HomeMy WebLinkAbout06-25-10PETLTION FOR PROBATE AND GRANT OF LETTF,RS
REGISTER OF WILLS OF ~/~~ ,IC.~(-~~ __ COUNTY, PENNSYLV"ANIA
f 'f ~~
Estate of ` File Number ~~ - / ~ _ ~~ L~~~
alsa known as
_ ,Deceased Social Security Number ~''~~~~~' ~~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
1.l~d A. Probate and Grant of Letters Testamentary and aver that Petitioned is ~ the ~-~c~ named in the
last Wit] of the Decedent dated- C~ ~/6~~~1 and codicil(s) dated +U~n
C~ c.~,
(State retevant circumstances, e. g., renunciation, death of executor, etc.) ~ -~j~j C.~ ~ ~ ; ' ~~~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of 1~te Dsiment(~offer~d~ ~~ ~ ~'
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: --~ k,-~, r-- ~ - -;;'.;~
- i r "~3 {_
B. Grant of Letters of Administration ~ ~~ ~'"
(If applicable, enter: c_t.a.: d.0.n.c.t.a.; pendente liter durante absentia; durance ornate) F~3 ~ -
G
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) ~~heirs: (If `~ ;
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and com~tete list of heirs.)
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sh/eels if necessary.
Decedent was domiciled at death in Lt Cl~ County, Pennsylvania with his•f-~ last principal residence at _
.~" UY
(List street address, town/city, township, county, state, zip code)
~ at ~
Decedent, then ---~~-Years of age, died on ~• ~ ~
Decedent at death awned property with estimated values as follows: ~~yy~~/~
(If domiciled in PA) All personal property ~ 1 -~ j~ ~.5~ '~•
(If not domiciled in PA) ~ Personal property in Pennsylvania $ if . 'j '~
(If not domiciled in PA) Personal property in County ~ ~ ~,
Value of real estate in Pennsylvania ~ -~`~~f,.--
situated as follows: ~~
Wherefore, Petitioner~espectfully 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 d or Tinted name and residence
~~ ~J
~'`~~~ ~~ `~ yv~
Form RW-02 rev. 10.13.06 Pa~,e 1 Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~ (/ C~f~-1.~~~X
The Petitioner 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 Petitioner~:'~nd that, as persona] representative(~,~of the Decedent, Petitioner will well and truly
administer the estate according to law.
Sworn to or affirmed an_d subscribed
~h
amore me the ~ ~~~ day of
Signature of Personal Representative
r~,a
Signature o/Personal Representative ~ ~~ ~
~ '~. G~ ~ t. _ ._.1
- - m ~.
,
r, _. __
Filc Numbcr: . ~ ~~ -~ ~
A t t f _ ....4y> . _
Estate of ~~ ~ ~ ~, _
writ Number: ' ` ~ ~ ~ `'" Date of Death: ' `~~ ~ ~ `~~ ~ ~~ ~ ,
Social Scc y ~ ~~gL
AND NOW, _~,,~ a ,lll ~ ~ ~ ~ ~ ~ , in consideration of the foregoing Petition, satisfactory proof
__----
having been presented before me, IT IS DECREED that Letters ~ ~' ''~,~
are hereby granted to
(~ _ in the above estate
and that the instrument(s) dated ~~~~~~ ~ ~ `~ ~ ~
described in the Petition be admitted to probate and filed of record as t e last Will (and dicil(s)) of D e ent.
r, -,
~ ~/~~~°~ ,, / ~
FEES ~ ~~~ ~~
/~~~ ~Q) Register o~~Wills ~ '~~"` ,~ /y
Letters ............... $ 1 ~~ (~~
Short Certificate(s) ........ $ ~ V: ~ Attorney Signature:
Renunciation(s) .......... $
~ . $ ~ Attorney Name:
J
=.~ ... $ ~ ~' Supreme Court LD. No.:
... $ ~~ ~ ~
$ Address:
... $
... $
... $
• • • $ Telephone:
... $
TOTAL .............. $ 0.00
~/~,5~
Form RW-02 rev. 10.13.06 Page ~ Of 2
U - ~ ~i ~.~~~
%l e ~ x 6 r, .., ; ~ .. t s2 " ~ a' t $ ~ y° t 1° 9 d~ 5-q r~.
H1pS743 REV 1112006
TYPE /PRINT IN
PERMANENT
BUCK INK
v
w
w
0
0
,ryM1 .~F
i~
i,.
. .
°a~' a ~
~' r,~"
~~
:,;tea. t +~ y A i ,} n
`;.f
,_ .~
j
~.t,.. ~ .. '. '~?r. N; ° I;li6~~41ir-)11 ~~'!'C' `;':' L:EI l~
~. ;i° r ~' -tl ,iii t,)')+ ij4 ii ~.. srE~(fi~t~~.:lCt' tl(~ r)L',)th
(; 9° `Ili _ ~;~: ~~'f ~ .'<I'~ ~'Lt'ttgtilTa! ~ ~~lt' t~1~~z.-')Il~l~
~q
f^~+J
C~
.1.;.~
~
i ~ _. _Y
~ ~
N '
COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) CTATF FII F N111/RFR
1. Name of Decedent (First, middle, last, suttiz) 2. Sex 3. Social Security Number 4. Date of (kath (Month, day, year)
Theodore W. Chylack Male 186 - 22 - 3546 May 18, 2010
5. Age (Last Birthday) Under t ar Under 1 da 6. Date of BiM Month, da , ar 7. Bi and state a for can 8a. Place of Death Check ana
$0 1Aonths Days Hwrs ~~~
1929
October 15
Detroit, Michigan Hospital: Other
Yrs , ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Hone ~ Residence ^ Other ~ Specity:
fib. Courty of Death 6c. City, Boro, Twp. of DeaM 8d. Farilky Name (If rtot institution, give street aM nunber{ 9. Was Decedent of Hispartk Ortgin? o ~ y15 I0. Race: Ameriran Indian, 81ack, White, etc.
Cumberland Mechanicsbur
9 56 West Keller Street °' yea, =parity Qrben,
P (spec.
Whi
Mexicen.
uar~ Rican, eta.) te
11. Decedent's Usual Lion Kktd d work done d u ~ most of waldn life. Do not state retired t2. Was Decedent eve in the t3. Decedent's Education (Speraty only highest grade cortip leted) 14. Marital StaNs: Manied, Never Married. 15. Surviving Spo use (ti wife, give maiden name)
Kind of Wqk
erations
O Kind of sines/Industry
State government U.S. Armed Faces? Elemenh !Seconds 412
" "( } Col
~ ('j4 a ~) Widowed, Divorced (Speaiy)
Di
d
p ~Y85 ^ No vorce
16. Decedents MaiNng Address (Street, city /town, state, zip code) DecedeM's
A
N
l R
id PA Did Decedent
Live in a
^
56 W. Kel le r Street
Mechanicsburg, PA 17055 e
es
ence 17a. State
c
t7b.Counry t 7c.
Yes, Decedent Lived in _ Twp
Township?
,
Cumberland 17d.~.N~,
wadwimin Mechanicsburg
~
~
ctty/pro
16. Father's Name (First, midde, IasL suffix)
Theordore A. Chylack 19. Mothers Name (First, middle, maiden wmame)
Mary Steffy
208. InbrtnanYS Name (Type! Print) 20b. Inlonnartt's Madirtg Address (Street city / tovm, slate, zip code)
Theodore J. Chylack 42 Pinetree Drive Audubon, PA 19403
21 a. Method of (Disposition ~ ~ Cremation ^ Donation 27 b. Date of Disposition (Month, day, year) 21 c. Place of Disposdion (Name d cemetery, crematory a other place) 21 d. Location (City! town, state, zip code)
^ Bural ^ Removal hen state ~ was cremaYan a Donab«t Ardhorixsd, May 21 2010 Conolite Crematory ;;chaefferstown Pa
17088
^ ~
^ Otl»r . ~ by dkal Examiner/ Yes , .
r
22a. S' f Furtrtrel Service as wch) 22b. Lk.ense Number 22c. Name and Address of FacAity
~ -,.d FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
Refrts when ceNlying
physician is not available at time of death to . To the best of , deatlt ocarted at the time and place tad. (Signature and title)
/ ,, I
JY
.t
f 23b. L' Number
~~ ~
~ 23c. ate Si
9~ lMonth, day. ye
r
Certify cause of death.
VJ
"
~ ~
~
~~ ~
/
ttartts P4_~ ~ ~ ~ ~ ~~ 24. Tune of
-
~ 2 Date Prop Dead ( y, year)
( 26. Was Case Refertea to icel Examiner !Canner la a Reason Ot Creme a Donation?
who Wonounces death. /
M. O ^ Yes No
CAUSE OF DEATH (See Inatruetlons and examples) , Approximate interval: Part 11: Enter otiter SiooiflSaut caWitiorts contriMrbrw to deatlt 28, Did Tobacco Use Contribute to Death?
Item 27. Part I: Enter the ~Bm d events -diseases, irtjuries, a complications - drat directly caused the death. DO NOT enter to nal events such as cardiac arrest, r Onset to Death
r but not restating in tlro urtdeAyirtg cause given in Part L ^ Yes
Probaoy
respiratory arrest, a ventricular fibrillation witltoN showing the etiobgy. List only ate cause on each line r ^ No ^ Unknown
IMMEDIATE CAUSE (Final disease or %~~ pp ~~ ~
caditian resulting in death) _~ a. :l A~ ~ i~e A" S' `~ r
i 29. If Female:
^ Nat
e
t
Phn
Due to (or as a consequence of):
~
r pr
gnan
w
past year
^ Pregnant at time of death
~AYy lest certdAions, iF any, b.
A
d
d
t
A i ^
na a
ro cause
c
e
on
Enter UNDERLYING CAUSE Due to (or as a consequence ot)~. t
r
Na pregnant, but pregnant wdhin 42 days
of death
(4sease a i ?tat initiated the
~~ resulMtg~Y ~~) ~~ c
r
^
Due to or as a
( consequenar off: r
r ~ reegn~t, but pregnant 43 days l0 1 year
d. ~ ^ Unknown if pregnant within the past year
30a. Was an Autopsy 30b. Were Autopsy Endings 31. Mamer th 32a. Date of trtjtny (Month, day, Year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Farm, Sheet, Factory,
Pedortrrod? Available Prior to Completion
tLLLJIJH~~SrrrNVVVaaa
t
l ^ H
i
id 0lfice Building, etc. (SpecNy)
of Cause of Death? ura
om
a
c
e
^ Yes No ^ Yes ^ No ^ Acczlent ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. d Transportation Injury (Spedly) 32g. Location of injury (Street, city I town, state}
^ Suicide ^ Could Not be Determined
M ^ Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian
.
Otlror - Sperily:
33a Certifier (check any one) 33b. Sig re arW Tale o ertifier
• GerlHying physician (Physician certifying cause of death wften artotfror physician has pronounced death and completed ttem 23) '~-,'1
To tfro best of my knowledge, death occurred due to the cause(s) and manner as shred _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
Pronouncln9 +^d ~Nln9 PhYsielan (Physican both prortolxtcvg death and certilyktg to reuse of death)
To the best of my knowledge, death oaurred at the time, date, arM plea, end due to tiro esuae(a) and manner as stated ~
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number 33d. Date Signed (Month, day, Year)
~ ~ L
Z Z
t
• Medical Examiner/Coroner i
/
I ~ S ~1.. ~
I
On the basis of examtnatbn and / a InvesUgatbn, in my oplnbn, death occurred at the time, date, and place, and due to ttte csuaa(s) and manner as stated. ^ 34. Name and Address of Per Who red Causaof Death (ttem 27) 7ypr~ /Print
f} ~ '~ ~
36. R ~ s Wre and District Number .
S~
36~.p ate Filed (Month, day, Year) ~ ~~.~J
~ p
- t
~ ~ Disposdicn Permit No. O ~~ 7 ~ (p ~ f0
LAST WILL AND TESTAMENT
OF
THEODORE WALLACE CHYLACK
=- ;~ c~,.
,~~, .:,
~(~r Mkt ryd '} r.
I~ f ~ ~ :J ~..;'.i f '~ L.. 'J 13 E 9 1 i.. ~
r~ ~ r -.
tii
v'~~a i"~~, ~i.
I , THEODORE WALLACE CHYLACK , being of sound and ~i~s ~r~g ~ ~rCri~Ql ,
~~., _.
memory and understanding, hereby make, publish and declare this to
be my Last Will and Testament and revoke any and all V~lills by me
at any time heretofore made.
FIRST - ESTATE EXPENSES: I direct that my just debts and the
expenses of my last illness and funeral shall be paid by my Executor
as soon after my decease as may be convenient from my general Estate
as part of the cost of administration.
SECOND - GENERAL BEQUESTS: I hereby give, devise and bequeath
all the rest, residue and remainder of my Estate, real, personal and
mixed, including, but not limited to my savings accounts,
wheresoever situate to be divided four ways unto my four children,
Theodore, Marie Elaine Harrington, Lawrence and John, and their
heirs, per capita.
THIRD - SURVIVORSHIP: In the event that any beneficiary named
hereunder and I shall die in a common accident or disaster, ar under
such circumstances that it is difficult or impractical to determine
who survived the other, such beneficiary shall be deemed to have
predeceased me.
fi .,-y„%"
~'.
FOURTH - TAXES: I direct that all Estate, inheritance and
succession taxes on assets passing under this my Last Will shall be
paid out of the principal of my general Estate to the same effect as
if said taxes were expenses of administration, and all legacies,
devises and other gifts of principal and income made by this my
Will, or by any Codicil hereto, shall be free and clear thereof. In
the absolute discretion of my Executors and Trustees, they may pay
such taxes immediately or they may postpone the payment of taxes on
future or remainder interests until the time possession thereof:
accrues to the beneficiary.
FIFTH - POWERS OF EXECUTORS: My Executors in their respective
capacities shall have, in addition to the powers vested in
fiduciaries by law and subject to any limitation or restriction
otherwise set forth herein, the following discretionary powers:
A. To retain for such length of time as they deem proper,
without any liability for so doing, any real estate and :personal
property which may constitute a part of my Estate at the time of my
death.
B. To invest principal and accumulated income in any
property which they may deem suitable, without restriction to legal
investments, including any common trust fund operated by a corporate
fiduciary.
C. To lease for any number of years, irrespective of: the
duration of any life estate, and to repair, alter or improve any
real estate or other property which may at any time constitute the
principal of my Estate hereunder, either at public or private sale,
-2-
.-
for such prices and on such terms and conditions, limit<~tions or
restrictions which my Executors may deem proper or advisable, to
release any of the said mortgages in whole or in part, any such
ground rent, and to execute, acknowledge and deliver to the
purchasers thereof, good and sufficient deeds of conveyance
therefore and assignments, transfers and other legal in:~truments
either necessary or convenient for passing the title anal owner:~hip
thereto, and free and discharged of all trusts, without liability on
the part of the purchasers to see to the application of the purchase
money; and to make and unite in any deeds to partition o~r square
real estate, and to make any exchanges or dedications thereof.
D. To register, or cause to be registered, investments,
either in their names, or in the name of a nominee, or to hold said
investments unregistered and in such form that they pass by delivery.
E. To subscribe for stock or bond privileges and to join in
any merger or reorganization affecting investments which may be a
part of my Estate.
F. To borrow monies for any purpose which, in the sole
opinion of my Executors may seem proper, and to mortgage any real
estate or pledge any personal property constituting a part of my
Estate, as collateral security therefor, without any liability on
the part of the persons making said loans to see to the application
of the proceeds thereof; to renew any unpaid obligations of mine, to
rely on affidavits as opposed to better evidence in any matters
having to do with my Estate hereunder; and to compromise claims and
reduce interest rates.
-3-
~..._._
G. To apply the income or annuity to which any beneficiary
shall be entitled hereunder for the maintenance, education and
support of such beneficiary, should he or she, by reason of age,
illness or any other cause be incapable of receiving or disbursing
it, without the intervention of a guardian.
H. To expend out of the share of principal and accumulated
income from which any beneficiary under this, my Will, may be
receiving income or an annuity, in addition to any other
expenditures or distributions which my Executors may be authorized
to make, such sums as my Executors may consider to be in the best
interests of the beneficiaries or any of them, during illness or
emergency of any kind.
I. To determine whether my Executors' compensation, any
administration expense or any other expenditure shall be charged
against principal or income, or partly against each; any such
determination by my Executors shall be conclusive as to all persons.
J. To make distribution in cash or in kind.
K. To do all acts, take all proceedings and to
exercise all such rights and privileges, although not hereinbefore
specifically mentioned, with relation to any and all property as it
the Executor were the absolute owner thereof, and in connection
therewith, to make, execute and deliver any instruments and enter
into any agreement binding my Estate under this Will.
SIXTH - EXECUTORS: I hereby appoint my Son, Theodore J.
Chylack, Executor under this, my Last Will and Testament. In the
event of his inability to serve for any reason whatsoever, I then
appoint my daughter, Marie Elaine Harrington as Executrix.
-4-
,.. ,
~~ - _
l
SEVENTH - WAIVER OF SECURITY: I direct that no Executor
shall be required to give any bond or security in any jurisdiction
in which he or she may act. If, notwithstanding the forE~going
direction, any bond is required by law, statute or rule of Gourt, no
surety shall be required thereon.
EIGHTH - FOREIGN EXECUTOR: Should my Executor not qualify
in any other jurisdiction, I then appoint as Executor therein, such
person or persons or corporations as may be designated by my then
existing Executor, in whose discretion such substituted Executor
shall, without giving any security have in such other jurisdictions,
all the rights, powers, privileges, discretion and duties conferred
or imposed upon my Executor by the provisions of this W ill.
IN WITNESS WHEREOF, I, THEODORE WALLACE CHYLACK, havf~ hereunto
set my hand and seal this /~'`~ day of ~~ru~-- ,
199C~' in the presence of the witnesses signed below.
~'~` 'f
~._...~HEODORE WAL CE C:HYLA ~-
r
-5-
. ~ •
SIGNED, SEALED PUBLISHED and DECLARED by the above named,
Theodore Wallace Chylack, as and for his Last Will and ~['estament in
the presence of us, who, at his request, in his presencE~ and in the
presence of each other have hereunto subscribed our namE~s as
witnesses.
~.~~
NAME
NA
ADDRESS
~~~~~
ADDRESS
OATH OF NON-SUBSCRIBING WITNESS(ES)
Estate of
Deceased
I ~ and ~ l~ - ,
(each) being duly qualified according to law, depose and say(~that ~ /they -~s-/ were well-
acquainted with ~ /' and -a~~are familiar
with the handwriting and signature of the decedent, and that the signature of 4f '~~- `_~
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of -~ ~ l~t.J .
6: is in his~er.own proper handwriting.
r------.
(Sig atz re)
~~ ~~~~
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
befoxe this ~~ day
of ~ ~ ~clt.~ . ~~~ C~
ty for
~p REGISTER OF WILLS
(' IJIrYII~~i~. (~(~ COUNTY, PENNSYLVANIA
,-~ I - lQ~ U~ ~ c~
O f~111 S
~~
~`~-~-
(Sign e)
(Street Address)
(City, State, Zip)
~..:
,~,
...~.
~~
~.:.
c3 ~' -. ;
~
n r-~
- - . r-n ,
rJ . ' ,
..
,
_, ~, __
~
~ 'C7
~_~ ptiJ ~ , r t
R? ~ ', ,
r.~
Form RW-04 rev. 10.13.06