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HomeMy WebLinkAbout02-02-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C (l.M B~2L Ai/1~ COUNTY, PENNSYLVANIA Estate of j ~~ ~ a~~S ~ 1- , /~'~ P O L] File Number r~ I - 1,~'"/ V + ~ I also known as ,Deceased Social Security Number 1 ~~ ~ ~ 33/ 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~ are the ~ ~ ~~ t ~ 1 n / ~ '- named in the last Will of the Decedent dated ~ ~z ~~ ~~ 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: ~~~~""-"' N n f~ C7 B. Grant of Letters of Administration ~ O `~' - (COMPLETE /NALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in ~ ~I' M ~ 412 Z /{- ,t/ ~ County, Pennsylvania with his /her last principal residence at ~3/ b ~~ E ~ D ~-7 ~~ CAMP i-f l 4 L, C J n 13~ L ,~, ,~ ~ C~ v N Ty P fF 1 7 p r l (List street address, town/city, trnvnship, county, state, zip code) r Decedent~hes ~~ ~ year ~ age, died on Z~ 4 at ~ ~ i~l~ l ~ ~ tf dC. Cy /-j D S,~' / 1 /~ ~ }. J- fij r Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ .Z '~ ,;;~ ~ ~ v (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ ~ ~7 ~ J ~ p, O.y e/ Form RW'-02 rev. 10.13.06 P2g@ I Of` 2 (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente hte; durance absentia; d~NTEJminoritat~Jrry Petitioner(s) after a proper search has f have ascertained that Decedent left no Will and was survived by the followin~~if an~nd 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.) ;.; ~~ ~ ~ `~ -' situated as follows: / 3 / tr C~tr Z L ~.- a /L- ~ 1/ ~ C /4 /"r 1 " i~ 1 L. L- vim' ~ ~ 7 r Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Leners in the appropriate form to the undersigned: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~ U M f3 ~ R t.. 1r}- .J ~ 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 affirmedr~and subscribed before me the ~/~~ day of \, f ,• ~^ 7 Signature o ersonal Representative 7 ~~~~ r the r ~a Signature of Personal Representative ~' ca 0 ..a ! ' J ~~ "~ ~- - Signature of Persona! Representative T) r- `~~~ N a:-, , f'7©~ ~ File Number: ~r " (~/ (~~Vy 3~.,,~ ~ I i1 ~~C S ~ f Ctt Estate of Deceased Social Security Number:_T~ ~' ~ ~ Q ' ,L~ ~ ~ ~ Date of Death: ~ I~, AND NOW, n"' ~ ~(..L~in consideration of the foregoing Petition, satisfactory proof having been presented before me, T I ECREED that tters are hereby granted to in the above estate and that the instrument(s) dated 5 ~~.9 ~~~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s))~f Decedent. .,,_ T FEES Letters ............... $ Short Certificate(s) ........ $ - Renunciation(s) .......... $ 1l1(~~ ... $ 5_ ' ... $ ~ .. $ r. ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ Register oT Wills ~j'y Q,~ ~ U C Attorney Signature: ~-~-,...~ ~?~~+w,,,,f.J ~ .!y~ct,,ty-a,.-. Attorney Name: Je~n/N~ M/9~i~~ M`~E~/z~~- +1 y Supreme Court LD. No.: ~ ~~ ~ f7i Address: ~ s. LUt J T S f 7/~ Telephone: L~1 ~ 9 /1 ~ :~ _ (~ ~ 9 Z Form RW-02 rev. 10.!3.06 Page 2 of 2 ~'~~' - G/C~~' LOCAL REGISTRAR'S CERTIFICATION ~~F LEA ~"~ WARNING: It is illegal to duplicate this copy by photostat or photo~r~ ph. I-:C [1) (hl> Ceh1ltlCale. `; ~).OO _.tlp ~,jH ~f p:~ Thl, IS LU Lf'I-I!Iv {hl IIr infor'111t In ;lel'C' ~1Fen lS arty ~Q! _ ---vE/y~~ ~(g1~Ll ~ W(11i)~.{ ~1 lIl] r.'l '.fl lr Inal ~cl ]Ilta(e l)f DCalb rxxo~,' ~ ~A Ltul~ tl.cd with nl 1, i. ull Rcx7~~uu. The ~iri~*inal ~r ,z~ celnhc~u~ ~~11~ I ,,'',,,udec', to (he State Vital ~\oj ~~, a, Kecord~ Offirc '~rl yx~uuanent filing. P 15 0 0 310 5 `~~.9~ ~~~°~ _ - ~~9rMENTOF~~'~,,,, L~~ r~~-- .JAI) 9 20 Certification Number ~~~~~rrr_ ~,~ Local Rc~l~tr-ar Date issued r'..~ ° ~ ~ ~ ~ ^*1 rYt n ~ , ~ ~ -- ~ I , N 7n~ C ~ - r -_ ~7 '~ ~ D _- --; tV ,~I,_I - ~ CJi REV ttnoofi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 1 PRINT'.N MANENT CERTIFICATE OF DEATH ,cK INK (See instructions and examples on reverse) S'~ATE FILE NUMBER 1. Mama of Decedent (First, mi0tlle, last, sutfx) 2. Sex 3. Social Secuflly Number 4. Da' of Death (Hoorn, day, year) Theresa L. Napoli female 195 - 16 T- 3317 (~.r'7L(G~.("7_ ~(G> ~(%( E. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Binh (Month, day, year) 7. Birtlglace (City and slate or fo rei n country) ea. Place of Death (Check only one) n~anlss Days Hours wnwes Hospital: Olney 85 Yrs. Au ust 2 1923 g x Harrisbur PA g x ®Inpatienl ^ ER l0utpaliem []DOA ^ Nursing Home ^ Residence ^Olney -Specify Bb. County of Death 9c. City, Boro, Twp. of Oeath Sd. Facility Name (11 not institution, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^ Yes 10. Race: American Indian, Black, White, etc. Dauphin Harrisburg (II yes, specify Cuban, (SPectyl Harrisburg Hospital Mexkan,PuenpRican,etp) white 11, Decedent's Usual Occ Lion KirW of work done dun moll of world life. Do not state refired 12. Was Decetlenl ever in the 13. Decedent's Education (Specify Dory highest grade completed) 14. Marital Slelus: Married, Never MardeC, 16. Surviving Spouse pf wile, give maiden name) Kind pl Work Kind of Business /Industry U. S. Armed Forces? Elementary / Secrondary (0-12) College (1-d or 5+) Widowed, Divorced (Speci/)7 Supervisor State Government ^ves ®NO 12 never married t6. Decedent's Mailing Address (Slr9el, city I lawn, stare, zip code) Decedent's Dld Decedent Pennsylvania Dve'ma A E l R Pennsbo 1316 Well Drive . ctua esidence na. state ,7p,®vas, Depedem eyed in ro ,w ° Camp Hi 11 PA 17 011 rpwnanip? ,7acpunry Cumberland rid ^ Np.DecedemLrvedwhnm , Anwal Limits pl coy / Bdre 18. Father's Name (First, middle, Iasi, sudlx) 19. Mother's Name (First, middle, maiden surname) Agostino Napoli Filomena Intrer:i 20a. Infomrant's Name (Type I Print) 20b. Informant's Mtiling Address (Slreel. city /lawn, slate, zip code) Raymond F. Napoli 3 Karen Court, Camp Hill, PA 17011 21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Dale of Dispositbn (Month, day, year) 21 c. Place of Dlsposirion (Name of cemetery, crematory or other place) ltd. Location (City i yawn. stale, zip code) ® Burial ^ Removal from Slate WasCrematlonorDOnatlonAUthorized ^ Other ~ Specify: i by Medical Examiner I Coroner? ^ Yes ^ No January 29, 200 Gate of Heaven Cemetery pper Allen Twp. PA 17055 22a. Signature of natal ~ e Lke (or person acting as such) 22b. Liceme Number 22c. Name aM Address of Facility FS 012 849 L Parthemore FH & CS, Inc., P.O. ]3ox 431, New Cumberland, PA 17070 Cortplete Items 23a-c on n cenirying 23a. To the best of my knowledge, death attuned at the time, date and place slated. (Signature and lille) 23h. License Number 23c. Date Signed (Month, day, year) physidan rs not available a 'm of deaN to [eddy cause of tleelh. Items 2a~26 must be completed by person who pronounces death 24. Time of De/ath ~ ~ 25. D k Pronounced Deed (Month, day, year - l ~ ~ ~ ~ ( 2fi. Was Case Rele ~retl to Medical Examiner /Coroner for a Reason Other than Crematron or Donation? ~ . M. L C ~,T J. ) `,t r ~ „ C (J ~ ^ Yes i~. No CAUSE OF DEATH (See Instruetlona and eaampba) r Approximate interval: Item 27. Pan L Enter the chain of events -diseases Injuries or complicalan5 -that directly caused the death DO NOT enter t~ events such as cardiac arrest Pan II: Enter other 2jgpjfjcgnt cand'tions contnbuCnq to deaN, 28. Did Tobacco Use Contribute to Death? , , . , r Onset to Death respiratory anesl, or ventricular fibnllatpn without showing the etiology. List only one cause on each litre. -~ r but not resulting in he underlying cause given in Pan L ^ Yes ^ Probably IMMEDIATE CAUSE (Foal disease or ~'x ^ No ^ Unknown wMeion resuaing In death) -~ a. \ S \ / V /.r~.. <.' ~ ~ ~-`- 29. II Female. ^ Oue to (or as a consequence ol): i Not pregnant within past year $equentialty list Lorrtlilions, II any, b ~ leadingg to the cause listed online a. ^ Pregnant at lime of death Enter the UNDERLYING CAUSE Due to (or as a consequence oQ: ^ Not pregnant, rim pregnant within a2 days (disease or injury that Initialed die c ~ i of tlealn events resuaing in death) LAST. 1 Due to for as a consequence off: ^ Nol pregnant, nut pregnant 43 days to 7 year d delore death ^ Unknown if pregnant wdhin the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32e. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place I Injury: Home, Farm Slreel. Factory Penormetl? Available Pdor to Completion ^ Natural ^ Homicide , Odlce Building, etc. (SOecityJ el Cause of Death? ^ Ves [~ No ^Ves ^ No ^ Accidem ^ Pending Investigation 320. Trme of Injury 32e. Injury al Wolrc? 321. II Transportation Injury (SpecityJ 32g. Location of Injury (Sheer, city'town, state) ^ Suicide ^ Could Not be Delerminetl ^ Yes ^ No ^ Driver 1 Operator ^ Passenger ^Petleslriar M ^Other- Specity: 33a. Certifier (check Dory one) 33b. Signature and Title of Cerafie(~ - ' ,. \ / Certityirg physkian (Phy lying P Y P D 1 sKian certi cause of death when anomer h skian has rorrouncetl deem arM cam leletl Item 23 • ~ ~"• ~ ' // ~~`_~ ~~~ - ' ` ~ To the best of m krawled death occurred due to the tau Y 9e. sate)aM manner as statetl_________________________________ ^ ~ s: ..:.._ F : .. ~ ti.. '--/' _ • Pronouncing end cenltying pnysicien (Physidan bosh pronormcing death and certiying m cause of death) To the best of m knowled e death attuned at the ti d t d l ^ 33c. License Numner 33tl. Date Signed (Month, day, year) y g , me, a e, an p ace, end due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Medical Examiner/Coroner ~ ,~ ( A, ~ I ~ On the basis of examinatlon and l or I nvestlgetion, in my oplnlon, death occurtetl al the time, date, and place, and due to the ceusafe) and manner as slated_ ^ (_ / ~ ~ ~ ~ Name and Address of Person Who Compleletl Cause of Death (Item 27J type l Print aa ~~ 36. Regrsh gnature aM Dt,~ri~lqup~r - // / i I ~I /l ~ I I /I 36. Date filed (Month, day, year) .(~~1`l ~(t ~QY ~'l i~ M~` ~ ~'UY1~1 "j bL` r ~j ~ / id 7 i~:'~I N Frcnt 51~eer ~~ I`11G2 V Disposnion Permit NO. u~_~ ~ ~~'zj 1 OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS C y M 6c,2t f! ti' ~ COUNTY, PENNSYL`'ANIA ~i- 09- aoy Estate of ~~1 f ~ ~~ q Z . /Ilk ~'~ ~ 1 ,Deceased /"~f3~1~ t'1 tZf,~1 ~ N~Nc /~~ f' o ~ l and (each) being duly qualified according to law, depose(s) and say(s) that she / he /they ~ /were well- acquainted with ~ ~ ~ /L ~ S .q L. ,/l1~ft ,F'~ ~--1 and am/are familiar with the handwriting and signature of the decedent, and that the signature of _ ~~/ f /L4 SA L-, .~A ~' ~ ~ l to the foregoing instrument purporting to be the Last Will and Testament/Codicil of is in his/her own proper handwriting. (Signature) (Street Address) (City, State, Zap) Executed in Register's Office Sworn to or affirmed and subscribed befor/eLm/e this `-a`'~. day of LJ~t , ~~~• ,,~~// ~J ~ ~VCrL~ ~ ; ~.- Deputy for Register of Wil n ~ ~~ ~ _- =n r__ ~ P"` m ~ i ~ ; r,, ~~. c~i ~ N ,, _ ~~ ~ ~ ~. ~C ~~ w - -- cr- v, Form RW-04 rev. 10.13.06 a 7G.~~.~`~ ~ i "Z i L.~.~ ryjrat~` e, ztp~,T ~..__._. ru o 0 ~ ~~ .o ~'} s~l ~'~~ ~`' OATH OF SUBSCRIBING WITNESS(ES) ~ _ _..~ REGISTER OF WILLS ~~~' y M $ ~C,rL ~ ~ n! ~ COUNTY, PENNSYLVANIA ~ ~` N cn c~ ~IYl~9- DIDLf Estate of ~ ~~ r ~ ~ S ~I L, /V~ Py ~- ( ,Deceased p ~ ~ l ~~- ~ ~ `7,11./ J ? ~ , (each) a subscribing witness to (Print Name/s) the Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she ~_v~ they ~~/ were present and saw the above Testator /~Testatri~ sign the same and that he / he /they signed the same and that e he / ey signed as a witness at the request of the Testator Testatrix m ~r his presence and in the presence of each other. R~ (Signature) (Street Address) (City, State, Zip) (Signature) (Street Address) (City, State, ZipJ Executed in Register's Office Sworn to or affirmed and subscribed before me this c~ 2 d day Deputy for Register of ills Executed out of Register's Office Sworn to or affirmed and subscribed before me this day of , Notary Public My Commission Expires: (Signature and Seal of Notary or other ot~icial qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 LAST WILL AND TESTAMENT Be it remembered that I,. THERESA L. NAPOLI, of .the Township of East Pennsboro, County of Cumberland, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament hereby revo}:ing and making ~ n null and void any and all Wills and Testaments and writ ~~ in ~ n~c~ p E_~;,_: the nature thereof by me at any time heretofore made. ~s~rn rv ~'';~ ~' cn~ .-.- `~ ~ -o , `~-~' ~-r' :71C ITEM l: I direct that all my just debts and fi~3~al ~ ~ ~ expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, .residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath unto my sister, CARMELA L. NAPOLI, absolutely, provided :she survives me for a period of thirty (30) days. ITEM 3: Should my sister, CARMELA L. NAPOLI, predecease me, fail to survive me for a period of thirty (30) days, or should we die simultaneously, I then give, devise and be=queath my entire residuary estate in equal shares, share a.nd shard alike to my brothers and sisters absolutely, or to the survi~~ors of them should any one of them predecease me. ITEM 4: I direct my Executrix to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing here- under or otherwise passing by reason of my demise, may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or federal law now in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my sister, CARMELA .L. NAPOLI, as Executrix of this my Last Will and Testament. Should my sister, CARMELA L. NAPOLI, predecease me, fail to qualify, cease to act or renounce probate, I then appoint my brother, ]ZP.YMOND NAPOLI, Executor of this my Last Will and Testament. ITEM 6: I direct that my Executrix or her successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. In witness whereof, I have hereunto set: my hand and seal this ~ 9~ day of ')'I1.Q,~ 198 ~/ o~ ~ ~ ( SEAL ) (NAME: ) - 2 - The preceding instrument was on the day and date thereof signed, sealed, published and declared by THERESA L, NAROLI, the testatrix herein named, as for her Last Will and Te~;tament, 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 thereto. NAME ADDRES~~ ~(Ll.~e~.- E.1lrtipo-Q~ ~8 5 G.u.~ucccJ ~d. /91aCk,f~_PA- ~7oSS u - 3 - ACKNOWLEDGMENT Commonwealth of Pennsylvania. County of Cumberland I, THERESA L. NAPOLI, 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 the instrument as my Last Will; that I ;signed it willing- ly; and that I signed it as my free and voluntary act for the purposes therein expressed. (.NAME) Sworn or affirmed to and acknowledged before me, by THERESA L. NAPOLI, the testatrix, this day of , 198 NOTARY) - 4 AFFIDAVIT Commonwealth of Pennsylvania County of Cumberland We , and __ ~ (rJp,~ ) ( NAME ) the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her Last Will; that THERESA L. NA]?OLT signed willing- ly 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; and that to the best of our knowledge the testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. (WI,TNESS) (,WITNESS) Sworn or affirmed to and subscribed to before me by and ~ wit- (NAME ) ( NAME; ) nesses, this day of 198 (NOTARY - 5 -