HomeMy WebLinkAbout11-25-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
Estate of Donna M. Pursley
also known as
Deceased
File Number ~~ G ~ t ~~
Social Security Number 209-16-6027
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' OR 'B' BELOW:)
^X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ExeCUtrlX named in the
last Will of the Decedent dated 10/16/1998 and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death 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
(If applicable, enter: c. t.a.,~ d.b.n.c.t.a.,~ pendente liter durante absentia; durante mrnoritate)
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 date of Will in Section A above and complete list of heirs.)
Decedent, then 82 years of age, died on 11/16/2008 at Manor Care
1700 Market Street Camp Hill PA 17011
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
4902 Carlisle Pike, Mechanicsburg, PA 17050
situated as follows:
g 200.000.00
TOTAL $200,000.00
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 Typed or printed name and residence
'~'~~Gc.~~j ~1 ~~~~/~,~~ ~
f Karen Andreoli 505 Barbara Drive
Mechanicsbur PA 17050
FoYm nw-oz rev. to. X3.06 Page 1 of 2
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. -_ ~ -~
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with his /her last princj¢~al residence at
4902 Carlisle Pike Mechanicsbura PA 17050 Camo Hill Borough
(List street nddress, town/city. township, county, state, zip code)
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 er affirmed and subscribed
before ~r~e the ~S ' day of
~~ V~~~ ~~>g~
For the Register
Signature of Personal Representative ' 7~ "-'
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Signature of Personal Representative -~}
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File Number: ~ t ~?~ , ~1
Estate of Donna M. Pursley Deceased
Social Security Number: 209-16-6027 Date of Death: 11 /16/2008
AND NOW, (~~s~k~~ ~~ ~6 ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that LettersTestamentarv
are hereby granted to Karen Andreoli
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 Codici,}(s)) of Decedent
FEES
Letters .....~~~~... $ ~lon
c
Short Certificate(s) ...~..... $ ~~
Renunciation(s) ..••..••........ $
.... $
.... $
.... $
.... $
.... $
TOTAL ........................
$ 3101
Regl o Will//s
Attorney Signature: C~
Attorney Name: Gerald J. Shekletski. Esq.
Supreme Court I.D. No.: 40486
Address: 414 Bridge Street
New Cumberland
PA 17070
Telephone: 717-774-7435
l•br,n Rw-oz rev- 10.13.06 Page 2 of t
105.805 kE~' t(N!(17 r
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNirJG: It is i(legai to duplicate this copy ~y photostat or photograph.
Fee for this certificate, 56.00
_ P ~.480~7~1
Certification Number
REV tv2oo6 COMMONWEALTH OF PENNSVLVAN(A • DEPARTMENT OF HEALTH • VITAL RECORDS
AANENTN CERTIFICATE OF DEATH
cK INK (See instructions and examples on reverse)
STATE FILE NUMBER
This is to c:ertifv that the. information here given is
con~ectly copied from an original Certificate of Death
dui} filed Keith nee a, Local Registrar. The original
certificate Gilt he for~~~:~_rded to the State Vital
ue~t„~d~ ulfiLe ftn~;~~mailcnl filing~OV 1 9 2008
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)..,Deal f2ez istr~r; Date Issued
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t. Name of Decedent (First. middle, teal sutliz) 2. Sez 3. Social Security Number 4. Dale of Death (Month, day, year)
Donna M. Pursley female 209 -16-6027 Nov. 16, 2008
5. Age (Lass Bjnhtlay) Under 1 year Under 1 tlay 6. Date of Birth (Month, tlay, year) 7. Birthplace (City and state or foreign country) 8e. Place of Death (check only one)
Monlns Days Hours Mlnrile5 HUapllal: Other'.
82 Jan. 13, 1926 Towanda, PA
Vrs. ^ Inpatient ^ ER /Outpatient ^ DOA Nursing Home ^ Residence ^Other ~ Specity.
Bb. County of Death &. City. eoro, Twp. of Death Bd. Facility Name (If not Institutlon, give street and number) 9. Was Decedent of Hispanic Origin? No ^Ves t0. Race. American Indian, Black, While, etc.
Cumberland
Camp Hill
Manor Care (II yes, specify Cuban,
MexmanPuennRican,efcl (Sueoity)
white
11. Decetlent's Usual Occu Ibn Kind of work D one B urin most of workin tile. Da not state retire I2. Was Decedent ever M the 13. Decedent's Education (Specify only highest gratle compl eletl) 14. Marital Slalus: Married, Never Married, f 5. Surviving Spo use (II wife, give maitlen Hamel
Klntl of Work Klnd of Business I Industry U.S. Armed Forces? Elementary I Secontlary (0-12) College (1-4 or 5.) Widowed, Divorced (Specify,
^vea 12 4 widowed
76. Decedent's Mailing Adtlress (SlreeL cAy i town, stele, zip tale) Decedents Did Decadent
Pennsylvania Live in a 17
A
id
17
Stat
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PMB 224,4902 Carlisle Pike ua
ence
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ent L
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Townahlp?
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Ne,Decadentr~edwithin Cam Hi11
„hcognry Cumberland
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Mechanicsbur PA 17050 AdaalGmihet
cirylBnrn
7B. Father's Name (First, mitltlle, last, suffix) 19. Mother's Name (First, mitltlle, maitlen surname)
David McNeal Alberta Allen
2i)a. Intonnant's Name (Type! Print) 2gb. Informant's Mailing Address (Street, city I town, stale, zip code)
Karen Andreoli 505 Barbara Dr., Mechanicsburg, PA 17050
21 a. Method of Disposition ^ Cremation ^ Donation 21b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 2t d. Location (City I town, stale, zip code)
}~Gpl Burial ^ Removal from Slate j Was Cremation or Donation Authorized
^
• Nov . 21 , 2 0 0 8 R o 11 i n g Green Cemetery Camp H i 11 , P A 1 7 01 1
^ Other. Spsdry i by Medical Examiner I Coraner7
Yes ^ No
22a. tureW Fwrerel S ice Licensee (or person acting as such) 22h. License Number 22c, Name and Atldrass of Facility
C
F -013163-L
M s elman FHSCS,324 Hummel Av=_.,Lemoyne, PA 17043
m ems 23ac Dory when cenityiry 2 Tot s~'Of my knowletlge, death Deco ~ tlme, date and place stated, (Signatuze hl ~/:,
` 23 License Numher
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' 23c. Date Signed (Moron, day, year)
physidan U not available at time of death to / ~
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Items 2446 must be completed by person 24. Time of Death
~ ' 26 Dot Pronou ed Deed (MOnM, day, year)
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~ V 26. Was Case Referred to Medical Examiner I Coroner for a Reason Other than emotion or Donation?
who pronouroes death.
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1 ~/ ~ PV ^Ves ^ No
CAUSE OF DEATH (See Instructions and examples) t Approximate interval: Pan IC Enter other Significant conditions conMbu6ne to death, 26. Did Tobacco Use Contribute to Deatn7
Item 27. Pan r. Enter the cna n of events -diseases, injures, or complkations -that directly caused the death. DO NOT enter terminal events such as cartliac arest. r Onset t0 Death but not resuAing in the undenyirg cause given in Part I. ^ Yes ^ Prohahly
respiratory arrest, or venmcular fibrillation without showing me etiology. List only one cause on each line. 1
/
Y
„~No ^ Unknown
IMMEDIATE CAUSE (Foal tlisease or I ,J
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corMrticn resulting in death) _' a. /~ ~ UI ~. l~ti~ V n i L I r l,' ~ (,~~ I ~ - G~ L ~~G/~ r ~ ~~ I I V 11T )
1
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29 If Female.
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Due to (or as a consequence ~'. NOt pregnant wohln Oast year
SequenliattY fist conddions, it any. b ~ ~ ~~ ^ Pregnant al time of death
leadingg to thhe rouse listed on line a. r
Due to (or as a consequence oQ: Not r g y
p egnanl, but pre rant within 42 da s
t
Enter me UNDERLYING CAUSE ~ of death
(disease or injury that initiated me g t
d
th) LAST
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.
events resu
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Due to (or as a consequence oQ: t f I ~ ^ Not pregnam, but pregnant 43 days to t year
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~ before death
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11 ^ Unknown if pregnant within the past year
3tle. Was an Autopsy 30h. Were Autopsy Fiodings 31. Manner of Deslh 32a. Data of Injury (Month, tlay, year) 320. Descrbe How Injury Oa:urted 32c. Place of Injury: Home, Farm, Street, Factory,
Pedortned? Availahle Prior to Completim Otlice Builtling, etc. (Specify)
of Cause of Deam? Natural ^ Homicide
1
~ ^ Accident ^ Pestling Investigation 32d. 7ene of Injury 32e. Injury at Work? 32f. II Tmnsponaeon Injury jSpeafyl 32g. Location of Injury (Street, city /town, state)
No
^ Yes /( j
(- ^ Yes ^ No
^ Suicide ^ Caltl Na be Determined
^ Yes ^ No
^ Dover /Operator ^ Passenger ^ Petlestnan
M ^Other - Specrly
33e. CertiYeer (check ony one) 33b. Signature and rtle of Ceniher. ~ ~
• Certdying physician (Physician certirying cause of tleam when another physidan has pronounced deem and mmpletetl Item 23)
To the best al my knowedge, death occunetl due to the causete) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ,- - !, - ~J __ I
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• Pronouncing arM cerlifying physician (Physician both pronouncing death antl cenilying to cause of death)
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^ icense Number 33tl. Date Igned (Month, tlay, year( '
e
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To the beat of my knowledge, deem accurted at the tlme, date, and place, and due to the cause(s) and manner as sta
• Medical Examiner/Coroner r
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On the basis of examination and I or investigation, in my opinion, death occurred et the time, date, and place, and due to the cause(s) and manner az sWterL ^ :
.
34 Name and tltlress of Pe/son Wno Completed Ca se of Deatry (Item 27) Type I Print ,~.
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nicnnsition Permit No.
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LAST WILL AND TESTAMENT ~-eC~ ~=~-~
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OF ^' ~~ ~'
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DONNA M. PURSLEY -~ f~
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I, DONNA M. PURSLEY, of Lower Allen Township, Cumberland C-aunty,
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 daughter, KAREN ANDREOLI, or her issue, per
stirpes.
ITEM II: Should my daughter, KAREN ANDREOLI, fail to survive me,
and leave no issue, I devise and bequeath all the rest, residue and
remainder of my estate, of every nature and wherever situate, as
follows:
A. One-half thereof to CAMP HILL UNITED METHODIST CHURCH.
B. One-half thereof to BUCKNELL UNIVERSITY.
ITEM III: I appoint my daughter, KAREN ANDREOLI, Executrix of
this my last will. Should my daughter, KAREN ANDREOLI, fail to
qualify or cease to act as Executrix, I appoint PNC BANK, N.A., Execu-
for of this my last will.
ITEM IV: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties
in any jurisdiction.
Page 1 of 3
IN WITNESS WHEREOF, I, DONNA M. PURSLEY, have hereunto set my
/~j ~'
hand and seal this i day of ~(' ~-~~ , 1998.
DONNA M. PURSLEY '
SIGNED, SEALED, PUBLISHED and DECLARED by DONNA M. PURSLEY, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses.
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~W' ~e Address
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Witness Address
COMMONWEALTH OF PENNSYLVANIA:
. SS:
COUNTY OF CUMBERLAND
I, DONNA M. PURSLEY, 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 instru-
ment 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.
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DONNA M. PURSLEY ~,
Sworn to or affirmed to and acknowledged before me by DONNA M.
PURSLEY, the Testatrix, this ~~~~~ day of ~~C.~..~= , 1998.
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Page 2 of 3
COMMONWEALTH OF PENNSYLVANIA
. SS:
COUNTY OF CUMBER ND
We , /,i' ~ ~ _ and ~_-~"c~~xc.~ . ~ ~ t~%%'(~.-~
f
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 more years of age, of sound mind and
under no constraint or undue influence . .~.-!
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'S~ tness
Sworn to or affirmed to and acknowledged before me by
C=~~3r°~!d ~"_ .~~, h~~ l~fskc and C~~ns~{`~nC ~' t-- ~`~ ~ t'~~~ ,
witnesses, this ~ day of ~~1~~~¢--~--~ , 1998.
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Page 3 of 3