HomeMy WebLinkAbout02-21-06
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
No. 21-06- ()?;S3
Estate of Eugene A. Muller II
also known as
I Deceased
Social Security No. 125-38-1106
Victoria J. Ambrose
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated and codicils dated
Administratrix
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:
00 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 has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs:
r Name Relationship Residence I
Victoria J. Ambrose Daughter 2435 Winona Drive
Columbus, OH 43235
(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 2109-101 Cedar Run Drive, Lower Allen Township
(list street, number, and municipality)
Decedent, then 59 years of age, died 04/15/2006 at Hershey Medical Center, Hershey, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
500,000.00
$
$
$
$
50,000.00
situated as follows: 2109-101 Cedar Run Drive, Camp Hill, Lower Allen Township, Cumberland County, PA
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:
I Signature
X-Vk~ {~
/
Typed or printed name and residence
Victoria J. Ambrose 2435 Winona Drive
Columbus,OH 43235
I
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group. Inc.
Form RW-1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
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 Decedent, Petitioner(s) will well and truly administer the estat~ 10~ding to law.
Sworn to or affirmed and subscribed ~ .~ ~
Victoria J. Ambrose
before me this5l J
,
day of
(/f!!7 ., ,~b
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~.~m1F~
No. 21-06- G ')~,
Social Security No:
125-38-1106
Date of Death:
04/15/2006
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AND NOW, '30 0' 2cDlo , in co~~n
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of the Petition on the reverse side hereon, satisfactory proof having been presented before me,~ ~
IT IS DECREED that Letters 0 Testamentary 00 of Administration ~ )>
Estate of
Eugene A. Muller II
also known as
:;rlII>
:x
~
N
U)
(c.I.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
are hereby granted to Victoria J. Ambrose, Administratrix
in the above estate and that the instrument(s) dated
described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
J~7i2~
FEES
Letters........ .......... .... .................... $
Short Certificate(S).....!.?.......... $
'ili 0
to
Renunciation............................... $
Attorney:
David J. Lenox
1.0. No: 29078
The Wiley Group, PC
Address: 130 W. Church Street
Affidavits ( )...........................$
Extra Pages ( )......................$
JCP Fee..........:t..lb!.tO"......$
/s
Dillsburg, PA 17019
Telephone8 717-432-9666
CodiciL... ........... ...... .................... $
E-Mail:
Inventory...................................... $
Other........ ........... ..... .................... $
TOTAL............................ $
535
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
'JVi
Form RW-1(1991~
Ii, ]~, iO certify that the information here given is correctly copied from an original certificate of death duly filed with me as
)( II H _~gistrar~ 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.
Fee for this certificate, 56.00
p
12410703
No.
t2wrv ft; ~
Local Registrar
APR 1 8 2006
Date
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COMMONWEALTH OF PENNSVLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIRCATEOF DEATH (CORONER) STATE FILE NUMBER
Rtv,OII06
1ft1NT IN
lAMENT
')(.MK
1, Name 01 Dececlenl {FllSl, rriddIe. Ia.ll
Eugene A. Muller, II
5. 1qe (WI blrtidly)
59 Yrs,
lib. County 01 Oea/II
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7. OIle oUlillh Mon1ll. de . ear
5,
8, Birth lace Inchlllear b '
Dauphin
11. Oeetdllnt'. UsuII lion ~ 01 WlIlIc dona ' . do no1 SlaI.llIlil'ed
Truck ~~wrver DARTK~r~g
111. Oeced8nI's Maino Address (Slr8el. ayltown, stal.. 211 code)
2109...101 Cedar Run Drive
Camp Hill, PA 17011
Hershey Medical Center
12. Was 0ecedInl1Mll' illht us
Armed Forces?
o Yes n No
Decedent's
Ad\IaI Residence 171. SIal.
t3. Oecedent's Education
~(G-121
PA
Cumberland
17b. County
3. SociII Securily Nurrtler
- 38
.. Del. of ONIh (Monfl. dIy. yeetl
April 15, 2006
. g 5poIISf (I will, ~. nwiden 1II11ie)
rade t 4. MarW SlalUS: ....rrilId. NIMII' manied. 15.
CAIege(t-4ar 5+) ~g~~
:~ 17c.r!Jr. Y...OecedentlNed~ Lower A
Townsh~?
1711. 0 No. DecedeN Uved wllhln
klu811..knb of
en
TWIl.
Clyllolo
18. Fl\Iler's Nama (F'nl rricldIe.lUI)
Eugene A. Muller
201. Inlarmlnl's Name (Type.'printl
Victoria J. Ambrose
19. Molfle(s Nan (FnI, riIdII, nid." surnama,
Mary R. Scully
2011. InlonrAnI's Maino .Iddr_ (Slreel. cly.1Qwn, slal.. ~ code)
2435 Winona Drive, Columbus, OH 43235
2211. license NlHIiler
FO 012342-L
21c. PIece of Disposllon (Neme 01 oemeCery, cremalory or oa.. 1*-) 21d. Location (Clly~ iii.. ~ codel
oIling Green Memorial Park Camp Hill, PA 17011
22c:. Namund Add,... 01 FICIly
Stone&Murray FH 408 Third St.,NewCumberlaJJ9pR
25. 011. Pronoanced Dead (Monlh. dIy. y..r)
April 15, 2006
: ~inIIINaI:
:onseItodeelll
CAUSE OF DEAllf (SeI1lIItNctIDnI and .......)
Ilern 27. Pill I: Enter 1tIe ~ - disea.... ;;mes. or c:o"1lkalions -ltal d'1I8Cltf caused 1IMl d810I. 00 NOT .nI.r 1,,"*,,11V8IIls such IS cardiac 8tfesl.
Iftest. Of Y8ftlric1Jlar tbliIIlion wIIIoul stlOWing Ile etDogy. 00 NOlIllbr8YiaII. Enter ontJ one CIUse 001 In..
..PMlt eAUSE (F'llIldis8lseor Closed Head Injury
~ resulilo ~ ~lhl ~ I. Due to lor IS I COIIS8Quent:8 oQ:
~ bCc:ancIiIbIs,ifany, b.
lIIdilg to Ihe ClUlllisted Oft Lile ..
EIller lie ijNDEftl VIIG CAUSE
(diseue or il~ IMI mled 1he
evenIs resuIiIg in dBe1ll) lAST.
0ut!D (or as I consequence 01):
c.
0IIe to (or IS e COIISBqUBIlCt oil:
301. Was an Aulop&y
~?
d.
3Ob. Wet. AWlpsy FildIlgs
MllblaPrilr to ~
01 Cause of 08Ith1
o Vese No
32d. Tmt 01 Injury
11 :30 P
32tJ. 0eIcrbe how InPY Oa:urrad:
Car versus pedestrian
u.
3211. 0I1e of Ir9Iry (folonIh. day. year)
April 1 0, 2006
31. Manner 01 0..'"
o NlWrII 0 Honicld.
~ Accident 0 ~ mesdgation
o Suicide 0 Could NCIl Be O.1lrined
a v.. -. No
331. C8lCIfIer fchlck 0Dtt 0fIll)
. c.rtJfyfng pllysIcIan (PIIysicIaIl cetllfying callSB of dedl ~ anaI/Ief ~ ha. pronoIJlCed dlIIIh and ~ "*" 23)
To IlII belt 01 ~ knowIIdge, d8IttI occuntd dill to IlII caUl8(111ftd IIIIMIr 1,1fNlt ____.________.________________________o
. Pronouncing and ce.tItylng phrIIcIIn (PhysIcian bolh pronounc'rlg .11 and ~ to ClUII 01 d..lh)
To 1M belt 01 my IlnlIwIIdge. deIth ~ .c1lle tfllll, dale, Ind pIIce..nd duI to the caUlol(sl and ,.,.. .. s1ated._____~__________O
. lledlcal uallllnadcoflt""
0lt1M bISIa of IDflIIfIIIIIor\..uor 1mwtIptIon.1n mr opinion. Mth oceurnll at 1Ile 1fN,.... and plact, and dUa ID 1he cauae(l) and 1NfIfW.........--M
35. \l.tOSlJ1t' 'Si\ToI\U1t aM ~ HuntlIf 36. 0aIe Red (UonfIl. clay. )'lit)
I"'<I/I~I /1/ I ~ I; ~,,~.1
(See instructions and examples on reverse)
231>. li:ense Nunar
23c. Dale S9l8d (MotIth. day. ~
PIr\ 11; EN. olher sianH'anl ar.ndmns CIlIIIIbIIina ~ dIaIIl.
bUt IlCll resulting illha underIyilgcauseglwinlrJ ParI\.
26. was CaIiII RMIMd to . MedicII ExaninerIConlner?
~ Yes. O. No
321. "Trllllplllslion kljUly (Spec:l;)
o Driv.JOparaIor 0 Passenger
. Pedesnn [J OIlIer - ~
33b. SIgna"r.
2ft. ~ T.x.ooo USe Coi*IluI.lD DeafIl?
o Yes 0 PIdlabIy
aNa o.~ .
29. "FerrM: '
o Hpt ~ MlIliI pal y8II'
. OPtIgnant IIIi'M of daaItI
ci. Not prlglllM. ~ pregnant YoiIhil.c2 days
old.1Il
o Ho1 pregnant. bIl pregnant 43 days to 1 year
~. deaCh
o U"knoMl i11lf'1'l1n1 dillhe put y.r
321:. PIece 0I1njdr(. Home, Farm. Slreet FIcIory, 0Ilict
oatJPImf- (~
329- localion (Slrett. ~~. s1IlI1
1800 block of Market St, Camp
iII,PA
33d. Dell ~ad~. day. YItlI
April 17, 2006
3.(. &~~~~~C~COn1JleIadCalMofOellJl(l1em27)T~
1271 South 28th Street
Harrisburg, PA 17111