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LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
I, ELLEN N. BENION, now of 1714 Bridge street, New
Cumberland, Cumberland County, Pennsylvania, do publish and
declare this to be my Last will and Testament, hereby revoking
all other prior wills and codicils made by me.
FIRST: Family Background and Appointment of Executor.
(A) Family and Background Information. I am married to
HARRY G. BENION. The child of our marriage is HARRY G. BENION,
JR., (and any children born or adopted hereafter). Throughout
this Will, HARRY G. BENION, will be referred to as "my husband"
or "my spouse" and HARRY G. BENION, JR., (and any children born
or adopted hereafter) as "my child." The word "issue" will
include my child as well as my other descendants.
(B) Appointment of Executor. I appoint as my Executor and
successor Executor (all hereinafter referred to as Executor or
Executor(s)) under this Will, the following named persons or
corporations to serve without bond and without being required to
account to any Court:
Executor: My spouse, HARRY G. BENION
Successor Executor: My son, HARRY G. BENION, JR.
SECOND: Funeral and Last Illness Expenses; Taxes.
(A) Expenses of Funeral and Last Illness. Notwithstanding
that my spouse survives me, I direct my Executor to pay my
funeral expenses (regardless of amount) and the expenses of my
last illness from my estate.
(B) Taxes. I direct my Executor to pay any and all estate,
inheritance, succession, legacy, transfer and other death taxes
or duties, by whatever name called, including any and all
interest and penalties thereon, imposed under the laws of any
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LAST WILL AND TESTAMENT
OF
ELLEN N. BENlON
PAGE 2
jurisdiction by reason of my death, upon or with respect to any
and all property included in my gross estate for the purpose of
such taxes, whether such property passes under or outside of this
Will, out of my residuary estate, without being prorated or
apportioned among or charged against the respective devises,
legatees, beneficiaries, transferees, or other recipients of any
such property or charged against any property passing or which
may have passed to any of them.
My Executor shall not be entitled to reimbursement for any
portion of any such taxes from any such person. The foregoing
provisions of this Article SECOND shall not apply to the
following:
(1) The amount, if any, by which taxes, interest
and penalties thereon shall be increased as a result of
the inclusion in my gross estate of property (a) in
which I may have a qualifying income interest for life,
under section 2044 of the Internal Revenue Code of 1986
(hereinafter, "IRC") (or the corresponding provisions
of any subsequent federal tax laws) or corresponding
provisions of state law, or (b) over which I may have a
general power of appointment under IRC section 2041 (or
the corresponding provisions of any subsequent federal
tax laws) or corresponding provisions of state law, or
(c) over which I may have retained an interest as
defined in IRC Section 2036 (or the corresponding
provisions of any subsequent federal tax laws) or
corresponding provisions of state law, and any taxes,
interest and penalties on said incremental amount shall
either be paid from said property directly or shall be
recovered by my Executor from the person holding or
receiving said property as provided in IRC Sections
2207, 2207A, or 2207B (or the corresponding provisions
of any subsequent federal tax laws); and
(2) A generation skipping tax imposed by IRC
Chapter 13 or the additional estate tax imposed by IRC
section 2032A(c) (or corresponding provisions of
federal or state law applicable to my estate and
LAST WILL AND TESTAMENT
OF
ELLEN N. BEHION
PAGE 3
imposing said taxes), and any and all interest and
penalties on said Chapter 13 and IRC Section 2032A(c)
and comparable state taxes; and
(C) Flower Bonds to be used to pay Federal Estate Tax. If
at the time of my death I own any United States bonds redeemable
to pay the United States Estate Tax at par plus accrued interest,
I direct my Executor to redeem said Bonds to the fullest extent
possible and to use said bonds ahead of any other assets held in
my probate estate to pay said tax, as well as any interest and
penalties thereon. To the extent that the Trustee of the Trusts
described below does not distribute to my Executor any such bonds
for my Executor to use in paying said tax, my Executor shall pay
said tax only after first ascertaining from the Trustee the
amount of tax and any interest and penalties thereon which the
Trustee can pay by redemption of the bonds held in the Trusts;
and thereafter, when my Executor has received the information, my
Executor shall redeem all said bonds held in my probate estate up
to the full amount of any remaining portion of said tax, interest
and penalties thereon not payable by redemption of said bonds
held by the Trustee. If the Trustee holds no such bonds or has
distributed all such bonds to my Executor, my Executor shall
redeem these bonds as directed hereinabove in this Article
SECOND.
THIRD: Tangible Personal Property. Except for those items
excluded below and those items enumerated in the Letter of
Instruction, I bequeath to my spouse, HARRY G. BENION, all
tangible personal property, including but not limited to
clothing, jewelry, heirlooms, furniture, household, garden and
lawn furnishings, equipment and supplies, bedding, rugs, carpets,
household goods, linen, silver, silverware, plate, china, glass,
glassware, pictures, paintings, antiques, works of art, clocks,
books, ornaments, personal effects, motor vehicles, and all other
similar articles, which I own, and the insurance thereon, if my
spouse survives me by sixty (60) days. Tangible personal
property shall not include: (1) any and all property used by me
in any business, (2) cash on hand or on deposit in banks, (3)
stock or securities, (4) any type of evidence of indebtedness,
and (5) any life, health or accident insurance policies.
'- ~ /;12 /t.--.
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 4
If my spouse is not living on the sixty-first (61st) day
after my death, I bequeath such tangible personal property to my
son, HARRY G. BENION, JR.. If my spouse and my son do not
survive me, I leave such tangible personal property to the issue
of my son, per stirpes. If there is any disagreement as to
distribution, I direct my Executor to make such distribution.
The decision of my Executor shall be final and binding. Any
items not selected or any items which my Executor considers
unsuitable for my son may be distributed or sold in the sole
discretion of my Executor and, if sold, the net proceeds
therefrom shall be added to the residue of my estate. Any such
article allocated to a minor may, as my Executor deems advisable,
either be delivered to the minor or to any person to safeguard on
behalf of the minor.
Notwithstanding any other provisions in this Article THIRD,
I may leave a separate, dated and unsigned Letter of Instruction,
which I shall place with my Will, containing directions as to the
ultimate disposition of certain of the property bequeathed under
this Article THIRD, and such Letter of Instruction shall
determine the distribution of such items.
Residuary Gifts.
FOURTH:
(A) If my spouse, HARRY G. BENION, survives me, I give,
devise and bequeath all the rest, residue and remainder of my
estate, of every kind and character, real, personal and mixed,
tangible and intangible, and wherever situated, including any
lapsed or renounced legacies, devises or residuary bequests (and
including any property over which I may have a Power of
Appointment), to my spouse, HARRY G. BENlON.
(B) If my spouse, HARRY G. BENlON, does not survive me, I
give, devise and bequeath all the rest, residue and remainder of
my estate, of every kind and character, real, personal and mixed,
tangible and intangible, and wherever situated, including any
lapsed or renounced legacies or devises (arid including any
property over which I may have a Power of Appointment), to my
son, HARRY G. BENlON, JR., per stirpes.
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LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
aGE 5
(e) Distributions duri~ Administration. Prior to final
distribution of my estate, t~e Executor, in his discretion, may
make partial distributions to one or more beneficiaries or
Trusts. As a consequence, the Executorship and any Trusts
created under this will may exist contemporaneously. A
distribution may be made subject to any indebtedness or liability
of my estate.
FIFTH: Spendthrift Provision. No beneficiary shall have
the power to anticipate, encumber or transfer his or her interest
in the estate in any manner other than by the valid exercise of a
power of appointment. No part of the estate shall be liable for
or charged with any debts, contracts, liabilities or torts of a
beneficiary or subject to seizure or other process by any
creditor of a beneficiary.
SIXTH: Powers of Executor. In addition to the powers and
duties as may have been granted elsewhere in this Will, but
subject to any limitations stated elsewhere in this Will, the
Executor shall have and exercise exclusive management and control
of the Estate and shall be vested with the following specific
powers and discretion, in addition to the powers as may be
generally conferred from time to time upon him by law:
(A) In the management, care and disposition of the Estate,
the Executor shall have the power to do all things and to execute
such instruments as may be deemed necessary or proper, including
the following powers, all of which may be exercised without order
of or report to any Court:
(1) To sell, exchange or otherwise dispose of any
property at any time held or acquired hereunder, at
public or private sale, for cash or on terms, without
advertisement, including the right to lease for any
term notwithstanding the period of the Estate, and to
grant options, including any option for a period beyond
the duration of the Estate; except that, in lieu of any
binding shareholder agreement or buy/sell agreement to
the contrary, the Executor shall not be permitted to
sell the stock or any other ownership interest in any
. ,
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 6
business owned by me, or my spouse, or held in trust,
at my death, without first offering the same for sale
to my children, or without next offering the same to
the corporation or business represented by such
ownership interest for redemption.
(2) To invest all monies in such stocks, bonds,
securities, mortgages, notes, choses in action, real
estate or improvements thereon, and any other property
as the Executor may deem best, without regard to any
law now or hereafter enforced limiting investments of
fiduciaries, except that the Executor may not invest in
any securities issued by the corporate Executor, or
issued by a parent or affiliate company of such
Executor.
(3) To retain for investment any property
deposited with the Executor hereunder; except that the
Executor may not retain for investment any stock in the
corporate Executor, or in a parent or affiliate company
of such Executor.
(4) To vote in person or by proxy any corporate
stock or other security and to agree to or take any
other action in regard to any reorganization, merger,
consolidation, liquidation, bankruptcy or other
procedure or proceedings affecting any stock, bond,
note or other security.
(5) To use attorneys, real estate brokers,
accountants and other agents, if such employment is
deemed necessary or desirable, and to pay reasonable
compensation for their services.
(6) To compromise, settle or adjust any claim or
demand by or against the Estate and to agree to any
rescission or modification of any contract or agreement
affecting the Estate.
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",
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 7
(7) To renew any indebtedness, as well as to
borrow money, and to secure the same by mortgaging,
pledging or conveying any property of the Estate,
including the power to borrow at a reasonable rate of
interest.
(8) To retain and carryon any business in which
the Estate may acquire an interest, to acquire
additional interest in any such business, to agree to
the liquidation in kind of any corporation in which the
Estate may have an interest and to carryon the
business thereof, to join with other owners in adopting
any form of management for any business or property in
which the Estate may have an interest, to become or
remain a partner, general or limited, in regard to any
such business or property and to hold the stock or
other securities as an investment, and to employ agents
and confer on them authority to manage and operate the
business, property or corporation, without liability
for the acts of such agent or for any loss, liability
or indebtedness of such business if the management is
selected or retained with reasonable care.
(9) To register any stock, bond or other security
in the name of a nominee, without the addition of words
indicating that such security is held in a fiduciary
capacity, but accurate records shall be maintained
showing that such security is an Estate asset and the
Executor shall be responsible for the acts of such
nominee.
(B) Whenever the Executor is directed to distribute any
Estate assets in fee simple to a person who is then under
twenty-one (21) years of age, the Executor shall be authorized to
hold such property in Trust for such person until he/she becomes
twenty-one (21) years of age, and in the meantime shall use such
part of the income and the principal of the Estate as the
Executor may deem necessary to provide for the proper support and
education of such person. If such person should die before
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 8
becoming twenty-one (21) years of age, the property then
remaining in trust shall be distributed to the personal
representative of such person's estate.
(C) In making distributions from the Estate to or for the
benefit of any minor or other person under a legal disability,
the Executor need not require the appointment of a guardian, but
shall be authorized to payor deliver the same to the custodian
of such person, to payor deliver the same to such person without
the intervention of a guardian, to payor deliver the same to a
legal guardian of such person if one has already been appointed,
or to use the same for the benefit of such person.
(D) In the disbursement of the Estate and any division into
separate trusts or shares, the Executor shall be authorized to
make the distribution and division in money or in kind, or both,
regardless of the basis for income tax purposes of any property
distributed or divided in kind, and the distribution and division
made and the values established by the Executor shall be binding
and conclusive on all persons taking hereunder. The Executor may
in making such distribution or division allot undivided interests
in the same property to several trusts or shares.
(E) The Executor shall be authorized to lend or borrow,
including the right to lend to or borrow from the estate of my
spouse or any trusts which I or my spouse may have established
during life or by will at an adequate rate of interest and with
adequate security, and upon such terms and conditions as the
Executor shall deem fair and equitable.
(F) The Executor shall be authorized to sell or purchase at
the fair market value as determined by the Executor, any property
to or from the estate of my spouse, or any trust created by me or
my spouse during life or by Will, even though the same person or
corporation may be acting as Executor of my estate or the estate
of my spouse or as Trustee of any of my other trusts.
(G) The Executor shall have discretion to determine whether
items should be charged or credited to income or principal or
allocated between income and principal as the Executor may deem
o.
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 9
equitable and fair under all the circumstances, including the
power to amortize or fail to amortize any part or all of any
premium or discount, to treat any part or all of the profit
resulting from the maturity or sale of any asset, whether
purchased at a premium or at a discount, as income or principal
or apportion the same between income and principal, to apportion
the sales price of any asset between income and principal, to
treat any dividend or other distribution of any investment as
income or principal or apportion the same between income and
principal, to charge any expense against income or principal or
apportion the same, and to provide or fail to provide a
reasonable reserve against depreciation or obsolescence on any
assets subject to depreciation or obsolescence, all as the
Executor may reasonably deem equitable and just under all the
circumstances.
(H) If at any time the total fair market value of the
assets of any trust established or to be established hereunder is
so small that the corporate Trustee's annual fee for
administering the trust would be the minimum annual fee set forth
in the Trustee's regularly published fee schedule then, in
effect, the Trustee in its discretion shall be authorized to
terminate such trust or to decide not to establish such trust,
and in such event the property then held in or to be distributed
to such trust shall be distributed to the persons who are then or
would be entitled to the income of such trust. If the amount of
income to be received by such persons is to be determined in the
discretion of the Trustee, then the Trustee shall distribute the
property among such of the persons to whom the Trustee is
authorized to distribute income, and in such proportions, as the
Trustee in its discretion shall determine.
(I) When the authority and power under this Will is vested
in two (2) or more Executors, the authority and powers are to be
held jointly by the Executors. A majority of the Executors may
exercise any authority or power granted under this will or
granted by law, and may act under this will. Any attempt by one
such Executor to act under this will on other than ministerial
LAST WXLL AND TESTAMENT
OF
ELLEN N. BENXON
PAGE 10
acts shall be void. The action of one such Executor under this
will may be validated by a subsequent ratification of the act by
a majority of the Executors.
SEVENTH: Rights and Liabilities of Executor.
(A) No bond or other security shall be required of any
Executor.
(B) This instrument always shall be construed in favor of
the validity of any act or omission by any Executor, and any
Executor shall not be liable for any act or omission except in
the case of gross negligence, bad faith or fraud. Specifically,
in assessing the propriety of any investment of the estate, the
overall performance of the entire estate shall be taken into
account.
(C) Each Executor shall be entitled to receive reasonable
compensation for services actually rendered to my estate, in an
amount the Executor normally and customarily charges for
performing similar services during the time which he/she performs
the services.
EXGHTH: Tax Elections. In determining the estate,
inheritance and income tax liability relating to my Estate, the
Executor's decision as to all available tax elections shall be
conclusive on all concerned. If the Executor joins with my
spouse in filing income tax returns, or consenting for gift tax
purposes to having gifts made by either of us during my life
considered as having been made one-half by each of us, any
resulting liability shall be borne by my Estate and my spouse in
such proportions as they may agree. In accordance with IRC
Section 2632(a) and without regard to whether a Federal estate
tax return is actually filed, my Executor shall allocate so much
of the Federal Generation Skipping Transfer (GST) exemption
amount as will fully exempt any generation skipping transfer
which may occur under this will.
l~
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 11
NINTH: Definitions and General provisions.
(A) survival. Any beneficiary, including my spouse, who
dies within sixty (60) days after my death shall be considered
not to have survived me.
(B) Trust Estate. "Trust Estate" means all assets, however
and wherever acquired, including income, which may belong to a
Trust at any given time.
(C) Children. Except for discretionary distributions which
may be made unequally among a group of persons and distributions
pursuant to a valid exercise of a Power of Appointment, in making
a distribution to the children of any person, the property to be
distributed shall be divided into as many shares as there are
living children of the person and deceased children of the person
who left children who are then-living. Each living child shall
take one share and the share of each deceased child shall be
divided among his then-living descendants in the same manner. A
posthumous child shall be considered as living at the death of
his parent.
(D) Code. Unless otherwise stated, all references in my
will to section and chapter numbers are to those of the Internal
Revenue Code of 1986, as amended, or the corresponding provisions
of any subsequent federal tax laws applicable to my estate.
(E) Other terms. The use of any gender includes the other
genders, and the use of either the singular or the plural
includes the other.
(F) captions. The captions set forth in this will at the
beginning of the various divisions hereof are for convenience of
reference only and shall not be deemed to define or limit the
provisions hereof or to affect in any way their construction and
application.
(G) Powers of Appointment are not Exercised. By this will
I exercise any Power of Appointment which I may possess at my
death.
~---
LAST WILL AND TESTAMENT
OF
ELLEN N. BENION
PAGE 12
IN WITNESS WHEREOF, I, ELLEN N. BENION, the Testatrix, have
to this my Last will and Testament, typewritten on thirteen (13)
pages, including th.e ACknOW~dgment and Affidavit, set my hand
and seal this /1 ~ day of u~~, 1990.
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tlJL--77 ( ~~
EL~N N. B NION
Signed, sealed, published and declared by the above-named
Testatrix, as and for her Last will and Testament, in the
presence of us, who have hereunto subscribed our names at her
request, as witnesses hereto, in the presence of the said
Testatrix, and in the presence of each other. Each of us further
declares that he or she believes the Testatrix to be of sound
mind and memory. The preceding instrument consists of this and
twelv (12) other consecutively numbered typewritten pages
incl ing the Acknowledgment and Affidavit.
residing at Medt~ CS~?---, fA- ...
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ACKNOWLEDGMENT AND AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF tllfY)~ l~
SS:
The Testatrix and the witnesses whose names are subscribed
to the foregoing instrument, being first duly sworn and qualified
according to law, do hereby acknowledge and declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her last will in the presence of the Witnesses,
that she signed willingly or willingly directed another to sign
for her, that she executed it as her free and voluntary act for
the purposes therein expressed, that each of the witnesses, in
the presence and hearing of the Testatrix, signed the Will as
witnesses, and that to the best of their knowledge the Testatrix
was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
,....,.,
Witness
-4/a~dfwd~~o
Sworn to, subscribed and acknowledged bef...9~_e
a1;Love-nam. ed Testatrix and witnesses this \'-i'Y)
Dl~Q.t:'(\ S 1.^-- , 1990.
me by the
day of
~~'
: N tary Public
or
\\~
( SEAL)
Attorney-at-Law
NOTARIAL SEAL
NANCY J. FWNK, PubHc
Can:p P A County
My Cmmn,s31on 5,1991
"
Register of Wills of CumberlandCounty, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of ELLEN N. BEN ION
No. 6 h - 0 '/ 0 Y
also known as ELLEN NOEL BEN ION
, Deceased
Social Security No. 097-38-8143
HARRY G. BENION. JR.. residina at 315 Monroe Street. Mechanicsbura. PA 17055
Petitioner, who is18 years or older, applies for:
(COMPLETE "A" OR "8" BELOW:)
X A. Probate and Grant of Letters and avers that Petitioner is the Successor Executor named in the Last
Will of the Decedent, dated December 19, 1990, and codicil(s) dated (None)
The first named Executor, Harry G. Benion. predeceased his wife. Ellen N. Benion. on Auaust 10. 1996.
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
(c.t.a., d.b.n.c.t.a.: pendente lite; durante absendia; durante minoritate)
Petitioner( s) after a proper search has/have ascertained that Decedent left a Will dated
and was survived by the following spouse (if any) and heirs:
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(',-.;)
Name
Relationship
Resieten~e
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence
at 1714 Bridae Street. New Cumberland. PA 17070
Decedent, then 92 years of age, died on Mav 3. 2006
at Manor Care. Carlisle. PA 17013
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$500,000.00
(If not domiciled in PA) Personal property in Pennsylvania ..............................
(If not domiciled in PA) Personal property in County ...................................
Value of real estate in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . . ., ............. .. $200.000.00
Total. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., $700.000.00
Real Estate situated as follows: 1714 Bridae Street. New Cumberland. PA 17070
Wherefore, Petitioner respectfully requests the probate of the Last Will presented with the Petition and the grant
of letters in the appropriate form to the undersigned:
Typed or printed name and residence
Harry G. Benion. Jr.
315 Monroe Street
Mechanicsbura. PA 17055
.
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner( s) above-named swear and affirm that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioner ) and that, as personal representative( s) of the
Decedent, Petitioner(s) will well and truly administer tate accor . 9 to law.
Sworn to and affirme~ Jnd subscribed
before me this I tJ day of
Mav. 2006 ·
"
,Adlitzi1~fi, Jdi1w~
~ "11" u tiJ-rtJAy {/
DECREE OF REGISTER
Estate of
ELLEN N. BEN ION
Deceased
No. 6ft; -IJWJ%
also known as ELLEN NOEL BEN ION
Social Security No: 997-38-8194
Date of Death: Mav 3. 2006
AND NOW,
, 2006, in consideration of the Petition on the reverse side
hereon, satisfactory proof having been presented before me, IT IS DECREED that X Letters
Testamentary are hereby granted to
HARRY G. BENION. JR.
in the above estate and that the instrument dated December 19. 1990 described in the Petition
Letters........................ $
Short Certificate(S~..I.?, $
RenuAciation .W.L'........ $
Affidavit ( ). .. . . . . . .. . .. .. .. $
Extra Pages ( ).......... $
Codicil... ......... ......... .... $
J C P Fee...................... $
~~hee~~~a:M?~,:.~~~~ ~
be admitted to probate and filed of record as the Last Will of DeCftvdt:L --1a.JL/U,,-.fi1W~
FEES 1JIlC7r'~ ~ 0 -
510.00
{PO, 00
15.00
i()~OO
[5,00
Attorney: Lowell R. Gates. Esa.
1.0. No: 46779
Address: Gates. Halbruner & Hatch. P.C.
1013 Mumma Road. Suite 100
Lemovne. PA 17043
Teleohone:(717731-9600
~ jv rJ jtJ(,;,
000. Dl)
TOTAL............. $
DATE FILED:
Ill(I'~II' RIV 11(1"
'hlS is to certify that the infornlation here given is correctly copied from an original certificate of death duly filed with me as
I,ocal Registrar. 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.
Fce for this certi ficatc, $6.00
No.
~fil~
Local Registrar
p
12411439
NA't 0 4 2006
Date
. Rev. 01106
)RINT IN
IANENT
::KINK
1. Name of Decedent (Firs!. middle. last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
~....
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92
6-24-13
8. Birth lace C' and state or fore'
Ellen Noel Benion
Yrs
7. Dale of Birth Month. da , ear
5. Age (Last birlhday)
Cumberland
Carlisle
o Residence 0 Olher. 5 ci ;
10. Race American Indian, Black, WMe, etc.
(Specify) whi t e
8b. Counly of Dealh
11. Deceoenl's Usual Occ ation Kind of work aone durin most of workin ~fe; do not state relired
hom;~k~kr dom~~OtBr~~sI1ndustry
16. Decedenl's Mailing Address (Street. cilyAown, state, zip rode)
12.
13. Decedent's Education eci
['rntary/secOndary (0-12) 4
h' hest ade co leted
CoReoe (1-4 or 5+)
14. Mar~al Status: Married, Never married,
Widowed, Divorced (Specify)
widowed
15 Surviving Spouse (If wife, give maiden name)
1714 Bridge St.
New Cumberland, PA 17070
17a. Stale
pA
Did Decedent
Live in a
T ownsh~?
17c. 0 Yes, Decedent Lived in
17dJtJ No, Decedenl LivedW~hinNew Cumbe r land
Actual Limits 01
Twp.
17b. County
r.llmherland
C~lBoro
18. Father's Name (First, middle. last)
19. Mother's Name (First, middle, maiden surname)
Joseph Noel
Margaret Reilly
Harry G. Benion, Jr.
2Ob. Informant's Mailing Address (Slreel, c~Aown, state. zip code)
315 Monroe St. Mechanicsburg, PA 17055
2Oa. Informant's Name (Type/print)
21 b. Dale 0' Dispos~ion (Month, day, year)
21 c. Place of Disposition (Name of cemetery. crematory or other place) 21 d. Loea/ion (C~llown, state, zip code)
ndiantown Gap NationalCemetery Hanover Twp., PA
22c. Name and Address of Facil~
FS 012849-L
ParthemoreF.H~&C.S.,Inc.NewCumberland,PA 17070
23b. License Nurrber 23c. Dale Signed (Month, day, year)
tILl SU/9 OS-- L III
Dead (Month. day. year)
?:3/
CAUSE OF DEATH (set! Instructions and examplet)
hem 27. Pan I: Enter the ~ - diseases, injuries. or cO"1llica/ions - that directly caused the death. DO NOT enter lerminal evenls such as cardiac arrest,
respiratory arrest. or ventrk:ular ftlrillation w~hout showing Ihe etiology. DO NOT abbreviate. Enter only one cause on a fine.
IMMEOIA TE C~USE (Rnal disease or "'-lo ~ Ie:..' :.. s (v. "..) A L . t....L J'2
cond~lOn resuftlng In death) -7 a. _, ~ ~ ~ ' rT'-''-
Due to (or as a consequ Q:
3; dDO{p
Approximate interval:
onset to death
o Yes )(NO
Part II: Enter other siooificant cond~ions contributina 10 death,
but not resultinO in the underlying cause given in Part I.
28. Did Tobacco Use Contribute to Death?
o Ye.~ 0 Probabty
.y..Nb 0 Unknown
29. If Female:
o Not pregnant wrthln past year
o Pregnant at time of death
o Not pregnant, but pregnant within 42 days
of death
o NoI pregnant. but pregnant 43 days 10 1 year
before death
o Unknown ff pregnant wrthin the pasl year
32c. Place 01 Injury: Home. Farm, Street, Factory, OtIice
Building, elc. (Specify)
Sequentially lisl condrtions, il any,
it leading to the cause fisted on Line a
Enter Ihe UNDERLYING CAUSE
. (disease or injury thai in~ialed the
events resufting in death) LAST.
Due to (or as a consequence oQ:
Due to (or as a consequence 00:
o Yes }l No
d.
3Ob. Were Autopsy Findings
Available Prior 10 Corrpletion
01 Cause of Death?
DYes 0 No
31 Manner ofDeath
;I( Natural 0 Homicide
o Accidenl 0 Pending Invesligalion
o Suicide 0 Could Not Be Delernined
32a. Date of InjUry (Month, day, year)
32b. Describe how Injury Occurred:
3Oa. Was an Autopsy
Pertormed?
32d. Time of In;ury
32e. Injury at Work?
o Yes 0 No
/J. 0 .
321.
32g. Location (Slreet, c~~own, slate)
M
33a. Certifier (check only one)
. Certifying physician (Physician certifying cause of death,when another physician has pronounced dealh and completed Ilem 23)
To the best of my knowledge, death occurred due to the cause(s) and manner as stated ,...""'....."'''..."..""..""""."."..""""........."."".....,,......".."."".."..."".."..."".""...,,0
. Pronouncing and certifyIng physician (Physician both pronouncing death and cer1i1ying \0 cause of death)
To the best at my knowledge, death occurred at the lime, date, and place, and due to the cause(s) and manner as slated ""...."."...."...."."...........""."..""..".........."...0
Medical examlnerlcoroner
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 as stated .........0
~()tf) ~
(See instructions and examples on reverse)
33<1. Date Signed (Month. day, year)
5' J '1/06
34. Name and Address of Person Who Co"1lleted Cause of Death (IIem 27) TypeJPrin'
:I>a..r{y I ~ otrl Wlk) j). 0 ·
S" ~ P . ..$. .'..5
L
'.
I ,l, /,..,3.1/ 1./ I