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HomeMy WebLinkAbout07-09-08PETITION FOR PRO/~BATE AND GRANT OF LETTERS REGISTER OF WILLS OF W~+ ~J~-~-t~ COUNTY, PENNSYLVANIA j L. ,r'~t Irv; Estate of ~~'- l~-{ Y~) also known as Deceased File Number ~ I ~ ~r~ ' ~ L ~~ Social Security Number ~7 -~ ' Z ~ / Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) c ~A. Probate and Grant of Letters T to ~ntary and aver that Petitioner(s) is /are the / Yhc ~ R!!L f1/'T 1'C~ c.i.l Oa-~t ~ named in the last Will of the Decedent dated ~~~ 5 and codicil(s) dated vUSt ~ ~ sue? ~ "~~ (State relevant circwnstances, e.g., rer:unciation, rlea[A of 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: ^ B. Grant of Letters of Administration (lfapplicable, enter: c.t.a.; d. b. n. c. t. a.; pendente life; durance absentia; durmrte nriaoritate) (COMPLETE IN ALL CASES:) Attach additional slteets if necessary. ~ C7 C~% ^q - ~ ;=~ ~J `-~~ ecedent was domiciled at death in ~//lr'- ~~ ~' t'" ~ County, Pennsylvania with his /her last principal rest -~tjtce at ~ ~ ~~ A/l . M t--G~iA~jti~t~ ~ici~ y ny tZ t-~--~ (List street address, torvrr/city, torvnslrip, count), stele, zip code) '" Decedent, then ~ ~ years of age, died on ~ Z ~ at ~ t7~ h-~ t ~LL Lv.~ t Jr~(~ ~.~ L` L~ /~~ Z~L- j~t' /"~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If rzo[ 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: ~ ..~~, Form RW-0? rev. 10.13.06 P1~e 1 Of 2 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 dale of Will in Section A above and complete list of heirs.) 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 COUNTY OF C.~,•,;~.z.2t~trt,,. SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will welt and truly administer the estate according to law. Sworn to or affirmed and subscribed (~_l + ~~ before me the day of ~ ~~~ r~~~-~~~~~?~ For tEre Kegister Signature ojPersa~a/ Representative 1 ~.J ~ ) `u C}7 File Number: ~ ! ~ ~ ~ ~ ~ ~ ~-~} `~ h ~ _ Estate of ~ ~ ~~ ~' ~ `-~ ~ ~ • ~°~ i i ~) ~ , DecEase~ r~ . --- ~~ n~ t f_~~ Social Security Number. h' ~ ~~ L,~ LJ ~ ~ ~ Date of Death: ;U a( !_ Z ~~~s` ~; ~' . ~~ -p AND NOW, )~ ~,,L 1 ~ L C~~' , in consideration of the foregoing Peirtia~n satisfactory proof having been presented before me, IT IS``DIlE,,,,,CREED that Letters ~{~ - ~i ' ~ 't" }-~ (~' _._., .. ` are hereby granted to ~Cfi l 1'~~_i 1Y \ (_ ~ ~ 11~7~ 4' Cs i~C,ti~t-= ('f i ~' ~ i", .D in the above estate and that the instrument(s) dated `~" ~ i `L~ I ~l ~ ~~ _ ___. . described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) cf Decedent. ~. ~_ i ~. ~ Regtstz,- of Y~ills {, r- Letters .. ~?.~?~: ~ ~~-~:~. $ ~y-~~ C' . L+~ ~ t- Short Certificate(s) ...3.... $ ` L Cam' Attorney Signature: Renunciation(s) ...... `~.~~ \1 (.'~ - -~~'~t .... $ ... $ \ `~ ~ Attorney Name: Supreme Court LD _ $ Address: ... $ ... $ ... $ ' ~ ' $ Telephone: ... $ F~,„~ Rw-o' rev. ro.r3.o~ Page 2 of 2 ttt;.zn. F,I:V r~.un~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 i4~4~i~07 Certificati~-Number .._ - • ~ - t'''? ~ ~ - _ - _, ., , _ ~ ~ ? , T ~"'~ ~ - I- U C,1 ~ ~~ ^ 41 - ~ 0 --~y Ca _.. ~.~ N This is to certify that the information here given is correctly cupied 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. ~~~ ~~~ JUN24~2008~ Local Registrar Date Issued lEV ltnoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN ANENT CERTIFICATE OF DEATH ;K INK See instructions and examples on reverse ~ ~ C, ~ - ~ZS STATE FILE NUMBER 7. Name of Decedent (First, middle, last, suXix) 2. Sex 3. Sxial Security Number 4. Date of Death (Month, tlay, year) Evelyn C. Bilous female 084 - 20 = 2577 June 22, 2008 5. Age ILast BlnMay) Under 1 year Under 1 day 6. Dale of Binh (Month, day, year) 7. Blnlpeca (City aM state or foreign country) 6a. Place of Death (Check only ane) xbnMS Days Noun Mnutes Hospital: Other: 82 via September 21,1925 Brooklyn, NY ^Inpatient ^ER IOutpatienl ^DOA ^NUrsing Home ©Residence ^Other Speciy 60. Count' of Death &. Clry, Boro, Twp. of Death Bd. FacilNy Name (If not institWon, give street aM number) 9. Was Decedent of Hispanic Odgin? ~C] Ne ^ Yes 10. Race. American Indian, Blad, Whae. etc. Cumberland Upper Allen Twp. ~ ~ SS.~f1 H UZ. (~(.~~ ~ pf yes, specity Cuban. Mexxan,PUenpRican etc.) ISpeciM white 1t. Decedent's Usual Occu Zion Kind of worse done Burin most of workin Ille. Do not state retired 12. Was Decedent ever In the 13. Decedent's Education (Speciy only highest grade completed) 14. Mama) Status: Married, Never Marred, 16. Surviving Spouse (If wife, give maitlen name) Kind of WaN Kind of Business /Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) Wkbwed, Divorced ISpeaM Homemaker Domestic ^vea ®Nn 12 widowed 16. Decedent's Mailing Atldress (Street, cM 1 town, stale, zip code) Decedent's Dld Decedent Pennsylvania Live ina t7c Decedent Uvedm UDDer Allen Twp {]Ves S 100 Mt. Allen Drive . . , late Actual Residence 17a. Township? e unm nd ^N D d mu Mechanicsburg, PA 17055 °a w . p, ECe e nbcpenly Cumberland Actusl LimNs of Ci 1 Bora ro 16. Father's Name (Rrsl, midtlle, last, suNix) 19. MoMer's Neme (First, middle, maiden surname) Felix Joseph O'Donoghue Josephine Manney 20a. Infortnanl's Name (Type /Print) 20b. IMOrmant's Mailing Address (Street, city! town, state, zip code) Katherine E. Hackenberg 5041 Waltersdorff Road, Spring Grove, PA 17362 21a. Mettnd of Dlsposaion ^ Cremation ^ Donators 21b. Dale of DisposNion (Month, day. year) 21 c. Place of Disposidon (Name of cemetery, crematory or olner place) 21d. Location (City /town, stale, zip code) ^ Removal fromSlale ' ® Bu ~R~ htl 1 2008 June 27 Rolling Green Cemetery Lower Allen Twp., PA 17011 ^ ~t COrone lalExamner ^Ves^No ~Md , 22a. S lure of F oral Service licensee (or person acting as such) 22h. License Numher 22c. Name aId Address of Facility FS 012 849 L O. Box 431, New Cumberland, PA 17070 Inc P Parthemore FH & CS ~ ., . , Complete ems corny when cerfiging 23a. To the best of my knowledge, tleath occurretl at the erne, date antl place staletl. (Signature and title) 23b. license Number 23c. Date Signed (Month, day, year) physcien 5 not available al lima N death to cenily cause of ceath. 24 Time of beam 26. Date Pronounced Deed (Monet, day, year) 26. Was Case Referted to Medical Examiner I Coroner for a Reason Other man Cremation or Donation? Nems 26-26 must be completetl by parson ' wM pmwunces death. . --YY ' ~y , ~j r~ ~~ M. ~, ~ r~ ~-'L ~ ~ ^ Ves ^ No CAUSE OF DEATH (See instructlo and examples) ~ Approximate interval: Part II~. Enter other a~gri (rant contlitions cronlnbNinp to death, 28. Did Tobacco Use Contnbule to Oea1M Item 27. Pan I. Enter Ufa chain of events -diseases, Inrynes. or complicatiaxss - mat dredty caused the ath. DO NOT enter terminal events such as caNiac arrest, 1 Onset to Death but not resulting in the undedying cause given in Pan I. ^ Yes ^ Probady resgmlory anesL or ventrialar fihnllatbn whhoul showing the etiobgy. Lisa only one cause on each line. ' 1 1 ^ No ^ Unknown IMMEDIATE CAUSE (Final dsease or corldnan resulli in death) ~ ~ ` / - - ' ^9 _)• a_ ~/,,. . >/k. ~~JL CL-Z ~..~-•~~e.m=-•sL_~<~ ~~ Ge l fit.- 1 ~ ~ L f7L~~G~C ~ ~C :CZ L.[r.~CY (-~t_11' al Female: [~~O N ihi t r t t Due to (or as a consequence op: ( 1 . ~ ~~ w n pas yea o Pregnan ^ Pregnant al time of death Segnennally Ibt corid9ons, N arty, b. ~ ,: .~ ~ LC_~I LC.~ J ~ ~~ -Ci:;t ~ kading Io the rouse (Wed on lire a. r Due 10 (or as a consequence oft'. ^ Not pregnant, but pregnant within 42 tlays Enter Iha UNDERLYING CAUSE (dcease or mNN that initiated me c / / ~ ~~ t", of death events resuaing In tlealh) LAST. Due to for as a consequence oD. ^ Nol pregnant, bet pregnant 43 days to 1 year before death d. ^ Unknown it pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Firstlings 31. Manner of Death 32a. Dale of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury. Home, Farn, SlreeC Factory. Penormed? AvaNable Prbr to Completion el Cause of Death? ^ Natural ^ Homicitle ONlce Building, etc (Specity) ^ Axident ^ Pentling Investgalion 32tl. Time of Injury 32e. In)ury at Work? 3N. If Transponatbn Injury (Specify) 32g. Locetbn of Injury (Street, city I town, slate) ^ Yes ^ No - ^ Yes ^ No ^ Suidde ^ Cwltl Nol be Determined ^ No ^ Yes ^ Driver I Operator ^ Passem3er ^Petlestnan M ^Other -Specify' 33a. Conifer (check only ore) 33b. Sgnature antl Title of Conifer • Cenllying physician (Physcian cenrying cause of death when another physkan has pronounced Beam and completed Item 23) death occurred due to the cause(s) end manner as slated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Te Ne beat of my kmwledge ~ ' ~ ~ / ~„ ~^ ~ ~ I z ~.-`-.,. ' ~". ~y ':.~ , • Promuncing and cedltying phyaelan (Physician both pronounnng death aM cedtying to cause of death) ,.1; 33c Llcgose-Number 33tl. Dale 6lgnetl (Month, day, year) 7o the beat of my knowledge, death occurred al the time date, end place, and due to the cause(s) aM manner ea slated_ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ Ll • Metlkal Examiner /Coroner ~- // )) _ J S ('Z~ L> V C/ ~G ` ~ ~'- ~~.~ ~~~ On the basis of examination and I or investlgallon, In my opinbn, death occurred al the lime, date, and place, and due to the cause(s) antl manner as staled_ ^ . 34. Name antl Address of Pyysan Who Completed Gause of Death (Item 27) Type /Print L J -C7 ~ ' ! '' ' ~ 35 Regis r I a antl c / Dat ikd (M Ih, day, yeap (_ ~ . < r / i = -. . /!e !..~ / l .z/ - ~ Disposition Permit Na. LAST WILL AND TESTAMENT +~ _ _' C7 i~- ~, - ~ ~'~ ' ~ l: ~~_ ~_. EVELYN C. BILOUS ,,,r _ - rn ` ~ ~ , -~ =' ~~ ~ I, EVELYN C. BILOUS, of the Township of Fairview, County of York, --~ ~ L -- ~ ' C~ - ~~ a4i$ Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate to my husband, WILLIAM H. BILOUS, if he survives me by thirty li days. 1' ITEM II: Should my husband, WILLIAM H. BILOUS, fail to survive me by thirty days, I devise and bequeath all of my estate of every nature and wherever situate in equal shares to such of my children, ROBERT J. BILOUS and KATHERINE E. HACKENBERG, as survive me by thirty days. Should any of my above-named children predecease me or die on or before the thirtieth day i following my death, I devise and bequeath the share of such child to his or her issue, per stirpes, living on the thirty-first day following my death. Should i any such child of mine leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such child to my issue, f per stirpes, living on the thirty-first day following my death. ITEM III: I appoint my executor and his successors guardian of any property which passes either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian STONE a. STONE shall not supersede the right of any fiduciary in its discretion to distribute Attorneys at Law 4, 4 Bridge Street Jew Cumberland, Pa. ,~o~o ' Page 1 of G a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including college educa- tion, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM III; I appoint my husband, WILLIAM H. BILOUS, Executor of this my ', last will. Should my husband, WILLIAM H. BILOUS, fail to qualify or cease i' to act as my Executor, I appoint my children, ROBERT J. BILOUS and KATHERINE E.'. HACKENBERG, Co-Executors of this my last will and testament. i ITEM IV: I direct that my Executor or Guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, EVELYN C. BILOUS, Testatrix, have hereunto set my hand and seal this ~ day of ~~,r~~ 1989. ~; ~~ ~' f \ ~,~„~-- rr~ ~ IIr--_~ is ~7` ~ ~, EVELYNI C. BILOUS STONE & STONE Page 2 of 4 Attorneys at Law 414 Bridge Street New Cumberland, Pa. 17070 SIGNED, SEALED, PUBLISHED and DECLARED by EVELYN C. BILOUS, the i Testatrix above named, as and for her Last Will and Testament, and in the pre- i Bence of us, who at her request, in her presence and in the presence of each E have subscribed our names as witnesses. ~' ` ~~ Witness Ad ess _ ~_ u G ~ ~~ DZil=ness ,. ~' Address COMMONWEALTH OF PENNSYLVANIA: :SS: COUNTY OF CUMBERLAND I, EVELYN C. BILOUS, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law do hereby acknowledge that I signed and executed this instrument as my last will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein contained. ~ ~ '~ ~'~ -~ -:. C ,~~` -~~ t C`l.'l17 EVEL C. BILOUS STONE 8~ STONE Attorneys at Law 414 Bridge Street dew Cumberland, Pa. 17070 Sworn to or affirmed to and acknowledged before me by EVELYN C. BILOUS, the Testatrix, this ~ a~~day of C~' 1989. Notary Public ~~ Page 3 of 4 NOTARWLSEAL CaNSTANCE L. KARLI, Natarypublic tVew Cumberland, PA twamberiand Ca. My Commission Expires Apra 13,1991 COMMONWEALTH OF PENNSYLVANIA :SS: ! COUNTY OF CUMB., j~ l ~! i We, ~ and -_ ~ i_ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it 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; that to the best of our knowledge, the Testatrix was at that time eighteen or a years of age, of sound mind ~~ and under no constraint or undue influen e. / ~-^~~,, 1 W. e ~ ~ Witne s Sworn to or affirmed to and acknowledged before me by ~~~ ~, G ,(lC,?c-~~,/ ~ . ~ a~,% and ~ _k' e'~-'u-~~,,~. ,~q~rc~~'"~c_.k'_~ , witnesses , '~ % ~' j'~ this ~~ day of ' (` 1989. ~.., :~~ ; (~ ~~~ ) , Notary Public t~:~ _ -~ NaTARigL-SEAL CONSTANCE L. KARLI, Notary Public New Cumberland, PA Cumberland Cc,. Nty Comrrdssion Expires April 13,1991 STONE Si STONE Page 4 Of 4 Attorneys at Law 474 Bridge Street lew Cumberland, Pe. 17070