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HomeMy WebLinkAbout01-13-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Estate of G-~~/~f~ln~1 (/~ ~ ~~~TF~ File Number a ~ - ~ ~ - ode a also known as ,Deceased Social Security Number Petitioner(s), who is/are 13 years of age or older, apply(ies) for: (COtY1PLE7E 'A' or `B' BELOW:) lvJ A. Probate and Grant oC Letters Testamentary and aver that Petitioner(s) is (are the named in the fast Will of the Decedent dated and codicil(s) dated _ (State relevant circumstances, e.g., renunciation, death ojexecutor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a clriid born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and vas never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration (lfapplicabte, enter: c.t.a.; d. b.n.c.t.n,: pendente tire; durance absentia; durance mi~ta•itnte) Petitioner(s) atiter a proper search has 1 have ascertained that Decedent left no Will and was survived by the following spouse (if any) and Heirs: (If Administration, c.t.a. or d.b.n.c.t.a., enter date of Wi11 in Section A above and complete list of heirs.) ~~~ (List sweet address, town/city, township, cou"nq+, state, zip code) Decedent, then years of age, died on at 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: _.~ `~. ~ _ r~- t ~ t^"; $ !V Form R6Y-U? rev. ro.ts.o6 Page l of 2 (CONIPLE7E INALL CASES:) Attach additional sheets if necessary. ~ C7 --t-1_ Decedent was domiciled at de h in ~ County, Pennsylvania with his /her last princip ence at °/ 7'T r -~ 7 ~ -~-~ ~~ i~ 't i ~ S ~a;?t/C'~ i7 rr- f!f (l / / a~~soC~ as ._ _ 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: ~~~ ~ ~~~ ~ i ~~ / ~ f~ ~ l/ ~t f ~, ~ f v ~~~~ J~' / ~`~'7 ~,'~ ~ v ~c !/r/.~ `U jam///J q 1 ~^ ~ ! ')~ c.J ~ sib iC~ ~~~"~ S` ~"~ ~~i C' `G- G~ ~~v ~S ~~~~1 ~ !~ J ~ 1 ~/ ~D,t) /~ ~ _ c 1~tC It !1 ~ ~ - - ~~ l ~~I / ~ t~ ~~~~ ~f ~ rrS ~~ ~~ti iC ~Lp~G~ cl ,G'~ N :~-a C_ Q r -, t~.- -, ~ _-.~ ~-j ~ .., JY ~1~ .,.. t`y t ~ _"f :"?J W '17 - '..J ~ ~ -:~ . Oath of Personal Representative COMi~tONWEALTH OF PENNSYLVANIA ~' / S S COUNTY OF _~ G~ yy/~~rc~(/~N~ The Petitioner(s) above-named swear(s) or affirm(s) th t~ the statements in the fore Oln Petition are hue and con~ect to the best of g g 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. Sworn to or affirmed and subscribed before me the ._--L +L , day of o1i~~ O Signature of Personal Representative N ~-- ~ `= ' , For the Register Signature ojPersonnl Representative i"rt n ~ - -',:.+ `a ~ W ~ '. rJ "~~ f 'i J File Number: ~ ~ - ~ ~ " O ~ ~ l . --~ t Estate of ~G>;r~Y~rra 2.~0 ,Deceased N Social Security Number: Date of Death: ~ ~ I Z'(~~ AND NOW, ~j']~~~_I~ _, o~.O~l~ ,inconsideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREE' \D t_ha-t Letters ~aoC~YY~_P~~ f~- -~~;1 ~ ~ ~/ are hereby granted to _ ~l~ t-~" 1~ P f~5~`(1 in the above estate and that the instrument(s) dated q, ~ ~ Z. described in the Petition be admitted to probate and filed of record as the last Will (an Codicil(s)) of cedent. FEES 1 ~ ~ ° ` QA.ti2.JV /~'' Letters ............... $ 0~10~.~ RegisteroJWills --~ Short Certificate(s) ........ $ Attorney Signature: Renunciation(s) .......... $ ~~ $ ~3,5'D Attorney Name: • • • $J, ~a Supreme Court LD. No.: alp ... $ ®~ ~~ $ Address: ... $ ... $ ... $ $ Telephone: ... $ TOTAL .............. $ Form R6V-0' rev. 1u.13.o~ Page 2 of 2 S lA St 25 30 ~~ a~ QS ~~ ~ ~ ~-Q 3 t+~V YORK STATE GEP9A~TMENT OP tfEALTH CERTfffCATE OF f}EATH 2 t - t ll- r~-~f2 STATE FlLE NUMBER 7 AtI0E1LF LAST 2. SEl(: 3A DATE OF OFATH t 3R. HOUR: /} ~ IEUE A314E r~aNrH DAr j J ' ^t 2 ~• Q l ~ 7 ~• sJ m 6C AE . T : NUR T ICE 0 R , AB. IF FACItiTY.. TF AD jQktkOUej DEN ET{ Ok1YPATiENT 1NPAiIIN7 HDAtE RESIDENCE FAOlL7TY FSpealy):. ~ p,ty Y~ . ^ ^ ^ ^ ^ ^ ~ ^ D5 0 7 a?o~9 ~C: F ~ ptrrotlx~j: pAaw>~) 4D. LOCALITY /CAeck ria uld spc+g~ 4E. COUNTY E]F DEATtt j$ITY Vft.LAGE TDWN ~ ~C~ i ~ e C~'aR2 ~ ~ ^ ^ ~' o ~S'a~2a ~ ~ ~h ct S Sa.E.~ TID t Q6. WAS ED OM NO R ON ftl)•rs..spedA'insf/Ntroxrta+ne, p'tyw.t,~a, counfp~ad ) tn f (tF 6A'A6E Nf IfiB.>F UNOERIYFAR7 ~ IF UNDEAI DAY ,lA CI AND STATE 8H2TH: (t1 Cowrtry uAf TB. IF iMOERTYEAR. 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D3F>fOTDR- FtNff DR: ` 22C. tiE(ABTAATION ERAABER Til ibAEOF AE613TAAR: I MQN~nI~ OAY yip s 2 OR RENI04AL PERMt! O BY; 1 2 , O~ E A O Y Y6{R s ~ 1 .St~lh ~ 2S 33 CO~IEfED tr CERTIiY1N6 PIfYSIC1AN - OR -- ibNOIIEW(~RDMEpT PHYfi(CIAN OR Ef(AMIMEq f~l}r[CA~I(MI: To the best of my knowkdpe, death occurred at ttce time, date and place artd due to the cause6 stated. Q~f'1 MYR:.. y LTCQfDe Ab._- $IQl1]EIX~"~ ..~ Monty Y('ar ceeKa roves a AtdpdYq FMysipen . ~ eetNN{ op E>dnlE of ATh+tdnp Phy+okan Addeas: t camel r Taalwta ro~ny r Fiaratrees ~ e f D /?'d O e alocer h ew sPArsk+ult same 6 Mle: lotaArfl+crw. cc«In .: s„e.,m,,: - rc e . ems AtllnUlp :~urne t tlee txnae ~: Altrest d 5F 9 O Com .' i t Yd 266: oeceasee tsst seen ~Irre MoNB wr ~ ro01t . ~ tk rthedmP d7sirbn: I Q Oae OEt ~ Y I4' L d w - ~ 1AAINIER DEARC ~E7F p~p~ MATtIRALGlISE ALCIOE7II HOIAIGMIE. SUICNF CN1gMSTAMCE$ NIYE5TI6ATION ZB WAS CASE F~ffRRED TD CORONEA OR MEDICAL E](AMRIER7 28A AUTOPSri , 29B IF YES WEAE USEf+TO N0 YES REFUSED tCAUSE Of DEAT}R t ^2 ^8. ^4 ^3,. [}6 0©.NO t S 0 ^1 ^2 ~.; 0^N0. t: YES. . C~HptaTGl :: SEE UISit#ICi1dN SNFFT FOIE C~ItPEETIN6.. OF DEATH - CBNRDEN1tAL 3D. DEATH N91S fA1RSE0 BY: (SNEER ONLY ONEGYISE RER LINE FOA (At, iB), ATW fD~] ,vvAamw~Yt errtalol ~1erCtrAMUw„cn I'ARF L H~OIA7E fJIEESE: ~ - ~ 0{'>Eit1DRASACON5E0Uf]M:E~:. .~'.:.. i ':.. - ` ~_ ~ iO01tA5A6~I1SE0UENCEOF: ! ~~~ 1 (81 1 IL &IGNN1CAlIT CONtIrTRi11S CONTRf8UTW6 TO OEd(iH'EUT NOT REUTt~ TO CAl1SE DrvEII HV Pi1RI 1(Al: • ' DID TOBACCD USE TO W 1 ' - vll ~ 0 ^ NO 1 {~ YfS 2 ^ AgOBABLY 3 UNK11Dtw1 1F ~.. 7E: tHF)UR: 1.318.OI.RERYLI/CALtrY:(Ggat mdmuMYandWtel 131 C.DESCSNBEHOwR1,wRrOCDUFtRED: 137O.PLACEOFiNJUNY: tJtf.RlA1RY~. 7 1 I I f t~ 1 nl l 7 I 1 1"l fl 7 1-.I 6 ANMSPORUTgN WIMIV, SPECIFY: R: WA$t~CfDE11T 33A IF FEMALE: 7QOI~eW Y^Msrp'.t^P'mrl HDSPitAI.RED W Iq YES a ~elagw.ieeamra 7^negaaare amm 2^'Nap+e~ ~l/IeOeem wtM /2lr torame ~~. ~~~ ' . . l LAS S?YONTH57 00 t a ea eelm~utuoenrol aloe < twtne.ni~reAdnl.on.awnw N n ° '"3 ~ ~~ <,s ' ~ ~ e t~ -~ r.~ b ~ . ~ `. ,_i ~~ "f'1 5 i l a: ~t .. . . _< . 3 :_ ;......{ .. C; ~ t„^) `'~ rT7 K f ~ File No. 2008-4541 tai The People of the State of New York, TO ALL WHOM THESE PRESENTS SHALL COME OR MAY CONCERN, SEND GREETING: KNOW YE, That having inspected the records and proceedings in our Surrogate's Court of our County of Queens, we do there find remaining the Decree and Petition of BARBARA R. BOGSTED, late of our said County of Queens, deceased, taken and had in our said Surrogate's Court, also the Letters Testamentary granted thereon, under date of October 13, 2009, in the words and figures following, that is to say: On the Date Written Below UTTERS are Granted by fhe Surrogate's Court, Stafe of New York as follows: Name of Decedent: Barbara R Bogsted File #: 2009-2907 Date of Death: May 12, 2009 Domicile of Decedent Fiduciary Appointed: Mailing Address Letters Issued Limitations Queens County Richard Henderson 29 Grissom Way Hauppauge NY 11788 LETTERS TESTAMENTARY NONE THESE LETTERS, granted pursuant to a decree entered by the court, authorize and empower the above-named fiduciary or fiduciaries to perform all acts requisite to the proper administration and disposition of the estate/trust of the Decedent in accordance with the decree and the laws of New York State, subject to the limitations and restrictions, if any, as set forth above. Dated: October 13, 2009 IN TESTIMONY WHEREOF, the seal of the Queens County Surrogate's Court has been affixed. WITNESS, Hon Robert L Nahman, Judge of the Queens County Surrogate's Court. ~~~ Alicemarie E. Rice, Chief Clerk These Letters are Not Valid Without the Raised Seal of the Queens County Surrogate's Court Attorney Lisa Leonick Lisa Leonick Esq 382 Larkfield Road East Northport NY 11731 Present: Hon. Robert L. Nahman, Surro¢ate SURROGATES COURT OF THE STATE OF NEW YORK COUNTY OF QUEENS X In the Matter of the Probate Proceeding, Will of BARBARA R. BOGSTED, Deceased X At a Surrogate's Court held in and for the County Of Queens, at Jamaica, State of New York in said County on OCT 1 ~ ZOD9 File No: 2009-2907 Decree Granting Probate SATISFACTORY PROOF having been made that jurisdiction has been obtained over all necessary parties and that all necessary notice has been given; AND the witnesses to said last will bearing date September20, 2002 having been sworn and examined, their examination having been reduced to writing and filed or their affidavits having been filed, and it appearing that said will was duly executed, and that the Decedent at the time of execution was in all respects competent to make said will, and not under restraint, and the Court being satisfied of the genuineness of the said will and the validity of its execution; and that a decision having been rendered by the Surrogate dated September 21, 2009 which reads as follows: "Based upon the evidence presented and a review of the instrument offered for probate dated September 20, 2002, the Court finds that the handwritten deletions and changes to the instrument were not made prior to the execution of the instrument offered for probate herein. The Court also finds that the instnunent as originally prepared was duly executed in conformity with the requirements for a Will pursuant to EPTL Section 3-2.1 and that the decedent was in all respects competent to make a will and free of restraint. Accordingly, the unopposed petition is granted. The Will is admitted to probate in its original form. Submit Decree establishing the terms of the Will as executed which reads as follows: LAST WILL AND TESTAMENT OF BARBARA R BOGSTED I, Barbara R. Bogsted, residing at 17-85 215th Street, County of Queens, State of New York, which I hereby declaze to be my domicile, do hereby make, publish and declare this to be my Last Will and Testament. FIRST: I revoke all Wills and Codicils made by me at any time heretofore. SECOND: I direct that all inheritance, estate, succession and death taxes or duties (including any interest thereon) imposed by any jurisdiction whatsoever by reason of my death upon or in relation to any property includable in my estate for the purposes of any such taxes or duties, whether such property passes under the provisions of this Will or outside the provisions of this Will, be paid out of my general estate without proration or apportionment. THIRD: I direct that all my just debts and funeral expenses be paid out of my general estate as soon as practicable after my decease. FOURTH: I do hereby give, devise and bequeath the following 1. My gold Waltham pocket watch, given to me by my late husband, George Bogsted and formerly belonging to his Grandfather, to George's brother, Roger Bogsted residing at 33 DeWalt Dr., Mechanicsburg, P.A. If Roger Bogsted pre-deceases me, I direct that the Waltham pocket watch shall be given to Roger's son, Michael Bogsted residing at 304 Sample Bridge Road, Mechanicsburg, Pennsylvania; 2. The sum of $20,000.(10 to each of the children born of the first marriage of George's brother Roger Bogsted and Barbara Bogsted, namely; a. Roger Bogsted residing at 105 Bobolink Dr. Levittown, N.Y. b. Thomas Bogsted residing at 56 Twisting La., Wantagh, N.Y. c. Mrs. Susan Bogsted Roby residing at 611 Ridge Rd, Lewisberry PA d. Sharon Bogsted Faucett residing at 32 Grove St., Massapequa, NY 3. The sum of $20,000.00 to Michael Bogsted, residing at 304 Sample Ridge Road, Mechanicsburg, PA, born of the second marriage of George's brother Roger Bogsted and Jolene Bogsted. FIFTH: All the rest, residue and remainder of the property both real, including but not limited to the Townhouse located at 1076 Lancaster Blvd.. Mechanicsburg, PA and my cooperative apartment at 17-85 215th St., Bayside, N.Y. and personal property and mixed and wheresoever situate which I may own or be entitled to at the time of my death (all such property being herein sometimes referred to as my "residuary estate"), I give, devise and bequeath to the Donovan and Henderson nieces and nephews. My estate, once solvent is to be shared amongst my eleven nieces and nephews as listed below: A} Children born of the marriage of my sister Doris and Albert Peter Donovan, namely-Peter Donovan of 1688 Pettit Ave., Merrick, N.Y.; Dennis Donovan of 28 Highland, Meredith, N.H.; Timothy Donovan of 144 Browster Rd., Massapequa, N.Y.: Patricia Kalkau of 24 Thorman La., Huntington, N.Y.; and Deborah Donovan Angst of 2 Brunswick Dr., E. Northport, N.Y., and B) Children born of the marriage of my brother Richazd Henderson and Karen Henderson, namely-Lori Henderson Conlin of 6 Knollwood La., Smithtown, N.Y.; Julie Henderson Divi of 14 Barton Rd., Yonkers, N.Y.; Eric Henderson of 4055 Beaver Rd., Loganville, Ga.; April Henderson Piecora of 40 Bluff Ct., Hauppauge, N.Y.; David Henderson of 25 Richman Blvd., Apt. 3A, Nob Hill. Ronkonkoma, N.Y; Jamie Henderson of 29 Grissom Way, Hauppauge, N.Y. EIGHTH: A. I hereby designate the parents of children under the age of twenty-one (21) to be Trustees for each such child except as provided for below. B. In the case of Michael G. Bogsted, the son of Roger Bogsted, I designate Roger Bogsted, Michael's father as the sole Trustee. NINTH: I grant to my Executors and Trustees full power to do everything in administering my estate and the trusts created hereunder that they deem to be for the best interest of my beneficiaries (whether or not it be authorized or appropriate for fiduciaries but for this broad grant), including all powers granted to them by the New York State Estates Powers and Trust Law TENTH: No person, firm or corporation dealing with my Executors and/or Trustees, shall be bound to see to the application of any money or other property transferred to them or to inquire into the authority for or propriety of any action by them; nor shall my Executors and Trustees be liable for any act or omission in connection with the administration of my estate or any trust created herein, except only that each Executor and Trustee shall be liable for his or her own actual fraud or willful misconduct, and no Executor or Trustee shall be responsible for any act or omission of any other Executor or Trustee. ELEVENTH: Any person who shall die in a common accident or disaster with me, or under such circumstances that it is doubtful which of us died first, shall be deemed to have predeceased me. TWELFTH: The neuter gender hereunder shall be deemed to include the masculine and/or feminine wherever necessary or appropriate, and the singulaz to include the plural. Wherever the expression "Executor" or "Executors" is employed, the same shall be deemed to include the words Executrix or Executrixes or their alternates or successors as the case maybe. THIRTEENTH: My Executors shall have the authority and power to make payment of any legacy or legacies provided for in this Will at such time as they, in their sole discretion, shall determine without regard to any statutory provisions affecting the time for distribution. My estate shall have no obligation to pay interest on any legacy provided for herein regardless of the time when distribution of such legacy is made. IN WITNESS WHEREOF, I hereby sign, seal, publish and declare this to be my LAST WILL and TESTAMENT in the presence of the persons witnessing it at my request this day of in the year two thousand and two (2002). L.S. Bazbaza R. Bogsted SIGNED, SEALED, PUBLISHED and DECLARED. by the above named Testator , to be her Last Will and Testament, in our presence, all of us being present at the same time, whereupon we, at the request of the said Testator and in his presence and in the presence of each other have hereunto subscribed our names as witnesses the day and year written above. Residing at: Residing at: Residing at: A,,~'ulavit ofAttesting Witnesses STATE OF NEW YORK ) ss: COUNTY OF NASSAU ) Each of the undersigned, individually and severally being duly sworn, deposes and says: The within Will was subscribed in our presence and sight at the end thereof by Barbara R. Bogsted, the within named testator, on the day of 2002 at ,New York . Said testator at the time of making such subscription declared the instrument so subscribed to be her last Will. Each of the undersigned thereupon signed his/her name as a witness at the end of such Will at the request of the testator and in her presence and sight and in the presence and sight of each other. Said testator was, at the time of executing such Will, over the age of 18 years and, in the respective opinions of the undersigned, of sound mind, memory and understanding and not under any restraint or in any respect incompetent to make a Will. The testator, in the respective opinions of the undersigned could read, write and converse in the English language and was suffering from no defect of sight, hearing or speech, or from any other physical or mental impairment which would affect her capacity to make a valid Will. The Will was executed as a single, original instrument and was not executed in counterparts. Each of the undersigned was acquainted with the testator at such time and makes this affidavit at her request. The within Will was shown to the undersigned at the time this affidavit was made and was examined by each of them as to the signature of said testator and of the undersigned. The foregoing instrument was executed by the testator and witnessed by each of the undersigned affiants under the supervision of Lisa A. Venturino an attorney at law. On the _ day of in the yeaz 2002 before me, the undersigned personally appeazed and and personally known to me or proved to me on the basis of satisfactory evidence to be the individuals whose names are subscribed to be the within instrument and acknowledged to me that they executed the same within instrument and acknowledged that they executed the same in their capacities, and that by their signatures on the instrument, the individuals, or the person upon behalf of which the individuals acted, executed the instrument. ORDERED, ADJUDGED, AND DECREED, that the instrument offered for probate herein be, and the same is, admitted to probate as the will of the said BARBARA R. BOGSTED, deceased, valid to pass real and personal property, and that the said will and this decree be recorded, and that letters Testamentary Issue to Richard Henderson upon his qualifying thereunder. V ~'! v u~l'/' OQQ.Tu STATE OF NEW YORK SURROGATE'S COURT: COUNTY OF QUEENS ~~ J ~C~~~ . FUing Fee Paid $ l 7'~~~ X PROBATE PROCEEDING, / WILL OF BARBARA R. BOGSTED a/k/a Deceased. ~~ Certs $ '~ ~ Certs $ $ Bond, Fee: $ Receipt No: No:_ PETITION FOR PROBATE AND: I ] Letters Testamentary [ ] Letters of Trusteeship [ ] Letters of Admtnlstration c.ta. File No. o7gU (~' ~ f O rl To the Surrogate's Court, County of QUEENS It is respectfully alleged: 1.(a) The name, citizenship, domidle (or, in the case of a bank or trust company, fts principal office) and interest in this proceeding of the petitioner are as follows: Name: Richard Henderson Domidle or Prindpal Office:_29 Grissom Way {Street and Number] HAuppauge New York 11788 (City, Village or Town) (State) (Zip Code) Mailing Address: (If different from domicile} Citizen of USA Name: Domicile or Prindpal Office: (Street and Number} (City, Village or Town) (State) (Zip Code) Mailing Address: (If different from domicile) Citizen of: Interest (s} of Petitioner (s): [Chedt one] [ X ] Executor (s) named in decedent's Will [ ]Other (Spedfy) 1.(b} The proposed Executor [ ] is [ X ] is not an attorney. [NOTE: A sole Executor-Attorney must comply with 22 NYCRR 207.18(e)] 1.(c) The proposed Executor [ ] is [ ] is not the attorney-draftsperson, athen-affiliated attorney or employee thereof. [NOTE: An attomey-draftsperson, athen-affiliated attorney or employee thereof must comply with SCPA 2307-a] 2. The name, domicile, date and place of death, and national citizenship of the above-named decedent as follows: (a} Name: Barbara R. Bogsted ~~ (b) Date of death May 12, 2009 ~~ (c) Place of death Hospice Care Network N. Hempstead, NY 11550 (d) Domicile: Street 17-85 215"' Street ~/~ City, Town, Village Bayside t/ County Queens State New York~~ ~~~_ (e) Citizen of: USA 3. The Last Will, herewith presented, relates to both real and personal property and consists of an instrument or instruments dated as shown below and signed at/the end thereof by the decedent and the following attesting witnesses: September 20, 2002 / Nick Varinos, Carolyn Hatton and Kathy Mediate (Date of WNl} (Names of All Witnesses to Will) (Date of Codicil) (Names of All Witnesses to Codicil) (Date of Codicil) (Names of All Witnesses to Codicil) P-1 (02108) 4. No other will or codicil of the decedent is on file in this Surrogate's Court, and upon information and belief, after a diligent search and inquiry, including a search of any safe deposit box, there exists no will, codicil or other testamentary instrument of the decedent later in date to any of the instruments mentioned in Paragraph 3 except as follows: [Enter "NONE" or specify] None 5. The decedent was survived by distributees classified as follows: [Information is required only as to those classes of surviving relatives who would take the property of decedent pursuant to EPTL 4-1.1 and 4-1.2. State the number of survivors in each class. Insert "NO" in all prior classes. Insert "X" in all subsequent classes]. a [ No ] Spouse (husband/wife). b. [ No J Child or children and/or issue of predeceased child or children. [Must include marital, nonmarital, adopted, or adopted-out of child under DRL Section 117] c (No ] Mother/Father. d.( 6 ] Sisters and/or brothers, either of the whole or half blood, and issue of predeceased sisters and/ar brathers {nieces/nephews, etc.) e. [ x ]Grandparents. [Include maternal and paternal] f.[ x ] Aunts and/or uncles, and children of predeceased aunts and/or uncles (first cousins). [Include matemal and paternal] g. [ x ]First cousins once removed {children of predeceased first cousins). [Include matemal and paternaq 6. The names, relationships, domicile and addresses of all distributees (under EPTL 4-1.1 and 4-1.2), of each person designated in the Will herewith presented as primary executor, of all persons adversely affected by the purported exercise by such Will of any power of appointment, of all persons adversely affected by any codicil and of all persons having an interest under any other will of the decedent on file in the Surrogate's Court, are hereinafter set forth in subdivisions (a) and (b). [If the propounded will purports to revoke or modify an inter vivos trust or any other testamentary substitute, list the names, relationships, domicile and addresses of the trustee and beneficiaries affected by the will in subparagraphs (a) and (b) below. Submit trust agreement] (a) All persons and parties so interested who are of full age and sound mind or which are corporations or associations, are as follows: Name and Domicile Address and ~ Description of Legacy, Devise Relationship Mailing Address or Other Interest, or Nature of Fiduciary Status Richard Henderson ~~„~j, 29 Grissom Wav Hauppau4e. NY 11788 Proposed Executor ~a-n1 Deborah Gerstner n'1 GC`s 2 Brunswick Dr. E. Northport, NY 11731 Legatee - ~ ~ T.f' S~1.dl'~ Dennis Donovan n+-~8 28 Highland St. Meredith, N.H, 03253 Legatee -- ~~ci~ ~Y`~ Patricia Kalkau (1 ~~- 24 Thorman La Huntington NY 11743 Legatee ., ~, T SYu~lr`P Peter Donovan h~~~ 1688 Petit Ave. Merrick, NY 11566 Legatee -- i ; j ~ Shams Timothy Donovan (1 i ~C ~ 144 Brewster Road Massapequa, NY 11758 Legatee ~ ~ir t ~ Shy ~ -2- (b) Alt persons so interested who are persons under disability, are as follows: [Fumish all information specified in NOTE following 7b] Name and Domicile Address and Description of Legacy, Devise Relationship Mailing Address or Other Interest, or Nature of Fiduciary Status 7. (a) The names and domiciliary of all substitute or successor executors and of all trustees, guardians, legatees, devisees, and other beneficiaries named in the Will andlor trustees and beneficiaries of any inter vivos trust designated in the propounded Will other than those named in Paragraph 6 herewith are as follows: Name Domicile Address and Description of Legacy, Devise Mailing Address or Other Interest, or Nature of Fiduciary Status Roger Bogsted r~ (~ht~t) 105 Bobolink La. Levittown , NY 11756 Legatee ~- 0~0,(7~ Thomas Bogsted A-~~he ~.t7 36-41 Princeton Dr. N• Wantagh, NY 11793 Legatee ~ oZ(7 Or7-p Sharon Bogsted Fawcett J11~C~• 7 Round La. Levittown, NY 11756 Legatee ~ ap ob m Susan Bogsted Roby v~~ e G~~ 611 Ridge Road Lewisberry, PA 17339 Legatee'~`•-ap pOn Michael Bogsted ~~3 u 304 Sample Bridge Road Mechanicsburg PA 17055 Legatee ~ gp OOc~ ~r~.., Jamie Henderson r 29 Grissom Way Hauppauge, NY 11788 Legatee _ f/t, ~ tiat"~ Julie Divi ~ ~ ~ c~ ~ 14 Barton Road Yonkers, NY 10701 Legatee _ t ~j 5_ ~x ~- ~ Lori Conlin ~ ~ C C. 6 Knollwood La Smithtown NY 11787 Legatee ~ / ,~ ~~~.e.~ ~ e Eric Henderson +^tA~~ 4055 Beaver Road Loganville Georgia 30052 Legatee ._ r - / a ~h,rr- April Piecora n ~ c 44_~,~, '~ r 3 Snowberry Ct. Miller Place, NY 11764 Legatee _ il~tr~ ~„ r° E David Henderson ~~ 754 Rogers Road Bohemia, NY 11716 Legatee - ~ ~ ~ /i! `~ T (b) All such legatees, devisees and other beneficiaries who are persons under disability are as follows: [Furnish all information specified in NOTE be low] Name Domicile Address and Description of Legacy, Devise Mailing Address or Other Interest, or Nature of Fiduciary Status None [NOTE: In the case of each infant, state (a) name, birth date, relationship to decedent, domicile and residence address, and the person with whom he/she resides, (b) whether or not he/she has acourt-appointed guardian (if not, so state), and whether or not his/her father andlor mother is living, and (c) the name and residence address of any court-appointed guardian and the information regarding such appointment. In the case of each other person under a disability, state (a) name, relationship to decedent, and residence address, (b) facts regarding his disability including whether or not a committee, conservator, guardian, or any other fiduciary has been appointed and whether or not he/she has been committed to any institution, and (c) the names and addresses of any committee, person or institution having care and custody of himlher, conservator, guardian, and any -3- relative or friend having an interest in his/her welfare. In the case of a person confined as a prisoner, state place of incarceration and list any person having an interest in his/her welfare. In the case of unknowns, describe such person in the same language as will be used in the process.] 8. (a) No beneficiary under the propounded will, listed in Paragraph 6 or 7 above, had a confidential relationship to the decedent, such as attorney, accountant, doctor, or clergyperson, except: [Enter "NONE" or indicate the nature of the confidential relationship]. None (b) No persons, corporations or associations are interested in this proceeding other than those mentioned above. 9. (a) To the best of the knowledge of the undersigned, the approximate total value of all property constituting the decedents gross testamentary estate is greater than $500,000.00 but less than $1,000,000.00. Personal Property $1500.00 Improved real property in New York State $450,000.00 Unimproved real property in New York State $None Estimated gross rents for a period of 18 months $None (b) No other testamentary assets exist in New York State, nor does any cause of action exist on behalf of the estate, except as follows: [Enter "NONE" or specify] None 10. Upon information and belief, no other petition for the probate of any will of the decedent or for letters of administration of the decedent's estate has heretofore been filed in any court. WHEREFORE your petitioner (s) pray (s) that process be issued to all necessary parties to show cause why the Will and the Codicil (s) set forth in Paragraph 3 and presented herewith should not be admitted to probate; (b) that an order be granted directing the service of process, pursuant to the provisions of Article 3 of the S.C.P:A., upon the persons named in Paragraph (6) hereof whose names or whereabouts are unknown and cannot be ascertained, or who may be persons on whom service by personal delivery cannot be made; and (c) that such Will and Codicil (s) be admitted to probate as a Will of real and personal property and that letters issue thereon as follows: [Check and complete all relief requested.] [ x] Letters Testamentary to Richard Henderson [ ] Letters of Trusteeship to f/b!o f/b/o f/b/o Letters of Administration c.t.a. to and that petitioner (s) have such other relief as may be proper. Dated: ~ - 1 n (Signature of Petitioner) 2. Richard Henderson (Print Name) (Signature of Petitioner) (Print Name} 3. (Name of Corporate Petitioner) (Signature of Officer) -4- (Print Name and Title of Offrcer) COMBINED VERIFICATION, OATH AND DESIGNATION [For use when petitioner is an individual] STATE OF NEW YORK ) COUNTY OF SUFFOLK ) ss.: The undersigned, the petitianer named in the foregoing petition, being duly sworn, says: 1. VERIFICATION: I have read the foregoing petition subscribed by me and know the contents thereof, and the same is true of my own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters 1 believe it to be true. 2. OATH OF [ X ]EXECUTOR [ ] ADMINISTRATOR c.t.a. [ J TRUSTEE as indicated above: I am over eighteen (18) years of age and a citizen of the United States and I will well, faithfully and honestly discharge the duties of Fiduciary of the goods, chattels and credits of said decedent according to law. I am not ineligible to receive letters and will duly account for ail moneys and other property that will come into my hands. 3. DESIGNATION OF CLERK FOR SERVICE OF PROCESS: I hereby designate the Clerk of the Surrogate's Court of Queens County, and his/her successor in office, as a person on whom service of any process, issuing from such Court may be made in like manner and with like effect as if it were served personally upon me, whenever t cannot be found and served within the State o. New York after due diligence used. My domicile is:29 Grissom Way Hauppauge New York (Street Address) (cityRownnrnage) (state) (Signature of Petitioner) Richard Henderson {Print Name) 11788_ (ZiP) On ~,1l~1~11 I ~J , 20 09, before me personally came Richard Henderson to me known to be the person described in and who executed the foregoing instrument. Such person duly swore to such instrument before me and duly acknowledged that he/she executed the same. ;,, / 4 ~1 i Nota ublica Commission Expires: (Affix Notary Stamp or Seal} usa A vENTURINO ~ Lts u L~°c7~~ c~) No ~V$E4~3T0u~~~ Cloonl~ed (Expires IApr!< 16. ~0,,~0 ~~~~ Signature of Attorney: Print Name: Lisa Leonick Firm Name: Lisa Leonick, Esq. Tel No. (631}368-8490 Address of Attomey:382 Larkfield Road East Northport, New York 11731 -5- Control# 11033 STATE OF NEW YORK) EXEMPLIFICATION SURROGATE'S COURT) FILE#: 2009-2907 COUNTY OF QUEENS) FILE NAME: Barbara R Bogsted 1, Alicemarie E. Rice, Chief Clerk of the Queens County Surrogate's Court, being a Court of Record, do hereby certify that the copies of the documents listed below, were compared to the original records of the Court filed in the Surrogate's Office of the County of Queens, and in my care and custody as the Chief Clerk of the Surrogate's Court, and that the same are full, exact and correct transcripts therefrom, and of the whole of each original record. PROBATE DECREE, PETITION AND LETTERS TESTAMENTARY IN TESTIMONY WHEREOF, I have hereunto set my hand, and affix the seal of the Queens Surrogate's Court on January 4, 2010. u~~ Alicemarie E. Rice, Chief Clerk STATE OF NEW YORK ) SURROGATE'S COURT ) COUNTY OF QUEENS ) I, Robert L Nahman, Presiding Judge of the Surrogate's Court, do hereby certify that Alicemarie E. Rice, the person attesting the above certificate, is Chief Clerk of the Surrogate's Court, that his/her signature to the attestation is genuine, that he/she is the legal custodian of the records and files of the Court, and that the certificate and attestation are in due form. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Queens Surrogate's Court on January 4, 2010. Robert L Nahman, Surrogate STATE OF NEW YORK ) SURROGATE'S COURT ) COUNTY OF QUEENS ) I, Alicemarie E. Rice, Chief Clerk, of the Queens County Surrogate's Court, do hereby certify that the Honorable Robert L Nahman, is the Surrogate of Queens County, duly commissioned and qualified, and the Presiding Judge of the Surrogate's Court, and that his/her signature to the foregoing certificate is genuine. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of the Queens Surrogate's Court on January 4, 2010. ~;~,~ ~ ~. Alicemarie E. Rice, Chief Clerk (Facsimile signature maybe used pursuant to Section 2609 of the Surrogate's Court Procedure Act) z ~ - l ~ -oo~.Z- AFFIDAVIT BY FOREIGN FIDUCIARY Estate of BARBARA R. BOGSTED No. also known as ,Deceased Social Security No. 130-16-5502 ra o S" .7 ~~;. ~ -,.-~, ~... ..... sn t-; ' ...1 being duly sworn depose and say as follows: , ~ ~-° m ~ -- ~= ` -= am Executor ~ ~h ,~. -~ w .7 ;, c; ~ _, We are A mlrns rator ' ~-' --r~, ~~ ~ ~ -~ ~ - , Trustee ~ ~ ' ~' Guardian in the above Estate. ~ c.~ `.:; ` ` N Decedent diedMav 12 2009 a resident of NEW YORK Date Cry QUEENS NEW YORK County State That deponent(s) desire(s) to exercise within the Commonwealth of Pennsylvania the authority vested in deponent(s) by virtue of an Act of Assembly of the Commonwealth of Pennsylvania, known as the Probate, Estates and Fiduciaries Code of 1972, P. L. 164, Sec. 4101 (1) AND (2}, and has complied with all the provisions of same. That after diligent search and inquiry, deponent(s) state(s) that so far as deponent(s) has/have been able to discover, the above Decedent is not indebted to any person in the Commonwealth of Pennsylvania; and that deponent(s) will not exercise any power which deponent(s) would not be permitted to exercise in the jurisdiction of deponenYs(s') appointment. HAUPPAUGE NY 11788 (Address) (Signature) Sworn to or affirmed ar~d subscribed ~•, II before me this.- day of Notary Public My Commission Expires (Signature and seal of Notary or other official quati8ed to administer oaths. Show date of expiration of Notary's commission.) (Address) CATHERINE WHITE Notary Public, State of New Ybrit No. 01 WH6097519 ttualifisd in Suffolk County Comntiseion Expires August 25, 201 t .~~r Rt~ha~ ~.,de~. NOTE : Do not file this affidavit until after one month from Decedent's death. An exemplified copy of probate proceedings must accompany this form. RW-8 29 GRISSOM WAY C20 (Rev. 1/07) Certificate# 59527 SURROGATE'S COURT OF THE STATE OF NEW YORK QUEENS COUNTY File #: 2009-2907 CERTIFICATE OF APPOINTMENT OF EXECUTOR(S) IT IS HEREBY CERTIFIED that Letters in the estate of the Decedent named below have been granted by this court, as follows: Name of Decedent: Barbara R' Bogsted Date of Death: May 12, 2009 Dor~~icile of Decedent: Quszns Ccun ;.~ Fiduciary Appointed:' Richard Henderson Mailing Address: 29 Grissom Way Hauppauge NY 11788 Type of Letters Issued:: LETTERS TESTAMENTARY Letters Issued On: October 13, 2009 Limitations: NGNE end such Letters are unrevoked and in full force as of this date. Dated: October 15, 2009 IN TESTIMONY WHEREOF, I have hereunto set my hanc and affixed the seal of the Queens County Surrogate's Court at Jamaica, New York. WITNESS, Hon. Robert L Nahman, Judge of the Queens County Surrogate's Court. ~~~ ~ ~ /~ ~~~c-a~1.P.~ Alicemarie E. Rice, Chief Clerk Queens County Surrogate's Court This Certificate is Not Valid Without the Raised Seal of the Queens County Surrogate's Court