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IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,PA
In Re: Estate of Corbin A. Edmiston, late of : Orphans Court Division
The Borough of Shippensburg, : ,
Cumberland County, Pennsylvania, :
Deceased : No. ��- 9�2-�
PETITION FOR SETTLEMENT OF SMALL ESTA TE
To the Honorable, the Judges of the said Court:
The Petition of Donald Eugene Edmiston, Executor named in the last will and
testament of Corbin A. Edmiston,respectfully represents:
1.
Your petitioner, Donald Eugene Edmiston, of 117 Featherdale Circle,
Fayetteville,PA is the surviving son of the decedent. The decedent has no other
children.
2.
Corbin A. Edmiston died testate on May 7, 2013 at the Chambersburg Hospital,
Chambersburg, Pennsylvania. A certificate of death for said decedent is attached
hereto, made a part hereof, and marked Exhibit A.
3.
A true and correct copy of the last will and testament of Corbin A. Edmiston
dated February 15, 1974, wherein he named his wife, Arla M. Edmiston as Executrix of
his will is attached hereto, made a part hereof, and marked Exhibit B. The said Arla
M. Edmiston died on October 24, 1999, and a copy of her death certificate is attached
hereto, made a part hereof, and marked Exhibit C. Your petitioner was named as the
alternate Executor in the Last Will and Testament of the decedent herein.
4.
The decedent was not survived by any person entitled to claim the family
exemption under 20 Pa. C.S.A. Section 3121.
5.
The decedent's last will and testament has not been probated, and letters
testamentary on the estate of the decedent have not been granted because your
petitioner has determined that the decedent owned no real estate, and the total value of
the decedent's personal estate is less than $25,000.00 and consists of the following
assets:
6.
The decedent, at the time of his death,was the sole owner of the following accounts:
A. Checking Account No. 488631 at Members lst Federal Credit Union- $5,056.61
B. Savings Account No. 488631 at Members lSt Federal Credit Union - $8,924.84.
7.
The decedent's funeral bill has been prepaid, and to your petitioner's knowledge,
other than expenses pertaining to decedent's death, the debts outstanding at time of his
death, (all of which have been paid from petitioner's personal funds)were:
Shippensburg EMS $100.00
West Shore EMS $983.70
Penelec $51.51
Chambersburg Hospital (four bills) $1,139.44
Comfort Keepers $45.00
8.
In addition to the above, there is an attorney's fee to handle the administration of
this estate in the amount of$1,000.00 which is payable to Keller, Keller and Beck,
LLC.
9.
A Pennsylvania inheritance tax return will be filed by your petitioner showing
the above-referenced bank accounts with Members 1 St Federal Credit Union as taxable
assets of the decedent's estate.
10.
It is proposed that the attorney's fee be paid to the law firm of Keller, Keller and
Beck, LLC, and that the bank accounts herein referred to in Paragraph 6 of this petition
with Members 1 St Federal Credit Union,be paid to your Petitioner as the decedent's
surviving son and sole beneficiary under his last will and testament.
WHEREFORE, your Petitioner, Donald Eugene Edmiston, respectfully requests
your Honorable Court to decree payment of the attorney's fee to the law firm of Keller,
Keller and Beck, LLC and the distribution of the bank accounts with Members 1 St
Federal Credit Union to him.
`�;---,
T acy J. s, ttorney for Petitioner
Attorney I.D. No. 309831
Keller, Keller and Beck, LLC
1035 Wayne Avenue
Chambersburg, PA 17201
(717)264-1110
I verify that the statements made in the foregoing document are true and correct, I
understand that false statements herein are made subject to the penalties of perjury
contained in 18 Pa. C.S. Section 4904, relating to unsworn falsification to authorities.
,� Z 7�t� C� f,
Date: � ��G ` ��������
�.
Donald Eugene Edmiston
H105.805 REV(9/11) �
� � LOCAL REGISTRAR'S CERTIFICATION 4F DEATH �
WARNING: It is illegal to dupiicate this copy by photostat or photograph.
Fee for this certificate, $6.00 �,,,,�������������-. This is to certify that the information here given is
��,,����p�SH OF pEN- _ correctly copied from an original Certificate of Death
��,��°�o�� =__ _- _y`rG, duly filed with me as Local Registrar. The original ;
;�_ � -�"° =-_ Z,� certificate will be forwarded to the State Vital ,
�° �-' � Records Offic for permane�a�ir�. #� ���3
;� y� a�
��' __ *,,��
�� � � � � � � 04 =° .- _- �,,
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_�`'.0,�91 : ��Q,�'��,
Certification Number ''-..-MENT,O�,►���'
ocal Registrar Date Issued
.,,. , ...._..- --
•FlfTilllflL CERTIFICATE OF �EATH �
Black Ink • State File Number.
1.Dec�deM's Le`al Name(First,Middle,l.ast,Suffix) 2.S�x 3.Sodal SceuHty Numb�r 4.Dace of Death(MO/Oay/Vr)(Spell Mo) .
Corbin A Edmiston Male 191-12-1958 May 7,20'13
Sa.Age-Last Birchday(Yrs) Sb.Und�r 1 Year Sc.Under i Da 6.Oatc of Birch(MO/Day/1lear)(Spell Month) 7a.Birchglace(Ci and Statg�o�►,FOrtlgn Coun[ry)
Months Oays Ho�rs Minut�s t3L1 Y
9'1 October 9.'192"1 7b.BiRhplace(County) 1 1T1
Sa.Residenc�(State or Foreign Gountry) Sb_R�sidence(Stree�a�d Numb�r-Ind�d�Apt No.) 8c Did Deceden!Uve in a TownshipT
PA l� �7�Z�]I�e St. A +• � �Yes,decedant lived in iwp-
8d.Resid��ce(Cou�ty) �Y� �
Cumberland Sc.Residence(2ip Cod!) 1 ,s �NO,deCOdGnt 11ved withi�limits Of Shippensbur� ��t,ribo�o.
9.Ev�r in US Armed Forces? 10_MarKal Status at Time of Death Q Marri�d �Widowtd li.Surviving Spouse's Name(if wife,give name pNOr to flrst marriage)
�Yes Q No �Unknown 0 Divorced �.Never Marrled �Vnknown
I 12.Fsther's Name(First,Middle,Lasc,Sufflx) 13.Mother's Nsme PNorto Flrst MarNage(First,Middle,Lsst)
Willism T_ Edmiston Ma Brid ens
. - 14s.InformanYs Name 14b_Relationship to Decede�t 14c-Informant's Mailing Addross(Street and Number,City,State,Zip Code)
Donald E. Edmis ton Son 117 Fea��7 P c`;m�P F tt�sill� PA 17222
�
.................... ..... a. ace o eat ec o� o�e -'•""'•"•""""'---'--...._...
.... ..........•'•'._......... .•"'•""................._.«.. ...�......'"............"'•"•'•'••""""'•"""--......_
'''''•'-• �....................."" - . . _.."•"•"•""'
uc tf Deaih Occurred ln a Hosp7tal: Q�Inpati�nt ;If Death Occurred Somewherc Other Than a Hospital: `�Hospic�Facility �D�cedenYs Home
� Q Emer e�cy Room/Ovt tiant � Oead on Arrival Nursing Home/LOn-Term Ca�e Facllity Other(S ecily) . �
� i5b.FaGlity Nsme(If not institution,give str�t and number) .15c City or Town,State,s�d Zip Code 15d.County of Oes[h
� Chambarsburg Hospital Chambersburg.PA 17201 F�anlclin
� 16a.Meihod of Disposition Burial Q Cremation 16b_Date of Disposltion l6c Place of DisposiUOn(Name of cemetery,crematory,or other piace)
°O Q Removal from State 0�onatio� � �
� oct+ar(Spectfy) u, �-3 Black Oak Ridge Cemetery
� 16d-Location of Oisposi4ion(City or Town,State,a�d Zip) 17a.Signature of Funeral Servic�Llcensee or Persor�in Chsrge�of IrKerme�t 17b.LJCenss Numb�r
g McClure, PA 17841 tic.�� - �,� FD 138456
� 17c.Nam�a�d Complc�Ce Addr�ss of Fun�ral Fadllcy �
� Pht?asant Funeral Home 316 W_ Market St_ Beavertown PA 178 3
°a� 18.O�cedeM's Education- eck th�box that b�st describes ihe 19.Dsc�dent of Hispanic ONgin-Ch�ck the 20•O�cedenY's Raca-Check ONE OR MORE r�ces to indicate what
�°- highest desree o�level of school completed at the tim�of death. boz that best describes wh�th�r the decederK th�dec�d�nt considered himseff o�hersNf to be. r
�Sth srade or less is Spa�ish/Hispanic/Latino. Checic the"NO" �White �Korean S
No diploma,9th-12th grade box if decederK is nOt Spanish/Hispanlc/Latino. �Black or African American Q Viet�amese
� High school sradwte or GEO completed �' No,not Spanish/Hispa�ic/Latino Q American Indian or Alaska Native � Other Asisn
Q Some collese credit,but no degree Q Yes,Mexican,Mexican American,Chicano Q Asian Indian � Nstive Hawalta�
�AssoGate degr�e(e_�.AA,AS) 0 Y�s,Puerto Rican Q Chinese Q Guamanla�or Chamorro
Q Bachelor's desree(e.s.BA,AB,BS) �Ycs,Cuban Q Filipino Q Samoan
� Master'S degre�(e.g.MA,M5,MEng,MEd,MSW,MBA) Q Y�s,other Spanlsh/Hispanic/latino Q Japanese �Other Paciflc Islander
' � Doctoraie(e_g_PhD,EdD)or P�of�ssional d�gree (SpecNy) �Other(Specify)
I c_ .MO DDS �VM LLB JO
� 21.DecedenYs Sinsle Race Self-O�slgnaHon-Check ONLY ONE to I�dicat�wha�the d�cederrt co�sidercd himsdf or herself to b�. 22a.Dec�dent's Usual Occupstion-Indicate type of work
�Whit� �Japanese Q Samoan done during most of working life. 00 NOT USE RETIRED-
Q Black or Africa�American Q Korean �Other Padflc Islander produe t Des ign
o� Q American Ind7an or Alaska Native �Vietnamese 0 Don't Know/NOt Surc �
_ �Ash�Indisn Q Oth�r Asian �Refused 22b.Klnd of Business/Industry
a Q Chinese �Native Nawalian Q Other(Specity) c�L �
� Q Filipino �Guamanian or Chamorrp Ji alrt ��O[LIp3I1�7
ITE 23a- MU BE COMPtETEU 23a.Date Pronounced Oead Mo Day r 23b.Signature o Person Pronouncing Dea2h(Only when applicable 23c.Uce`+s�Number
�BY PERSON WHO PRONOUNCES OR
CERTIFIES. EATH
23d.Dste Sign�d(MO/Day/Yr) 24.Tim�of O�aih
9:50 PM 25.Was Medical Examiner or Gbroner Contacted7 J$[ Ves C� No
CAUSE OF DEATH Approx�mate
� 26-Part t. Enter the chain of cwents-dis�ases,inJuri�s,o�complications--that direccly pused th�death_ DO NOT errter urminal�venu such as wrdiac arrest, � �Interval: �
respiratory a�rost,or v�ntNCUlar flbrillation without showing the etiology. DO NOT ABBREVtATE_ Ent�r oMy one cause on a Iine. Add additionai lines if necessary � Onset to Death
IMMEDIATE CAUSE --- a a. Cardiopulmonary Arrast
(Final disease or condttion Due to(or as a co�sequence ofl:
rcsulting in death)
� b_ Acuta re�al failura
S�quential�y IiR conditions, Ou�to(or as a cons�qu�nca o�:
. � if any,leading to th�uusa
. list�d on line a. En[er the G Orthostatic hypotension
( UN�ERLYING CAUSE Due to(or es a consequence o�:
�; (dis�ase or injury that
� - ini[lated the evint5�GSUlting d. '
( � in death)I.AST. Oue to(or as a consequence o�: �
u
s 26.Part 11. ErKer other staniflcant conditions contribuiina to death but�ot resulting 7n the underlyi�g cause given in Part 1 27.Was an autopsy performed7
o Ves No
� Hyp6rFC81BfTi8 � 28.Were sutopsy Nndings available
m to complets the cause of death?
� �re5 No
1 29.If Fema e: 30.Did Tobacco Use Contrlbute to D�sth7 31.Mann�r of D�ath
� Q Not prlgnant within past yea� []Ye5 � Probably �Natural � HOmiCide �
u° � Pragnantattimeofdeath �[No Q Unknown Q Accident �Q Pendi�g�lnvestigation
°s� Q Not pregnant,but pregnant within 42 days of deatF Q Suidde Q Could not be determined
�-° Q Not preg�aM,but pregnant 43 days to 1 y�ar before death 32.Date of InJury(MO/Day/Y�)(Spell Mor+th)
� � Unknown if pregnant within the past y�ar 33.Time of InJury
34.Place of I�Jury(e.g.home;construction sit�;farm;school) 35.Location of Injury(Street and Number,City,State,21p Code) � ,
�
I3fi.Mjury at Work 37.lf Transportation Injury,Specity: 38_Oescribe How Injury Occurred:
1
' Q Y!5 Q Driver/Ope�ato� � Pedlstriarf � ,
0 No �Passenger Q Other(Specify)
re � 39a.Certifler(Check o�ly one):
vi� �Certi(ying physician-To the besi of my knowledge,death occurred due to ihe cause(s)and manner stated
� �$Pronouncing 8.Certlfying physician-To the b�st of my knowledge,death ocwrred at the time,date,and place,and due to the cause(s)and man�e�stated
Q Medical Examiner/Coroner-On the bas(s of exami�aUon,and/or InvesUgation,in my opinion,death occurred at the time,dat�,and place,a�d due to the cause(s)and man�er stated
Sisnature of certiRer:� �� /� .�a�caf.u, �i�T� 7it1e of certiRer. CRNP License Number. SPO'10936
� 39b.Name,Addresa and Zip Code of P�non Compieti�g Cause of Oeath ptem 26) 39c.Date Signed(MO/Day/Vr)
Ms.Kayla R_Burckar,CRNP '1'12 N 7th St,Chambersburg,PA'1720't May 7,20'13
� 40.RegiStra�s ittrlct Number 41.Registrar s Signature 42.Re istrar FUe ate(MO ay r)
0
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° n3.Ame�dments
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� �t��^�, , o� H 105-143 �•'�
. � Disposition Permit No._y J�/�'�� lC REV 07/2011
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EXHIBIT A
....�._.�-- ..�_. �....
��.�.� ��11 �n� ���x�m�nx
I, COR�IN A. �'DMISTON, a� R. 'D. #2, McC.�.uc2, U/ea� Beave�c Tvwwsh,i.p,
Snyde�c Caun�y, Penv�y�vawi.a, be,i.ng �{� �auv�d and d.i�s�oa�,ng m.ind, me.many a.�.d
;���!c�;;,s�'.��r�div�g, mah.e, pu.6.��F�. a.nd deee.at�e. xh.�,a �:a b� my .Lu,s� Ul.��,2 ;�i�� TL.{,f�,�m�r�r
I:�vczby tcevvFz.i.ng a.2.2 w.i.2�s and cadi:c,i.2�s by m2 a,t any.t,i,me hene.�abvne. made.
ITFM I: I g�.ve and bequeath a.� my hun�',i.ng, {�.ush.�.ng au�.d �s�an�',i.ng �
eqeu:pmev�t �a m� aon, �vnu.2d �'ugene �dm��av�.
1 T�M 1 I: A.22 xhe n2�s�, ne�stidu2 and teema.i,nden a 5 m y pnape�c,t y, a�
� � wha�a ev 2�c ncLtwz.2 an h.i.nd avcd wh.¢tce�s a e.ve�c. a.i.t,u.a,te, I g�.v 2, dev,i,a e and b eq uea,th
�a my be..2oved w,�be., Atc,2a M. �dm.i�xan, �.� dhe aunv�.ve� me.
IT�M IIT: Shou2d my w�.Ue, Nc,ea M. �dm.i.sxan, nnede.eeaae me, �h.en
I g�.ve, dev.i�se and bequeath u.�C2 my aa,i.d pna�eh,ty, an �h.e pnaeeeda �he�c,e�nam,
�ta my aan, �ana2d �ugev�e �dm.i�s�an, on �a ltic:.s .i,c,due, pe�c b�',i.tc.�e.a.
IT�M I V: Shau.2d my w�.�e, my d o�. a�.d h,i,b .i�s.aue a,2e �nedeeea�s e me
�hen T y�ive. my �a,i.d pnv}�eh.ty, arc zh.e nnae2ed�s �'rce�c.e5nam, �a my daugntie�c-�.n-.�aw,
Ra�se M. L-cfmi.��an,.
IT�M V: I d,i.tc2e,t �h.a,t u.Ze xccxe� wh.i.eh may be a��se.��sed �.n covvse-
� quenee as m y dea,th, a{� wha,teven �.azune av�d b y wha,teven �cv�,i�s di.c,t,�.vn .i.m�a�s ed,
�ha,2� be pa,i.d �nam my tc¢�s�.du.alcy e:sxate a,� �an,t ob xh.2 2xnev�e a� �'he adm-i.wi�xir.a-
�',c:a�. a� my e,b�a,te.
1T�M VI: I appa�.n,t my w�,�e, An,ea M. �dm.i.b�tan, �xeewth,i,x a� �h.us,
my La�� GI.i.P.2, Shau2d my w�.�e, An,ea M. �dm.i�sxor�, {�a,i.�. an eeade �o ac,t as �xecu-
�r,i.x, �he�. I a��o�,� my �san, �ona.ed �ugene �dm.i,a�oK, Exeeu,tan o� �h,i�s, my La��t
w�i.Q,2. Shau2d my don, �aKa.ed �ugene �dmi��an, Ua.i..0 vn cea�se �a ac,t a�s �xeewtan,
�h.ev� I ap�o�.wt T�c.i.-Cauv�,ty Nc�#',i.ana,e 8anfi ab M,idd226utcg, Penn�y.2van�s,a,'"�.�
�5uece.6�aa1c.s and a,ab�.gr�s, �xecu�an a� �'hi�s, my Laax W-i.?,�.
ITFM V I I: T di.nec,t �'Ja.a,t m y �e�c.s avca,2 ne�ne�s ewt,a,ti,ve� b ha,e.e nati b e
nequ,in.e.d �o pa�x band �an xh.e �a,�.th�u.� ne�c.{�anmanee a� xh.e,i�c dux,i.e�s �,n an�
�un,i�s di.c,ti.an.
IN (UITNESS GIH�R��F, 1, Cvnb�,n A. �dm.i��an, have heneun�a .aex my
r�(1 • �/"
hand and .a ea.Q �l� /�--' day ab .�2c�r.• , ]914,
�
• C�t,��-ti:�. �� ��rt,�•SG��. (S�AL)
- ] -
EXHIBIT B
�
The pneced,i.ng �,na�'icwnewt, cavv�.i,ax,i,ng aU �h,i.� ax.d aKe, v�h.elc zyy�e-
. wx,i,�ten �age each .�dewt,i.��.ed by �he b�.gv�a��uc.e o� �'h.e Te�s�a,tan, wa.a an �h.e day
and da,t� �l�.e�cea� a�,g�.ed, �u6.Q,i�Shed, aN,d de.c,er.vc.e.d by Canb�.n A. �dm.v��av�, x(a.2
Te�s�a,tvn �'1ce�ce,i.n named, as and �an Gi,i�s La�s� GJ.i.2e a�.d Teaxam2wt, �.n �'he. �n�sence
vv cv�, wha, at h,i�s h2que��, ti�. f�.i�s pnebe.nce, and �.n �'h.e .pn�sence v{� eaeh a�hvc,
have �ub�s c�c.i.bed aun v�ame,a a�s w.i.tne.ab e.a hetce,ta.
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� This ;�to certify that the information here given is correctly copied Erom an original certiFicate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the St��te Vital Records Office for permanent filing.
WARNING: It is illegai to dupiicate this copy by photostat or photograph.
Fee for this certificate, $2.00 ���''''`�H�OF p�
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�"'9lMENY,O,,;��`
No. Date
!T�/r� �J 7i �b , �c., ��
shoccld Read: n1cClc�r�__ _ __
Lewtsr'own uospttr�t, t�.Qrry?cvp•, JVI��`F'!�n Co.
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H�os.ia n.�.yn COMMONWEALTM OF PENNSYLVANIA•OEPAATMSNT OF HEALTH•YITAL RECOROS
trw►mwt
CERTIFICATE OF DEATH
u� �ocr rxs Nuw�►
�E�MANENT NAME Of OECLOEM(FnM.MiOCN,lr1 �tX SOCIK 9ECUMTY NUM�EN D�cTQ Of OfaTM;M�nn.Onx'hwl
B.ACXJNK t. Arla M. Edmiston :Fsmale �• 180 — 22 — ?201 ��October 24 1999
AGE{L�M 8ir4W�y► UNOEN 1 YEAq UMO[I11 010' ORT!OF MRTN WIi1VlACi�Cily yd 1�/IC�OR Dl�QN ICMcM ONy an�—iN wlncLpr m aMr wN
� �y,ry � O�„ �WV� t MY�u�w �MOnin.Oay.'hrl� S�wafapnCarurT) llOi/l�l: Oi11l11:
74 rn. ; � Nov.6,1924 Shamokin, PA �� ���+� �►� �p M.a,�.❑ ;,K,,,,❑
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L1� Montour Mahoning Geisinger Medical Center ""�^�»��• white
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