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HomeMy WebLinkAbout04-05-13 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)thl following and respectfully requests the grant of Letters in the appropriate form: George K Miller,Jr. Decedent's Information Name: Jean Miller File No: 21 -13-- au a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 168-24-4544 Date of Death: 10/08/2012 Age at Death: 82 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 267 Carlisle Avenue,Enola 17025 East Pennsboro Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at 267 Carlisle Avenue,Enola 17025 East Pennsboro 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 $ 5,000.00 If not domiciled in Pennsylvania................. Personal property in Pennsylvania $ If not domiciled in Pennsylvania................. Personal property in County $ Value of real estate in Pennsylvania........... $ 125,000.00 TOTAL ESTIMATED VALUE$ 130,000.00 Real estate in Pennsylvania situated at 267 Carlisle Avenue,Enola 17025 East Pennsboro Township Cumberland (Attach additional sheets,I necessary.) Street address,Post Office and Zip Code City,Township or Borough County ❑A. Petition for Probate and Grant of Letters Testamentary 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 © n (State relevant circumstances,e.g.,renunciation,death of executor,etc.) —p Except as follows:after the execution of the instruments)offered for probate,Decedent did not marry,was not divorced,w to a:Wdin divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§§3323(g),and did not corn or 9� CX adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. rrf rrt �X NO EXCEPTIONS F1 n EXCEPTIONS C C rl ZT) -r; ❑X B. Petition for Grant of Letters of Administration (If applicable) O n _3 tt ata.; . .n.; . .n.c..a.;pe uran a en la mmonta e If Administration,c.t.a or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs. 4 I­ rte- - a vi Except as follows:Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been estailtshed as define `t1 in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person. FX NO EXCEPTIONS❑ EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Deoederd left no Will and was survived by the following spouse(if any)and heirs(attach additional sheets,if necessary): Name Relationship Address Sharon L.Ensor Daughter 488 Lancaster Avenue Enola,PA 17025 Richard Miller Son 267 Carlisle Avenue Enola,PA 17025 George W.Miller,Jr. Son 492 Lancaster Avenue Enola,PA 17025 Fomt RW O2 rev.io-i i-2oi i Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2 \ Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s)Printed Name Petitioner(s)Printed Address George W.Miller,Jr. 492 Lancaster Avenue Enola,PA 17025 C rn Cn rn C-11 C3 -v r M C:3 � n a ° u" c� 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 th Decedent,Pett ioner(s)will I and ly administer the estate according to law. Sworn to or affirmed anp subscribed before Date - m t .s a of Date B Date the Register Date BOND Required? Yes 2-*No To the Register of Wills: FEES Please enter my appearance by my signature below: Letters............................................ $ Attorney Signature: ( )Short Certificate(s) t )Renunciation(s)..........._. Y W."11 t )Codicil(s)......................... t )Affidavit(s)....................... Printed Name: Debra K Wallet Bond.............................................. Supreme Court Commission................................... ID Number: 23989 Other w �r .✓�_ e; CD Firm Name: Law Offices of Debra K.Wallet 44 Address: 24 North 32nd Street �J Camp Hill,PA 17011 _ Phone: 7171737-1300 Automation Fee............................. Fax: 717/761-5319 JCSFee......................................... TOTAL.........................I................. $r V E-mail: walletdeb @aol.com DECREE OF THE REGISTER Date of Death: 10/08/2012 Social Security No: 168-24-4544 Estate of Jean Miller File No: 21 -13 alkla: AND NOW, ;)t n Ck 3 in consideration of the foregoing Petition, satisfactory proof having been preserited before me,IT IS DECREED that Letters of Administration are hereby granted to George W.Miller,Jr. in the above estate and(if applicable)that the instrument(s)dated described in the Petition be admitted to probate and filed of record s h last Will(and Co nil(s))of ILA 4-" u Register of Wills Copyright(c)2011 form software only The Lackner Group,Inc. W H105.805 REV(9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OFFICE OF Fee for this certificate, $6.110��FFGIST'ER OF WILLS """--- This is to certify that the information here given is R11�p I�,,nl�p�TH OF pEN _ correctly copied from an original Certificate of Death R 1013 HPR 5 1 ! 11 0U duly filed with me as Local Registrar. The original _= Z certificate will be forwarded to the State Vital CLERK OF ?° a Recor Offic for permanent filing. S' COURT P 1897J AN Aid D CO., PA --_,MENT 0 Certification Number °""""""�j1 Local Registrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS Permanent Black Ink CERTIFICATE OF DEATH State File Number: 1.Decedent's Legal Name(First,Middle,Last,Suffix) 2.Sox 3.Social Security Number 14.Date of Deatrh'(MO/Day/Vr)(Spell Mo) So.Age-Last Birthday(Yrs) Sb.Untler 1 Year Sc.Under 1 Da 6.Date of Birch(MO/Day/Near)(Spell Month) Birth lace(Gityy d Laic or F Ign Country) 82 Months Day, Hours Min tes September 9, 1930 owleia2l(county) ma 7b.Birthplace(County) Cum er an 8a.Resitlen<e(State or Foreign Country) Sb.Residence(Street and Number-Include Apt No.) 9c.Did OecetlenT Live in a Township? 267 Carlisle Ave. Y. decedent lived In East Penns born -P. 8d.Residence(County) Cumber land Be.Residence(2 p ode) 0 No,decedent lived within limits of <ITy/boro. 9.Ever in US Armed Forces? 30.Marital Status at Time of Death 0 Married j� Widowed 11.Surviving Spouse's Name(If wife,give name prior to first marriage) - 0 Yes 10 NO 0 Unknown 0 Divorced 0 Never Married 0 Unknow 12.Father's Name(First,Middle,Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last) Samuel Quickel Catherine Radabaugh 14a.Informant's Name 14b.Relationship to Decedent 14c.Informant's Mailing Address(Street and Number,City,State 2tp Co o Richard Miller g n 267 Carlisle Ave, Enola, �a 1lq/025 ..... °........... S If Death Occurred in a Hospital: • ..........................•; .--esss...•sm3F.....- o •y o e • ....•It... .. th Occurred n Hos p al: - - •- �•HOSplce FacIIITy -( Oecetlent'sHgme Emergency Room/Outpatient 0 O.ad on Arrival 0 Nursing Hpme/long-Term Car!Facility Other(Specify) a SSb.Facility Nam.(N not Institution,give street and number; -16c.City or Town,6tate,and Zip Code 15d.County of Death 267 Carlisle Ave. Enola, Pa 17025 umberland 16a.Method of Disposition EABurlal Cremation 16b.Data of Disposition 16C.Place of Disposition(Name of cemetery,crematory,or other place) T �Removal from State �Donation othe,(SP-4) 1 11 1 2 Rollin Green Memorial Park 16d.Location of Disposition(City or Town.State,and Zip) 17 . of Funeral 5 Ice Licen or Person In Charge of Interment 17b.License Number Camp Hill, Pa 17011 FDO11897-L 171.Name and Complete Address of Funeral Facility 18.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the 20.Decedent's Rac -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 considered himself or herself to b- 0 Bth grade or less is Spanish/Hispanic/Latino. Check the"No'• White 0 Korean 0 No diploma,9th-12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese 0 High school graduate or GED completed 6d No,not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian 0 Some college cretlit,but no degree 0 Yes,Mexican,Mexican American,Chicano 0 Asian Indian 0 Native Hawaiian 0 Associate degree(e.g.AA,AS) 0 Yes,Puerto Rican 0 Chinese 0 Guamanian or Chamorro 0 Bachelor's degree(e.g.BA,AB,Bs) 0 Yes,Cuban 0 Filipino 0 Samoan 0 Master's degree(e.g.MA,MS,MEng,MEd,MSW,MBA) 0 Yes,other Spanish/Hispanic/Latino 0 Japanese 0 Other Pacific Islander 0 Doctorate(e.g.PhD,EdD)or Professional degree (Specify) 0 Other(Specify) .MD DDS DVM LLB 1D 21.Decedent's Single 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 I,White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islander 0 American Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure Home make r )�Asian Indian 0 Other Asian 0 Refused 22b.Kind of Business/Industry 0 Chin 0 Native Hawaiian 0 Other(Specify) 0 Filipino 0 Guamanian or Chamorro ITEMS 23o-23d MUST BE COMPLETED 23a.Date Pronounced Dee Mo Day r) 23b.Signature o Person Pronouncing Deat Only When applicable umbel BY PERSON WHO PRONOUNCES OR .O�� _ CERTIFIES DEATH �� � u 23d.Date Signed(MO/Day/Yr) 24.Time of Death 0 .t/V,t 12S.Was Medical Examiner or Coroner Contacted? 0 Yes No CAUSE OF DEATH Approximate 26.Part 1. Enter the chain of a ents--tliseases,injuries,o mpllcations--that directly caused the death. DO NOT enter terminal a ents such as cardiac arrest Interval: respiratory arrest,or ventrlcuiar fibrillation without showing the etlo/ly��y DA�N REV�jjq/j.E y�Jter o ly one cause on a Ilne.Add atldltlonal Ilnes If necessary Onut o Death IMMEDIATE CAUSE ---------- (Final disease or condition resulting In death) - b. sequen IQ list conditions, Due to(o a,a consequence of): if any,leading to the cause listed on line a. Enter the UNDERLYING CAUSE Due to(or as a consequence of): (disease or injury that initlated the events resulting d. In death)LAST. Due to(or as a consequence of): ,g 26.Part IL Enter othersl-Ificant conditions co tributine to death but not resulting in the underlying cause given in Part I 27.Was an autopsy performed? 0 Yes No 2B.Were auto findings available _i Pth g to eom pieta the cause of death? g 0 Yes 0 No g29.if Female: 30.Did Tobacco Use Contribute To Death? 31.Manner of Death E rR Not pregnant within past year 0 Yes 0 Probably - 2M Natural 0 Homicide ,g 0 Pregnant at time of tleath 0 No 10 Unknown 0 Accident 0 Pending Investigation 0 Not pregnant,but pregnant within 42 days of death 0 Suicide 0 Could not be determined 0 Not pregnant,but pregnant 43 days to 1 year before death 32.Date Of Injury(Mo/Day/Yr)(Spell Month) 0 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 137,If Transportation Injury,Specify: 38.Describe How Injury Occurred: 0 Yes 0 Driver/Operator 0 Pedestrian 0 No 0 Passenger 0 Other(Specify) 39a.Certifier(Check only one): Certifying physician-To the best of my knowledg ,death occurred due to the cau,e(s)and manner stated Pronouncing E,Certifying physlcia at f my knowledge,death occurred at the time,date,and place,and due to the cause(,)and manner stated 0 Medical Examiner/Coroner nation,mid/or Investigation,in my opinion,death occurred at the time,date,and place,and due to the cause(,)an{d�'jmanner tated Signature of certifier. gt'f•// Title of certifier '�" License Number 0����`" 39b.Narfi` e_gddfpss pdgtl �S{�arson I SI aysg gf�yjjl�t< `7`� 40.Registtrram's/District(Number /C{J 411-RRegglilr,r',Signature IrI� 111 42. gistrar il<q,to(MO Day 43.Amendments Disposition Permit No. Oat 7 1 cl (-P REV 07/2011 RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA cj r.; M co `°? o Estate of Jean Miller s 'Devi$& m Cn cn M M F `= rn b- c-) t o Sharon L. Ensor in my capacity/relationss ip 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 George W. Miller,Jr. �5L-2 ��!3t (Date) (Signature) Sharon L. Ensor 48$Lancaster Avenue (Street Address) Enola, PA 17025 (City,State,Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the party executing this renunciation and certified before me thiG day that he or she executed the renuncicVion for the of purposes stated within on this day La,w,of Deputy for Register of Wills otary Public My Commission Expires: NOTAWAL SEAL JAMIE LYNNE SWOPS (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Notary Pubik DALLASTOWN BORO.,YORK COUNTY My COff"S i08 Expiry May 14,2016 Form RW-OS Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc. RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Jean Miller , Deceased rn Ck MC'> ' c" per. r rn r � M cn Richard Miller , in my capac&/gafibnshig as (print Name) , C> ::I . .,.:. c son of the above Decedent, 63rafiv renod ce t�e-dot to administer the Estate of the Decedent and respectfully request that Letters be issued to CZ) George W.Miller,Jr. (Date) (signature) Richard Miller 267 Carlisle Avenue (Street address) Enola,PA 17025 (City,State.Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified Y that he or she executed the renunciation for the of purposes stated within on this 'rte day of &d.rr,Lo 13 Deputy for Register of Wills Notary Public My Commission Expires: (Signature and seat of Notary or firer official quaGried to administer oaths. Stow date of expiration of Notary's commission.) COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL RENEE DREISBACH,Notary Public Lower Paxton Twp.,Dauphin County My Commission Expires November 3P,2P form RW-06 Rev.!o-mow copyright(c)2006 for,software only The Lackner Group,Inc.