HomeMy WebLinkAbout02-20-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C u. rn 13clll..;fA)b COUNTY, PENNSYL VANIA
Estate of (!.narltS p. ~S4NJOi 1r. I Ii/(4 Cha,rk-S P.
- :il~. k; It cf~Sl ~1<4 CJ{4r/~ PcJr,'Gk HJ~
1/1 u,c:. IS IJIfI,() , Deceased
File Number
J\
~I () i LD I
Social Security Number
/'8 -Sij-Ilb 'I
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'D' BELOW:)
i'"--_ ')
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / 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.)
r"~"
c:.;
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instru~nt(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ".~
~ B. Grant of Letters of Administration
"0
(If applicable, enter: c.t.a.; 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: (If
Administration, c.t.a. or db.n.c.t.a., enter date of Will in Section A above and complete /ist of heirs)
i J'tl " IJ
County, Pennsylvania with his / her last principal residence at
. I,. f>~ /70'13
Decedent, then
45" yearsofage,diedon Fe-b.IOJ2DOfat Lthif r../lttr HbSf;fa,/. ~/;st"''''yT~p.l.t.''1,a.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value ofreal estate in Pennsylvania
$ SOt). 1Jt)
$
$
$
situated as follows:
fA /701/3 Aterr JJA-mME
18//", .
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:
Si"nature
T ed or rinted name and residence
IS If/E7ilEIf$/fRA' R./).. EtlPtA" /JA /71) 2S'
CIIA-I2.i..E,S ~
,/,,$,f..N"-
~
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF C l.\mBl!iYl.U'fNl>
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
.2.0
day of
X (!/~d~~)~
~lfnature of Personal Representative
IJIcrk.~ P. Pi.s.nD
Sworn to or affirmed and subscribed
Signature of Personal Representative
. r the Register
f'J
..,,,,,\
Signature of Personal Representative
i'"
~ .,.
File Number: rl. \ - 0 I -0 lCo \
CJ,.)'J~S P. p"Sd:nfJ) .Ir. tt.l<.. ChA-rles p. P;~I akA
Estate of Ch.4.r\~' PI1.n-:c./( p,'SAno caK4 Ch~K PisA.l1.O , Deceased
Socia[SecurityNumber: l~g-5'1-IIDif- Date of Death: FeJ,. 10,2.001-
AND NOW, :l~ 0 +- \=' eb'\'>"c""~ ' .;)()D l , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED t at Letters o~ Adminls'fra.f1Dt1
are hereby granted to c.h A.r\~ R -=Pi SM'lO
N
Letters ............... $
Short Certificate(s) . . . . . . . . $
Renunciation(s) .......... $
(\v-\o ... $
~C F ... $
... $
.. . $
'" $
.. . $
.. . $
.. . $
... $
TOTAL. . . . . . . . . . . . . . $
IJj/r
in the above estate
FEES
l..\-S 00
~OoO
Attorney Signature:
Supreme Court LD. No.:
CJ/1heL.E5 E.
3SS/3
k ClJ;tlSE"71. /u:).
MEt!H1l-JJ/~8UM,1'1I- 170SS
[000
-oD
~
Attomey Name:
Address:
Telephone:
7/7" 7fpfp- 0;)01
~e:>D
Form RW-02 rev. 10.13.06
Page 2 of2
H] 05X05 REV 1/05
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.
Fee for this certificate, $6.00
p
13377990
No.
~ \ 0 I ()\ LoI
fL~~('''L ;t.4./i ~~h""1
\ Local Registrar ~
j'~ I~ "dO?
Date
..,
,
--.J
r,)
G
li):)144ktV 11'<:t"l16
T ~ i-'[ PHINT IN
PfrlMANfN I
m'\CK 1NI<
COMMONWEALTII OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instrucllons and examples on reverse)
v
I ~Mme of DE,~IIc:.( lFlls!. nlidde, ,as!. ~1I1f1~\
Charles Patrick Pisano
5.Aga(llisla.rtklayl
ad. Facirirj Nafl'lll (" ilOlinstitulioo. G;'i6sltaetandl'\urnber)
Lehigh Valley Hospital
6 Dale cJ &Ilh jMOIlIh day. yelll)
- 54
Iwp
45
PA
Sa Place ,j [)e.ath (Ct18l.'iI onl one)
HQsplldl
~ InpJ.(H:'fll [J EA I Ou!ik,1161lt [J DCA [] Nurslog HOllll!
9 Was DeceOOnl 01 Hiiparlic Ollgln?
I'l yes. spec;ifyCullall,
MOXIC.lIl, Puel1oRit:m, el(;)
December 8 1961
Pittston
v~
&b COllnl)' ot Dealh
Lehigh
11 De.:;~nl's U~Uill QQ:;J~..a'iWi "'in(! of wvrk IYlfle jUlio' ffiOsl 0/ WOfki/l' life Du not ~lale re~fw
Kind Of Wed, K./llJ 01 BJ:>lness " Il1th:try
Ftrlilift Q:eratIr Ti Ie Distr:ihJtI:r
- 16 ~adi.;lor6 tvt.lillng AadcUJ5. (Slreel. Cif,,' I<.lWn. sUlle, ZIp cooe)
28 South Second Street
Wormleysburg, PA 17043
12,WasDecedeoleiJerintl'le
U.S. Anlll)d ForCllS?
DYes ~No
13 lJe<;edant's EdutaliVn (Specify Oll~, h:{jt,eSI grade (.Ql'Ilj;letedi
Eltlm&nli:1";2WJndary (0-121 Collage (1-4 or &+)
=;~:kl6IiC<' 17;jj, Slate Pennsv 1 vania
l1b c"""" CUmber land
n
20b InlOfmanl's MaiI,ltg AdJtess (SlIest. ~ IlOwn, Ilale, lip eo<kll
15 Wetherburn Road
2.~mOOlribul4lol.le8lll?
VIs Probably
No Unlr.rlown
2i_ U F8IlliII6
~Nolpttrj\illtwilt.inpast~eat
Pre\jo1al1tallirnllold8atti
Nolpr~nI,ootP/lllJiifll'MUltn420i.V'
~ ...~
DN:l1 pregnant, but prO;iJl'lant 4J tU~'''lo 1 ~&at
O~~pr~alll'Mlhillll'lltpastYflo.r
321:, fltace of Il"Ijlllj': Home, Farm, Sl.'~, F~,
Inhaled products of combustion during house fire. Rc:iJ:.:'~'~ (5""",>)
321 II TnmportalionInjury (Spdcify) . ~~th'~ha(~~:llown,s1.1e1
Onver I Clp&ralOl 0 PassengerO&das1rlafl I b
r . SpecIfy: orm eys urg
33b Signal ndTItlsOlCeltiher
33lt. Criier (d'leC:1 onry one)
Cttbfylng pllyUc!an tPh)sluan Cil111tyil'lg WiUSC ot de.<ilh tthen anoUler physidan has pfO~ oeath and lXJl1VlBled <<10m 23)
lob b41,1 of my knowMtdgI, duthocwrred'duetolhecauaa{a)and,..nnor aasUted.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ____
=~n:. -: ::.~~=~~~:~ =li:e~~e;race~:'::~o~:C:~~~~ manner.. ,tale<L _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 33d. Date SVwd~, da~;;a~/2007
= ~:mo~:;= and I or inv~itig.atiQn. '" mW opinion, death OCClJlred .1 tho time, d.le, andpAiIl/;O, and dlJt 10 the CIIU'!:(I) and II'Ianner II NkteL rx 34 Name and Address Cll Parson 'Who Compltttad Cau!08 oIlkllth (Hem 27) Type I Pmt
Scott M. Grim Coroner
501 W. Hamilton Street Allentown, PA 18101-1501
18, Filhar'. Ham.. (FilSt. :nidda, lasl $l;ttix)
Charles P. Pisano
208, Irllomwll's UarrllllT)"Y' I Pnul)
Charles P. Pisano
Home
llemS 24-261Tl1JSl. be UJrlllJlelOO b) per.lCr1
whopr~o..r.lh
24 flffiEl01 O.3th
3:06 PM
M
25 Date Ptonoonced DHd {Monlh, day, year}
2/10/2007
t, CAUSE OF DEATH (8M InslrucUona and .x.mplea)
n........ 27. Part t Erletl\e ~iLmDlI- diseoiMli, "jl,lIl8S, or cc.rnplK.atlQlll-Ihal d118\.11y caused \he d6ct1l1. 00 NOT 8f'I1er Icfmillal wellls su.:h as canllit <Ane&t,
re~..acwy arrest. Of V8tlttJCl~aIIlOOLwon wiIlocl ~mg Ihe etiologj, UsI only one cause on eadi IN
ApprcXlmatelfl1emil:
Qr\~toDeillh
==S:~"!:I""'::;
. Anoxic Brian Injury
Due 10 10( as a consequence 01):
b Carbon Monoxide Poisoning
~ 10 (Ot as: a COl\li.Elquence of):
House Fire
0ui1 to (01" &i a consequence ot).
&lq=~:O~'~~a.
= UNOERLYING CAUSE
~~II~~II~~~rnt~
d.
30a Was an AlMp~y
Pilfom~'i'
:llb Were AlItopst Fi"ldings
Available Prior 10 (;omplcllorl
01 Cause oj Daalh1
31. Mantlaro!DfIeltl
ON,...., [] """do
!KI Acddent [J P~ridiClg tn...esligalv(l
o &iil:1do 0 Could No! b.l (klt>>lllirled
M
Ov" XlNo
Ov" ONo
32d. Tme 01 Injury
ApprO)(.
4:15 AM
~d-..II
1.;1.1
10" Race Ame'can 1OdIilf; &iCII, While ele
ISP>'>'rl}1
W~ite
1-1. M-.rlt& SlaM: Matti&d, Never MarriOO,
WiGJWed, Divorced (SpeCily)
Never Married
Did Decedent
uye in a
Townahlp?
171: 0 '(e$, Decadent Lived in
17d [8 ~~~t~lvedwithin Wonnleysburg
Citt1Bo:'O
PA
23tl. LICense Number
23c. Ollie Signed (Month, Clay, year)
26. Was Case Raterred 10 Mel:IcaI ExamJl&f f Coroner kor a Reasoo Other ilan Crf:lmaUon Of Dunalion'i'
~v" ONo
Pitt.:EntefOih&rWJlliiDl,~COOItiblltirl$l~,
1M fIOl res..Abng ill tle undBrt~causegivM In Parll
PA
Coroner