HomeMy WebLinkAbout04-02-09PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of JOHN CAMPISI
also known as
REGISTER OF WILLS OF CUMBERLAND
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
COUNTY, PENNSYLVANIA
File Number ~ I` O l~ D ~' I
Social Security Number 041-18-8462
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated November 3, 1971 and codicil(s) dated None
(State relevant circumstances e.g. renunciation, death of executor, etc.)
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution oQ ~ment~offeref~s
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - - ._ ="r~
B. Grant of Letters of Administration c.t.a. ~..1
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritate)
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., enterdate of Will in Section A above and complete list of heirs.)
Lauren C. Fulton ~ Daughter ~ 138 North 25th Street, Camp Hill, PA 17011
o.
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
20 North 12th Street Lemome (Boroush) PA 17043
(List street address, town/city, township, county, state, zip code)
Decedent, then 92
years of age, died on March 20, 2009 at Harrisburg Hospital, Harrisburg, PA 17101
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 no[ domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as follows: N/A
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:
or printed name and residence
$ 100,000.00
TOTAL $ 100,000.00
C
Lauren C. Fulton
138 North 25th Street
Camp Hill, PA 17011
Form RW-02 rev. 10.13.06 Page 1 of 2
..~~
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 Irnowledge 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 an~ subscribed
before me the ~ n day of
F r Register
~~~~ ~_
Signature of Persona! Representative
Signature of Personal Representative ~O f -^'
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Signature of Personal Representative
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File Number: ~ ~ ~~ ~ ~/~' I ~ 0
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Estate of JOHN CAMPISI ,Deceased
Social Security Number: 041-18-8462 Date of Death: March 20, 2009
having been presen ,
are hereby granted to Lauren C. Fulton
in the above estate
and that the instrument(s) dated November 3, 1971
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES L--
O, /~'\ Regisd o s' l'~Y
Letters ............... $ lJ lV ~~'"'``''
Short Certificate(s) ........ $~~L Attorney Signature:
Renun 'ation(s) .......... $
Attorney Name: F cis . Zulli, Esquire
... $
~ ... $ Supreme Court I.D. No.: .531
$ / Address: 109 Locust Street
... $
$ Harrisburg, PA 17101
... $
... $
••• $ Telephone: 717-232-1488
... $
TOTAL .............. $ 5p . 0
AND NOW, ~ I 1 ~ rx~ 99 . in consideration of the foregoing Petition, satisfactory proof
ted befoi me IT IS DECREED that Letters of Administration c.t.a.
1~
Form RW-02 rev. 10.13.06 Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF Df=A'~F~
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
P 15188169
Certification Number
This is to certify that thL, information here given is
correctlt/ copied from an l~~riginal Ce aificate of Death
duly fil(~d with one a~. Local Kegistrar. The original
certificate will be forwarded to the State Vital
Records Office ''or permanent filing
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Local Registrar Date Issued
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3 REV 11/1006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
aiAnnErTrr" CERTIFICATE OF DEATH
ACK INK (See instruction8 and examples on reverse) CTATF FII F NI IMRFR
1. Name of Decedent (Fist, nlidde, lest, suaa) 2. Sex 3. Serial Seadty Number
041 - 18 - 8462 4. le al DeaM (Month, der yeQr)
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John Campisi Mal ;
6. Age (Lest BMhday) Uakr 1 year UMer 1 der 8. Date d BIM (Modh, day, r) 7. Bidlplece C' adt stele a autlry 8a. Place d Death (Check on one)
Moans 0•rx Noun kexxex Fbspkal: Other:
92 Yrs.
• July 10,1916 Middletown,Conn C~patlent ^ERlOulpatient ^DOA ^Nureing Home ^Resitlence ^oNer-Speaty.
gb. Counry d Death &. CKy, Born, Twp. d Oedh &1. FadNy Name (II rid ImIkIAMn, Siva stred all number) 9. Wes Decetlenl d Hispanic OAgin? No ^Ves 10. Race: American Indian, Black, WNte, etc.
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Is
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Dauphin Harrisbur an,
ty
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(It yea ape
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Harrisbur Hos ital Mexipn,PUertoRican,eh.) White
11. Decedent's llsuel tlan KkN d work done ~ most of tile. Do rid slate redred 12. Wes Decedent ever in the 13. Decedent's Education (Specity any highest grade congided) 14. Medtel Status: Monied, Never Monied, 15. Surviving Spouse (II wife, give maiden name)
Divorced (SpeaM
widowed
Kid
Work ,~ KmD d pugnesse/ IMuatry
1
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U.S. Armed Forces?
Elementary /Secondary (0-12) College (1-4 or 5+)
IIII JLC
anagf.
t ^Y~
~~ 2 Widowed
16. DecedenYS Mailirg Address (Strad, city I town, state, zip code) DecedanYS Did Decedent
Sale Pa Live in a t7c. ^ Yes. Decadent lived in Twp.
Actual Resitlerlce 17a
20 North 12th Street .
Township? I~,
~netl wdhn Lemoyne
d 17d.'-AAc
n
~
Llmds
Lemoyne, Pa 17043 t7b. coany . ,m
city, Boro
an
IUa
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o
18. Faaiu's Name (First, nestle, leak sulYuJ 19. Motlrer's Name (FNS4 mitlde, maiden surname)
Mario Campisi Sebastiana Bartolotta
Zoe. InfomlanYS Name (TYpa !Print) 20b. InformanYS Meikng Atldrese j56ee6 airy /sown, state, z9 coAel
Lauren Fulton 138 North 25th
21e. Melted d Disposition ~ ®CremeBon ^ Donation 21b. ode d Dhposaron (MOmh, day, year) 21c. Place d Disposition (Name d cemetery, aemerory a dher place) 21 d. Caption ICIry I town, state, ap code)
^ Burial ^ RemovalfranSate j waacremsnonaoonatronAdhortzed
• March 25 2009 Hollin er Cremator Mt Holl S tin s Pa
^
^ Ogg . ~ M/ IAeddd ExeMner I Cororwrl ^ Yes No f
~ 22a. Nre d Funs Licerdee as such) 22b. L'¢enae Nwlber 22c. Name entl Address d Fadiry
. ~ 011654-L Myers-Hamer Funeral Home Inc 1903 Market St Cam Hill Pa 1701
Camplde germ Dory certltyng 23a. To the hest of my knowletlge, death amured at tla time, dale all piece orated. (SgpWre and title) 23b. Cleanse Number 23c. Date Signed (Monts, day, year)
plryaiden a not eveBabM d tone d tleeo+ ro
oer8ty cause d Deem.
Mama 2426 must be conpleled by person 24. Time of DeaN
v 26. De rretl Deed ( . tle ~ year) 28. Wes Case Retorted t Medpl Examiner I Coroner for a Reason Other than Cremation or Donation?
[ 1
^ Y
~ who plar101111CA5 deem. D M. D ~ 0
es
CAUSE OF DEATH (See inatrudlom arts examples) r Approximele inlervd:
Me
rreaL r
t
h
T
e
l
D
M PaA 11: Eder other gjgnific m cerldltiores conlnhulkn to deem,
Nan in Pan I
pose
kin
in the undeA
ki
dx
t 28. Did Tdrecco Use Conlrihule to Death?
^ Yes ^ Pmbdsy
even
s suc
as p
c a
odor lem
na
Onset to
ea
Item 27. Pen I: Eller me ciiein d evens -diseases, inrydes, or cadglicalions - met directly caused die death. DO NO
respharory ertesL a venlrbAer 6hdllatbn without snowing the etiology. List any one pose on each line. r
i .
g
g
y
g
m
rew
^ No ^ Unknown
NNIEDIA3E CAUSE Final disease a 1
~ (ice {^ ~ ~ i
L. i /// r
~~ (/ / ~/ Q ~
ceMkbn reoultirg n ~aM)
a
(, J
G~-lylll Gtr / ~CC7
29. II Female:
ear
r
n
nt witlm
est
^ N
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-~
.
fff
Due to (err °~ consequence o~o• r
/ G Q r-r L/', ~ ~ ! ,r-e ~~ i
Sequeritidy kd condcions. if any, b ~ /S~~ ~ ` p
y
o
p
eg
a
^ Pn:gnant at time of death
.
kuding ro Ma plea timetl on Nrie a. Due m (or as a con d):
UNDEIILYING CAUSE
Ed
B ^ Nat pregnant, out pregnant within 42 days
f d
M
er
ic
r ~
(dsease or mhuy tlld inNiated the c
C... o
ea
.
i
Zvenb nsWAng m deem) LASL i
^ Nol pragnanL but pregnam 43 Days l01 year
Due 10 (a 85 a Ca13BQUBnp Of]:
d
bemre loam
^ Unkrrown a pregnant within the pass year
,
30a. Was an Autopsy 30b. Were Autopsy Findings 31. Mannar d Death 32e. Dale d Injury (Modh, day, Year) 32b. Describe How Injury Occixretl 32c. Poop of Injury: Home. Farm. SreeL Factory,
Odice Building, etc. (Speci/yJ
PeAOrtried7 Available Prior to Completbn
of Cause d Deelh? ^ Natural ^ Homicide
^ ACdtlenl ^ PeM'sg Imeslgetion 32tl. Time of Injury 32e. In'Nry et Worts? 32f. N TrerispOnalion Inju7 (Specify) 32g. Caption of Injury (Street, eery I town, slate)
^ Yes ~,NO ^Ves ^ No ^ Suicide ^ Could Not he Delermkietl ^Ves ^ No ^ Driver / Oparelor ^ Passenger ^Pedestrian
M Odler - Speciy:
33a. CemYer (check adY anal 33b. S' nature all "er ~ I„ ,
re / ,,
~
/'~ / ~
• D•rlNylnB phyaroim (Phyaicien certiyvg pose of death when ariotlier physiden has pronourxxid deeM ell completed Item 231
death accumd dos to the auaa(s) and manner N ataled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
To IM hest d my Mnowledge , /Ly„Q~~
-
-
,
• PrdrlOUlltkp and ceMMn9 phyficlalt (Physiden ootll proralndrlg deem and cerolYMg b pose d 1leeth)
^
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ll 33c. License Num r 33tl. Dale Signed (MOnm, pry, year)
- _ _ - - _ _
- _ _ _ _ _ _ _ _ _ _
mantle w o
a
e
To the heat d my knowbdge, death oceurted d 1M tNfe, date. and place, and due to tlro pmya) a p
/'~ ~ 'Q ( 1~1 ~ S (L
j Z O 2'J U 9
• kMdieal Examner I Cagier
On the bsala d enrninatlon and I a Invedlgstlorl, in my opinron, deaM occurred el Me time, date, and place, and due l0 the ceuee(s) and manner sa elated- ^ d Cause of Dealn Qtem 21) Type /Print
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~, Name erd Address dPerron
Who C
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Dispostion Permit No
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KNOW ALL MEN BY THESE PRESENTS:
That, I, JOHN CAMPISI, a resident of the Town of Branford,
County of New Haven, State of Connecticut, do hereby make, publish
and declare the following to be my last Will and Testament, hereby
revoking all former wills by me made.
FIRST:
I direct that all my just debts, except those secured by mortgage
or pledge, my funeral expenses and the costs of administration of my
estate be paid as soon as practicable after my death.
SECOND:
All the rest, residue and remainder of my estate, of whatsoever
it may consist and wheresoever it may be situated, T give, devise and
bequeath to my beloved wife Irene Anderson Campisi, to be hers absolutely.
THIRD:
In the event that my wife Irene Anderson Campisi and I should die
as a result of a common disaster, or in the event my wife should pre-
decease me, then, and in that event, I give said rest, residue and remainder
of my estate, of whatsoever it may consist and wheresoever it may be
situated to my daughter Lauren Anne Campisi, to be hers absolutely;
provided, however, that in the event my said daughter predeceases me
leaving issue surviving, I direct that such issue shall take the share of,y
the deceased parent, a:' + :, .
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FOURTH:
I hereby nominate and appoint my wife Irene ,9.n.derson Campisi
as Executrix of this my last Will and 'Testament and I direct that no
bond be required of her as such Executrix by any Court or Judge having
jurisdiction of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this bra day of November, 1971.
S.
Signed, sealed, published and declared as and for his last Will
and Testament by the above named Testator, John Campisi, in the
presence of us, who at his request and in his presence and in the
presence of each other, have subscribed our names as witness hereunto.
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OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
~ I -D9 - D311
Estate of JOHN CAMPISI ,Deceased
Francis A. Zulli and William J. Fulton
(each) being duly qualified according to law, depose(s) and say(s) that -else-/-ke /they was-/ were well-
acquainted with John Campisi and ~m/are familiar
with the handwriting and signature of the decedent, and that the signature of John Campisi
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
John Campisi is in his/her own proper handwriting.
~~~~~
(Signature)
106 Walnut Street
(Street Address)
Harrisbure, PA 17101
(City, State, Zip)
Executed in Register's Office "~
Sworn to or affirmed and subscribed ~ o
=,,. -` :'
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before me this day ~ `=~
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of ~~ .,,~ c.:r: ~ c,~~
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Deputy for Register of Wills '`~
Form RW-04 rev. 10.13.06