HomeMy WebLinkAbout09-09-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C l~rYl. ~~ n ~ COUNTY, PENNSYLVANIA
Estate of ~2 ~ f A- ~ . ~R V i S
also known as
Deceased
File Number ~ I ~ lJ I ~ v y ' J
Social Security Number
I$7_/z -bstL
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
A. Probate and Grant of L tters Testamentary and aver that Petitioner(s) is /are the Y ~ ~ I y ~ • p ~V l ~ named in the
last Will of the Decedent dated ~u~ t7~ !Cl ~7 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
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
,r3
_~ ,..~
offe~~ ` -i
t'f:t?
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in ~ ~ n S~tZ.L R 0 ~ County, Pennsylvania with his /her last principal residence at 12 ~ ~' ~° ~ Z7H
rvN>Yru E , ~>4 17y ~~
(List street address, town/city, township, county, state, :ip code) f ~*~-
Decedent, then ~ ~` years of age, died on f ! y ~ "~ S at i 2 7 N • ~oJ 2~-Fi ° i ~~ aVn/~ ~~ t~
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 $ GD ytv • q 7
(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:
Si nature T ed or tinted name and residence
t Z7 NE ra r/~~k ~
Form RW-02 rev. 10.13.06 Page 1 Of 2
^ B. Grant of Letters of Administration ~~~~ '!e CT; ` ~
(If applicable, enter: c.t.a.; d. b.n.e.t.a.; pendente life; durante absentia; durra~'~inorirate) ~ a-"
~r. _'`'~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following~ouse (if any)~d heii'~:-;(~f ~
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ~`*~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
~~~~ ,^ o,~ ~,N ~ SS
COUNTY OF ELI UU ' UJ 1~
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, Petitioners} will well and truly
administer the estate according to law.
Swom to or affirmed an subscribed DV < < E~~=~L ~Q'~i
Signature of Personal Representative
before me the day of
O~~ Signature of Personal Representative
n d
For the Register Signature of Personal Representative z Q ao
~ CJ -. ~,,1.'
0
File Number: C~/I-~~%'~ 0~`~t'~ c~?~ 'D ~:~`~'
Estate of ! 1 a ~.. L~,i.y ~ a~ , ~c ased N - ` r'
~y Gh "~`=
Social Security Number: ~ b ~ - ~ Z~ ~~ ~~ Date of Death: ~ - a ~- 09
AND NOW, "'
having been presented befor itr, T IS
are hereby granted to ~/1~
in consideration of the foregoing Petition, satisfactory proof
Letters
in the above estate
and that the instrument(s) dated ~ (~,i'1 E' ~ ~]. ~Q q ~}
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES t '
Register of Wills ~. ~
Letters ............... $ ~ '
Short Certificate(s) ........ $ .~~ Attorney Signature: Ctl~l.~1~C~
Renunciation(s) .......... $
YV ,I ~ ~_ _ ... $ l Attorney Name: GV e ~ ~ / 6l- M ~ 1L-r/r-L~ ~
... $ t0~
... $ t D
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ '~-
Supreme Court I.D. No.: ~31i'~
Address: // f7`~ ~C~IG fJ Alin /j ~ r<4 ~t7f / a`/-
L ~~ 1 ~I LL ~~' ~~JU~~
Telephone: ? ~ 7 7 ~ ~ - ~ 6 61G
Form RW-02 rev. 10.13.06 Page 2 of 2
05.905 REV.(3y09) ~ ~ .~ ~~ ~, ~ ~~
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Vital Statistics Law of 1953, as amended.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~D
>L,,,.
c ~- N
.,
t--
. '
~ O~~
~
~~,, a- 'C~J1Q_
['1 cY.. Q~ Ix`
J
L l.r :•i.1 ( _
~ ~
4
~~~~~ ~~
Q1
~~.
tev
C4 ~{ . ~ ~,Qia____
Linda A. Caniglia
State Registrar
JUN 2 9 X009
Date
H1os-1a3 REV nnoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS 052104
TYPE I PRINT IN
PERMANENT CERTIFICATE OF DEATH
BLACK INN (See instructions and examples on reverse)
STATE FILE NUMBER
1. Name of Decedent (First, midde, IasL sumx) 2 Sex 3. Social Secudty Number 4. Date of Death (Monet, day, year)
Ste la E. Davis female 187 - 12 -6552 May 25,2009
5. Age (Last Bulhday) Under 1 year Under 1 day 6. Date d Binh (Month, day, year) 7. Binhplace (City and state a forego country) Ba. Place d Deam (Check only ace)
Months
88 Yrs Days Hours Ninutes
Apr. 14,1921
Wilkes-Barre,PA HOSpilal:
^ Inpatient ^ ER I Outpatient ^ DOA Dmet:
^ Nursing Hane Residence ^Other ~ Speciry.
' Bb. County of Death fic. City, Bom, Twp. of Deam !d. Facility Name (If not insldu(ion, give street and number) 9. Was Decedent of Hispank Origin? '~ No ^Yes 10. Race: American Indian, Black Wh4e, eh.
Cumberland Lemo ne
y 127 N. Fourth St. mYesspedrycuban, (svecrY1
Mexican, Puedo Rican, etc.) whit e
11. Decedent's Usual Oa tbn Kind of work done Burin most of wore life. Do not sate refired 12. Was Decedent ever in the 13. Decedent's Education (Speciry only hghest grade completedf 14. Marital Bolus: Marred, Never Married, 15. Surviving Spouse (d wife, give maiden name)
Kind of Wak Hind of Business / IMusfry U.S. Armed Forces? Elementary 1 Secondary (0-12) Cdkge (1 d a 5+) Widowed, Divorced (SpeciM
~(
r e tionist ov.'s office ^Yes
ND 12 married Allen Davis
16. Decedents Mating Address (greet, city 1 town, state, zip code) Decedents Did Decedent
1 2 7 N. F O U r t n J t. Aclud Residence 11a. Bate P P n 11 C ~/ 1 V a n i a Ux'e u~ a 17c. ^Yes, Decedent Livetl in Twp,
Lemoyne, PA 17043 Township?
17d. No Decedent Lived widdn
„bcaDnry Cumberland AqualLimnsd Lemovne cnylBoro
td. Fame's Name (First, mukde, last, wtlix) 19. Motlcer's Name (First, mddN, maiden surname)
Ralph English Mary Marinaro
20a. Informant's Name (Type 1 PdnQ 206, Idomanfs Mailing Address (Street, city t town, stale, zip code)
D.. Allan Davis 127 N. Fourth St.,Lemoyne,PA 17043
• 21a. Memod d Disposition ^ Cremation ^ Dmadon 216. Dale of DxsposiUOn (Monet, day, year) 21c. Place d Disposition (Name d cemdery, aemalay a other place) 21d. Location (City I town, state, ap code)
Burial ^RemovalhomBete ;waeCrematbnalMnatronAumaized
^
^ May 30,2009 Rolling Green Cemetery amp HilI,PA 17011
^ ~ Specdy: ; q' Medical ExrnNrer! CaoneA
Yes
No
•
' ~e d Facerd Se Licensee (or persa adult as such) 22b. License Number 22c. Name and Address d Fadiry
FD-013153-L Muss?lman FH&CS,324 Hummel Ave. ,Lemoyne, PA 17043
Hems 23ac any when certiMng 23a. To me hest d my luawled9e, Bea aaunad al me tune, date and place stated. (Signafae and Me) 23b. License Number 23c. Date Signed (MadA, day, Yom)
phyaidan s nd aveilabk at mne d deem b
certify pose d deem.
• Hems 2426 must be cmpleted bt' person
l
m
B 24. Tone of Deam n
~ 25. Dale Praaunced Dead ( year)
^ a~ ~ ~ 26. Was Case Re N Medkal Examiner I Coroner fa a Reason Other man Cremation a Doretbn?
w
a pranasices
ea
. . I' M. ~ ^Yes No
CAUSE Of DEATH (See insWMlons and examples) r Approdmate nrorvel: Pad n; Ems filer ' 26. Did Tobatto lke ContrdAe b Deem?
Hem 27. Pad I: Eder machain d weds- dseases,injures, aampipdaa- mat directly puled me dedh. DO NOT enNr temwcel events such as cardac anal, r plsq o Deem hd nd reai6lg in me wdery6ig case given ro Pan L ^Yes ^ Pmbebhy
respualay surest a ven6iadar fiMilation witlxad alpwiig me e0dogy. Ust ody one cause on each ire. r
~
'
Q lJngpwm
N6IEDIATE ~ E 'Fus1a)dseasea A
v _e. /~~
midtimresu' mdeam ' ~((j -~ G~~'h~~ ; j lJfQl
2s.n angle:
-~ a
Due to (a as a o^: A ~
~ l
ti ~Nd pregnant wlmin pest year
IseWarroany I~f ceridddm, d pry, b. ~ U ,M Q ~a f
~ n ~ ~ ~ l d
t;
N
~ ^ Preyrent at tire d dim
i CAFE a Duero (or as a casequence dl: ~
Eder 6~e
1 DEH~LYgM ^ Nd pegnaA, 6d pregnant xsMin 4z days
' (dsease a bWY tlat mated me c, r
evens reallmg n Beam) LAST. d deem
Due to (a as a consequence on: i i
^ Nd pregnml, dd pegnad 43 days b 1
year
• d. i bite
^ lAYaawn i pregnant wimur tlce past y~r
30a. Was an Autopsy 30b: Were Autopsy Fudings 31. Maurer d Deem 32a. Date d Injury (Month, day, Year) 32b. Desamee How Inryry Oauned ~ 32c. PWce d 6Na'f fiane, Farm, Bred, Faday,
Pedomced? Avanade Prig to Cartpletbn
~JaN21 ^ Homkide Otlice Bul'Idn' g, dc, (Spagly)
of Cause d Deem?
~
/ ^ A
dd
nt ^ P
d
M
li ~d
Time d Nyury 32e
6Mu0' at Wodc? 321
n Tmm
aW6on Inju
(S
edf
) Lepton d I
32
B
t
d
I t
t
t
,
^ Yes (~'NO
^Yes ~Ih c
e
en
ng
ves
gadon . . .
p
y
p
y g.
nNry (
res
,
ty
arn, s
a
e)
»,111 ^Sdcoe ^CaddNdbeDetammed ^Yes ^No ^Ddrerl0perata ^Passenga ^Pedeshian
M Oma' Spedry
33a. Cer6fia (dwdc tidy ace) 33D. d Certil' r
' Cednymg phyakMn (Physidan cedilyiig pose d deem when another physician has praqunced deem end canpleted Beet 23)
-
To thebatdtm/knowkd90.deemacurreddueromepasels)andmrmaasaroted------------------------°-_----- ^
' Pronamrdng nd uAXYro9 ~~ IPM~n hour prmaxxing deem and cadnyuig b cause d Beam)
To thebeatdmyprowkdge,deamocpnedallhetlme,date,ardplap,andduetomeause(s)endmannerasshted------------------ .. N ,,,,,,,,, 7SolG
ce ~ ~ldony(v
~',•~'~ ""
//7'
• Medgl Examinant Caorkr
On the 6esh d examinatbn and I a irnestlgsdon, in my opudon, d~th oauned el the tlme, ate, and place, and due to the pose(s) and mmtner as stafeti ^ l(
. J
'
~ P 21) T /
I
- Regrslrara and ~ l a21 / I oil / I /~
~po~
~ '"l'd et
Q
~~e ul G
r Nt~~ ~~ ~~`' '
q Do ~Jh~a~ ~ ~
, .
j
(
V Disposi0on Permit No. O ~ ~ ~ ~`~
LAST WILL AND TESTAMENT n
~ w
~
': T't'"O t/')
P'*'1
4
DAMS
STELLA E ~o~i ~"'
. s
-~-1 N
a
N
I, STELLA E. DAVIS, of the Borough of Lemoyne, Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament, Hereby revoking all prior Wills and Codicils.
FIRST: I have provided for my funeral expenses, but I direct that my Executor or
Executrix pay all other debts as soon after my death as may be practicable. I further direct that
all state, inheritance, transfer, legacy, or succession taxes which may be assessed to my estate, or
any part of my estate, whether passing under my will, shall be paid out of my residuary estate as
an expense of administration and without apportionment.
SECOND: I devise and bequeath all of my estate of every nature and wherever situate
to my husband, DAVID A. DAVIS, also known as D. Allen Davis, provided he shall survive me
by Thirty (30) days. In the event my husband predeceases me or dies on or before the thirtieth
(30th) day following my death, I devise and bequeath all of my estate in equal shares to such of
my children. SANDF.A LEE FENTQN, DD';;vA DEE HALL and PAMELA BEE O'HEARN,
or their issue per stirpes.
THIRD: I direct that all taxes that may be assessed in consequence of my death, of
whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as
r
i~ i '~~
~~~'~
,~
f°.-7 `; ~
<'"~ {~->
_:n ~~
~3 ~
a part of the expense of the administration of my estate.
FOURTH: I appoint my husband DAVID A. DAMS, Executor of this, my last will.
Should my husband, DAVID A. DAMS, fail to qualify or cease to act a s Executor, I appoint my
daughter, SANDRA LEE FENTON, Executrix of this, my last will.
FIFTH: I direct that my Executor, or their successors, 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 this ~ 7 day of
1999.
-~ ~ ~ ; j
~~ ~- ,--
~'~,~~~ ~ (SEAL)
STELLA E. DAMS
SIGNED, SEALED, PUBLISHED and DECLARED by the above, STELLA E.
DAMS, as and for her Last Will and Testament, in the presence of us, who, at her request, in her
presence, and in the presence of each other, have hereunto subscribed our names as witnesses:
~~
WITNESS
w,~~~~
WITNESS
of ~ ~ IC ~e ~ l /J /Zr~le
of "1 ZU ~.Q,~'J U ~ Y ~ , ~ ~~
~.C~~t~,~Tw~ ~~~I
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
I, STELLA E. DAVI5, Testatrix, whose name is signed to the foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I have
signed and executed the instrument of my Last Will and Testament; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes therein expressed.
Sworn to acknowledged before me by STELLA E. DAMS, the Testatrix, this
l7 ~ day of 1999.
f
STELLA E. DAMS
ti
Otary Public Notarial Seal
Dawn E. Nace, Notary Public
Lower Allen Twp., Cumberland County
My Commission Expires Oct. 16,198
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS:
We, i1Jil~~tsxn C - +L.UI\c~5 and ~'GYCJ ~ 2 t'a~ ~ ~C.s~
the witnesses whose names are signed to the attached instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testatrix, STELLA E. DAMS, sign
and execute the instrument of her Last Will and Testament; that she signed it 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; and that to the best of our
knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed to before me by t~~ iL~;~a~n C . ~C t~ Itc~~ and
C?t~:f U 12 Ct` . ~~C -2.._. ,witnesses, this - j ~7~ day of ~~ 1999.
Witness Witness
Notary Public
Notarial Seal
Dawn E. Nace, Notary PubAc
Lower Allen Twp., Cumberland Coun~ .
My Commission Expires Oct. 18, 1 ~9
LAW OFFICES OF
KOLLASAND KENNEDY
1104 FERNWOOD AVENUE
CAMP HILL, PENNSYLVANIA 17011
WILLIAM C. KOLLAS
JAMES W. KOLLAS
Glenda Farner Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
September 9, 2009
RE: The Estate of Stella E. Davis
Dear Ms. Strasbaugh:
OF COUNSEL
MARY KOLLAS KENNEDY
TELEPHONE NO. (717) 731-1600
FAX NO. (717) 731-1460
.~~~~
1~
Enclosed please find the original Estate Information Sheet, Petition for Probate
and Grant of Letters, Oath of Personal Representative, Will of Stella E. Davis and
Certificate of Death. On September 2, 2009, the Personal Representative, Executer
David A. Davis did personally appear and was sworn in at your office.
For your reference, enclosed is a copy of a document check list. Finally, enclosed
is a check in the amount of $140.00 for the filing fees and short certificates.
Thank you for your attention in this matter. If you should require anything
further, please do not hesitate to contact my office.
Very truly yours,
WCK/car
Enclosures
KOLLAS AND KENNEDY
~~1 c ~ou~~ccc~
William C. Kollas
a
cn `~
~~ ~
~
4.4 ~x
~ C. .._~ -: S
~~ {'Y
_~-: :..~
~ ~
~
-t
N ~,
`_..c
.`- _?
F
'j