HomeMy WebLinkAbout06-25-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Sophie E. Yasko
also known as
File Number s~ ~ d~ ~ l~ J
Deceased Social Security Number 186-24-9905
Petitioner(s), who islaze 18 years of age or older, apply(ies) for:
(COMP'LETE 'A' or 'B' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the x~arrted in the
last Will of the Decedent dated and codicil(s) dated _ r-~ c==
_ _ :4~ ~,~
(State relevant circumstances, e.g., renunciation, death of executor, etc.) -~-~ i ~
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Except a:; follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instru~xent(s)~fered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ' ' - -
~`~~ {~7
B. Grant of Letters of Administration `~ ~ ~'~+
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate)
Petitioner(s) after a proper search has 1 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.)
L- Name Relationshi Residence
Mary A.nn Marte Daughter 837 Kiehl Drive, Lemoyne PA. 17043
John D. Yasko, Jr. Son 9337 Via Elegante, Wellington, Florida 33411
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
837 Kiehl Drive, Lemoyne, Pennsylvania 17043
(List street address, town/city, township, county, state, zip code)
Decedent, then 92 years of age, died on December 24, 2007 at Holy Spirit Hospital, East Pennsboro Township,
Cumberland County, Pennsylvania
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 57,988.77
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
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:
C Si nature T ed or Tinted name and residence
~L Mary Ann Marte 837 Kiehl Drive, Lemoyne, Pennsylvania 17043
Form RW-U2 rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
COMPvIONWEALTH OF PENNSYLVANIA
COtJI~1TY OF Cumberland
SS
The Petitioner(s) above-named swear(s) or 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 tc or affirmed and subscribed
before me the ~ ~-~ day of
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Signature of Per al Representative
Signature of Personal Representative
r the Register Signature of Personal Representative ~ E=
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File Number: -
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Estate of Sophie E. Yasko , Deceased ~ r, ~
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Social Security Number: 186-24-9905 Date of Death: December 24, 2007
AND NOW, ~~ , ~, in consideration of the foregoing Petition, satisfactory proof
having been presented b, IT IS DECREED that Letters of Administration
are hereby granted to Marv Ann Marte
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
FEES
Letters .... ~~ ~ OP.`~ $ j?j`J
Short Certificate(s) .... ~ .. $ ~
Renunciation(s) .......... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ ~0 0.00
Decedent.
Register of Wills
Attomey Signature:
Attorney Name: Anthony L. DeLuca, Esquire
Supreme Court I.D. No.: 180b7
Address:
Telephone:
113 Front Street
P.O. Box 358
Boiling Springs, Pennsylvania 17007
717-258-6844
Form RR'-02 rev. 10.13.06 Page 2 of 2
105.8p5 REV 101/OT
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14124716
Certification Number
This is to certify that the information here given i
correctly copied from an original Certificate of Dead
duly filed with me as Local Registrar. The origina
certificate will be forwarded to the SCate Vita
Records Office for permanent filing.
~,~ _ ~ ~
Local Registrar Date Issued
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Rtgs~ta3 REV n¢ooo COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS -' (_ ,, rr `~ _ _
TYPE PFINT IN
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PBLACNNNKT CERTIFICATE OF DEATH ~ _..~ ~=;-~
(See instructions and examples on reverse) „___ _. _ _._ ___ ~.~,_ Y a i
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1. Name of Oecetlenl IFirsl, made, Wsl. stifle) 2. Sex 3. Sacal Securay Nwriber V •^• ` • ""• V'•' 4. BalrrofDe (Morn .day, ye ~
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5. Age (Lass Binntlay) Under 1 year Under 7 y 6. Date of &nh (MOnm, day, year) 7. &nhplace (City and dale a br canlry) aa. Place d Daam (enetA one)
l awn: oars Novrs uiaarvs Fbspilal: Omer:
C~ J- Yrs. ~ ~ U f ~
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Y ~ Inpatient ^ ER / Oulpalienl ^ DOA ^ Nursing flume ^ Resitlence ^Omar -Specify:
BD. County of Deelh &. City, Boro, Tip. of Death Btl. FaziYly Name pl not YvslYWion, give eked rxxMer) 9. Was Decedent d Hispanic Orgin? ~ No ^ Ves 10. Rate American kxaan, Dlazk, WMe. ek
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pf yes. spedlyCWan, (~ryy
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C V F'>''1 Q AJ 'z A/,V S O v /• 1~ O 5 / Mexican, Pueno Rican, etc.)
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tl. Decedent's Usual Occ tbn KYd d wod dwm moll d wa Yle. Do ml sale retired 12. Was t ever dw 13, Oecetlem's E ~ Ispeciry only Ngtiesl grans rwrrpleled) td. Manly Smlus: Married, Never Marrleq 15. Surmlrp Spouse (II wna
glue rroidan name)
,
Kits d Worts Kmd d Business I Industry U.S. Armed Faces? Elementary / SecorKfery (0.12) CoMega (1-/ w 5a) WyON'~ avwrad ISwt'~b)
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~~ ~ ~ ~ ^Yes ~No ~ 1
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76
Decededs MaJUg Addess 19 et, uty 7 town, Blare, zp code) Decedent's /~ n pid pecetlem
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17t. ^Yes, DtredeM lived in T
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Lived wdtkn
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1B. Father
s Name ( el, mitlde, last, wnix) 19. Momer's Narre (Firs, middle, maiden sunwrie)
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20a. Inbrmant's Name ype / Pndl 20b. InfwmanYS Matlr
p Address (Saeet dry / bwn, state, zp code)
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2t a. k,zmod d D aiYon cremakon oonyion 21D. Dyed
I ~ ^ Disposition (MOmh, Oay, Year) 21c. Place of Disposilbn (Name d cemetery, wematory w Omer place) 21 d. l.acaeon (Cdy I kwm
stye
zip mtle)
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^ Banal ^ Rertwval trwn State
was Cremation or DanaDOn Aulhorued ~ Z _
^ Omer ~ Speay: t by Medical Examiner / CoronerT ~ Yes ^ No ~ 7 ~ 7
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22a. SYgret a ry
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lke (w pe such) Y1b. License NwMer 22c. Name and AddeSS d Family ~ e 1 1~ F v ~ e r/) 2 ry U 7'Y7 ey .L A! ~' •
- F D O1 L a/~ D I r k t° ~ S -P • C l -r o~
compels Hems z tdy when tennyYq z3a. To u,a best a my knowre ceam occwred at ma lima, aye end pate slated ISgnatwe and anal tab. Lkenae Number xx. Date sigrwa IMenm
day
yeeD
pnyskian u ode al orris d seam to
canny caua• d dvnln .~~,._„•.,,. ~ ~~
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Gems 2426 must be cumpleled by person
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ronuaK
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m 2<. Txne a beam ~ 5 tJ 25. Oale Prwnurketl Dead (Monm, day, year) 26. Was Case Referred to Metlky Examiner 7 Corwrer for a Reason Omer man
Crerfia( w Donalan?
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`f' ^Yes [f No
CAUSE OF DEATH (See InaVUCtiona arW examples)
r Approxunale ntervy:
Item 27. Pan t. Enter Ilre ids d yyymis - dseases, injures, w compkcaliau - Ihel dredly caused the deem. W NOT enter terminal events such as cardiac arrest
On
et b D
m Pan II: Enter ether =•mific M .,n. ~a,~ L^^ yr_ggyB
b 26 Did Tobacco Use CmviDule to Deam?
.
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resprtalory arreei. a venlrkdar libritrenon wdhrwl 5fwwirlg me elwbgy. Lisi ody one Cause m each IYIe. r d not resWlYg n me ufdedying cause given n pan I. ^Yes ^ Prpbady
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IMMEDIATE CAUSE IIFinal dsease or r
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~ ^ No ^ Unknown
condlwn resulerg m tleaml _~ a ~' p` (' 4 "~ 1 "1 q 1
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e~ S 29. II Female-.
Due IAIw as a sequence oQ: , ~ ~
Sequemiyty Yet wndlkxvs. n any p, /~C- k~ M ~ /k t G>\
kadngg to die muse Ysled on Ane a Y ^ Nd pregrwnl wanin pall year
^ Pregnant y time d loam
Emer me UNDEIILYINf: CAUSE Due to (or as a consequence otl: r Nw
^ pregrum. M pegnam wimin 42 days
Idsease w xyury mat initialed Hie r
events rewnwg m deatry IAST c. ~ d dean
Due to (or as a consequence oQ. Not
^ pepum. Out pregrwu 43 days b 1 year
d, belere dean
^ Udmown d prep aru wdhin the past year
30a. Was an Autopsy 3gb. Were Autopsy FYidrrgs 31 Maruier of Deam 32a. Dale d Irywy (MOnm, day, year) 32b. Describe Flow k4ury Occurte0
32c. Place d kMeY: Hone Farm Esrey
Fadwy
Perlomiedl Ava~lade Prior la C IaYOn
~
Natural ^ Mankrtlu ,
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d Cause d DeaN
^ Yes Q"No ^Yes ^ No ^ Accident ^ Pendkg mvesYyalbn 32tl. Trans d Injury 32e, Injury y Wwk? 321. If Transporlaaon Iryury (E'pecilyl a2g. Location d Iryury (Street, dry /tam, stale)
^ Sukiae ^ Could Nd De Determined ^Yes ^ No ^ Onver / Operalw ^ Passem3er ^PetlesMan
M Olfier - Spenty:
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33a Cedfier c~~ DanhY lean Ph skian ce pnyskian has pronouncetl tleyh aM wrnpletetl Item 23)
• Can ( y ndylly reuse of deem when anomer
336 lure/
and
SSne /•Title of CerNier
r ~~^~~~iir
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
To tM best of my knowledge, deem occurred due b Ne teasels) and manner as cuter _ _ _ _ _ _ `
l
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• Prorrouncing and rerllyug physkun (Physx~an both pronouncing deans and cenirymg to cause of death)
To We Desl of m
knowled
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deem a
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^ 73c. Cleanse Number 33tl. Date
Sgnea (Mwan, day Year)
y
g
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curr
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me.
a
e, an
place, and dw to ma nose(s) antl manner as s1akM_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• kxdity Examiror / Coromr M
! ' 1 /~ ~ ^ l ~ ~7 ~ I ~ ~ ~ ~/ _7
~ 1 , J L b J
On tM basis d eiaminalion antl 7 w invesligallon, In my opinion, d:alh occurred al IM time, dale, and pace, and due to Ise teasels) aM m0mbr as sWtad_ ^
34. Name and Adders d Person Vllq Cortpleted Cause d Deam (lam 27l Type / Pnm
3~ Ra a S. two and D~amm NaAmar -
gas gna
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36. Dale Flled (Monm, aey, year) G ~ ~ G.a~, G.. -.~, •~ 5
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ICI flx~l ~I~ -~. ~ 60" 503 N 5~ sr 1~.,-, ,~/,7( ,~~
Drsposnion Penns No. U U ~ 9 a ~
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