HomeMy WebLinkAbout11-03-09 (4)PETITION FOR PROBATE AND GRANT OF LETTERS
REGI TER OF WILLS OF~.~~.-cz.F COUivTY, PEI~NSYLVAMA
Estate of ~;:~~~,~~~~ ~~ _~-~ f.,~'.., File Number ~~ `(-t ~ /l../;tf'~~
also known a ,+
_~~~ Deceased Social Security Number l~_~ ~~ -'L%~~
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(CO,LIPLETE 'A' or 'B' BELOW:) ~
A. Probate and Grant oC esters Testamentary and aver that Petitioner(s) is /are the ~~~~'~~ named in the
las Will of the Decedent date ~ j and codicil(s) dated N
w -:
(State relevant circumstances, e.g., renunciation, death of executor, etc.) CX1 p (~ ~ _'?
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executi ~sttum~it(s) off~tied~`
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
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^ B. Grant of Letters of Administration ~ ~ ~ '
(lfappficable, enter.• c. t. n.; d.b.n.c.ta.; pendertte fire; durance absentia; d~ to minoritnte).~.
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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. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sGeets if necessary.
~ ~
Decedent was domiciled at death in County, Pennsylvania with his /her last principal residence at
(List sweet address, town/city, township, county, state, ¢ip code) ~
Decedent, then years of age, died onj ~ ~ at ~t- r
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 not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
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Fan, RW-0? ,~~~ lo.r3.o6 Pabe 1 of 2
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the gran[ of Letters in the appropriate form to
the undersigned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~~_~,~~~~ ~ ~~ SS
'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are titre and con•ect 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. ~, ~ i~~
Sworn to or affirmed anal subscribed ~ _.
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Signature Personal RefdiesAntattve T~-
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i Si iature of Personal Representative ~~~ ~ '~
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For e gister SignntureojPersona!Representative -
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Estate of ,~ ~ ~Ca ~~~~ e e
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Social Security Number: ~ (~~ -~v~ ~ C
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v~~`~ Date of Death: fLi' ` ~;~f `f ' ~ /
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AND NOW t,,~ in consideration of the foregoing Petition, satisfactory proof
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efore me, IT IS DECREED that setters ~~~~ /~.~1 G~-~
having been presented
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are hereby granted to ~ 17~- ( ~~- i~~dY~=~ ~_~ ~ ~ ~
in the above estate
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and that the instrument(s) dated ~-~c,C~'
described in the Petition be admitted to probate and filed e last Will (and~odicil(s)) ofgDeced~nt.
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of recor (as
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FEES
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Letters Register of WillJ~ Y
...............
Short Certificate(s) ........ $ ~ ~ Attorney Signature:
Rey nciation(s) .......... $
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Atto47iey Name:
... $ ~ Supreme Court LD. No.:
a ~. $
$ Address:
... $
... $
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• • • $ Telephone:
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TOTAL .............. $ ~ (~(g .
Torm kW-0? rev. l0.lJAG Page 2 Of 2
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LOCAL REGISTRAR'S CERTIFICATION OF aEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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H100-143 REV 112006
TYPE / PRINT IN
PERMANENT
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NIIMRER
1. Name d Decedent (F t, mitldre, mu, suffix) 2. Sex 3. Social Secudry Number 4. Data of Death (Monet, tlay, year)
ANNA MAE LANDIS Female 163 -22 - 0667 October 24, 2009
5. Age (last Bintbay) Und« 1 year Under 7 day 6. Date d Birth (Monet, day, year) 7. Birthplap (City aM elate a tor si country) Bor. Piece d DeaM (Check ony one)
Newu oen Hwrs MkwNS HWDhei: Other
87yrs Nov 17, 1921 Lancaster Cty PA ^Inpatient ^ER/Outpatient ^DOA ®NursirgHOme ^Residance ^Olher~Spedy:
Bb. Donny of Deem &. City, Boo, Twp. of Deam Bd. Fadliry Name (h rwt imtilution, give street and naMrer) 9. Was Decetlem o/ Hispank Origin? ^ No Ves 10. Race: Amerban Indian, Black, White, etc.
Cumberland Carlisle Boro (If yes, speciy Cuban, (Speayl
Thornwald Home
Mexkan,PUertoRican,etc.) White
11. Decedent's Usual Ibn Kind d wok done du' moll d worki Ne. Do not slate reti 12. Wes DecetleM ever ro the 13. Decedent's Edupf (Specify onN hghesl grade completed) 14. Marital Status: Horded, Never Married, 16. Surviving Spouse pf wife, give maiden name)
KiM of Work Kkb d Business / Industry U.B. Amxx1 Forces? Elementary 1 Secondary (0-12) Collage (id or Br) Widowed, Divorp0 (Speciryd
Factor Worker Food Processin ^Yea ~lo -------g____ _____________ Widowed
16. DepdenYS MaiHn Address (SIreeL dy I town, state, zip code)
2 Fox Follow Lane Decedent's Did Decedent
sore Pennsvlvania L;ra ins 17c
a°n,at Reaiaa,°e 1Ta
1]CVBa
Decadent Livetl In Penn
Carlisle, Pa 17015 .
.
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Twp.
Cumber 1 and T°wn~~°? nor. ^ N°, Dacedem l;~ad wahm
nb.ca,nrv
Aclualhm4sd ciryleom
18. Fath«'s Name (Firs4 midge, last, suffix
B 19. Homer's Name (First, mode, maiden sumameJ
arry
rown Mary Bossier
20a. Irdormam'8 Name (Type /Pmt) 206. Infartnanfs Mailkg Atltlrea5 (Slreei mY /town, state, z9 ~)
Andrea Moretti 2 Fox Hollow Lane, Carlisle, Pa 17015
21 e. Mema1 of DlSpoaltian ^ Cremation ^ Damtion 216. Date of Disposition (MOdh, daY, year) 21 c. Plop of Disppition (Name of cent«ery, crematory a dher place) 21tl. lzralion (City! town, strte, ziP code)
Buda) ^ Removalhan Slate 'wee Cranetron «DOrotbn AUmorized
• Oct 29, 2009 Baker's Cemetery Mechanicsburg
Pa 17055
^ Om« - Specrty: W Madkel Fsaminar I Coranar? ^ Vea ^ No ,
22e. SigreWre d of Service lice pe es such) 226. lJCenae Number 22c. Name aMA«xess of Feriliry
. ~ FD-012909-L Ronan Funeral Home 255 York Road, Carlisle, Pa 17013
Complete h Sec any when catifyln9 23e. To best d my Wtovkdge, deem a«uned at me time, dale and place stated. (Signahee orb Lille) 236. License Number 23c Date Si~natl (Month, tlay, year)
PNYSidan U rid available at tlme of Beam ro
certiN puwddaam. /
P`}I~btQ~ !kd- '~ / ~.-~..C._C~iC d.E~• ~/~i~
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compleletl q, person
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F 24. Time d Deam 25. Date Pranou
Deed (Madh, d
ay
, year) 28. Was Case Reterretl to McGral Examiner /Coroner /or a Reason Other man Cremation or Donation?
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/ _ -~ ~`~ ^Yes ^No
CAUSE OF DEATH (See Instructions antl examples) I llpproximale interval: Pert II: Eriter Deter sgniGpnl cal&Gorn conidbutina to deem, 26. Db Ta6earo Use Cmtlibute to Deam?
Item 27. Pad I: Enter the chain d events -diseases, injuries, a compecetias -met dredy reused the tleam. W NOT emer lertninal even6 such az cartliac anent, Omel M Deam hd rid resulti n me un pose
n9 i dedNn9 given in Pad I.
^Ves ^ Probably
reapirerory arrest, or ven6iader N6nfietion without shawilq the etiobgy. List onN one pose on each late. l
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' No ^ Unknown
NIMEpATE CAUSE fFinal dseese a ~ //
amdbon resulting in deem) -~ a ~~,1{'~ZiH~ZLLI
i i 29. If Female:
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Due to ore
~( sz consenuerlp on: I // Not pregrenl witk
n pest year
SeguentielW Xal mttlllbre, if any, b, / ~~~7,,.y~ ~ f
to the pose Gsted on M1ne a
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.~ ^ Pregnant a1 Gme d deaU
. Due to (or es a corN o .
~
Enter UNDElILYNG CAUSE ~/ ^ Not pregnant, bd preglad within 42 tla
Ys
(assess «kpury lw kMaled me °. (~Q.,~~ L*~G Lx4i.+G:~-2 ~ G .awl
events re&dting in death) LAST. m deem
Due to (or as a consequence aQ: r ^ Not pregnant, bd pregnan143 days to 1 year
d bemre death
^ unknown n pregbnt waNn aw par year
30e. Was an Aubpay 30b. Were Autopsy Finarga 31. Meurer of Deam 32a. Date d Injury (Mash, tlay, year) 32b. Describe How Injury Oarrmed 32c. Plop of Injury: Home, Falm, Street, Factory,
Perbmied? Avedable Prior to Completion
~Naluml ^ Homicide Omce Builaig, eh. (Specify)
of Cause d Deam?
^ Ves ~NO ^ Yes ^ No ^ A«bent ^ Pandilg Invesagetion 32tl. lets °t Injury 32e. Injury al Work? 321. If Transportation Inlury ISpeai/yl 329. Location °I Inryry (51reeL oily I town, slate)
^ Suidde ^ Could Nd ba Determined ^ Yes ^ No ^ Driver I Oparala ^ Passenger ^Pedeslnan
M Omer - Speciy:
33a. Certifier (check any one) 33b. Sgrtamre ant T e d Certifier
• Cenlying physkian (Physidan pniykg pose of tlealh when another {nysiden has Ixoriamced deem antl completed Item 23) , /r//~
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To the hest Of my krrowkdge, teeth occurred due to the cause(s) ant manner ea stetM_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ tl,l
• Pronoundng and artgying P6Ysiclen (Physk:ian bodl prawundng deem and cenirying Io pose d death)
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^ 33c. Licelue Number 3x. Data Signed MaM, tlay, art
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medipl Ezamin« /Coroner [.
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On the beats of exandrmtlon antl / «Invesligefion, in my opiMon, death omumed M the time, date, orb place, end due to the gues(s) antl manner ore abted_ ^ ,
34 Name and Atltlress of Parson WM Can led Cause of Deam (Item 27) Type /Print
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Disposition Perms Na. ~ ~`1'\)\ )~ ~~
WILL OF
ANNA M. LANDIS
I, Anna M. Landis of Cumberland County, Boiling Springs,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be as follows:
A. I direct that my entire estate be divided equally
between my children, Allen W. Landis and Andrea
M. Moretti.
B. If any of the above named children predeceases
me the deceased person's share shall lapse and
go to their surviving children.
LAW OFFICES OF
STEPHEN J. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
4. I appoint Allen W. Landis and Andrea M. Moretti, jointly
as Executors of this my last Will.
5. The Executors of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
IN WITNESS WHER I h~ ~ hereunto set my hand this
day of 05. d
~~
mac, ~~
,~ :, --~
I-
Anna .Landis ~ '~ ,_~'-
~ ~
~''by ~ ~ ~Wr , ...
~` T ~ _ +
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The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Anna M. Landis as and for her last Will in the presence of us, who at
her request, in her presence and in the presence of each other have
subscribed our names as witnesses hereto.
WITNESS WITNESS
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
MY
LAW OFFICES OF
STEPHEN J. HOG
19 S. HANOVER STREE'
SUITE 101
CARLISLE, PA 17013
State of Pennsylvania
County of Cumberland
ss
I, Anna M. Landis, the testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
~~~ -yam
Anna M. Landis
Sworn to or affirmed and acknowl dg k~ef fe me by Anna M.
Landis the testatrix, this ~ ~ day of ~ :-. rat.- ,
2005.
~/~ ~-
NOTARIALSEAL 1. '~"~!'
:PHEN J 'tOGG, NOTARY PUi3Ld~:
IsLESO~~,cuMBeRLANaco. ~~ Notary Public/Attor
NISS90N eXPIRES SEPTEMBER'J, 20t~~+
AFFIDAVIT
State of Pennsylvania
County of Cumberland
ss
We, I.i~a, ~. ~ I ~ ~-r'~ and 2b;\~~~}_t-orthe
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her last Will; that the testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of
so nd mind and under no constraint or undue influence.
- ,-,-c -w~.v _
Sworn to or
this G day of _
d s scribed o b fi
r
me by witnesses,
NOTARIAL SEAL
STEPHEN J. HOGG, NOTARY PUBLIC
CARLISLE BORO, CUMBERLAND CO., PA
COMMIS910N EXPIRES SEPTEMBER 3, 20(15
ra ry`P u b l i c/Attorney
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