HomeMy WebLinkAbout11-12-09PETITIOV' FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ u r...~~--~ tv cQ, COUNT', PEN~tSY"LVANTA
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Fcr~ro of .\ ~- ~0 ~ ,. ~_ \V . ~~,~.,n ~ File Number ! L' ~ D
also known a° {~
,Deceased Social Security I~Iumber ~~~~ - Z f'~r-- 3 (1
Petitioner(sl, who is/are 1 S years of age or older, apply(ies) for:
(CO.~LIPLETE 'A' or 'B' BELOW":)
~{ A. Probate and Grant of Let rs Te amentary and aver that Petitioner(s) is /are the ~K~ r-t^~J"~ natrted in the
last W ill of the Decedent dated r~~ ~__ and codicil(s) dated
(State relevnrd circwnstnnces, e.o., renur:ciatian, denth of executor, etc.) C~ ~ ~` 'p
., 7 ~ "_ ~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of'he?t"nsnt(s' red ~
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - ". ~ rTt --- ,
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^ B. Grant of Letters of Administration -~E `~
(ljapp[icable, eater: c. t. n.; d-b. n. c. t. a.; pearlentelite; durmue nbsentin; durmae ti:uior~P-t:e) -
Petitioner(sl after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoub(if any) and lf~s: (If `
Acl~atinistr:;tiott, c. t. a. ord.b.n.c.t.a., eater date of Will in Section A above and complete list of heirs.) ~
Name ~ Relationship _ Residence ~
(COrYlPLL'7fi 1N ALL CASES:) Attach additional streets if necessary.
Decedent was domiciled at death in ~kn~]t
_ ~ ~ rJ i,~. ~ ~ S L: t,~,~ ~,y , r c,
(Liar street nddres's, towtr/city. township, coon` ~, stnle, zip code)
County, Pennsylvania with his /her last principal residence at
_ years of age, died on ~c~ at '-~\~ 5 O S ~.~ rry~ t~~ `~
Decedent, then _~.~.~'~-~• ~ 1
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ~~ `~ ~ ~~ `~~ ~ _~`~Y~~
(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 tLis Petition and the gran[ of Letters in the appropriate form to
the .mdersigned:
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._pp-~~ ~ ' ~ ~ ~t-~ - ~ ~ ~L.e rz ~N ~ t
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or printed name and residence
Form RYV-03 rev. /0.!3.06 Pale 1 Oi
Oath of Personal Representative
COIvI~.10NWEALTH OF PENNSY"LVANI_A
COUNTY OF ~ ~,,tv,~-~c~,~.~
SS
The Petitioner(s) above-named swear(s) or affit~~(s) that the statements in the foregoing Petition are ti~ua and correct to the best of
the kno~,vledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and t-uly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ ~'~~'1 day of
~ _ ^
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Fob he Register
Signature of Personal Representative
Signature ojPersonal Representative
Sigrtnture of Personal Representative
SV
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File Number: ~ ~ ~~ ~~,i ~ ^ ~~,~,~~ --~ ~
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Estate of ~~ t ~ ~ ~ CL~~I ~ • ~V ~~~ ~1 _ a O ~.
{{~~ ('~ -7 ,Deceased ~
Social Security Number: (~~ `,~1~ ~` ;~ (~ ~ Date of Death: ~ ~~ I `L~~
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AND NOW, ~ ~~ ~ ~~'~` ~ (~~11 I~l~.~'~ , -~,~ ,(,r ~ , in consideration of the foregoing Petition, satisfactory proof
having been presented t~~fore ze, IT IS ECRE~D that Letters ~~ ~~ ,l f- 1 ~'
a-e hereby granted to ~~ ~ ~ . ~; ~ ~~~~
_ in the, above estate
a:~d that the instrument(s) dated `~ ~ "C~ ~ _
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
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FEES `~-- '~-l. ~ ~ ? ~~ ~.`J ~ ~r/L
'1 ^^~ RegisteroJWills~ ~ - l
Letters ............... $ ~ . ~ ~`~ ,
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Short Certificate(s) ........ $ Attorney Signature:
jenunciation(s) .......... $
'"l _ ... $
"~ ... $
~ L ~~ L, . $
... $ 1
... $
_ ... $
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TOTAL .............. $
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
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REV 11/2006
r PRINT IN
MANENT
\CK INK
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructlons and examples on reverse) cTnrr Ft~ F ~~~ ~~xn~o
1. Noma of Decedenr (First, middle, last. suffix) 2 Sex 3. Social Security Number a Date of Death Month, tla ear!
William N. Moon Jr. male 174 - 20 - 8128 11-0~-20~~
5. Age (Last Birthday) Untler t ear Under t tla 6. Date of Birth Month, da ear) 7. Birth lace Ci and state or torei n count Ba. Place of Death (Check onl one
82 Months Jays Hours Minutes
01-07-1927
Harrisburg Hospital'.
'~ Other'
yr5 G
in arenr ^ ER I om arem
p p ^ DOA
^ Nursing flame ^ Residence ^ Dtner - Spenfy
Bb. County of Death Bc. Clry, Boro, Twp. of Death 6tl. Facility Nama (If not insthurion, give srreel and number) 9. Was Decetlent of Hispanic Origin? [~ No ^Ves t0. Race: Amer~can Indian, Black, Wnrte, etc.
Cumberland
East Pennsboro
Holy Spirit Hospital pl yes, specity Cudan,
Mexipan, Peanp Ripen, etp) I Specily,
white
t t. Decedent's Usual Occu atlon Kind of work done Burin moll of workln life. Do not state retired 12. Was Decadent ever in the 13. Decedent's Education (Speciry only highest grade comp leted) 14. Marital Status. Marned, Never Married 15 Surviving Spo use Ilf wife
grve maiden name/
Kind of Work
cooker Kind of BUSinessrlndust
C0T15trUCtl0n U.S Armed Forces?
,,~~((
LJ~Yes ^ Np
Elemen~tayy /Secondary (o-t2)
L
CQllgge (1-4 or Sa)
1L ,
Widowetl, Divorced (Seecrty)
widowed .
16. Decedent's Mailing Address (Svaet. mty /town, state zi code)
x p Decedent's Did Decetlent
Pa
House
20 N. 12th St . Esse •
Artual Residence 17a. State
t7c ^ Yes. Decedent Lived In
~wP
T
h
Lemoyne, Pa. Apt. #222 pa 7s•~
owns
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77d. E'1 No, Decedenr Lived within Lemoyne
,7b county
Actual Gmlts of Cry! Boro
t3 m ame First ddle, ' suffix!
iY~'ia~n T~. l~dnn Sr. t9. Mother's arge (First, mt die, maiden Su m )
Mer~ine 1~. Seic~ef
20a. Informants Name (Type I Print) 20b. Informant's Mailing Address (Street, city I town, stale, zip code)
Richard W. Moon 802 Nottinghill Walk Apex, North Carolina 27502
21 a.
M
e
thotl of Disposition ^ Cremation ^ Donation 21 h. Date of Disposition (Month, day, year) 21c. Place pl Disposition (Name of cemetery, crematory or other place) ltd. at o (0 town, stale, p code
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M_J Bunal ^ Renwval Irom state r Was Cremation or Donation Authorized 11-13-2009 Prospect Hill Cemetery 2500
~iarket St .
^ Other ~ S eci ~ by Medical Examiner/Coroner? ^ Ye3^~ Np Harrisburg, Pa . 17103
22a $ aturelol Funeral Selh~ice Ligek!see,(o5 person acting as such
~
~~
1 22b. License Number 22a Name antl Atltlress of Facility p
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_ FD 013945-L Neumyer Flaneral Home Inc. Harrisburg, Pa. 17102
Complete items 23a-c only when cenifying 23a. To the best o y owledge, death occurred el the time, dale and place staled. (Slgneture and btla) 23b. License Number 23c. Date Signed (Month Uav ynan
physician is not available at lime o! death to
cenily cause of death, /^ ~ ~ ~~~ Yt~ 1 a~(.~ (~f ~~t m ~Z ~ 4V,, r ~
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Items 24-26 must be completed by person 24 Tlme of Death 25. bete Pronounced Dead (Month, day, year) 26. Was Cese Referred
m Medical Exam~ne~ r Coroner for a Reason Orner man Cremaaon or Donation°
wno pronounces death. (~ '7 ~ ~ M ~l r:7 V ~-Y/1 r j G ~ (f '~ L (.~ ~ ~
^Ves L'J No
CAUSE OF DEATH (See instructlons and examples) , Approximate interval- Pan II: Enter other sgnitlcant cond't'on co trLjryq'o tleath 26. Dld Tobacco Use ConCibute to Death
Item 27. Pen I- Enter the SI3n of events -diseases. mlunes, or complications - That directly causetl the tleath. 00 NOT enter terminal events such as cardiac arrest, I Onset to Death but not resulting In the underlying cause giver m Parl I ^ yes ^ P~obabrv
respiratory arrest. or ventricular IibrJlatlon wilhour showing the etiology. List only one cause on each Ilne, ^ No ^ Unknown
IMMEDIATE CAUSE Final disease or
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29 I~ Female
.
(
condillon resulting In
eeth)
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Dua Ip f a conseq a of). ~
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p ot pregnant wrthm pas: year
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Seq entially Ilst conditions, if any, h.
~ n~ l regnant al ume c
deat
^
leading to the cause listed on line a.
UNDERLYING CAUSE Due ro tar as a consequence cfp.
th
E
t Not p;egnarl, buy. uregnarr within 42 days
er
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th of death
e p ;
(disease or injury that
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atetl
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events resultin
in tleath) LAFL ^
g
Due ro (or as a consequence ofp t Not pregnant, buy oregnam 43 days t6 t year
before death
d ^ Unknown II pregnant within the oast year
30a. Was an Autopsy 30D Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month, tlay, year) 32b. Describe Haw Injury Occurred 32c. Place of Injury. Home, Farm. Street Factory.
Penormed? Available Prior to Completion rr~~~TT
`
^ Office Building, etc. lSpecrNJ
of Cause of Death? T Natural
Homicide
L
^ Y
I~ N ^ N
^ Y ^ Accident ^ Pendng Investigation 92d. Time of Injury 32e. Injury at Work? 321 II Transponatlon Injury (SpeciryJ 32g. Lopabon of Injury (Street, city r town, stele)
o
es es
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^ S
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^ C
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^ Yes ^ No
^ Driver/Operator ^ Passenger ^ Pedestrian
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erm
ne M ^ Other- Specity~
33a. Certifier (check Dory one/
Ph
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d 33b. Signature and Title of Certifier
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To the best of my 4:nowledge, death occurted due to the cause(s) and manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ , _
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• Pronouncing and cendying physician (Physician both pronouncing death and certirying tp cause of death)
To the beat of my knowledge, death occurred at the time, date, antl place, end due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. L'Kense Number
M ~ ~ ~ ~ ~- ~'~- 33tl. Date Signed (M1onth. day. yearr
~ LD `
Medical Examiner) Coroner 1 L l ~
(
On the Dasls of examinatlon antl I or Investlgatlon, in my opinion, death occurred at the time, date, and place, antl due to the cause(s) and manner as staterL ^ 36. Name and Atltlress of Person Who Completetl Cause of
Death (Item 27)'ype r Pnnt
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35. Registrar's afore ono Dietr N
21/ I ~I ~ I ~ I
~ I 38 Date FIWd (Mont day, year
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Dlsoosition Permit No. ~) •. "`) ~„ ~!' yj_~ l~
~~t ZViCC~z Testament of
~ViCCiam ~V. ~l~lonn
I, William N. Monn, Soc. Sec. No. 174-20-8128, of Dover Township, York County,
residing at 4308 Beaumont Road, Dover, PA 1.7315, declare this to be my will, herelty,revoking~a
.:~ ._^~
,. ; -, ~''
all. prior wills and codicils made by me. ~,.~ ~-? -
_ _ __
Payment of Debts, Funeral Expenses & Death Taxes - `~ ;~ ~
-, - _,.
FIRST: I direct the payment of my just debts and the expenses of my last illness i#nd =~ - ~'
'J __
;Funeral as soon as maybe convenient after my death. I further direct that all estate, iiill'eritance, c~ r''
a•
and other death taxes, together with interest and penalties thereon, of whatever nature and by
whatever jurisdiction imposed, shall be paid as an administrative expense of my residuary estate.
Disposition of Estate Property
SECOND: I give the rest, residue and remainder of my property (real, personal, and
:mixed) to my beloved wife, Naomi R. Monn. In the event my wife fails to so survive me, I give
the same to my son, Richard W. Monn, provided he survives me for a period of thirty (30) days.
In the event my son fails to so survive me, I give the rest, residue and remainder of my property to
his issue, my grandson, Jeremy N. Monn, per stirpes. Additional issue born to my son, if any,
si:aii ire included as part ofihis wTiii.
Powers of Executor
THIRD: In addition to and not in limitation ofthe powers conferred upon executors by
law, I authorize the exercise of the following:
William N. Monn
(a) To hold, or to sell at public or private sale, without order of court, or to lease and
exchange, any real or personal property composing my estate;
(b) To compromise claims; and
(c) To waive the requirement my executor furnish security in any jurisdiction.
Annointment of Executor
FOURTH: I appoint my wife, Naomi R. Mona, executor of my will. In the event my wife
;predeceases me or is unable or unwilling to qualify, act or serve as my executor, I appoint my son,
Richard W. Mona, executor of my will.
I have signed this, my will, this ~ ;~ day of D" ~~ ,v ~; i_~ . ' ~• a~- P~` _, 1997.
:~
William N. Moran
Signed by William N. Moran, the testator, as his will, in the presence of us, who, at his request, in
his presence, and in the presence of each other, have signed our names as witnesses.
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Address
Witness
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Address
Page 2 of 3
Acknowledgment and Affidavit
Commomvealth of Pennsylvania
County of York
William N. Monn, the testator in and the undersigned witnesses to the will,
the attached or foregoing instrument, who have signed the instrument, having
been qualified according to law depose and say:
(a~ that I, the testator, do hereby acknowledge that I signed the
instrument as my will, that 1 signed it willingly and as my free and voluntary act
for the purposes therein expressed; and
(b) that we, the witnesses, were present and saw the testator sign the
instrument as his last will, that he signed it willingly and executed it as his free
and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the testator signed the will as a witness and that to the best
of our knowledge the testator was at that time I S or more years of age, of soured
mind and under no constraint or undue influence.
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Witness ~
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Witness L
William N. Monn
Sworn or affirmed to, subscribed and acknowledged before me by the testator
and the aforementioned witnesses this ~~`-~ day of ~~`~,,~~ ~'y;;:/~ , 1997.
RICHARD R. REILLY
ATTORNEY A.T LAW ~,
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(7t'n 843-lS355 I ~'~,~ 1 ~~~~ ~~~1`.,~~.t_~._.:
Offices nt the con+er oj.~ ~ LVOtary PubhC
lh~ke & King Sn~eels I
56 South lhtke Street ~
Yank PA 174U1-1402 ; ~__ ,_~.d,.....~..___~~..
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I~ax: ~ _ ~ ,~ ~'ub~'c
(717) 845 - 6761 ~ ~ ~ y f
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