HomeMy WebLinkAbout07-26-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of FIORIY C. SGRIGNOLI
also known as
Deceased
COUNTY, PENNSYLVANIA
File Number d ~ - ~ ~J -~~ `-I~
Social Security Number 711-07-7901
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
~/~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Surviving Executor named in the
last Will of the Decedent dated Aug. 20, 2002 and codicil(s) dated
Note: James G. Sgrignoli predeceased, the decedent herein, Fioriy C. Sgrignoli, on October 29, 2009
(State relevant circumstances, e.g., renunciation, death 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
(If applicable, enter. c. t. a.; d.b.n.c.t.a.,~ pendente liter durante absentia; durante minoritate)
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: (~f
Administration, c.t.a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
I Name Relationship Residence I
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND
7 SGRIGNOLI LANE ENOLA EAST PENNSBORO T~
rU
~.-- o •-~
~T ~ N ~:; ,.;,
`-r^~ "sue ~ ~ . ; i
County, Pennsylvania with his /her last principal reSi~ee`~ ~. f= ~ ,
CUMBERLAND COUNTY PA 17025 ~=
(List street address, town/city, township, county, state, zip code) ~ -~^i ~, -~~ ~'r`
. ~ , ._.
Decedent, then 88 years of age, died on JUNE 24, 2010 at GOLDEN LIVING CENTER BLUE RIDGE M~NTAIN ~ ~"~
FACILITY, LOCATED IN DAUPHIN COUNTY, PENNSYLVANIA
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: ~ SGRIGNOLI LANE, ENOLA, PA 17025
$,
$ 50,000.00
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicils} presented with this Petition and the grant of Letters 1n the appropriate form to
the undersigned:
I Signature _ _ Typed or printed name and residence
BRUNER, 29 N. Humer St., Enola, PA 17025
1,000.00
Form RW-02 rev. 10.13.06 F~agE; 1 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief of Petitioners} and that, as personal representative(s) of the Decedent, Petitioner(s) will well aid truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ day of
Signature of Personal Representative
L~ ~~ ~ ~ I Signature of Personal lZepresentntive ~J '
~ a ~ `~ ~' ~ C `t
)~ Or the Re teT Signature of Persona! Representative ~-`-~ ,~~ f"" ~ ~:: ~ .~ ~~-
:~ ~, -
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File Number: ~ ~ ` ~~ % - 7 ~~ -~~ ~~ -_
~ ~~
Estate of FIORIY C. SGRIGNOLI
Deceased
Social Security Number: 771-07-7901 Date of Death:JUNE 24, 2010
AND NOW, ~ i (~~ ~~ ~ , .a~C , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TESTAMENTARY
are hereby granted to ALAN BRUNER
in the above estate
and that the instrument(s) dated AUGUST 20, 2002
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~" ~ ~ t
FEES ~ r ~ ~ -~ " ~~ ' -
i
- . ~t~,~tSt~,- of w~us .~'_~ ~ ~ / ~ ,
Letters ............... $ ~ ~
~ ~
Short Certificate(s) ..... , .. $ ~,~,~ ' ~?7`; Attorney Signature: _ __ ..~--~
Renunciation(s) .......... $
~ Attorney Name: Lt ARIE COYNE, ESQUIP.F
~~ ... $ k~ L`~
.._ p 53788
~ ~ ~ $ -~~~ ~~ ~ Su reme Court 1.D. No.:
~f~ ;~r..a t~~~~ ... $ ~ - o-z~
Address: 3901 MARKET STREET
... $
$ CAMP HILL, PA 17011-4227
... $
... $
• • • $ Telephone: 717-737-0464
... $
TOTAL .............. $ ~C~ ~~T(~~ 0.00
Form RW-02 re>>. 10.13.06 ~a~e 2 01 2
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) „ .
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1. Name of Decedent (Fret, middle, last, suffix) ~ 2. Sex 3. Sodal Security Number 4 Date of Death (Month, day, year)
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5. Age (Lest Birthday) Under 1 ear Un r 1 de 6. Dale of Birth Month da , ar 7. Bi end state or fore' coun 8a. Place of Death Check on one
Yre Months Deys Hars Minutes tt )
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' Hospital:
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^ Other.
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DOA Nursing Home ^ Residence ^ i~ther -Specify:
' 8b. County of Dent
h Bc. City, Boro, Twp. of
Death Bd. FadlRy Herne (if rat Inatltutlon, g
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ve she
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er) 9. Was Decedent of Hispanic Origin? No ^ Yes 10. Race: American Indian, Black, White, etc.
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(j q ~~ ~i /J i'1 l L°.j lei ~p~cl C R•' yrr~`n, Mexicanso Riran, etc.) (S~~ '~
11. Decedents lJsual Lion Kind of work done du' most d work IRe. Do not state retlred 12. Wes Decedent ever in 13. Decedent a Educatbn (Specity on highest grade completed) 14. Madtal Status: Martled, Never Marred, l5. Surviving Spouse (It wife, give maiden name)
Kind of Work Kind of Business / lndust~rylA/
~~ ~A i ~/ 4:CY U.S. Am>ed Forces? Widowed, Divorced S
rn/ Elementary /Secondary (1112) College (1-4 or 5+) ~ (~~ e
t!7 Yes ^ No O (,a~~_i1/
~ 16. Decedents Mailing Address (Street, cfry /town, state, zip code) Decedents 0 Did Decedent ~~
Actual Residence 17a
l;ve in a
State
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17c. LJ Yes, Decedent Lived in
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17b. County 17d. ^ No, Decedent Lived wdhin
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18. Father's Name (Flrst, middle, teal, suffix)
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' 1 g. Mdhefs Name (Flret, mktdle, maiden surname)
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-70 o ..7~~t a ~a
20a. Informants Name (Type / 'nt) 20b. Informants Mailing Address (Street, dry ! town, s te, zp code)
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21e. Method of Disposition i ^ Cremation ^ Donaton
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i 21 b. Date of Dispositbn (MOMh, day, year) 21c. Place Dk itlon (Name of cemetery, crematory or other place) 21 d. Location (City /town, state, zip code)
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Wes Cremation or Donetlon Authorized
^ Other • r by MedkN Exerninar/Coroner'1 ^ Yes^ No
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22e. Signature of Funeral Se nose (a person actlng as such) 22b. License Number 22c. Name and Address of FadlRy
- - fo ~,~-~ .~ ~G a 9 ~.. ~~~ (a ,cam. ,~.~~~~ 1° /~d ~s---
Complete items 23ac oMy when cerlNyin9 23e. To st of my knowledge, death occurred at the time, date and place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year)
physican is not available at tkne of death to
reARy cause of death.
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~ hems 24.26 must be completed by person 24. Time of Death 25. D Praaurtced Dead (Month, day, year) 26. Wes Cese Referted to Medical Examiner !Coroner for a Reason Other than Crematon or Donation?
who pronounces death. ~ 1
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^ Yes ®No
CAUSE OF DEATH (See Instructbna and examples) r Approximate interval: Part II: Enter other 1gnificant condiNOns contrih~rrina to death 28. Did Tobacco Use Contribute to Death?
Rem 27. Pad I: Enter tfta fain of events -diseases, injuries, or compiicatbns -that dredy caused the death. DO NOT enter terminal events such as cardiac arrest, i Onset to Death but not resuRing in the undeAyhtg cause given in Part 1. ^ Yes ^ Probabl
respiratory arrest, or ventricular fibdlletlon wRhout showing the etiology. t.iat only one cause on each line.
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IMMEDIATE CA
SE
Fl y
No Unknown
(
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oat disease or ,n, q
condRion resuhing in death) L L G. 6'TlL1 ~'~ !r~,s i ~ I r tt 29. If Female:
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Due to (or as a consequence of): r
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elly list condtlons, tl any, b. r
b the cause Hated on line a nanl at time of death
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Enter UNDERLYING CAUSE Due to (or as a consequence of): t ^ No
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p egnant, but pregnant within d2 days
(disease a InJu that InNated the r
everrts resuHing m death) LAST. c' ~ of deatn
^
Due to (or as a consequence ofj: Not pregnant, buy pregnant 43 da to 1 ear
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bekre deaM
^
r Unknown if pregnant within the past year
30a. Was an Autopsy
Pedomred7 30b. Were Autopsy Findings
Available Prior to CompleRon 31. Manner of Death 32a. Date of Injury (Month, day, year) 326. Descdbe How 1nJury Occurred 32c. Place of Injury: Home, Fann, Street, Factory,
of Cause of Death?
QNatural ^ Homidde Office Building, etc. (Specify)
^ Yes ~No ^ Yes ~ No
^ Aaident ^ Pending Investigation
32d. Time of Injury
32e. Injury at Work?
32f. R Trensportatbn Injury (Specify)
32g. locatbn of injury (Street, city /town, state)
^ Suicide ^ Couk Not be Determined M ^ Yes ^ No ^ Ddver/Operator ^ Passenger ^ PadesMan
Other -Specify:
33a. Certlfier (check Doty one)
• CsrtHying physlden (Physk9an cer8lying cause of death when another physician has pronounced death and completed Item 23) 33b. Signature nd TR{e d nHier
~4~ ~~ ~4 {~ ~ d
To the best of my knowedge, death occurred due to the cause(s) and manner ss stated _ _ _ _ _ _ _ -
------------------------- 1
• Pronouneing and artNying physcian (Physidan both pronouncing death and certifying to cause of death)
To th
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^ 33c. Ucense Number
' ! 33d. Data Signed (Month, day, Year)
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occurre
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ata, end place, atM due to the a e and manner a stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical Examhrer/Coroner ~°() `t
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On the bas4 of axaminatbn end / or tnvestigetlan, In my opMion, death occurred at the tuns, deh, and pkce, end due to fib cease(s) and manner as stated_ ^ 34
Name and Address of Person Wta C
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I, FIORIY C. SGRIGNOLI, of the Township of East Pennsboro, Cumberlan~'p"County,
Pennsylvania, declare this to be my Last Will and revoke any will or codicil previously made by me.
ITEM 1: I direct that my body be buried next to my late wife, Dorothy M. Sgrignoli, at
Fort Indiantown Gap National Cemetery.
ITEM 2: I direct that all my just debts and funeral expenses be paid as soon as practical
after my death.
ITEM 3: I give, devise and bequeath all the rest, residue and remainder of my estate of
every nature and wheresoever situate, together with insurance thereon, in equal shares to my children
living on the date of my demise, namely: James G. Sgrignoli, Jane M. Rode, Thomas J. Sgrignoli, Sr.,
Rita A. Stimeling, Sandra L. Weikel, Robert M. Sgrignoli, Karen S. Duncan, and Brian M. Sgrignoli. I
direct that the distribution to my children be on a per capita basis and not a per stirpes basis.
ITEM 4: Until distributed, no gift or beneficial interest shall be subject to anticipation or
{~~
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voluntary or involuntary alienation.
ITEM 5: I direct that all taxes and interest and penalties thereon that may be assessed in
consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from
residuary estate as a part of the expense of the administration of my Estate.
ITEM 6: I appoint JAMES G. SGRIGNOLI of 514 South River Road, Halifax,
Pennsylvania and ALAN BRUNER, of 29 Humer Street, Enola, Pennsylvania, Co-Executors of this my
Last Will.
ITEM 7: I direct that my personal representatives, or their successors shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this ~ ~ day of , 2002.
°~
// ~/ r
FIORIY C. SG GNOLI
Signed, sealed, published and declared by the above-named Testator as and for his Last Will and
Testament in our presence, who, at his request, in his presence and in the presence of each other, have
hereunto subscribed our names as attesting witnesses.
' ~vun~..¢.. residing at •70 -
~~h~-~...~~ ~~1 ~Z-+-~..~ residing at ,~~~ ~ ~Y+-~-~..~, ,~ f~~l ~ f ~`~ /~~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
We, FIORIY C. SGRIGNOLI, ~ is A- M ~i, ~ ~ l.o N c _, and
~in~t y(,(, j~j~/i1,~,~ ,the Testator and the witnesses respectively, whose names are
signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as his Last Will and that he
had signed willingly, and that he executed it as his free and voluntary act for the purpose therein
expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the will as
witness and that to the best of his or her knowledge, the Testator was at the time eighteen (18) years of
older, of sound mind and under no constraint or undue influence.
1 r
y ~` ~
FIORIY C. GRIGNOL
_.__.-
~'W' ess
Witness
Subscribed, sworn and acknowledged before me r ~ '' by FIC-RIY C.
SGRIGNOLI, the Testator, and subscribed and sworn to before me by
L-~ ~ and the witnesses, this
~~ day of , 2002.
Notary Public ` (S~
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