is
REG~S~~;~ ru(rerllrs c0pie(i~I~rum:ul (~ri~~inal Ccnifieutc u(lleath
fiuh f~i(eJ ~~itl( ine as 1.0(..(1 Registrar. The original
~~i2 ~~~ ~+ cerhGca~c ~r.~lll h(° ii)rtiardrd t0 the Slate Vital
i U Kc~~1IrLi, i)ffici~ I~ur ;,ernruicnt filing*.
C LE R L ~~___~ ~ ~ __L-
ORPNA(dS ~'~ ~~ N~ 2 1 2012
L0ca1 R,.~hi~n-..r Date Issued
CUMBERLAND CC?., PA
COM MONWEq LTH OF PEN NSVLVq NIA pEPARTMFNT OF HEALTH VITAL RECORDS
/"COTa Ca!•ATC ~~
- - - - - - -' _ 6[at¢ Flle Number:
1, prc<d¢nC'S Legal Namr (Firs[, Mldtlle, Last, SufFlx) 2. sex 3. SocIa15¢ruri[y Number q. Oat¢ of DeatFr (MO/DaVNr) (Spell Mo)
Janet M_ Darr emal 182-40-8299 ovember 17, 201
Sa. Agu-Las[ Hlrtlyday (Vrsl Sb. Under 1 Year Sc- Under 1 Oa H. patC of girth (MO/Day/Year) (Spell Month) 2a. BirtM1Place (City antl Stale or Foreign Country)
M
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s
6 5
ays Hpurz Mlnptes July 1 9 , 1 9 47 Newv i 11 e PA
2b. 6lrthplap¢ (cpunty) Cumber 1 a n d
Ba. Residence (State or Foreign Country) Bb- Residence (StreEC and Number -Include Ap[ No.) Sc, pid Drcetl¢n[ LIVe In a Townshlp2
925 Greens pri ng Rd Yes, deceaent lined ln
No rill N
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Btl. RCSldcnrr-(COVmy -
(_' umbe r 1 a n d R¢. R¢sldence (Zip code) 1 7 2 4 ]- 0 No, tlcreJ¢n[ IlVed WI[M1ln limits of
_ _ [lty/boro.
9. Ever In US ArmCd Fnrces2 10. Marital Status at Timr uI Death Q Married ~ Widowed 11. Surviving Spouse's NHmn (1( wife
give name
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~ No ~ Unknown ~ Diwrced ~ Never Marrletl ~ Un4now
lG. Fe[h<r's Name (FIrsC. Mld Alr, Laz[, Su/frx) 13. MotM1lr'.s Name Prior to firs[ Marrla¢C (Ffrzt, Midtlle, Last)
Merle E_ Mixe11 Sr_
Sqa. Informant's Namc Sqb
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s Ma(Iing Adtlrezs (StrPnt antl Number, Llty, 5[at¢, Ip Codp)
Merle E_ Mixe11 Jr_ BrotYler 121 Steeistown Rd Newvi lie
PA
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tu(lon, give street antl number; 15c. CI[Y or Town, State, antl Zip CCoJe 1 tl. Cou tY of Death
Carlisle Regional ed'cai Carlisle PA 17013 ~umfierland
16a. MetM1Otl of DizPUSltion ~ Purial rnma eon
pR<mnval from stet,. ppnnah~n }66. Date of OlspoSltlOn Pla ¢ of OIs 'Ilion Na Of came[!ry, crematory, or [h¢r place)
~umeber`j°a ncj ~e
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O[M1!r (Spe[Ify) a
ey Memor
11/24/2012
al GArdens
2 16tl. Location of Olsposltlon (City or Town, Sta[a, and 21pj
C 17a. SIP,rratyc f Funeral Servile Lirens¢e or Pelson In Charg! of Interment 37b. LlGensa Number
arlisle PA 17013 -
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D 13895 L
E 1JC_ Name antl CompllCe Address of Funeral Far-ility
5 E er Fu p 7
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I8. pttedent
s Educa(lon - (Check the Lox that best dlscrlLes tli! 19. needs [ of Hlsp Ic Origin _ C eck [ e acetlnnt's Race - CDeck ONE OR MORC rates to fndltatG what
Itighczt tlegfee or Icvel of school compl![rrrf at iM1e [line of death
box that best de
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e dacetl¢ni the dCCCtlent consld<retl himself or herself to be.
~ H[It grade oY less i
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ispanic/Latino. CM1eck the
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O No tllploma, 9tM1 - 12th Beetle box If dered<ni Is not spenlzh/Hispanic/La[Inn. 0 Black or Afri
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® Hlgh s Fool gratluatc ur GED completed ~ No, not Spanish/Hispanic/Latino ~ American Intlian nr Alaska Native p Other Asian
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~ Some co
lege credh. but no degree ~ Yrz, MaxiCan, Mexican Amarlcan, Ctricano ~ gslan Indian ~ Native Hawaiian
Q Associate Ee
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) ~ Ves. Puertu Rican O CM1lnese O 6uamanlan or Chamorfo
~ Hathelur'S dlRrCe (C.g_ 94, A8, HS) Q Y¢z
CUban
,
~ Fllip{no Q Samoan
0 Master's degree (e.g. MA. M5, MFng, MEtl. MSW, MBA) ~ Yes, Mher Spanish/Hispanic/La[Ino ~ Japanese ~ Other Pacific I
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~ Doc[orat¢ (e.g. Php, Etl D) nr Prufasslonal Eegrae (Specify) Q Other (S
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MO pDS, VVM, LLP, JO - -
21. Oocetlent'S Single Race Self-Designation -Check ONLY ONE to Intllcate wM1at tM1<tlecedent consid<ratl M1lmself or M1nrzelf [o be. 22a. p<catlent's Usual Occupation -Indicates [ypC of work
WI'I[s
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[] Samoan
apanase done Burin g
0 Hlack nr q(rlcan American ~
~ Korean ~ Other Pa CIfIC IslanJer B most of Wofkln Iifa. DO NOT UfE RETIRED.
p gmerlcan Indian or Alaska Native p vlecnames! O Dnna Know/rvot sure Lab TB ch
[1 Aclan Indian ~ Other gslan 0 RefuSGd 22 b. Kind of Husinla5/mdust
C]<hinese ONatW¢Hawalian ppmer (spepln.)
Rubber RooPin Factory
p Flupino O Gu elan nr cl.a..,orro - g
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ITEMS 23H - 23 MUST BE COMPL FD 23a_ Date
Prnnouncetl Dead (Mn pay r) 23b. Signature of Perzo ncing p!a[ (Only Wh¢n app Icablel 23c. Ucenz¢ Number
PRONOUNCES OR
CERTIF ES U[ATH
~' ~~ ?~olZ-
23d. Da[r Signed IMO/pay/Vr) 2q. Time of Deatn ~LAfI"K~` M7 y 3~ g ¢~p
`H ~ ~ 3 25. Was Medlcai Examiner or Coroner Con[aR¢tlT Q Yes No
CAl15E OF DEATH
APPrnnlma[¢
26, Parf 1. Fnter tM1¢ Chain of events--diseases, injuries, or comphcatlnnc--that directly caused tM1a death. DO NOT ¢ntlr [lfminal events sUCh Hs ra Ydia
rr
C a
est Int¢ryak
r¢spuatory arrest. ur ventricular fibrilla VOn whM1OVt showing [M1e
etl
o l
Y. DO NOT
og
gHBREVIATF_. Enter only one cause on a line. Add addluondl lines If necessary Onset [o DeatM1
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IMMEDIATE CADSE ------ - - -- > a, ~t~. `1 G. S tq,p ~~
(Final Disease or condihnn Due [o (or as a consequence nf).- - --
resultlnH in death)
A~t~~~~ ' '~~
b. ~CArt-ts:_ ~'~¢Nali Pte.
SequlntiAlly Ilzt Conditions, pue [o (Or as onc¢quenc6 oT): '~
1I any, leatling [o tVrr c
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IlstGd on Ilne a. EnteY thc
c. {7 ~° ~CWY\OH r 0.
UNOERLVING CAUSE pun to (or as a conslgn¢nce of): --
- (tlisr rlnjury that
F Inltia[etl the nis resul[Ine d. _ -
a
~ hr death) IAST.
pue t0 (or as a Consequ nee of): -
s 26. Part 11. Enter oth
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co
ed t s Dote but to [o tlea[h but nni resultlnR In the underlYing cause given In Part I 27
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to complete the ca VZe of deatM1i
a 0 V¢s No
29. If Female:
T
E 30. Dld
ubacco V5¢ ContrlLuf¢ to pcafh7 31. Manner pf pea[M1
B'NOt uregnant wl[M1ln past year
Q Yas ~ Probably
0 Pregnant at [hn< of tleath O No nG •Natural ~ Homicide
O'NnknOwn
u Q 4ccltlent Pentling Investl
Not per
Q gnant, but preHnan[ wit M1ln q2 days of deatf
O
l
Q Sulcld!
Could not be tle[er
mined
Not pregnant, Lu[ pregnant q3 days to 3 Vear before dealt 3J. Data of Inuury (Mn/Day/yr) (Spell Month) ~
1J nknown If pregnant wltM1ln the past Year
33. Tlmc of Injury
3q Place of Injury 1!-g. Fume; construt[ion cite; farm; sCM1OOR 35. location of Injury (StrClt and Number, City, 5[a[±, 21p Cotle)
3ti. Injury at Work 3l. If Tranzporta[lon Imury, Specify: 38. Daccrlba How injury Dccurred:
[] Y¢5 Q Dnv¢r/Vp¢ratnr Q P!tl¢Strlan
~ No ~ Passcngrr 0 Othr•r (Specify) _
39a. CertlTlef (Lhrfk only one):
~ lertifying pM1ysician - To Lh¢ best oY my knnwletlge, tleatM1 o <tl due to the c ¢(s) and m statetl
z
~6ronoV nring g. Certifying phyalrlan - TO the best of my knowledge, tleath occuYretl
aY tM1e tune, date, antl piers, antl tluC t0 the t s¢(5) and Tan r ta[
d
e
~ Medical Examinlr/fnron¢r - On t of examinatlan, andfot Investigation, 'r t my opinion, death o
retl a[ tM1e! [Ime, tla[6. and place, nd tlue to fhr cause(s) antl m nna stated
~
Signature of certifier: TI21<uf cartlFlCr: ~-I !_ _ License Number: Nl~ L-~ 31 g g (p
396. Norma, Address and Zip ode of Person Cnrn pl¢[InR Cau3e of paath (Item 26{ 3
9c. Date Signed (MO/Day/Yr)
o_ gegistra~ s Vlstrlc< Number q1. Registrar's uf¢ }y~`~ _f~~.z` ~ \\ q2. R< [rB
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F c Date Mo Dey r
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43. ArnrndmCn[5
DlSposi[ion P¢rmh No. L~ Il ~t ~(y. ~~-~ REV 0//2011