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HomeMy WebLinkAbout07-21-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF C YY)~I4i1t'~ COL>~TY, PENi~tSYLVANI_A Estate of ~^ ~/ n / "1 YQ ~ I ~!~,~ /1 ~ t ~ b'2'h also known as .Deceased File Number rX ~ V C~ w 1 Social Security Number ~ O ~~ ~~ - "7 a ~ O Petitioner(s), who is/are 13 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 ..1JQ1/f ~ YV tC +nalQ b.Q/'1 named in the last Will of the Decedent dated 9-.{,3 ' /9~ d 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 instt~ment(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration (lfapplicable, enter: c.t.a.; d. b. n.c.ta.; pendenre lire; durante absentia; durante minoriRTt~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the follo~ouse (if may) and firs: (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.) ,.~-p .-r ~- ~ I` Name Relationship =Res~eh~ej I ~l ~ -- - (CONIPLETElNALL CASES:) Attach additional sheets if necessary. ~ Decedent wa omiciled at deat i U County, ennsylvania wi his /her last princi al residence at ss c r (List street nddress, town/city, t nsAip, county, state, zip code) Decedent, then / Q eZ years of age, died on 7' ~~ ' ~~~ 7 at ~'/ Q110 1' l CAr F-- ~/7 ~1 ~ ~I • IJ~7 ~ ~d ~~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ D O D (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ ~ situated as follows: 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 Ty ed or rioted name and residence f..._i w ~ v- ~ W . ~ ,~ I a b.u~n G ~ ~ Y ~CLr'r' ~ cr o sS /vl.~~ slur /~ i 7a~~ Form RW-0? rev. 10.13.06 babe I Of 2 Oath of Personal Representative CO~I~IONWEALTH OF PENNSYLVANLa COUNTY OF SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tale and con-ect to tl;e 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 n 1, 4 For the Register ___ _._ Signature of Personal Representative rv c:~-~ r C._ f'- Signatm~e of Personal Representative ~ ; ~ ~ --- ~ :~ "T~ .7 <- .^ -- File Number: ~\ ~i"1 b~FJI °~ ~7 ~ --i .. -~' ~ ~ ffII Estate of w~l l1 j r 7Y~ ~~ ~~l `7~ ' ~~~ ,Deceased ~y Social Securi~ Number:~11 ~ ~~ J ~~~ ff ~ II /fi'~ AND NOW, IS ~ 1~ 1 I, c UV~~ Navin! bccn presented before m , IT IS DECREED at Lettcrs Date of Death: ~ 1 conside ation t ~ \5~0:,' rr L~ ~' ~G J ~' f~ the foregoiCPetition, satisfactory proof L C1Gv1 are hereby granted to 11 in the above estate and that the instrument(s) dated ~1(1 '~ O~ ~ ~~~ described in the Petition be admitted to probate and filed of record ~~ the lastjWill (,a~I Codicil(s)) o~I~eceder~t. ~ FEES ~1_L~-' v~r ~ ~, ' Letters ...~ ~1UC? ~ ~7 Short Certificate(s) .. ~... . $ ~~ Attorney Signature: Renunciation(s) ........ ~~ l~ .. $ lS Attorney Name: r $ J (- ~ . • • $ f U Supreme Court LD. No.: ,,~~ $ Address: . .. $ . .. $ . .. $ • • $ Telephone: . .. $ TOTAL ............ ~• i .. $ ~_ ojPersonnl Representative Register of Wills Fo„n R6V-0? rev. l0.13.Or; Pdge 2 Of 2 105..405 REV- (Ii~O' LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. 56.00 Certification Number i~ I~~ rrv n .+nnb 11F'r PRINT IN FtR1A.1NF.N1 BLAI,K INN This is to ceriit`~,~ that the inforrnation here t~i~~en '. correctly copied Front an ori~~inal Certifi~at~ of Dcat duly filed ~~~ith me ns Locai Re~]isu~ar. `Che ori~~im ce~ificute wit ~e forwarded to the Stale Vit, Ki~c~trds Office igc.perrnanent t`'rLn`,_*. . , '_ [3cacal Re;?istrur Date hsued N c .n • ~~ ~ ' ~ m t , ~ ~ ~_ .~ ~ r _ - u ; -~ ., ~ ~-n ~ ..rr• _ ` j~ ~ ~ ; CA COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) ~,.•r< <„ ~ ,,,,,,,,~„ Ov~ - - - - rev i Ie 11 3 ly (, VI . d ty rg p v 5 1 I n n eot oee0 tp 29~_IU ~esl of my knowledge death occurred al the I >e. date and place slated (Sgralure arW Inlet ( , 23D. L¢ensa Number 23c. Dale Signetl IM n h. tlay, year) Icy n>e t - ~ ~ , ~i -.~ ~ _ 7 /D/05 11 ~ 24-16 r sl De cu np eled Dy periur ~4 T ne of Death 25. Date Pronouncetl Deatl tMOnth, tlay year) 26 Was Case Ralened to Meo cal Exam r er/Coroner for a Reasun 011 e: than Cremat on or Donal,cnp woo ptanounwsDeam CI 3 `t Ya M ~ D ^Yes fiQNo Item 2]. Pa t I E - In 4n;t Igg3s tl' ' -fis. nlur es or comp) talons -Ihel tlleclly caused the death. DO NOT enter term nal events such es cartl ec mrasl, rr 0 I I D th ~ ~ ~ ~~ V~ ~ ~y~~y a~YIV ~' O ~ opacc U' l;ontr Dule to Death? o ea D 'I ry arre t - t ajar Dr Ilat on w thou) show nglne el oltgy. Lsl only one cause on each l nfi- ul not result ng n the unoedy ng cause g ver n Pan I. ^Yes ^ PI IMMEDIATE CAUSE IF rat disease or n ^ No U known cunJlDOn resulDUy in tlealn) _i 29 II Female: Due t- lur s Vuen p '~)JI Nul pregnanl wahtn past year y J'equ Dally Dsl wnUtDan~ it any. b ~ j - ~ LJ Plegnant al lime of tlealh leatliny to the cause h51etl ~n line a. II, s our u Enter Ilse UNDERLYING CAUSE seq n ^ Nol pregnanl, Dut pregnanl mthtn 42 days / ~ BDtsrase or inluty coat nrnteled the t lD n LAST of tlealh ven s resu nq in tleal i . Due to Inr a- onseque ce olt ^ Nol preynanl. but r pregnanl 43 days to I yea d belare Oeeln ^ Unknown .I pregnanl wahm the pall year 30a. Was an Autapay 3nb. Were Aulupay Fmdtngs 31 Manner of Death 32a Dale ul Inryry tMonth. day, year) 32b Describe How Injury llccurretl 32c Place o! In : Hom F g F PenonneU l Available Pnur to CompleDOn , / . jury e, arm reet actory Odice Bwltltnq etc. tSpenly/ ul Cause ut Dealh'~ .C~ Natural ^ Homicide , ^ Yes LNo 5'~ ^ Yes ~'NO ^ Accident ^ Pending InvesDgalton 32U Time of Injury 32e. Injury al WorA; 321. If Transpodalwn Injury (SpecAyl 32y Localwn of Injury (greet city t lawn, stale) • ^ Swclde ^ Coultl Nol be Determined ^ Ves ^ No ^ Dnvar/Operator ^ Pas eager ^PndesYnan M ^olner- speciry 31a. Gerltlier tchecl, only anal 33b. Signature antl The • Cerlllylnq physician IPnysician cfinuymg cause of tlealn when arwlher physcian has prwaunced tlealh antl completed Item 231 To Ina best of my knowledge, death occurred tlue to the cauaela) antl manrwr es slaleQ_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _~ , • Pronouncing aM cart ty g plly Iclan IPhy r Wlh prorwurk ng death ar tl cedty ng to cause of tlealn) 33c L en m 33d l d M l _ - _ - - _ _ _ _ To the best of my kn ledge d atn o d t the time, Bata and vlace and aae to tna caaselsl and moon s aMled_ _ _ _ ^ • M Ica) Examiner/C . e t e t n nday year) U .X~y/T e basis of eaam t / or i lg I on, y opin on tlealh occurred al Ina lime date and place d tlue to the c sets) n0 mean as sMted_ ^ ~ N A ' am antl dtlress of Persu n Who Corrpletetl Cause W Death teem I pe t Pm 75 RegnD notate and Uisut NuniDer - .~. a~,a.~, ~'~ I (J I.3 17 I y I 3fi Dele tied IM Ih, day. year) 7J 1y ~°ti ~ ~ ~~ , ^ ` '~ ~ 1 _ ~ J 7 Illrv /L.~ G , 7 ~ ., r ~ ( > u 3 ~i ~~ F ~ ~ D R N ~,,,~Dn~~rn unna „ a~ ~a~,~Z 301 WILL FORM Executive Sales Co., Philadelphia, Pa. v ~r~~~ Y~~ ~~~ C~~e~#~~~e~# I' - WINIFAED M. AINGLABEN _ of City of Hazleton ,County of Luzerne, and State of Pennsylvania, being of sound mind and memory, do hereby make, publish and declare this to be my Last will and Testament, in manner and form following, hereby revoking any will or wills or codicils thereto heretofore made by me. First. I direct that all my just debts and funeral expenses be fully paid and satisfied, as soon as conveniently may be, after my decease. Second. I dive, devise and bequeath all of the rest, residue and remainder of my estate, real and personal, of wha±;ever kind a.nd character and wheresoever situate, unto my son, David S. Aing- laben, absolutely and forever. n r..:, ~. o '" c.... `n -~ :-?., --~-. C7 r- rn i`: _ _ ~7 ~t~3 --~ C : ~ 7 ~-,. Q CSC' 1 do hereby make, constitute and appoint my brother, James B. Johnson, to be execut or of this my Last Will and Testament and Guardian of my minor son, David S. Binglaben. ~1n itnPSS ~ItPrPII#, I, Winifred M. Ainglaben, the Testat rix above named, have hereunto subscribed nay name and affixed away seal, the ~.3 K day of Se~ternber in the year of our Lord one thousand nine hundred a~ad sixty 1196©). .~........is. ~;.<...t ........._. Signed, sealed, published and declared by the above named Winifred ~. ginglaben, as arad for her Last Will a~ad Testanreaat in the presence of us, who have hereunto subscribed our ~raanaes at her reclacest as witnesses thereunto, in the presence of said testatrix, Winifred M. ~inglaben , , a~ad o f each other. __ ~~!th,~~,~-.. ..... ~ ........ ......... . .G~ ............................1................................. is ~' as ; ~: ~---t ~~t ~ ~~ a: ~: ~~ x: .~ Q~ ~i H ~~ H ~~ I~ s~ .~. n U m ~ W '~ ~" ~ ~ `tea ~ a z f W J N Q I a ~ c~1 ~~a OATH OF NON-SUBSCI2IBItiTG WITNESS(ES) REGISTER OF WILLS ~u-~ ~.e.-^~0.~ COUNTY, PENNSYLVANIA Estate of w l ~ I :f'Y ~n Deceased ~A V I CI vV ~ ~ i f1 Gt' ~ Q ~X.~"1 and {- /~ l 1 r1 h , (each) being duly quah' ied acc ~ ing to law, depose s) and sa ~(s) ~ hat she / he /they was /were well- acquaintea wrtn ~ 1 -/ , and arr~/are familiar with the handwriting and signature of the decedent, and that the signature of / ~ ~' (,j~ Q~-~ to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~~ h ~ ~r~~ 1 " I . ~ ~,a l a b-~, is in his/her own proper handwriting. (,~ _. i `"-~ (Sig~uuure) lP~IH C~ar,'na Cro s s (Street Address) ~- I`'l«har~~csbur~ ~A ~7o~--b (City, State, Zip) e (Sig ure) ~l/y ~~'TT Cry (Street Address) ~~ ec f~~.~ i c ~ u ra ~~ / 70 ~ (C~ty, State, Zip Executed in Register's Office Swom to or affirmed and subscribed before this cat ~ day A of ~~ L~ ~'~ . 2GU~ /; Deputy for Regis~r of Wills Form RW-04 rev. ; U.13.06 M ~~ w ±7 ~ ~ vJ ~ ~' .. r ;" Z~? ~ . ;. ~~ ~ --~ :- co