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HomeMy WebLinkAbout05-28-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of Marion Czirok also known as Deceased COUNTY, PENNSYLVANIA File Number Social Security Number 139-20-5491 r_7 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 Petitioners} is /are the Executrix iV named in the last Will of the Decedent dated July 6, 1995 and codicil(s) dated ~ " _` t Francis Joseph Czirok died January 12 2004. _.~-, ~.. -.- _ - ~.. (State relevant circumstances, e.g., renunciation, death of executor, etc.) --=t J `J Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the instrumeri~s offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~a B. Grant of Letters of Administration (If applicable, enter: c.r.a.; d.b.n.c.t.a.; pendente lire; durance absentia; durance 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: (!f Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) (COMPLETE IN ALL CASES:) Attach additivnat sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 140 Belvedere Street Carlisle Cumberland County Pennsylvania 17013 (List street address, town/ciry, township, co:rnry, state, zip code) Decedent, then 81 years of age, died on May 4, 2008 at Sarah Todd Memorial Home, Carlisle, PA Decedent at death owned property with estimated values as follows: ([f domiciled in PA) All personal property $ 100,000.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 0.00 situated as follows: Form RW-02 rev. 10.13.06 Page 1 of 2 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: ,., - - - ___ ;, Oath of Personal Representative , COMMONWEALTH OF PENNSYLVANIA . ss ~s~n~, ,~,,,t ~~ 6'~~ '• 26 COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true} C~reC~to-the k~etst of ~ ~ ~ ~ ~~. the knowledge and belief of Petitioner(s) and that, as personal representative(s) ofthe Decedent, Petitione~)'will"welt and Truly ~^~ administer the estate according to law. Sworn to or affirmed and subscribed before me the ~ ~ day of ~! , CI CI ~' or the Registe ~~ ~' G, ~ 1 y<. ~-} Signature of Pe onal Representative Signature of Personal Representative Signahrre of Personal Representative File Number: ~ ~~Cy'`~-~' ~ ~ / Estate of Marion Czirok ,Deceased Social Security Number: 139G-20-5491 ry Date of Death: May 4, 2008 AND NOW, ~~ ~,(.' ~0 ~'G ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before IT IS DECREED that Letters Testamentary are hereby granted to Carotvn R. Henry in the above estate and that the instrument(s) dated July 6, 1995 described in the Petition be admitted to probate and filed of recor~ja~,the task Will (and~Eodicil(s)) of L~c~'dent. ~ ; -~' FEES / ~, `~ ~ Letters ............... $_ '~` / cu Short Certificate(s) ........ $ Renunciation(s) ....... $ (~,~~1~~ ...$ l ~~ ri ... $ ~Q~C,~ Z~ ... $ ~ ~ ~e, ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ 0.0 Register Attorney Signature: - Attorney Name: Susan J. Hartman _ - Supreme Court I.D. No.: 65184 Address: 1 Irvine Row Carlisle, PA, 17013 Telephone: 717-249-7760 Form RW-02 rev. !0.13.06 Page 2 of 2 C~~-~.~~ LOCAL REGISTRAR'S CERTIFICATION IMF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Fee for this certificate. $6.00 This is to certify that the information here given is correctly copied from an original 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 145284.75 Certification Number Q• ~- ^a~..c~~-+~~eAY/ 5 /2008 Local Registrar Date Issued r--.x ~ ~ r~ c-> _ -_ (~ c=' -:. ] ; ~t , yr rJ ~ r ~ CJ _ _ - ._., " _y ._1 C ~ i7 N Cfl H10S143 REV ltrzoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE / PRmIT IN PERM"NFNr CERTIFICATE OF DEATH elACK INK (See instructions and examples on reverse) t. Name d Decedem (FNst, made, ksl. sugu) Marion McLain Czirok .Sex emote 3. Soda) Secwiry Number 4. Date of Death (Month, tlay, year b 139 _20 _ 5491 May 4, 2 08 5. Age (Last Binltlay) Unoer 7 year Under 1 tlay 6. Date of Binh (Month, tlay, year) 7. Birthplace (Cdy and sofa or Iaeign country) Be. Place of Deam (Clreck any ou) S 1 ~~ n'y' "~ N"°' March 2 0 , 19 2 Newark, NJ Hospdal: other Y a ^Inpalianl ^ERIOutpeliem ^DDA ~lursing Hama ^Residence ^Dmer-Spedty: 3b. Courtly of Deam &. CRy, Bore, Twp. d Deem fid. Fadl4y Name (If rim nstildion, give street and number) 9. Was Depdenl of HisPank Origin? ®No ^ Yes 10. Race: American Intlian Black While etc Cumberland Carlisle Boro , , , . Sarah Todd Memorial Home Qt yea, atxfdN Clan. (spadry, Mexican, Puene RNan, ek.) White 11. DeppnYS Uwel Oax: lion Kind d wont don ,fur m0.41 d wom life. De rid dale rdired 12. Was Decedent ever In Me 13. Decedent's Etlucaaon (Spedfy mty highest grade tomplatetl) 14. Marital Status: Married, Never Married 15. Surviving Spouse (II wife, give maMan name) KiM of Work KNa d Budness / IMUSiry U.S. Annetl Forces? Elame /Secondary (D-12) Collage (1 i a 5+) (~+b9 Race tionist Hos ital 12 ^Yea $]Ne Wl'd ~ • 16. Decedents Mailing Address (Sired, city /town, dale, rip code) Decedent's Did Depdam 1000 West South Street Actual Resltlence 17a. Slate PA Live Ina t7c, ^ y~ Decedent Livetl in Twp Carlisle, PA 17013 ,?b.ceanty Cumberland T°"a"'"p' na.I~1NO,DepdamDVeewimm Carlisle Acaal Lim9a of cityreao iB. Fatlafs Name (FNsI, ntitlda, HST, suffix) 19. Mdher's Name (First, middle, maipn 9umeme) Unknown Katherine Welebir McLain 2pa. Infomant's Name (Type / Priml Carolyn Henry 20b. Infamant's Meakg Atltlress Sired, city /town, stale, zi i mde 140 Belvedere St.r C~.ar~lisler PA 17013 21 a. Meltnd of Dispceilion I ^ Crernatbn ^ Donation [g Bales ^ Ramovalrmm5lare 21b. Date d Disppitlm (Month, day, Year) 21 c. Place d Dbposilion (Name of cemetery, crematory or dher pace) 21d. Loption (City / rown, date, dp code) ~ wocrerralbnorDOnaNOnAWprizetl ^ ouar - Spedy ; by Metlket ExmNier / Comrld? ^ Yea ^ No - May 7, 2008 Cumberland Valley Memcrial Garde s Carl isle , PA 17013 27a. d Fugal seryka (a rsa, acting as such) 22b. Uceme Number rn. Nana aria Atltlrasa d Fadity Hof fman-Roth FUne~ral Home & Crematory, Inc . - - 013144 L ems 23a<py when prRYL'r9 Idly'ddan is na avaiede at Una d seem b 23a. To iha ~~ , death accurted a lime, dare and pace slated. (Signature and Title) 236. License Member ' ' 23c. Date Signed (Month, day, year) ceNty pax d deem. - ~ U.C. ~ N 3o y ~ ~slay~a~ tlems 2M26 muss be canpleled by person ' 24. Time of Deam 25. sourced Dead (Monty, day, year) 26. Wes Case Refaned IolAedkal Examiner / Coroner la a Reason Other than Cremetlon a Donation? , wM paraares death. ~M. ~~ Q~7 a ^Yes WrS, no/I CAUSE OF DEATH (See inetruetlons end exempks) ~ Approdmale interval: Rem 27. Part I: Enter the chin al events- dseesas, injuries, or conplicd'ara - dal diredty posed me dpm DO NDT enter terminal erenR such as cardiac arrest Pan II: Enter dher gjgpifipm plMakna ca,trmuarw to death, 26. Did Tobacco Use Conlnbde to Death? . , Onset b Death respedory arrest a ventricder fibdletion wAhad showing the diobgy. Lid ody ono pose on each lip. but ml rssutlin4l k the underlying cause given in Pan I. ^ Yes ^ Probably NIMEDIATE CAUSE Final disease a ~ 'j'~ ~ ^ No ^ Unknown ( caaiWnresuking wt eaml ~ a. Ct~etn~ari•tr ~ ~t.A t.~lv.•~ i a 29. II Female: Due to (a as a consequence op: ^ Not pregnant within pad year Rryy Nd pndddkrLS, g arty, b_ aatlup the pose Ndetl an Ga a. ^ Pregpnt at Arne d deem Due to q Enter Bw UNDEBLYNG CAUSE (or es a copse uarce oQ: ' ^ Not pregnant, but pregnad within 42 days ~~~ad (drseese a iyury mat ri me eveds resoling n aaaln) LASL c~ D t of path uo o (a 95 a consequence off: r ^ Nd preganl, but pregnan143 days to 1 ypr d. i balsa tleath ^ Unknown it pregpnl wimin the pest year ape. Wes m Aukpsy Panormetl? 3gb. Were Auapsy Findrgs Available Prior to Completion 31 Ma d Deem 32a. Date d Irryuy (MOnm, day, year) 32b. Describe Fbw Injury Occuned 32c. Place of Injury: Flans, Fa , Street Fedory, d Cause d Deem? Natural ^ tionzcitle DIIIce BwMNg, dc. (SpeaNl ^ Yes ~ ^ Ves ^ No ^ ~~ ^ Pdldng Imestigdkn 32tl. Time of tnju7 32e. Injury at Work? 321. II Transportation Injury (SpedNl 32g. Location d Inlu7 (Sired, dry /town, stale) ^ Suictitle ^ Coultl Nd p Odermirretl ^ y~ ^ Nc ^ Driver/ Operate ^ Passenger ^Pedestrian M OUer - Speciry- 33e. Certifier (dredi ony one) • Grtilyirg phyalelan (Ph siden ceniryir pose f d m h h 33b. SignaNre iae of Cenmeyg y g o ee w en anot er physidan has prawurlced tlealh aria canpleled hem 23) Ta lM best of my hrrowretl a tlnih occurretl due to the cw tl l ~ ti. ~"~ g , se(a)an menrrcr 98 date(L.________________________________ ' Prorloundn entl pdH in h kl Ph i i b h g y g p ya an ( ys c an at prorwurcing death erW pnaying to pose of death) To the beat d my krrowletlge, tleaM occured et Nu dine, dare, aM place, ens sue to the cause(s) arxl manner es suted ^ 33c. License Number 33d. Date Signed (MOnm, py, yeaq _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medkal Examiner/Coroner + ~D ~ y b 2 b{, ~ 6 ~ 0.~ ~ q ~ Q 1 On the basis of examination end / or investigation, k my opinbn, death occurred at the tkro, dale, and place, end tlue to the puaeLa) and manner ea sgkd ^ _ 34. Name a6A ~ss of Person Wfp (npleletl ! Deam (Ile m 27 ) Type / Pnnl 36. Regalm lure aM 1 N b Dete Fibs (Month da ear) * p ' ' 2V` ~'r ~/ ` ~ `' 1\ may /1r~ J , y, y w~~ nu $~ Disposition Permit No. ~ ~t'Y>_7 ~ OAF ~~ -~_ ~tt~# t11 ttn~ ~~e~#ttnt~en~~ of ,:; MARION CZIROK =-'~~` I, MARION CZIROK, of 16 Clay Road, CarlislE~, Cumberland County, Pennsylvania, being of sound and dispos_Lng mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revo}:ing any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts anti funeral expenses be paid from my estate as soon after m~T death as practically and conveniently may be done. SECOND. I direct that my remains be interx-ed within my family's burial plot. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my per~;onal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable: marker for my grave. FOURTH. I specifically give, devise and bequeath the reinvestment shares of my General Electric Company stock to my children, Carolyn R. Henry and Andrew C. Czirok in equal shares per stirpes. r ~~ `:'~F <;-~ L-J -y ~`J ~~ ~- ;a cr, FIFTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my husband, FRANCIS JOSEPH CZIROK, provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said tangible personal property unto my children, Carolyn R. Henry and Andrew C. Czirok in equal shares per stirpes. SIXTH. I give, devise and bequeath any and. all real estate owned by me at the time of my death, unto my husband, rFRru'QCIS JOSEPH CZIROK, provided he survives me by thirty days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate unto my children, Carolyn R. Henry and Andrew C. Czirok in equal shares per stirpes. SEVENTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto my husband, FRANCIS JOSEPH CZIROK, provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto my children, Carolyn R. Henry and Andrew C. Czirok in equal shares per stirpes. EIGHTH. I direct that any and all Inheritance, Estate and ~ih Transfer taxes imposed upon my estate passing under my will or lv otherwise, shall be paid out of the principal of my residuary estate. NINTH. I hereby nominate, constitute and ~~ppoint my husband, FRANCIS JOSEPH CZIROK as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of= FRANCIS JOSEPH CZIROK, I nominate, constitute and appoint CAROI~YN R. HENRY, as Executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction iri which he may be called upon to act insofar as I am able by law t:o do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. TENTH. I have made, or may from time to time make, a written memorandum expressing my desire to give certain items of personal property to specific persons. I urge my Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be stored in conjunction with this V~lill. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this G day of ~-l, 1995. ~'u ~~! L ~~~ ~C0 MARION CZIROK ~ Signed, sealed, published and declared by the above named Testatrix MARION CZIROK as and for her Last Will and Testament, in the presence of us, who, at her request, in h.er sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ss. I, MARION CZIROK, Testatrix whose name is ;signed to the attached or foregoing instrument, having been dl~ly qualified according to law, do hereby acknowledge that I :signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntar act for the purposes therein expressed. ~ MARION CZIROP v Sworn or affirmed to and acknowledged before me, by MARION CZIROK this day ~,yG1,~ of ~, 1995. J ~~~ ~ ~~ Notary Pu is (S L) COMMONWEALTH OF PENNSYLVANIA: COUNTY OF CUMBERLAND ..r.-~ NOTARIAL SEAL WENDV M. SHAFFER, NOTAI;Y PUBLIC CARLISIE BORO, CUMOERLAWD COUNTY MY COMMISSION EXPIRES AUGUST 3, 1196 ss. We, ~us~,,,,.5. O-ttc~ and ~N~- I-~~-~-'~ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw MARION CZIROK sign and execute the instrument as her Last Will; that MARION CZIROK signed willingly and that MARION CZIROK executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by 5~..~5~",~- . ~-~~, C~ tti-1-G` ~~ >_ .~,~ c r- and witnesses, this G~~day of„~a-rfl, 1995. J~u-~-~ Notary P is (SE ) INENDY M. SHAFFERL NOTARY PUgL1C CARLISLE BORO, CUMBERLAND COUNTY MY COMMISSION EXPIRES AUGUST ;I, 1996