HomeMy WebLinkAbout08-20-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cl~ COUNTY, PENNSYLVANIA
Estate of G~.. _,-.
~ ~~ ~~~~~
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
File Number ~~ I /O + oo (~~
Social Security Number ~ tpy - a~ - , ~' q
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~ { ~, ` YC. (j,Sl
last Will of the Decedent dated ~¢.~<'VrcLry ~3 .~~~ and codicil(s) dated named in the
(State relevant circu,nstances, 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:
r,.a
^ B. Grant of Letters of Administration ~ ~ ~ ~"~"i '_
L7 r" .:.,
(If applicable, enter: c.t.a.,, d.b.n.c.t.n.; pendente life,, durance absentia; duraaten3xn rflltte) ~ ~ r t"
--
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoils" (i"f`'any) and lheirs:r (ff v r
Administratiort, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) C~3C~ -Z --;=i
r _>~~~_n --r-
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Name „ -.. .. ,
(COMPLETE IN ALL CASES:) Attach additional she s if t:e ssary.
Decedent was omiciled at death in Count ,Pennsylvania with his /her last principal residence at
~ f C. ~. ~ 1 O ----
(List street add,-ess. [owrt/city, township, county, state, zip code)
Decedent, then ~ ~ years of age, died on ~G ~~ ~ Q~h 3'~ ~ ~ ~' S' ~ ~~1
~~t-1 ~ ~~o t PA ~ `~ ~ 13
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ t ('j ~ ~C~ ~~ 1
(If not domiciled in PA '~'
) Personal property in Pennsylvania g
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania $
situated as followc•
Form RW-0? 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
COMMONWEALTH OF PENNSYLVANIA
,,~I, SS
COUNTYOF ~ ~1~~~~1~ :
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.
~~ f _ __
Sworn to or affirm~ed/a~nd{1subscnbed
before me the __~! '~_~_,da/y off
,~
F he Register
Signature of Pers na! Rep~sentative
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Signature ojPersonal Representative ' ri -y <') ~ -j
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Signature ojPersaial Representative ,
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File Number:
Estate of ~~~ L[ 1 VI l .COLS ~~ > Deceased
Social Security Number:~l~~'~y ^' ~~ ~ Date of Death: ~-la ~ ~~
AND NOW, ~Dw'vi" /T~-~~fi ~ ~ ,inconsideration of the foregoing Petition, satisfactory proof
having been presented b re me, I DEC~~RAAEED that Lett~erfs,..~Ty ~`QYYL~YI ~~rL.l
are hereby granted to ~r~t_,li_ i l~• Nt ~ i d S ~ C.~ 1
in the above estate
and that the instrument(s) dated ~ ` ~ - ~ 3
described in the Petition be admitted to probate and filed of recoFd as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............... $
Short Certificate(s) ........ $
Renunciation(s) .......... $
I/11i 11 ... $
...$
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ -
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form RW-0_' rev- iv.t3.o~ Page 2 of 2
US,yp9 RED r01/(1?i
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 16535674
Certification Number
This is to certify that the information here given
correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origin
certificate will be forwarded to the State Vita
Records Office for permanent filing.
~~irR- ~~t-~,,,,c~,~~~~~x At1~G 1 3/201.0
Local Registrar Date Issued
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TYPE / PRIM IN
1105'~°O REV ++~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
BLACK INK
PERMANEM CORONER'S CERTIFICATE OF DEATH
X132-321 (See instructions and examples on reverse)
1. Name a Dawson (Flnt. mHdle, bp, aulR,) STATE FILE NUMBER
Matthew J 2' Se" s. loan saaray Nurox e. Deb a Drm
Mejasich Male 469 - 24 - 1998 August 10,2010
s. Age (Lrl RkUNey) Unaer 1 UMU 1 8. Deb a BMh (Haan, ) 7. S Webb «
Mwah save ran ,,a,,,, 1 s.. Pbp a Deem Check ore
81 rB.
February 7, 1929 Eveleth, MN ~~ °tl"n
- ab. cway a Deem ac. cxy rwp. a Dr+n ad. F ^ aiPetlent ^ ER / aae.pm ^ DDA ^ Nurrg Name 1gJ Reapeae ^omr- ~h:
i eanlr Name (n as ksAllapn, ewe seep end semen) s. was Dspaea a Hiepaac ongh7 No
Cumberland Carlisle n+rr, epadly Cuban, ® ^~°° 70 ~e1 "^~°0 ~°^~&rK wNb, eb.
518 Thornwood Lane Mealnn,PUanowpn,etc.) I~+dM White
11. Dsedufe Ueup a wok done mwt d pa. Do ml ebb 12. Wee DepaerN ever In me Y3. DepdanYe ENptlon
Khtl d wok Nktl a Stapes / Imrlry U.s. Amed Famr? IsAea+r ear ayep P•ae mnnbled) U. Heap stab: Merrba, Never Meaed, ts. 9urvwkie Speer (n wne, ewe meben reme)
Military Police US Army ®Yr ^~ E1B11Bn1B~'/s°`oidery(°''zl ~ga(,+«s.l wMawea,Dw~,rpalsPayg,
tS. Decease's McYkg Aaarer tareat dlyl town, ebb, zip soda) Divorced
518Tlornwood Lane Arne ne.aeb PA D1d0eCadi'K
Lwe in a 77c. ^ Yr, Deceapx Urea h
Carlisle, PA 17013 ,n.Dwmy Cumberland T°wnaMp7 na.C~ ~ Uvedwaih T"0'
1B. Fanera Nuns (First, mldae, baL eufla) Carlisle
1B. Motler'a Nuns (Fkn. noddle, mebr eumeme) Cny! Rao
Matthew Measic
20a. lnbmienre Nuns (Type/Pnml Anna Ralan
Richard Mejasich 20° "b'"r'r°Mb'"°A°°""(~,,~1~,,,~,,~~,i
414 Andorra Glen Ct., Lafayette;l)~A 19444
21a MemoO a Obpoepon ®~~
^ BurW ^ RunoW hen Sae ^ Daetlp 216. Dpe a Olaparian (March, dY• Y•a+) d DbpoYlba (Nemqa
wr Auneara Au 1 ~o~fman-Roth F Hera aHomel & 27a'`°°""'ccm'/lown,abb, ap wa,)
~ ^ ~'- IEpmer/corar7 rr^~ 8• 8, 20I0 Cremator Carlisle, PA 17013
_ ~ ??a. a Farts mn acting r rch) 226. Ucense Number
~ 2zc.wmerdAaararaFaafily Hoffman-Roth Funeral Homes & Crematory, Inc.
138504 219 N. Hanover St. Carlisle PA 17013
Hens «Nh'kig 23a. To me ben a my kriowbage, seam accred u ae tlme, cab and Plug ebbd. (Swum ub Mle)
bb a aw~~~ge n mne a aem is 236. acmes nurox z3c. Deb signed (Main. tlar, sue)
name 2426 man a oanolned M parson 2/. nets a Deem A r2:. 25. Deb Praeueea Drs (Moms. ah'. Yrrl
~ who Pmeaaes seem. 28. Wr Car Rebrrea b Medcel Eaernher / Corarer for a Rreon Omx men Cremetlon «DOream7
3:0 P. M. August 10, 2010 ~vr ^No
CAUSE OF DEATH (Sae Nrzzuwlone arts exempaes)
Hem Z7. Pr l: Eau me ffiBIRa-NaB _ tleanr, iryunr, or mnpkcsnae _ nW diaNy area me detlh. W NOT alter tumhp everib e«h r pNa ertap, i ApOmidinb kauvp: Pan II: Emu emu 2B. Dkl Tohacp Ur Corerbir b Deph7
rrpirabry wren. a vuufcaer Sxieap weea aMwirg IM enaopy. Up oay ae ease an each 6e. r Onrt b Deem ha Hat rruAYg h me uMenykg woes giwrn h PM L ^ Yee ^ pmbeey
a«IW~d 01"r~..~ng indwm(aerr« ~ ^~ ^
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Due b (a r a axeeuras ' 28. n Femur:
an arlASae, n ~ ~ prepbe wnhh Pap Year
b wr.,www"rnB"'e 6 -~oronarv Artery- Disease Remote CABG ^ ~
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(u~ee'iens~n ~mT. °~ ^ Na
Due b la r a oowegrurw - r pteprp, ba prepnna wnnh a2 says
al: I a deem
a. ~ ^ Na off, ba wevra e3 mya b t yw
bales arm
90a Wr an Araapay 30b. Woe Aubpey RKbge 31. Munn a Daph r ^ UrYobwn p ~ Yeer
PeAamed? AveBaae Pna b Carobap p~ 32a. Dab d Mpny (Monet. say, yuxl 32b. Deurba How Ir~ury Oaerred 32c. Pbp d Pia wean me ~Y.
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• ea4a1 Esrarr/ Cesar _
on ee twb a eabnYrbn era! «anwatlpWm, h my aphMq arm aplarad a tlb tlma, aeb, ana pbp, one rhr Yes tle aur(p bla mercer r whbL ® August 11, 2010
~ ed sN ToG~.P~c~cen°l"roa~eea~"oronzet~e/Pmm
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Diapwltloa Permit No. , ", /
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LAST WILL AND TESTAMENT --' ~ ~
,_~
(Pour-Over Will) ~ `- ~' _
~~"
OF ~ ' ~ 7
~ ~--_~ ~-~ .~
-.,~,, `
MATTHEW J. MEJASICH ~ ~ ~ ~~
•r~
IDENTITY
I, MATTHEW J. MEJASICH, residing in the County of Cumberland, Commonwealth of
Pennsylvania, being of sound mind and memory, and not acting under duress or undue influence of any
person whomsoever, hereby declare this to be my Last Will and Testament, and I do hereby revoke all
other former Wills and Codicils to Wills heretofore made by me. My Social Security Number is 469-24-
1998.
I have the following children: Paul J. Mejasich, born March 17, 1959 and currently residing in
Albuquerque, NM 87113, and Kim M. Taylor, born May 26, 1962 and currently residing in San Diego,
CA 92123, and Ann M. von Recum, born August 10, 1964 and currently residing in Copperas, TX
76522, and Richard M. Mejasich, born October 11, 1966 and currently residing in Ft. Washington, PA
19034, and Mary K. Mejasich, born December 19, 1968 and currently residing in Alexandria, VA 22314.
DEBTS, TAXES AND ADMINISTRATION EXPENSES
I have provided for the payment of all my debts, expenses of administration of property wherever
situated passing under this Will or otherwise, and estate, inheritance, transfer, and succession taxes, other
than any tax on ageneration-skipping transfer that is not a liability of my Estate (including interest and
penalties, if any) that become due by reason of my death, under THE MATTHEW J. MEJASICH
REVOCABLE LIVING TRUST executed on even date herewith (the "Revocable Trust"). If the
Revocable Trust assets should be insufficient for these purposes, my Executor shall pay any unpaid items
from the residue of my Estate passing under this Will, without any apportionment or reimbursement. In
the alternative, my Executor may demand in a writing addressed to the Trustee of the Trust an amount
necessary to pay all or part of these items, plus claims, pecuniary legacies, and family allowances by court
order.
PERSONAL AND HOUSEHOLD EFFECTS
It is my intent that all my personal and household effects were transferred to the Revocable Trust
as a result of the Declaration of Intent signed this date. If there are any questions regarding the ownership
or disposition of these assets, it is my desire that such assets pour into the Revocable Trust, signed by me
this date in accordance with the provisions of the section titled "Residue of Estate."
RESIDUE OF ESTATE
I give, devise and bequeath all the rest, residue and remainder of my property of every kind and
description (including lapsed legacies and devices), wherever situated and whether acquired before or
after the execution of this Will, to the Trustee under that certain Trust executed by me on the same date of
the execution of this Will. The Trustee shall add the property bequeathed and devised by this item to the
corpus of the above described Trust and shall hold, administer and distribute said property in accordance
with the provisions of the said Trust, including any amendments thereto made before my death.
POUR-OVER WILL
Page 1
estaier
If for any reason the said Trust shall not be in existence at the time of death, or if for any reason a
court of competent jurisdiction shall declare the foregoing testamentary disposition to the Trustee under
said Trust as it exists at the time of my death to be invalid, then I give all of my Estate including the
residue and remainder thereof to that person who would have been the Trustee under the Trust, as
Trustee, and to their substitutes and successors under the Trust, described herein above, to be held,
managed, invested, reinvested and distributed by the Trustee upon the terms and conditions pertaining to
the period beginning with the date of my death as are constituted in the Trust as at present constituted
giving effect to amendments, if any, hereafter made and for that purpose I do hereby incorporate such
Trust by reference into this my Will.
EXECUTOR
I hereby nominate and appoint Paul J. Mejasich to serve without bond as my Independent
Executor of this my Last Will and Testament.
In the event the first named Executor shall predecease me or is unable or unwilling to act as my
Executor for any reasons whatsoever, then and in that event, I hereby nominate and appoint Richard M.
Mejasich to serve without bond as my Independent Executor.
Whenever the word "Executor" or any modifying or substituted pronoun therefore is used in this
my Will, such words and respective pronouns shall be held and taken to include both the singular and the
plural, the masculine, feminine and neuter gender thereof, and shall apply equally to the Executor named
herein and to any successor to substitute Executor acting hereunder, and such successor or substitute
Executor shall possess all the rights, powers, duties, authority, and responsibility conferred upon the
Executor originally named herein.
EXECUTOR POWERS
By way of Illustration and not of limitation and in addition to any inherent, implied or statutory
powers granted to executors generally, my Executor is specifically authorized and empowered with
respect to any property, real or personal, at any time held under any provision of this my Will: to allot,
allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims, contract
with respect to, continue any business of mine, convert, deal with, dispose of, enter into, exchange, hold,
improve, incorporate any business of mine, invest, lease, manage, mortgage, grant and exercise options
with respect to, take possession of, pledge, receive, release, repair, sell, sue for, make distributions in cash
or in kind of partly in each without regard to the income tax basis of such asset and in general, exercise all
of the powers in the management of my Estate which any individual could exercise in the management of
similar property owned in its own right upon such terms and conditions as to my Executor may seem best,
and execute and deliver any and all instruments and do all acts which my Executor may deem proper or
necessary to carry out the purpose of this my Will, without being limited in any way by the specific grants
or power made, and without the necessity of a court order.
My Executor shall have absolute discretion, but shall not be required, to make adjustments in the
rights of any Beneficiaries, or among the principal and income accounts to compensate for the
consequences of any tax decision or election, or of any investment or administrative decision, that my
executor believes has had the effect, directly or indirectly, of preferring one Beneficiary or group of
Beneficiaries over others. In determining the Federal Estate and Income Tax liabilities of my Estate, my
POUR-OVER WILL
Page 2
or
Executor shall have discretion to select the valuation date and to determine whether any or all of the
allowable administration expenses in my Estate shall be used as Federal Estate Tax deductions or as
Federal Income Tax deductions.
SPECIFIC OMISSIONS
I have intentionally omitted any and all persons and entities from this, my Last Will and
Testament, except those persons and entities specifically named herein. If any person or entity shall
challenge any term or condition of this Will, or of the Living Trust to which I have made reference in the
sections "Household and Personal Effects" and "Residue of Estate," then, to that person or entity, I give
and bequeath the sum of only one dollar ($1.00) only in lieu and in place of any other benefit, grant,
bequest or interest which that person or interest may have in my Estate or the Living Trust and its Estate.
SIMULTANEOUS DEATH
If any other Beneficiary should not survive me for sixty (60) days, then it shall be conclusively
presumed for the purpose of this my Will that said Beneficiary predeceased me.
.. _.. t
f`
A - J. JASICH
Testator ~
This instrument consists of 5 typewritten pages, including the Attestation Clause, Self-Proving Clause,
signature of Witnesses, and acknowledgment of officer. I have signed my name at the bottom of each of
the ceding pages. This instrument is being signed by me on this ~ /~ day of
u.4 00._3 .
POUR-OVER WILL
Page 3
ATTESTATION CLAUSE
The Testator whose name appears above declared to us, the undersigned, that the foregoing
instrument was his/her Last Will and Testament, and he or she requested us to act as wifiesses to such
instrument and to his/her signature thereon. The Testator thereupon signed such instrument in our
presence. At the Testator's request, the undersigned then subscribed our names to the instrument in our
own handwriting in the presence of the Testator. The undersigned hereby declare, in the presence of each
of us, that we believe the Testator to be of sound and disposing mind and memory.
Signed by us on the same day and year as this Last Will and Testament was signed by the
Testator.
WITNESSES:
ADDRESSES:
1Zi Jb~alSef ~e.f~
(Printed Name of Witness)
~ ~
(Punted Name of Witness)
V'~; . ~ c.~ it S PQ~.~ c} j ~q . 1 "1 d 1~ 5'
City, State, Zip
City, State, Zip
POUR-OVER WILL
Page 4
or
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SELF-PROVING CLAUSE
BEFORE ME, the undersi ed authority, on this day rsonally a eared MATTHEW J.
MEJASICH, /_~/L'.~j,9 ej ~, ~ej/ and y,~iN j j/
known to me to be the Testator and the witnesses, respectively, whose names are subscribed to the
foregoing instrument in their respective capacities, and all of them being by me duly sworn, MATTHEW
J. MEJASICH, Testator, declared to me and to the witnesses, in my presence, that the instrument is
his/her Will and that he or she had willingly made and executed it as his/her free act and deed for the
purposes therein expressed; and the Witnesses, each on his or her oath, stated to me in the presence and
hearing of the Testator, that the Testator had declared to them that the instrument is his Will and that he or
she executed the same as such and wanted each of them to sign it as a witness; and upon their oaths, each
witness stated further that he or she did the same as a witness in the presence of the Testator, and at his
request and that he or she was at that time eighteen (I8) years of age or over and was of sound mind, and
that each of the witnesses was then at least fourteen (14) years of age.
`~" ~~
ATTHE SIC
Testator
l ~1 /
t (( ~ ~{,~
Witness
(Printed Name of Witness)
~~~
W ess
ru-,
(Printed Name of Witness)
SUBSCRIBED AND ACKNOWLEDGED before me by MATTHEW J. MEJASICH, Testator,
and su cribed and sworn to before me by ~iL'/fP,4/ ~, ~e j/
s-?iZiv e// and
witnesses, this the ~/~~ day of
,~.iq- , Zoo.3.
r_-
G-'«-!-~~/~C/
ary Public, Commonwealth of Pennsylvania
~~~
POUR-OVER WILL
Page 5