Loading...
HomeMy WebLinkAbout05-23-08Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of George Robert Freistak No. ~~' ~ ~ ' F- also known as ,Deceased Social Security No _ 168-48-3979 Petitionegs). who islare 18 years of age or older. appty(ies) for. (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the Decedent, dated and codicil(s) dated circumstances, e.8.. 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 e:cecution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente life; durante absentla; durance minoritate) Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and wa:i survived by the following spouse (if any) and heirs: ,~.; Name Relationshi Residence _; ~ Richard T. Freistak Brother 601 Harding Street - ; -, :~ New Cumberland, PA`1=-'7f1~ ~~ ~~ ._; _ . Alfred P. Freistak Brother . 601 Harding Street , ~ , New Cumberland, PA 1T~7~( "~ - Frank J. Freistak Brother ~~ i~, 515 Park Avenue ` _=7 i~.T ' New Cumberland, Pt~f7b70 ~~ Joseph R. Freistak Brother (Deceased 1996) Helen Marie Trepanier Sister (Deceased February 2006) Dennis Freistak Nephew (Son of Joseph F. Freistak) 1001 W. Foxcroft Drive Camp Hill, PA Ronald L. Trepanier Nephew (Son of Helen Marie Trepanier) 1300 Doral Road San ,Angelo, Texas 76904-9323 (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedentwas domiciled at death in Cumberland County, Pennsylvania, with his/her lastfamily or t~rincipal residence at 601 Harding Street, New Cumberland, Pennsylvania 17070 (list sbee[, number and municipality) Decedent, then 74 years of age, died May 7, 2008, at Middlesex Township, Cumberland County, Pennsylvania (Location) Decedent at death owned property with estimated values as follows (If domiciled in PA) All personal property .................................................... $ 474,000 (If not domiciled in PA) Personal property in Pennsylvania ................................. $ (If not domiciled in PA) Personal property in County ....................................... $ Value of real estate in Pennsylvania ................................................................. $ 0 Total ................................................................................. $ 474,000 Real Estate situated as follows: None 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: Si nature T ed or tinted name and residence ' C.t.~:~lk~'I l ( ~ ~ Richard T. Freistak 601 Hardin Street New Cumberland, PA 17070 Ponn RW-1 Page t of 2 fCumberlantl Cbuntyl -Rev. 9192 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioners} above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct 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. ~;', Sworn to and affirmed and subscribed ..,. rya Richard T. Freistak ~ ~ -, =~# before me this ~ day of ~= ~ ": -~ Ma 2008 ~ -- k ~t _. f,a, ~_ ~ ; .. ,1 ~ No. ~ I ~ l~ tJ ` ~ UJ -' Estate of George Robert Freistak Deceased Social Security No: 168-48-3979 Date of Death: May 7, 2008 AND NOW, , 2008, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ^ Testamentary ^ of Administration d.b.n.c.t.; pendente Ide; durante absentia; durante minbritate are hereby granted to Richard T. Freistak 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 of Decedent. FEES Letters..... ~..t.~~~~`~? Short Certificate(s)...5...... Renunciation......... z-..... Affidavit ( ) ................. Extra Pages ( ).......... Codicil .......................... JCP Fee ...................... Inventory ....................... Other....-?~Lt`('~Afi~~r1 ~ (~ ~~^ Register o ills ~,c1 v' -.Ll~ `-~ `-^~ 1` ~.~ ~~" $ 1CJ. C)G $ ~ $ tC- ~C7 Attorney: Stephanie Kleinfelter, Esq. $ I.D. No: 80089 $ ~.~ Address: Keefer Wood Allen & Rahal, LLP 635 N. 12th Street, Suite 40C1, Lemoyne, PA 17043 TOTAL ................ $ Telephone:717-901-7786 Form RW-1 Page 2 of 2 (Cumberland County) -Rev. 9192 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is il{egal to duplicate this copy by photostat or photograph. 1 k'L till t'ii ,~ertific att~- .56.t)l) Certification tiumher This i~ to certif4 that the information here gi~~en is t,o'~~c,P~~H OF Pfij~ all reL tlv copied fi om an original Certificate of Death ;~`ro~i ~ ~~l ~ dull Bled with me av Loc Il Registrar. The original ,~' ~ ~z~ c~rnficat~ will he torwardcd to the State Vital U! ; A~ i:ecorLl, Oificc for permanent t~hng. ~~`'~9r~-~~~~`?1 LG~ ~ ~ MAY 0 200 iilt''~' """"~ Local Registrar Date Issued r-~.s c~ REV TTF2006 PRINTIN dANENT CK INN :1 L is y COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECOIRDS CERTIFICATE OF DEATH See i t ti nd I e C~ ~ _ _}-~ - } _ ~ ~ I ~ , -; , N _' _-, , W _ - -~y _ --~ i "`1 C _ ~I:i ;"U ( ns ruc ors a examp es on revers J STATE FILE NUMBER 1. Name of Decetlenl (Flrsl, mkltlle. Wsl suffix) 2. Sex 3. Social Seardy Number 4. Date of Death (Month, day, year) ' st k Male 1 68 - 48 -• 3979 Ma 7 2008 5. Age (Last Binhday) Under 1 year Under 1 tley 6. Date of Birth (MOnm, day, year) 7. Birthplace (City aM slate a foreign country) Ba. Place of Death (Check onl one) kbnms nays Hours MMila Hospital'. Dmer: 7 4 yrs. June 9 , 1 9 3 3 M i dd 1 e t o wn , PA ^ Inpatient ^ ER /Outpatient ^ DOA Nursing Home ^ Residenco ^Omer spedty. 00. County of Death 8<. City, Boro, trop. of Death >)d. FacilHy Name (II not inst8utgn, give slreel and number] 9. Was Decetlenl of Hispank Origin? ~ No ^ Yes 10. Race: American Indian, Black, White, etc. (II yes, speciy Cuban, (SpecihJl Cumberland Middlesex Twp. Claremont Nursing & Rehab. Ct .Mexican,PuenoRicen,etc) White 11. DecetlenYS Usual ation Kintl of work d one tlun most d workin tile. Do not stale retired 12. Wes Decedent ever in the 13. Decedent's Eduattion (Speciy only highest grade comp leted) 14. Mental Btatus~. Married, Never Married, 55. Surviving Spo use (li wife, give meitlen name) Kind d WaM Kintl of Business! Industry U.S. Armed Farces? Elementary /Secondary (I}12) College (1.4 or 5+) Widowed, Divorced (SpecilN Never Em to ed N/A ^yee []~Jo 0 Never Married i 6. DecetlenYS Maikrg Address (Street. city /town, slate, zip code) DecedanYS Did Dacetlenl M 1 dd 1 e S e X Stale PA Live M a 17 17a a tual Re idenc ~ Y D ce t li d i i 601 Harding Street . c s e c. es. ea> n ve n wp. Tawnahro? Decedent Lived within Cumberland t7d^ No , 17b. County Actual limits of Ciy / Bao 1B. Famer`s Name (RreL middle, last, sulfa) 19. Mother's Name (RrsL mMtlle, maitlen sumeme) Frank J. Freistak Frances V. Jacobs 20a. InlormanYS Name (Type! Pnntj ZOb. Inlortnanl's Mailing Address (SIreaL rely /town, state, zip cae) Richard T. Freistak 601 Harding Street, 21e. Memod of Disposition ^ Cremation ^ Donalial 21b, Date of Disposition (Month, tley, year( 25c. Place at Dispoation (Name of cemetery, aematory or Omar place) 21d. Location (City /lawn, stale, zip code) g~-{-~1 Banal ^ Removal imm slate rose crwmahon ar Donatlan aathadxad Ma 1 2 2 0 0 8 y ~ Ho l Cross Catholic C e m . y Harrisburg P A 1 71 1 1 ^ Oth r spaciy ; by Metliubl Examina l oraner? ^ Yea ^ Na , 22a. n re of Purest Licensce (or ding as such) 22b. Ucense Number 22c. Name aM Address of Fatlliry p 7O ;~ ~ ~ FO 012342-L A Stone & Murray F.H., 408 Third St.,New Cumberland ele ttems 23at any when certifying 23a. Tot a ,death rtetl al tie time, date and place stated. (Sgnahxe antl title) 23b. License Numbsr 23c. Date S' ed (Month, day, year) l n ' art a not availeWe at time of deem to ~ ~ ~ J S cermy cause a tleam. ~ / (J L Hems 24-26 must be completed ny person 24. Tine W Deem 25. Dal raraunced De m, day, year) 26. Was Case Referred to Medical Examiner / Cornier for a Reese Other than remotion or Donation? who lxomuncas deem. M. GU,Q `J ^Ves [~i Na CAUSE OF DEATH (See Instructions entl exa les) r Approximate interval: Pan II: Enter aher Hjgpj(trgpt coMifions contnb mrw to eam, 28. Did Tobacco Use Contnbule to Death? ttan 27. Part I: Enter the rdlain of events -diseases, injures, a cdnptlcations -coal &reay ceased the death. DO NO7 enter terminal events such as cardiac ertast, r Onset to Death bN nd resulHng'm me undenying rouse given in Pan I. ^ Yes ^ Probably respirebry ertast, a ramdcuher Hbdyalbri views showing ire edobgy. List ony one rouse on each line. r r ~No ^ Unknown ~~ IMc~D~TE~C~SEdeath)disea'= ~ ~j /~ r~l 1 m a ,+ ~ ` ~A^ v ~x--1- - n d yea ny~ l u / rl ~'t ~ ~ / 29. If Female. ^ Due to (or as a cons uencg oQ: ' jV n ~ L ~ ~ ~' t l Na pregnant witMn past year ^ Pre nant at time of death h G ) L SequenHatly list ooriditkxvs, if arty, b. g Iaad~q to die cause listed m Gne a. Due to or as a con uence I Enter 8le UNDERLYING CAUSE ( ~ r ^ Not pregnant, but pregnant wHbn 42 days (tllsease a injury coal initiated the c }7 ~ ~ n d r events resulting m death) LAST l of tleam . Due to (or as a consequen ^ Nol pregnant, but pregnan143 tla s l0 5 ear Y Y d. before death ^ Unknown it pregnant watsn the pass year 39a. Was an Autopsy 306. Were Autopsy FVMmgs 31. Manner of Death 32a. Date of Injury (Month, tley, year) 32b. Describe How Injury Occuretl 32c. Place o! Injury: Home, Fartn, slreel, Faaory, Penormetl? Available Pna to Completion IJalural ^ Homicide ~ Office Battling, etc. (SpeayJ of Cause d Death? . ^ Yes ~~ No ^ Ves ^ No ^ Accident ^ PerMing Investigatbn 32d. Time of Injury 32e. Inlury al Work? 321. If TrensportatiM Injury (Specity) 32g. location of Injury ($ireel, dry /town, slate) ^ Surcide ^ Could Not ba Determined ^ Yes ^ No ^ Driver / Operela ^ Passenger ^ Pedeslnan M ^oma sPeaN, 33a. Conifer (check a1ty are) 33b. Signature end Rtie of Ce 'ter • Cerlilying physician (Physician ceniying cause of tleam when another physician has pronounced death and canpleted Item 23) ~ /~ /~ ,r ~ ~ l~/yy1~/ 1 - To the beat of mY knowledge, death occurted due to ttce cause(s) and manna as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ "`~ w "~ i (/ • prawurtcing erM catlfying physician (Physwan bath pronwndng death and cenilying to reuse of tleam) t l d d m l ^ 33c. License Number 33tl. Dale Signed (Norm, day, year) ace, an e cause(s) aM manner as s To the beat of my knowbtlge, death occurred a the lime, date, and p ue to ated,. _ _ _ _ _ _ .. __________ • Medical Fxamina / DOfaner /~ j~ ~ © ~ ~ ~ ~ ~ l r r / 4 ,S O~^ ~ On ttre basis of examination and / or investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ ^ 34 Name and Address of Person Who Completed Cause of Death (Item 27) Typo / Pnnl 36. R tr is Sgnature um r Z / `~ ~ ~ f 36. Dale Rled (Month, day, year) ' l ~ I rj~rL i a I ~ i S ~Gt~ ,f' Dispositpn Pertnr No. ~~ / ~ ~~ o Register of Wills of Dauphin County, Pennsylvania RENUNCIATION Estate of George Robert Freistak No. Z 1 ~ ~t~ - ~i~~ also known as .Deceased The undersigned, Alfred P. Freistak, brother of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued Witness ~-hanti~his" ~a r~,p day of M , 2008 a~ ~~,~~. (Sign ure) Alfred P. Freistak 601 Harding Street New Cumberland, PA '17070 Before the undersigned personally appeared the party executing this renunciation and certified that he executed the renunciation for the purposes stated within on this„ ~Cs71 day of ~ , 2008. ~~ ~ ~ ~~ Nota Public My Commission Expires: (Signature antl seal of Notary or other oBicial qualified [o administer oaths. Show dale of expiration of Notary's commission.) Form RW-4 (Dauphin County) -Rev. 9/92 N ~- ~-- cos r_ ,~ - - _ . c. G_ C> <_ L ` ` Y- t_~ .- ~'. - CT ` (_ ~~.~ t'~ NOTE: Renunciations executed outside the Office of Register of Wills are required to be ni~tarized. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL I CYNtHIA J. RULE, Notary Public Lemoyne Boro., Cumtx3rland Coupryry My Commission Expires F 3, 2012 Register of Wills of Dauphin County, Pennsylvania RENUNCIATION Estate of George Robert Freistak No. L,. ~l~ • ~~^ also known as ,Deceased The undersigned, Frank J. Freistak. brother of (Relationship) (Capacity) the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Richard T. Freis k Witness ~~' `""'~ a is aaN-d day of , 200~8-'.,~ ~~ • ~,~~Z (Signature) Frank J. Freistak 515 Park Avenue New Cumberland, PA 17070 Before the undersigned personally appeared the party executing this renunciation and certified that he executed the renunciation for the purposes stated within on this ~-~~.r~ day of ~~-~-^ , 2008. ~- N~tary u~lic My Commission Expires: (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission.) Form RW-d (Dauphin Countv) -Rev. 9192 cv c F.- t. .µ L., .. CL.. ~ _.. .. -' - {~ _ CV +_' i , C: _ Cr~ _. _ C==~ r: : U . rd NOTE: Renunciations executed outside the Office of Register of Wills are required to be notarized. W EA~,7 N OF !'tNNSY --V A,.pr- ~MM~N NtJTAR1AtS~' p~buc ~YN~HIA ,!. R G~r'~ ~12 lettay'~~°tOExo~~