HomeMy WebLinkAbout11-03-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGI TER OF WILLS OF~,,~~z~ COUNTY, PENNSYLVANIA
Estate of ~.. File Number ~~ " ~ ~ /~~~ ~~
6
also known a ~ / s~
/_e,.~....-~ n``-,-Deceased Social Security Number /~i~%_ ~ '~ ~~ ~~i6 ~ /
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Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(COtLIPLET6 'A' or 'B' BELOW:J 7
A. Probate and Crant of etters Testamentary and aver that Petitioner(s) is /are the ~e~~~~-~'~`~. named in the
las Will of the Decedent date ~ ~ and codicil(s) dated ev
w ~z~ ~ `",
(State relevant circumstances, e,g., renunciation, deadr of execufor, etc.) (~ Ca ,;
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executidr}'~,p ~sttumg~tt(s) off~iecN`;
~~ w _r :. ;._7
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
0 = _
^ B. Grant of Letters of Administration ~ ' '~
(lfapplicable, eruer.• c. t. a.: d. b. n. c. t. a.; pendente lire; duranle absentia; dr 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
Admirtistratiat, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name Relationshi Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in ~ County, Pennsylvania with his /her last principal residence at
(List sL•eet address, town/city, torvns/tip, county, state, alp code)
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Decedent, then ~_ years of age, died on` - ` at ~ t-
Decedent at death owned property with estimated values as follows: yj
(If domiciled in PA) Ail personal property $ .~~ ~~ C ~ ~ ~'
(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
7
Form RdV-0? re~< 10.!3.06 Page 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
COMlvIONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~~~~L~~~~a ~.~
'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect to the best of
the knowledge and belief of Petitioner(s) and that, as persona] representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law. „ ~ f,,~^
Sworn to or affirmed anl3 subscribed
before me the ~l~ day of
i
For. e egister
t
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Signature Personnl Repfasgntntive -j'
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Si insure ojPersonal Representative ~~ ~} W r•t -j
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Signature ajPersain! Representative ~ -
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File Number: ~ l ~V ~ / D~~~
Estate of 1~ ~~~~ ~~Cl ~ ~~ ~~~~ 5 ~ /, Deceased
Social Security Number: ~ (D~ .~c~ J ~~_. Date of Death: ~~y ` ~~ `i
AND NOW, x m~co.~nsideration of the foregouig Petition, satisfactory proof
having been presented before me, IT IS DECREED than (.etters j-~ I (,t, /~~ ~~~-/~
are hereby granted to
,II in the above estate
and that the instrument(s) dated `t'~c>C~
described in the Petition be admitted to probate and filed of recor ~as~+the last Will (and~odicil(s)} ofpDecedent.
FEES ~~ U~: ~~ jj~-/`~G ~~1 L~%,l ~ ~' ~ ~ ./~?~ ~ "~
Register ojWi(l ~~'Z~~~~r--,(rC~C..
//~~ ~. _ ~! ~l l 1
Letters ............... $~~lJ
Short Certificate(s) ........ $ e
Rei mciation(s) .......... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
r-o,~,n xw-o= rev. la.l3.or Page 2 of 2
FOCAL REGfSTRAR'~l CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee fr>r (h)ti cettifir:zCr ~ti.t1U
P 1593.2.055
ertifirltirm titm;her
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~' ~ (t1;ir.uL ltii;f he (;)r~~arded CL~ ,hr St~(te Vital
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o .z,•'; RECnrds U~tl~~~ '1tr }~el~~ianenl fili)~_`
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H105~163 REV 11Y2008
TYPE / PRIM IN
PERMANENT
BUCK INK
0
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) CTATF FII F NI IxARFR
1. Name d Decederil (Fast, midge, hsL surex) 2. Sex 3. Serial Security Number 4. Dale of Deam (Month, day, year)
ANNA MAE LANDIS Female 163 -22 - 0667 October 24, 2009
8. Age (Last Bintxfay) Under 1 year lkvfer 1 day 6. Dale d Birth (Monet, day, year) 7. Bktllpace (C and crate a for eign Gantry) 8a. Piece a Deam ICheck any one)
Montle [bys Nwaa MkxM HospihL Other.
87y,~ Nov 17, 1921 Lancaster Cty PA ^Irpadant ^ER/a,tpadem ^DOA ®NUreingHome ^Residence ^omer-speciry:
Bb. County of Death &. Cny, Born, Twp. of Deam 8d. Fedltly Name (If not inslihfion, give street and number) 9. Was Decedent of Hiapank Origin? ^ No Yes 10. Raca~ American Inq'an, Black, White, etc.
' Cumberland Carlisle Boro Thornwald Home (If yes, speuiy Cuban, (Spedly~
Mexican, Puedo Rican, eh.) 1 t e
11. Decetlea's Usual Fort Kkx1 d work dana mast d waki Ida. Do rot stele reH 12. Was Decedent ever ro the 13. Decedent's Educatbn (Speciy only highest grade completed) 14. Marital Status: Maned, Never Married, 15. Surviving Spouse (II wife, give maiden name)
Kind d Work Kind d Business! Industry U.S. Armed Forces? Elementary / SecoMary (0.12) College (ti or 5+) Widowed, Divorced (Specr/}9
Factor Worker Food Processin ^Yes ~lo -------g---- ------------- Widowed
16. Decalent's Mail' Address (SlreeL city I town, state. zip coda)
2 Fox Follow Lane Decedent's Did Decedent
score Pennsv lvania LNe trier n
Actual Real4nce nor
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~enn
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Carlisle, Pa 17015 .
or.
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ent
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Tw.
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O~Dec~
t.medwdhin
nb.coanty Cumberland rid.^N
A
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18. Fedlar's Name (FmL middle, last, sunix
L 19. Motlrer's Name (First, mitlde, maiden surname)
arry Brown Mary Bossier
20a. Inlormanys Neme (Type / Pna) 20b. Infomlent§ Matlmg Address (SrceL dry /town, state, zy code)
Andrea Moretti 2 Fox Hollow Lane, Carlisle, Pa 17015
_ 21 a. Memod d Disposition ^ Crematlon ^ Dawllon 216. Date of Orspcsmm (Monet, day, year) 21c. Place of Disposition (Name d cemetery, aenletay a dher
place)
21d. lacalion (Cdy /town, state, zip code)
[1X Budd ^ RemovalhomSlate wa.CrematlonaDonetlonaumorlmd Oct 29, 2009 Baker's Cemetery Mechanicsbur
Pa 17055
^ Omer - SPad/Y: by Medical E:eminer / C«onen ^ rea ^ No g,
22a. SigreMe of al5ervice liw es Such) 226. Licari%NUmbar 72t. Name aMAdlresa of Fedllly
. ~ FD-012909-L Ronan Funeral Home 255 York Road, Carlisle, Pa 17013
Cenrolete n 3a<oxy whw~ aamryiry 23a. Ta Beat a my knowledge, deed, oaurted at the lime, doh and place Mated. (sgnakxe and mlej z3b. Ixense Number 23c. Date sr~nea (Monet, eery, year)
physaien b not avatlable at Ioh d deem to
ramNcausaota~m. /~~ ~ /-
~.H3t~ptlt. ~4~~ar.L ~~.LLfCd.E.k~ ~~%
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' nens 2428 mull Ua Canplerod 6y person 24. Time a Death 25. Data P Dead (Month, day, year) 28. Was Casa Referted o Medcal Examiner / Coroner fa a Reason Omer man Crematon a Donation?
who pronounces deem. ~~ M. ,/ '~~~
"T ^Yes ^No
CAt/SE OF DEATH (See Inezzuciloxrs end examples)
s pgproximete interval: Ped II: Emer atlrer yionifcaM card'dms emuihulrtw to deem, 28. Oid Tobaan Use Conhi6ute to Deam?
Item 27. Pad I: Eller the chao d erenla -diseases, inlurks, a compFcedons -met directly caused the tlaatlr. 00 NOT enter terminal aven6 such ss cardiac artesL Onset o Deam but rid resuMng in me undartydng cause given in Pad I. ^Yes ^ I'tohady
respiretvry artasl, a venkiwler fmriNatbn wNwa stawFg the edoWgy. Lill only one cause pn each Gne. ~
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y
1ATE
AUS
aMI mssasa a
cadnon resWGng ~ ~aem) _~ ,~~r ~`L~ ;
a 29~.uIf--F~em~le:
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Due to (or a consequence op:
y
~ (,K! Not pregnant wihin past year
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.
Seµreaiely Fat carldiFOns n any, b.
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to die Cause lieled on Grin a ^ Pregrrent at tune of deem
.
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Enter UNDERLYNFG CAUSE Due m (or as a
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^ Nd prerplaa, hul pregnant vdtl~ 42 days
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(daease a kqury mat kridatM me c, W" v % ~'d' VCy~ ~~~
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areas res,mng In deem) usr a deem
Due to (or as a consequence oq:
^ Nd Pregnant, but pregnan143 days to 1 year
d. betas Beam
^ Unknown it pregnant within me past year
30a. Wes an Autopsy 30b. Were Autopsy Fndngs 31. Meurer d Daam 32a. Date d Injury (Mach, day, Year) 326. Describe flow Injury Occurted 32c. Pmce d Injury: Home, Feml, Street, Factory,
Paeormad? Avarlede Prror ro Corrp7esaa
Natural ^ Homkide
` Omca Buildiig, etc (Speciryl
of Cause d Deem?
^ YBS ~NO ^Yes ^ No ^ nnddent ^ Peidirg Investigedon 32d. Time of Injury 32e. Injury al Work? 321. If Trenspodatbn Injury (Specify/ 32g. Location of Injury ISIreaL sty l town, state)
^ Suidtle ^ Could Nd he Delermirled ^ Ye5 ^ No ^ Deter / Opereta ^ Passenger ^Pedesoian
M oma soedry:
33a. Cedifier (check anty one) 33h. SyiuNre and T e d CedlTrer
• Certdylny pbysidan (Pnysiaarl ceditying cause of deem when another physician has pionamced deem and completed nem 23) ~ /e//', ~
~
Ta tlh best of my knowhtlga, death occurta0 due to the oauaga)eiM nearer es ateted_________________________________ay r'
• Pronouncing and cerldying physiden (Physician ham prtxwundng deem and ceditying to cauw d death)
To the eeata
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^ 33c. Cicalae Number 33d. Data
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e ceuse(sl arM manner as shte0__________________
• Medical Examiner / Canner /
( ,~ ~ ~ ~ ~ ~ (~ ~ ~
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On the basis d exembMeon and / or mveMlg9nom In my opinion, deem oaarre0 at the tMre, doh, all phce, end due h tM cause(s) and manner ere atelad_ ^ 34. Name anti Address of P_rson Who Ca
m
~ad Cause of Deam (Item 271 Type / Print
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Disposition Permit NC. ~ ~ ~` )~\ )_ J ~~
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 WIT ESS WHER I her ~ hereunto set my hand this
day of 05. a
_-
Anna .Landis '~
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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 Wiil 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. NOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA I7013
ACKNOWLEDGMENT
MY
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.
Anna M. Landis
Sworn to or affirmed and acknow~ ~ kaef t`e me by Anna M.
Landis the testatrix, this ~ ~` day of ~ ';~ i~G ,
2005. ,~
ri /~~
NOTARIAL SEAL `~' ~ ~ f ' _ -'C. ~t~,,-
hIEN J 3{'ClGG, NOTARY PUi+1L1~ ~,
LE FI{)F!tl,CUMBERLANDCO. ~~ '-° Notary"Public/Attor
SSIDN eXPIRES SEPTEMBirR 3, 30t7~;
State of Pennsylvania
County of Cumberland
AFFIDAVIT
ss
We, ~~Sa ~. G - ~l ~-~ and r2co;\~~q-.~4-o~the
LAW OFFICES OF
STEPHEN J. HO(
19 S. HANOVER STREI
SUITE 101
CARLISLE, PA 17013
x
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 Wil! 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
~ ~ ~ ~~
Sworn to or
this G- day of _
NoTARULL sEAI. Notary`P ubl is/Attorney
STEPHEN J. HOGG, NOTARY PUBLIC
CARLISLE BORO, CUMBERLAND CO., PA
COMMISSION EXPIRES $EPTEMBcR 3, 3005
e me by witnesses,
005.