HomeMy WebLinkAboutOC1969-0076 - ESTATE OF HEMELRICK..
IN THE ORPHANS' COURT OF WASHINGTON COUNTY, PENNSYLVANIA
IN RE: )
)
ESTATE OF RAYMOND GORDON ) No.
)
· 7_{:; · of 1969 --'-----
HEMELRICK, DECEASED )
PETITION UNDER SECTION 202 OF THE
FIDUCIARIES ACT OF 1949 FOR SETTLEMENT OF
ESTATE
TO THE HONORABLE P. V. MARINO, PRESIDENT JUDGE OF SAID COURT:
AND NOW comes Anna Mae Hemelrick, Petitioner, and
represents to your Honorable Court as follows:
1. Anna Mae Hemelrick is an adult individual who
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resides at R. D. #1, West Finley, Washington County, Pennsylvania;
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2. On December 15, 1968, Raymond Gordon Hemelrick, i
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Finley, Washington County, Pennsylvania.
R. D. #1, West j
No letters testamentary
a minor age 11, died intestate domiciled at
or of administration have been granted. A copy of the death I
certificate is attached hereto as Exhibit "A".
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3. The gross value of the decedent's estate, . 1 . I exc us1.vel
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l of real estate and of wages, salaries, or accrued pensions
payable under Section 201 of the Fiduciaries Act of 1949, as
amended, does not exceed $1,5oo.oo. The items of personal
property in the estate of decedent are as follows:
(a) Proceeds of a life insurance policy, Prudential
Insurance Company of America, No. M52945924, in the amount of
$2,170.00 plus interest from the date of death.
4. Decedent died unmarried.
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5. The following expenses and debts of the estate
are admitted and are entitled to preference:
Brownlee Funeral Home
Claysville Cemetery
There are no other creditors of the e~tate. Th~ joinder of the
creditors is attached hereto as Exhibit "B".
6. The consent to the proposed distribution of the
agent of the Commonwealth of Pennsylvania for t~e collection of
transfer inheritance taxes is attached as Exhibit "C".
7. No disbursements have been made to the estate
prior to the filing of this Petition.
WHEREFORE, Petitioner requests the CO\.lrt, pursuant to
Section 202 of the Act of April 18, 1949, P.L. 512, as amended,
20 P.S. Section 320.202,
(a) To direct Prudential Insurance Company of America
to pay to the following persons:
Brownlee Funeral Home . . . . .
Claysville Cemetery Assoc. .
Frank A. Conte, Attorney's ...
fees plus advance on
filing of Petition
$473.50
85.00
108.00
$666.50
Inheritance Tax ......... $90.21
(b) To direct Prudential Insurance Company of America !
to pay the amount of $2,170.00 plus interest from the
date of death of the decedent to Frank A. Conte,
as attorney for Anna Mae Hemelrick, to be distributed
as aforesaid.
tarney for Petitioner
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WARNING: It is illegal to du.plicate this copy by photostat or photograph.
lAIJ 1 6 1969 \OIIL\-Io
Date No ..
This is to certify that this is a true copy of the record which is on file in the Pennsylvania
Department of Health, in accordance with Act 66, P. L. 304, approved by the General Assembly,
June 29, 1953.
(Fee for this certificate, $1.00)
HVS-20144 REV. 4/60 a !J
1 0 LOCALREG.NO. --------~L~~~-----
~w&-~~t~
Thomas W. Georges, Jr., M.D.
Secretary of Health
Harrisburg, Pennsylvania
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
VITAL STATISTICS
PRIMARY
DIST. NO. ():·:•q6 t/-~ 5l~ CORONER'S CERTIFICATE OF DEATH
1. DEATH a. County b. City or borough
OCCURRED
IN: washington
c. H death did not occur in city
or borough, give name of township W t
(Do 00[ use R.D. or Box Number) e s Finley Twp.
2. DECEASED'S
MAILING
ADDRESS
b. Post Office, Zone, and State
a. Street address, R~D., or Dox Number
R .D./11
vJes t Finley, Pa.
d. Full Name ~·
of uosrit•t Reside nee, West Finley, R. D. .
VETERAN Yes 0 No KJ
or Institution (If not in hospital, give srrcct address)
4. NAME OF a. (First) b. (Middle)
6. WHERE DID
DECEASED
ACTUALLY
LIVE?
RAYMOND GORDON
Pennw. a. State---------,----,-------
b. County__.1-.[La~s'"'h..,l ... • .... n..,.g~t'"'o""n'"'----
a. Which War
c. (Last)
HElfJ.ELR ICK
c. Did deceased live in a township?
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S. DATE
OF
DEATH
b. Serinl Nc·.
(Month) (Day) (Year)
Dec.l5,1968
Dt Yes, deceased lived in WeSt Finley township. 0 No, deceased lived within actual limits of -----------------------City or borough.
7. SEX
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8. COLOR OR RACE
\rlhi te Hale
19. MARRIED 0 NEVER MARRIED
I WIDOWED D DIVORCED
Dt 10. DATE OF BIRTH rl. AGE (In years I If under I year I If under 24 houu 0 613 I
19
S 7 lastf•rday) !Months j Days I !lours I Min.
12. USUAL OCCUPATION (even if retired)
1
13. SOCIAL SECURITY NO.
None 1
14. BIRTHPLACE (State or foreign country) 115. CITIZEN OF WHAT COUNTRY?
Greene Co.Penna. None School Bov
16. FULL NAME OF SPOUSE 17. MOTHER'S MAIDEN NAME
None Anna Hae Welling
18. FATHER'S NAME 19. INFORMANT'S NAME AND ADDRESS
Gordon William Hemelrick Mrs .Anna Hemelrick, \~Jest F:l.nley.,:, P~ lh
MEDICAL CERTIFICATION !INTERVAL BETwto:EN ...... •II ...
20. CAUSE OF DEATH: Enter only one cause per lineffor (a, b) & (c.), :ONSET AND DEATH
PART I. Death wa;M~;~~~;~: CAUSE (a) ·~ I
Conditions, if any, which DUE TO (b) .fill~-~::_ ______ ~-~----/-/r,h-r..,--f--t9AA--,,..,-,'L->-£-i'-'~J-d;;;~
gave rise to above cause
(a) stnting the underlying
DUE TO (c) ----------------------------------------------------·cause Jasr.
PART II. OTHER SIGNIFICANT CONDITIONS: contributing to death but not related to the terminal disease given in Part I (a). 21. WAS AUTOPSY
SUICIDE 0 OF.l ~.Xm• .l."lo lJe C ol_?' /0 122. a. ACCIDENT 0 122. b. DESCRIBE HOW INJURY OCCURRED r22. c. TIME, • 2 )J'Illr M Mt.r~h Oaf--1\~W 8
HOMICIDE · G} l~ht'"'l+-; n hAAA h~r h-r•t'"'lt-hr--1"'-22 Cal.Rifle INJURY E.S.T. 22. d. INJURY OCCU~fl!ED l22. e. PLACE OF INJUR"\' (e.g., home, farm, 122. f. CITY, BOROUGH, TOWNSHIP COUNTY STATE
\\'bile at 0 Not while "'Fl factory, street, etc.) H l.T t F·' l T l.r h c ..... Penna work atwork A-1 ome vves ln ey wp.lvas '. ''"'• . •
23. I hereby certify that investigation of the death of the above named deceased rcsuhed in the findings here stared. and that time of cleath is estimated as
J : JOP ern. E.S.T., o_yf:ja~ated above 8
a. Signature of coroner tftZ/~k ~Jlo/Ljp.l, b. Address Claysville' Pa • c. Date signepe(~ .16' 196
24. a. BURIAL YJ 24. b. DATE 124. cfNAME OF CEMETERY OR CREMATORY r24. d. LOCATION (City, Doro ... Twp., & County) (State)
CREMATiolX. 0 I 81 68 • ll p REMovAL 0 12 l 19 Claysv1 e Donegal Twp.vlash.Co. a.
2S1.~AT/E ~?C~ B'j ~G. 26. R';.~~~~-T~R~;s/lSIGN,ATUR~.;,/ •/ F _j 127.~~URJ1'ND ADDRES}1JF FUNJRAL DIRlEC!OR 'll p
·"' .-(; 6 ,;,'~ /· ...... [...~..-rs-:,. · ./.· e-~ t...q _ (JIJI"J~ J• ./~A/Yo;/ C ay s v1 e , a.
Exhibit "A."
J 0 I N D E R
Brownlee Funeral;,Home, do hereby join in and consent to the
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within Petition and the prayer thereof.
JOINDER
I, .~"7/?'7!tc~· , representing
Claysville Cemetery, do hereby join in and consent to the
within Petition and the prayer thereof.
CLAYSVILLE CEMETERY
E:xhibit "B"
J 0 I N D E R
I, -~e.L...I<.IO.....:. ·"--"'-=-t=efA'---IC..... ---~_,_;:___, Agent for the
Commonwealth of Pennsylvania, do hereby join in and consent to
the within Petition and the prayer thereof.
Exhibit "C"
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COMMONWEALTH OF PENNSYLVANIA )
) SS:
COUNTY OF WASHINGTON )
Before me, the undersigned authority, personally
appeared ANNA MAE HEMELRICK, who, being duly sworn according to
law, deposes and says that the statements contained in the
foregoing Petition are correct and true as she verily believes.
sworn to and subscribed
before me this /{tJ_;_.:tiG
day of -~-;:.1 q:.;. ~~~~~--' 1969.
~u,b ~,
BA,R31.RA CRAIG, IIOTARY PUBLIC
\V,\S'li:JGTO:~. WAS;i!NGTO~I COUNTY
MY COMMISSION EXPIRES JUNE 25, 1970
Anna Mae Hemelr~ck
IN THE ORPHANS' COURT OF WASHINGTON COUNTY, PENNSYLVANIA
IN RE:
ESTATE OF RAYMOND GORDON No. of 1969
HEMELRICK, DECEASED
D E C R E E
n
this 4 day of ~ /, 1969,
of the within Petition, lt is decreed
Raymond Gordon Hemelri~ be distributed as
AND NOW,
I follows:
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(a) To direct Prudential Insurance Company of America
to pay to the following persons:
Brownlee Funeral Home
Claysville Cemetery Assoc.
Frank A. Conte, Attorney's
$473.50
BS.OO
108.00
$666.50 fees plus advance on
filing of Petition
Inheritance Tax . . . . . . $90.21 II · It is further ordered that the proceeds of Prudential
r ... : Insurance Company of America policy No. M52945924 in the amount
.. of $2,170.00 plus interest be paid by said Prudential Insurance
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1! Company of America to Frank A. Conte, Attorney for Anna Mae
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"! Hemelrick, for proper distribution in accordance with this order.
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