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Home My WebLink About07-14-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ~~ -C~~- ~ 7/% Estate of ADDA MAE MARGIN File Number also known as ADA MAE MARG I N Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) 197-16-9796 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTRIX named in the last Will of the Decedent dated MAY 7 , 2 0 0 4and e~i~l~~'r~at~ IN THAT SHE I S THE EXECUTRIX NAMED THEREIN (State relevant circumstances, e.g., renunciation, death ojexecutor, 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: ~ NO EXCEPTIONS ) ru (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with~is /her last principal residence at 41 S WF ~ T (List street address, town city, township, county, state, zip code) Decedent, then 8 4 years of age, died on JUNE 17 ~ 2 0 0 8 at M . S . HERSHEY MEDICAL CENTER ~ HERSHEY, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 4 0 0 x 0 0 0. 0 0 (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 Form RW-01 rev. 10.!3.06 RECORDED OFFICE OF REGISTER OF ~~'ILLS 200r~ JULY 03 CLERIC OF ORPFL~NS' COUR7P CliDiBF,RL_~ND CO., f2 B. Grant of Letters of Administration ~ ~ ~ ` ' (If applicable, enter: c.t.a.; d.b.n.c.t.a.,~ pendente life; durance absentia zleir minoritafe).- -'rt C t ~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followtng~ (if an~and h~Trs ~~ Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) = ~ ,~- ., c n ;~ - Wherefore, Petitioner(s) respectfully requests) 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 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 to or affirmed a d subscribed ^'-~Z2C`U L« ~~ J ~ Signature ofPersonalR presentative KAR TART~GLIA before me the ~- day of ~~ ___ ~ ~ '°{ ~+ ~" ~ // " . ~ mil V ^ ~ ~S "" (,, Signature of Personal Representative ~ j '~ C _ _ ~ .c- • ~ZIA P--+--~ For the eglStei Signature of Personal Representative : ~~ ~ ~ ; i j ___1 :'~ •• -. t'~ (~ ~ ~~ ~O ~ ~ ~~ ~ ~ File Number: ~_ Estate of ADDA MAE MARGIN ,Deceased Social Security Number: 19 7 -16 - 9 7 9 6 Date of Death: ,TTTNF 1 7, ~ n n R AND NOW, •~~ r ~ ~ 2 0 0 8 , in consideration of the foregoing Petition, satisfactory proof having been presented before e, IT 'DECREED that Letters TESTAMENTARY are hereby granted to KAREN TARTAGLIA and that the instrument(s) dated MAY 7 . 2 0 0 4 described in the Petition be admitted to probate and filed of record ~s the last Will ~a(~`~i`~s)) of FEES ~~ Letters ............... $ Short Certificate(s) ........ $ ~~r Renunciation(s) .......... $ ... $ ... $ ... $ $ ... ... $ ... $ ... $ TOTAL .............. $ 9:A9'' Form RW-02 rev. 10.13.06 Attorney Signature: Attorney Name: kegister o Ills ~~ in the above estate Supreme Court I.D. No.: 16 2 6 8 KELLER, KELLER AND BECK, LLC Address: 343-B SOUTH POTOMAC STREET WAYNESBORO PA 17268 Telephone: 717 - 7 6 2- 3 3 31 RECORDED OFFICE OF REGISTER OF VOILIS ~e 2 of 2 200'~aJUi-Y 03 cl:~Rh of ORPH-~S~ COtiRT •~igERL-~~~ LO„ P~~ ~~ CL LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Pee for this certificate, X6.00 P "14~4.02~ ~+ Certification Number __._ _~ _ _ O - !, r ~' ,~ _ t__ G_ ~ ter, r__ _ ~ t` C~ f -. _ , . -~CJ.- ~ c~ ~; aaiNtilNaofi ~ L..C ~ ,_ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 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 he forwarded to the State Vital Records Office for permanent filing. /~ _~_ ~ a JU f 1 9 00~ Local Registrar ~~ Date Issued RECORDED OFFICE OF REGISTER OF' ~`C~ILLS 200$ JULY 03 CLERIC OF'' ORPI3~~~iS' COLRT cu~rBERL.~~D co., P~~ ~ti (ANENT ti 0~ CERTIFICATE OF DEATH .KINK Q r , V (See instructions and examples on reverse) STATE FII F NI IMRFR 1. Name of Decedent (First middle, last, sutlix) 2. Sex 3. Social Security Number 4, Date of Death (Month, day, year) Adda Mae Mar in Female 197 -- 16 - 9796 June 17, 2008 5. Aga (Last Birthtlay) Under 7 year Under t tlay 6. Date of BIM (Month, day, year) 7. Birthplace (City and slate or for eign country) Ba. Place of Death (Check only one) rwonms nays Nows Mimosa Hospital: Olnar: _ 84 October 22, 1923 Chester, WV Yfe Inpatient ^ ER! ONpatient ^ DOA ^ Nursing Home ^ Residence ^Other - Specity. Bb. County of Deem 8c. City, Born, Twp. of Death 8tl. fadliry Name (II not insliNtion, give street and number) 9. Was De,:edent of Hispanic Odgin? j!C] No ^ Ves 10. Race. American Intlian, Black, While, etc. hin Der Tw Dau (II yes, specity Cuban, (specil» Hers eyMe ice Center S ry p. p . . Mexican,PUenoRican,etc.) its 17. Decedent's Usual Occ tion Klnd of work done Burin moss pt world tile. De not stale retired 12. Was Decedent aver in the 13. Decedent's Education (Specity Doty highest grade completed) 14. Marital Sglus: Monied. Never Monied, 15. Surviving Spouse (II wife, give maitlen name) Kind of Work Kintl of Busirass / Intlustry U.S. Armed Forces? Elementary /Secondary (0-12) College (1 ~4 or 5.) Widowed, Dlvorcetl (Specify) Housewife ^vea ®No 12 Widowed t6. Decetlent's Mailing Atltlress (S)teel, cdy !town, state, zip code) Decedent's Did Decedmt lvania Penns 415 West North Street y A[Wdl Residence na slate Live ina 17c. ^ Vas, Decedent Lived m Twp. Carlisle PA 17013 Township? nbcoenty Cumberland nd.lt] No,Decetlemuvedwdlrn Carlisle , Actual LlmkS Of city, Roro 18. Father's Name (First, mitldle. last. sutlix) 19. Mother's Name (Flrsl, middle, maiden surname) Paul C. Milligan Kathleen Stull Zoe. Inlormanl's Name (Type /Print) 20b. InhrrtnanYS Malting Address (Street, clry /town, state, zip code) Paula A. Green 415 West North Street, Carlisle, PA 17013 21 a. Method M Disposition ®Cremation ^ Donation 21b. Date of Dispositon (Month, day, year( 21 c. Place of Disposition (Name of cemetery, cramntay or other place) 21 d. Location (City I town, state, zip code) ^ Bunal ^ Removal from Stale ;Was Cremation or Oonatbn Authorized E ^ 0 ~ ty: i byMeekalExaminer/Coroner? ras^No June 19, 2008 Cremation Society of PA Harrisburg, PA 17109 22a. 5 of F rat Service Lice ' (or person acting as such) 226. Liceme Number 22c. Name and Address of Facilit~ll e r Memo r i a 1 Home and Cremation Services , Inc . - FD 013376 - L 4100 Jonestown Road, Harrisburg, PA 17109 Items 23at Doty whence I ~ 23a. To the best of my knowledge, death otturted al the lime, dale aM place slatetl. (Signature aM title) 23b. License Number 23c. Date Siqned (Month, day, year) ysidan R rat available al lime of tl ' l0 ceniry cause of deem. Items 2446 mull be completed M person 24. Tine of Death ~ A I- 1 25. DatTe Pronouncetl Dead (Month, day, year) ` 26. VJas Case Referred to Medical Examiner I Coroner for a Peason Other than Cremation or Donation? who praaunces tleath. 1 M. JJ ~1G ~~ , Z„~~ ^Yes ^No CAUSE OF DEA7H (See instructions and examples) 1 Approximate Interval: Pan IC Enter Diner ggni! and cattlkions conlnhulinq to am, 28. Did Tobawo Use Contribute to Death? rem 27. Pan I. Enter me dwn of evenLS - diseases, Injures, or comDlicalbns -that Olrectty caused the death. DO NOT enter terminal events such as cartliac arrest, Onset to Death but not resulting in the undedying cause given in Pan I. ^ Vas ^ Probady respiratory arrest, or ventricular fihnllation wdhout showing the afbbgy. Llsl Dory one rouse on each line. IMMEDIATE CAUSE (Fi l di ~ ~ No ^ Unknown sease or na caMiHon resuhing m death) U ~ 29 II Female: _~ a.. _ O.S ln $ I S r Y . ® r Due to (o as a con Sequarke off: Nol pregnant within pass year L Sequentaay asl conditrons. it any. b. Hy ~O'fi hSl ~Yl lea~q to bte cause ksled on line a ^ Pregnant al time of tleath . Enter 8,e UNDERLYING CAUSE Due to r as a consequence of): NO~ egnanl, but pregnant within 42 days ^ (disease or Injury Thal initiated me c o at evems resuking m cealh) LAST. Due to (or as a consequence ol). ^ Nol pregnant, but pregnan143 days l0 7 year d helots death ^ Unkrawn II pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findirgs 31 Manner of Death 32a. Date of Injury (Month, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Street, Factory, Pedormed? Availade Prior to Completion NaWral ^ Homaide Okice Building, etc. (sPacilVJ 01 Cause of Death? ~ ,,(.~, ^ Yes yr I No ^Yes ^ No ^ Accident ^ Pending Investigation 32d. Time of In Jury 32e. Injury at Work? 32f. If Transpadation Inlury (SpecityJ 32g. Locatan of Injury (SlreeL city I town, stale) (/- ^ Suicide ^ CalO Nol be Determined ^Yes ^ No ^ Diner /Operator ^ Passenger ^ Petlaslnan M Omer ~ Speciy: 33a. Certifier (check only one( 336. Signature and Title of Candler - • Certdying physician (Physician ceniying cause of tleath when another physician has pronouraed death and completed Item 23) ^~J •z,~` `~^ ~ ~ To dte best of my knowledge, death acurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 1_ , ' J - ~1/~~--k • Prorrouncing and cedlfying physician (Physician both pronouncing death and certifying to cause of death) Ta the best of m knowled d th d t th Il d t d l d tl ^ 33c. License Number 33tl. Dale Slgnetl (Monet, tlay, year) y ge, ea occurre a e me, a e, an p ace, an ue to the causes) entl manner as sleted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner I Coroner 1 • l \ 1 ~ 9 ~ ~ r I. ~ ~ {~ g On the basis of examination and I or Investlgetion, in my opinion, death occurretl at the time, date, entl place, and due la Ma wuae(s) and manner as shted_ ^ 34. Name entl Atltlress of Person Who Compleletl Cause of Death Iltem 271 Type I P I 1V~ S H h M di l C ' . . ers ey ca tr. e 35. Registrar s S ure and Disln - ~~ ~ I ~'Z I ~I '~I ~ I ~ I 36. Dat Filed (Month, tlay, year) ~' P' ~rKy ' 1 '~'~ Hershey, PA 17033 / ~~~~ Disposition Permit No. 0228290 LAST WILL AND TESTAMENT gECOIU~ED OFFICE OI' REGISTER OI' `FILLS 200$ JULY 03 CLERK OF ORPH.I~S~ COURT CL~iBERL ~tiD CO•, P I, Ada Mae Margin, of 17 Pen Mar Street, Waynesboro, Franklin County, PA 17268, declare this to be my Last Will and revoke any will previously made by me. I. The expenses of my last illness and funeral shall be paid by my estate. II. If any named beneficiary herein is indebted to me at the time of my death, I release and discharge such indebtedness but direct that such beneficiary's inheritance shall be reduced by the amount of such indebtedness, including any amounts of principal and interest which is due and owing at the time of my death. III. I direct that the residue of my estate be divided into five (5) equal shares and I give to each of the following who survives me the number of shares set forth below: n a ~ ~= A. To Karen Tartaglia, my daughter, one (1) share. - 7 -,~ ~.rc~ ~ c ~=~ B. To Kathy Failor, my daughter, one (1) share. ~; ~~ r ~~ ~;: -T, ~ C . To Alexander Margin, my son, one (1) share . ~,~ ' ,- , r --o --~ ~ ~ ' '-. -- D. To Paula Green, my daughter, one (1) share. o o~ , E. To Allison Donley, my daughter, one (1) share. If any of the above-named beneficiaries fails to survive me, I direct that that beneficiary's share shall descend to that beneficiary's surviving issue, per stirpes. In the event that any of the above-named beneficiaries fails to survive me without issue then surviving, I direct that his or her share be added to the shares of the others in the same proportions they now bear to each other. IV. I further direct that any beneficiary under this Will who has not attained the age of twenty-one (21) years who shall inherit under this my Last Will and Testament shall have his or her share deposited into an account established pursuant to the Pennsylvania Uniform Transfers to Minors Act (or the similar law of the state in which the beneficiary resides at the time of my death). Said account shall have custodian for the beneficiary, the parent of the beneficiary who is a child of mine. In the event the beneficiary has no living parent who is a child of mine, then the beneficiary's surviving parent shall be the substitute custodian of the beneficiary's account. V. All administrative costs, including inheritance taxes, estate taxes and transfer taxes imposed upon my estate passing under my will or otherwise shall be paid out of the principal of my residuary estate. VI. I appoint as Executrix of this my Last Will Karen Tartaglia. In the event an alternate or successor Executrix be required, I appoint as such Allison Donley. I direct that no trustee, executor, guardian or other fiduciary named, nominated, or appointed in this Will shall be required to post any bond or give any security of any type for any purposes whatever. IN WITNESS WHEREOF, I, Ada Mae Margin, the above-named Testatrix, have to this, my Last Will and Testament, set my hand and seal this 7th day of May 2004. ~~ ~~.. ~~--- Ada Mae Margin SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her will, in the presence of us, who at her request, in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. ~ j ~~ ~ ~ ~C%t- ~' C~ Address 343-B S. Potomac St. , Waynesboro PA 17268 ,~' ~ (.~ ~~LC~ Address 343-B S. Potomac St., Waynesboro, PA 17268 COMMONWEALTH OF PENNSYLVANIA: :ss COUNTY OF FRANKLIN We, Ada Mae Margin, Cindy Lee Daley and Roxanne o. Martin the Testatrix and the witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~ ~ ~, Ada Mae Margin 1 ___. Witness ~~ ~~~~~~ Witfiess Subscribed, sworn to and subscribed and sworn and Roxanne 0. Martin May 2004. and acknowledged before me by the Testatrix to before me by -Cindy Lee Daley witnesses, this 7th day of ~~ ~ Notary Public COMMONWEAL'T'H Of Pt:NNSYLVANIA Notarial Seal Sharon Darlene Sense, Notary Public Waynesboro Boro, Franklin County My Commission Expires Sept. 26, 200 Member, Pennsylvania Association of Notaries