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HomeMy WebLinkAbout03-06-08 Estate of li),f.::I also known as i+- Ie PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF .~u:nb,fla;ll) COUNTY, PENNSYLVANIA ,] l~OC;; -~") Sc)- r' [--Jj/6Wl 0' ~)i7C>WJ ( I" , File Number , Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) P A. Probate and Grant of Letters Tejtamentary and aver that Petitioner(s) is / are the [3 X-eC l) lor last Will of the Decedent dated C) 1 \ q _ 0 y 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 instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: .;J ~B. Grant of Letters of Administration (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 d.b.n.c.t.a.. enter date of Will in Section A above and complete /ist of heirs.) Name Relationship Residence ) ~) (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in ,::)- (List street address, tOWll/city, towns! ip, county. state, zip code) cr., Decedent, then .--, G.- -..::> l) years of age, died on 'te~ J9 ,~)c8 at \~ei~ev frIO d.,cQ l ( t"ll~rer Decedent at death owned property with estimated values as follows: (If domiciled in P A) All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania -' $ :=:'.:i() , \.:'[) $ $ $ 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: Ty ed or rinted name and residence I /rIt1.+Q41J C9.X.ij )('i'6,)/7 /2.{"'--oct IloDe: -) i::,.I~ ~ "- Form RW-OJ rev. 10./3.06 Page 1 of2 Oath of Personal Representative COMMONWEALTH OF PENNSYL VANIA COUNTY OF Q.L'{'r\}Jp('\n.f\d SS The Petitiooer(s) above-named swear(s) or affirrn(s) that the statements in the foregoing Petition are true and conect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Estate of day of r; .\...- Signature of Personal Representative Signature of Personal Representative File Number: ~ \ -O~ -O:)S~ Y lA.-X'\:\7od Icl\. , Deceased h-)r <?, <', j - Social Security Number: Date of Death: Fe .......). ,:}S / ,:jcK\6 AND NOW, \ 0 \::;''' fY\~" 6LC(')~< in consideration of the foregoing Petition, satisfactorj proof having been presented before me, IT IS DECREED th~t Letters Tf,<J C);ll\e_(\-\(l.n_y__~_ are hereby granted to Do. (\ cl S\Nr~rh")w \( .h U in the above estate and that the instrument(s) dated c-J. \ \~\r\7) described in the Petition be admitted to probate and filed of record as the last Will ct Codicil(s)) 0 FEES t~) l....\': _ / "' Letters Short Certificate(s) . . . . . . . . $ Renunciation(s) .......... $ \,ud(~ $ , j r r $ ~ )..1;-n $ $ $ .. . $ . .. $ .. . $ .. . $ TOTAL .............. $ Form RW.O] rev /0./],06 $ r-J(jW I~OD Attomey Signature: 1500 It'), OD S.DD Attomey Name: Supreme Court I.D. No.: Address: c-; ...- ~ ; Telephone: (;\ lil.Dl) Page2of2 Lilli" "In;:; !}f:\' /(\1/", " J~/ - \\.-;?"- cJ~\. - I) ~.) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. S6.00 Certification Number ~~;-",,;,; IIIII~ ~\.i" OF PEl---- l~..../~~'n.,..,. l~ U..J.:"",. 1'l_~'! ~\ ~~\I :/i' i!h~ (~*\( '''-~,'' ", "~'*$ ~a\ "~. /~", \. ~~ ,/-~,l .,. -i',.?>:::--- /,-\\-'r ,I' "-"-.../MENl \\\ """" ""''''''///h'NIIII111J!II This is to certify that the information here given is correctly copied from an original Certificale of Death duly filed with me as Local F:egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. P 14288855 \JjuJr{44.iI./'/1~~,-3/3 f!L Local Registrar 1 if' Date Issued c.,.... H105.143 REI/ 11/2006 TYPE; PRINT IN PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See Instructions end exemples on reverse) 1 Name a Decedent (First middle, last, suffix) 7, Bi and slate Of STATE FILE NUMBER 11 Deceoonl'sUsua,IOccu allon Kllldof~ort\dooedu' moslolw lile,DoOOlstaterelired Klf'ld 01 Woo. Kind 01 Business I Industry Fleet Su rvisor Dai 12. Was Decedent ever in the U.S Armed Forces? KJv" ONo 13, Decedenl's Education {Specify only highest grade oompIeIedl Elementary { Sacoodary (0-12) College (1-4 or 5+) 12 3 Social Security Numbe, 186 - 64 -5568 Sa. Place of Death (Check only one) Hospilal: Other It] IOp;ltien1 0 EA I OuIpa\llOI 0 DOA 0 NurSIng Home 0 Audtoc. DOIhtl' Spec;ty 9. Was 0ec~1 01 HispatIic Origin? IX! No 0 Yes 10. Race American Indian, Black, While, lie (II yos, $pecify Cuban, (Specil)1 Mexican, Puerto Rican. ele.) Whi te 4 Dilte of Death (Month, day, year) Feb. 29 2008 Forest 5 Age iLasl Birthday) 38 v" 8b County of Dealh Dauphin Philipsburg, PA 17b.Counly Pennsylvania Cumber land Did Decedent live in a Township? 17c, ag Yes, Decedent lived 111_ 17d 0 No, Decedent Uved wlUlln Acluallimitsof Kline . 16, Decedent's Ma~jng Address {Slreel, city flown, stale. Zip codel 14. Marital Slalus: Married, Nevar Marril~d, Widowed, Divorced (Specif)ol Married 278 Stumps town Road Mechanicsburg, PA 17055 18 Falher's Nami! (First middle, last, suffix) Alex Wo' towich Decedent's Actual Residence 17a, Stalil Twp DarIa J 19. Mother's Name (firsl, middle, maiden surnamel Doroth Jones 2Ob, InJormanl's Ma~jng Address (Sl:reel, city Ilown, state, z" code) 278 Stumps town Road, Mechanicsburg PA 17055 21e, Place 01 DisposiIion (Name of cemelery, crematory or other place) 21d. Location (City f town, slate, zip code) Cily/Boro 208 Inlormant's Name (Type I Print) ~ ~ PA 21a, Melhod 01 Disposihoo 23b. License Number 23c. Date Signed (Month, day, year) lIems 24.26 must be completed by person . who prooounces aealh 26. Was Case Relerred to Medical examinel { Coroner for a Reason Other lhan Cremation or Donation? OV" !la'No ,~ 321, Jf TlansportallOn IllfUlY (SpoofyJ o Dri~er IOperator 0 Passenger Op.,destflan M lOlher . Speedy 33.1 Certltler IchdCk only one) 33b Sigll..lIUre and Tille of Ctlfllliel Certitwing physjc~n (pn~:;lCldn ct!rtlt~mg CdUSl! cl iJe<l11i wt,w d!llll/l"r phl'~ICI"1l hdS pronounced ooalh and wmpltlled It"m 231 J .. ffi To the best of mw knowledge, death occurred due to the cause(s) and manner'l slated... _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ '^' ") ~~~:u=~~~,a~: ~~~~~~rL:a~~i1~c~~~~~~I:~ ~~t;i~~:)~~111~:n:l~~:~C~~~~~iDt~a~::~~~ manner .. .taled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ [J 3:k llceoSd Number ~~:ea~~:~an~n::~;:I= Bna I or lnllelillgalion, III my opinion, death occuued al the lime, dall, ilna placl, and due 10 the caUM(I) and manner a. lllale(L [] Dye; ON<> 31 Manner 01 Death jJ Nalurid 0 HOITHClde o Al.:tIUenl 0 Pending In~6sligalion o SUICIUti 0 COlltU Nol be Determl/led Part II. Enler DIller ~.kll11,*IKHlHgnlIiWl1IrQ,gLlitlilb, 28 Old Tobac<;o Use Conlubule 10 De.a1h1 bul not resultiog If) ttle und&rlymg cause gi~en in Part I 0 Yes D Probably o No 0 UnI<.oown 29 II Female o Not pr&gnant WJIIII(I pusl year o Pfegnantal\IrTleofdeath o NoIPfegnant,butpr&gnilnIMttlln42lia~~ oflJealtl o NoI PflWlant, bul: pregNlnl 43 aaw' tu 1 yeilr belote de.lh D UnlIl'IOWO if pregnant wrthrn IhtI ~l ~e.1 32c. Place of InJUry: Home, Farm, Streel, Factory, OlhceBlJlldiog,etc (SptJO/y) ~Ar:,,~S~d:~~~ dlSd~ I/t;d "/ Due 10 (Of as a consequenCil ofl /)'(1-1 r[-~J1 Due to (or as a consequence 01): I~/ /c~rt" '1 Sequenll4ll~ist coodItlOf'\S, II any ~:ni~o U~Rts;::a~~~i a Idtseasa or infINY that iOl\latedltlti events re5ulhng III de.t1h) LAST. ( II...-:~ ..J /~ '/~"~"" -S' Due to (or as a consequence 01) ~ 30a Was an Aulopsy Per1ormed? 30b Were Autopsy FlI1dtogs A~allable Prior to CompJl:Jhon ot Cause ot Oealt,? ... DYes D(lNO 32d, TIfTIe 01 Injury ~ 1 121/1211 -. , \.Z.J 34. Nan I:J all\:! Addless 01 P 11>011 W/lO Completed Cau';t 01 Death (116m ;17) Type./ Priol , M.S. Hershey Medical ClIo ~/I 'J ~~/ Hershey, PA 17033 Dl~j!0i>lhOfl Pel/TIll No 0l-0~ _;Ji>C) LAST WILL AND TESTAMENT OF Forest P. Woitowich [Name of Testator] .....-......-' I, Forest P. Woitowich [Name otTestator], a resident of 278 Stumpstown Rd., MechanicSbu~.. c . Cumberland County, Pennsylvania, being of sound and disposing mind and memory and over the age gfeighteeo::~' (18) years or lawfully married or having been lawfully married or a member of the anned forces of the United States or a member of an auxiliary of the anned forces of the United States or a member of the maritime serviCe Df the 0) United States, and not being actuated by any duress, menace, fraud, mistake, or undue influence, domsk.e. pubijsp, and declare this to be my last Will, hereby expressly revoking all Wills and Codicils previously made bYfne. . . , "'1 I. MARRIAGE AND CHILDREN f'...:: I am married to Daria J. Wojtowich, and all references in this Will to my wife are references to her. I have the following children: Name: Vanessa M. Woitowich Name: Karissa A. Woitowich Date of Birth: November 26. 1986 Date of Birth: April 1 , 1991 II. EXECUTOR: I appoint Daria J. Wojtowich as Executor of this my Last Will and Testament and provide if this Executor is unable or unwilling to serve then I appoint Vanessa M. Wojtowich as alternate Executor. My Executor shall be authorized to carry out all provisions of this Will and pay my just debts, obligations and funeral expenses. III. GUARDIAN: In the event I shall die as the sole parent of minor children, then I appoint Vanessa M. Wojtowich as Guardian of said minor child. IV. SIMULTANEOUS DEATH OF SPOUSE: In the event that my wife shall die simultaneously with me or there is no direct evidence to establish that my wife and I died other than simultaneously, I direct that I shall be deemed to have survived my wife, notwithstanding any provision of law to the contrary, and that the provisions of my Will shall be construed on such presumption. V. SIMULTANEOUS DEATH OF BENEFICIARY: If any beneficiary of this Will, induding any beneficiary of any trust established by this Will, other than my wife, shall die within 30 days of my death or prior to the distribution of my estate, I hereby dedare that I shall be deemed to have survived such person. VI. BEQUESTS: No specific bequests requested. VII. ALL REMAINING PROPERTY; RESIDUARY CLAUSE: I give, devise, and bequeath all of the rest, residue, and remainder of my estate, of whatever kind and character, and wherever located, to my wife, provided that my wife survives me. I make no provision for my children, knowing that, as their parent, my wife will continue to be mindful of their needs and requirements. If my wife does not survive me, then I give, devise, and bequeath all of the rest, residue, and remainder of my estate, of whatever kind and character, and wherever located, to my children per share, but if any child predeceases me, then his or her share will pass, per share, to his or her lineal descendants, natural or adopted, if any, who survive me; but if there are none, then his or her share will lapse and pass equally as part of the shares of my other named children; but if none of my named children survives me or leaves a lineal descendant who survives me, then according to the order of intestate succession in the Commonwealth of Pennsylvania. VIII. ADDITIONAL POWERS OF THE EXECUTOR: My Executor shall have the following additional powers with respect to my estate, to be exercised from time to time at my Executor's discretion without further license or order of any court. IX. WAIVER OF BOND, INVENTORY, ACCOUNTING, REPORTING AND APPROVAL: My Executor and alternate Executor shall serve without any bond, and I hereby waive the necessity of preparing or filing any inventory, accounting, appraisal, reporting, approvals or final appraisement of my estate. I direct that no expert appraisal be made of my estate unless required by law. x. OPTIONAL PROVISIONS: I have placed my initials next to the provisions below that I adopt as part of this Will. Any unmarked provision is not adopted by me and is not a part of this Will. If any beneficiary to this Will is indebted to me at the time of my death, and the beneficiary evidences this debt by a valid Promissory Note payable to me, then such person's portion of my estate shall be diminished by the amount of such debt. Any and all debts of my estate shall first be paid from my residuary estate. Any debts on any real property bequeathed in this Will shall be assumed by the person to receive such real property and not paid by my Executor. I direct that my remains be cremated and that the ashes be disposed of according to the wishes of my Executor. I direct that my remains be cremated and that the ashes be disposed of in the following manner: I desire to be buried in the County, Pennsylvania. cemetery in XI. CONSTRUCTION: The term "testator" as used in this Will is deemed to include me as Testator or Testatrix. The pronouns used in this Will shall include, where appropriate., either gender or both, singular and plural. XII. SEVERABILITY AND SURVIVAL: If any part of this Will is declared invalid, illegal, or inoperative for any reason, it is my intent that the remaining parts shall be effective and fully operative, and that any Court so interpreting this Will and any provision in it construe in favor of survival. IN WITNESS WHEREOF. I, For st P. Wojtowich, hereby set my hand to this last Will, on each page of which I have placed my initial,s, on '5 day of , 20-'2.L at . n'1J. ( hU. , Commonwealth of Pennsylvania. ~j/~ Fdr,..c;, r ? t<.J<:?j70LJlc J-. [Signature] [Printed name of Testator] [278 Stumpstown Rd.] [Mechanicsburg, PA 17055] WITNESSES The foregoing instrument, consisting of 3 pages, induding this page, was signed in our presence by Forest P. Woitowich and dedared by him to be his last Will. We, at the request and in the presence of him and in the presence of each other, have subscribed our names below as witnesses. We dedare that we are of sound mind and of the proper age to witness a will, that to the best of our knowledge the testator is of the age of majority, or is otherwise legally competent to make a will, and appears of sound mind and under no undlJe influence or constraint. UI'JAer, penalty of perjury, we dedare these statements re true and correct on this ~ day of ~UQLlL ,20 0 Ys' at ') .~ I ')0S"::. , CommonwealtJ of Pennsylvania. ~~ ~fcd [Signature of Witness #1] [Printed name of Witness #1] [278 Stumpstown Rd.] [Mechanicsburg, PA 17055] ~~;~{'YW1 [Signature of Witness #2] [Printed name of Witness #2] [58 Fieldcrest Dr.] [Palmyra, PA 17078] ~cf-J:tt/ [Signature of Witness #3] [Printed name of Witness #3] [59 Fieldcrest Dr.] [Palmyra, PA 17078] . SELF-PROVING AFFIDAVIT commonwe~ of t;;I~nia County of \II leh . A ,~ L- the testator and the witnesses respectivel . whose nam s are signed to the attached instrument in those capacities, personally appearing before the undersigned authority and first being duly sworn, do hereby declare to the undersigned authority under penalty of perjury that the testator declared, signed, and executed the instrument as hislher last will; he/she signed it willingly or willingly directed another to sign for himlher; he/she executed it as hisJher free and voluntary act for the purposes therein expressed; and each of the witnesses, at the request of the testator, in his or her hearing and presence, and in the presence of each other, signed the will as witness and that to the best of his or her knowledge the testator was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. w- /~~ fd-eif ? k.JjIiuIC..J.. [Signature of Testator] [Printed name otTestator] [278 Stumpstown Rd.] [Mechanicsburg, PA 17055] ~~l,~~h [Signature of Witness #1] [Printed name of Witness #1] [278 Stumpstown Rd.] [Mechanicsburg, PA 17055] ~~ r;~~ [Signature of Witness #2] [Printed name of Wrtness #2] [58 Fieldcrest Dr.] [Palmyra, PA 17078] &:#~ [Signature of Wrtness #3] [Printed name of Witness #3] [58 Fieldcrest Dr.] [Palmyra, PA 17078] , a notary public, by , the testator, and by ,20...D2-. , , and , the witnesses, this JLfk day of [NOTARIAL SEAL] {9,1111 D ~ Of Notary ublic's Signature My Commission Expires: nwealtn of NOTARIAL SEAL BETH A. KRUPA Notary Public Gulich Township, County of Clearfield My Commissi~~~~.~~~.~:.:,May 10, 2010