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HomeMy WebLinkAbout11-02-09PETITION FOR PROBATE Al`~D GRANT OF LETTERS REGISTER OF WILLS OF (,,0~~'~1GI~'1~ COUNTY, PENi~1SYLVANIA Estate of _ also known a Deceased File Number Social Security Number ~ 4 ~ ~~ Z ~ `s r-~ ~ ` Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COhIPLETB 'A' or 'B' BELOW:) ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~~ t.-~~ ~ ~ ~ i1.~ named in the last Will of the Decedent dated vl`o'~ ~ U y' C1 ~ and codicil(s) dated (State relevant circumstances, e.g., renunciation, depth 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 (Ifapplicable, enter: c. t. a.; d.b.n.c.t.a.; pe,tdenre life; durance absentia; durance minoritate) _~ C:,7...~..t (COMPLETE IN ALL CASES:) Attach additional sl:eels if necessary. rl ; ~~ ~ "p ~~~;~ ~,.r~ Decedent was domiciled at death in ~ ~ ~' 3Gs~ L ~y u County, Pennsylvania with his I her last prii~pa~ re~i~nce at `~'~N .-~-: (List su-eet address, townlcity, township, count), state, zip code) ~ ° Decedent, then __ ~2 _ years of age, died on / ~ G ~ at ~ J~ 1 J"' Decedent at death owned property with estimated values as follows: ~j ~p C ~. ~ ~~/ (lf domiciled in PA) All personal property S (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 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 rinted name and residence ~ ~ 2 ~- o ~~ Fo,~„+ Rrv-r~? re,~. l0.l3.06 Page 1 of 2 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 Adntirtistratiort, c. t. a, ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative ~~ ,~_, ~7 ~ -~ COMi/10NWEALTH OF PENNSYLVANIA 'F r ~ f-y ~ ~ ~_ SS ~.~~r i ~ i4~~..~:r.,~ r ~. ~} t~~` 1 ? s COUNTY OF ~lll _ : "T u~ ~ ~ "' --' The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tiu~~~~ect tole be oaf -~ .~.~ _ ~„ _ r ...~ the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s,~v~ well and-~-uly =-'~ administer the estate according to law. ap ""' Sworn to or affrrr?~ped and subscribed before me the t ~~ day of Z~~' ,,,,/( , ~ y`i . For the Register GZ~ tonal Representative Signature ojPersorral Representative Signature of Personal Representative File Number: ~ ~ ' ~~ 1 ~ l/ Estate of ,Deceased f /~ ~ Social Security Number: ~`'1(O ~ 2~'S~ ~ ~ _ ___ Date of Death: Grp' ~ ~~ AND NOW, ~ ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, I IS E REED tl t Letters are hereby granted to in the above estate and that the instrument(s) dated ~ 2 ~ -- described in the Petition be admitted to probate and filed of recor as the last Will (and Codicil(s)) of L'GCedent. FEES ,r-~ ~~ Register of tl s Letters ............... $ L~ Short Certificate(s) ........ $ ~ ~~ Attorney Signature: - - Ren nciation(s) .......... $ $ a~ Attoi7iey Name: ... $ ~• ~ ~ Supreme Court I.D. No.: $ Address: ... $ ... $ ... $ • • • $ Telephone: ... $ ,--- TOTAL .............. $ J r o-~ r-~,•r,- Rw-o? ,~ev. 1u.13.v~ Page 2 of 2 IlQ,5.2iUS REV ((11/Q71 ~ ~- o~-a9 Z LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this c'~rtificate, $6.00 1564131 'Cer~f~catioq~ lumber G.,L_.` ~• _' ~~ -- ~ l~ t.a." ~ t._l.. , _ /~ _.. per,. ~ C:i ~-- C~ t..? t'~', ~ ~ : ~~~ :~ ~:~-- ~•r `-~ cry ~~~.. L 1 _-___.._ --..-.-.~..._~-~-..~._ _...-.+~..... -_____._._.___. __...__.. -___~ .~ ' This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for perr~a~ent filing. ' ~~ ~ E Local egistrar Date Issued H105.143 REV 11/2008 ~ ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~PEERtiuwE"~Nr"~ ~`'' CERTIFICATE OF DEATH BU1CK INK (See Instructions and examples on reverse) eTete ar e w rueca a 1. None d Decedent (F3st, rrAtkNe, tat, wAfiz) 2. Sex 3. Social Secuny Number 4. Dab d DsNh (Mash, day, yar) G~FP7'1A p, $~tg F~Mele 146 - 28 -5417 July 16, 2009 5. Ape (Last BMtlxby) UMer 1 Under t 6. Wb d RIrBt Manh 7. end ebb a 8a. Plea d Dath Cfxtclc one 92 "°M•"` ~a "°~"' July 18, 1916 Nemec, ~• Hoeplbl: Other. dl i ^ Otl S ^ R ^ ^ ® ^ rr - pe y: derra Nurekp Hans w ER ! t>wpetlent DOA IrpatbM Yrg. 9b. Courry d Death 8c. Cly, Boro, Twp. d Death Bd. FadWy Nrrre (N not M+rdiMrtlon, give elnet end rwxrber) 9. Was Decedent d Ifspenle ~^? No ^ Yea 10. Rea: Aaredan Indan, Sbtde, White, etc. QTI~t'1PRIC1 Q7. S1'Ltp~a~'g '~. F~mc~oft OF 81i 1~.tiJ Mezkan, Puerto Rk;an, etc.) (te 11. Decederd'e Lkrpl Bon Kind d wak d ab moat d We. Do nd eMb retl 12. Was Deadern ever ht the 13. Deadera's Educatbn (Spadfy ony hlplbal pads oomp bted) 14. Martlal BbUU: Married, Never McMed, Dh d y 15. Survivnp Spo use (tl wNe, prva maiden rxarre) d ak KlnddBueinwsllMustry K U.S. Ambd Face? EbmeMary /Secondary (D'12) Cole9e (1~ a 5+) rorce ~ ($Dep Y~ AB~ly ~ Sl',ejY1ffi1 ' ^ Yee ®No 8t1'1 T~Vt~'OeCI 18. DsadeM's Matlup Address (Street, dty /town, slate, zip code) DeadeM'a ~ DeadeM g j,~ ~j• ~ Live in a 17c Decedent Lived ti Twp ~ Yes 129 W91rn1t F3ottt~ Rd. Shippt~eUulrg PA 17257 . , . Aduel ReaMtena 17a. Stets Qz~bErlr9[Ir3 Township? t7d. ^ dw~in DeceeeM ~ a A 17b. ~ cnyleao 18. Father's Name (First, middle, bat, eultlz) ~p],8g g 19. Mdher's Name (First, nriddb, maiden sumeme) ATma Do~rlahallw 20a. IMorrrwn's Name (Type I PrfM) ZOb. IMortront's Meitlnp Address (Street, ctlY / tovm, state, zq code) Jsta~b A. Suta ~ 41 Shsidy Finad, Newburg, PA 17240 21a. tvletlad d DMrposldon r g] Cremation ^ DonaOon 21 b. Deb d Disposition (MarIR day, yar) 21c. Place d DMpafdan (NBme d ametary, crematory a other place) 21d. Locatbn (City Mown, slate, zip code) ^ Iturlel ^ fbmovatlromSbte ~ WaCnmaNon A ~~ w `~S' 20,2009 Smit2]&but~g GYeDIRtAriL~l 9riithf$x1Yy ND 21783 ~n nr Coroner ? ea^ No ^ Otlrer 22a. Fuxerd Service s wrdr 22b. LMxaa>e Number 22c. Name end Address d Facity ~ . Ffl014351-L F~ ffi3dcer Planter Flame Int:. 112 West King St. 3iippertsbtag PA 17257 tlerrw 23trc a4y when 23a. To the lxan d my , death ocwrred et tM time, date and plea stated. (fiipnaturo and tltle) 23b. Lioenae Number 23c. Dab Signed (Monts, day, Year) phyaldan ra not avatiabb at time d death ro aMNy awe a death. a ,~ ~ ,t/ a~ n/ 5 So° a7 So !i6 0 tlema 24.28 mwt be axrrplsted by person 24. Tme d Death ~t 25. Date P Dead , day, 28. Was Ceae Relertedjo Medial Examiner / Canner for a Reason t Crertratbn a Donation? ^ Y Q ~ who pronoarow death. `lp oZCJ P M. ~ ~ 9 es ~' .^' CAUSE OF DEATH (See fnstructtons and • m r Approximab kderval: cardiac arrest h t ro D ath t O h DO NOT nt t e d Pert II: Enter other ' iven at Pan I but not resuNr Mt the underl in ease 28. Did Tabexo Use Conlnbub ro Death? ^ Y ^ P b bl , ~ er rr even s eac as nse e . e em Ibm 27. Pan I: Enter the g~~Y9016 - , kyurles, a oomptiestiars • that dMee9y eased the deat raeplrNay erred, a veMricubr ttbnlbtion wltlraA ehowinp the etiobpy. Lill ady one arse on each Ilse. ~ . y g g g a ro a y No ^ Unbawn r IMar dtlr~orr ~ fn dfeeese a ~ r (~ • rzcl'/Ovl ' y 'i _~ a r p ` Q~a~ ~ ~ [u rt? 29. fl FyrrPab: ~ 1 reM wltlrn est ear Nd re ~ . l)ve ro (a a):. ~ ~y Met condtlbrre, N arty, b ( ~ 'r r .. ~7 i ~ Y` -' p y p p ^ Pregnant el time d death ^ . r ~b the cause IWed on line e. Eller UNDERLYING CAUSE Duero (a a ot): r ~'f'/~ i QQ (dbeae a ~ that kYtiebd the c ~ Nd pregnant, but prepteM wMlrkr 42 days d death ^ ~ M l01 ear t M 43 d b . everMS pests) ~~ ' preprg , y prepre ays u Due to a as a ( d)~ r ~ d balsa darn ^ Unknown tl prepnerd wtiMn the pest year . 30a. Ww en Autopsy 30b. Were Auapsy Findkps 91, d Death 32e. Date d Injury (Month, day, Peer) 326. Desabe Flow Injury Occared 32c. Plane d Iry'ury: Horn, Farm, Stet, Factory, Otlbe Building etc• (SPedfYl Penomxid? Avalbbb Prior b Cialpblbn d Csuw d Death? Nalurel ^ HaMdde , ~N ^ ^ Yes ~No ^ Aadrbrd ^ Psal'rrp Inveatipetion 32d. TMne d Injury 32e. Injury at Wait? 321. tl Trerreporbtion IrQury (Spedly) ^ ^ ^ 32g. Loatbn d Injury (Street, cNy I town, slate) o Yes ^ ^ ^ Yes ^ No Pedestrian Drberll)pereror Paeaergar Could Nd ba De1wnlMred Sukdde M, 09rer • Specily.• 33a. Grtlfafr (dreck oNy ab] 33b. SigneWre and Ttlb d nNbr • Certllylnp physician (Physidan antlyM,p ease d death when arwdrer ptryeldan has praxxnad dwth and carwbt•d Hem 23) t th p a d er r staled bd th d d k d ~ ~~ ~ / ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ue e aw(s) n mamr pe, ea oesuna o To its bat of my now 33c. License Nrxnber 33d. Date ( . ~Y. Y•~ • Wonorardrrp ~ ~NYb9 physbbn (Pfiyslaien bdh praarsroYg death end artiy4rp b ease d death) t ^ d /) ~ sle _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ To the bat d my krawbdpe, loth oawred silts time, date, and pba, and due fo the erase(s) and manner w s l i /C • / ~ O ~ / v t 7 i O I ororNr Exam ner flledla On 1M bats d aamingbnand /orb n, In my opinion; path otxwrred al the time, date, and platy, and due to pre paw(s) ant mmner a stated_ ^ 3,. Name and Address d~'' Who Completed d Death (tlem 27) Type Print r- /~/( ~e ~~ "' K 35. rar' and unbar Z I ~ I Z I ~• Ir I I 38. Data led (Month, day, year) ` , ~s o ~- °i ~ .y ~ ~ P/1 172 S , ~ 8 ao ~s 7 n ~, m Dlapatlbn Permit No. O J ~ ~ /' Gd `/ LAST WILL AND TESTAMENT rv "S~ f...... s..F ~~ s ~ , F V +~ ~"I `~ I'- . ~ ~~ r r , . ~,,, -~~ KNOW ALL MEN BY THESE PRESENTS, that I, STELLA SUTA, of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment of all my legal debts, funeral expenses and all expenses of my last illness, state, federal estate and inheritance taxes and administration costs shall be paid as soon as may be conveniently done following my decease leaving all specific bequests free of tax to the legatee. SECOND: I give, devise and bequeath all my property, be it real, mixed or personal to my children, Jacob A. Suta, Carole Ann Thompson and June Suta Rolfe, in equal shares, share and share alike, per stirpes. THIRD: I nominate and appoint Jacob A. Suta as Executor of this my Last Will and Testament. If he should fail to serve or be unable to serve, I nominate and appoint, June Suta Rolfe, as Executrix of this my Last Will and Testament. No Executor appointed herein shall be required to post bond of any nature or kind. IN WITNESS WHEREOF, I, STELLA SUTA, to this my Last Will and Testament set my hand and ofhcial seal, this ova day of ~.4-~ 2007. ~n~lL~~~V' G~''~~~" (SEAL) STELLA SUTA Sworn to and subscribed, declared and Published by STELLA SUTA, as Her Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at her request, And in her presence, and in the presence Of ch other. ~, i~~ ~~ ~ ' ~~ .,~ 5 ?~ ..~':''~~+ G I F / >" COMMONWEALTH OF PENNSYLVANIA: SS COUNTY OF CUMBERLAND I, Stella Suta, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. STELLA SUTA Sworn to and acknowledged, before me, By STS SUTA, t Testatri This day of ' 2007. k Q'"~'w~,~ +, Notary Public COMIVIQNWEALTfi ~~~ PENNSYLVANIA Notarial Seal H. Anth©ray Adams, Notary Public ShiPPe~sburg ec,~~ Cumbert~d County My Commt~.~ion Expires May 3i, 20~a COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testatrix sign and execute the instrument as her Last Will and Testament; that she signed 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 Testator signed the Wili as witnesses, and that to the best of our knowledge and belief the Testatrix was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ,, ~,7 ,~--~~~ ~ '. l /'J '~ /~ 7 4' r ~l~t-- Sworn to and subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this s~~ day of " 2007. Notary Public COMM+Civ'vv ~ALi i-I {~~ ~ENN~ YI,\1ANIA Notarial Seai H. Anthony Adams, Notary public Shippensburg Bc?r;;, t;umbeiranri County My Commission Expires May 31, 2t~1 C