HomeMy WebLinkAbout11-19-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of C 0..,('" "'"' '" ,l c...... ")) D-,V l\s
also known as
File Number
~ I - eft - C1eo b?
, Deceased
Social Security Number \ ~ I - ~ &. ~ l-t ~ 0 ~
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 / are the C:)<. e c v -+ y' \ )<.
last Will of the Decedent dated ~C</'t) 7 . ~~O "f and codicil(s) dated ..Jr. ..., 7:< -In\ U
I , =+
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 bom or adopted after execution of the instlUment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
'"
=
Q =
(fjapplicable, elller: c.t.a.; d,b.n.c.t.a.; pendente lite; durante absentia; d,ihfj linoritatejz i~< :~.::.)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the fOlloWing;-p~f any~d heif~';;(%3
Administration, c.t.a. or d.b.n,c,t.a., enter date of Will in Section A above and complete list of heirs.) ;::-;n \.0 :::c; C,]
R~~~~ i ; ill
Name
Relationship
o B. Grant of Letters of Administration
(COMPLETE IN ALL CASES:) Attach additional sheets ifllecessary.
Decedent was domiciled at d~ath in f.. """ h~Y" \ 0.. Y\ d County, Pennsylvania with his / her last principal residence at
Ch,-,-r-<:,I-- or G..,d. 1~t'fY>~ ty- I'~a"lf~~<' ~-+ C.:....""\tsl_
(List street address, tow/J/city, township, county. state, zip code) .
Decedent, then
S' g years of age, died on n~ ~ I ).)06 7at
C\,. vvr.....l .,.1;; Co> d
l~ Q.... C "V" \ l'" \-.a-
I
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 of real estate in Pennsylvania
$ , ~ <;;:c, C\
$
$
$ ---
situated as follows:
Wherefme, 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:
Sionature
T ed or rioted name and residence
f ~ ~ I \ I j) '. V', "-" ~ \ :t.
Form RW02 reJ'.10./3.06
Page 1 of2
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The Petitioner(s) above-named swear(s) or affim1(s) that the statements in the foregoing Petition are tl~f~~orre~ the ~es.tCOf~
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, petitioner{'s'JiYill well ~ truly~ S'l~
-u'---l .. ,.-
administer the estate according to law..!> .:;:-'
\D
Oath of Personal Representative
COUNTY OF
r!wn&r~
SS
COMMONWEALTH OF PENNSYLVANIA
Sworn to or affirmed and subscribed
-?~ S) .
(/ ~,,~ '....A~
Sig~atur Personal Representative
Signature of Personal Representative
Signature of Personal Representative
File Number: ~I - ~Oory - 09 t., d
Estate of {J Q/tr1l-/a.. )jf} uS
Social Security Number:18 / - Ol(' - t..fCj(J~ Date of Death:
AND NOW, ~I/.fmb;. Ie;, ~()'7, in
having been presented efore ~T ISJ)ECREW that Letters
are hereby granted to (' :W.~ 1/;.5 lJC{ 1/1 S
, Deceased
fl-WJud ~to?()I)1
FEES
&Q/~
C. I. (/lJ
,
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to prob
Letters ....... _ . . . . . . . $
Short Certificate(s) . . . _ . . . . $
RenunClatiO~n(s). . ........ $
L /} ...$
$
010 $
$
$
$
$
$
$
TOTAL .... . . . . . . . . . . $
Attorney Signature:
j5,uJ
(OlcV
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Attomey Name:
Supreme Court J.D. No.:
Address:
Telephone:
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Fa/'1/1 RW-02 rev. /0./3.06
Page 20f2
r0'1.H05 REV (()]/()7J
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
P 13822716
Certification Number
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.
~~~ i/U./o2
ocal Registrar Date Issued
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TYPE i PAINT IN
PERMANENT
BLAC)'; INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
Carmela M. Davis
6. Dale 01 Birth (Month, day, at)
88 v"
8b County 01 Death
March 20, 1919 Braddock, PA
SQ. Facility Name (If 001 institution, give street and number)
Sa. Place of Death (Check only one)
H"'l'itaI'
o Inpalienl 0 EA IOulpati&nt OOOA (!j Nursing Home 0 ReSld8nct OOlher . Specify
9. Was Decedent of Hispanic Origin? ~ No 0 Yes 10. Race: American indian. Blacll. YItlite. fl(C
(n ,.s, specify COOan, (Specify)
Mexican, Puerto Rican, etc.1 whi te
7 &rthpIace (Ci! and state or 10
Church of God Herne
13. Decedent's Education (Specify only higl1aSI grade completed)
Elementary I Secondary 10-12) College (1-4 or 5-t)
10
Pennsylvania
Cumberland
11.Oe<:eclenhUsualOccu tion Kind 01 work done dUfin mos.tolworki li1eDoooIslatefem-ed
KindotWork Kindof8uslnesSllndUSlry
Herne maker Herne
. 16. Decadent's Mailing Address (Streel, City / town, slale, liP code)
12 Was 0ecedMt eVe! in !he
U.S. ArmedFOfces?
DYes u(No
Decedent's
Acwal Residence 17a State
17b.Counly
~l~~ ~~ohstreet
14 Marital Stalus: Married, Ne~el MaUled,
W_,__(SpociIy)
Widowed
Ood_
LiYe in a
TOWl1Ship?
Twp
17e. 0 las, Decedent U~ed in
17d. 12'" No, Decedent lIVed Within
ActualliTlilsot
carlisle
C!ty/Boro
19. Mother's Name (FirM, miCXIe, maiden surname)
Nicoletta Nucci
18 Father's Name (FlIsl. rruddle, last, Sulllx)
Nicola Melocchi
20lIl. jroom-,anl's NamEl{Type / Print)
Ph His Davis
2Ob. Inlormanfs Mailing Address (Slreet, city I towo, slale. zip code)
512 Post Lane Camp Hill,
21c. Place of Disposition (Name of cemetery, crematory or olher place) 21d. Location ICily I town, stale, zip COde)
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, Approrimale ifNenoal:
: Oosello08all;
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,
,
,
,
,
,
,
,
,
.
,
.
,
,
. ~
Hollinger Crematory
22c.Narr.andAddoessolFaciliIy 8 Mar t Plaza Way
Mal zzi Funeral Herne Mechanicsburg, PA
23b. License Number
Springs, PA
~
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CAUSE 01= DEATH (See Instructions .net eum )
I1em 27 Pal1l: Enler the ~ - di~ases, injuries. Of complications -lhal directly caused the death. 00 NOT enter leoninal events such as cardiac arrest
respllalory arrest or ventriculaf libriIIation without showing the ellOklgy. List ooly 008 cause an Bach line
\ ...Q ~ &;. ~ { 1./ V Q....-
=~~~~t~~~:;
( o~s;i
OuelO{orasaCOfl nceot)
Sequenllally ~slcoodlllOOS, if any,
~~~~~Aus'7a
(di$eClse ortfllury lhalinihatedlhe
tl~enls rl:sultll'lg In OOil.lfl) LAST.
Due to lor as a consequence 01);
Due IQ (Of as a consequence of)
d.
32a. Dale ollnjUlY (Month, day, year)
30a Was an Aulop&y
Perlormed?
3Oll.WereAutopsyFindings
Available Prior \0 CompletIOn
otCau~e 01 Death?
31. Ma/lfltlr01 Dealh
Natural 0 HomICide
o Accident 0 Pending Investigation
o Suicide 0 Could NOl be Determined
M
~
...
....
Dv" DNo
3211. Trmeot/fiiury
DYes pINe
~
3Ja C~JiH l(hK~ OOIy one)
Certifying physician W. hysiclan certltyUlg causa 01 dealh when anothel phY~lcian has pronounced death and completed Item 23) \171
To the bes1 of my knowledge., deathoccUfredddlo1he cause(l)aod manner as staled.. _ _.... _ _ _ _.. _.... - - _ - -... - -- -.. -.... - - - -.. ~
~~,:u=i~~la;~ =:'~:::thWl O:~~~I: ::~i:~~~:n2n~:~c:~~~~':t:~h~=~~a~~ mannef as slated.. _ .. .. _ _ .. .. _ _ .. .. _ .. _ .. _.. 0
:c:: ~:~;~~I~;~:= and J or investigation, iI1 my opinion, dealh l)C;cuned at the time, dale, and place, and due 10 the clluse(il and manner at stale(L 0
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~
o
w
~
I.J..II loll \ Idl
00 .)0 S-7~
Disoosilion Permit No
~ () ~10 fJhl'l1
[ill No
Pan It: Emer oUJer sionitic-..1tlI COIIdilions conIribuIino 10 dealh,
bu1notresullinglnlhe~ingcausegi\leninPartl
28. Did TobacCO Use Contribule to DeaU'l?
DYes j] PfObably
.~ 0 Unknown
29.11 FllIITIaIi
o Notpl'egni:lnlwllt\lnpd:>IYf;:ar
o Pr890anl alllme at death
o Not piegnanl, byl preyoanl wlthlrl 42 da~5
01 death
o NoI plegnanI, bus pltilgl'lalJl4J Qa~5 to 1 year
beIol'e dealll
o Unknown if preQnarll withlfllhe past year
32c. Ptace 01 Injury: Horne, Farm, Sreet. Factory
Olfico &oIdiog,.1e 15J>ooM
LAST WILL AND TESTAMENT
OF
CARMELA DAVIS
I, CARMELA DAVIS, of the Township of Hampden, County of
Cumberland and Commonwealth of Pennsylvania, being of sound mind
and memory do make, publish and declare this my Last Will and
Testament in the manner and form following, hereby revoking any
Will or Wills heretofore made by me.
FIRST:
I direct my Executor, hereinafter named'oto pay~~y
r- c::>
:";;0 e
the expenses of my last illness and my funer~ ~
'~p ~
=iust debts,
expenses.
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autQ~blle~
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as such
SECOND:
I give and bequeath all my jewelry,
clothing and other purely personal effects, as well
.t:-
\.0
household goods and equipment which I may own, to my son, NICK
vHLLIAM DAVIS.
THIRD:
All the rest, residue and remainder of my estate
of whatsoever kind and wheresoever situate, I give, bequeath, and
devise to my son, NICK WILLIAM DAVIS. In the event that my said
son does not survive me, I give devise and bequeath my residuary
estate to my son's wife, PHYLLIS DAVIS. In the event that
neither my said son or my said daughter-in-law survive me, I give
and devise my residuary estate to the surviving issue of my son,
NICK WILLIAM DAVIS, per stirpes.
FOURTH:
I name and appoint my son, NICK WILLIAM DAVIS,
Executor of this my Last Will and Testament.
In the event that
my son, NICK WILLIAM DAVIS, fails to survive me or is unable or
unwilling to perform, I name and appoint my son's wife, PHYLLIS
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f -., t 1"1
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DAVIS as my Executrix. Further, in the event that my daughter-
in-law, PHYLLIS DAVIS, fails to survive me or is unable or
unwilling to serve, I name and appoint my granddaughter, JO ANN
DAVIS ALEXANDER, as my Executrix. My executor named herein shall
not be required to post bond or any additional security in any
jurisdiction in which he shall be required.
IN WITNESS WHEREOF, I, the undersigned Testatrix, CARMELA
,rh
DAVIS, have hereunto set my hand and seal this I day of
~January
, 2004-:
(1~ B~~
CARMELA DAVIS
SIGNED, SEALED, PUBLISHED and DECLARED by the above named
Testatrix, Carmela Davis, as and for her Last Will and
Testament in the presence of us, who have hereunto
subscribed our names as witnesses, at her request in the
presence of said Testatrix and in the presence of each
other.
WITNESS:
-u WSj~
SId- L~ ~STLt4--P
CC;1;st'/ If:&{ fl} I 701 /
ADDRES
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ADDR ss I .
ACKNOWLEDGMENT OF TESTATRIX
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF ALLEGHENY
I, CARMELA DAVIS, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the
instrument as my Last Will; that I signed it willingly; and that
I signed it as my free and voluntary act for purposes therein
contained.
~ ;jJ~
CARMELA DAVIS
SWORN TO AND SUBSCRIBED
me by Carmela Davis, Testatrix,
th -r
:; day of (flnuay , 2004-0
~C~~1 !.
otary b' Notarial Seal
MaIY C. Domisd1. Notary Public
Camp Hill Boro. ClJnber1and County
My Commission EJCpires Mar. 11. 2007
Member. pennsylvania Association Of Notaries
Before
this