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HomeMy WebLinkAbout11-12-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~(i'Yi~(Y~ldf~ COt~1TY", PEi~NSYLVA'vrIA Estate of___~'f ~ f-{x~ If ~~y ss Fi!eNwnber~;~/ ~d /~~~ also known as ~~ Deceased Social Security Number ~J ,3 ,v ~~ - /~ rP~ Petitioner(s), who is/are 13 years of age or older, apply(ies) for: (COtbIPLETE A' or 'B' BEL06P:) A. Probate and Grant of Letters Tes amen_tary and aver that Petitioner(s)~are the L ~'~ Gh 4' ~A ' LiOs/u named in the last Will of the Decedent dated ~ ~ and codicil(s) dated -~- (State relevant circumstances, e.g., renunciation, death oJexecutor, etc,) r.~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executior~of the insttum9~s) offered __ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: .-_ -~ ' ~ ._ ~ -L7 L~ ~ ~ i ^ B. Grant of Letters of Administration k:' ~ ~_ ~ _j (lJapplicable, enter: c.t.a., d. b. n. c. t. a.; pendente lire; durance absentia; dur¢~~nt1/ oritateJ _ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following Sg9t~ (if any) ~herrs..{If ,~~ Adtttinisb•atiott, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ;': r .~ ~1 Name _ Relationship Residence ~ County, Pennsylvania with his /her last principal residence at Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania ~ > ~~ C~dO ~C~ situated as tbllows:~/~ C ,~ y~ QL ~ C ~ ~re~~~- ~h 1`(N~ Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition anc the grant of Letters in the appropriate form to the undersigned: I Signature Typed or printed name and residence ~ 'l 3 O G..A /~€.SA .D~ ~ v~ 9 ~D~ Form RdY-0? rev. 10.13.06 Pflbe I Of 2 (COMPLETE IN ALL CASES':) Attach additional sheets if r:ecessary. - - __~ __.. ~ .,... , ,..r ,.,, ..y C O~ Decedent, then ~ years of age, died on ~('v, at 0 ~- Oath of Personal Representative CO~I~IONbVEALTH OF PENNSYLVANIA SS COUNTY OF ~~{~~,~ING~ "I'he Petitioner(s) above-named swear(s) or affirni(s) that the statements in the foregoing Petition are true and coned 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 affirmeda/n~d subscribed b~ef~o(re me the r r `1 day of ~r~~;, Fer t Register "~~ ~ ~ ~ SignntureojPers nnlRepresentative Signnture of Personal Representative `_ ~ ,,, :_ ~ ` ~ ^ ~ t7 ~ C~ ~ c -, r Signnture oJPersonal Representative 7 _ fV ,, , f -~ '~, ~ j _~, -- ~ _~ -1 .. File Number ~ ~ -~/6 `~ ~ ~ ~ ~ ~ "'- (1~ ,J ~ / ~ Estate of_~~`~r ~(.~ ~(. ~/~ ~~~ ,Deceased Social Security Number: D 33 ~ ~ - 0 ~ ~ ~ Date of Death:~~~~"Y1 ht's ~~ ~ ~~ AND NOW, I ~ De~;,i ~~ 1~luvemh~r aZ~~~ ,Lin consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters E'~I Pl'1~ 1' are hereby granted to in the above estate and that the instrument(s) dated ~C " b,' CS ___ _.-~_-_ described in the Petition be admitted to probate and filed of record as theme l/a~st~Will (and Codicil(s)) of ecedent.\ /, FEES d t.L~S.i. c~~L~ ~ _~~~~:~Gl:~ - ^ L~ Registero(Wi!!s ~ /~ Letters $ t/ Cs, ~ ~ ~ / ~' Short Certificate(s) ...... .. $ ~, ©~ Attorney Signature: Renunciation(s) ........ .. $ ` 1 ! r I ~ • • ' $ i S ~ Attorney Name: C ~-~ • ~ • $ ~~• ~Q Supreme Court LD. No.: fi~ . .. $ ~.~`L $ Address: . .. $ . .. $ . .. $ $ Telephone: . TOTAL ............ .. $ .. $ I (D Funs RW-(ld rev. /0.13.0( Page 2 of 2 HIOSK(LS REV (01/0'1 LOCAL REGISTRAR'S CERTIFICATION ~~F DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. I Fee for this certificate. $6.00 P 14809224_ Certification Number 'This is to certify that the information here given is con•ectly copied from an original Certificate of Death duly fixed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records C)ffice for permanent tiling. NOV 0 7 2008 Local Registrar Date Issued C7 0 _ = 0 -- - - 00 .; _ .~ -~ ~ r f > T~ r- •~ -. _ _ • f'77 '-• ` -, _ - ~7 n _. .? J ~ _ I l ~, I REV 1112006 PRINT IN AANENT CK INK :1 L~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) STf TF FII F NI IMRFR 1. Name of Decedent (Flrsl, mitltlle, last, suflixl 2. Sex 3. Social Security Number 4. Dale of Death (MOnlh, day, year) Alfred V. Weiss male 033 - 09 = 8653 November 3, 2008 5. Aqe (Last Blnntlay) Under 1 year Under t tlay 6. Dale of Binh (Month, day, year) 7. Binhplace (CAy and state or fo reign country) 8a. Place of Death (Check only one) MonUS Days Hors Minutes Hospital. Other: 89 yrs. October 19, 1919 Lawrence, MA ^lnpauenl ^ERlompauent ^DOA ®NUreing Hpme ^Residence ^othen Spepiry. Bb. County of Death Bc. Cny, Bono. Twp. of Death Bd. Fadliry Name (II not insrilulion, pve street and number) 9. Was Decedent of Hispan c Origin? ®No ^Ves 10. Race. American Intlian, Black, White, etc. Cumberland Lower Allen Itap. Uf yes, spedty Guben, (Speci/)q Loyalton of Creekview Mexican,PuenoRlcan,em.) white 11. Decedent's Usual lion Kind of work done tlurin most of workm Ilfe. Do rwl stale retired 12. Was Decedent aver in the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Marred, Never Mametl, 15, Sumving Spouse (If wife, gNe maiden name) Kintl of Work KIrM of Business I Intlusrry U.S. Armed Forces? Elementary /Secondary (0-12) College (1-4 or 5+) Widowed, Dlvorcetl (Specify) Lt. Colonel US Arm ®Yea ^Nn 12 4 widowed 16. DecsNenrs Maiing Address (Slrcet city /town, state, zip code) Decedent's Did Decedent Slate Pennsylvania Lower Allen ActualRaeitlence na ® •• 1100 Grandon Way p . es, Decetlem Lived.n Tw Tow~shP „p Mechanicsbur PA 17050 ivetlwithin ,7bcp~nry Cumberland 77d'^, ~ ' aeL mi g, , a i sol u ci /Bpm ry 18. Earner's Name (First, midde, last, suaix) 19. MoNer's Name (First, mitldle, maitlen surname) John Weiss Anna Wilk 20x. Inlonnanl's Name (Type / Pnnl) 206. Informant's Mailing Atltlress (Street, city /town, slate, zip cotle' Virginia Weiss Evans 430 La Mesa Drive, Poi•tola Valley, CA 94028-7413 21 a. Method of Dapos4ion ^ Cremation ^ Donzlwn 21 b. Dale of Disposition (Month, day, yeaQ 21 c. Place of Dlsposilbn (Name pl cemetery. crematory or other place) 21d. Location (City I sown, state, zip cotle) ® anal ~ Ramovalnpmswta WasCremadonorDOnetlonAuthorizetl ^Np ^ Omer ~ Specify. i by Medical Examiner I Coroner? ^ Yes December 9, 2008 Arlington National Cemetery Arlington, VA 22211 22a. Sigrratureol ~ Licensee (or pemon acting as such) 22b. License Numher 22c. Name and Address a Facility - ~,~~-=+ FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete barns t onry when cersrying 23x. To dte best of my knowledge, death occuned et Ire Time, dale and place staled. (Signature end tiNe) 23b. Lcense Number 23c. Date Signed (Month, tlay, year) pnysxtian is not available at lime of tleaN to ceniry cause a death. Kerns 24-26 muss be competed by person 24. Time of Death ~ 26. Date Pmnwlmced Dead (Month, day, year) 26. Was Case Referred to edlcal Examiner I Coroner for a Reason Other than Cremation or Donation? ~ wtw prgpUnpeS death. ~ ~ L7 M. IVO l.y •7 ~( U O ~ ^ yes [} CAUSE OF DEATH (See Inatruetlons and examples) ~ r Approximate inlervel: Pad II: Enter aher fil9nifiranr contlbions conMbaino to tlearh, 28. Dkl Tobacco Use Contribute to Death? llem 27, Pan I: Enter Vre chain of events - daeases, injuries, or complications -that tl~rectly caused the death. W NOT enter terminal events such as cardiac arrest Onset to Death ha na resubing in rho underlying cause given in Pan I. ^Ves ^ Probably respralory arrest, or ventricular Gbalalron wAhour showing the etiology List onry onto cause on each litre. r IMMEDIATE CAUSE /Final disease or ~ ~ r No ^ Unknown condition resulting in death) _~ ~/ ,.l~7~rtiQe•vt.2. a „(~~1l,~„[.~~ r a a ~ / G~k!~li•~iM'xi '~~+ ~ 29. II emale: DUB to (o s a consequence ofJ: ~ ^ Nat prBgrlanl within pall year Sequentially fist mrldadions, if arty, h ~ leading Ip the cause listed on IMe a ^ Pregnant ar time of death . Enter the UNDERLYING CAUSE Due to for as a consequence oQ: ~ ^ Not pregnant, but pregnant within 42 days ev~Nssresutl~n ry ttlelalhd LASLe U- r p n ) of death Due Io (or as a consequence oQ: , ^ Nol pregnant but pregnam 43 days 101 year d r before death I ^ Unknown if pregnant within the pall year 30x. Was an Autopsy 30b. Were Autopsy Findings 3t Manner of D~pF, 32e. Dale of Injury (Month, day, year) 32h. Descrihe How Inlury Occurretl 32c. Place of Injury: Home, Farm, Streal, Factory. Penom d! Available Prior to Completion ^~N/ etural ^ Homicide Oflice Builtlirlg, etc. (Specify) of Cause of DeaIM ^ Yes No ^Ves ^ No ^ Acotlent ^ Pending Investigation 32d. Tme of Injury 32e. Injury at Work? 321. 11 Trensponarion Injury (Specify) 32g. Localbn of Injury (SIr961, city! town, slate) ^ Suicitle ^ Coultl Nol De Delertnined ^ Yes ^ No ^ Driver /Operator ^ Passenger ^Petlestnan M ^ Other ~ Specify: 33x. Ceaifier (check Doty one) 33b Si nature and Title of Ce " • CeAltying physician (Physidan cenitying cause of tleatn wren another physician has pronouncetl tleath and completed Item 23) ~ /~jf~~ io the best of my krrowletlge, death occurred due to the cause(s) antl manner as staletl_ _ _ _ _ ____________________________ GGG ~/y.~f iPY • Prorwuncing and urtlry4rg physician (Physician bah pronouncing death aid cediying to cauSB of death) To the beat 01 m knowled death occurred al the time e d t d l tl d t th ^ 33c. License Number 33d. Dale Signed (Month, tlay, year) y g , , a e, an p ace, an ue o e cause(s) and manner as sMlatl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . • Medical Examiner 1 Coroner ~ n ~ /~ ~l ~._ r O ' , !/ (/ L ..~ :~L'J f n the Daale a examination and / or investigation, In my opinion, death xcumed at Ne time, date, end place, and due to the cause(s) end manner m stated_ ^ 34 N m f P d Add Wh l f D C d C a e an ress o erson o omp ete ause o eath (Item 27) Type / Pnnl ~ 35. Registrar's Sgnaru Disrncl Num v J - ~ I ~ I ~ I ~`I ~ I I 36. Date F tl (M rh, day, year) ' ~(~ of A G}'sC ~ 1~ fir. J rl ~~~` ~ .;tr.~) rk:c,se y1 ! / ~ ~ a~' ~ „/,e,/JOB , I~ v Disposition Permit No. ,(~ (~ C~~ (Ji ("j LAST WILL AND TESTAMENT OF ALFRED VITOLD WEISS I, ALFRED VITOLD WEISS, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. I am retired from the military service of the United States. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in ;any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: (a) If my daughter, VIRGINIA WEISS EVANS, survives me, to my daughter, or if shy t~s not N c~ ~ _ fir? survive me to my granddaughter, LAURA HOPE EVANS, and any then living isstrp_~f my ~ '? '' daughter, VIRGINIA WEISS EVANS, per stirpes. ' '' - - ~ -~ (b) If no issue of mine survives me, my residuary estate shall be paid and distributed to=fri ~s"sn- ' ~ ~.--, {~.,~ ` ~~? in-law, PHILIP C. EVANS, if he shall survive me. ~,. -. -, ;.z_~ - (c) If none of the beneficiaries described in clauses (a) and (b) above shall survive me, E~~ give ~ ~ '~ my residuary estate to those who would take from me as if I were then ro die with~t a will, ~:. ~~ ~ unmarried and the absolute owner of my residuary estate, and a resident of the Commonwealth of Pennsylvania. THIRD: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executor, at any time and without court authorization, may: distribute the whole or a.ny part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole or any part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or persons with whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution is made shall be a full discharge of my Executor from any liability with respect thereto, even though my Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of twenty-one (21) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article FIFTH hereof. If the ben- eficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. FOURTH: I appoint my daughter, VIRGINIA WEISS EVANS', to be my Executor. If my daughter, VIRGINIA WEISS EVANS shall fail to qualify for any reason as my Executor, or having qualified shall die, resign or cease to act for any reason as my Executor, I appoint my son-in-la~~v, PHILIP C. EVANS as my Executor. I direct that: no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. FIFTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, ar.~d all powers conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to pay any legacy or distribute, divide or partition property in cash or in kind, or partly in kind, and to allocate different kinds of property, r i.__~ disproportionate amou-its of property and undivided interests in property among an}~ parts, funds or shares, and to determine the fair valuation of the property so allocated, with or without regard to tax basis; to determine what property shall receive basis increases pursuant to Section 1022(b) and (c) of the Internal Revenue Code and the amount of such increases and to make such determinations without regard to any duty of impartiality as between different beneficiaries; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executor" wherever used herein shall mean the executors, executor, executrix or administrator in office from time to time. SIXTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. SEVENTH: I have served in the Armed Forces of the United States. I therefore request that my Executor make appropriate inquiries to ascertain whether there are any benefits to which I, my dependents or my heirs may be entitled by virtue of any military affiliation. I specifically request that my Executor consult with a retired affairs officer at the nearest military installation, the Department of Veterans Affairs, and the Social Security Administration. This document was prepared under the authority of 10 U.S.C. § 1044 and implementing military regulations and instructions, by Captain Victoria Ko, U.S. Army, who is licensed to practice law in the State of New York. IN WITNESS WHEREOF, I, ALFRFI~ VITOLD WEISS, sign my name and publish and declare this instrument as my last will and testament this ~` day of February, 2005. ALFRED VITOLD WEISS The foregoing instrument was signed, published and declared by ALFRED VITOLD WEISS, the above-named Testator, to be his last will and testament in our presence, all being present at the same time, and we, at his request and in his presence and in the presence of each other, have subscribed our names as witnesses on the date above written. ~~. /~ ~~ `~ -fir's .~ ..~,~~d~~-- having an address at -~~~ ` ~ having an address at 11~~C~ 2 ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF CUMBERLAND, ss. We, the Testator and the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator, ALFRED VITOLD WEISS, signed and executed said instrument as his last will and testament in the presence and hearing of the witnesses, and that he had signed willingly, and that he executed it as his free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testator, in the presence and hearing of the Testator and each other, signed the will as witness, and that to the best of his or her knowledge the Testator was at the time at least eighteen years of age or emancipated, of sound mind and under no constraint, duress, fraud or undue influence. .,, ALFRED VITOLD WEISS Testator print: GSA 14• !~ Witness ~~ '~. C>~ /1 ~ z~y(,'1 print: 1~ev°) tis ~ 5.~ ~,;~~'. Witness Subscribed, sworn to and acknowledged before me by the said t~I FRED VITOLD WEISS, Testator, and subscribed and sworn to before me by the above-n ~med witnesses, this _~ day of February, 2005. -, v _~- No ary Public ,~ _ My commission expires on ~l~~~- ~~ ~~~ Notarial Seal Betty S. Kistler, Notary Public Carlisle Boro, Cumberland County My Commission Expires May 14, 2005 Mr'fnl~er f'2nn5vsu~rna AScn!'~s4i- ~ rt Nnt~nes