HomeMy WebLinkAbout02-19-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C U yY] 13 ER L~ f\J D COUNTY, PENNSYL V ANfA
Estate of-B.Jv tV ETTE
also known as
R, LIPovS/<.V
File Number
/J) -QfI- Ol7S
;)"olf-03-310S-
, Deceased
Social Security Number
Petitioner(s), \\ho is/are 18 years of age or older, apply(ies) for:
(COillPLETE 'A' or '8' BELOW:)
;g( A. ProlJak and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last \Vill of the Decedent dated Au 9 3J I q q :;). and codicil(s) dated
~Xec.u..trl,x
named in the
o B. Grant of Letters of Administration
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of1!1~menlffioffered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ (j) ^ '. ' .'
.... ()'. -0
o :on 3-
C
~ ':?
(If applicable, elller: c. t.a... d. b. n. c. t.a.: pendente lite; durante absentia; duralltl'ii/.inoritate) .r::-
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(State relevant circulllstallces, e.g., renunciation, deatl, of executor, etc.)
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 d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name
Relationship
Residence
(CO,"IPLETE IN ALL CASES:) Attach additiollal sheets if lIecessary.
Decedent was domiciled at death in C LJ M Ii E R. LA N 0 County, Pennsylvania with his / her last principal residence at
I g n) (J BEL l P Lee fHYl P 1-// L L A I 0 II
(List street address, townleity, township, county, state, zip code) IN () p.. m LEY .s BUR G I ( U M t3 E R.. L l'1 N D C 0 lJJ'n T Lf
Decedent, then q L( years of age, died on 'J AN I/o at h €I\. ~ J.,C1.NU'- I g C. A M r 13 E /...-L (> LA c r=
~oo8
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(lfnot domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
situated as follows:
I 8 (I-l fYl P B EL L P LA CE
$ 300,000
$
$
$ S-o,ooo
CAmp HILL
PA
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:
Signature
Ty ed or printed name and residence
s~ 'n1
~
5uSClh M, LI
I g CCl.Nt1 bell
CCUW1 Hili
Form RW-02 rev. 10 13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH UF PENNSYLVANIA
SS
COliNTl'OF ~lLmJ3Eg l-flND
The PetitJt;ncn; I :1r.U\ ':-IUl:l<:J -;'.\ carls) or a 'Tirm(s) that the statements in the foregoing Petition are true and con-ect to the best of
the "no\', led",c :1nd belief of Pctitioner(sj and [hat, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law,
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Signature of Personal Representative
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Sigllllture q( Persol1ul Representative
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Sigllalllre of Persollal Representative
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File Number:
r::21-ro~--{)175
Estate of
AN NErrE p" LI POUS' I<.l{
~ 0 Y - () s ~ 3 10 S- Date of Death:
, Deceased
AND NOW, , r9..tf)f ,in consideration of the foregoing Petition, satisfactory proof
having been presented befo(\e me, IS DECREED t t Letters
are hereby granted to 011San Ml1ru WOOyglt.y 19rol.on
y--r in the above estate
and that the instrument(s) dated ~
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
FEES JJeJnctL C9aJtflJJU Jl7uuJmolt -'
$ '~J _I". ^" ReglsterofWtlls tJtJffj/
Letters ,,'............ ~y~V_ YL r-' a
Short Certificate(s) . . . . . . . . $ 00. DO Attomey Signature:
Renunciation(s) ......,... $
Wll\ ". $_15.g0
~ ~".$ {O. 0
~.Ll.!l1l $ 8.00
$
$
$
$
$
TAN Ilo,2008
,
Attomey Name:
Supreme Court I.D. No,;
Address:
Telephone:
TOTAL
$
$.jIO.OD
Form RW-O] rev /0. J 3.06
Page2of2
H105".~0::; 'REV (0'/07\
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
Certification Number
This is to certify that the i!lfolTI1ation here given is
correctly copied from an orisinal 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.
P 14120495
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Local Registrar Date Issued
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
I REV 1112006
I PRINT IN
MANENT
\CKINK
5.~(LastBir1hday)
6. Dale at BIrth
7. .
STATE FILE NUMBER
{' and slateorl
4. Date of Dealt1 (MonIt1. day. _)
3105 January 16, 2008
94
VIS.
March 11, 1913
Norththumberland,
DOther.Speci~:
10. Race: American Indian, Black, 'Mme, alc
(SpeclM
White
8b. County of Death
6d. Faciity Name (II noI_, givo _ and n""""
Cumberland
Wormleysburg Boro.
Kindolworkdonedu' _01 1iIa. Do noIs1a1e
rmy~~'nduslry
18 Campbell Place
12. Was Oecedenl ever in the
U.S. Armed Forces7
Dvee No 4
~s PA
AcIuaI Re&idence 17a. SIale
17b. Countv Cumber land
1(. Marital Status: Married, Never Married,
_,O_(SpecIfo/I
Divorced
Old Decode..
liYeina
Township?
17c. D Vas. Decedent lived in
'7d. G( ~ ~'..lived wiIhin Wormleysburg
Twp.
11. Oecedent'sUslJll
Secret~yWork
. '6.~sMaiing_(_,cityl_,_."'_1
18 Campbell Place
Camp Hill, PA 17011
CltyIBoro
19. Molher's Name (FlnI, _,""" surname)
Anna Roe ne
201>. Inlormanl's lotaIIing Adcnsa (Slraet, city 1_, slate. '" code)
18
~
23<. Dele Slgnod (MooIt1. day, _)
I I '" ZLD 1"
~ems 24-211 """ be compleled bv person
. who pronounces 0eaJh.
32t. II T_lloo Inju<y (Spsd/y)
D 0...1 Operator D Paaaenge< DPedeetrian
M ~~.~:
331. Certifier (check on~ one} 3:JIl. s;g.,a... T.. 01 Cd.,
c.tlfyfng _ (PhysJclan -f;ing causa 01......... _ phvs<ian .... pronounced _ and completed Item 23) ~
To the but of my knowIedge,death occurYed due IoIheClUle(I,.nd Nnner.. staled........ ___................................................ __.................. _ _... ~
PronoIlnctng and ~ng _ (Pflvsjclan boIt1ll/OflO11'<ing dee~ and ceItif;ing lo causa of -J 330. Ucanse N<.mber
To the beet 01 my '-.cIge, mi' occum at the Hme, dale, and pIaca, and due lo the cauao(s) and mannet as.-.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D 'A I) '7'" > 1_ '
_EJamlnerlCcronor ,., 0'...,- _
On the baeI. at eumln.t1on and I or Investigalton, in my opinion, deatfl occurrecllll: the Ume, date, and ptace, and due to the cauee(s) and "*'ntr as stItecL 0
Dyes DNo
ID- D-
D _, D PencIng "'-lloo
D Sl.<cide D Cook! Not be Determined
26. Was Cue Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
DVes ~No
ApproxImate interval: Part II: Enter other similicantc:ordlion!l oonlrhJlinu to dAath 28. Did Tobacco Use Contribute 10 Death?
Onsetlo Death but no! -9 in Ihe underf;in9 causa jjwn in Part I. D Ves D Probably
D No JR1Jnknown
29. If Female:
o Not pregnant wilhin past year
o Plel1lant al time of death
o NoIpregnant, but PfE9l8I1I within 42 days
oIdee'h
o NoI pregnant, buI pregnarll43 days to 1 year
beforedee~
o Unknown" ~anl within lhe past year
32c. Place of Injury: Home. Farm, Street. Factory,
OlficeBuiIding,elc.{~)
--..
::=~=~d~
e.
(0 f'f)
Due to (or as a consequenc:e of):
5eQuentiaIy istconcltlons. R any,
I8aCIna IotheC8iJS8Ustedon Mne a.
En"" the UHDERLYlHG CAUSE
=~nu:.mrSTUle
b.
Due to (or as a consequence on:
Due to (or as a consequence of):
308. Was an Autopsy
Per1oImed?
d.
311>. We<a Autopsy FIndings
AvaIabIe Prior 10 Completion
of Cause 01 Death?
31. Manner of Death
D Yee XXNO
32d. Ttme olln;.y
32g. location of Injury (Street, city I town. stale)
33<1. Date Sigoeq (Monlh, day, year)
il, T- / ;z.~O?
:.~strar'S~Ol&trict
34. Name and _... of Person Who Con\>l9led Causa of DeaIt1 (Item 27) TVP91 Prinl
.A ,...,,... ~ c::.. ,J:::.a. n'7'7>~" ,AA t:J
19-11 /\k>rAA Fi-u--or S~,,-r
,J' ,,-, =f-' 0 'Z-
0Isp0siti0n Permit No.
-alt.
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ANNETTE R. LIPOVSKY
w
I, ANNETTE R. LIPOVSKY, of 18 Campbell
,") .----',
Hill, Cumberland County, Pennsylvania, being of full age and of
sound mind and memory, do hereby make, publish and declare this to
be my Last will and Testament, hereby revoking all Wills by me
heretofore made.
FIRST: I direct that all my just debts and funeral
expenses be paid out of my estate as soon as practicable after my
decease.
SECOND: I give, devise and bequeath all the property
that I own, real, personal and mixed, to my daughter, Susan M.
Brown, if she survives me. In the event that my daughter, Susan M.
Brown, does not survive me, I give, devise and bequeath all the
property, real, personal and mixed, that I own to my grandson,
william Rhoads Brown.
THIRD: In the event that both my daughter, Susan M.
Brown, and my grandson, William Rhoads Brown, predecease me, I give
and bequeath all the property, real, personal and mixed, that I own
to the Trinity Lutheran Church of Camp Hill, Pennsylvania.
FOURTH: I make, nominate and appoint my daughter, Susan
M. Brown, to be the Executrix of this my Last will and Testament,
and direct that no bond shall be required of her. In the event she
can not serve, I make, nominate and appoint my grandson, William
Rhoads Brown to be the Executor of this my Last Will and Testament,
and direct that no bond shall be required of him.
IN WITNESS WHEREOF, I, ANNETTE R. LIPOVSKY, the
testatrix above named, have hereunto subscribed my name and affixed
my seal this
.-)
day of August, 1992.
~~i~~ .~'~~,
An ette R. Lip vs \
"
.~
(SEAL)
Signed, sealed, published and declared by the above
named Annette R. Lipovsky as and for her Last will and Testament,
in the presence of us, who have hereunto subscribed our names at
her request as witnesses thereto in the presence of the said
testatrix and of each other.
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(Address)
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COMMONWEALTH OF PENNSYLVANIA:
SSe
COUNTY OF FAYETTE
We, AnnetteR. Lipovsky and, La-u.\'<, \::>iO\...0(","
and c.onf\\e. ~e.:-\ row
, the Testatrix and witnesses,
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the
instrument as her Last Will and that she had signed willingly (or
willingly directed another to sign for her), and that she executed
it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and
hearing of the Testatrix, signed the Will as witness 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.
1"-, \;~ (t:", ~ Sub s'p r.l..' bed, sworn to and acknowledged before me by
Q . ).;\__9-. \ ') . \~~'h9-4-k'~
,# - /'<V!'.(_ .~ n- =-..n th~ Testatrix, and subscribed and sworn to before
me by
Lo..v...\ \€. ~'O\.A) n
and QO[)f\\e... ~-\ r-OLAJ
,
witnesses, this
.3
day of August, 1992.
Di.Jrt a h KOe .uL~
Notary Public
NO[a,jai Seal
Deborah K. OGremer, Notary Public
East Pennsboro Twp., Cumberland County
My Commission Expires Sept. 12, 1994
M0mber, Pennsytvarua Association of Notaries '