HomeMy WebLinkAbout10-15-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYL`~ANIA
Estate of Jap~.eth T. MaCa1uSO File Number ;~ ~G~ '-' ~i~~~-I'
also known as
Deceased Social Security Number 1 3 9 8 0 6 8 3 3
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
last Will of the Decedent dated
and codicils} dated
named in the
r-.a
~-~
State relevant circumstances, e. ~"`"'
( g., renunciation, death of executor, etc.) - ~--~ c~ - -,
_.s _. -
~7 ~s r ;.. ; ..,
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of tie ~trume) off~t-ed -
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 life; durante absentia; durante_niinoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following~iouse (if any~d heirs: ~'~~
Administration, c.t.a. or d. b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ri0 SpOUSe , ri0 lta~ue
burg,
burg,
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
PA 17257
Decedent was domiciled at death in Cumberland County, Pennsylvania with his ~~ last principal residence at 9 N . Earl
t. ~, Shippensbura, Shippensbura Township, Cumberland Country, ~-IT~'ST
(List street address, tow~r!c rty, township, county, state, zip code)
Decedent, then years of a e, died on June 2 0 , 2 010 at . 9 N . Ear 1 S t . , AX> t . 31 ,
Shippens urg, PA 1/257
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $_~ , 6 3 0.00
(11'not domiciled in PA) Personal property in Pennsylvania $_ N/A
(If not domiciled in PA) Persona! property in County $ __N/A
Value ofreal estate in Pennsylvania $_ 0
TOTAL: $1„630.00
situated as follows:
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:
5i nature T d or rinted name and residence
t Amy L. Macaluso, 9614 Rowe Run Loop,
Form RW-02 rev. f 0.13.Ob Page 1 of 2
.,\
~~'
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ___OUMRF.RT,ANT)
~'he 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 ~•state according to law.
e~~-te-e>~firme~~ rand subscribed r (/ L''
Signature of sonal Representative
before rrie the ~r~ day of
`~ ~, P ~.,
_ ~. _~ - ~ l
_ ~ ~ ~~ t ~_ _,_, -=`~` Signature of Persona! Representative -V ' r'Y. (~., _.. -.
~_..
j~ or the Register Signature of Persona! Representative : ~ -, -_ _~ _ '
CS'i r ;.
-.
File Number: '-~ ~ ~ ~ (;' - ~ C' -~ '
~~ _ .> ~_
Estate of J a rn h e t h T. M c~ a 1 Lts_n ,Deceased
Social Security Number: 13 9 8 0 6 8 3 3 Date of Death: - ,Tu n r~ ~ n r-2 n ,~,n _
,, r
AND NOW, ~ ~ -f (; ~ ( ~ (j r--~ , ~ in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters o f Adm i n i ~ ~a t j nn
are hereby granted to Amy ..~.L . Ma C a 1 u s o
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 ............... $ ~~~-' . Ls~~
Short Certificate(s) ........ $ ~ r`!' ~ ~'('
Re/nunciation(s) .......... $_,I~ ~ G' ~~-~
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
-,. ,...~~~ ,
wills ' ~.~~: ~ Cr c `-C^'?5~
//w /T~~s'1 ~ ~ ~~~/~
Joseph Aa. Ma
62
... $
$ Address: 9614 Rowe Run :Loop
• $ Shippens.burg, :PA .17257 ,~
... $
... $
' ' ' $ Telephone: ~ 17 ~ 3 2-~ ~ 3 a
$ a
/ s' Q.~~
TOTAL .............. $ { , ~_-~ ,
Form RW-02 rev. 10.13.06 Page 2 of 2
RENUNCIATION
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GISTER OF WILLS '= :~~ ~
~- Ul}'~ ~~Q~~~ COUNTY, PENNSYLVANIA ~":~>
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Estate of `~~~ ~ ~ ~~ ~ ~ ~ ~-C /,~- L ~ s ~ Deceased
_----.
I ~`~ ~ ~-~ ~-~ ~ Gi C' ~u .~ 1.1
in my capacity/relationship as
(Print Name)
~~ ~~ ~-~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
/ ~1n
(Date)
Executed in Register's Office
-~' f rn,ed and subscribed
before me ,his ~~~ ~ day
Deputy far Register of Wills
V
(Sig ature) !'/
1 ~ ~ ~ ,~~C-~ (~~~,
(Street Address)
C , ~ ~.
(City, State. Zip)
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
~~A~ RECaIISTRAR'S ~ERTIFIA~'IN ~QF E'A''I-~
'V~(~~N1~1G: It is illegal to duplicate this Copy 1~~~' ~1hcy~tnstat o~- phot~~ra~~l~.
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18. Father's Name (First, middle, last, sul8x) 79. Mother's Name (First, middle, maiden surname)
Joseph Maealusn Anry L. Olsen
20a. IrBament's Name (Type /Print) 20b. Informant's Mailing Address (Street, city I town, state, zip aide)
.9cLy L. Macaluso 9614 Rowe Run Loop Shi nsbur , Pa 17257
21 a. Method of Disposition i ^ Crematbn ^ Donedon 21 b. Date of DisposiDon (Month, day, year) 21 c. Place d Disposition (Name of cemetery, crematory a aher place) 21 d. L.ocetion (City /town, state, zip aide)
°w ' ~ Burial ^ Removal from State I was cramstlon «Donadon Authorized June 26, 2010 East Shelby Cemetery ToLan of Shelby, NY
r3 ^ Other - Spsclly: I by Medial Exemkrr / Coroner9 ^ Yes ^ No
•
22a. Sigreture.of -unerel Service liteyisee (or ptllson actlng es such) 22D. Licervte Number 22c. Name and Address of FacNBy
~ - - . -:~y~..->.,,,-. f~~ `'~ a' F~-012909-L Ronan Flmeral Home 255 York Road Carlisle. Pa 17013
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H105.144 REV 11/2006 ~ "v ~ ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS _ _ I;,,,r~ -~~_- -- .'~•~- j '
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TYPE /PRIM'
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PERMANENT
ACK INK
B • .
CORONER'S CERTIFICATE OF DEATH -==~'
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432-284 ,,,,
(See instructions and examples on reverse) STATE FILE NUMBER ~ -.")
1. Name of Decedent (First, middle, lest, suBix) 2. Sex 3. Social Security Number 4. Date of Death (Monts, day, year)
Ja heth T Macaluso Male 139 - 80 - 6833 June 20. 2010
5. Age (Last Birthday) Under 1 year Under 1 day 6. Date of Bits (MOMh, d ar) 7. Birthplace (C aM state or laeign count) fie. Place of Death (Check ony one)
MonrM Dix H~,B Mwxau Red Bank NJ Hospital: Other:
24 Yrs. November 3, 1985 ^Inpatient ^ER/Outpatient ^DOA ^NursirgHOme Residence ^Other-Specity:
fib. County of Death 6c. C Twp . of Death 80. FacBiry Name (Brat Instit ution, give street and number) 9. Wes Decedent of Hispanic Origin? No ^ Yes 10. Race: American Indian, Black, White, etc.
• ~
( (~~
Cumberland Shippenburg 9 North Earl Street MexN;an, P
ueno Rican, etc.) White
11. Decedents lJsual lion Kind of work do ne d moll d life. Do nd slate 12. Was Decedent ever in the 13. Decedent's Edrrptlon (Speciy only highest grade canpl eted) 14. Marttal Status: Maned, Never Marded, 15. SurvWing Spo use pf wife, give maiden name)
Kind of Work
A
raiser
K' d Buskreas / Industry
Real st
t
A
i
l U.S. Amred Farces?
Elementary /Secondary (0-12)
Coll a (1-4 or 5+)
~ Widowed, Divorced (Specify)
i
pp a
e
ppra
sa ^Yea ®No Never Marr
ed
~ 16. Decedent's Maittng Address (Street, dtY /town, state, zip code) Decedents Perms 1VSnla Did Decedent
y
9 North Earl St . Apt 31 Actual Residence 17a. State
? 17c. ^ Yes, Decedent Lived in _ Twp.
hi
T
Shi
b
P
17257 owns
p
Caunry C3IIi)bCerland 17d.~ No, Decedent Lived wshin ~~ ~~,
17b
e]:LS
ppens
urg,
a .
g D;h, / Bono
Aclaal Limdts d pp
Complete ttAma 23et Doty when certNylrq 23e. To the best d my knowledge, death ocprred at Bre tlrtre, dale and place stated. (SlgnaNre and mle) 23b. Ucense Number 23c. Date Signed (Month, day, year)
physician re rrol avaNeNe et Bme d death ro
cerBly cause of dealt.
ttems 2428 mull be completed by person 24. Time of Deets 25. Date Pronounced Dead (Month, day, year) 26. Was Case Referred to Medaal Examiner /Coroner fa a Reason Olfter than Crematbn or Donation?
'"''°~'°'~""~r'~a"'' A rx. 5:00 P:^~ June 21 2010 ~ves ^No
CAUSE OF DEATH (See Inatructlona end examples) n Approximate interval: PaA II: Enter other ~jtmtticant cendPoons contdbutirtg to death, 28. Did Tobacco Use Contribute to Death?
ttem 27. Pad L Enter Bra Blain devents - dbeasea, inprries, a cartplicatlons -that directly caused the death. W NOT enter terminal events such as cardiac ertest, n Onset to Death but not resuking in the underlying cause given in Part L ^ Yes ^ Probabry
respiratory ertest, a ventricrdar fbdgation witlwul showing the etiology. list Dory one cause an each line.
IMME r
n
n
^ No ^ Unknown
DIATE CAUSE (Firel disease or
mndrtronrasultmgindeath)
Probable Seizure Etiolog
Unknown 29. It Female:
y
-~ a ^
Due to (or as a consequerxxr of): ~ Not prerprant within past year
Del list conrlidarw, tt an
I~ng to the puce Hated on line e
b' r
r
Pregnant at Brtre d deaN
.
Enter the UNDERLYING CAUSE Due to (or as a consequence off: n - ^ Na Ixegnant but pregnant within 42 days
(disease a injury Bret ktiDeted Ne c
events rasuttirg in death) LAST. ~
r of Beats
Due to (or as a consequence of): r ^ tJW pregnant, but pregneM 43 days to 1 year
~ d r
n before rleath
Urdcnovm if pregnant wtthin the pest year
30a. Wes an Autopsy
Pedorned? 30b. Ware Autopsy Fkt6ngs
Available Prior to Com
letion 31. Manner d Death 32a. Date d Injury (Morah, day, year) 32b. Describe Flow Injury Occurred 32c. Place d Inryry: Home, Fern, Street Factory,
p
d Cause d Death?
~ Natural ^ Homidde Office Building, etc. (Specify)
Yes ^ No Yes ^ No ^ Accitlent ^ Pending InvesDgeaon 32d. Time d Iryury 32e. In)ury at Work? 32f. II Transportation Injury (Specify) 32g. Loption of Injury (Slree~rAt,Yl town, state)
^ Suicide ^ Cook Nol he Determined ^ Yes ^ No ^ Driver / Opereta ^ Passenger ^ Pedesidan
33a. Certifier (check Doty one) 33D. Signature and Title Of er
' CanHyktp PhY~+n (Physician ceroying pose of death when aratlrer physician has prorarrrced death and completed Item 23)
'~
To tlta beat of my knowledge, Bats occurred due to the auae(t) one manner as atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ C 1~
c:r~ o r one r
• Pronouncing end artllying pftysklerl (Physiaen txBh pronouncing death and rxrtttykg to pose d death) 33c. License Number 33d. Date Signed (Month, Bey, year)
To the beat of my knowedge, death occurted et the time, data, end place, erW due to Bte auae(a) end manner a atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• k~~l~m~/~~
On Bte baste of exemlru8on end / « Invaati
etlon
In m
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b
d
th
~ September 17, 2010
g
,
y op
n
n,
ea
occurred N tM thne, date, end plea, and due to Bre auae(s) and manner as atated_ ~ ~ f Pe Canplated d Bl Item 27) T / Pdm
~oc~d~feS~
r~°c"~ce
de
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3s.Regiatre "".nand q~~ mbe
' 3s~ ateFaed(ktomh,dar,year) .
nro
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one
o
6375 Basehore Rd., Suite iiEl
~ Tt}.t
I~ If i~ I ( IQ I Mechanicsbur Pa. 17050
Disposttion Permit No. ~ ~ ~~ `'f"lC'(O ~ ~.