HomeMy WebLinkAbout09-22-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Angeles Fernandez Greene File Number ,~ 1- 0 S - 09~ 7~
also known as A 6G-'GCs ~' l"RE,E/li.~
Deceased Social Security Number ~ " _~~?
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 Petitioner(s) is /are the named in the
last Will of the Decedent dated and wdicil(s) dated
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rate relevant circwnstances, e. renunciation, death o executor, etc. ` ; ~ ~ ' ? i t'-'
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of t~met~) offjie~l , ~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
® B. Grant of Letters of Administration
NO Surviving Spouse (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; dutlAlte inoritate) •• ~ -
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Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any)~d 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.)
Deceased son Richard Chotas died without souse or issue on 11 27
Name Relationship .Residence
Elliott Chotas I son 1175 Stiles Drive, Marysville,PA 17053
*only child of deceased son Michael Patrick Greene (D.O.D. 1/7/79)
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
8 Round Hill Road East Pennsboro Townshio Camo Hill Cumberland Countv PA 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then 89 years of age, died on July 16, 2008 at her residence in East Pennsboro Township
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 68,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 150,000.00
situated as follows: 8 Round Hill Road, East Pennsboro Township
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:
Si tore T d or tinted name and residence
r
Elliott Chotas
175 Stiles Drive, Marysville, PA 17053
Form RW-02 rev. 10.13.06 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF C.tiarn ber la n
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 and subscribed
before me the ~~ day of
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For Register
of Persona! Representative
Signature of Personal Representative ~ r,>
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Signature of Personal Representative ; ~ n ~~
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File Number:
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Estate of Angeles Fernandez Greene ,Deceased
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Social Security Number: Date of Death:
AND NOW, . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters
are hereby granted to
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 (and Codicil(s)) of Decedent.
FEES
Letters ............... $ J-r ~o • cx~ Register of Wills
Short Certificate(s) ........ $ 12. - OCR Attorney Signature: ~ ~ '
Renunciation(s) .......... $ 5 • CEO
J~ $ i O UO Attorney Name: Terrence J. Kerwin, Esquire
~~'~'~c-t~ c~'1 ... $ 5 - C7~ Supreme Court I.D. No.: 29922
' ' $ 27 North Front Street
$ Address:
.. , $ Harrisburg, PA 17101
... $
... $
• • • $ Telephone: 717-238-4765
... $
TOTAL .............. $ .0U 0~
Form RW-02 rev. 10.13.06 Page 2 of 2
105.805 REV (01/07)
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 14541636
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 Registraz, The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
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Local Registrar Date Issued
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REV 11f2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 3- O '"~~-~
,IUiE " CERTIFICATE OF DEATH lI3
CK INK (See instructions and examples on reverse) STATE FILE NUMBER
1. Name d Demdenl IFasl, middle, lest, sulRx) 2. Sex 3. Sodel Security Nrmher 4. Date d Deets IMmm, day, year)
An ales F. Greene emale 460 - 66~-3096 07-16-2008
S. Age (feet &rmdey) under t year fader 7 8. Date d Bits (Month. d ,rear) 7. &Mplece ( end Bleb «faralpl country) W. Plerp d Dwm (check ony one)
89 paww dew razz taivae HmDad: Omar
Yra. 03-01-1919 San Juan , P . R . ^ mpetlent ^ ER / Outpatient ^ DOA ^ Nursing Home ®Residertce ^OMer Specify
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Bb. Ccunry of Death Sc. City, Bono, Twp. d Deem 8d. Faddy Name (II Ipt batiMlan, gNe wheal and number) 9. Wes Decetlenl of Hbpank Origin? ^ Nc ~ Ves 10. Race: American Indian, Black, Whib, etc.
Cumberland
E. Pennsboro Trap.
8 Round Hill Rd. (II yea, apacNy Cuban,
Mexlcan,PaerbRx;en,etc.) ISpedM
S nish
11. DecednYS Uewl tlon KM d work d om moat d ~ file. Do not ebb re 72. Wee Decedent ever in the 13.Oemdanl'a Educelbn (Seedy my hgWd grade mrtpl detl) 14. Medbl Slelue: Married, Never Mamed, 15. Survwktg Spo use III wile, gNe maiden nemej
Kind d Work Ipd of Bminws / IMwtry U.S. Armed Forme? Elementary! Secondary (U12) Colbge (1 ~ « St) Wdowed, Divormd (Specify)
- Social Worker ortmonwealth PA ^Yw ~No 4 Widowed
- ,e.Qema~raMaBr~g ( /town,aate,dPmde)
~ DeaedenYe °1dD~'em y~(-~, E. Pennsboro
PA Live Ina , 7c
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Decedent lived in Tw
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1 B. Femar'9 Name IFeet, mdde, bd, edtlx) 19. Momere Name 1~ mdde, madw aumeme)
Gumerzindo Fernandez Josefa Alonso
20e. IMOnnerlYS Name (type / PrM) ~ 20h. IMmronl's Mating Addrem (Shed, ctlY /town, slate, nD mdel
Elliott Chotas 175 Stiles Dr., Marysville, PA 17053
21a. Mafhod d gepmdion ^ Crelmaal ^ Donetlon 21b. Date d DrepoelUat (Mmm, day, year) 21a Plece d Dlepodlian (Name d mmelery, «em-tory «dhar pain) zte. L«ation (Gy / tovm, stete.:IP code)
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- 226. Furrelservim ) 22b.UmmeNunber 22c.NUneardAdkwedFadNry ers- roar unera Ome
. ~ 014819 L 1903 Market St. Hill PA 17011
Ibrrp 23ac ody when cedtlykp 23a. To iW best of my knaterlge, main occ«rod at me Ikm, deb and Pbce spied. ISigneMe and ttlle) 23b. Licerlw Number 23c. Date Signed (Mmlh, day, year)
ptiyeidan s rid evailede el Mme d dwm to
~_ mntlY mane d deem.
Ibme 2426 mint W mmplN-tl by parean 2d. Time of Deem 25. Dale Pronaawed Deed (. ~y~ Ymr) 26. Was Case Referred to MeduMl Examiner / Cararer for a Reason Other then Cremation «Donation?
' wnopralaaxwewm ~ /~ M. Jul 16 2008 ^Yw ®"°
CAUSE OF DEATH (SSS Inesrucdats end examples) r Approxkrele kdervel: Pad II: Enter other 28.Od Tobeao Use Conldbute to Deem?
Nem 27. Pan I: Ent« tlp mBID.0ld11~la -diswsw, Injuries, a canDkcMions -mat drectly mmad me deem. DO NOT solar terminal evade sots es mrdiec arrest, r Ousel to Deem Wt not reaultlng h the uMedying muse given in Pan I. ~ Yes ^ Pmbedy
reepirebrY erred, « ventricukr fibaaam wimwd ehowklg me elbbgy. Lid ony one wipe m each km.
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DA DUKE CAUSE Feel disease « r
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29. If Female:
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D ( cent ^ Not pregnenL bW pregnam within 42 days
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Due to «ae a Can9egrlenm o0: ^ Na pregnenl, but pregnant 43 says l0 1 ywr
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age. Ww en ANOtpy
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b 30b. Were Aubpey Findrlgs
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^ Yet ~ No ^ Yw ^ No ^ Aaxbnl ^ Pruding Inveatlgaaon 32d. Tmp d Injury 32e. injury d Wark? 321. If Tremp«IaHon Inury ISlpcfi'I 32g. Lomllon d Inlury (SIree6 dry /town. state)
^ Suidde ^ Coub Not W Determined ^ Yw ^ No ^ Diner I Op«ala ^ Paaeerger ^Pemslnan
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33e. Cer6fpr (fired any one) 33h. Sgm aM Title d
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• CeNlying phyalclan (Physiden ceNlying cause d dexm when another physidan hw Pronowlced deem and Cmyleled Item 23)
To rile Wet d my knowledge, death occurred due to the tame(s) and manner w aleted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~
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• Prorwundng and rprNfying phYeklen (Physiden both pronouncing dwm aM cerlityMg la muse of deem)
To IW Wet d my Nnowledga, dwm xamed at me time, date, antl pleas, and due to the cause(s) aM manner ea sbled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• kkdcal ExaminerlC«onx 33c. Licen W r ~
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gsgosilbn Permit No.
Sep 17 OB 03:27p
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RENUNCIATIO~1
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1ZEG1S'1'Elt OF W t LLS ~ =~ ~ > ~ ~ --
CUMBERLAND COUNTY, PENNSYLVANIA ~~ ~ c~ `~='
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Estate of
ANGELES FERNANDF.Z GREENE Deceased
I, CHRYSANTI-TE OF LQS ANGELES CHOTAS BAKER , in,t,y capacity/relationship as
(Pruu Nana)
dautzhtcr of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
!~LLIU'1"[' C;HU'1~Aa, son of the above Decedent
~~
Executed iii Register's O,~`ice
Sworn to or affirmed and subscribed
before me tbis day
oY ,
Deputy £oc Register of Wills
,x~~~
4683 Ba ue Drive
(srcer ~aeirc.)
Santa Maria, CA 93455
(City. Sam, Zip)
Executed out of,Register's Office
Before the undersigined personally appeared the
patty executing this renunciation and certified
dust he or she executed the rcnuncirttioe for the
purposes stated within on this day
of ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other olTieial qualifkd to
admintata oaths. Show date ofexpiration of Ngary's (:etnmat3tott.)
Form RW-06 nv. l b.13.Od
CALIFORNIA JURAT WITH AFFIANT STATEMENT
^ See Attached Document (Notary to cross out lines 1-6 below)
^ See Statement Below (Lines 1-5 to be completed only by document signer[s], not Notary)
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Signature of Document Signer No. 1 Signature of Document Signer No. 2 (N any) lt,~
State of California
County of ~C.+.r-~ ~J0.fC~..
CARO! ROlLES
CommMfbn # 177790
tdotaq- iwaic - ~a~omo
•onto tto>tboro COU1My •
Conn Nov
Place Notary Seal Above
Subscribed and sworn to (or affirmed) before me on this
__1 q day of ~~~~ 4-em hem , 20~, by
Date Mon Year
Name of Signer
proved to me on the basis of satisfactory evidence
to be the person who appeared before me (.) (,)
(~
(2) ,
Name of Signer
proved to me on the basis of satisfactory evidence
to be the person o peared before me.)
Signature
Signature of Notary Public
OPTIONAL
Though the information below is not required by law, it may prove
valuable to persons relying on the document and could prevent
fraudulent removal and reattachment of this form to another document.
Further Description of Any Attached Document
Title or Type of Document:~i~/~ UnC..,/G~J ~fM~
Document Date: ~~~ Number of Pages: ~_
Signer(s) Other Than Named Above:
• •
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®2007 National Notary Association • 9350 De Soto Ave., P.O. Box 2402 • Chatsworth, CA 91313.2402 • www.NaUOnalNOtary.org Item #5910 Reorder: Call Tdl-Free 1-800-876-6827