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HomeMy WebLinkAbout08-13-10PETITION FOR PROBATE ANl~ GRANT OF LETTERS REGISTER OF WILLS OF CI,(W( YJ~I~~~d1~~ COUNTY, PENNSYLVANIA Estate of ~~ ~ ~ V~ ~ '~ also known as Deceased File Number ~~ ~ " ~ ~; ~'" Social Security Number ~ ~~ `-~ "~ d ~' "~ Lek-~~~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) ' ~CIQri~s A. Probate and Grant of Letter Te tamentary and aver that Petitioner(s) is /are the ~- -~~ named in the L~. last Will of the Decedent dated and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) r~,a Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ol~e~+~strument~offer~d. ~' ' for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - ~~ ~" ~ ~s„ c~ ;~ L, B. Grant of Letters of Administration __ ,,,~,~~7 C.) - ' -- (Ifapplicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; durarite:h~ri~wpzit~te) .. ._. t, _:, ~, .:~ ~. ~~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spo~se,~if any} weirs:, (lf Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) ~ ~---~ _.. _ ~ ~ _ • ~ c-- (COMPLETE INALL CASES:) Attach additional sheets if nec ssary. ~~ Decedent was~omic'led at death ' av~' County nnsylvania with his /her last principal residence af"~ ~, f ~. Y t -~ ~ (List street address, townlcity, township, county, state, zip code) l' Decedent, then ~Z_ years of age, died on ~ ~ ~ at ~ jT 1 ~ ~ C ~.~ Decedent at death owned property with estimated values as follows: p P p Y $_ ......._. (If domiciled in PA) All ersonal ro ert ~~~~~ "~ ~~~ ~~ (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: _ ~~3a , l~ ~ r r iZ~[.(~ Form RW-02 rev. 10.13.06 Page 1 of 2 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: Oath of Personal Representative COlv1MONWEALTH OF PENNSYLVANIA SS COUNTY OF ~ ~ L p~ ~~'~ ~ ~ C( ~(~.~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true 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. :~,, l' Sworn to or affirmed and subscribed L- `'' ]~ ~ ~~ Signature of Personal Representative ~ ~ ' before me the ~ ~) day of r~= ~ c ~ •~~~ _ _;~ ~ ; ~ , Signature of Personal Representative -~ ~ ~~ ~ i ~ L.-t~ ~_ ~--~ (~ 1 ~~ For the Regist r Signature of Personal Representative ~~ ~ "" ~- ~ -, File Number: ~ ~ _ 1 ~ - `~~ C~ Estate of 1 ~,~ ~ t- • 1 r'1 G ~~t ~S~ ~ 1~f1 .`'~ ,Deceased Social Security Number: ~ ~~~~ ~~ (Q • C.~ ~ ~ c~ Date of Death: t~ ~~ ~ -~ ((~ AND NOW, _r- ~ ~ L~ ~' ~ , d~ ~' , in consideration of the1foregoing Petition, satisfactory proof having been presented bef' e me, IT IS DECREED that Letters ~{~`1+~1(~1 ~' f~) 7 ~C,-l (~`~~ are hereby granted to ~~ ~ y ` ~ \Cu~.-~s~~ - / / __ in the above estate and that the instrument(s) dated ~ ~ J `1 ` ~:~'~ __ _ 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) ......... . $ ~ ~ .. . $ n Register of Wills , ; Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: ... ~ ... $ ... $ Telephosle: ... ~ ... $ TOTAL .............. $ ~ ~ ~ . ~L~ r-~,~„raw-v' rev. 10.13.0<> Page 2 of 2 OAL REGISTRAR'S CERTIFICATION ~JF DEA'Th~ i~ff-tNiNG: It is illegal to duplicate this pony by photostat or photograph, 1~L~.:~ f~~ 1r tf~i ~ ~~~~rti i-ic~ue. `~~'>.~ ~t r'I'(;ft~~l.l)i~r1 ~tii~~~r_' __ __ ,,;;,,,,"~,,,~~ ~ ~(~~is i~~ tf1 ~firt)fv t}~at the Information lita-e ~;iverl is l~b ll;;r ~,P~~~~-F~'~i,V =`~ )rrc~ctly cf~hi~d 1r~~ll~ zir~ original Certific~lte (~f Ueath co, ~,~~;~ du1~ filed e~~~th nit ;x~, l.(~cal Registrar. The original ~~' v~: ~L:~)-tiiirat~~ ~~~r~ll -~+~ i~~,1ru'~Ird~ed to thr. State Vital ~` . ~ ~_~ _ t--~~ `i ~~ '.raj; ~I:t.:(11°l'~ ~._)~~t1Ct: tt11- ~)t'E'kll~ltl~l~lt j1~ln~T. ,,~1 `\~~~A~'9~ ~ -_ ~,~~~~~ L~ ~~~~ AU 1 012010 - MEl~j ~}~ ____.__ __ _ __ _ .__-_- ---- _. _-_-- ~s. I V . ,,,~,,,~rl!~."~'~' _ 1_'.1I_~(I ~~chls~rar Date Issued ~.. C~ ~...,. . _ x ~ - ~ ~~ t ~' '-:, 7 ~ - - -_ f:; ~;` ' 1 I _~ ~ H105-143 REV 11ntw6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH a VITAL RECORDS TYPE /PRINT IN PERMANENT CERTIFICATE OF DEATH BLACK INK (See Instructions and examples on reverse) ~r,r~ ,,,, ,, ,,,,,,,,~„ w ~ • <_ 0 w w 0 0 1. Name of Decedent (First, middle, last sulfiz) 2. Sez 3. Social Security Number 4. Dah of Death (Monty, day, year) M f uha Hawkins Female 533 - 46 - 0212 August 7, 2010 5. Age (last Birthday) Under 1 ar Under 1 da 6. Date of Birth Month da , er 7. Bi CI and state or tor si count 6a. Place of Death Check an are 77 Gtontirs Days Hours Minutes 1933 June 10 China Beijing Hospital: Other: vrs. ~ , ~ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Hrxne ^ Residence ^ Other -Specify: 6b. Counry of Death tic. Ciry, Boro, Twp. of Death 6d. Feciliry Name (If not insliNtlon, give street and numbor) 9. Was Decedent of Hispanic Orgin? ®No ^ 'fen 10. Race: Amercan Indian, Black, White, etc. Cumberland South Middleton Carlisle Regional Medical Center (It yes, specify Cuban, (Specil)~ 4vhite . Mexican, Puerto Rican, etca 11. Decedent's Usual tk tiort Kind of work done d urn nest of wo Ids. Do trot state refit 12. Was Decedent ever In the 13. Decedents Educatbn (Specity Dory highest grade comp leted) 14. Marital Status: Marred Never Mamec:, 15. Survhrng Spo use (If wRe give maiden name) Kind of Work Kind of Business/Indust ry U.S. Armed ForcesT Elementary /Secondary (0-12) College (1-4 or 5+) , Widowed, Divorced (Specify) , k OWn HOme ^Yes ®No 1L W1dOWed 16. Decedent's Mailing Address (Street, city /town, state, zip code) Decedent's Did Decedent pn Middl S 56 Bullock Circle Actual Residence 17a. State • eton Twp, Live in a 17c. ®Yes, Decedent Lived in _ T hi ? owns p 17d. ^ No Decedent Lived within 17b ' Carl isle, PA 17015 , . County ~EFUaeic'18l'3t~ Actual Limits of Ciryl Boro 16. Fathers Name (First, middle, last, suffix) 19. Mother's Neme (Prat, middle, maiden surname) Safi llah A der Sadiye Agi 20a. inlomram's Name / Prnt) ~ 20b. Infonnent's Mailing Address (Street city /town, state, zip code) Nuria Ku ach 127 Terlyn Dr. Johnstown PA 15904 21a. Method of Disposition t ^ Cremation ^ Donation ~ 7 i 21 b. Date of Dispositon (Month, da , ear) 2~~0 10 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (City/town, state, zip code) Q Burial ^ Removal fromStete WasCremstlonorponatbnAuthorized ' ~ August , peace Centre Cemetery Cavalry Road Carlisle, ^ Other- t IExaminerfCoroner7 ^Yes^ No 22a. Signs al a "--~ 22b. License Number 22c. Name and Address of Feciliry ~ 138504 Hoffman-Roth Funeral Home and Cremato .Inc. 219 N. Hanover St. e items 23e-c rtltyirg 23a. To the best of my knowledge, death oaurted el the fime, date aM place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year) physician is not evailebl ime of death to certify cause of ties Items 24-26 must be completed by person 24. Time of Death 25. Date Pronounced Dead (Month, day, year) 26. Was Case Refened to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? who pronounces death. Aug 7 7 2010 ^Yes [~No CAUSE OF DEAL-H (See instructions and examples) r Approximate interval: Part II; Enter o r simifirant conditions contrbutina b ~;~, 26. Did Tobacco Use Contrbute to Death? Item 27. Part I: Enter the chain of events -diseases, injures, or txxnpkcations • that directly caused the death. DO NOT enter terminal events such as cardiac anent ~ Onset to Death but not resulting in the underyirx~ cause given in Part I. ^ yes ^ Probably. - respiratory anent or ventricular fibrllation witlaut showing the etiobgy. List Doty one cause on each line. r ^ t No nknown IMMEDIATE CAUSE Rnal disease or condition resulting in ,Il.ath '[1~ ~ ~ l r 29. If Female: , ^ N Due to es a consequence oQ ~ ot pregnant within past year uendalry list conditions, it arty, b ~~ (,~S t ~ ~ Is to 1Fie cause listed on line a r ~ ^ Pregnant at tlme of death ^ . Emer UNDERLYING CAUSE Duet (or e~ conseq nce of): i 1 Not ant but r rant within 42 de Pre9n P a9 Ys (disease or ktju that initiated the ~~ p I /'~~ LYv~.~ ~ r V~~/a` r events resultingin death) LAST. c. ~ of death ^ Due to (or as a consequence oQ: Not pregnant, but pregnant 43 days to 1 year t d' ~ t before death ^ Unknown if pregnant within the past year 30a. Wes an Autopsy 30b. Were Autopsy Findings 31. Mannar Pf Death ~ 32e. Date of Injury (Month, day, year) 32b. Describe Fbw Injury Occurred 32c. Place of Injury: Home, Ferm, Street, Factory, Pertormed? Available Pdor to Completion ~-7 ~ ~t r l ^ H i id Office Building, etc. (Specify) of Cause of Death? u a om c e ^ Yes ~'No ^ Yes ~~~ ^ Accident ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Injury (Specify) 32g. Location of injury (Street, city /town, state) ^ Suicide ^ Cwkl Not be Determined ^Yes ^ No ^ Driver/Operator ^ Passenger ^ Pedestrian M. ^ Other - Speciy. 33a. Certifrer (chedr any one) 33b. SyneNre and Title of ~1 r • Certlrying physician (Physician certitying reuse of death when another physician has prorrourtced death and completed Item 23) i J To the Mast of my krtowlsdge, death occuned due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • PronourtGng end certifying physieNn (Physician both pronoundng death and certityirtg to cause of death) To the best d my knowledge death occurred M the time dote and lace and tits to the cause d d .License Number 3:ki. Date 'goad (Month, day, year) `-~ I ~ , , , p , (s) en manner as atate _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • tlMdkxlExaminer/Coroner ~_ ~ ~ ~ ~ /„ ., / lY lam. n u / ~ ' ~/Z}ti LJ~ • C Q..-L~'/ On the basis of examinelbn aM I or Inveatigstbn, in my opinion, death occurred at the time, data, and place, and due to the auae(s) and manner as atated_ ^ 34. N a me e M Ad^dre~ss of Person Who Completed/Caause of Dee (Item 27) Type//Print .. 35. Registrars n re and District bar , 36. Date Flied (Month, day, year) , . ~ ~ r~ Disposition Permit No' l IJ t'"t-~~~Q ~ V LAST WILL AND TESTAMENT OF MEFTUHA HAWHINS I, MEFTUHA HAWKINS, a resident of the Commonwealth of Pennsylvania, make, publish and declare this to be my Last Will and Testament, revoking all wills and codicils at any time heretofore made by me. FIRST: I direct that the expenses of my last illness and funeral, the expenses of the administration of my estate, and all estate, inheritance and similar taxes payable with respect to property included in my estate, whether or not passing under this will, and any interest or penalties thereon, shall be paid out of my residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property. SECOND: I give all the rest, residue and remainder of my property and estate, both real and personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time of my death (collectively referred to as my "residuary estate"), as follows: ;..~ ~-~ (a) If my daughter NURIA N. KUDLACH and my grandson ALEXA P. ~' KUDLACH or either of them shall survive me, to those of my daughter l~A c N. KUDLACH and my grandson ALEXANDER P. KUDLACH who suY'vv~ Vie, ~,~ in equal shares. ,~~- ~ ~~ ~~ ~~ (b) If none of the beneficiaries under clause (a) above shall survive me, I gix~~ my ~: - ~ ` ~~ .; residuary estate to those who would take from me as if I were then to die without -- ~ ' ~ =' a will, unmarried and the absolute owner of my residuary estate, and a resident of the Commonwealth of Pennsylvania. THIRD: If any property of my estate vests in absolute ownership in a minor or incompetent, my Executor, at any time and without court authorization, may: distribute the whole or any part of such property to the beneficiary; or use the whole or any part for the health, education, maintenance and support of the beneficiary; or distribute the whole or piny part to a guardian, committee or other legal representative of the beneficiary, or to a custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or :persons with whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to whom the distribution is made shall be a full discharge of my Execu-tor from any liability with respect thereto, even though my Executor may be such person. If such beneficiary is a minor, my Executor may defer the distribution of the whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the same as a separate fund for the beneficiary with all of the powers described in Article FIFTH hereof. If the beneficiary dies before attaining said age, any balance shall be paid and distributed to the estate of the beneficiary. ~~~', FOURTH: I appoint my son-in-law ALOIS KUDLACH to be my Executor. I direct that no Executor shall be required to file or furnish any bond, surety or other security in any jurisdiction. FIFTH: I grant to my Executor all powers conferred on executors under the Pennsylvania Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon executors wherever my Executor may act. I also grant to my Executor power to retain, sell at public or private sale, exchange, grant options on, invest and reinvest, and otherwise deal with any kind of property, real or personal, for cash or on credit; to borrow money and encumber or pledge any property to secure loans; to exercise all powers of an absolute owner of property; to compromise and release claims with or without consideration; and to employ attorneys, accountants and other persons for services or advice. The term "Executor" wherever used herein shall mean the executors, executor, executrix or administrator in office .from time to time. SIXTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me unless such beneficiary survives me by more than thirty days. IN WITNESS WHEREOF, I, MEFTUHA HAWKINS, sign my name and pu 'sh and declare this instrument as my last will and testament this _~~ day of 2007. %~~MEFfiUHA HAWKINS s' The foregoing instrument was signed, published and declared by MEFTUHA HAWKINS, the above-named Testatrix, to be her last will and testament in our presence, all being present at the same time, and we, at her request and in her presence and in the presence of each other, have subscribed our names as witnesses on the date above written. ~~ ~~ having an address at C-c~ r ~s /c /~~ r ~ s~ 'i r ~y`J ~ . l i' f . t . ! ~'~ i' ~ j^,. 170/ 3 having an address at ~,a_~ I, ....4' ! ACKNOWLEDGMENT AND AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA, COUNTY OF _ , ss. We, the Testatrix and the witnesses, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix, MEFTUHA HAWKINS, signed and executed said instrument as her -last will and testament in the presence and hearing of the witnesses, and that she had signed willingly, and that she executed it as her free and voluntary act and deed for the purposes therein expressed, and that each of the witnesses at the request of the Testatrix, in the presence and hearing of the Testatrix and each other, signed the will as witness, and that to the best of his or her knowledge the Testatrix was at the time at least eighteen years of age or emancipated, of sound mind and under no constraint, duress, fraud or undue influence. ME TUHA H///AWKINS Testatrix ~ ~,,,~ ~_ print: yL.r f, S s. Y~~~~ s Witness k-~r,d ' ~'~ r ~.,, ._.. v print: ': Witness Subscribed, sworn to and acknowledged before me by the said MEFTUHA HAW NS, Testatr' ,and subscribed and sworn to before me by the above-named witnesses, this day of , 2007. N ry Pu lic My com fission expires on ` O~G ~~ l~~ - , Lr iw .. 1-i ', r . w; ~ ~ . ~..~__., ._ .._ ,_ _ _,.. a_,....._..a~._._.. .. ,_ .. _ . r ~ .. ~. ~~~ _. ~ ~ ,%`~ . ~ ' ~'.^, tee. .~ a _... ~ ~\,+i ~- . ~......--~.. ..