HomeMy WebLinkAbout12-02-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF_ J,//')'J /"�� p� COUNTY,PENNSYLVANIA
Petitioner(s) nained 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 request(s)the grant of Letters in the appropriate form:
Decedent's Information •
Name:��" e I'��-'�/�C'i/7 /fi�� File No: ��� _I �� � L ��
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No• " fy�- - f �
Date of Death: - / Age at death:
�
Decedent was domiciled at deat ' � Count , �� (srure)with his/her last
principal residence at � a � f �
Street address,Post ffice d Zip Code City,Township or Borough Count
Y
Decedent died at � �('j �.�r0 �[ � ��, ��� �� �
` _.L`c.
Street address,Post Office and Zip Code C�ty,Township or Borough Count
y State
Estimate of value of decedenYs property at death:
If da�:iciled in Pennsy[vania.......... ...... ............ All personal property $ ��•Q�
Ifnot domiciled in Pennsy[vania. ......... .............. Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ............. .......... Personal property in Coimty $
Value of rea[estate in Pennsylvania........................... .............. ................ $
TOTAL ESTIMATED VALUE. ... $ .(x�
Real estate in Pennsylvania situated at:
(�ittach additional sheets,i/�necessary.) Street address,Post Offlce and Zip Code City,Township or Borough Count
Y
�A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated -/ "�—��
tliereto dated and Codicil(s)
State relevant circumstances(e.g.renunciation,death ofexecirtor,etc.)
Except as follows: afrer the execution of the instrument(s)offered for probate Decedent did not marry,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.u.,pendente lite,durunte absentiu,durmzte minoritute
If Administration,c.t.a. or d.b.n.c.t.a.,enter date ot Will in Section A above and com lete list..of heirs.
Except as follows: Decedent was vot a party to a pending divorce proceeding wherein the grounds for�orce had beeriestabl�e�defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated pe►�m.� C)
� � -�p rn �"7 �
❑NO EXCEPTIONS EXCEPTIONS � � �
Petitioner(s),after a proper search has/have ascertained that Decedent left no Wiil and was survived by•.;;e f�o�jig�ouse�any)ii��i}f��iYs(uttuch
udditionul slieets, if'ii�cessury): A ,.._ � � �]
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Name Relationshi d�ss� � .�,.. �i
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Page 1 of 2
Oath of Personal Representative off�;a�us�o�iy
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Pr' ted Name
Petitiouer(s)Printed A dress
/�/ ryj��� y7 �
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 Petition�r(s)and that,as Personal Representative(s)of the Dece ent,the Petitioner(s)w l] ell and truly administer the estate according to law.
Sworn to or a�irmed n�i subscribed before / �
� ��tday of . ,:2�? " Date
y: l � ' � " ��, r � Date _ '
, . �-�1�L
Foi•lhe Re;isrcr ` � Date
Date
�
BOND Requixed:❑y�s!�rp To t/:e Register of Wi[Is: � Q �"' f`�tZ �
FEES: Plea s e e n t er m a
y ppearance by��nature�ow;� �
Letters . . . . . . . . . . . . . . . . . . . . . . $ . �.C�(� �
Attor��ey Signature: � 2> �"" ��
( 2 ) Sl�ort Certificate(s). . . . . . I(` '�(� 1' �"°�' r'�
'--r-�!=-�-- :�„ '� � t�.' =:� �
( )Renunciation(s).. . . . . . . . —_ � U? � � �
� ) Codicil(s). . . . . . . . . . . . . C� � �..z Tl `+� 'r`!
( )Af�davit(s).. . . . . . . . . . . �— _—_� C7 -�,-t _..
� �t
Bond.. . . . . . . . _--- C�7 � ..�: r?
. . . . . . . . . . . . . . . Printed Name: ` 'i7 ~ �' f"+3
Commission. . . . . . . . . . . . . . . . . . �— _�{ p--
tl�er ------- S u p rem e C o u rt �, t--�+
" " " ' ID Number: � �
. . . . . . . ��—
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�� � ( , I�-�-, Firm Name:
.- . . . . . . . _ I.��./`�� Address:
. . . . . . . .
. . . . . . . �—
Phone:
Automation Fee. : ::::::: : :: .: : �,��--�L, Fax:
JCS Fee. , r
TOTAL. . . . . . . . . . . . . . . . . . . . . $_�� Finail:
DECREE OF THE REGISTER
Estate of�'}���'�� � � �� n(�� � ( �/
a/k/a: �`I � Tile No'�� — f���
,
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AND NOW, � � ' (� % , %l I �-'�( �
satisfactory proof having be � resented before me,IT IS DECRE tters�n i�era �on of the for going Petition,
are hereby granted to � r � ���{�.YL
.
the instruinent(s)dated in the above estate and(if applicable) that
��/�
aesciinea in the Petition be ad'mitted to probate and filed of iecord as the last Will (and Codicil s)) of Dec�dent.
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�egister of Will �� � � � ,
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Fonn RW-OZ rev. !0/IU20// �� / /�
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HI05.805 REV(9/l l) .. .. . . . . . .. . .. . . . . . .... . .
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 �������� ���#�� ��
,j1���,,,���""'������"' This is to certif that the information here iven
�p�1M QFPFN` correctl y g
R���S��� �� �rt�� � ,���.�., yJ,__ y copied from an original Certificate of Deat
`�� - _- l , duly filed with me as Local Registrar. The origin�
�4�i3 �1,�C � m `� .,. , aF certificate will be forwarded to the State Vit<
pt t .� ' y a� Records Office for permanent filing.
� �. � � � � `' � �:_ - *''
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� t � � .d.. C l E R� (�; �'��° ~? �Z�Can��.`�.,,�l,.�r
Certification Number p R p y A�S• �g�,R.� �99lMfNT OF��`P �ex- N(�l 2 0/2 p�_
,,,,,,,,,,,,
���'''
```� R /�/� Local Registrar Date Issued
� T V P e/P r i n t In C.�M V����i.�.7 [� .
Parrnanent Ero�LY}{QF(p�NSVLVANIA.DEPqRTMENT OF HEA�TH•VITAL RECORDS
Blacklnk CERTIFICATE OF �EATH
1.Decedent's Legal ryame(First,Middle,Last,Sufflx)
AY�ZeI12 F'� 2.Sex 3.Social Security N�mb�.r5tate Flle Number:
Sa.A Mi11er 4.Date of Death(MO/Day/Yr)(Speil Mo)
ge-LastBlrthtlay(Yrs) Sb.VnderlYear f''gnale 2�4 �3 ��56 /�
. Sc.Under 1 Da 6.Date of Birth(M
92 Months� Days Hours Minytes �/Day/Year)(Speli Monih) 7a.Birthplace CI � � �
� N�_,111ty�a s Pe o�Foreign Country)
sa.ne:iden�e eseate o�Fo.eig„co�na Jutie 4. l 92 l 1 A
�j� . �'Y) 86.Residence(Street and Number-��clude qpt N 7b�B�rthpiace(COUnty) �Yland
8d.ftesid � � °�) 8c.DFd Decedent uve in a Township]
ence�co�ncy . l 426 Bradl2y Dr. � Apt_ 2�3 s,de�eae„i p�ed t� N
�� ���Y'1c'1nd ae.aes�ae��e(z�a coae> e oY'th Middleton
9.Ever In US Armed Forces7 l 701 3 �No,tlecetlent Itvetl withln Ilmiis of tWp
�Ves � No �Unknown 10.Mariial SYatus at Time of Deach �Marrled
� Divorced 0 Never Married ,� w�d�wed 11.Survivinq Spouse's Name(If wife,gWe n ��h'/boro.
12.Father's Name(Flrst,Midtlle,Last,S�ffix) �Unknown ame prior io first marriage)
K�£er S� j{eC}C 13.Mother's Name Prlor to First Marrlage(Firs[,MldCle,Last)
14a.Informant's Nam� M�iy Morrison
Bonita M. Hai�n 14b.Relatlonship to Decedent 1qc.InformanS's Maiiing qddress(St�eet and Naamber,Ci
G _ �.� .� Daugkitar
_ If Death Occ�rred In a Ho- - - - �.� �- - �1 47O.='�ngS Gap Rd_ , Carlisle�Ht�piP coae> .
spital: � pQ �npatient - - - 15a_P ace o Deai C g �7p�3
� � Emergenry Room/Oyf atleht .� Dead on Arrlval ��f Deaih Occurred Somewhe e Otheri'Th�a Hospttal �
� 156.Facility Name(if not InsNCUtlon,give t�eet and n 0 N�rsing rypme/L r �eospice Facillty �Dec
� Harrisb � ong-Term Care Facility �p�her(Sp �iry� - eaeni•s Ho,,;e- -
.� ux'q Hospitai . "'bef� 1s .ciiy°�r �,scace,a„a ziP coae � -
�� 16a.Method of DlsposfHOn p B„�ia� Harrisburg, PA � 7� p� isa.ce,,,, f osath.
0 Removal from State � Donatio� Cremation 16b.DaYe of Dlsposltion 16c.P�ace of pis DauP�1n
Z-� � Other(SpeclTy) PosiHOn(Name of cemetery,crematory,or other p�ace)
16d.Location of DlSposifion(Ctty or Town,State,and ZIp) � ��2��20�3 �ans C �
$ Leo1a, P va.sis�ac��e or r'�rrr�����,��ntion Services
j� unaral Service Ucense �Charge of Interment 17b.License Number
� 1J N me a p1aSe AdCress f Funeral Fa 111 FD
nd Com
m �in Brothers Funez-a�1�3 630 5_ O�2633 L
I8.DecedenYS EducaNOn-Check the box that best desc�r�ib�the n 9 Decedent of Hls Hanover .S't� �
t- highesf degree or level of school completed at the time of death. box that best describes wh rther the decetlent �r11S12� pj-� �'7O�3
0 Sth Pa^����H��-Check the 2D,DecetlenYS Race-Che<k ONE OR MORE races co Indica[e what
grade or less the decedent considered himself or herself to be.
�NO dlploma,9(h-12th grade �s Spanish/Hispanic/Latino eCheck the"NO"
� Hlgh school graduate or GED c mpleted b if decedent is not Spanish/lii gwhite � Ko
� Some college credit,but no de - �NO,not Spanish/His spantc/Latino. � Black or qfrican qmerlcan rean
� Assodace de Hree panic/Laiino �American Indian or q�aska Native � Vietnamese
gree(e.g.qq,q5� �Yes,Mexican,Mexican qmerican,Chicano � Other Asian
� Bachelor's degree(e.g.BA,Ag,BS) �Yes,P�erto Rlcan O Asian Indian O Native Hawailan
O Master'S degree(e.g.MA,M5,MEng,MEd,MSW,MBA O Yes,C�ban �Chinese O Guamanlan or Chamorro
� Doctorate(e.g.PhD,EdD)or Professlonal de � 0 Yes,other Spanish/Hispanic/Laiino � F���P��� � Samoan
.MD DDS DVM,LlB �D 6ree (Specify) �Japanese � Other Pactflc Islander
21.Decedenf's Single Race Self-Desi 0 Other(Spec(fy)
.��Whife S�atlon-Check ONLY pryE to intlicaie what the tlecetlent consldered himself or herself to be. 22a.Decedent's Usual Occ�
� Black or African qmerican �Japanese � Samoan
� � Amer(can Indlan pr Alaska Native � Korean O Ofher Pacific Islantler do�e tlurin ga���^-�^tlicate typ¢of work
�Asian Indian �Vietnamese B mosY of workin Iffe. DO NOT USE RETIRED.
O Other qsian O Don't Know/Not Sure K1't.Cr1E'.TZ
¢ 0 Chinese 0 Nattve Hawailan � Refused Managar
O Fllipinp . O G�amanian or Chamorro � O[F�er(Specify) zzb.Kind of BusinFss/Intl�}try
ITEMS 23a-23d MUST BE COMpLETEO ( �f f 1C�-'r S L'1i�h
B`�PERSON WHO PRONOUNCES OR 23a.Dafe Prono� c d Dead Mo/Day/Yr N
CERTIFIES OEATH �� ` � Q a a�3 Z36.Signature of Person Pronouncing Death(Only uyhen a
zaa.oa.ce s8„ea�nno�oay/vr� � � aa�came) 23c License Numbef
24.Time of Death �
� 25.Was Medical Examiner or Coroner Coniactetl7
26.�art 1. Enter the�chain of event CAUSE OF DEATH �O ves No
respirafo �---�--diseases,Injurtes,or complicafions--ihat directly caused the death. DO NOT enter terminal events su<h as cardiac arr �
ry arrest,or ve tricular fibrlilation without showing the efiology, 00 NOT ABgREV1ATE. Enter only one c APProximate
IMMEDIATE CAUSE �I_�� ���� ause on a iine. Atld atlditional lines if necessa � ���erval:
(Final tlisease � a' ry'. 1 Onset to Death
onditlon � V}J
resulting In death) /� p � ( 9 f) 1
Sequentially Nst conditio�s, � b� �
if any,I�atling to Lhe ce�ee �ue to(pr as a conse �
ilsted On Iine a. Enfer the quence of):
UNDERlY1N6 CqVSE � �
,� (disease or Injury tHat Due to(o eq�ence of): �
F Initiatetl the events resulting d r as a cons ' --
In death)LqST. � �
Due to(o �
� 26.Part/1, E�ter other�t¢nif' r as a conseq�ence of): �
. ondi' t d . 1
� but not resulting in the untlerlyin � 1
e g cause given in part 1. 2i.Was an a�topsy perf mad7
°V' � O Yes �No
°' 29.If F ale: Zg-Were a�topsy flndings avaflable
E 30.Oltl Tobacco Use Contrib�te�o Dea�h? to complete the caus f death7
s O P eL PreHnant within past Year � Yes �o
gnant at time of death p ves O Probably 3i'M of Death
m � Not pregnanY,bui pregnant wlthin q2 days of deaih � No CY�Unknown �atural � HamlGde
�- � No�pregnant,but pregnant 43 days to 1 year before death C O Accident � pentlin Invasti
O Unknown if pregnani within the 32.Date of Injury(MO/Da � Suicide � Could ot be deie�iminetl
past year y/Vr)(5pe11 Month)
_-_ 34.Place of InJury(e.g.home;wnstruction site;farm;school) 33.Time of Injury
-- 35.Locatlon of InJury(Street and Number,City,Co�nty,Sta[e,Zip Cotle)
36.InJury at Work 3'].If Trans �
portatiOn infury,Specify:
� Ves � Driver/Operator 38.Describe How Inj�ry Occurretl:
� No Q Passenger � Pedestrian
� Ofhar(Specify)--
39a.�rtlfier-physician,certlfied nurse
��Certifying only-To the best of my knawtled�er,medical e minere/coronerause ska^I
� � Pronoun<ing 8.Certify� ge,death oc urred du uo tehe c Yma en�e
� Medical Examin �g-To Yhe besf of my knowledge,tleath o ( � �d ^ r scated.
� er/Cor r-On th b sis of exam(naLOn a d o �c rr d at the time,o ate,and paace antl deue to the c
Signature of certifler� ^ � r Investigation,in my p�nion,tle th occur e(�s)antl manne�stated.
J r d aS fhe timesd te,and place,and due to the cau
396.Nama,qddre5s and C� � Title of certiFler:�,L��pL.�y6�.p sse(s)and mann r statetl.
. b of Person Completing Cause of Death(It 26 L(cense NuTber:Qd (`j��"1�J
� 1 1 S �' �
40.Reg st�a�5 DisYrict Number �(� �-}- 39c,Date Signed(MO/Day/Yr)
� � � 41.Registrar's Signature ���0�
o ���,\b 1
� 43.Amendments ��::/��' �� 42. egistrar FIIe�ate(Mo Day r)
P�('
� 6
Disposition Permit No._ C.��Q�'
� . . H105-143
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LAST WILL AND TESTAMENT � -� � " "� �'
� � � N � t;�y
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ARLENE F. MILLER 7 `� � `'
, .:"t ►—' � _ r-rt
ro _.,,i t� ,�°' C�
I, Arlene F. Miller, of 1426 Bradley Drive, Apt. 213, Carlisle, Cumberland
County, Pennsylvania , do make and declare this to be my last Will and Testament, hereby
revoking all prior Wills and Codicils.
FIRST: I direct that all my debts and funeral expenses be paid as soon after my
death as may be practicable. I further direct that all estate, inheritance, transfer, legacy, or
succession taxes which may be assessed to my estate, or any part of my estate, whether passing
under my will, shall be paid out of my residuary estate as an expense of administration and
without apportionment.
SECOND: I give my specific personal property as follows:
1. My engagement ring to my daughter, Bonita M. Hamman of 1470 Long's Gap Road,
Carlisle, Pennsylvania.
THIRD: I give all the rest and residue of my estate as follows:
1. Or�e half tc m.y daughter, Banita M. Har;�;m�:� �;�;�r issue; ene half to my son, Robert
C. Niiller, of 116 Brody Lane, Newburn, North Carolina, or his issue.
FOURTH: I appoint my daughter, BONITA M. HAMMAN, Executrix of this
will. In the event my daughter, Bonita M. Hamman does not survive me, or in the event she will
not or cannot serve as my Executrix, I appoint my son, ROBERT C. MILLER as Executor of this
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will. No Executrix or Executor acting hereunder shall be required to post bond or enter surety in
any jurisdiction.
FIFTH: In addition to having all the powers conferred by statute or by general
rules of law, my Executor, with respect to properties in my estate, subject to any limitations
stated elsewhere in this Will, are specifically authorized and empowered:
(a) To invest any funds of my estate in any corporate shares, bonds,
notes, or other securities or personal property, including any common or commingled funds
maintained by my Executor hereunder. This is to reflect my intention to give the broadest
investment powers and discretion to my Executor;
(b) To sell or otherwise dispose of any property, real or personal, at
any time forming a part of my estate, for cash or upon credit, in such a way and on such terms as
my Executor may deem best;
(c) To manage, operate, repair, improve, mortgage, and lease for any
term any real estate at any time held;
(d) To make distribution in cash or in kind upon any division of my
estate; and
(e) In general, to exercise all powers in the management of my estate
which any individual could exercise in the management of similar property in his own right, and
to do all acts which my Executor deems necessary or proper to carry out the purposes of this
Will.
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IN WITNESS WHEREOF, I hereunto set my hand this �`
. day of
, 201 l.
BY:
ARLENE F. MILLER
SIGNED, PUBLISHED and DECLARED by the above, Arlene F. Miller, as and for
her Last Will and Testament, in the presence of us, who, at her request, in her presence, and in
the presence of each other, have hereunto subscribed our names as witnesses:
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COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND •
I, ARLENE F. MILLER, Testatrix, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I have
signed and executed the instrument of my Last Will and Testament; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes therein expressed.
� Sworn to and ac owledged before me by ARLENE F. MILLER, the Testatrix,
this day of 201 l.
� 1
����
ARLENE F. MILLER
(,�l��l���, L�'���� N..�b,.o�..
F CAROLE A ROSE
Notary Public Notory PubflC
LOWER AILEN 1WP,CUNiB�RLAND COUNTY
My Commission Expires Dec 6, 2011
COMMONWEALTH OF PENNSYLVANIA :
: SS:
COUNTY OF CUMBERLAND •
We, `� nf� � �_�. �`' ��- ��� and %-��)C� l.t �.. t�' ���� 1`C�l'l-t �..
the witnesses whose names are signed to th attached instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testatrix, ARLENE F. MILLER,
sign and execute the instrument of her Last Will and Testament; that she signed it willingly and
that she executed it as her free and voluntary act for the purposes therein expressed; that each of
us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of
our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
, Sworn to and subscribed to before me bv ,' ��'
I�`�G� ��-t I�G � and
��`�k'��� �� ��tirC��Y�- , witnesses, this� `� day of 2011.
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Witness �j, Witness
n NOTAUTAL SEAL
� � n CAROIE A ROSE
«j Notary Public
otary Fublic LOWER ALLEN TWP,CUMBERLAND COUNN
My Commission Expires Dec b, 2011
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