HomeMy WebLinkAbout04-25-08PETITION FOR PROBATE AND GRANT OF LETTERS
~ //
REGISTER OF ~i~'ILLS OF ~GC/n b COIJN"I'Y, PEN~]SYLVAi~IA
Estuteuf~Q,E'OT _ _~~.(_/Ue-L
also known .1;
File Number U~/"~~~07~~
Deceased Social Security Number ~ / ' ~~- ~ ~~ ~
Petitioner(s), ~,vLo is(are 14 years of age or older, apply(ies) for:
(CO:LIPLETL'' '.a' or 'L3' /SELO1i":)
A. Pruh:tt~ and Grant of Letters Testamentary and aver that Petitioner(s) is /are the / £I~SE~ Nf{ ~ ~/aRE sf,v.q-TU£.named in the
ast ~~'ill of tn~_ D~;a:~!cnt dated .S 3/- 89 and codicil(s) dated ,c~CaL
(State relevant circunutmrces, e.g., rentrncintio+t, rleadr of executor, etc.)
r~
Except ss follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of,Fi~ instntment(~ffered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: r=C>
-~
__~ :~
-' --t fv ~ i ~ .,~
^ B. Grant of Letters of Administration _ __ _,_.t r~,j ~
(lfapplicnble, enter: c.t.a.; d.b.t:.c.t.n.: pendente ltte; duraale absentia; durnnte n:uibi-ltcrte7
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse ~any~ and he~'trs: (If
Administration, c. t. a. ord.b.tt.c.t.a., enter dote cf GVill in Section A above and complete list of heirs.) i~ O
n '
L Name Relationship Residence W
(COrYIPLETE LNALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in ~ u _ County, Pennsylvania with his /her last principal residence at
J` A rE t4 tt % d ~ P -r~ e~ rC' t ll•L _ _ _ rrt L-
(List sU eet address, [own/city, township, counh~, state, yip torte) /
Decedent, then _~_ years of age, died on '`~-l g -per at ~S~4iE' t4t-F vcl ~ /~ ~ ,.~ ie t /+[: /-~p,.,-,
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
Qf not domiciled in PA) Personal property in County
Value of real estate in Pennsylvauia
situated as fo
~~-
bVherefore, Petitioner(s) respectfully request(s) the probate of the last Wtll and Codicil(s) presented with this Petition and the grant of Letters in the appropriate tone tee
the undersigned:
J~usa-,~ ~.. ~Rt~~~S 3
/"cam i~oi3
Fa~nr RtV=O? rev. !0.13.06 Pabe I Of 2
Oath of Personal Representative ?0~~ ,,.,~ ~ ~~ ~~~~ Sp: 23
Co~~l~lovtivr,-~t_~rt! ~_~~r 1>E~~rsY-LVANIA
SS l~l ~ ~~'~
_ ("s ~ , , ;, , ~
I'hc P:.~r.cr.~~~ ~ ;~F.~; t;.t~ i ti..~ar1,1 or ~, iim~(s) that the statements in the foregoing PetitioII' re hue and con-ect tothe best of
ti~,c I;urY~ i,~ci~~~ ~ti~i h~tief~ot Petition~r(~) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed~iand subscribed
before me the ~J ~~ day of
Ox~~
For the Register
x~_~4~.
ojPersonnl Representative
Signcuure aj Personal Representative
Signature ~~Personn! Representative
File Number: ~~ ~~~'--mow ~ C~TLO
Estate of_ ~ ! JGIeO~ /'1 [riiU NO LL(..1 Deceased
T, /
Social Security Number: ~ ~ ~ - ~ ~,~ / Date of Death: ~7 - / ~ - U ~
AND NOW, ` ~ UG , i consideration of the foregoing Petition, satisfactory proof
having been presented ef~re me, IT IS D~RE.ED that Letters
are hereby granted to ~l
~yy_/ in the above estat:;
and that the instrument(s) dated / i (~G/ ~~~. ~ ~ 7
described in the Petition be admitted to probate and filed of record as the last Will nd Codici ) of Decedent.
FFLS /
O ~ Re ster of Wills
_ C
Letters ............... $ ec~
Short Certificate(s) ........ $ D' ~ Attorney Signature:
Renunciation(s) .... $
~,~~"j~P~% $ ~S ~ Attot7ley Name:
_ ~"° .. • $ fd' av Supreme Court LD. No.:
_ ~ .. $ 5 ~'
$ Address: _
... $
... $
... $
• • $ Telephone;
... $
TOTAL ~~
Furni RlV-(J_' rev /O li.Oti Pale 2 of 2
8-a~~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee Cl3r this rertilicate- ~6.OU
-- I 1~~9~~~~?
Certification Number
H10S/43 REV 172006
TYPE / PRINt IN
PERMANENT
BLACK INK
0
Chis is to certify that the information here given is
:orrectly copied from an ori~~inal Certificate of Death
~I~ly filed with me as Local Registrar. The original
:ertificate will he forwarded to the State Vital
2ecords Office for permanent filing.
_Q • ~'~.~.CS~~ax~~e:~•AP~ 2 1~ 2008
~ocal Registrar Date issued
r -..~
c°a ~
C-"7 ~~
--- ~ ~
-; ~-;..
~, _.~
"'? ~ :-~
.(--
_. ~ __ _
_! ,
~:; .
- -~ r
FJ C~ i ~j
^`~ -~ tV ,
W
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
1. Name d Decedent (Fret, neddk, ksl adore) 2. x 3. rlry Number 4. Date a Death (, y ear)
1851 A
14
2008
ri ~
~emale ~~
_
p
,
_
Dorothy Connolly
5. Age (last Binhday) Untlar 1 lhdar 1 tley fi. Dale of &M (MOnm, day, r) 7. ce ( end eats or foreign coadry) fie. Piece d Daeth (Ch«k Dory one)
86 "'"'°" °a" "°" M'""° July 20, 1921 East Pittsburgh PA "°~` °"'~~
Yra. ^ Inpasenl ^ ER / Odpabenl ^ DOA ® Nursing Horne ^ Reaidarge ^Omar - Spedry:
e6. Ceunry a DeaM Ik. Ciry, Born, Twp. of Daam Bd. Fadliry Nana (x rid nsaution, 9Ne attest and rwrrteN 9. Was Decedent a Hispanic Orgk? ®No ^ Vas 10. Race: American Indian, Black, While, ek.
Cumberland Carlisle Sarah Todd Memorial Home ("'~`'sD~dyCuben'
Mexican, Porno Rican, etc.) ( White
11. DecetleMS Usual tkn Kntl d work tl ora dud most d Ilfa. Do rid state red 12. Was Decedent ever k ma 13. DecalanYS Educatlon (Spedty a,ty highest grade canpl etedj 14. M«dd StaNe: Marred, Never Married, 15. SurviWng SDo uea (II wik, give maiden name)
KIM of Work Kind d Busewss / IMuaby U.S. Amred Forces?
~
f Elementary / Sacoridary 1412) Callegg (1 ~ or 5+) w d ea ~~
Teacher Public Schools ^Vea I
No
~ 4
~ 16. DecedanYS Meaaq Address (Sheet dy / stele, rip wde)
~7 Decedents Old Decedent
Mn N. Middleton Tw
D
tl
Mli
17
®Y
N
5
PA
r.
39 Prickly Pear
Carlisle PA 17013 o.
ece
v
Once na.
lata
c.
09,
e
AcludRes
~?
um er an 17d.^NO, Decedent lived wdhn
tn~
Aduel Lknls a Gry / Boo
1B. Fetters Name (FM, mHde, lest. saga) 19. MdMr's Name (Poor, middle eumame)
i
John Pavlick c eetz
Anna S
20a. ImpnrrenYS Name (T / Pdm)
Susan Davis 20b. Inl Street /loan, dP wtle
°`"~"'~iic y ~ar'~°t., artiste PA 17013
21 e. Method d D'epodtlon ^ Ganalbn ^ Dmeam 216. Dale of Disposlliw (MaM, day, year) 2/c. Place d Olsp«itlpl (Name d wmekry, aemetay a dter place) 21tl. L.ocason (Gry /town, skk, zip cetla)
p &mal ^ RemovellremSate
• cr.lutlat«DonenonautMdaed Aril 22, 2008
p Ashland Cemetery Carlisle PA 17013
^ om« - spady nedkal lFxammr / cerenerr ^ va9 ^ No
22a.sigm a marelsaviDe a bdr) 22b.UwnseNumDar 22c.NameaMAtltlressdFaciiry Hoffman-Roth Funeral Home
_ ~ 138504 219 N. Hanover St., Carlisle PA 17013
Can Items 23ac Doty vmen 23a Tome best a my knoxledge, tleam rretl at me sore, date ant place slated. (Signahxe ant oriel 7,ib. License Number 23c. Date SigreO (Mwm, day, Year)
plryskiar M rot aadlahla et time d, m m R ~ `
worry wwa a aaam. 7
w aema 2428 mwt M canPlded by penon
• 24. tans d Deam
- .Dort Pmnaunced Dead (Mama, da . Y~r) 28. wag case Relened to Medcel Examiner / coroner mr a Rawson abet Irian Crematlon a DalaliM?
~
who Ixonamwa seem. J!
M. O ^ Yes
No
CAl1SE OF DEATH (Sea Instruetlons and exampba) , Approxnnele interval: Pan II: Enter dher eVninwd mMtlma cerdr0caov! m mem 2B. Did Tobacco Use ContrroMe m Deem?
Item 27. Pen I: Enter me dram d eaa,s - sasses, nludes, a cenggra6on9-mat mrectly eased the tleadl. W NOT enter mrtnnd evenly Such as cervix snarl, r Orset m Deem hm rid resuring in the undedtdng cause given in Pan I. ^ Yes ^ PrabaMy
reedmmrY erreel a vemMukr flMYaliw wideM ehowmg me eaaogy. Liel only one verse «eedt qne.
~•Nti ^ UrAn«m
IyyyatEEPATE CAUSE Mal deesse a
Condaprl re9dtlngn ~m) _~ a. P~yd Ci~'K-~1 ~'L II'v ~/k~C (~T li~U r ('~ll'LL14f~ Q ~/ ~~ ~ p
TJI`^n~t.la}'l T1J
28. rI -F~em~~a'le:
imi
t
l Dw to for as a conaegenw d):
SeOuentleMV Nn midi"acs, N enY. b.
~ b}Q~O(,A~- ~Q..~.N~L ~/~ (LL4~ t.J.wn pregnant w
n pas
year
^ Pralnent al Inns a tleem
Na6q to the wise fated on M1na a.
Ems the UNDERLYING CAUSE Due m (w ss a consequarx:e art: ^ Na pregnant, but pregnant whin 42 day9
Idwase a' '~~uury met nitieted the
c.
n{
m
LABL
b
d d death
evens msu
ng
n
ee
)
Due to tar es a conseguare a0: ; ^ NM Dregnam, but pregnant 43 days w 1 year
baron deem
d.
Unknown"pregnant wKhin lM past year
30a. Was en Aaap9y 306. Were Autopsy Fmdngs 31. Mamer of Deeth 32a Date d Injury (Mash, day, year) 326. Describe How Injury Ommed 32c. PIOw d Injury: Home, Fenn, Street, Faaory,
Performed? Available Pdw to Cariplelron
a caa9e a Deem?
~°~ p "a"idm Olfke Mme. ~~ (•SPa<vNl
^ Yes ~io ^ Yee ^ No ^ Accroerx ^ Pendng Investlgeam 32tl. TNne a injury 32e. Injury el Work? 32f. If Trensponalian Iryury (SpeatyJ 32g. Lowlion of Injury (Sheet, ceY /town, slate)
^ Suicide ^ Caum Nd 6e Detemdned ^ Yea ^ No ^ OrN« 1 Operator ^ Passealer ^Pedesman
M char - spear
33a. cem6« (u~ea~ «aY w.) srgaaM ant ru Ld
c
ry
r
~
336. '
am/
-/
• Caralying phyeklen (Phyaipan caatying woes of dim when comer physiden has prau ~ed deem ant conplded Item 23)
TotlrebNldmyMnowedge,deem«wrred due totM uuWe)aM manneru eteted_________________________________ ~
- ~'' J~'~~/ `~ .~-
~
(
/
f
-
-~~
'
• Praeunclrp eM wnllylrrg phyelelen (Physiaen boor pranamrip worm ant wditying b wore d deem)
^
d
tl 33c. license Numwr 33d. Date Signed (MOnm, wy, Year)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
manner ac alete
To 1M beet a my Xrrowkdge, dent warred el me Hme, dde, end place, errtl due to tM cause(s) an
• Medical Exemher/Coroner yY ~.~Y~l~~-/~
~~ ~A "lJ'a'*lJ.I~C-_`- L
T / I /~ V ~.
On me be01a d exemlmtlon arM / « imeatlga6on, in my olNnkn, tleam occurred al tM time, date, eM place, ant due to me woo(s) ant manner e9 steted_ ^
__ 34 Name antl Address of Peron Who Complemd Cause al Deem (Item 27) Type I Print
Ld A
~k
G('
H
Q
J
36. Reg'
pnaWre ^^ 3fi. Date Flied (Momh, daY• Year) ~.Y,y.
•
, lM,
avL S
M14iA
IAi 1 L
6
z
'
~ >.. r~C~ I.~ IT~I I I h I 1
121 ,J~t
"A,rr, I[-oFl~ Cd1W-rSL(~ +P/~ ~
c
Disposition Permit Nc. Q 1 ~ _ ~~ (i
LAST WILL AND TESTAMENT
F'J
O F c`~
~ r ~ ~~~
-,
_, ~--~
DOROTHY M. CONNOLLY ~?''
;,
u~
_,;, ~- .~
I, DOROTHY M. CONNOLLY, of Lee County, Florida, de~lare:_`Lhi~ ~
to be my Last Will and Testament, and I revoke all firmer W~lls '
and Codicils. I dispose of my property in the following manner:
ITEM I
I may leave a written statement or list disposing of certain
items of my tangible personal property not otherwise disposed of
herein. In the event that more than one such written statement
or list is found by my Personal Representative, then the written
statement or list with the latest date after the execution of
this Will shall control. Such statement or list shall be
determinative with respect to all devises made therein only if it
specifically refers to this Will, is signed by me, is dated and
describes the items and devisees therein with reasonable
certainty. If no written statement or list is found and properly
identified by my Personal Representative within thirty (30) days
after my Personal Representative's qualification, it shall be
presumed that there is no such statement or list and any
subsequently discovered statement or list shall be ignored.
ITEM II
I give all of the remainder of my property to the Successor
Trustee under that certain Revocable Trust dated the 31st day of
May, 1989, between DOROTHY M. CONNOLLY as Grantor and DOROTHY M.
CONNOLLY as Trustee and SUSAN LEE DAVIS as Successor Trustee.
ITEM III
I hereby nominate and appoint my said daughter, SUSAN LEE
DAVIS, Personal Representative hereof, but if he shall not act or
continue to act, I appoint my son, RAYMOND JOHN CONNOLLY, as
Alternate Personal Representative of this, my Last Will and
Testament. I authorize my Personal Representative to serve
without bond. I hereby give to my Personal Representative full
a~
t,
,.
_,
power and authority, at any time or times, to sell, mortgage,
pledge, exchange or otherwise deal with or dispose of the
property comprising my estate, upon such terms as shall be deemed
best; to settle and compromise any and all claims in favor of or
against my estate as shall be deemed advisable and for any of the
foregoing purposes to make, execute and deliver all deeds,
contracts, mortgages, bills of sale or other instruments
necessary or designate therefore. My Personal Representative is
expressly authorized to postpone final distribution of my estate,
pending final determination of tax liabilities in connection
therewith.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
,.
this _:,- ,+.,f_. day of ;!`, :4-'~: , 1989.
~~`^-.tea ~, _r ~'~:..~a ~'/ i i __ f°-, Y ~ .`~"!_.~
Doi'b t by M . no l ly °----~...
. .. «~ ..............~ ..1
The foregoing typewritten instrument was, on the date
thereof, signed by the said DOROTHY M. CONNOLLY, in our presence
and by her declared to be her Last Will; and we, at her request
and in her presence, and in the presence of each other, have
hereunto set our names as attesting witnesses thereto.
"_./~
/ ~ ~ _ -..
>r ~/'~r/ ~ ly/y~
/,'
~ ~ }
,~.~,
STATE OF FLORIDA
COUNTY OF LEE
--r°'"_ ~~ ~-- ~
WE, DOROTHY M. CONNOLLY, ~. lei' i c- ~ ~=~ ~- `~-fit:-t ~ ~~~-~~~ ~'~,~ and
~~~-~~~111~1f/,/`.~.~~~fJ/F`~~~ , 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 officer that the Testatrix signed the instrument as
her Last Will and that she signed voluntarily (or directed
another to sign for her and did so voluntarily) and that each of
the witnesses in the presence of the Testatrix at her request,
and in the presence of each other signed the Will as a witness
and that to the best of the knowledge of each witness the
Testatrix was at that time twenty-one (21) or more years of age,
of sound mind and under no constraint or undue influence.
i __
,..
,.
Fes: `! ,~ != k. ~
Testatrix ,.~~~" -~~?
__._._~/
' ~"~
W~irtnes s ~'
~, r
~~~
' ness /
SWORN TO and subscribed before me this >/ day of
~~,%<;_ _, 1989.
~/ ~` ~~,`~ ;. ,,r'
Notary Public
My commission expires: