HomeMy WebLinkAbout09-12-08PETITION FOR PROB~~A~/TE AN.D/ GRANT OF LETTERS
REGISTER OF WILLS OF [ ~/~~G'~%~~N ~ COUNTY, PENNSYLVANIA
Estate of f--~/ / ~- ~J~ ~~t/ ~'!~-/, File Number ~ ~ ~ 0 ~~ \a3
also known as ~ ~ c~ _ , //~ ~, J ~~
,Deceased Social Security Number / ~i (~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CONtPLETE 'A' or 'B' BELOW:)
L~1 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~.. IC.At ~Q~ % ~ ~ ~-~W ~'~~•R-I named in the
last Will of the Decedent dated yl'1Lt y 2.' Z(}iv3 ~ and codicil(s) dated ~': Z3 , 7.V4 7
(State relevant circwnstances, e.g., renunciation, death of executor, etc.J
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
fot• probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(ljapplicable, enter.• c.t.a.; d.b.n.c.t.a.; pendente lire; durante absentia; dairante mtnoritate)
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Petitioner(s) after- a proper search has /have ascertained that Decedent left no Will and was survived by the following s~se~(if any) at~eirs: (!f f~
Adtni,iistration, c. t. a. or d.6.n.c.t.a., enter date of WiU in Section A above and complete list of heirs.) ~ --[~ _ -,- t
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Name Relationshi Residences t- ~ -: d`
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-; 7 :~~
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(CONtPLETE IN ALL CASES:) Attach additional s/Teets if necessary. ~' 0 ~ -~~
Decedent was domiciled at death in C t.~. ~ ~ ~ C unty, Pennsy is with his~er last principal residence at ~ r
S'c~?~t.. rYLr~ tT T7•, /Y)~r r t-S ,c.R S~ • ' ?d .,
(List scree[ address, town/c~ity/, township, coung~, s ate, zip code) ,,/ `'
Decedent, then 7 years of age, died oi~~~ at ~ R ,~ r~.e~/L ~
Decedent at death owned property with estimated values as follows: ~~••~~'GrD
(If domiciled in PA) All personal property $ ~, V 4J fJ
(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: i ~
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:
Signature Ty ed or rioted name and residence
(.` J - L'd-~Pr~~fre-Ri (S ~ ~ r5i G11~d~-i~~1~t~S~
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Fonn RW-0? rev. 10.13.06 Pabe 1 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~cc, WL~PtC C-.~~/~ -_-
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are titre 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.
Signaha-e of Personal Represe~ntive r,r,
d
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Signnture of Persaial Representntive - 3 t~'t _ -%
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For the Register Signnture of Persaral Representative - - _
_ - 1 ~ ..-1'_3
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File Number: a. ~ ~~ ~ ~~ ~
Estate of [ I~ ~'~•-~ /'~ ~~" ~ %"~ ,Deceased
~ ~~
Social Security Number: ~ ~ J "1r r' ~ ~`~ ~~ Date of Death: ~ i ~ ~
AND NOW, >< 1 ~.~~;"~~ ~ ~ ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters
are hereby granted to G t~~g `~ ' ~'J ~ /C~Q.. i
in the above estate
Sworn to or affirmed and subscribed
before rr~e the ~~_ dda~y of
~SLtd.)__._
c
and that the instrument(s) dated J !
described in the Petition be admitted to probate and
FEES
Letters .. ~ r ~U... - $
~.~~ Short Certificate(s) . ~ .... $
Renunciation(s) .......... $
_ ~rt~ ... $ /S
Jc P ... $ ro
~ ... $~~
... $
... $
... $
... $
... $
... $
0
TOTAL .............. $ s~
Form R4V-0? rev. 10.13.0(
as the last Wall (and
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
of Decedent.
Page 2 of 2
lO5.A05 RfsV (01!0?I
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 1454223
Certification Number
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.
d`~ AU6 01 7 08
Local Registrar Date Issued
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IEV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~
4NENTN CERTIFICATE OF DEATH
K INK (See Instructions and examples on reverse)
STATE FILE NUMBER \ U ~ ~~a~
1. Name of Decedent (First, middle, last, sulfx) 2. Sex 3. Serial Security Number 4. Date of Death (MOntR day year)
Lori Jo Canevari emale 193 - 46 -` 3590 Jul 31 2008
5. Age (Last Blnhday) Under t year Under 1 day 6. Date of Binh (Month, day, year) 7. Birthplace (City and stale or for eign coumry) Ba. Place of Death (Check only one)
Manors oaya Haurs kenmes Hospital: Other.
(+ Yrs. ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ~ Residence ^Otner ~ SDeciry.
6b. County of Death &. City, Boro. Twp. of Death 8tl. Facility Name (If not Institution, give street and number) 9. Was Decedent of Hispank Origin? ~] N° ^Ves 70: Race: American Indian. Black, White, ek.
Qf yes, speciy Cuban, (Specity)
Cumberland Mechanicsbur 501 South Market Street Mexicart,PuertoRkan,etc.) White
11. Decedea's Usual Occ tqn Kind of work d one dun most of world Ida. Do rat state retired 12. Was Decedent ever in the 13. Decedent's Education (Specity Doty highest grade compl eted) 14. Marital Status: Martied, Never Married, 15. Surviving Spo use (Ii wife, give maiden namel
Kind of Work Kind of Business I Industry U.S. Annetl Forces? ElemeNary /Secondary (412) College (14 or 5+) Widowed, Divorced (SpecVM
Personell S ecialis De t of Arm ^Yea ®"°
16. Decedent's Melling Address (Street, city I town, slate, zip code) Decedent's Did Decedent
501 South Market Street Actual Residerae 17a. State PPnnay1 van i a Live in a 17c.
^ Ves, Decedent Lived in Twp.
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Mechanicsbur PA 17055 t
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16. father's Name (First middle, last s~xl 19. Mother's Name (Frst, mkatlle, maiden sumeme)
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20a. Informant's Name (Type / PrinQ 20b. Infomtant's Mailing Address (Street, city /town, stale, zip cotle)
e
27 e. Method of Dispositbn ®Cremafion ^ Donation 21b. Date of Disposi¢on (Monm, day, year) 21 c. Place of DisposMiw (Name a cemetery, crematory a other pace) 21 tl. Location (City I town, state. zip cotlel
^ Burial ^ Removal from State ,i Was Cremmbn a Donaton Aumorized ,_,(
^ Other ~ Specti/y: by Medcal Ezeminer 1 Coroner? C!J Yes ^ No
22a. ~ of unerel nice Ucensee (a person acting as such) 22b. License Number 22c. Name and Address of fadlity
Auer Memorial Home and,Cremation Services, Inc.
- FD 013376 - L 4100 Jonestown Road Harrisbur PA 1710
e ems 23ac Day dilyirg tated. (Signalwe and title)
23e. To the best o/ my knowledge, death occ al dte time, date and
pac
e s 23b. Ucense Number 23c. Date Signed (Month, day, year)
physician n not available al time of death to n
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nnn
/A 1 1 ~ 3S ~ ~
ceniry cause of deem.
, ` , / ~t a on
Items 21-2fi must ere completed by person 24. Time of Death .Date Pronamced Dead (Monm, day, year) 26. Was Case Refened to Medical Examiner I Coroner fora eason r Than Crem ion or Donation?
who Praaunces deem. ~ . SD P N1' (s ~ a ~ v 8 ^ Yes ~
CAUSE OF DEATH (See tnalruetlona a exam s) r Approximate interval: Pan II'. Enter Diner lgnificant caidilions comnbutmo to death, 26. Did Tobago Use Conttlbae to Deelh?
hem 27. Pan I: Enter the chain of events -diseases, Injuries, or complkalions -that directly caused the deem. DO NOT enter temanal events such as caroYac arrest, s Onset L° Deam but not resuamg in the undenying cause given in Part I. [] Yes ^ Probabry
respirelory arrest, a ventricular fibrillaaon wdlwta showing M¢ etiology. List only one cause on each line. t
~ No ^ Unknown
'
IMMEDUITE CAUSE IFinal disease or
~ 29. If Female.
,
mndilion resuting in Beam) a. ^
Due to (or as a consequence °Q: i
SequentalN Us! wnditions, if any, b. t
~ Not pregnant within past year
^ Pregnant at lime of death
leading to the cause listed on Ime a.
Enter me UNDERLYING CAUSE Due to (or as a correequence op: ^ Nol pregnant, but pregnant within 42 tlays
(disease a injury mat mNated the c t
m death) LAST
events resultin
of death
g
. Dve to (or as a consequence oQ: i ^ Not pregnant, but pregnant 43 days to 1 year
d ~ before deaM
^ Unknown it pmgnant within Ina past year
30a. Wes an Autopsy 30b. Were Autopsy Finangs 31. Manner of Deam 32a. Dale of Injury (Month, day, year) 32h. Describe Fbw Injury Occurred 32c. PWce of Injury: Home, Fame, S1reeL Faaory,
Periomted? Available Prior to Completion t~•
Natural ^ Homictide Ollke Building, etc. (Specity)
of Cause a Deam?
^ Yes ~ No ^ Yes ^ No ^ Accakm ^ Peno9ng Inveskgatron 32d. Tone of Iryury 32e. Injury at Wode? 321. II Trensportation Inryry (Specity) 32g. Location of Injury (S1ree1, city I town, state)
^ Sukide ^ Could Nol be Detertnirred ^ Yes ^ No ^ Dover / Operetor ^ Passenger ^Pedestnan
M Other - Spealy:
33a. Ceriifier~~ PhYslc e)n (Pn N P
• rR ystcran cam ing catse of death when anomer hystolan has pronouraed deaM antl completed ttem 23) . SignaWr¢~n~ ^of Cenif~c L1 r~ L.~"" /A-~~-~
.
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To the beat a mY knowledge, death occurred due to the cause(s) and manner as sMted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
_ _ _ _ _ _ _ _ _ _ _ _ _ __ _ -
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• Pronounang r!M cenHying physician (Physician bah pronounang deem and certifyktg to cause of death)
^ 33c. License Number 33tl. Dale Signed (Manor, day, year)
To tM beet a my knowledge, death occured at the ttme, date, and place, end due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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oroner
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On the bests a ezamiwtlon and / or investigation. in my opinion, death occurred al the time, date, and place, and due to the cause(s) antl manrcer as staterL ^
on Who Compbtetl Cause of DeaN (Item 27) Type !Prim
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v nsrvs;rnpenndhb, 0228531
LAST WILL AND TESTAMENT
OF
LORI JO CANEVARI
I, LORI JO CANEVARI, having my legal residence at 501 South Market Street,
Mechanicsburg, Cumberland County, Pennsylvania, hereby declare this to be my Last Will and
Testament, revoking all other Wills and Codicils heretofore made by me.
~.~
~~
ARTICLE ONE ~ ~~ ~ ~~ ~~=`
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I declare that I am married to GILBERT J. CANEVARI, II (my "spouse"). , , ~ ~a T
_-
ARTICLE TWO - c:~ ~~ ~' <~'
crY ..,
I have one child whose name and birth date is as follows:
NAMES BIRTH DATES
JOHN GILBERT CANEVARI May 26, 1992
Any references in this document to my descendants are to this child and his descendants.
ARTICLE THREE
I direct the payment from my estate of the expenses of my last illness and funeral as soon
after my death as conveniently may be done.
ARTICLE FOUR
I direct that all estate, inheritance and other taxes in the nature thereof, together with any
interest and penalties thereon, becoming payable because of my death with respect to the property
constituting my gross estate for death tax purposes, whether or not such property passes under this
Will, shall be paid from the principal of my residuary estate, and no person receiving or having a
beneficial interest in any such property, whether under this Will or otherwise, shall at any time be
required to contribute to or refund any part thereof; provided, however, that this direction shall not
apply to the taxes on any property included in my estate solely because of a power of
appointment thereover which I possess but have not exercised or on any qualified terminable
interest or to any generation-skipping transfer taxes.
ARTICLE FIVE
I intend to leave a memorandum which will direct the distribution of certain items of
tangible personal properly, and I request that my wishes as set forth in said memorandum be
followed. To the extent that my tangible personal property is not disposed of by memorandum, I
give all of the tangible personal property that I own at my death, including any household furniture
and furnishings, automobiles, books, pictures, jewelry, art objects, hobby equipment and
collections, wearing apparel, and other articles of personal and household use, equipment and
ornament, and all insurance thereon to my spouse, provided she survives me by thirty (30) days. If
my spouse fails to survive me by thirty (30) days, I give all such items, in equal shares, to my child
or his descendants, per stirpes, provided they survive me by thirty (30) days, to be divided among
2
them as they are able to agree. If my child and his descendants fail to survive me by thirty (30)
days, or are unable to agree as to distribution, all such items shall be sold and the proceeds
distributed with the residue of my estate.
ARTICLE SIX
I give the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate to my spouse, GILBERT J. CANEVARI, II, provided he survives me by thirty (30) days. If
my spouse fails to survive me by thirty (30) days, I give the rest, residue and remainder of my
estate, to my Trustee, hereinafter named, to be held for the benefit of my child, JOHN GILBERT
CANEVARI, in accordance with the provisions of Article Seven hereunder.
ARTICLE SEVEN
The trust share established in Article Six shall be held, administered and distributed as
follows:
A. My Trustee shall pay to, or apply for the benefit of, my child so much of the net
income and principal of the trust share as my Trustee, in its sole discretion, deems appropriate for
such my child's health, education, maintenance and support, taking into consideration all other
resources available to such beneficiary prior to making such distributions.
B. In making the aforesaid payments for the health, education, maintenance and
support of my child, the Trustee shall give a liberal interpretation to the discretionary authority
conferred by this Will.
3
C. The Trustee shall distribute the Trust to my child as follows:
1. Upon the attainment of the age of 21 years, the Trustee shall distribute 25%
of the remaining assets of the Trust.
2. Upon the attainment of the age of 25 years, the Trustee shall distribute 50%
of the remaining assets of the Trust.
3. Upon the attainment of the age of 30 years, the Trust shall terminate and the
Trustee shall distribute to my child the remaining assets of the Trust.
D. If my child dies before the complete distribution of his trust share, such trust share
shall be distributed to his descendants, per stirpes. If my deceased child has no descendants, such
share shall be distributed to my brother, DIRK SUERETH.
ARTICLE EIGHT
If any portion of my estate is distributable to a beneficiary who is then under the age of 25
years, my Executor may distribute that beneficiary's share, without further responsibility, either
directly to that beneficiary, to a qualified individual or trust company designated by my Executor as
custodian for that beneficiary under an applicable Uniform Transfers to Minors Act or similar law,
or to the individual having personal custody of that beneficiary (whether or not court-appointed),
and the receipt of the distributee shall. discharge my Executor.
ARTICLE NINE
No beneficiary or remainderman under this Will or any codicil hereto or any trust created
hereunder shall have any right to alienate, encumber or hypothecate his or her interest in this Will or
any trust created hereunder in any manner, nor shall any interest of any beneficiary or
4
remainderman be subject to claims of his or her creditors or liable to attachment, execution or other
process of law.
ARTICLE TEN
Should the payment of expenses, claims and taxes from any Qualified Retirement Plan or
Individual Retirement Account ("IRA") assets which comprise my estate cause my estate to be
disqualified as a "Qualified Beneficiary," it is my intent, and I hereby direct that, to the extent
practicable, no expenses, claims and taxes shall be paid from such Qualified Retirement Plan or
IRA assets.
ARTICLE ELEVEN
I hereby appoint my brother, DIRK SUERETH, as Trustee of any Trust created under my
Will.
ARTICLE TWELVE
I appoint my husband, GILBERT J. CANEVARI, II, as Executor of my Will. If he is
unable or unwilling to serve, I appoint my brother, DIRK SUERETH, as Executor of my Will. I
give to my Executor and Trustee, in addition to and not in limitation of the powers given by Iaw or
by other provisions of this Will, the following powers with respect to settlement of my estate to be
exercised from time to time in the discretion of my Executor or Trustee, without further order or
license of the Register of Wills or of any court:
5
1. To retain any property, pending distribution hereunder, to invest in or purchase any
property without restriction to Iegal investments for fiduciaries, to distribute property in kind, to
compromise claims, and to sell any property at public or private sale;
2. To borrow money from any person including any fiduciary acting hereunder, and to
mortgage or pledge any real or personal property;
3. To engage in litigation and compromise, arbitrate or abandon claims;
4. To make distributions in cash, or in kind at current values, or partly in each,
allocating specific assets to particular distributees on a non-prorata basis, and for such purposes to
make reasonable determinations of current values;
5. To make elections, decisions, concessions and settlements in connection with all
income, estate, inheritance, gift or other tax returns and the payment of such taxes, without
obligation to adjust the distributive share of income or principal of any person affected thereby;
6. To invest and reinvest in every kind of property and investment which persons of
prudence, discretion and intelligence acquire for their own accounts;
7. To manage, control, repair and improve alI real property;
8. To procure and carry at the expense of the estate insurance of the kinds, forms and
amounts deemed advisable by the Executor or Trustee to protect the Executor and Trustee and the
estate against any hazard;
9. To pay all taxes, assessments, fees of the Executor and Trustee and all other
expenses incurred in the collection, care, administration and protection of the estate;
10. To exercise such powers, herein conferred, after the termination of the trust estate
until final distribution of the estate assets; and
6
11. To do all the acts, to take all the proceedings, and to exercise all the rights, powers
and privileges which an absolute owner of the property would have, subject always to the discharge
of their fiduciary obligations; the enumeration of certain powers in this Will shall not limit the
general or implied powers of the Executor or Trustee; the Executor and Trustee shall have all
additional powers that may now or hereafter be conferred on them by law or that may be necessary
to enable the Executor or Trustee to administer the estate in accordance with the provisions of this
Will, subject to any limitations specified in this Will.
No bond shall be required of airy fiduciary hereunder in any jurisdiction. No fiduciary
hereunder shall have any liability for any mistake or error of judgment made in good faith.
My Executor and Trustee shall receive reasonable compensation for services performed as
determined by the court in which this Will is admitted to probate.
ARTICLE FOURTEEN
I realize that the Executor is given discretion by law to make various elections which affect
the income and estate taxes payable by estates and beneficiaries, as well as the relative shares of
beneficiaries, such as taking administration expenses as deductions for either estate or income tax
purposes, selecting options for the payment of employee death benefits, electing to take a qualified
terminable interest as part of the marital deduction, selecting alternate valuation dates, postponing
the payment of taxes, filing joint income tax or gift tax returns and redeeming corporate stock. The
decisions made by my fiduciaries in any of these matters shall be binding upon, and not subject to
question by, any affected persons. I rely upon my fiduciaries to take into consideration the total
7
income and estate taxes payable by reason of their decisions including those payable by my
survivors, and they are authorized in their discretion, but not required, to make adjustments between
income and principal as a result thereof.
IN WITNESS WHEREOF, I have this ~wday of May, 2007, set my hand and seal to this
Will, consisting of eight (8) pages.
._%~ i"
~~ ~~
JO CAt VARI
SIGNED, SEALED, PUBLISHED and DECLARED by LORI JO CANEVARI, the above
named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request
and in her presence, and in the presence of each other, have hereunto subscribed our names as
witnesses.
VI-~I ~~- Residence ~ ~
Residence
8
t~'I~Ghani~.~s~u~ta ~~-
MEMORANDITM TO THE LAST WILL AND TESTAMENT OF
LORI JO CANEVARI
It is my desire that the items listed below be distributed in-kind to the individuals whose
name or names appear opposite the items listed:
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DATE '~~ ~ ~G`
L Rf JO C ~~~ARI
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OATH OF NON-SUBSCRIBING WITNESS(ES)
JJREGI~TER OF WILLS
GC,l./'(~.~ ~ ~W~ COUNTY, PENNSYLVANIA
Estate of
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/'a' ~-- yC.~' / ~ ' ~~- ~Ul~' j~ ~ and ~"~i~-~' ~ K- s
(each b ing duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with L-o1'~-/ ~ 1L~ ~P ~G-~ 1' and am/are familiar
with the handwriting and signature of the decedent, and that the signature of LORD ~U C'iU-~ ~/~ r
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~,v ~-~` /o ~unl ~wR.`
~~
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is in his/her own proper handwriting.
(Signatu~'~J
(Street Address)
~,,..~ ~T l ~ Y v ~
(Cit~(f State; Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before rr~e,this ~a day
~~ Ir'IiIL.Lt~~ ~ t ~.CJ(J~
Deputy fdr Regist~ of Wills
(Signature)
Form RW-04 rev. IO.13.06