HomeMy WebLinkAbout11-09-05
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of
JEAN M. MILLER
No.
d / 05- D qqo
also known as
, Deceased
Social Security No.
162-22-2497
Petitioner, who is 18 years of age or older, applies for;
(COMPLETE "An OR "B" BELOW:)
PATRICIA D. TEPSIC
A. Probate and Grant of Letters and avers that Petitioner is the executrix named in the Last Will of the
[[) Decedent, dated AUQust 24,1982 and codicil dated NONE
Item 4 of decedent's Will names Richard S. Miller as Executor of her Will. Richard S. Miller died on March 30. 2005. Petitioner
Patricia D. Tepsic is named as alternate Executrix in said Item 4 of decedent's Will.
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:
NO EXCEPTIONS
o
B. Grant of Letters of Administration
(d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate)
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:
I
Name
Relationship
Residence
I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
3526 Chestnut Street. Hampden Township
County, Pennsylvania, with her last family or principal residence at
(list street, number and municipality)
Decedent, then -BL-years of age, died October 18. 2005, at Manor Care, 1700 Market Street. BorouQh of Camp Hill. Cumberland
County, PA
(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 ............................................................................................................................$
Total........ ............................... ..... ..... ..... ........ ....................................... ...... ......... $
Real Estate situated as follows: 3526 Chestnut Street. Camp Hill (Hampden Township. Pennsvlvania
50.000.00
N/A
N/A
100.000.00
150.000.00
Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the
undersigned:
Signature
Typed or printed name and residence
..)), ~
Patricia D. Tepsic, 632 qavis Driv,e, New Cumberland, PA 17070
(~ ~'.:,
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Form RW-1 Page 1 of 2 (Dauphin County) - Rev. 9/92
584809.1
Oath of Personal Representative
;Z I b <)..{) qq()
Commonwealth of Pennsylvania
County of
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 10 law;), .. . _____ .
Sworn to and affirmed and subscribed -t ~~-,.2J. /./?~
before me this ?S i- 11 day of
~ 6'\)...Q,"lV\ L~ 20 05-
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No.
Estate of
d f D .5--(; C;qo
J (" 0- rJ f1. /lit i' fie ~
Deceased
Social Security No: / & :; ~ J ,'l--)Y1TDate of Death: ;!J . / f' dO{) )'
AND NOW, jJVO verYIb-ey (,/7fr... ,20~, in consideration of the Petition on the
reverse side hereon, satisfactory ereof having been presented before me,
IT IS DECREED that Letters D :Festamentary D of Administration
are hereby granted to
PM /J C/h o. 7<os\,
/
d.b.n.c.t; pendente lite; durante absentia; durante minoritate
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters. ....... .... ..... ... .......
Short Certificate(s)../.~)...
Renunciation.............. ....
Affidavit ( ).................
Extra Pages ( )............
CodleH.. h'-:.'.k..............
JCP Fee........................
Inventory........ ...............
Other........................... .
.530
TOTAL:...............
Fonn RW.1 Page 2 of 2 (Dauphin County) . Rev. 9/92
$
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Attorney: Lawrence B. Abrams ~ ~<:;-; \J i '<.~ \.~
I.D. No: 18028
Address: Rhoads & Sinon LLP, PO Box 1146
1 South, tI,1a,rket Square, Harrisburq, PA 17108-1146
Telephon~:717-233-5731 I I
$330
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Tllh is io certil\ that the information here given is correctly copied frolll an onginalecrtific~:~ \ f .r lill d d~' I ,,(~.Jth me as
IlK,1i R.,'gistrar. The original certificalc will hc forwarded to the St,ltl' Vital Records Otlicl' 1'1 l'In' \I CII! fi II,
WARNING: It is illegal to duplicate this copy by photostat or phot()~lrapl.
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (First. Middle, La'3t)
1.Jean M. Miller
AGE (Last Birthday)
STATE FILE NUMBER.
SEX _ fSOCiAL SECURITY ;~UMRER
:Je~~ 62 - 22 - 2497
BIRTHPLACE (City and PLACE 'JF DE,b,TH Ctlec..k onl one - see instructions on other side
State or Fo~ejgn Cnuntry) HOSPITAL OTHER
,Wormley sbu rg , f{f'"' 0 ERIO",p~I"", 0 DOA 0
DATE 0< DEATH (Monlh, Day, Year)
pctoher 18, 2005
Camp Hill
Rasider.ca D ~~:~ify) D
RACE - American Indian, Black, White, el
(Specify) ,
Whlte
1n.
FACILITY NAME (If not institution. give street and number)
SURVIVING SPOUSE
i1fwife.gilfemilid!nnama)
Cumberland
11b. Cuunri-
Die
decec'('n!
live in a
township?
twp.
17d 0 ~~h~e~~~~~ii~i~; of
citylboro.
MOTHER'S NAME:: (FirSt, Middle, Maiden Surname)
19.Ida Sheely
INFOI1MAIJT$ M!\li,.INGft.DDRI'SS (Slrne, Cilyrrown, SlaletziR Gode)
20b. I !UII l:olumbld Five. lAp lf4, Lemoyne,PA 17043
Jo;:;:EOFDlSPOS'ITiON".----- PLAC((JF DISI-'OsrTi'O-I.J- Name of Cemeter/, Crematory
Qonlh Day Year) or ()ther Pl~ce
o d::ober 21 ,2005 Rolllng Green Mem. Park.
lb, ~lc.
G .~S SUCH LICENSE t1U~8~~ _ ~ME AND ADDRESS OF F~ClcITY
. ~,-~~,~I~J42_=-~_ Ebt?ne&MUrrayFH4gS
LlCE'ISE NUMBER
LOCATION - Cityrrown, State, Zip Code
2Samp dill,
PI-\. 17011
31'::'1 St New cumb2rlllg;~1',
DATE SIG'IED
(Month. Day, Year) ')...... ~
23b' I.J 53-;), ~ '-I S- ne. je,// 3/ CXd!.) S~.
WAS CASE REFERRED TO A MED1CAl EXAMINER ICORONER?
26. Yes 0 No
: Approximate J ?ART II: Other significant conditions contributing to death. but
I interval between not resulling in th@underlying cause given in PART I.
: onset and death
Sequentially list conditions
if any. leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or injury
thai initiated events
resulting on death) LAST
1 :
d.
wZ--
DUE Tv (OR AS A CONSF.QUENCE OF)
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH
PERFORMED? AVAILABl.E PRIOR TO r.;r'
COMPcETION OF CAUSE Natural Homicide 0
OF DEATH? 0 0
Accident Pendil"g Inv3Stigatiorl
YesO NolZl Yes 0 No j2l Suicide 0 Could not be detennined 0
DATE OF INJURY
(Mont~. Oay. teari
T~ME OF INJURY
lNJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
Yes 0 No 0
28a. 28b,
CERTIFIER (Che>ck only one)
*f~~~:F:~~tGor~~~I;~Jfgh"S~~:~h ~~~~i~r~c1":iu~: t~ ~~:~a~~:~{:r~~dr~~lX~i;~a~s ~t~r~~~~~:~.~~.~ .~~:~~. ~.~~ .~o.~~~:~:.G . i.t:~ ?~.).
29.
.30a. 30b. M.
PLACE OF INJURY - At home, farm, street, factory, office
building. etc. (Specify)
30n
*PRONOUNCING AND CERTIFYING PHYSICIA~~ (Physician both pronouncing death and certifying to cause of death)
To the best of my knowledge, death occurred at the time, date, and place, and due to the causes(~) and manner as stC!.ted..
'H"H.ja
..0
*MEDICAL EXAMINER/CORONER
On the basis of examlnatlon and/ot'" Investigation, In my opinion, death occurred at the time, date, and place. and due to the causes{'i) and
manner as stated... ...... ..................,."..,......,.. .........".......
31a.
REGISTRA~'S SIGNATURE AND NUMBER
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33.
.~ /101/1'
34
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This is to certifY that this is a true copy of the record which is on file in
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
02 I {) S' .,(/ C(Cj IJ
the Pennsylvania Division of Vital Records in accor'aance
1.1111".')n"\I~ IU'\'.' "-w;,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
/7 ~ -4
C4(5~ ~ )/~,
No.
Charles Hardester
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
0664333
SEP 0 7 2005
Date
Hi05144Rsv1191
CORRECTED ITEM(S):3
PER:FD DATE:9-7-05 bas
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
026059
n)
1
I'E/PRINT
IN
:tMANENT
.ACK INK
ST.AJE FILE NUMBER
NAME OF DECEDENT (F'irst, Middle, last)
SEX
Sf"IrlJl.! c:.~('IIDITV." ..."'.....
Miller
UNDER 1 DAY
Hours Minutes
Male
185 01 0538
B!RTHPLACE (City and
Slate or Foreign Country)
~;~ify)D
RACE. American Indian, Black, White. elc.
(Specify)
White
10.
13.
MARITAL STATUS. Married
Never Married, Widowed,
Divorced (Speci1y)
,..Divorced
D;d Huntington
decedent
Hveina
township? 17d.D ~~h~:~~~j~':Of
MOTHER'S NAME (F,rs1, Middle. Maiden Surname)
19. Ida. M. Sheel
INFORMANT'S MAILING ADDRESS (Stree1. CilyfTown, Stale, Zip Code)
200. 201 P 1 r Hill Rd. Gardners Pa. 17324
PLACE OF DISPOSI ION - Name of Cemetery, Crematory LOC~ION - CityfTown, State, lip Code
or Other Place
SURVIVING SPOUSE
(Ii wife, give maiden name)
17.. Stale
Pa
twp
Adams
17b. Coun
city/boro
23b. 23c.
WAS CASE REFERRED 10 MEDICAL EXAMINER/CORONER?
VO'. a 0.
NoD
("ti/4-I:CN~ "l1e"!
UENCE OF)
'6.
t~proximate
I Interval between
i Oo,"t ood do.th
PART II:
Other significant conditions contributing to death, but
nol resulting in the underlying cause given in P~RT I
DUE iO (OR AS A CONSEQUENCE OF)
DUE 10 (OR AS A CONSEOUENCE OF):
d.
WERE AUlOPSY FINDINGS MANNER OF DEnH
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEAJH? Natural
DATE OF INJURY
(Month, Day, Year)
TIME OF INJURY
INJURY ATWQAK? DESCRIBE HQVoIINJURY OCCURRED
v.s0
No 0
Accident
. Homicide 0
0 Pending Investigation 0
0 Could not be determined 0
Vo. 0 NoD
28a. 28b.
CERTIAER (ChecK only one)
.CERTIFYING PHYSICIAN (PhySIcian certifying cause at death when another physic'an has pronounced death and completed Ilem 23)
To tM ~ of my knowledge, deattl occurred due to the cauH(a) and menner e. .tailed. .
Suicide
'9.
30.. 3Gb. M. 3Oc.
PLACE OF INJURY - At hOme, farm. street, factory. office
building, etc. (Specify)
300.
o
34.
epRONOUNCINQ AND CERTIFYING PHVSIClAN (Phys~ian both pronouncing death and certifYing to cause 01 death)
To the but at my knowledge, d..tt! occurred at the time, date, and pIece. and due to the cauM{S) and manner as stated
o
'MEDICAL EXAMINER/CORONER
On the bael. 01 examination end/or Investigation, In my opinion, death occurred lit the time, date, and place, end due to the ceuae(e) and
31a.mennerHeteted........................... .... .....................................................................
REGI
~
I(~ II~ III.}
, f
JAMES M. BACH
ATTORNEY AND
COUNSELOR AT LAW
107 ST. JOHN'S
CHURCH RD.
SUITE # 2
CAMP HILL, PA. '70ft
TEL. (717) 737.2033
/
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA~
COUNTY OF CUMBERLAND )
ss
We,
James M. Bach, Esquire
and
Nancy J. Renninger
the witnesses whose names are signed to the attached or foregoing instrument,
being duly qualified according to law, do depose and say that we were present
and saw Testatrix sign and execute the instrument as her Last Will; that she
signed willingly and that she executed it as her free and voluntar,y act for
the purpose 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.
wi tnes
Sworn or affirmed to and subscribed to before me by
417
,// /-7'1)'_/1 <;l __ Y' '
/ ;;
, 1982.
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, this e2.Ljtil
rt5~'d y'j-;{eJ2&
Notar,y Public r
MY Commission Expires:
- .Jiary Public
Cumberland County, PA";". ' 'J
My Commission Expires August 19, l!iS --.
; ~.../
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JAMES M. BACH
ATTORNEY AND
COUNSELOR AT LAW
'07 ST. JOHN.S
CHURCH RD.
SUITE # 2
CAMP HILL. PA. f70n
TEL. (717) 737.2.033
LAST WILL OF JEAN M. MILLER
I, JEAN M. MILLER, of the Township of Hampden, County of Cumberland,
State of Pennsylvania, being in good bodily heal th and of sound and disposing
mind and memory and not acting under duress, menace, fraud, or undue influence
of any person whomsoever, merely calling to mind the frailty of human life,
and being desirous of disposing of my worldly goods while I have the strength
and capacity so to do, I do make, publish and declare this my Last Will and
Testament. I hereby revoke, cancel and annul all my former Wills and Testa-
ments, including codicils thereto, by me at any time made, and declare this
alone to be my Last Will and Testament.
ITEM 1. I direct that my executors hereinafter named pay and discharge
all of my just debts and funeral and testamentary expenses.
ITEM 2. I order and direct that I be buried in a lot which I own situate
in the Rolling Green Memorial Park Cemetery located in Camp Hill, Pennsylvania.
ITEM 3. All the rest, residue and remainder of my entire estate, where-
soever situate and whatsoever it may consist of, I give, devise and bequeath,
absolutely and in fee, to the following named individuals, share and share
alike, per stirpes.
1. Richard S. Miller
2. Elizabeth A. Wolfe
3. Patricia D. Tepsic
4. Michael J. Spangler
5. Deborah S. Wolfe
6. Mark D. Miller
ITEM 4. I hereby nominate and appoint RICHARD S. MILLER as Executor,
of this my Last Will. Should the Executor herein named fail to qualify or
cease to act as Executor, then I appoint PATRICIA D. TEPSIC as Executrix in
his stead.
\ .' )"n 'oTl/J&v
'~_...~
! JEAN M. MILLER
I.
1/
JAMES M. BACH
ATTORNEY AND
COUNSELOR AT L.AW
'07 ST. JOHN'S
CHURCH RD.
SUITE # 2
:,I,MP HILL. PA. f70"
TEt.. (717) 737~2033
-
ITEM 5. I direct that my personal representatives, as well as their
successors, shall not be required to give bond for the faithful performance
of their duties in any jurisdiction.
~MI~.
C-/"l. /..,
'~')'I ''Ll~te A../
COMMONWEALTH OF PENNSYLVANIA)
) ss
COUNTY OF CUMBERLAND )
I, JEAN M. MILLER, Testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; that
I signed it willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
~~~~7
(/ Residing at
, ,
107 St. John's Church Road
Sui te #2
Camp Hill, Penna. 17011
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7!{,,, P/ rj e ''''Residing at
107 St. John's Church Road
Sui te #2
Camp Hill, Penna. 17011
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