HomeMy WebLinkAbout04-17-13 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:
BARBARA M. LAUGHLIN and MARVIN J.ZINN
Decedent's Information �(
Name: V.JANE ZINN File No: 21 -13 -44
4
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security
Date of Death: 03/27/2013 Age at Death: 85
Decedent was domiciled at death in CUMBERLAND County, PA (State)with his/her last
principal residence at 1000 W.SOUTH STREET,CARLISLE CARLISLE BOROUGH CARLISLE Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at 1000 W.SOUTH STREET,CARLISLE CARLISLE CARLISLE 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 $ 6,000.00
If not domiciled in Pennsylvania................. Personal property in Pennsylvania $
If not domiciled in Pennsylvania................. Personal property in County $
Value of real estate in Pennsylvania........... $
TOTAL ESTIMATED VALUE$ 6,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets,if necessary.)
Street address,Post Office and Zip Code City,Township or Borough County
[ 'A. Petition for Probate and Grant of Letters Testamentary C
Petitioners)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated rmn
thereto dated it
=R5 95
(State relevant circumstances,e.g.,renunciation,death of executor,etc.) �
Except as follows:after the execution of the instrument(s)offered for probate,Decedent did not marry,was not divorced, a party to a pgndin
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. 3323(8),and did noav cS borrl�7yr
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. f
c.D C: C7
❑
X NO EXCEPTIONS❑EXCEPTIONS i"' rii
❑ B. Petition for Grant of Letters of Administration (If applicable) :r (-�? Cr, cD
c.t.a.;d.b.n.;d. .n.c..a.;pe ente rte;dura n k a sen la; .,ante minonta 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.
Except as follows:Decedent was not a party topending 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.
❑X 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
additional sheets,if necessary):
Name Relationship Address
MARVIN J.ZINN SON 248 WHISKEY RUN ROAD
NEWVILLE,PA 17241
VICTORI E.BURNSIDE DAUGHTER NEWVILLE,PA 17241
DEAN E.ZINN SON 250 WHISKEY RUN ROAD
NEWVILLE,PA 17241
DELMAR A.ZINN SON 224 WHISKEY RUN ROAD
NEWVILLE,PA 17241
See continuation schedule attached
Form RW-02 rev.10-1 f-2o 11 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 n
BARBARA M.LAUGHLIN 14 LAUGHLIN LANE O rn rT1
NEWBURG,PA 17241 - 2 c.
MARVIN J.ZINN 248 WHISKEY RUN ROAD c: '' r^ r-41
NEWVILLE,PA 17241 Cn _;TJ -``�
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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)o the Decedent,Petitioner(s ill well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before/ Date LI-/7/,3
me y of krw 0 W 1.3 �'=- Date l/-/7-/3
By: Date
For the Register Date
BOND Required? ❑ Yes MIQo To the Register of Wills:
FEESfi Please enter my appearance by my signature below:
Letters............................................ $ V Attorney Signature:
($)Short Certificate(s)..........
( )Renunciation(s)...............
( )Codicil(s).........................
( )Affidavit(s)....................... Printed Name: Hamilton C Davis
Bond.............................................. Supreme Court
Commission................................... ID Number: 10264
Other
i l l D Firm Name: Zullinger Davis,PC
Address: 20 East Burd Street
Suite 6
Shippensburg,PA 17257
Phone: 717/532-5713
Automation Fee.............................
Fax: 7171
JCSFee......................................... ,
TOTAL........................................... $ E-mail: hdavis�ullinger-Davis.com
�r
DECREE OF THE REGISTER
Date of Death: 03/27/2013
Social Security No:
Estate of V.JANE ZINN File No: 21 -13
a/k/a:
AND NOW, Iri m in consideration of the foregoing Petition,
satisfactory proof having been pres nted before me,IT IS DECREED that Letters Testamentary
are hereby granted to BARBARA M.LAUGHLIN and MARVIN J.ZINN
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 last III(and odicil(s))o Deced t.
0 In d a lay, _QPA
Register of Wills
Copyright(c)2011 form software only The Lackner Group,Inc. Page 2 of 2
H105.805 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
OFFICE o�
Fee for this certificate, $6.00 RECORDED
,„Ijf --- This is to certify that the information here given is
BE6ISTER OF V11(_{_$ ,ttt,, �p�1H-OF pf�;� correctly copied from an original Certificate of Death
�� 3 ��� 1 ° duly filed with me as Local Registrar. The original
J 7 R19 j 33 o za certificate will be forwarded to the State Vital
v ' n� Records Office for permanent filing.
CLERK 0�
P 19435 1 �- MAR 18 P13
��__nn __ tt
�-4�RPHANS' CQURT 99jMENTOF;��`P�,1
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is
Certification NumbeC U M B E R L A N D CO., P,Q ------ ocal Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA-DEPARTMENT OF HEALTH-VITAL RECORDS
Permanent
Black Ink CERTIFICATE OF DEATH State File Number:
1.Dec.dent's Legal Name(First,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Death(Mo/Day/Yr)(Spell Mo)
V. Jane Zinn F 211 22 6540 March 27, 2013
Sa.Age-Last Birthday(Yrs) lSb.Under 1 Year Sc.V nder 1 Da 6.pate of Birth(MO/Day/Year)(Spell Month) 7a.Birthplace(City and State or Foreign Country)
Months pays Hogs Minutes Shi nsbur PA
85 Feb_ 1 7, 1 928 76.Birthplace(County) Gysn7�ex land
8Residence(State or Foreign Country) 86.Residence(Street and Number-Include Apt No.) 8c.Did Decedent UV,in a Township?
PA 1 000 w_ S011th St-- QYes,decedent Iived in twP,
Sd.Residence(GOUn[yL
CLUrlberland 8e.Residence(Zip Code) a M P6N,,decedent Rv.d within limits of Carlisle city/born.
9.Ever in US Armed Forces? 10.Marital Status a[Time of Death Q Married _E2CWidoed 11.Surviving Spouse's Name(If wife,give name prior to first marriage)
Q Yes IR No 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)
Arthur R. Kendall Effie E_ Cover
14a.Informant's Name 146.Relationship to Decedent 14c.Informant's Mailing Address(Street and Number,City,State,Zip Code)
m
Barbara M_ Lau hl= Dau liter 14 Laughlin Lane, Newburg, PA 17240
0
G .....................................................•-- ---....Pa..................................,........15a.P ace_Of.U.at..,C_ec_•on y one _
s If Death Occurred in a Hos Ital: ........................ .................................�+a' ...............................
p in tient ;If Death Occurred Somewhere Other Than a Hospital: Hospice Facility tJ Decedent's Home
° Q Emergency Room/Outpatient Q Dead on Arrival Nursin Home/Long-Term Care Facility Q Other(Specify)
156.Facility Name(if not institution,give street and number; .15c.City or Town,State,and Zip Code 15d.County of Death
Sarah A_ todd Memorial Hcxne Carlisle PA 17013 Cimiberland
16-Method of Disposition Burial Q Cremation 16b.Date of Disposition 16c.Place of Disposition(Name of cemetery,crematory,or other place)
m Q Removal from State Q Donation
- other(specify) 4/l/201 3 CLanberlanc7 Valley Memorial Gardens
16d.Location of Disposition(City or Town,State,and Zip) 17-Signature of Fun! 1 Service License n 1., b"ge of Interment 1?b.License Number
Carlisle, PA 17013 CS FD 012633 L
17c.Name and Complete Address of Funeral Facility
Ekvin Brothers Funl=_ra1 Herne, =n,-_ , 630 S_ Hanover St_ , Carlisle, PA 17013
m 18.Decedent's Education-Check the box that best describes the 19.Decedent of Hispanic Origin-Check the 20.Decedent's Race-Check ONE OR MORE ra s 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 be.
®'Sth grade or less is Spanish/Hispanic/Latino. Check the"No" 8'Whlte 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 �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 Associate degree(e.g.AA,AS) Q Yes,Puerto Rican Chinese
Bachelor's de Q Q Guamanian or Chamorro
Q degree(e.g.BA,AB,BS) Q Yes,Cuban Q Filipino Cl Samoan
Q Mas[.is degree(e.g.MA,MS,MEng,MEd,MSW,MBA) Q yes,other Spanish/Hispanic/Latino Q Japanese
Q Doctorate(e.g.PhD,EdD)or Professional degree Q Other Pacific Islander
(Specify) Q Other(Specify)
.MD,DOS DVM,LLB,JD
21.Decedent's Single Race Self-Designation-Check ONLY ONE to indicate what the decedent considered himself or herself So be. 22a.Decedent's Usual Occupation-indicate type of work
LVyhite Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure HC7lnana7ter
Q Asian Indian Q Other Asian Q Refused 22b.Kind of Business/Industry
.q Q Chinese Q Native Hawaiian Q Other(Specify)
c Q Filipino Q Guamanian or Chamorro Her Cn r1 rjCgftE
ITEMS 23a-23d MUST BE COMPLETED 23a.Date Pronounced Dead(MO/Day/V r) 23 b.Signature of Person Pronouncing Death(Only when applicable) 23c.License Number
CE PERSON WHO PRONOUNCES OR Q F G / O
CERTIFIES DEATH / !"1
23d.Dale Slgrr(MO/Day/Yr) 24.Time of Death -
N-Q 7 d f g` 25.Was Medical Examiner or Coroner Contacted? es Q No
CAUSE OF DEATH I Approximate
26.Part I. Enter the chain of a Vent s--diseases,injuries,o mpII,,tions--that directly caused the death. DO NOT enter terminal a ents such a ..diet arrest Interval:
respiratory arrest,or ventrl ular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional Ii nesrif necessary Onset to Death
IMMEDIATE CAUSE - > E- �K-Art-- V I�SC wLYirM-- �L'C. t
(Final disease or condition Due to(or as a consequence of):
re-ft,ng iI,death)
b.
Sequentially list conditions, Due to(or as a consequence of):
If any,leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE pue to(or as a consequence of):
(dis or Injury that
initiated the a nts resulting d-
in death)L Te AS Due to(or as a consequence of):
S 26.Part 11. Enter other sianifi<a nT conditions c tribut'ng to death but not resulting In the underlying cause given In Part 1 27.Was an autopsy performed?
�1,�►Mt'S['DES ,/fltn�L.LI Tt1.stn Q Yes 80.
"7V
C �IR--T- -✓! -0 is E s F 28.Were autopsy findings available
to complete the cause of death?
Q Yes Q No
29.If Female: 30.Did Tobacco Vse Contribute to Death? 31,...�M,�a!nner of Death
o4j "ot pregnant within past year Q Yes Q Probably �vatur., Q Homicide
Q Pregnant at time of death Q Unknown Q Accident Q Pending Investigation
m Q Not pregnant,but 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)
_s
f\ t 36.Injury a[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)
V
�. 39a.Certifier(Check only one):
Lice rtifying physician-To the best of my knowledge,death occurred due to the ca uses)and manner stated
Q Pronouncing-Certifying physician-To the best of my knowledge,death occurred at the time,date,and place,and due to the cause(,)and manner stated
\\\\ Q Medical Examiner/Coro /�-O e b f exami aT(on,and/or Investigation,In my opinion,death occurred at the time,date,and place,and due to th�fe.c^,use(,)yy and manner stated
Signature of certifler:�Q vl Title of certlfler:_ 10*0 License Number:
39b.Name,Address and Zip Code of Person Completing Cause of Death(Item 26) 39c.Date Slgnetl(Mo/DaY/Yr)
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40.Registrar's District Number 41.Re s Signature ' 42.ReHist rar File Date(MO D.Y/Yr)
-� /0 GtI C of �Z o i3
° 43.Amendments
o_
Od&7 /-A-45 H107/20
Disposition Permit No. REV 07/2011
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On May 16, 1994, V. Jane Zinn, Vivian J. Cohick and Janet P. VanScyoc appeared before
me and signed this document.
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