HomeMy WebLinkAbout07-07-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
Estate of Zekerijah Ljuca
also known as Aekerijah Ljuca
Deceased
COUNTY, PENNSYLVANIA
File Number ~ ~"
Social Security Number 157-02-6904
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Petitioner(s), who is(are 18 years of age or older, apply(ies) for: -~-
(COMPLETE 'A' or 'B' BELOW:) ~,,,,,, ~'
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® A. Probate and Grant of Letters Testamentary and aver that Petitioners} is /are the ~ named`~~th~~`:
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last Will of the Decedent dated and codicil(s) dated ~~ '~ ~ ~ '"
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(State relevmat circumstances, e.g., re-imieiation, death of executor, etc.) .,..t ~` `~~'~•~~~ ~~+
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrumer~l 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; darrante mir:oritate)
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: (If
Administration, c. t. a. or d. b. n. c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name Relationshi Residence
Jasmina Ljuca Wife 6302 Valley Brook Dr., Mechanicsburg, PA 17050
Eldin Ljuca Son 6302 Valley Brook Dr., Mechanicsburg, PA 17050
Eldina Tandir Daughter
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his (her last principal residence at
6302 Valley Brook Dr MechanicsburP PA 17050
(List street address, town/city, township, coartry, state, zip code)
Decedent, then 61 years of age, died on April 12, 2010 at 1-40 Mile Marker 186.5, Hazen, AR 72064
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 0.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ _ 0.00
situated as follows:
Wherefore, Petitioners} 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:
Jasmina Ljuca, 6302 Valley Brook Dr., Mechanicsburg, PA 17050
Forrn RW-(I? rev. 10.13.06
Page 1 of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF Cumberland
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 Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law. n
Sworn to o~ affirmed and subscribed
before e the ~ day of
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Fer the Register
` ~~~~~ tun s2' ~ii.C,~-
Si~r ttsre of Personal Represent t e
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Signature of Personal Representative
Signature of Personal Representative "
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File Number: ,~ ~ ~.~~ ~ ~~ ~ ~~ "`~
Estate of Zekerijah Ljuca ,Deceased.
Social Security Number: 157-02-6904
AND NOW, ~
having been presente
are hereby granted to
Date of Death: April 12, 2010
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ik:-U~C.~ , in consideration of the foregoing Petition, satisfactory proof
IT IS DECREED that Letters ~ ~ .~-~ r"t ~ ^ ~ s-~r'~.~`^
F'~ ~, rw , 1.S A. L-J V C Pa
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will and Codicil(s)) of Decedent
FEES
Letters ............... $ ~~`
Short Certificate(s) ........ $
Renunciation(s)~.^ ........ $ ~ ~
i~c.i~ ... $ ~- ~~
... $
... $
... $
... $
... $
... $
... $ _
TOTAL ......... . .... $ -5 '..~-60
Attorney Signature:
Attorney Name:
Sonya'1Civisto
Supreme Court I.D. No.: 92919
Address: 1200 Walnut Bottom Rd
Third Floor, Suite 331
Carlisle, PA 17015
Telephone: (717) 240-4686
Fo,-n~ Rw oz Yeti. ~o. ~3.0~ Page 2 of 2
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RENUNCIATION
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Q#R#~'~} ~Ok~RT
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REGISTER OF WILLS
~ ~-~ zs ~ k ~ ~ COUNTY PENNSYLVANIA
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Estate of ~~~. ~~--~..;~ . ~, ~. L.-
Deceased
I, ~- ~ ~~ a ~~=~- lY 1 c~ r~ ~ ~ " , in my capacity/relationship as
(Print Narne)
=~ ~: ~ ~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
_ __ _
(Date)
Executed in Register's Office
Sworn to or affi~}eand subscribed
before e t is (y' day
of 2U (U
Deputy for Register of Wills
(Signature)
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(b~treet ~iddress) '
(City, .,._tte, Li~~
Executed out of Register's Office
Before the undersigned personally appeared tl-~e
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's C'ommission.)
Farrn RW-U6 rev. 10 13.Oh
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RENUNCIATION
REGISTER OF WILLS
~y ~~ `~,~~ COUNTY, PENNSYLVANIA
Estate of ~-~.- ~~ ~ ~~ ~
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CI~RK ~F
t~~'S C,1RT
Deceased
in my capacity/relationship as
(Print Name)
C, p !,, of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
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(Date)
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C.
(Signature)
(Street Address) ~-~
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(City, State, Zip) ~
Executed in Register's Office
Sworn to or affirmgd~and subscribed
before e t ~s (.l~"" day
of _,
. ~`7`~
Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of _
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13 06
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ARKANSAS DEPARTMENT OF HEALTH 1 /'~ _ !„ ~ /
Vital Records t (~ (,(r, t
CERTIFICATEiOF DEATH
C. E, _, r~- CEO ~. . dE (IiGudeAKr,'s A any) (Post. hfiddle. Last, Sudiic) 2 SEX 3a DATE OF DEATH (NbrDa/Nr) 3b TIME GF DEATH
Z ~ < eri ~ ,:I
:h Ljuca ^ AM
_ M, A r 12 2010 Unknownp r'M
a SO,: A '.i,RlTr 'd Sa AGE -LastBrrthday 5f}. UNDER t YEAR Sc UNDER ~t DAY- 6 DATE OF 6177TH (INmUaylYr)~.., ?. BIRTHPWCE (Ciy and SIz1etw FotegrtCaunUyj
1 5 7-02-E "104 (Years]
61 Months Days Hburs M mutes
June 1 9,'f 94
Bosnia
Ba RE: I C'~E VCE STATE r F 072E!GN COUNTRY
Pe.lnsylv~_~nia 8b. COUNTY
Cumberland 9t: CITY OR TOWN
Mechanicsbur
8d NUt'£cR AIJD STR=1: T
630_2 VaL1e Brook Drive ee. APT NO-- 8f ZIPCODE
07050 6q INSIDECITY LIMITS?
~;-~5 . ^Nd
w J EVE? 1.^~SARMEC F )PCES~ 70 MARiTA1STAT1J5ATTiMEOFDEATH 11 SUFtVIVINCiS00USE'SNAAtE~wdegneaatneprmrtalistmdmal~ej
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~ Q'~e> ~ No %I Maned ^ Widowed ^ NeverMamed
Jasm~.na -Isa}CC+vie
^ Mamed:i7 tHSeparated - ^ Divorr-ed ^ Unknown
w 12a ~F I lE 4'~H GCCURRFD itJ A HOSPITAL. 12b. IF DEATH OCCURRED SOMEWHEP.E OTHER THAN A HOSPITAL 1?: COUNN OF DEATH
? ^ Inpa!erI ^ Er712rye-cyRoom/ ^Deadon.. {] Decedent's ^ Hospr[e ^Nur,~ng~HOme./ ~Otherlnterstate
L Outpane ~r Arrive!
__ :..Home Faalrry Long rerm Cale Faclllry .. (Spaafy)<,,,,~ -
~- Prairie
c 12d. FA ;II.:T" NAtAE fl! nr.t ~nstiluUOn, 9w~e number 8 steep. 12e CITY OR 7C74'VN 127 ZIP C(3DE
I- 40,Mil.e Marker 1$6,5` `Hazen 72064
13. FAT 1E R ~ tJAME (F~~s". Middle, Lasll 14. MOTHER'S NAME PRIOR TO F1 RST MARRIAGE (Fiat Midtlle, Last)
d Rizo Ljuca Hava(Unknown)
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J t5a INFJf'rraNT'SNAME t6b RELATIONSHIP TO DECEDENT 75c.MAILINGADDRESS(NpnbtrandStreetorPOBoxCdy,State.ZpCadel ~A O'7Q50
ml JaFSmina Ljuca Wife 6302 Valle Brook Dr':,Mech~nic~bur
tfra nnE...H~::x:; OF CrtSPO:~-ITION. 6unal ^- Crerrobon -.Donation ^ Ottr6r(Spenfy)_-------~-,-
R1 {]. ^ ErrtomE+men[ ^ Removal tram Stale
t6b PLF r t~ DI POS'TION (Name of cemetery, crematory, other pbce) 16c LOCATION- CITY, TO'MV, AND STATE
Sarajevo Cemetery, Sarajevo;Basna>
~ 7a EMEAL I~tER'S hAtvlt CI Noi Embalmed 7 7G. EM9ALMER ~ 1Tr- St ~ TIiRE (FUNEf3AL $ rCE LICENSEE 0R OTHER AGENn
SCQt.t Grimmett iICENSE>R 24:33 7
t7d NAn+E AND COMPLETE ADDRESS t7F FUNER{il1?ACII.tT'! i 7e UCEtQSE p
Islamic Funeral Home,Inc.,251 Dekalb Ave.,Brooklyn,NX 11205
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78a DATE PRGNOUNCED DEAD 18b. TIME PRONt9UIYCE~~DEAD IBt NAME ANDTITLE OF PERSON PROtJO! INCING DEATH. (PR7HT7TYPEj 19. WAS M.EQICAL EXAMINER
' (M~NDayfYr - ^ AM :. bR C
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ROIVER CJNTACTED?
l4pr 12, 2010 11:35 d PM MilSe Cprley, Deputy Coroner r
~t
,F+ Yes ^ No
CAUSE QF OEA'kN ~
2U PART 1 Er{e• the chain of events-diseases. ~niune s, or complicao one-that deecty caused the Cea[h. DO NOT enter terminal events such as caNiac arrest
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resprratn r, arrest dr ventr~i.ular fibrillation rnthotit sh rnmng the etiolpgy. DO NOT ABBREVIATE. Enter only tine cause on a Tine. ~ r APPROXIMATE INTERVAL.
r Onset to Death
IMMF_DIaTE CAUSE [
(Finaf>iseaseurGOriddian ......;.,.~ aNiuit-pie Blunt FOree IniUt'I@S ~
reSUltnp n dedhl D'JO to (ar ~, a COrtSErye11R ap r -
Stquen!raSly list wndiiorrs, b t
it any, leadmglaffw cause - [
Due lo(ores a coreequenbe:d) t ~:
Ir.,leA un the a. Emer the
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UNDER..YI JG CAUSE t
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(d SaesE of iniufY lh~ -Dbl to (aT LSa.Wt6e~It1tCl ap ~.
imtiateA mr ~ rr.E
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rtsul!uig n deajhl LAST d i..
s PART. it Entr'~ other sinndreant conddipns cuntnbubnu to~Aaath tiu[ not resuRrng inthe undarlymg cause-given in PART I. 2 to WAS AN AUTOPSY P1=RFORM>D
L7/Y
y 21b. WERE AUTOPSY FINDINGS AVAI ETE
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J TFIE. CAU5E OF DEATFI?
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22 MANNER OF DEATH ^~ Natural ~AEpdent ^ Suicide [~-Homiade ^ PentEirag Invr. gigabnn ^ Could not be determined a...i.
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0 23 DID 709A000 U5E Ct7NTRtBUTE TO DEATH? 24 iF FEMALE'.
a ^ Yes ^ Prtlb ably -^;-Np; pregnant within past year ^ Not prognaht;},ut Regnant within 42 deys~ot death ^ Unknown if pre gnant'[uithin 1a5 yEer
[g NoUnknown ^ Prcgn ant at time of death ^ Not pregnarrt, but pregnant 43 days to t year before death
u:.: 25a OA
7E vF INJURY
IA
7o'Uay 25b. TIME OF IT,iURY ~ ~ AM 25
'c. PLACE OF INJURY (eg Decedent; tome, cortshudion site, reytauant, wpodedarea) - 25d INJURY. AT WORK?
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~, 25e LC}~"ATIO J OF I URY
(NUmh r ~ h et pa ntNo; Ertl, „ Z;c-Cale)
I-4~, N~iie darker f>~~.~, l~azen, ~~ ,
r- 25f DESCRIE3E HOW INJURY OCCURRED
Tractor Trailer
Tractor
Trailer Collision (Driver) 25g iF /TRANSPORTATIGN INJURY, SPECIFY
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. E9 Dnver/operator
^ Passenger
- ^ Pedestrian
^ Other S eayt
?Ea. CER'1FIER (Check anN-one):
O Cenifying Physician -TO the best df rr,t• knawledg?,death occurred due [o the cause(s) and manner stated.
^JPronounCing & Certilyrng Physician - To 1> e best or my knawfedga..death occurred at thetQne, dare, and place, and due to [he pause(s) and manner stated.
L7 M ed cat Examiner - On th=basis of erdmmahon. andtor rmestigahon~:in my optlnon, death ocnrrred. at [he time, date, and place, and due iq thg>:ause5(sYahd mannet.stated.
Q CrYSOner _ On the bays nt examination; andtor rnvesugabon;Jn rrry bpinrdn. seam nCpuKed at d*e t;me, date, and place. antl due to me [3use>'(6) artd mannaf statatl
^ Hospice Replster urse- T e best or edge, dean ocaned due m the cause(sIand manner state~SSOClBt@ fVi@tl1Cai
siGNnTU~
Apr 14
2010
~xaminer
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<6b NAME DCO}i1PLETEt1 iL ESSOfPERSONSIGNINGITEM28a(TypelFritgi 26i.LICtNSE~
Dan;Konzelmann; M,D. 3 Natural Resources Dr Little Rock, AR 72205 E-1431
?7a jlGfilATL1RE DF REGISTRAR r ?>b. FOR REG 4T R ON • DpT- FIL
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w p~-~sT~ `~ ~'~ f THIS IS TO CERTIFY THAT THE ABOVE IS A TRUE AND CORE~ECT COPY OF THE CERTIFICATE ON
-•'""`+a l~ ~~~ F!F_E'tN THE. ARKANSAS DE?f~ART1vlENT O7~.HEALTH...
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d SEAL = ~~~ ~; ~ 200 Michael A. Adams
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1~~~( ~-~t~1 A REPRObUCTION OF THIS DOCUMENT RENDERS IT VOID AND INVALID. DO NOT ACCEPT UNLESS
E R~K' WA R N I N G a EMBOSSED SEAS QF THE ARKAi~1SAS: DEPARTMENT OF .HEALTH IS PRES-ENT. IT IS ILLEGAL TO
AEiTirR fJR CQUNTERFEIT. THIS DOCUMENT. VR-1 12