HomeMy WebLinkAbout02-09-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~~""^~""~ ~'^ ~ COUNTY, PENNSYLVANIA
Estate of _ ~ ~~ ~ `~ ~- t0'~~-~ ~ ~ ~'
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
Deceased
File Number ~~' ~~ ~ ~ 1 z tp
Social Security Number ~ b 2 ~ `O
~A. Probate and Grant of Letters Testamentary d aver that Petitioner( is / re the ~'~Cv ~~~ ~ nar~ned in the
last Will of the Decedent dated ~c~/. ~ ~ Z'E7C7~nd codicil(s) dated
(State relevant circwnstnnces, e.g., renunciation, death ojexecutor, 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
(!f applicable, enter: c. t. n.; d. b. n. c. t, a.; pendente lire; durnnte absentia; durnnte miaoritn~
C7 °
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the follow~ouse (if at4~ and leis;°jl~'
Adtrrirristralion, c.t.a. ord.b.n.c.l.a., enter date of Will in Section A above and complete list ofheirs.) ~ =~ ~ ~~ ~ -~
C7
Name Relationshi ~~ ~ ~ ~ t ~ j `..:~
...,
L T~ i:: -
~~ ,~ ..i
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(CONIPLET'E IN.1LL CASES:) Attach additional sheets if necessary. ~
Decedent was domiciled t death in ~~ 04` ~ County, Pennsylvania with his /her last principal residence at
~+ r l art
(List street address, totiwdcity. township, coi h~, state, zip code) j ,[~
Decedent, then --- Years of age, died on ~ ~~ d 1 at `' t n ( r r (`rn •~
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $~ ~ ~~ Ol'7 ~?
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
ValluQe of real estate in /P~ennsylv`ania $
situated as follows: 1(~ ~ ~ 1~ `Ir'k 1 { ~ ~,,~~'~`~~~~ ~~ ~ ~ `~ .
Wherefore, Petitioner(s) respectfully request(s) the p~•obate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
~ ~ Signature Typed or printed name and residence
{1(l e ~ . CwC s (Crl~j ~ l t' ~ ~ ~ J ~ ~ ~ i 2, 1. (° 1~,r~ o ~t +a.4% ,
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F~,-„~ Rrv-a~ r~,~. lo.i3.o6 ~ Page 1 of 2
Oath of Personal Representative
COMI/ION~VEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirnl(s) that the statements in the foregoing Petition are tine 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. ,~
Sworn to or affirmed and subscribed ~ ~+ ~v` y ~A ~ (,,(~ ~ i7,,! ~(
~. j..~~ Signature of Personal Represenlalive
before me the day of ~^-~
} c y_.~
v Si
t
P ~ri "
gna
ure of
ersonalRepresentative ;`D..~
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For the Register Signature of Personal Representative ~~ ~ ~'~ i'~. " j ' ~`
File Number:_ ~ . ~ - l (' - d !~ (~, uD
Estate of
l ~ ~ v ~r
a
~ - L¢
r-'
~C~S~~
_ ,
.
,
,
. ,Deceased
Social Security Number: ~ ~Q,Z '3~" / 7~ Date of Death:~~ - ~~ - ~9
AND NOW, , ~d 1 D ,inconsideration of the foregoing Petition, satisfactory proof
having been presented before me, I ECR.EED that Letters `T"
are hereby gra~ited to A ~,,
in the above estate
and that the instrument(s) dated ~ ~ -~ ~ -~ ~ 9
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
FEES
Letters ..........:.... $~10.Oe~
Short Certificate(s) ........ $ L.~Q .QC~
Ren'_w/lciation(s) ......
!'~1 ~
c^~ ~--5
~ 1Md'~' ~ rc~..
... $ 1S. o0
... $z3 .so
... $ S.
... $
Regi 'lls v . v
Attorney Signature:
(~ h
Attorney Name: JJre, ~~(~S~,..
Supreme Court LD. No.: 2~ ~ ~ S
Address: ,_~ ~p ~_~ ~'~ ~
... $
... $
$ Telephone
...~
TOTAL .............. $ 9 ~ .
r-~~,•„~ Rcv-r~? rev. ru.i3.ur Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 15934140
Certification Number
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 pernianent filing.
/'~/^/~.•~~ ~---~ DEC 1 71009
Local Registrar Date Issued
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aEV 11;2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN
ANENT CERTIFICATE OF DEATH
,K INK
(See instructions and examples on reverse)
STATE FILE NUMBER
1. Name of Decedent (First, middle, last, suffix) .~
/~ ! t ~ 1 2. Sex 3. S~I Security Number 4. Date of Death (Month, day, year)
5. Age (Last Birthday) Under 1 year Under 1 da 6. Date of Birth Month, da , L / y't-' _ /
Y ( y year) 7. Birtfrplace (Ci and slate or feral country) Ba. Place of Death (Check onty one)
Mourns oeys Hwrs Mmure~ Hospital: Other:
~~ Yrs. `-~/~Q// ~~ Haze 1 t o n , PA Inpatient ^ ER /Outpatient ^ DOA
^ Nursing Home ^ Residence ^Other -Specify:
8b. County of Death 8c. City, Boro, Twp. of Death Bd. Facility Name pf not institution, give street and number) 9. Was Decedent of Hi ~ J:7.
'`,~ spank Origin. ~No ^ Yes 10 Race: American Indian. Black. While. etc.
/ ~`
'~ Pittsburgh ~„-~~J~~yl /',~/r~f~1/~~~/s~ (It yes, specify Cuban, (SpecilY)
~~ ov 9 t:le/.7 Mexican, Puerto Rican, etc.) wll l t @
11. Decedent's Usual Occ lion Kind of work done dud most of world life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade completed) 14. Marital Status: Marred, Never Married, 15. Surviving Spouse pl wife, give maiden name)
Kind of Work Kind of Business /Industry U.S. Armed forces? Elementary /Secondary (0-12) College (1-4 or 5+) Widowed, Divorced (Speci/»
owner/CEO laundry equipment ®Yea ^No 12 5 married
16. Decedent's Maikn Address Street, ci /town, state, zi code a t he r i v e K. Ku r t e nb a c h
g ( ty p ) °~~en''a Pennsylvania Did Decedent
Actual Residerxxi 17a. State Live in a
Crain Circle 17c. ^ Yes, Decedent Lived in
Township? Twp.
Lemo ne PA 17043 17b. county Cumberland nil. ~ No, Decedem Lived t '
Actual Umits of y
~'~'m0 ne Cily! Borc
18. Father's Name (Flrsi mktdle, last suffix) 19. Mother's Name (First, middle, maiden surname)
Philip Anthony Costabile Angela Garramone
20e. Informant's Name (Type / Prinq 20b. Informant's Mailing Address (Street, city ! lownt. state, tip code)
Katherine K. Costabile 18 Crain Circle Lemo ne PA 17043
21a. Method of Dispositon ®Cremation ^ Donation 21b. Dale of Disposition (Month, day, year) 21c. Place of Disposition Name of cemete cremate or other ace
( ry, rY p 1 21d. Location (City I town, slate, zip code]
^ Burial ^ Removal from Slate !Was Cremation or Donation Authorized
^ Other-specify: byMedicalExaminer/Coroner? l~Yea^No 12-17-2009 Evans Crematory Schae:EferstowTt PA
22a. Signet neral Licensee (or person ailing as such) 22b. License Number 22c. Name and Address of Facility
~ ~''"~ FD 012848 L Parthemore FH & CS, Inc., PO Box 431,New Curberland PA 17070
Complete hems 23at only when certifying 23a. To the best of my kn death occurred the 'me, date and place stated. (Signature end title) 23b. License Number 23c. Date Signed (Month, day, year)
physician is not available at time of death to ~
certi cause of death. r
Items 24.26 must be completed by person 24. Time of Death 25. Date Pr Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation?
wtro pronounces death. ~ jt' r~G~ ~ 1 ~. `.~ i ``~~j//G.~ Yes ^ No
CAUSE OF DEATH (See atructlone and examples) I Approximate interval: Part 11: Enter other sianitkant crontiif c rnnrraur
Item 27. Pan I: Enter the chain of event -diseases, injuries, or complications -that diredty caused the death. DO NOT enter terminal events such as cardiac arrest, , kna to death, 28. Did Tobacco Use ConMbute to Death?
respiratory arrest, or ventricular fibrillation without showing the etiology. List only one cause on each line. r Onset to Death but not resultiny in the underlying cause given in Part I. ^ Yes ^ Probably
IMMEDIATE CAUSE (Final disease or i `~/i ~
r ~No ^ Unknown
conddbn resulting in death) _~ a. ~~S-Y~ O U L/ l,(~~~• ,r! .p~~~, L/~~
••• ~~_~~~ "` / ` ~ 29. If Female:
Due to (or as a uence of) r
SequentiaNy list canditbns, H arty, b. h' -l' ~ ~ ^ Nol pregnant within past year
to the cause listed on line a. ~~ -~~~ r ^ Pregnant at time of death
Eller UNDERLYING CA~~UddSE Due to r as a Cron uence of):
~resugi g rn~deslth) aLAST a c. t k i ^ Not pregnant, but pregnant within 42 days
of death
Due to a uronseq nce at): r
, aa I/ lL , i ^ Nol pregnant, but pregnant 43 days to 1 year
d' >''~L~Kt~ ~ -' r before death
30a. Was an Au opsy dings ^ Unknown if pregnant within the past year
topsy 30b. Were Aut Fin ' 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occuned
Pedonned? Available Prbr to Completion 32c. PWce of Injury: Home. Farm, Street, Factory,
of Cause of Death? Natural ^ Homicide 08ice Building, etc. (Specify)
^ Yes I }q No Yes No ^ Acckknt ^ pending Investigation 32d. Time of Injury 32e. Injury at Work? 32t. If Trans onatbn In'u S /
77""" ^ ^ P I rY (PeciY) 32g. Location of Injury (Street, city /town, state)
^ Sukide ^ Could Nol be Determined ^ Yes ^ No ^ Driver /Operator ^ Passenger ^Pedestrian
M. Other • Specity.
33a. Certdier (check oMy one)
33b. Signature and Ti C,edffier ~
• Certifying phyaldan (Physician certifying cause of death when another physician has pronounced death and completed Item 23)
To the best of my knowledge, death xcurted due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~ _ _ _ ^ ~ - -CG lam' ~ ~~ ~ ,~ r
• Pronouncing and Certifying physician (Physician both pronouncing death and certifying to cause of tlealh) 1
To the best of my knowledge, death occurred at the time, date, and lace, and due to the cau 33c. license Number 33d. Date Signed (Monlh,.day. year)
P sa'(s)andmannerasstated__________________
• Medical Examiner (Coroner /~,~ ~~~ `~ `,.-ter ~` ~ ~~/~C,
On the basis of examination and / or investigation, in my opinion, death occurred at the time. date, and place, and due to the cause(s) and manner u staterL. ^ / ` ~~ ~~ ~j'~' _
34. Name and/AJ~dress ofd-Peyryon Who C p~ Causao~Cea17 (Ile 2 pe P I - ~ ~~!
35. Registrar's Signs and District N 36. ate F' (Month, day, ye '~ f~ '"' ~L~~~ ~(~ ~ ~~~~~' 3
Disposition Permit No. ~ ~~ ~ _ /% ~ ~+J l/T ~'"- ,~ ! c~
LAST WILL AND TESTAMENT
I, PHILIP F. COSTABILE, of Cumberland County, Pennsylvania,
declare this to be my Last Will and Testament, hereby revoking
any and all Wills by me anytime heretofore made.
rte,
~-
FIRST: I direct that all of my funeral expenses ~aid.~
SECOND : I direct that the amount of the Unified Cf~ '~°
shall be paid to PHILIP F. COSTABILE FAMILY TRUST, to hag: '"~'n
~:~- ~,i.
Trus t f or the bene f i t o f my wife , KATHERINE K . COSTABIL~'~The
~,~~ """'~ s r
Trust shall pay to the benefit of my wife, KATHERINE K. uQ
COSTABILE, during her lifetime all income and, at the discretion
of the Trustee, all principal necessary for the support, comfort,
health, welfare, maintenance and enjoyment of my wife, KATHERINE
K. COSTABILE.
THIRD: Upon the death of my wife, KATHERINE K. COSTABILE,
the remaining Trust principal from all Trusts shall be paid to my
children pursuant to the following terms. The Trust(s) shall be
divided fifty percent (500) to my son, PHILIP A. COSTABILE, II,
and fifty percent (500) to my daughter, KAITLYN COSTABILE.
FOURTH: To my wife, KATHERINE K. COSTABILE, I give, devise
and bequeath all of the rest, residue and remainder of my Estate,
real and personal, of whatever nature and wheresoever situate.
If my wife, KATHERINE K. COSTABILE, does not survive me then the
rest, residue and remainder of my Estate, real and personal, of
whatever nature and wheresoever situate, shall be sold and
liquidated by my Executor/Executrix and the proceeds therefrom
shall be distributed fifty percent (500) to my son, PHILIP A.
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COSTABILE, II, and fifty percent (500) to my daughter, KAITLYN
COSTABILE.
FIFTH: My Executor/Executrix shall establish a Trust or
Trusts in a financial institution(s) at my Executor/Executrix
discretion. The Trustee shall be BRET KEISLING of Harrisburg,
Pennsylvania. If BRET KEISLING, cannot act as Trustee for any
reason, then I appoint RICHARD HEETER of Mechanicsburg,
Pennsylvania to be Trustee. All Trustees named herein shall serve
without bond.
SIXTH: The Trustee shall pay for my children/beneficiaries
from respective Trust Shares the Trust income and principal as
follows:
A. In the event that a child/beneficiary pursues
secondary education, then:
1) One-half (1/2) of principal and accumulated
earnings, interest and dividends thereon, calculated
from the date of my death, shall be made available when
needed, at the discretion of the Trustee, for secondary
education; trade school, college, graduate school and
the like, including expenses for tuition, room, board
and other related expenses. The Trustee shall have the
discretion to utilize additional Trust funds in excess
of the amount set forth in this paragraph in the event
that additional funds are necessary for the direct
2
expenses related to educational pursuits of each
child/beneficiary;
2) To distribute one-half (1/2) of each
child's/beneficiary's remaining Trust principal when
each attains the age of twenty-five (25) years for
business, medical, residential uses, subject to the
Trustee's discretion;
3) To distribute the remaining principal and
accrued interest when each attains the age of thirty
(3 0 ) years .
SEVENTH: Any income not expended as provided herein shall
be accumulated and added to the Trust principal. The Trust shall
terminate on the date when there is no living beneficiary of mine
under the age of thirty (30) years. On such termination, the
Trust property, including accumulated and undisbursed income,
shall vest in and be distributed to my beneficiaries in equal
shares or to their respective issue per stirpes.
EIGHTH: In the event any beneficiary predeceases me or
predeceases any distribution due him/her, then said beneficiary's
share shall be distributed to his/her issue per stirpes.
NINTH: In the event that all beneficiaries hereunder do not
survive me or their distribution hereunder, then in that event, I
give, devise and bequeath all-of the rest, residue and remainder
of my Estate to the Thomas E. Starzl Transplantation Institute at
3
the University of Pittsburgh Medical Center.
TENTH: The interest of beneficiaries in principal or income
shall not be subject to the claims of any creditors, any spouse
for alimony or support, or others, or to legal process, and may
not be involuntarily alienated or encumbered except that nothing
in this article shall preclude the assignment of all or any part
of a beneficiary's interest to his/her descendants.
ELEVENTH: In handling the Trust estate, the Trustee shall
have complete power to manage, invest, sell and do and perform
any and all other acts and things deemed by the Trustee necessary
or advisable in the management of the Trust estate that may be
done by an absolute owner of property including the sale,
distribution and/or retention for the benefit of the
beneficiaries of any property herein and/or the acquisition of
any additional assets.
TWELFTH: My beneficiaries as determined in accordance with
the provisions herein may select specific items of my Estate to
be retained by them. The fair market value of those items shall
be determined by my beneficiaries or by the Executor/Executrix if
they are unable to agree on a fair market value. The
distribution due any of my beneficiaries shall be reduced by the
fair market value of any items chosen by each of them.
THIRTEENTH: I hereby nominate, constitute and appoint my
wife, KATHERINE K. COSTABILE, to be the Executrix of my Estate.
4
If my wife, KATHERINE K. COSTABILE, cannot act as Executrix for
any reason then I appoint my son, PHILIP A. COSTABILE, II, to be
the Executor. The Executrix/Executor shall serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
these five (5) typewritten pages as, and for, my Last Will and
Testament, this ~ day of ~(„wc~~x~-~ i3~ X2009 .
P F. COSTABILE
5
Commonwealth of Pennsylvania
County of Dauphin
I, PHILIP F. COSTABILE, the Testator whose name is signed to
the attached or foregoing instrument, having been fully qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament, and that I
signed it willingly and as my free and voluntary act for the
purposes therein expressed.
Sworn to or affirmed and acknowledged before me by PHILIP F.
COSTABILE, the Testator, this q~ day of ~e,~;
2009.
PHILIP F. COSTABILE
~:
ry Public
C4MM4NWEAl~H OF PENNSYLVANIA
NOTARIAL SEAL
JANICE L. MEADATH, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires April 30, 2011
7
Commonwealth of Pennsylvania
County of Dauphin
we, ba,,-c~ ~r~~~, ~~~,~ ~~~ ~~~ tom. ~.
and v,n n^Zr"^c,`~
~'"~~ ~-~ ~•~~-~ ~ the witnes es 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 Testator sign and execute the instrument as
his Last Will and Testament; that the Testator signed willingly
and executed it as his free and voluntary act for the purposes
therein expressed; that each subscribing witness 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 the time
eighteen (18) or more years of age, of sound mind and under no
constraint or undue influence.
Sworn to or affirmed and subscribed before me by
A ---~~~-^ ~ ~ Q - Z~ ~ and
n.~ ~-~ +nr-- witne ses, this q.,µ, day of
-i~c,K,~1c,,,,•~ 2 0 0 9 .
Witness
,-
Witn s
Wit
Not ry Public
COMMONWEALTH. Oi= .PENNSYLVANIA
NOTARIAL. SEAL
JANICE L. MEADATH, Notary Public
City of Harrisburg, Dauphin County
MY Commission Expires April 30, ZOl l
8