HomeMy WebLinkAbout01-31-05
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Michael J. Chilenski No. 21-05. Ooqe
also known as
I Deceased
Social Security No. 206-64-4675
Roger E. Chilenski and Carol L. Chilenski
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s} is/are the
the Decedent, dated and codicils dated
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
[!] B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs:
ame
Relationship
eSI ence
See attached schedule
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
or principal residence at 315 North Mountain Road, Upper Frankford Township,
(list street, number, and mUnicipalIty)
at Newville, PA 17241
-"'~
c'
-
Decedent, then
23
-
years of age, died
12-18-2004
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal, property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
0.00
$
$
$
$
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
of leUers in the appropriate form to the undersigned:
ype or printed name an reSidence
Roger E. Chllenski 315 North Mountain Road
Newville, PA 17241
Carol L. Chllenski
315 North Mountain Road
Newville, PA 17241
Prepared by the Pennsylvania Bar ASSOCiation
Copyright (el 2004 foon software ooIy The Lackner Group, Inc.
Form RW-1 (1991)
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
SS:
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that 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 the above
decedent petitioner(s) will well and truly administer the estate according to law.
L
Sworn to or affirmed and subscribed
Before me thi, 0) 81=\.....- ~ of {
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Estateof~\~~..(\ ~. ,Deceased
C,",.\~sk..
GRANT OF LETTERS OF ADMINISTRA nON
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o
AND NOW 20~in consideration of the petition on the reverse
side hereof. satisfac g been presented before e.
IT IS DECREED that ...
is/are entitled to Lette~ of Administration, and in cord with such finding, Letters of Administration
are hereby granted taLa.. OPL. ~ Qoq-lr ~
in the estate of (The t"l~ .I.L T. C-h,,; ~. '^ AJI_;
FEES
Probate, Letters, Etc. ......... $ .;2 0
Will................................. $
Renunciation..... '."..." _"....... $
Short Certificates ( ) 12..c.:Q ~-
JCP...... ....................... $ \() ,()\:)
$ 11=1 5. ff)
$
$ I-\....LoD
20.M..
~UV\"~l~~
Re:ister of Will ~_
. 00 ~ --;{LJ /7. ~
Attorney (Sup. Ct. J.D. No.)
=>
Address
Automation Fee...................
Bond.................................
Total
Filed \ - al
Phone
In the Court of Common Pleas of
INRE:
Estate of
Michael J. Chilenski
also known as
Name of Decedent:
Date of Death:
Michael J. Chilenski
12/18/2004
Name
Carol L Chilenski
Nicholas P Chilenski
Roger E. Chilenski
Stephen M Chilenski
Cumberland County, Pennsylvania
ORPHANS' COURT DIVISION
NO. 21-05 - OOq 8
, Deceased
Social Security No. 206-64-4675
Petition for Grant of Letters
(Continued)
Relationship
Mother
Residence
315 North Mountain Road
Newville, PA 17241
Brother
315 North Mountain Road
Newville, PA 17241
315 North Mountain Road
Newville, PA 17241
923 Bucknell Avenue
Johnstown, PA 15905
Father
Brother
IV
00
(.~1
<:)
I [I(l<;.~I)" Rl,V q/~r,
This is to certify that the information here givcn is correctly copied frorn an original ccrtificate of death duly filed with mc as
Local Registrar. The original certificate will be forv./arded 10 the State Vilal Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fec for Ihis certificate. $2.00
f" 1J017623
DEe 21 2004
Date
p',)
C:J
H\06_1~Rev.\191
.;2/- 05'-OOq<:j
COMMONWEALTH OF PENNSYLVANIA - DEPARTMENT OF HEALTH - VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
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'PEIPRINT
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.......~
LOCK""
UNOER1DAY
HNsJ. Mlnut..
Chilenski
DATEOFBIRTI1
1~lh,Oay.\Ur)
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2. Male
S'OOEfILSNUMIlSA
SOCl.oJ.llECURITYNUMBER
DATEOFDEATH(Mof'lln,Oay.YM~
4. December 18. 2004
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PLACEOFDEAl11(Cha.:kcnlycne .....instrLdOon.oncllh!"!Iirj&)
HOSPITAL'
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FAClllTYN...MElllnoIinlli'u'oon.Q.....IlIrAllt.ndnum"-<)
. 206-64-4675
9IRTI1PLACE(CiI'/&r1d
edni:'~PA;
Olh_r M
(Spoo~YI """
~CE.Am&rl"..,I"'""n,9lacl<,Whll8,alc
~liite
Newville
100 Block Fairfield Street
k.
Restaurant
11b.
(JECEOf:I{T"SI,fA/l-!NGAtIDJl1'SS/SlleBl, Cil)lJTOwn, Slale.ZipCodBJ
QECEDENT.SUSALOCCUPRIDN
(OO;eIlind"'wor1<<lcnoO~~CBl
Ass"t-:.'1ifll.t~~€r'
SUAV'VINGSPOUSE
~lwiI..giv"mo<lonnBrl'lll)
315 North Mountain
11. Newville, PA 17241
FnHER'SNAME(Fir51.MkId..,l.ast)
11. Roger E.
/NF()Rw.NT'81Wt1E(T~Roger E.
Rd.
DECEDENT'S
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RESIDENCE
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Cumberland """""'lIl? l1d.D~n=cl
MOTHER'SCM~~oiiddle~~mli son
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Chilenski
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. 1:15 A.M. 2&. December 18. 2004
fl1.Frl1IT',Em.""'~bJ}>Irie.Qrccms>l~llOIIowllich..l.Udlh_dIIBlll.Dc1>Cl_nl_'lhemcde<>ldylng.I"""..CIOrdIaCQrrolpi'OIOry.rrest.lhoci<.......nl.Uuro
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Closed Head In uries
DUElO(ORASACONseOUENCEOf):
Motor Vehicle Cash
DUE1O(ORASACClNSEOUENCEOF):
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DUElO(ORABACONsEaUENCEOf):
.
Wlf:RE AUlOPSY FINOlNGS
AAILABLEPFIlORlO
COMPLETIQNOFCALlS"
OF DEATH?
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o 3 2:45 A. ...- _.
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SlGNATUREANDTTT
TlMEOFIN./UR\'
Aprx.
INJUR\'ATWORI<?
DEst:IlIBEIroWJN.IURYOCCUFlAED
Belted passenger.vehicle
left roadway, struck tree
~JR..D ~}<l,."D
210. 21b.
CEA'TIFIER~onIvQn"l
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Newville. PA
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C>uld""~.lo!"""lned
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Coroner
.IEDfCALEXAAlJNENCOflONER
On \he ..lol.....ln._ "'<11'" Innflllllllllon. In my opinion. dulh OCC1lrr'" fill"" Ilm_, chI_, .nd place, .nd du_ to u.. CBUUj'.j_nd
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31..
R'EGISTRAA'SSlGNmJRE"-NDNUMBE~ _ .
u. LJo.i..e t:\. \';
13.11 ,,,<,\ ,ll 1
DATESIGNED(Mootl1.D8';._,)
o 310. 31d.December 20. 2004
NAMEANDf.OORESSOFPEflSONWHOCOMPlETEDCAUSEDFDEA:rH
(lIem27)TypeorPrlnt Michael L. Norris. Coroner
M 6375 Basehore Road. Suite HI
p.. >>. Mechanicsburg, Fa. 17050
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