HomeMy WebLinkAbout03-17-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CL'}.A EJ:-!<.J.Af-J D
COUNTY, PENNSYLVANIA
Estate of
fP.ffJE MA-e
(-J"D R ff
File Number
/2/-D9: ~ OJ q&
also known as
, Deceased
Social Security Number / if 9 - / Jj - ;; ~'.':{ i
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
,,/
~..... A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated tr/)^- 7' ;;. 5 r / CJ 7'" and codicil(s) dated
( "
.f?!!}!.?r!;;' N r ,'l'';/A/k'CA/
PC"MIA/ltI1' 5. Ct'-lij named in the
(State relevalll circumstances. e.g.. renunciation, death oj 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:
D B. Grant of Letters of Administration
(If applicable. enter' c.t.a.; d.b.n.c.t.a.: pendente lite; durante absentia; durante minor/tate)
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 additional sheets if/lecessary.
County, Pennsylvania with his / her last principal residence at 3.1.5 !tt"L,>JJ../ PR-
,
Decedent, then <6 I
years of age, died on ~ - J 1-/ ~ 0 3'
at flp/,/ (f;tri .'i~JEc.-1 ~f5UII^fj Jf~5Plr/1L.-
t/f/lAf )l1}-.t-- fit.
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; C'(N' , C/(/
$
$
$
$
76: U"I' I (:?
,
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of [he 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
j//. ~ HE'VB)')
Form RW-02 rev. /0./3.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
SS /f;~ -1/ J ~u;!'.2 7
COUNTYOF CU/Vt8;{R JI{j,J /--->
The Petitioner(s) above-named swear(s) or affirm(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.
before me the
; 'I 111
/' 7 /
..1 . / " / (
,1.~'1/?j//> _..\.:;< (,~/: cV'?~P
Signa~.e oj Personal Representative
r~~_, "A./7 ~/
'-t ., /V / ~. / -"_ _ _
,.~' /_ '.- ~.v-Y.....-..-' c~,,~
Signature of Personal Representative
Sworn to or affirmed and subscribed
Signature of Personal Representative
AND NOW, /1-tv) d(Y)g ,in consideration of the foregoing Petition, satisfactory proof
having been prescnted before me, T IS ECREED that Letters
are hereby granted to IX m III I LL S. Cwle~ 011 cL j( anc-fk:-. M. H an n 0Yl
in the above estate
, Deceased
File Number:
Social Security Number:
Date of Death:
'1-,J ~ ;(j 7&
and that the instrument(s) dated '}- d 3- '7 {tJ
described in the Petition be admitted to probate and filed of record
FEES
Letters ............... $ I. ~C; ~
S h C fi ( ) $ 0().' (Jl..)
ort erti lcate s ........ C2!.__
Renunciation(s) .......... $
~ ... ~J8.'8R
jUj7)YYVltIt2rL $ (~,CX)
$
$
$
$
$
$
TOTAL .............. $ (8(-) ro
Attomey Signature:
Attomey Name:
Supreme Court LD. No.:
Address:
Telephone:
Fa,.". RW-O] rev 10,13,06
Page 2 of2
H !IJ_"'ifl_'i I~F\' illl/(I; I
n / /'Y'""
:~! ..- ,_/" ,
I..
If"', ':\ () 1,-
./oL- 1(/"
LOCAL REGISTRAR'S CERTIFICATION OF DEATIH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1III't'~(1\rotpl;;---__
1II'~~"(,AI-"
I\~' , . """'-
",~ _ VA':.
f~_"" ~\
(r~~!' '... \~~
~c::a\_' I-~
~ t,.)\I,fh'. :h~
... \ - - . ~
~ * ~ " " ~ . . " * ~
"\ ~'" ..: ..' /~i
~~,o~ /~/
"'-.,.-!rMENf~ ~~",\I\\
'''''''''''''UUIIIIJJ",I I'
This is to certify tnat the mfoflnaticn here given is
correctly copied fn11Tl an original Cecificate of Death
duly filed with m,~ as Lo:al RegistflL The original
certificate will he forw,lrded to lhe State Vital
Records Office for pcrllla1ent filing.
(2;u. ...... -""'7~ #L4.
--rJ ~ ,; ~~/ /
Fee for this certificate. $6.00
P 1433830b
Certification Numher
Local Registrar
FEB 1 9 2008
Date Issued
.... .
H105-143 REV 1112006
TVPE I PRINT IN
PERMANENT
BlACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Inatructlona and axamptea on reverae)
STATE FILE NUMBER
e. Dlte of BirItl (Moolh, dI, If)
61. AaCf oj Oelllh Check on! one
HospiIII: Other
13, 1926 BALD MT., PA. m,""'.... DER'Outpal~n' DOOA ON'''.9Hom. DR....."""
8<1 F_ .....1" ncllnst"'""'1" _ end "'-r) i. Wu - of HiIporic Origin? IJ No D VIS
HOLY SPIRIT SELECT SPECIALTY 1"",._ClJbln.
HOSPITAL "''''''''.P\lIIlORlcon,.~.1
12. Was Oecedenlever in IhI 13. OIcIdenI'. EI1ation (SptcIty only hIghnt ~ade compIIttd) 14. MariII St_: Mamtd, Never Married,
U.S. Annod FO<COll E""""'"'Y'~ll [0,12) ColIoll.('...'5.) W_. llivorcod (Spec'M
Ov" ~ 11 TH WIDOWED
7. .
.(C' 1l'ld.....0I'
3. Social Security NI.mbIr
199 -14
4434
4. Oal. 01 Death (Monlh, diy, yell)
FEBRUARY 14,
200B
1. Name of Dectdenl (First, middle, "'st.ItIffi~)
IRENE
5. Ago ILaII_,)
MAE
GORA
B1
v~.
AUG.
OOlll".St>o<<l'(
10. Alee: American Indian, Blick. Whilt, .Ie.
(Spec~
WHITE
17l>.CoIt'Cy
PA
CUMBERLAND CO.
OidO~nl
Uvtlnl
Township?
l7c. 0 V... o.cedenl Lived in
17d IX! ~",=,~i""wi1I1in MECHANICSBURG
Twp.
8b, County 01 Dealh
11. o.c.dent'. UtuII moat at lift. 00 oat I&Itt rHrtd
KindofWolk I<indc:l........,Ind""'Y
SEWING MACH OPR GARMENT MFG.
. 16. Otclldenl'. MIiIing Add*, (51r.... clly flown, ..... zip code)
335 WESLEY DRIVE, APT. 106
MECHANICSBURG, PA 17055
_.
AduII RtIidInct 171. SlIl,
COy/BolO
18. Flther', NamI (FirIt, middle, lut, aufftlt)
STANLEY KOWALSKI
201. Informant', Nun. (Type / Print)
MR. DOMINICK
19. MoNr'1 Name (flnlt, middle, maiden IUfftImI)
BERTHA SMACHER
2Ob._r. Molling_ISlrIl\ cJIy,-._.lil>COdI)
1646 WEST LISBURN ROAD, MECHANICSBURG,PA 17055
~
~
21c. PIleI of 0lIp0eitI0n (Name of ctlMlery, tftITllIOfy Of of'Itl' pIIct)
ST.JOSEPH CEMETERY
2M. Locallon (City/IowR, llItt,llpoocll)
HUDSON,
PA
18705
YANAITIS FUNERAL HOME 55 STARK ST,PLAINS,PA 1B705
230. UoInI. Number
23c. Date Signed (Monlt\, day, yNr)
html 24.2& mult ~ compIlIted by perIOfI
who pronouncel death.
26. WI' Cast Releff8d 10 Mtdic:11 Examiner I Coron.r IOf a Reuon Other ItIan Cremation or Donalion?
DV" 11I0.
~i
M~
Ov" DNo
31. MII'H'lIfol Death
t!JN,.urtl 0 Hom"""
0- Dpondlng'''-
DS;;;cido OCoWdNofboOo",","",
Approlimal. inltrVaI Pelt II: Enter other ~I condiIiont. conlrlbulina kl death, 28. Did TobIcco UI. Contrlbultlo Oealh?
OnMl 10 DHIl't blAnotrelUb'lg in the 'AldefIyIng cal,/$e given In Plrl.\ 0 Ves OPfoblbly
I!f'No [J Urlonown
29. II Female:
.-i3' Not ~nt within pall yt"
D Progna"Mimoc:ldllttl
D Oc:l"_",,,",_"'''''42''YS
oldNlh
o NCltpreg;II'lI.butprtgnanl43d1yslOlytlr
beforedellh
o Unknovotn 1l1M'~n1 wiWn !he put yur
32c. P~ 01 Injury: Home, Ftrm, SIrNt. FaclOty.
Olfico""kIng,"'. (SpeeJIyi
CAUSE OF DEATH (See In.tructlona .nd .umptee)
Item 27. PlI1l: EnllM1he ~ - di......, iolurles, Of compIicIlionl- 1\11 directly caused 1he death. 00 NOT en" tll'lTIi'IaI twnll such II cardiac arrl",
respiratory Irrut, or vtntrlc:uiar rtlrilllion wittloullhowlng!he etiology. List only <<II ClUN on NCh lint.
A f.j>. ~~ k~tL \ r~ \ l\.~{... .
Due to (or II a consequance oll:
=~:~~~~)d~:;
..
Soquonlioly""_,,, IMY.
INding 10 the cauMlsttO on int I.
EnItt the UNDEALYWG CAUSE
=r.:::~n":.;m't'1if."
b.
OU81o (or as a consequence of):
Due 10 (Of as I consequtnce of):
d.
308. Wes an Autopsy
. Pertonntd?
U. Wert Auklp8y Findingl
Ava~1blt Prior 10 Completion
of Cluse 01 DHth?
o V" )i'No
32d. TIfM of "'ury
32g.localion ot Injury (Street,city/lown, ILllt)
..
33a. Certifi8l' (checK or*'! one)
Ctrtffylnf ptlyllclan (Pt1ysid1n Ctrtilylng caUQ 01 0Mth fttItn lnoIh4r phyIiciIn hll pt'OnOYt'IOId dHlh and lXWl'IpIMd Ittm 23)
TO tt\t blat of "'Y 1mo\lMcIge. dtllh occunt4 due to IhI Cluettl) and IMflner..lIIttcL.... - - -... -.. -- -- -........... -... -... ---- - - - --... --
Pronouncing and otrtIfytnl ~ (PhySiQIII both pmnouneing dMlh and certifying to eauM 01 0Hth)
To !hi bUt 01 my knowttdgl, dIIth occumd It "'..... .., Ind pIKe. and .. to 1M CMl-.(II andlMMtr......teL. _ _ _ ... ........ ... ... ... ........ ..... .. - 0
....., EllmIner I Coroner
On \tie bull ol ,xlmlnatlon Iftd , 01' "'''"''tdon, In my~, death OCcunM It ttll tIMt, date, Ind fMc., IftCI dUI to"" eaUlt(I) 1ftII1fIInnIl''' IlIltd.. 0
33d. Oat' Signed (Monlh, day, year)
2-- j .1-08
~
~
l'l
~
ILfI Ot,~ l.g I '51 "~~(;g;"::~g'
34. Name and Addrt$s of Pinon Who C~ Cause or Dealh (item 27) Type I Pool
i4' ~ortE""I""".o. L (.)-
4"l1::> ,(-', d(....'~-~
l>.pooltlon Porm;' N.. #00979B7
II
I
,-
LAST WILL ANV TESTAMENT
on
IRENE M. GORA
~-~---~--,-------------
1, IRENE M. GORA, On th~ Town~h~p on Pta~n~, Luz~~n~
County, P~nn~ytvan~a, 6~~ng on ~ound and d~~po~~ng m~nd, m~mo~y
and und~~~tand~ng, do mak~, pubt~~h and d~cla~~ th~~ to be my
La~t W~ll and T~~tam~nt, he~e6y ~~vok~ng all W~lt~ and Cod~c~l~
h~~~tono~~ mad~ by m~.
ITEM 1: 1 g);v~, d~v~~~ and b~qu~ath all On my ~~tat~,
~~al, p~~~onal and m);x~d, On what~o~v~~ k~nd and whe~~~oeve~
~~tuate, to my hu~band, Stanley V. Go~a. How~v~~, ~n th~ ~vent
that my hu~band ~hould p~~d~c~a~e m~, then and in that ~vent, 1
di~~ct that my ~~tat~ b~ d~~po~~d On a~ nollow~:
(A) 1 d);~~ct my Ex~cuto~~, h~~~~nant~~ nam~d, to ~~ll
all On my ~~al e~tat~ a~ ~oon a~ may b~ conv~ni~ntly don~ ante~
my death and 1 di~ect that the p~oce~d~ On ~aid ~ate o~ ~ate~
on my ~~al e~tate be ~qully d~v~d~d b~tw~~n my daught~~,
J~an~tt~ and my ~on, Vom~nick,~ha~~ and ~ha~~ alik~.
(8) All On th~ ~~~t, ~~~idu~ and ~~maind~~ On my e~tat~,
1 giv~, d~vi~e and b~qu~ath in ~qual ~ha~~~ to my daughte~,
J~an~tt~, and my ~on, Vominick, ~ha~~ and ~ha~~ alike.
rTEMll: 1 he~eby nominat~, con.6titute and appoint my
hu~band, Stanl~y V. Go~a, a.6 ~ol~ Ex~cuto~ on thi~ my La~t Will
and Te~tam~nt. How~v~~, in the ~v~nt that my hU.6band ~hould
LAw OFFICES
ANTHONY B. PANAWAY !
WILKES.BARRE. FA. II
p~edece4~e me, th~n and ~n that ev~nt, 1 nom~nate, con~t~tut~
and appoint my daughte~, Jeanette, and my .6on, Vominick, a.6
Executo~.6 06 thi~ my La~t W~ll and T~~tam~nt. 1 6u~the~ di~ect
that no niducia~y acting he~~und~~ .6hall b~ ~~qui~ed to n~l~ a
bond o~ po~t any ~~cu~~ty ~n any jU~~.6d~ct~on ~n wh~ch ~aid
niducia~y ~kall act.
I
r I
r-
...
IN WITNESS WHEREOF, I, IRENE M. GORA, ~he Te~~a~nix,
have ~o ~hi~ my La~~ Wilt a~d Te~tame~~, ~et my ha~d a~d ~eal
thi~ 23nd day 06 July, 1916.
J~h;. tip
..........t1.~.
(SEAL)
IRENE M. GORA
Signed, ~ealed, publi~hed and dectaned by the above
named Inene M. Gona, a~ and non hen La~t Witt and Te~tame~t,
in the pne~e~ce On u~, who have heneu~~o ~ub~cnibed oun ~ame~
at hen neque~t a~ wi~~e~~ e~ theneto, i~ the pne~ ence 06 .the
~aid Te~tatnix and 06 each othen.
~.O) .. @~<(4</~ .
~.;:2~?LA<-~
,Ice
/' ~
.,~,~'
LAW OFFICES
ANTHONY B. PANAWAY
WILKES-BARRE, PA.
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
GVM6I?RLA,J I:::> COUNTY, PENNSYLVANIA
:lJ - ()F- O;2Q(p
Estate of
.-- -
...Lf'<' e IV c
M
G-QR...A
, Deceased
J( Al HIe Y N /<, H R I C ~J IS D tJ , (each) a subscribing witness to
(Print Name/s)
the !gWill 0 Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he / they was / were present and saw the above Testator / Testatrix sign the same
and that she / he / they signed the same and that she / he / they signed as a witness at the request of
the Testator / Testatrix III her / his presence and in the presence of each other.
C>7)/ ,...;) "'f-'/ .,
./C ~-t.( ;";1 l , i /~\;
(Signatur~) ..... 7 / /
'1. -.JJ ( iL
(/\ _l ~( r '~r .
(Street Address) j
~) ~
. .t:L~t:7 pet { I 'b/ 10 ~
(~. Slate. Zip) -
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this
of~ O/uJ."
~ day
, ~OC&
before me this
of \1, 0'l r$.-
l1J O))~ )n r
Notary Public
My Commission Expires: ;rl.oJt. Z, 2D II
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
~ 'fl day
,J 0 'c; g
Deputy for Register of Wills
A",~~
I ~
NOTE: To be taken by OtIicer authorized to administer oaths. Please have present the original or copy of inslrument(s) at time of notarization.
Form RW-03 rev 10.13.06
NOTARIAL SEAL
MARIE M. BENSON, NOTARY PUBLIC
WILKES-BARRE C, fV, LUZERNECOUNTY, PA
~'(COM.MISSiOI'l EXPIRESJUNE2, 2011
OATH OF SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
G u(} ~ LA,vO COUNTY, PENNSYLVANIA
J I-OX" OJq&
Estate of
.:I"R GN C
fV\.
G~ IC. A
, Deceased
A rf[lJO NY
-;g,
-i)
j r/;JA LJ A Y
, (each) a subscribing witness to
(Print Name/s)
the ~ Will 0 Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he / they was / were present and saw the above Testator / Testatrix sign the same
and that she / he / they signed the same and that she / he / they signed as a witness at the request of
the Testator / Testatrix III her / his presence and in the presence of each other.
! L
'-- Q"1V<-&V..-.! /
(Signature)
(;S' U;, )~01 z;r
(S"'";;~>' ~ (?c^
(City, State, Zip)
(Street Address)
/3'701
(Ciry, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
Executed out of Register's Office
before me this
of~
-+&' day
,~,
before me this
\ .
of (VI tU'\A'L
Sworn to or affirmed and subscribed
J c '-J-f..
day
~D<08'
Deputy for Register of Wills
I'
t:>.fI~-"..J
NOTE: To be taken by Ot1icer autborized to administer oaths.
FormRW-03 rev. 10.13.06