HomeMy WebLinkAbout09-06-05
Estate of
WILLIE C.
CUMBERLAND
Register of Wills of County I Pennsylvania
PETITION FOR GRANT OF LETTERS
No. d.. I - OS - 67<0 I
BENNER
also known as
Late of Cumberland County, Pennsylvanic;lpeceased
Social Security No. 17S-48-?,Q12
Joshua C. Benner,
l'etlliwltHlsl. who ill/ale 18 yelll. of AQ8 Of older, 8pP'Vliesl 101:
(COMPLETE "A" OR "B" BELOW:)
Q
A. Probate and Grant of Letters and aver that Petitioner(s) Is/are the execut
Decedent, dated and codicil(s) dated
named in the Last Will of the
StaTe relevBnt ciICUmSUm{~ell. e,g., umunci81ion, 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-lI_. d.b.n.c.l.a.: pendente lite; dUlltnle IIb"entia; t.lUlfII'ltl~ mino,itllle)
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:
Name
Relationship
Residence
No souse
divorced
Joshua C. Benner
son
226 East Glenn Road
Hershe
. '':~J
-'I
>-' !''-) C:::J
with his/her last family orp~i~pal
- :.~~ ~~,'~~;
Decedent was domiciled at death in Cumberland _ County, Pennsylvania,
residence at 815 Windsor Place. Mechanicsburg-, PA 17055
(Iisl stleel. number And lnunicipnhty) ., C' )
Decedent, then 47 years of age, died August 23, , 20~, at in Lower Al!Em To~nshi~::~
(lOCAtion! t...J I ; t
Cumberland County? PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property .............................. $ 10 ,000 . 00
(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
Total . . . . . . . . . . _ . . . . . . . . . . . . _ _ . . . . . . . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 1 0 . 0 0 0 . 0 0
Real Estate 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 letters in the
appropriate form to the undersigned:
Signature
Typed or printed name and residence
..ifr~
Joshua C. Benner
226 East Glenn Road
Hershe
PA
17033
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and 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 Decedent,
Petitioner(s) will well and truly administer the estate according to law.
Sworn to and affirmed ~ subscribed
befo:5;" this cJ day of
C ~~-)lr
DECREE F REGISTER .
,J ~ ,...L L ~ '<
f
,
\
Estate of
WILLIE C. BENNER
Deceased
No.
also known as
Social Security No: 175-48-2932
Date of Death: August 23, 2005
AND NOW, , 20~, in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 0 Testamentary Kl of Administration
(c.t...; d.b.n.e.t.; pendente lite; du,enle abSentia; dUf...e minon'8Ia)
are hereby granted to
Joshua C. Benner
in the above estate and tha.t the instrument(s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters........................... $
Register of Wills
Short Certificate(s).......... $
Renunciation:. ..... ........... $
Affidavit ( )................. $
Extra Pages ( )............ $
Codicil.......................... $
JCP Fee........................ $
Inventory & Tax Forms... $
Other............................ $
TOTAL............... $
b tv fJ,%
Attorney: G::f1;e W. porter,
1.0. No: 42752
Address: 909 East Chocolate Avenue
Hershey, PA 17033
Telephone: 717-533-7130
DATE FILED:
Esquire
o
RW-7a
Thi" i'. 10 certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Loc.t1 Regi'.trar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 119~~E)72~)
No.
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Fee for this certificate, S6.00
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H105. 144 Rev. 1191
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
TYPE/PRINT
IN
PERMANENT
BLACK INK
I-
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C
Benner
SEX
2. Male
STATE FilE NUMBER
SOCIAL SECURITY NUMBER
1130-068
Hours
Minutes
,. 175-48-2932
L August 23, 2005
UNDER 1 YEAR
Days
UNDER 1 DAY
DATE OF BIRTH
(Monltl. Day, Year)
HOSPITAL
InpatienlO
...
FACILITY NAME (It 1l011/lshluhon, UIVC ~lreel and 11\llIll.!4::f)
BIRTHPLACE (Clly and
Stale Of F Ofelgn Country)
PLACE OF DEATH (CIHc'Lk 01111' ,)I)e $ee Il)$tlU,lo(JIIS UII u:tlt'r $lcJel
7.Carlisle, PA
~:~~~"y)~
CITY, BOR
RACE - American Indian, Black, While, alc
(SfJOCily)
Lower
'0.
White
SURVIVING SPOUSE
(11 Wile, gIVe miilrJelll"irllt')
80.
DECEDENT'S USUAL OCCUPATION
(Give kind ot wOlk done dUflrlY mas!
at workIng hie; do nol use felired 1
11.. Insulator 11b. Insulation Ind.
DECEDENT'S MAILING ADDRESS (Slree!, C,tylTown, Sldte, ZiD Code) DECEDENT'S
815 Windsor Court ~~~~t[LNCE
Mechanicsburg, PA. 17055 ~~l..~I~::I~~~~ns
I..
FATHER'S NAME (FifS!. Mlddle,last)
Otto C. Benner
KIND OF BUSINESS/INDUSTRY
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
Yes !XX No 0
MARITAL STATUS. Married
Never Married, Widowed,
Divorced ($pel..lty)
Divorced
12.
Cumberland
Did
decedenl
IiVtlina
township? 17d.~ ~~h~e~~t~~7~i~:~ of
MOTHER'S NAME (1-'IISt. Middle, Maiden Surname)
17c,D Yes. decedenllived in
twp
17a. Slate
Pennsylvania
17b.Counl
Mechanicsburg
cityfboro
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8-29-2005 "o.HooverF
lICENSE~aER
22b. /'7) t:> I'I/J"". .:1l.ooverFH&Crema tor
LICENSE NUMBER
23b. 23c.
WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER?
Yes~ NoD
23a.
TIME OF DEATH DATE PRONOUNCED DEAD (Month, Day. Year)
2.. 7:20 ... August 23. 2005
27. PART t: Enter thll diseases, injuries or complicalions which causad the death. Do nol anlar Ihe mode 01 dying, such as cardiac or respiratory arrest, shock or heart lailure
list only ana cause on each Iina.
b.
Head Injuries
DUE 10(00 AS A CONSEOUENCE Of):
Motor Vehicle Crash
DUE TO (OR AS A CONSEQUENCE OF-):
2..
,AppfOximale
: inlerval between
!onset and dealh
PART II: Clher significant conditionscontlibuting to dealh, but
nol rasulling in the underlying cause given In PART t.
DUE TO (OR AS A CONSEQUENCE OF):
d
WERE AUTOPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
MANNER OF DEATH
DATE OF INJURY
(Month, Day. Yecll)
TIME OF INJURY
Aprx.
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Unbelted operator,
Va, 0 No1:l( partial rollover with
,~.partial ejection
LOCATION (Streel, CllyfTOWfI, Slale)
~ettysburg Rd.,Mechanicsburg,PA
Natural
o
p<l
o
Homicide
o Aug. 23,2005
o ,... 'Ob. 7: 20 PM. 'Oe.
D PLACE OF INJURY. At home, larm, streat, laclolY, office
~O:~lng.alc,(Spenfy) Rural Road
SIGNATURE AND T
Yes 0
No 0
Accident
Pending Investigation
288, 28b.
CERTifIER (Check only Of"')
.CERTlfYING PHYSICIAN (Physici,m certifying C<:luse of death when 8rlotller physician hCis DfOrl()urlced (JeaUI Cind completed Item 23)
To the best 01 my knowledge, death occurred due to the cause(s) and manner a. stated. , '
Suicide
2..
Could not be determined
o
Coroner
.PRONOUNCING AND CERTIFYING PHYSICIAN (PhySiCian both pronouncing de<llh and certrlylll'J to CCillS!;! 01 dealt I)
To the best olmy knowledge, death occurred at the lime, date, and place, and due to the cause(s' and manner as stated..
DATESll~g~~'tD'2V~'; 2005
[J 31c. 31d.
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH
(llem2l)TypemPdnl Michael L. Norris, Coroner
6375 Basehore Road, Suite III
~ 32. Mechanicsburg, Pa. 17050
'MEDICAL EXAMINER/CORONER
On the basis of examination and/or Investigation, In mY' opinion, death occurred at the time, dale, and place. and due to the cause(s) and
manner.sstated............. ......,...........,.,.......... ......,..........
31a.
REGISTRAR'S SIGNATURE AND NUMBER
1;tI,)..I,f...I).,.I'-!.1
DATE FILED (Montl1, Ddy. Yedl)
,..
'6 - ,;;7-05