HomeMy WebLinkAbout10-01-09Prepared By: Francis A. Zulli, Esquire
Date: October 1, 2009
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Thomas A. Worrell
also known as
. Deceased
No. `2 I - Zoo y- ~~ zc~
Social Security No. 247-01-3401
(COMPLETE "A" OR "B" BELOW:)
Q A. Probate and Grant of Letters and aver that Petitioner is the Executor/Executrix named in the Last
Will of the Decedent, dated
and codicil(s) dated
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
^ B. Grant of Letters of Administration
Petitioner(s) after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and
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Name Relationship Residence
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(COMPLETE IN ALL CASES:) Attach additional sheets, it necessary.
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last #~nify or pri~pal ~ '
residence at 527 Ninth Street New Cumberland (Borough), Cumberland County, Pertnsylvania f7?070 ,
Decedent, then years of age, died August 20, 2009 , at Claremont Nursing & Rehab
Center Carlisle PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 13,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
Total
Real Estate situated as follows:
$ 13.000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with
this Petition and the grant letters in the appropriate form to the undersigned:
Signature Typed or printed name and residence
Preston A. Worrell Thomas A. Worrell
527 Ninth Street 138 Yellow Breeches Drive
Neer Ct.ynberland PA 17Q,Zp„ Camp Hill PA 17011 ~
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Oath of Personal Representative
Commonwealth of Penns Ivania
County of Cttiw~berle~~
The Petitioner(s) above-named swear(s) and 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 esta ccording to law.
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Sworn to and affirmed and subscribed ~ G'/ " ~'
Before me this `day of ~U %~
2009. Pr ston A. Worrell
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., k Thomas A. Worrell
DECREE OF REGISTER
Estate of Thomas A. Worrell No. 7 1- Z Dy ~ - ~ ~ Z(~
also known as
,Deceased
Social Security No. Date of Death: August 20, 2009
AND NOW, this .1Srday of ('~.r~.~ , 2009, in consideration of the Petition on the reverse
side hereon, satisfactory proof having been presented before me,
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IT IS DECREED that c~ o ° = ~-~
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Letters D Testamentary ^ of Administration s ~~ --~
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are hereby granted to _' :^. ~, ; ~ < <--,
Preston A. Worrell and Thomas A. Worrell ~ -- ~ ,"
in the above estate and that the instrument(s), if any, dated ~iescnbed the ~ .-
Petition be admitted to probate and filed of record as the last Will of Decedent. N
FEES
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Letters------------------$ ~Q
Short Certificate(s) - - - - - - - - - $ ~ 2 - cy
Renunciation------------- $
Affidavit( )--------------
Extra Pages ( )----------- $
Codicil------------------ $ '
JCPFee---------------- $ (~.~r~
Ipye~~tory & Tax Forms - - - - - - $ _ J ~~
OWWther-~~'r'~'h~------$ `a ~t>~
TOTAL----------- $ (i~Z ~~~
of Will
Attorne~ 1=rancis A. Z li Esquire
I.D. No" 15316
Addre ~ 109 Locust reet
Harrisburg, PA 17101
Telephone: (717) 232-1488
DATE FILED: ~ U ~ (~ ~
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105.905 REV. (3109) ~ ~ '- ~, ~ C ~ -- ~ ~ 7 -~
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.
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H105~743 REV 11/2006
TYPE /PRINT IN
PERMANENT
BLACK INH
5166904
No.
Linda A. Caniglia
State Registrar
SEP 10 2009
Date
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and exaplples on reverse) sraTE FILE Nl1MBER
1. Name of Oecetlenl (First midtlle, last wlHx) 2. Sex 3. SoclBl Security Number 4. Uate of Death (Month, tlay, year)
Thomas A. Worrell Male 247 - 01- 3401 Au ust 20 2009
5. Age (Last &dhtlay) Under t year Untler 1 day 6. Date of Bldh (Month, tlay, year) 7. Bidhplace (Cly and state or lorpgn muntry) 6a. Plate of Death (Check only one)
Mmms Deya Hours „xae Hospital: Other:
1 91 5 Tallassee, AL ^
June 21
94
^
^
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^
,
yrs.
,npaaent
ER/Outpatient
DOA rsing Hgrle
Resitlance
Olher-Speciy:
6b. County of Death &. City, Boro, Twp. of Death 6d. Fadkry Nam¢ (If not inslhution. give street and number) 9. Was Decedent M Hispanic Origin? ~] No ^ Yas 10. Race: American Intlien, Sleck. White, etc.
(If yes, speciry Cuban, ISpealr
Cumberland Middlesex Twp. Claremont Nursing & Rehab. Ct .Mexkan,PUerloRxan,etc.) White
Decedent's Usual Occu anon Kind of work tlone tlum most of wgrkin life. Do rwl stale retiretl
1 f 12. Was Decedent ever in the 13. Dacatlent's Education (Specify only hlghesl grade tnmpleled) td. Marital Status: Married, Never Mametl, 15. Surviving Spouse (II wife, give maitlen name)
.
(( Kind of Work Klnd of Business / IMUSay
L~ieu£~nant Colon 1 US Arm U.S. Armetl forces? Elementary / Secontlary (0 12) College (1-4 or 5+) WitloweQ Divorcetl (Speciy,
5c7Yes ^Nn 12 Widowed
16. Decetlenl's Mailing Atldmss (S1reN, thy /town, stale, zip c¢tle) Decedent's Did Decetlenl
PA Live in a 11c
^Ves
Decetlenl LNep in Tw
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5 2 7 9th Street ~ .
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Township? 11tl. ~] No, Decedent Lived wiNin
New Cumberland
Cumberland
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New Cumberland PA 17070 pany
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Adualumdad
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16. FaMer's Name (Flrsl, mldtlle, last, sufgx) 19. Mother's Nam¢ (first; rtetltlle, maiden surname)
h n 11 Mar L. Ra
20e. Infomrent's Nam¢ (Type / Pdni) ZOb. Informants Meiling Adtlres9 (Street dy /town, slate, zip code)
Preston A. Worrell 527 9th Street, New Cumberland, PA 17070
21 a. Methatl of Disposition ^ Cremation ^ Donation 21 b. Dale of Dlspos8an (MOnM, tlay, year) 27c. Ponce of Disposilien (Name of cemetery, prematory ar Olfkf Dlece) 21 tl. Location (City I town, stale, zip mtla)
® Burial ^ Rempyalrmmsmte wncrem.tipnarDOnatmnANladzed 1 5
2009
Sept Arlington National Cemetery VA 2221 0
Arlington
^ Other -Specify ! by MMicel Examklar / Cararur? ^ Yes ^ Ne ,
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228. S re d Funeral ice Licensee (or person arlg as such) 22b. Ucerlw Number 22c. Name end Atltlress of Facility
O 012342
L PA 17070
New Cumberland
St
408 3rd
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ale Items 23a-c only wn¢n cedilyng 23e. To Me ~ f krawletlga, death occurratl et tM tlme, date and pace salted. (Sgnature antl Title) 23b. Licerae Number 23c. Date Sgnetl (Month, tlay, year)
physkian a not evaileole at time of death to ~1 ~/,,. f~
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hems 24-26 mull b¢ completed by perms 24. Time of Daelh 26. Dafe Pronourc
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d Dead (Month, day, year) 2fi. Was Case Relerretl)o Metlioal Examiner /Coroner for a Ree Other than Cremation or Donalion4
wlw pronounces tleath. 7
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CAUSE OF DEATH (Sae Inatruotlona and axamplea~ , Approx male interval: Pad II: Enter Mhar sion fkam mMt'ons conldbufng to tlealn, 28. Did Tobacco Use Contribute to Death?
Item 27. Pad I. Enter the chainol averas- dseases, mjuriea, or comp6callms -that dlrealy causetl IM tleath. DO NOT enter termnal events such as cartliac arrest. Ousel to Death bN trot resuhirg n Me untlerrying cause given In Part I. ^ Yes ^ Probably
respiraWry arrest, or ventricular fibdlletron wiMM showing the atbbgy. List only one rouse on each IMe. (
1 ^ No ^ Unknown
IMMEDIATE CAUSE IFinal tl5ease or ~
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Due to (ar as e,~,O~n+9 yy~: f (
$eq Bally list conMions, if any b. !L'~ ~./1 H ! C't
~ ~ ll -~ .rl ~.t Not pregrent whhin past year
^ Pregnant al time o1 death
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leatlMg to the cause listed on Are a. Due to or a Ise
( as wnsey stn oQ: 4 ^ NM pregnant, but pregnant within 42 days
Enter fhe UNDESLYING CAUSE
deasa pr Injury Mat iniliat8edd me
c of tleath
rds resulting in deaM) LASL
Due to (or as a comequence off: Not 1, but t 43 da s to 1
^ pregnan pregnan y year
before deem
d. ^ Unknown if pregnant within Ih¢ Past year
30a. Was an ANOpsy 30b. Were Autopsy Findings 31 Me net of Death 32a. Dale of Injury (Month, tlay, yearl 320. Describe Haw Injury Occurred 32c. Place of Injury: Home, Fans, Street. Factory,
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Performed? Available Prior to Completion ~ce 0uildrg, etc. (Specify)
OR
of Cause of Deals? Natures ^ Homkitle
~/ ^ Au'denl ^ Pestling Imestigetion 32d. Tme of Inlury 32e. Inlury at Work? 32f. It Transpodalion Injury (Specify) 32g. Location of Injury (SYreN, c'M / tavn, stales
^ Ves LsQ No ^ Yes ^ No ^Ves ^ No ^ Dnver I Operator ^ Passenger ^ Patlaslnan
^ Su,ctle ^ Coultl NN be Oelarminetl M ^omer. spetiy:
33a. Certifier (check Only ono)
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23 33h. Signatures~antl Ttle of Ceditier
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• Cerlllying physician (Physipan ceMlymg rouse of death when another physician has prorrouncetl death an
Malh occurretl tlue to the cause(s) erM manntt as ateterL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To the beat of my kr,owletlge ..+
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• Pronouncing end eerdtyllg physician (Pnyscian bosh pronounang tleath antl cediying m quse of death)
To tta best of my knowletl¢, tleath occurretl at the time, date, and place, and due to the cause(s) and manner a atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
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oroner
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Dn the basis at examinetion and /or invesligetion, In my opinion, tleath oecurretl at tM Ilma, date, and place, antl due to the cause(s) and manner as ataletl_ ^ ) Type /Print
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1°~i,~OMAS A.
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THOMAS A. WORRELL
WORRELL, of the Borough of New Cumberland, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this to be my Last Will and Testament hereby revoking all
other Wills and Codicils by me at any time heretofore made.
ITEM I: I direct that all of my just debts and currently due debts and
funeral expenses shall be paid from my estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II: I give and bequeath my 1988 Cadillac automobile to my son,
THOMAS A. WORRELL.
ITEM III: I give end bequeath all of my household goods, automobiles
and all other articles of household and personal use, tools, equipment and similar items to
my son, PRESTON A. WORRELL.
ITEM IV: I give and devise my real estate known and numbered as 527
Ninth Street, New Cumberland, Cumberland County, Pennsylvania, to my son,
PRESTON A. WORRELL, only if he survives me.
ITEM V: I give, devise and bequeath all of the rest, residue and
remainder of my estate, whether real or personal, or wheresoever the same may be situate
or located, iri equal shares, to my sons, THOMAS A. WORRELL and PRESTON A.
~~zsY ~i11 ~zn~ (~TP~Y~zmPnY
~v'ORRELL, per stirpes.
property hereunder may be subject, and to charge such taxes as a pa~_-t of the expense of
the administration, payable out of my residuary estate.
ITEM VIII: I direct that no Co-Executory or other fiduciary named,
nominated or appointed in this my Last Wil and Testament shall be required to post any
bond or give any security of any type for any purpose whatsoever, any law or rule of the
Court cf the Commonwealth of Pennsylvania or any other jurisdiction to the contrary
notwithstanding.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~
~,..- ~ 'day
of --J ~. 'v ~- , 1998.
~,..a_.
Thomas A. Worrell
Signed, sealed, published and declared by the said Thomas A. Worrell, the above
named Testator, as and for his Last Will and Testament, in the presence of us, who at his
request anti in his presence and in the presence of each other, all being present at the
same e, have hereunto subscribed our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, THOMAS A. WORRELL, Francis A. Zulli and Wendy S. Paul, the Testator and
the witnesses respectively, whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do hereby declare to the undersigned
authority that we were present and saw Testator sign and execute the instrument as his
Last Will, that he signed willingly (or willingly directed another to sign for him}, and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
of the witnesses, in the presence and hearing of the Testator signed the Will as witnesses;
and that to the best of our knowledge the Testator was at that time eighteen (18) or more
years of age, of sound mind and under no constraint or undue influence, and I, the said
Testator, do hereby acknowledge that I signed and executed the instrument as 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. ~- _
T TATOR ~ '_' -_......~
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WITNESS
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Subscribed, sworn to and
acknowledged before me by
Thomas A. Worrell, the Testator,
and subscribed and sworn to
before me by Francis A. Zulli
and Wendy S. Paul
witnesses, this ~ day of
June, 1~98~1
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Notary Puh1iE /~ ~~-