HomeMy WebLinkAbout07-24-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Helen Catherine Ward File Number 21 - 09 L';~ ~~~
also known as
,Deceased Social Security Number
Marian L. Silveri
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or `B' BELOW.)
QX A. Probate and Grant of Letters 7estamentaryand aver that Petitioner(s) is/are the Executor named in the
last Will of the Decedent dated 11/12/1997 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
app rca e, en er c..a.; ..n.c..a.; pe en e i e; uran e a sen ia; uran a mino a e
Petitioner(sj 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 ill in Section A above and complete list of heirs.)
Name Relationship Residence ~ ~ ~~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at ~
404 Pawnee Drive, Mechanicsburg, PA 17050
(List street address, town/city, township, county, state, zip code)
Decedent, then $7 years of age, died on 07/17/2009 at Country Meadow Retirement Community, Mechanicsburg, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows:
All personal property
Personal property in Pennsylvania
Personal property in County
or
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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
~j Marian L. Silveri 400 Pawnee Drive
' --~ ~°~1-L~l',~~~L.~L~ Mechanicsburg, PA 17050
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Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
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 affirmed and subscribed
before me this ~~ day of
of Personal Representative Marian L. Silveri r-.~
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J ~~ , '1 V~~ Signature of Personal Representative ' _?-~ r"'~ 1-
the Re Inter Srgnature of Personal Representative
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File Number: 21 - 09 (`j~}~
Estate of Helen Catherine Ward ,Deceased
Social Security Number: 183-16-6795
Date of Death: 07/17/2009
AND NOW, ~'1 ~ ~. ~: - ~ ~x ~-' ~-L~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IS DECREED th Letters Testamentary
are hereby granted to Marian L. SIIVerI
in the above estate
and that the instrument(s) dated 1 111 211 997
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters..........~,~~..... ..... $ 135
-.
Short Certif+cate(s~.......... C?...
..... $
3 a
Renunciation(s) ....................... ...... $
L~t11 $ \S
~~' ~~ $ j ~
~~ $ ~
$
$
$
$
$
$
TOTAL .............................. .... $ ~ol~--~~c~
Attorney Signature:
Attorney Name: David R. Morrison
Supreme Court I.D. No.: 17478
David R. Morrison 8 Associates
Address: 600-A Eden Road
Lancaster, PA 17601
Telephone: 7171560-1500
Vac
Form RW-O2 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
los.no~ ttE~c rovfn;
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
Certification Number
This is tf~ cerhf~ that the inforn~l~u[un here ~i~~tn
correctly copied ;`r<mT an ori°~il~a] C'ertiticate of Dea
duly filed with me as Local Registrar. 't'he ori°~in
certificate ~L~iti ~e ft~r~sardcd (n the State Vit
Records Ofiic~• fur ;,ermunen[ 1~ilin~~.
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Local Rex~isu-~fr ?~atc Issued
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H1o6-wsREV n/2e°6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Cn.)
TVPE /PRINT IN ~""
PERMANENT CERTIFICATE OF DEATH
BLACK INN (See instructions and examples On reverse) STATE FILE NUMBER ~ \ ~ ~~ ~ ~~ `~
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1. Name ei Decedent (Errs(, middle, IasL SuKx) 2. Sex 3. Social Security Number 1. Date of Death (Month, day, year)
Helen C. Ward Female 1g3 -16 - 6795 July 17, 2009
5. Age (Last Birthday) Under i year Under 1 day 6. Date of Binh (Month, tlay, year) 7. Blnhplace (City and state or loreign wunlry) 6a. Place of Deatn (check oNy oriel
'"°""` °a"' "°°`6 kk"°~` 9-11-1921 Phila., PA. Hospital: OMec
87
_
Yrs ^ Inpalienl ^ ER / Oulpalienl ^ DOA ~I Nursing Home ^ Residence ^Other -Specify:
rM. County d Death ea City Boro, Twp. of Death Btl. Facility Name pf not institution, give street and number) 9, Was Decedent of Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black, Wh4e. etc
Cumberland echanicsbur
q Count Meadow Retirement Comm (If yes,speciryCuban, Ispaay,
Y Mexican, Puerto Rlcaq etc.) hi to
11. Deceden's Usual Occupation Kird of work done dudn most of workin life. Do not state retired) 12. Was Decedent ever In the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Married, Never Married, 16. Surviving Spouse (If wife. give maiden name)
ed
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Wid
KindW Work Kits of Business I Industry v
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ow
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U.S. Armed Forces? Elementary! Secondary (0-12) College (1-4 or Sr)
Homemaker pwn Home ]Yes ^Ne 12 Widowed
16. Decedents Mailing Address (Street, city /fawn, state, zip code) Decedent's Dltl Decedent
PA Live trio 77c ^ Yes
Decedent Lived in Twp
S
404 Pawnee Drive .
,
AclaN Residence 17a
tate
Township?
Mechanicsburg, PA. 07050 rib coemyCumberland 17d ~No.DecetleniLvedwtthin Mechanicsbur
Actual Limits of q Ciry / fioro
18. Father's Name (Fist. middle, IasL suHa) 19. Mother's Name (Flrsi mitleNe, maiden surname)
Christian Krauss Maria B. Berger
2Oa. Inlormant's Name (Type /Print)
Marian L. Silveri 2Ob. Iniormanys Mailing Address (Street, city /town, state, zip code)
404 Pawnee Drive, Mechanicsburg, PA. 07050
21a. Method of Disposition ^ Cremation ^ tlonatlon 216. Date of Dlsposilion (Month, day, year) 21c. Place o/ Disposttion (Name of cemetery, acmatory or other place) 21 d. Location (City !town, state, zip code)
® Burial ^ RertwvalfromState WasQemationoNMnationAuthorized
• 7_21 _2009 Hillside Cemetery Roslyn, PA.
^ Other ~ SperAty: i by Medical Examiner I Coronar7 ^ Yes ^ No
~ 22a. S- alu 1 Funeral S9tvme j.ioep~gyr par cdng as such) 22b. license Number 22c. Name and Address of Facility ~j Q ~] We S t AV e ,
(„~/y)[~ (,~jr(fAj(,' FD 011 672-L Joseph J. McGoldrick Jenkintown, PA, 1 9046
Complete Items 23ac only when ceNtying 3a. To the hest of my owledge, death occurred of the dine, dale and place stated. (Signature arW (tile) 2 License Number 23c. Dale Signed (Month, tlay, year)
physician is not available at lime of death to ~ 35~ 6 ~ /
ceNfy cause of death. ,Jb ao l.~
leted b
erson
co
24
26
t D 24. Time of Oealh 26. D ronounced Dead (Mon h, day, year) 26. Was Case Referred t Medical Examiner I Coroner i fleas Mar Man C motion or Donation?
mp
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Items
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wno pronounces death. ~ . M. ^ Yes o
CAUSE OF DEATH (See Instructions d exa les) r Approximate inlervah. Pan II: Enter other ~ .ant conditions conlribming to death, 28. atl Tobacco Use Contribute to Death?
Item 27. Pan C Enter the chain of events - dseases, injures, or complications -that direUly caused me . DO rifer terminal events such as cardiac arrest r Onset Po DeaM Cal nU resudinq M Me underlying cause given in Pan I. ^ Ves ^ Probably
respiratory arrest, or ventricular lihnllalion without showing the etiology List only one cause on each line. ~ ^ No ^ Unknown
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IMMEDIATE CAUSE !Final disease or C
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'(~ ~'~ 29. N Female:
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cmdltion resNWg In death) ~ a Y r I ~ vvj ~ I
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Due m~(or -a consequence otj: r
r
Segrendagy Nsi cordaions, tl any, p
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pregran
n past year
wi1
^ Pregnant at time of deaM
.
leading to the cause Ilsled on line a. r
nce
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D ^ Not pregnant, but pregnant wiihln 42 days
o (or as a conseque
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ue
: r
Enter the UNDERLYING CAUSE
of death
(disease or inpxy Mal initialed the c
.
evenh resNlmg in death) LAST.
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^ Not pregnant, but pregnant 43 days b 1 yea
Due to (or as a wnsequence op:
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d be/ore deaM
^ Unknown d pregnant widen ire past year
,
Was an Autopsy
3Oa 30b. Ware Autopsy Findings 31. Manner of Deatn 32a. Date of Injury (Monts. tlay, year) 32b. Describe How Injury Occuned 32c. Place of kgury~. Home, Farm, Street, FaUory,
.
Pedormed? Available Prior to Complelbn
of Cause of Death?
Natural ^ Homicide Odice Building, ek. (Specity)
^ Axidenl Q Pending Investigation 32d. Time of Injury 32e. Injury at Wwk? 32f. If Transportation Injury (Specity) 32q. Location of Injury (SlreeL. city /town. stale)
^ Vas ~No
~~~~~CCCCCC ^ Yes ^ No
^ Sukide ^ Could Not De Determined
^ Yes ^ No
^ Driver /Operator ^ Passenger ._ Pedestrian
M Other ~ Specify:
33e. Genlfier (check only one) 330. Signature a
i il'
)
?~
. CertNying physician (Physician cenitying cause of deaM when arolhar physbian has pronounced deaM and compkved Item 23) ~
To the beat of mY knowedge, death occurred due to the cause(s) and manner es aWted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ , 1/(
Pronouncing and ceNtying physician (Physcian both praaunciry death aM tenitying to cause of death)
^ 33c. License Numb r 3e. Date Slg ed IMon1 day, year)
- _ _ _ - - - -
To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) arts manner as atated_ _ _ _ _ _ _ _ _ _ . O (,~ Z ~ Q ~ j ~y
_, I ~ ~ A
. Medical Examner/Caonar
ine, date, and place, and due to the causes) arts manner as sMled_ ^
he (
ath occurred at
e
On the basis of examination and 1 or invesdgatlon, in my opinion, d otf'ersgn Vyrho ~ t Cau of ih ptem 27) Type I Print
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36. Registrar's Signature and District Number 1
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Disposition Permit No.
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OF q ~.;: _
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HELEN CATHERINE WARD ~~
I, Helen Catherine Ward, of the County of Lancaster and
Commonwealth of Pennsylvania, being of sound mind and memory, do
hereby declare this to be my Last Will and Testament, hereby
revoking all wills and codicils 'r~~retofore made by me.
ARTICLE I
I devise and bequeath all of my estate of every nature
and wherever situate to my two daughters as follows:
1) Fifty Percent (500) to Judith Ward Meckley,
born February 15, 1945, and
2) Fifty Percent (500) to Marian L. Silveri,
born February 23, 1950.
In the event either Judith or Marian predecease me, I give
their share to their children in equal shares, per stirpes. My
' son, Robert Bruce Ward, died in 1970 leaving a son, James P.
Ward. I leave nothing to my grandson, James P. Ward, as I have
provided for him in the past.
ARTICLE II
No fiduciary under this Will shall be required to give
bond or other security for the faithful performance of the
fiduciary's duties.
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ARTICLE III
I hereby nominate and appoint Marian L. Silveri,
personal representative of this, my Last Will and Testament. In
the event that Marian L. Silveri predeceases me, or is unable to
serve, I hereby appoint Judith Ward Meckley, alternative personal
representative. It is my preference that David R. Morrison &
Associates be retained as counsel for the estate.
IN WITNESS WHEREOF, I, Helen Catherine Ward, have
hereunto subscribed my name grid alined ,~iy seal Chic ? 2t~-: ~~y of
November, 1997.
~.J~LJ ~.~~c1.~~¢./l.,cw~„Q~ :,J~'G/L~~;Q,~ ~ SEAL )
HELEN CATHERINE WARD
Signed, sealed, published and declared by Helen Catherine
Ward as and for that person's Last Will and Testament in the
presence of us and each of us, who, at the request of Helen
Catherine Ward, and in the presence of Helen Catherine Ward, and
in the presence of each other, have hereunto subscribed our names
as witnesses thereto the day and year last above written.
residing at: 3091 Harrisburg Pike
Landisville, PA 17538
residing at: 9 Wolf Circle
Ephrata, PA 17522
OATH OF SUBSCRIBING WITNESS(ES)
Cumberland
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Estate of Helen C. Ward
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. Deceased
David R. Morrison, Esq. , (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 / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his
(Signature)
presence and in the pr nce of each other.
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
(Street Address)
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this ~2/!1 ~ day
of , ~-f-
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Deputy for Register of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer o 1~1{Tt ~~~~~r~o R 's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the origi al ~ c~~r{strument(s) ~°t t~fYi~9l~~fon.
Manheim °; ~„, , + , -"i J of Lancaster
My Commissfcar, s?: ~:~±res July 28, 2009
Form RW-03 rev. 10.13.06
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OATH OF SUBSCRIBING WITNESS(ES)
Cumberland
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
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Estate of Helen C. Ward
Deceased
Cathy M. Montague , (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 / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his presence and in the presence of each other.
tee i ~t~'...
(Signature) (Signature)
1
(Street Address) (Street Address)
~AMC_ ~~ 17 IO ~
(City, State, Zip) (City, State, Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed
before me this day before me this o`la/Yt ~, day
of of 02_ ~U9 .
c~~liG ~. ~~.~/IC-oo'YtJ
Deputy for Register of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official 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 co ~i4SiUtVt~n=„US:.~tth' "
SAN~~A i~ " °: hiotary Public
Form RW-03 rev. 10.13.06 MBnheirfY " ',5 ~~ LatlCast@f
My C®~rtm ~s~ .. €~:ly 2a, 2009