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HomeMy WebLinkAbout10-26-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of RUTH B. BERTOVIC also known as File Number / ~ ~~ ~ ~ ~~ J i ,Deceased Social Security Number 196-14-0705 ~: r--~ ~~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: _ `"'? --~ (COMPLETE 'A' or 'B' BELOW.) `-j"' ~' ~ ~ .._ „ , __... ®/ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the Executor ~, ~;~ Qiamed in the _~ _.. last Will of the Decedent dated June 13, 2000 and codicil(s) dated -- - -~ - - , - _.,.f - -} t» _.T.• ~~ _ ~. (State relevant circumstances, e.g., renunciation, death of executor, etc.) 7 ~~' rte: 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: B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente life; durante absentia; durante minoritatE) 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.) (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 100 Mt Allen Drive Mechanicsburg Upper Allen Township PA 17055 (List street address, townlcity, township, county, state, zip code) Decedent, then 86 years of age, died on October 2, 2010 at Holy Spirit Hospital, Camp Hill, PA 17011 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (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: N/A Wherefore, Petitioner(s) respectfiilly 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: or printed name and residence j ., /~ I Thomas R. Bertovic Jr. 4, c., -}~ v-~~.. ~ L ` ~~ ~ 601 South Norway Street, Mechanicsburg, PA 17055 717-766-7520 25,000.00 TOTAL ~ 25, 000..00 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS 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. ~(~ ~~ I ~'1 v~.--~ ~ ~ Signature of Personal Representative ~-y ~ ~., J Signature of Personal Representative '. _~ =•-- ~--~- ~ ^.tir - Signature of Personal Representative - - - . l .... ~._ ...~ ~ ~r~ __. - ~~~~ ~ . j ~, ~ rte. ~ /~ - File Number: (J Estate of RUTH B. BERTOVIC ,Deceased Social Sec ~ty N umber: 196-14-0705 Date of Death: October 2, 2010 AND NOW (1 J"~.'~ c~~ ~~ ~ ~~ ~- - ~ , in consideration of the foregoing Petition, satisfactory proof having been presented befo e IT IS EC ED that Letters Testamentary are hereby granted to ~ ~ 4~ ; L , in the above estate and that the instrument(s) dated :~. ~~ ~<-~~~`•' described in the Petition bc; admitted to probate and filed of recor s'the last Will (a d Codicil(s) Decede t. ~' FEES ~' V~ Letters ............... $ ~ G l~ ~~ t l.: ~ Regis r o s , ~- Short Certificate(s) ........ $ ~ 2 - ~ Attorney Signature: ~.®.._® y Renunciation(s) .......... $ ~~ 1 l l .. • $ `~ . ~lr-~ Attorney Name: Shelly J. Kunkel, Esquire ~~ CS • • • $ ~~ ~ Supreme Court I.D. No.: 64485 ~.,' fit; l V~'l~~- ~ l' .1 l ... $ ~ U-C) ... $ Address: 109 Locust Street • • • $ Harrisburg, PA 17101 ... $ ... $ $ Telephone: 717-236-9301 ... $ TOTAL .............. $ . ~~ -4-A9 Form RW-02 rev. 10.13.06 Page 2 of 2 Sworn to or affirmed and s~scribed ~. SAL RECaISTRAR'S ~~ERTIFI~4TI~t~ ~F ~Et,".~`~ `~d~~NfNG: bt i~<:~ illegal to du;~iic~t(a ttzi~ ~~;a~~y ~Pt;~ ~~6ztd~~tca~~~t ar ph+ata4~~~~t:~~~ ~ 7'C~' 1111' i[114 t.'c`I°I(t~;tlr.'. `~/~.i}; p _ -__16__8.-0.5__a 2 A t'~r,il~~ltt,)~ ~ur~il..~r t REV 1t2W6 / PRINT IN 1MMlENT ACK INK ' ''iJ, yy ,,nn{{ i ~i 4~ VI(ii~~~ \~ rt. ' ~ ~°.~. :~~ "< ~' „~ ~~ . • b~w~ ~ r~6 f`~ 9 4~ ` 5't r`` - ~.ir ~..1 t ltl~- ( L } ~.` ~E- i~ -~:})1 ttf \. ~)?.1~)^. {;L {1) .'curl r r !:' '~`i~ IY'~~ 'sit .i~ i ~, ~_k~ ~a~~T;~11~t1~. i !'~' .si~ R]).x n<.' 'C?~ ~,i ~~ )till [ti~~ill.'t~ C'> C_ ~-~ -- --' _ ~.i =; .~ , . ~. ~___ ~ ; .I . :: . _-_~ i COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS `-- CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FIL F Nl1MRFR _~ d :~ ---~ ~•..:,~ G"; ~~~ _ - r. ~~-~ - __- I~`,~: 1. Name of Decedent (Frst, middle, last, suffix) 2. Sex 3. Sar9al Security Number 4. DSte of Death (Month, day, year) Ruth B. Bertovic Female 196 - 14.- 0705 October 2, 2010 5. Age (Last Birthday) Under 1 ar Under 1 da 6. Date of Birth Month, de , ar 7. Birth a and state or fo re cam Ba. Place of Death Check on one Months Days Haurs Minutes Hospital: Other: 8 6 YiS. December 28 1923 ~ Lemo ne PA y ~ ®Inpetient ^ ER !Outpatient ^ DOA ^ Nursing Home ^ Residence ^ Other - Specrfy: 6b. County of Death tic. City, Boro, Twp. of Death 6d. Faality Name (tt not institutlon, gNe street and number) 9. Wes Decedent of Hispanic Origin? ®No ^ Yes 10. Race: American Indian, Black, White, etc. Cumberland E. Pennsboro Twp. Holy Spirit Hospital (Mexican~ertoCR~en,etc.) (5/~M white 11. DacedemPs Usual don Kktd of work d one d wi most of world I'rte. Do not stale reti 12. Was Decedent ever in the 13. DeadenPs Educatan (Spealy Doty highest grede comp leted) 14. Madtel Status: Married, Never Married, 15. Surviving Spo use (If wife, give maiden name) Knd of Work Kind of Business/Industry U.S. Armed Forces? Elemerdary 1 Secondary (0.12) College (1-4 or 5+) Widowed, Divorced (Specify) Clerk State Government ^ vea ®No 12 Widowed ~ 16. Decedent's Mailing Address (Street, city /town, state, zip code) Decedents Did Decedent Upper All e n Pennsylvania Live in a „ ~ Y A t l R id 17 st D 100 Mt. Allen Drive ~. ence c ua es a, ate es, ecedent Lived in Twp. Township? Mechanicsburg, PA 17055 ,7d.^No,DecedentLiveawithin Cumberland '~ AriwlLimitsof crtyrsorm 18. Father's Name (First, rnidde, last, suffix) ig. Mother's Name (Frst, middle, maiden surname) Ira C. Blocher Emma C. Stonesifer 20a. Informant's Name (type /Print) 20b. Informants Mailing Address (Street, dry f town, state, zip code) Thomas R. Bertovic, Jr. 601 S. Norwa Street, Mechanicsbur , PA 17055 21a. Method of Disposition r ^ Cremation ^ Donation 21b. Date of Dispositlar (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Locator (City /town, state, zip code) ® Braiet ^ Removalframstate i WaCrematlonorponatlonAuthorhed [~ Otief. r by MedkN ExaminerlCoroner? ^ Yes^ No October 6, 201 Woodlawn Memorial Gardens Lower Paxton Twp. ,PA 1710 • 22a Signature o1 I (or person actirrg as such) 22b. Ucense Number 22c. Name end Address of Facility • - FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete ' Doty n certifying 23a. T best of my knowledge, death occur at the time date ant place stated. (Signature and fide) 236. License Number 23c. Date Signed (Month, day, year) physician is not avei at time of death to ~ ~r~,tr ~ ~ 11"~~"" j _ ~i ~ ~ -y) ~ a a b O~ ~ certify cause of death. ~J ~ I ~ C.(l O O Q r t:-t- ~ ttems 24.26 must be completed by person 24. Torre of t>e 25. Date Pronounced Dead (Month, day, year) 26. Was Case Refer~d to Medical Examiner /Coroner fa a Reason Other than Cremation or Donation? ~ who ronounces dam. p ~~y~ Pry M. b ,~}„ oZ aof a rt~Vl. ^ Yes o CAUSE OF DEATH (See Inatructtons and examples) r Approximate interval: Part II: Enter other ' 26. Did Tobacco Use tribute to Death? Rem 27. Part I: Enter the chain of events - diseases, injuries, or complications -that drectty caused the death. DO NOT enter terminal events such es cardiac arrest, i Onset to Death but not resulting in tfte underlying cause given in Part 1. ^ yes Probabty respiratory crest, or ventricular fibn7letbn without showing the etiobgy. List only one cause on each iMe. , ^ No ^ Unknown IMMEDUTE CAUSE (Final disease or 1~ ~ i /// condition resulBng in death) _~ a T ~ e, u N` Q /'1 I ~ ! ~ l 29. It Fe t N t ithi t to (or as a consegrence af); ; Due ~ o pregnan w n pas year ^ Pregnant at time of death Sequentially list condlfions, i( any, b. S ~ ~-P 5 t i ^ r le~dng b the terse Nsted on line a. r the UNDERLYING CAUSE Due to (or as a nsequence of): r Ent Not pregnant, but pregnant within 42 days e - (disease or injury that Initiated ttre c. ~ LAST d h of death ^ N events resulting m eat ) . ~ Due to (or as a consequence otJ: ~ ot pregnant, but pregnant 43 days to 1 year before death ~ d. ~ Unknown N pregnant within the ast ear y p 30a. Was en Autopsy 30b. Were Autopsy Endings 31. Manner of = 32a. Date nt Injury (Month, day, year) 32b. Descdbe How Injury Occured 32c. Place of Injury: Home, Farm, Sheet, Factory, Performed? Available Prxx to Completion - of Cause of Deeth7 aturel ^ Homidde Office Buildng, etc. (SpecilyJ ^ Yes o ^ Yes ^ No ^ Accident ^ PeMhg Inveatlgetion 32d. Time of Injury 32e. Injury at Work? 32f. If TrenapoAation Injury (SpecltyJ er ^ Pedestdan ^ Driver/O rator ^ Passen 32g. Location of irNury (Street, dry /town, state) ^ Suickfe ^ Could Not be Determined M ^ Yes ^ Na pe g . Other- Spectty: 33a. Certifier (tdteck ony one) sictan (Ph sician certif in cause of death when another h sican has ronounced death end com leted Item 23) rtH in t C 33b. signature and Tttle of Ce '"w~'"'~ M y g p y p e y g p ry y p To the bat of my krrowMd9s, death oxurrod due to the cares(s) and manner es stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - - - - - - - - - - - - - - - - - - , Pronouncing and artllying physkfan (Physician both pronouncing death ant certNying to cause of death) t d t d ^ 33c. LksnsnnnennnNumber ~ ~ ~ ~ ~ ~ 33d. Date Signed (Month, day, year) ) ~ 3 o tlta ease(s) an mrmrrer a sta e _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ To the best of my d9e, death occured at the time, dace, and plea, end due • Medipl ExemMer/Coroner .7 y t ~ j 1 ' t _ l On the bale of axrnlnatlon and / or Investigation, In my oplnlon, death occurred at its time, dste, end pica, end due to the awe(s) and manner as stated_ ^ 34. Name and A`~rasa of Person Who C tad Cause of Death (tlem 27) Type / Pdnt /mot D G to `. -~^'1 ~ 1L1~1 u S Rego gnaure and ~ N~ ~~-[ ~ ~ vZ ~ ~ ~ ~ a ~a j~ ` aoi a r' , ~© N ~ ~ ~ ©l I ~~ ~ 3 ,Z S ~ , r' Disposition Permit No. O`, ~ ~ I ~ ~ Y . i ~_ . . . <~ LAST WILL AND TESTAMENT f _ OF ~ ~``,,_'~ 1 . Wit. I~i. ~° ~ RUTH B. BERTOVIC I, Ruth B. Bertovic, of 106 Walton Street, Lemoyne, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and expenses of my a SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•[.AW 26 W. High Street Carlisle, PA last illness and funeral from my estate as soon after my death as conveniently may be done. I direct my body be interred at the Woodlawn Cemetery, Harrisburg, Pennsylvania. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate to my son, Thomas R. Bertovic, Jr., per stirpes absolutely and in fee simple if he survives me by thirty (3 0 ) days . THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH In addition to the powers conferred by law, I authorize any personal representative acting under this instrument, in his absolute discretion: ~. To retain in the form received, or to sell either at C~ SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•I.AW 26 W. High Street Carlisle, PA public or private sale any real or personal property; B. To exercise any options to subscribe for stocks, bonds, or other investments; C. To join in any plan of lease, mortgage, consolidation, exchange, reorganization or foreclosure of any corporation in which my estate or any trust may hold stocks, bonds or other securities; D. To sell, transfer, convey, mortgage, pledge, lease or exchange any property, real or personal, which at any time may form part of my estate, for the payment of debts or taxes, or for any purpose of administration or distribution, for such prices and upon such terms as my personal representative, in his sole discretion, may deem wise, and to execute and deliver deeds of conveyance or transfer thereof; 2 .~ , E. To make settlements and compromises on such terms ash my personal representative in his sole discretion may deem wise without the necessity of obtaining any court approval thereof ; F. To make distribution hereunder either in cash or kind, as my personal representative in his discretion may deem wise. FIFTH I do hereby nominate, constitute and appoint Thomas R. Bertovic, Jr. to act as Executor of this my Last Will and Testament. SIXTH SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•I.AW 26 W. High Street Carlisle, PA I direct that no personal representative, guardian, trustee or other fiduciary appointed under this instrument shall be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, Ruth B. Bertovic, have hereunto set my hand and seal to this my Last Will and Testament, consisting of three typewritten pages, the first two of which bear my G~~N signature in the margin for identification, this j3 day of ~• ~~ Ruth B. Bertovic Signed, sealed, published and declared by the above-named Ruth B. Bertovic, Testatrix, as and for her Last Will and 3 Testament in the presence of us, who have hereunto subscribed SAIDIS, SHUFF & MASLAND ATTORNEYS•AT•I.AW 26 W. High Street Carlisle, PA our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. °_'~ r '1 ® (~Z~ADDRESS % ~~~%,~2 .~1..L~~ r~ / ~-- ~~, ~/' ADDRESS f COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, Ruth B . Bertovic, (~, ~d~n.,; ~'? . r~ ~.r ~ p5.~'~" and "~~ ~~~} ~~. 5~~ tyl+ g' the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that executed as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of_ sound mind and under no constraint or undue influence. / ~~ . Ruth B. Bertovic ~, ~-' ,Witness ,Witness Subscribed, sworn to and acknowledged before me by Ruth B. Bertovic, the Testatrix, and subscribed to and swore; c~:~ a.f_f i rmed to before me by Rob ~r _~ say Ci? s and yi v; an M __ witnesses, this f,,3 day of - 2 ~. ,. ~~~~..- Notarial Seal Sallie Osman, Notary Public Notar Public Carlisle Boro, Cumberland County Y My Commission 1=xpires Mar. 29, 2004 ~.__.__.__.. _ .... „ ........a,.,_...~..R._~..._...._.a.. 4