HomeMy WebLinkAbout02-05-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF eu N\l~Lf\ ~ COUNTY, PENNSYLVANIA
Estate of EV ~ 1-..\ \l \ T (
also known as E Vl1 N V I 'I
File Number
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, Deceased
Social Security Number ~ \) 4 0 3 ~ lo I q
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is 1 are the
last Will of the Decedent dated and codicil(s) dated
named in the
(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 instlUmell$) offered
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: s:::) , C_?,
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~ B. Grant of Letters of Administration
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente Ute; durante absentia; durantelll~Yt!e)
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Petitio~er(s) after a proper search has 1 have ascertai.ne? that ~ecedent left no Will and w.as survi:-ed by the following spo~fU,fJiity) an~irs: (If
AdmlfllstratlOn, c.t.a. or d.b.n.c.t.a.. enter date of WIll In SectIOn A above and compLete lzst of heIrs.) . j ,,'- =-
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent was domiciled at death in C4~'~f.~ LA ~l b County, Pennsylvania withG, I__last principal residence at
4 I\ZA LE f\ bKWe' \n.,... \-I() LLY Si"QIKG "?A 1'10bS-
(List street address, townlcity. township, county. state, zip code) J
Decedent, then 8'1 yearSOfage,diedon~at.~_J\2.ALEA'DRIIle:..JMTKOLLY Sffil).(.(;, PA j')ObS
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
.----~---'.,_.-
$
$
$
$ 19) '711\. ;59
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:
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF _Cl i r<I h.("~
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
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the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
-
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~....ili~
, Signature of Personal Representative "
Sworn to or affirmed and subscribed
before me the
day of
Signature of Personal Representative
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Signature of Personal Representative
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File Number:
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E Va-n U' I,'
Social Security Number: ex 640 -3 d 0/9
AND NOW, ~l.ACLA~ S ,;;txJ7
having been presented befor9\me, IT IS DECREED that Lettfrs
are hereby granted to ~cz. 8~/L U / +t
(....)
~
Estate of
, Deceased
Date of Death:
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of reco
Letters ............... $
Short Certificate( s) . . . . . . " $
Renunc\a;rnLs) ./:....... $
.JC P f-1--f..ut f6 . . . $
.. . $
. . . $
$
$
$
$
$
$
TOTAL. . . . . . . . . . . . . . $
&JO ..eX)
c1~ .. 00
Is.aD
/5-00
Attorney Signature:
FEES
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
ItJr:o .OU
Form RW-02 rev. /0. /3.06
Page 2 of2
HIOS.805 REV I/O:;
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local 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.
No.
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Local Registrar .
Fee for this certificate. $6.00
P 12996110
JAN 1 6 2007
Date
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH 1"\ \ r--... I
STATE FilE NUMBER <:::>\. l '-' I
4. Oaleol'Oealtl(Monlh,day,yelJ')
Jan. 16, 2007
Hl05.143REV.02l2(Xl)
TYPE f PRINT IN
PERMANENT
BLACK INK
1. Nane ofDecedenI (Fits!. mKkIe, last suffix)
Evan viti
5. Age (las,_"j
4 Azalea Or.
C)\\l)
6. Dale of BIrth Monlh, d
"""
87
Oec. 25, 1 91 9
Bb.CoonlyofDealh
Cumberland
&1. FaciIlyNane(Unotinstilulion,givestreetandnc.mber}
.e"", DOlIMl<.Specj~'
10. Race:Americanlndiil'l,8lack,WhiIe,etc.
(Specify) Whi te
11. DecedenrsUsualOccu ion Kindofworlldone rnosl of worti lie. Do nol slal8retired.
KInd of Work KindofBusinessflnduslry
Mixer Driver Quarries
. 16. Oecedent's Mailing Address (SIreet, city I town, state, zip rode)
4 Azalea Or.
Mt. Holly Springs,Pa. 17065
18. Father's Name (Fits~ mddIe, last, sufftx)
Mario viti
12. Was Ollcedenl ever in Ihe
u.s. Armed Forces?
~y" DNo
Decedent's
Adu8l_ 17.._ Pa.
Ilb."""" Cumberland
14. MarilaI Status:MarTied, NeYer Married,
W_. 0Natad (Specifyl
Widowed
n
D
-I
),
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Did Decadent
LNelna
Township?
17C.m Yea,DecedentUvedin ~n
17,. D No._U""""",
Actu8ILimitsd
Mi nill..ton Twp T."
~/Boro
19. Molher's Name (First, middle, maiden surname)
Anna Orazi
"
3
~
2Ob. Inlorrna1rs Mailing Adli'ess (Street. city / town. stale, zip code)
109 Front st. Boiling Springs, Pa. 17007
21c. Place of Oispositlon (Name of cemelery, crematory or other place) 21d. LocaIion(Cily/town,state,zipcode)
Hollinger FH/Crematory Inc. Mt. Holly Spgs.Pa.170 5
Inc. 501 N. BaIt. Ave. Mt. Holly Spgs
o
CAUSE OF DEATH (See Inab'Uctlone.nd .ump"')
1Iem'Z7. PARTl: Enlerlhe~.liseases,I1juries,orcomplicallons.lhatdirecllycausedlhedealh.OONOTenterterminaleventssuchascardiaccrrest,
respiraklry arrest, or venlliaJl.-lbiIation wiIhoot~ tie etiology. Ustooly one cause on each In..
=~~J:~I"""-+. r< tJ~(A fti\; III Y('"
Ouelo Cor as a consequence oq
-"-.,any,
leadingbeauselstedonna.
Enter ihe UNDERLYING CAUSE
(diseaseoril)ju'ylhalinitiatedlhe
events resuIti'lg WI death I LAST.
.--.
: CilsetIoDeaf1 .
28. DidTobaccoUseCoolributetoDeatl?
DY"D_
o Unknown
29. If Female:
DNolpqgnant,"Ihinpas1'f08'
o Pregnantattimeofdealh
o :X:an~bulpregnantwilhin42days
D Nolpregnant,bulpregnanl43dayslolyelJ'
of_
D Unknown if P"lQI'lanl wi1hin the past year
32c. Place of Injury: Home, Farm, Slr8et. Fac:lcWy,
Office Bulding,etc. (SpecifyJ
1=
Doe 10 (or as a consequence 01)'
Due 10 Cor as it conseque~ 01)
d.
Dyes P!No
Dyes D No
31. MannerofDealh 32a. Date of Injury(Month,day,year)
i:1 N.... D Horn....
rD_ D__32d.Trneofl",,~
D ..- D Could Not be 0e1em1""
M.
32g. Localionoflnjury(SIreet.cityllown,stale)
3Oa.WiEan~y
e_'
.:n. WeteAulopsyFincings
A'IalabIePrior IoComplelion
01 Cause of Death?
330. CortIIlor(ched<"'~onej
CortlfylngphyalcJon(F'I1ysDaIC8ltifyingcauseofdealtlwhen......._...JlI'lllClO'<Odde......_Ilam23j
ToU. belt of my knowledge, dllllh occutfld duttothl ClUH(I} and mlnntra mtI5I_ _ _ _ _ _ _ _ _ _.. _.. _.. _ _ _ _ _.... _ _ _ _ _ _ _ _ _ __
=:c~.==~IMO::::=~~~.~:=~~~dmlnnern~___..__..__________LI
= ~":~ md/orlnYfttlQltion, In my opinion, deIth occumda thltime, dlle,.nd pIKe, and dutto the ClUH(S' andmlnner II mtt<L _..D
38. Dale Filed (Month, day, year1
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(See instructions and examples on reverse)
~\"n-"'if NO'. 61S()0Cl~
RENUNCIATION
REGISTER OF WILLS
~/): } .. . 't
tA IJdHd",'L/udj COUNTY, PENNSYLVANIA
d.\ Ot. O\\a
Estate of
",/ ~-/ .
( /';"i',1 { ;;.c: u
, Deceased
I, t / N T)f-/ D k}; N /) / 5/1
(Print Name)
.,'I-u',d $,!Jh.</
,
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
./
administer the Estate of the Decedent and respectfully request that Letters be issued to;,~
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(Date)
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(Signature)
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(Street Address)
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, i I" J/.~,.( / '7A/':7
C<~ z, L~l( L: &:.., 2..
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this S.1: day
of Pebu..rCU11 ' ~J .
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths, Show date of expiration of Notary's Commission,)
FormRW-06 rev, 10,13.06
RENUNCIATION
REGISTER OF WILLS
COUNTY, PENNSYL VANIA
d.- \ D L 0\\0
Estate of Ei//iiV t/lf-f
I, Ric.D IAII
(Print Name)
r~ 1. ~
.
, Deceased
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
D ,q tv {; u; il
).-5--07
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this ,5 day
of PelYu... ClJLf ,r--XJD l .
~
Form RW-06 rev. 10./3.06
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(Signmure)
tf Ij t (b,e,.uWl J1 fJ
(Street Address)
(]Iltz( {Set
(City, State, Zip)
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Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
RENUNCIATION
REGISTER OF WILLS
COUNTY, PENNSYL VANIA
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Estate of
....: ()?\ Q) U ;' 1
, Deceased
I, /1 /b / I A D A R ~ 0 <..-0 c=. t'<- , in my capacity/relationship as
. (Print Name)
.l=.,;;, to S. ,~, '7 0 A u C, h 1 c f.<.. of the above Decedent, hereby renounce the right to
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administer the Estate of the Decedent and respectfully request that Letters be issued to
DAPA U/ fJ
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(~ /1< /iR.A "J~
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(Signature)
(Date)
/07;J~ :sJ.
(Street Addres;)
(~~i<J;/.~ /7007
Executed out of Register's!Jffice
(::=0
Before the undersigned penf~ly app~ed the
party executing this renunciafi<[?~~ ceftified
that he or she executed the ren1F9OlatlortIor the
purposes stated within on this (-:) ~__; ~~ day
f C..J--, I
o ;t~
f---.)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this . S- day
of Pc-hr ~ I ' CitXJ7 .
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Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
FormRW-06 rev. 10.13.06