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Home My WebLink About12-03-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMB_E_R_LAND COUNTY____ Estate of Mavis H Hart also known as COUNTY, PENNSYLVANIA File Number 21 ~-10 -' (~ ~-~ ~' ,Deceased Social Security Nurnber 225_22-~q,910 Kathy A Bolash Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or `B' BELOW.) ^X A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executrix named in the last Will of the Decedent, dated All personal property $ _ 20.000.00 Personal property in Pennsylvania $ Personal property in County $ State relevant circumstances, 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 i:he 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 app rca e, en er: c. a.; n c..a ; pe en e r e; uran e a sen ra; uran a mrnon a e 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 Relationship Residence C7 ° ~ .. l_ , . _ r` ~ _ : ~ 9 S~` ,G r ~ ~ i `~_-~ ~__ ~1 _ J (COMPLETE IN ALL CASES.) Attach additional sheets if necessary. ~ •• r - Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at C!'1' ' 4525 Valley Road, Enola, East Pennsboro, Cumberland County, PA 17025 (L~st street address town/city, township, county, state, zip code) lj ~S Decedent, then ears of a e, died on ~"~ --~- y g 11 at Golden Living Center West Shore, East Pennsboro Twp, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: and codicil(s) dated 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: Signature Typed or printed name and residence Kathy A Bolash 4525 Valley Road ;~ . v~ ( Enola, PA 17Ka25 rorm KVIr-VL Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland County } 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. Sworn to or affirmed and subscribed -> before me this ~~_ day of r -,~=~~L-~...XJ ~~~ ~ C~ I _ ' 1 ~~ %`~ For the Register Signature of Representative Kathy A BOlash ~rgnarure or rersona/ Representative ~ignarure or rersona/ Representative C7 ~ C ~~ ~, ,,~_ ~ ;x,.? g ~ ...r..i ...1... i. l .7 `" r-- File Number: 21-10 "' l ~~~"~ Estate of Mavis H Hart lY ~~ r ~ =~ W ~.......; w~ " ~ ~~ 1 ..-> C7 ~--r~=i ~ Dec~e~l -p .`.~ :. :.~.:;; __,, ., T. .:=; _ ~; ~,~_._ ,, ...._.i r: -, - ~ _- ; rw~~t~ SociahSecurity Number: 225-22-4910 Date of Death: 11/2010 ~ ~ AND NOW, ~r+-~ L~ C~ I ~i ~ ~-~ I ~U L ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Kathv A Bolash in the above estate and that the instrument(s) dated _ ~ _ ~ j~ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters .......................................... $ ~ ~ L~` Short Certificate(s) ....................... $ ~ (~ ~- ) Renunciation(s) ............................ $ ~~ ~ ~ ~ $ I "~ ~ Cwt 4 {~ TOTAL $ $ $ $ $ ~ ~ - ~~ ~ A Supreme Court I.D. No.: 4 Johnson Duffie Address: 301 Market Street P.O Box 109 Lemoyne, PA Telephone: 717-761-4540 Form 14NV-Q2 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attorney Name: DAVID W DELUGE '~'•~; ~~0 1t ~~ ~~ft~gal ~E~ d~~:,~ic~~ ~~;i~ ~,:~ ~:)/ i~:{~tC~t~'(~~ ~:~~ ~xc~tc~c~~~~~~1-=. ,;,,:.,. /~ ~, 1, 'C7 is ~ ~ ~ ~~~. r ~ , ~ 'r` .. ~ . r ~ ~ ~~ti ' ~~~` '''~'E ~ ~~ `~"` w e,~ /j l~t d " , (~s~'a I t 11'~• ~ I _ rN~j 't. 'I~tlt._1 , .ii f,',~~~,, t r Y{. ,( .~ ". ~' t ~~-` it+it~rl~l~tttitsn hi~)'~ ~~i~ct; i~ i,'~~s~,~nal ('c';•t;d1~'E1te. t11 [~)t~lth i ,~. ri~/1~;°(i (f, 11~1~` ~>(~slt' V)tG(1 '1~ii9~~'(31 lllltlt?~ ~ ~~ v z z zolo __ ~ -- --_. _. a ___P .,17045210 r ,I,, , ;, l3 REV 1101006 - /PRINT IN RMANENT .ACK INK 1. Name of Decedent (First, middle, last, suffix) Mavis H. Hart 5 A B' tai _ ..~,~i COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH .VITAL RECORDS ~ ~i ...~ ~ `~ , ` CERTIFICATE OF DEATH U7 ` ~ C'~ (See instructions and examples on reverse) O'~ . '' ; STATE FILE NUMBER 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) Female 225 2 - ~ ~ ~ r~Y) under 1 r under 1 de 6. Data of Birth Month, de r 7. BI lace and state q tore coup Ba Plea of Death check 2 are 4 9 ] 0 November 19 , 2 0 ] 0 - MOMS Days Hours MhWea • 91 Hospital: Y~• 10/20/ 19 19 Arcadia, Virginia char: ~' CouMy d Death Bc. CRy, Boro, Twp. W Death ^ Inpatient ^ ER / Outpatkxtt ^ DOA ®Nursing Honre ]Residence • 8d. Facility Name (If rat insfltutlon, give street and number) ^ Other • Specify: Cumber 1 a nd East P e n n s b o r o Tw p . 9. Was Decedent of Hispank; Origin? ®No ^ Yes 10. Race: American Indian, Black, White, etc. Golden Living Center West Shore (IfY•a'eP~Yaban' (spec;/}, 11. Decedent's Usual Occ lion Kind of work done du • most of worki Ilte. Do not state retlr 12. Was Decedent ever in the 13. Decedents Education S Mexican, Puerto Rican, etc.) White C 1 e r i c a ~"o'k Kind of Business/ Industry U.S. Armed Forces? (P•dy ony highest grade completed) 14. Marital Status: Married, Never Married, 15. Surviving Spouse (If wife, give maiden name) Penn DO t Elementary,( Secondary (a12) College (1.4 or 5+) Widowed, Divorced (Specr/y) - 1 . Decedents Mailin Address (Street, city /town, slate, zip coda) ^ Yes 1 _I No i5 Divorce d 4 5 2 5 V a 1~1 e y Rd . D"Ye Die Decedent E n o l a P A 17 0 2 5 Actual Residence 17a. State P A Live in a • r 17c. ~ Yes, Decedent Lived in Hampd e n ,m, moony Cumber 1 and Township? 17d ^ No, Decedent Lived within Twp. 18. Father's Name (Frst, middle, last, suffix) Actual Limits of Jessie Shorter 19. Mothers Name (Flret, middle, maiden surname) City /Boro 20a. IntomtertYs Name (Type !Print) Bessie Go 1 d e n Kathy A . B o 1 a s h 20b. InfomtanYs Mailing Address (Street, city /town, state, zip code) 21a.MethodofDisposltbn 4525 Valley Rd. Enola, PA 17025 • ~ ^ Cremetbn ^ Donation 21 b. Date of Dis ® Buda) ^ Removal from State i Was Cremation Or DOIIatlOn AuthOMZBd Posrhorr (Month' day, year) 21 c. Place M Dispoeiflon (Name of cemetery, cremato a other lace ry P ) 21d. Location ICity/town, state, zip code) • °"~'- 'bYNsdkalExaminer/coroner? ^vee^Ne November 24, 20] Chestnut Grove Cemeter 22e. signature of Funeral L~ensee (q person actlng as such) Y Ma r y s v i 11 e , PA 1 7 0 5 3 22b. license Number 22c. Name and Address of Facility • ~ - FD 012774-L Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025 Complete items 23a-c y when certifying 23a. To the of my knowledge death occurred et the time, a and place stated. (Signature and tills) physidart is rat available al time of death to 23b. License Number Cep ~~ of death• //_ j / 23c. Date Signed (Month, day, year) Items 24-28 must be completed by person 24. Time of Death 25. Date Pronounced Dead (Month, day, Year) r r• l a O O • who pronotmces ' ~~ Q, q t~ 28. Was Case fieferred to Medk:al F~caminer /Coroner for a Reason Other than Crematlon or Donaton? "'I ~~ / ~ U+ ^ Yes ~1'No Item 27. Pert I: Enter the ftiain of everos _ CAUSE OF DEATH (Sea Inatructlons and examples) diseases, injuries, acomplications -that directly caused ltre death DO NOT enter terminal events such es cardiac arrest, ~ Approximate interval: Part II: Enter other respiratory arrest, or ventricular flbrillatlon witltout shows the a Onset ro Death but not resulting In the underlying cause gNen in Part I. 28. Did Tobacco Use Contribute to Death? n9 tk>logy. Ust ony one cause on each line. ~ ^ 'Yes ^ Probaby MGMEDIATE CAUSE (Ernst disease or ~ ~ conditlon resuHirg in death) C~, _ /1Q ~~ /~ r ^ Na~nknown ~ 29. I( Female: Due to (or as a consequence of). r Sequerrtally Gat conditions, A any, ~ ^ Not pregnant within past year beding to the cause listed on line a. b' r Enter the UNDERLYING CAUSE Due to (or as a consequence of): ~ ^ Pregnant at time of death (disease a injury that Initlated the ~ • events resulting m death) LAST. c. ~ ^ Not pregnant, but pregnant within 42 days Due to (or as a consequence of) ~ ' of death • d. i ^ Not pregnant, but pregnant 43 days to 1 year r hefore death 30a. Was an Autopsy 30b. Were Aut ~ ] Unknown R pregnant within the PeAormedv ~Y FlMings 31. Manner of DeaM 32a. Date o1 I 'u Month, da , past year Available Pdor to Completlon ref" ^7 ry ( Y treat) 32b. pescnbe How Iryury Occurred of Cause of Death? (.~J Natural ^ Homidde 92c. Place of Injury: Home, Farm, Street, Factory, Office Building, etc. (Specrly) ^ Yes No ^ Yes ^ Na ^ Accident ^ Pending Invesdgaton 32d Time of Injury 32e. Inury at Work? 32f. If Trens rtation In'u ~ 1 ry (') 32g. Location of Injury (Street, city /town, state) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Driver/Operetor ^ Passen er M. 9 ^ Pedestrian 33e. Certifier (check qty one) Other - Speci/y: • Certllying phyakfan (Physician certifykg cause of death when another physician has pronounced death and corn tad Rem 23) Signature and of Certlfler 7o tfb beat of my Imowbdge, death orxurrod due to the cease(s) end manner a stated _ _ _ _ ~ .~----„' Pronouncing and oertNying phyakian - - - - - - - - - - - - - - - - - - - - - - - - - - - Tothe beat of (Physican bO~ Pronouncing death and certNyirg to cause of death) - - 33c. Lk:ense Number my knowledge, death occurred at the time, date, end place, and due to tM cause(s) and manner a stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33d. Date Signed (Month, day, Year) • GGedlcslExaminer/Coroner ~~D~ ~ ~ f/` l ~ _ r O On the heels of sxsminatlon end / or Investigation, In my opinion, death occurred at tf» time, data, and place, end due to the ease(s) and manner as stated_ ^ ~ 34. Name and Ad~f Peen Who Comple Cause th (Item 7) Typo / Pdn 35. Registrars lure end District Number ~--~.,/~r~ ~ ~~~ ~~~ p ~-r.,~'1 I a' 1 1 ~ ~ / 36. Date Flied (Mortlh, da r ~-r'~ "/J Disposltion PennR No. _ tJ 5"5` ~ l~ ~~~~ til ~ ~t~~ ~.~~~~t~~e~ r~, ,T~, ~~ a ~~ -~ c> ,.. C7 _ _.~ MAVIS H. HART `~ ~ =~ `"' ~- ~ 4 „ t ~ ~ ~~ ^C) _•a .. .~'' C_l1 I, MAVIS H. HART, of Enola, Cumberland County, Pennsylvania, do make, publish ands declare this to be my Last Will and Testament, hereby revoking and making void any and all former Wills made by me. ARTICLE I I direct my Executrix to pay all the expenses of my last illness, my funeral and burial and of the administration of my estate as soon as practical after my decease. ARTICLE II I direct my Executrix to pay all inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death on any property or interest in property which is included in my estate for the purpose of computing taxes. My Executrix shall not require any beneficiary under this Will to reimburse my estate for taxes paid an property passing under the terms of this Will. ARTICLE III I bequeath my household and personal effects any other tangible property of a (like nature (not including cash and securities) together with any existing insurance thereon, to ROBERT S. BOLASH, SR. and KATHY A. BOLASH. Should ROBERT S. BOLASH, SR. or I~CATHY A. BOLASH predecease me, I bequeath such items of tangible personalty and the insurance thereon to the survivor of them. ~' ~ - ~'; '`.: ., --- . T= _~ :~! Y ..,:.~ ARTICLE IV I give, devise and bequeath all the rest, residue and remainder of my estate of every nature and wherever situate to ROBERT S. BOLASH, SR. and KATHY A. BOLASH in equal shares. Should any such person predecease me, then the entire residue of my estate shall go to the survivor of them. Should both of them predecease me, then the entire residue of my estate shall be distributed to the children of ROBERT S. BOLASH, SR. and KATHY A. BOLASH in equal shares. ARTICLE V I nominate and appoint KATHY A. BOLASH, as Executrix of this my Last Will and Testament, and require that said Executrix serve without bond. In the event that the above named Executrix shall, for any reason, fail to qualify, or having qualified, fail to complete the administration of my estate, I nominate and appoint ROBERT S. BOLASH, SR. as E=xecutor of this my Last Will and Testament. IN WITNESS WHEREOF, I hereunto set my hand and seal this / ~_ day of .~ ~ , 2004. '~7 'Q.y"~' H~ A`~~~`GZ- (SEAL) MAVIS H. HART Signed, sealed, published and declared by the above-named Testatrix as and for her Last Will and Testament in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto subscribed our mes as itne s. ,\ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: I, MAVIS H. HART, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that f signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~~ ~~~ MAVIS H. HART Sworn or affirmed to and acknowledged before me, by Mavis H. Hart, the Testatrix, this ~~~~day of `~,~... X004. Notary Public 4~ .~"~~ - NO ~ARiAL SEAL ®IANN~ LE~iIGP ~lotary Public ~ ~y Corn~mis~s cn E ~ire~ Decl 21 00~ r AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND -.. ` , 1 P.. t ~, W e, ..~ `^~ - '~C~----'~ and ~ ~.r..-~~:~..~.._ `tom _ _ ~~ ~ ~ ~,.. _ ,, the witnesses whose names are signed to the foregoing instrument, being duly qualified ccording to law, do depose and say that we were present and saw the Testatrix sign and execute the foregoing instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at that time at least 18 years of age, of sound mind grid/under no constraint or undue influence. / ~ ~`-~~ _-- 1 ~~ ,,y_- Sworn to or affirmed to ~~. ~ `~r.5 and 'lam 4 this ~'~ay of ~~ ti,2004. and subscribed to before me by '~ --r-~ ~~.. witnesses, _,,,n._,.,._.,, NOTABIAL~SEAL OIANNE L.ENIG, Notary Public ~.ernoyne Borough Cumberland Co. ~y Co~msssion Expsres Qec. 21, 2005 .,~~:_....a_~ ~.~....,z..,..~. ~. ,~,.,:..t.~....,~,,....,.,...,~..f p ~\ Notary PubCi 234657