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HomeMy WebLinkAbout03-08-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS n , Estate of ~ D ~~' % ~ ~( t°,~~ ~ 1 C~j ,Deceased ESTATE NO: 21- /~~ ~~~ a/k/a: a/k/a: aJk/a: SS No: l 99 - /~. ~ ~a 9 ~ Petitioner(s) who is/are 18 yrs of age or older, apply{ies) for: COMPLETE SECTION `A' or `B' .AND "C" as ap licable: CAA. Probate and Grant of Letters Testamentary or ^Admnistration c.t.a., or d.b.n.c.t.a. {com lete. Part C also) P and aver that Petitioners} is/are entitled to the aforementioned Letters T ~~ AA m ~~ ~ A 2~ _ under the last Will of the above-named Decedent, dated Sc~r~e,h h erS"~oa ~ and codicil{s) dated i (State relevant circumstances, e.g. renunciation, death of executor, etc.) Except as follows, Decedent did not many, was not divorced, and did not have a child born or adopted after execution of the instruments offered for probate; was not the ~~ictim of a killing, was never adjudicated an incapacitated person, and w as not a party tv a pending diF°t~rce pmGeeding at the tune of death wherein grounds far di~-orce had been established as defined. in 23 Pa. C.S.A. § 3323(8}: ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pende~ life, durante absentaa, durante minoritate) C. Petitioner(s), after a proper search, haslhave ascertained that Decedent left no Will and was survived by the: following spouse (if any) and heu-s (If Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of heirs); was not the victim of a killing; .vas never adjudicated an incapacitated person; and was not a party to a pending di~~oree proceeding wherein grounds far di~-orce had been established as prop-%ded in 23 Pa. C.S.A. § 3323(8), except as follows: 1 ame Address R 'onshi to Decedent ~_- C~ __~ ,_ .4 ~ F _: lf~L AUUI'1~1()!V AL SH~:1:TS Il+' '~IECESSAR~ THIS SECTION MUST BE COMPLETED: Decedent was domiciled at de~h in Cumberland County, ~~ ~~ ~i~ a _. ~,_k '~ •~ ~__ r last family or principal residence " (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then ~ years of age, died ~ cad' / '~~ ~` at ~ ` ~ (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: _If domiciled in PA All personal property - $ Q ~~ , _If not domiciled in PA Personal property in Pennsylvania r. $ ~ , (~Q , (~s('~ _If not domiciled in PA Personal property in County $ --"`-f--"_ _Value of Real Estate in Pennsylvania $ Total Estimated V $ ~~~~ 0.00 '• 1 Location of Real Estate in Pennsylvania: (Provide full address if possible.) ` -~ 1J Signatures} Names & Martin Address es 1 ®1 I E} ~ ( } r ~7 R ~1~~ o ~r ~ E~~rD~~~ LV ~~~~ir~n ~csbur~-_ ~ `70 5~5 Itttcrim I c}r,rtz R ~~ -~14 c< tsc:d t ~.2tr.1 t} h4- CtFtithertat~d Cottiit~~ ~et~ditt~ actiotl h~ the C.~tu-t Pa~,~c 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF 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 ~~ 1 ~~ Si ature oJPersonal Representat e bef P me the ~ day of ~ .~ ~~~~ "r __ Signature ojPer nal Representative C7 ~_ 1~ or she R.,gister S~,,nature of Personal Representative . z {__ - 1. a.-~ + r y~ ~~ "~ File Number: ~ ~ " ~l y (~'~ ~ ~ a ~: Estate of L (~~~~~ ~ ~i° ~ Y ~ ~ ,Deceased. ~~``' Social Security Number: Date of Death: ~~ 2-z ~~ AND NOW, _ ~~~~ h ~~ / in cons'deration of the foregoing Petition, satisfactory proof having been presented befo e me, IT IS DECREED that Letters - ~ ~ /~ L° are hereby granted to / ~ and that the instruments} dated /lf~.(~~ described in the Petition be admitted to robate and filed of FEES / ~~ Letters ........... $ ! ~ Short Certificate(s) . ~ ~,1... $ r~~ en tl i tion(s) .......... $ ... $ ... $ ~~ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ , the last Will (aryd Codicil(s)) of of Wills Attorney Signature: Atton~ey Name: Supreme Court I.D. No.: Address: Telephone: in the whose estate r-~,~,n Rw-o? rev. 1v.13.v~ Page 2 of 2 _ _ _ _ I~IOS_roi Itl~:~' inv(t~, .~1 ~_ ~ ~ _ ~~~ li'C LOCAL REGISTRAR'S CERTIFICATION OF DEAT'F~~ WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ,rprrniiii~=, ~~ 'T'his is to certif that thc~ il~forrnali(~n ~(~re l~ van is t~~'''` ~,ZH OF p~ y ~i 1,1t~~,P Fiy' correctly copied from an (>r)~~~r~al (,~rrifi~.,(te ot~ Death ,off ~l~J~, ~,~~ p ~ ~ daily tiled with nee ~~~ 1 oc=(~ ke~i~~trar. Th~~ original ~~~ - ~~~ certificate will he fc/r~~~~arde~l to the State Vital o ~ ~Z ,v~ -,;~~ ,~.; Re~:ord~ Office for perirlat~hnt filing. P 17296441___ =99j _=~~a,1 ~ r/ MENT OF Itr ~ -~---~---1 Certification Number ~~~°'-~~~~~~~~~/~~''' Lc>cal Registrar ( Date [sued ........ _ ......................_......... . ___ _ _ _ n :.~ ~ -- :._ C~ _ ~ _, , ,--, _.._ ~ ~. 1-~ i 7 ( ~~ f7 ~P~ ..~~ ~:r , r'a ~ .~~~ a -~t ~-~, t:•'~ ~ r ._ --i-~ H105.143 REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE r PatNT IN PERMANENT CERTIFICATE OF DEATH BLACK INK (See instructions and examples on reversal .._•__ _.. _ ......___ 0 U w a 0 w 4 Z t. Name d Decedent (Prat. middle, last, suffix) 2. Sex 3. Social Security Number ~ ~ ~ -4. Date of Death (Month, day. year) Lottie S. Rebovich Female February 27, 2011 5. Age (Last Birthday) lMder 1 Under 1 day 8. Date d Birth (Momh, day, year) ]. Bi (Gry and state or rxxxdry) Sa. Place d Death (Check onl one) Q~ 8 ~j4 Y • -lorxns Days yours Mriw:s 6 /22 / 1926 ~L1POTlt PA Hospital: Other. ~- rs. , ^ Inpaz~ ^ ER /Outpatient ^ DOA [~[ Nursing Hone ^ Residence ^Other - Speraty: ' Bb. County d Death Bc. Ciry. Bono, Twp. d Death fid. Fecildy Name (II not instiNBon, give street and number) 9. Was Decedent of Hispanic Origin? [~ No ^ Yes 10. Rata: American Indian. Bieck, White, etc. • Cumberland Carlisle (K yes, specify Cuban, (Spmjf» ('hureh of cod. Home Mexican. Puma Rion, etc.) white 11. Decedent's Usual lion Kind d work done most d ~ tae. Oo rat stato retired 12. Was Decedent ever in the 13. DacedenYS Edudtan (Spedly oMy highest grade completed) 14. Marital Status: Married, Never Married, 15.:iurvrvtng Spouse (!i wife, give maiden name) Krrq o} WoAc Kind of Business /Industry U.S. Armed Faces? Elementary /Secondary (0-12) CoNege (1-4 or 5+) Widowed. Divordd (Specify) seamstress manuf ^Yes C~No idowed • 16. Decedent's Maiartg Address (Street. city /town, state, zip code) Decedent's Did Decedent PA 31 SUSSeX Rd . Adual Residence I7a. Slate ~~ i^ a 17c. ®Yes. Decadent Lkred h lei' T' A 1 1 an hvp. H] 1 PA 1701 1 ,ro. county Cumberland Tawrehrp~ 170. ^ No, t)acedent Lived wilMn . ~ Atonal omits d Ciry /Born 18. Father's Name (Pest, middle, lest srdfbr) 18. Mdher's Name (Flrst. middle, maiden surname) Francis 8u z k hie Cza h 20e. Infamant's Nertk (Type! Print) _ 20b. Informant's MaNkrg Address (Street, city /town, state. zip code) Patricia L Rebovi h . c ~ • 21 a. Method d Oisposilion ^ Cremation [] Donation Burial ^ Removal from State ;W C 21 b. Date d DispositOn (Morton, day, year) 21c. Place of Disposition (Name d drtretery, crematory or other place) 21d. Localan (City /fawn, state, rip coda) as remation or Donatbn Adh«ized • ^ - spaarr: ; by Medical ExamNrer f c«onr>r ^ Yes ^ No March 4, 2011 Mt . nl ivet Cemetery erton, pA • zza. signature d Frxterel service Lioensea (« parses, aclmg as such) 1~' 22b. License Number 22c. Noma and Adaess d Facilky ~ Market Plaza Way FD-011667 Malpezzi Funeral Home Mechanicsb PA 17055 Complete Hems 238 when physician fe nd availshle at tlme d death to . To the best d my knowledge. death accuretl at the time, date surd place stated. (Signature and title) 236. License Number 23c. Date Signed (Month, day, year) drtlry teats d death. • genic 24-28 mtel be completed by person 24. Time d Death 25. Date Praauiced Dead (Morah, day, Yead 26. Was Case Referred to Medal Examiner I Coroner for a Reason Other than Cremation or Donation? • "'''° °"°'x'°ad°a"' a ~ 12:50 P M. February 27, 2011 ^Yes ®Na CAUSE OF DEA77i (See inrstructiona and exampiu) r Approxinwte interval: Part IL Eller dher ' ' 28. Did Tr>baoco ilea Conaibute to Death? Item 27. PaR 1: Eater the dleii d events -diseases, iMu^es, « artrpkratims - that directly caused the death. DO NOT enter lenrMrsal events such as cardiac artest , r Onset ro Death lwt nd resuttirg in the txrdetlyxg cause given in Part i. Yes P respiratory arrest, « venlripdar fixrYfation wgtaut sfxtwrsg the etiology List orgy one dose on each kris. r ^ ^ ~~ r ^ No ^ lJrlknown WM€DIATE CAUSE (Pinto disease « /`~ .[ ~/,~y ~ t~ ~j r 29. If Female: condr6an resulting in death) _~ a. (~(i 'ti/!r / . ~ ~ ( "~ - / '~.Lv- 1 ` `f-"u i ~y V C.ef ' Due to (or as a ot): ~ - ^ Nd pregnant within past Year lest Cordifons. N any. b, r ^ Pregnant at time d death to cause listed on kne a (Enter UNDERLYING CAUSE Due to (or as a consequence oQ: r . ' - ^ Nd pregnant but pregnant within 42 days • ivrewlU'~g indeath) LA c' r d deaM r Due to (« as a consequence of): r ^ Nd prer~iaM, but pregnam 43 days to t year • d. ~ before death D~ year _ ^ UrVuawn tt pregnant within the 30a. Wes an Autopsy 30b. Wero Autopsy Frdings 31. Marabr d Death 32a. Date of Injury (Month. day. year) 32b. Deecdbe How Injury Occurred Performed? AvaYade Prior to Cortrpletion ~~ Pfad d Injiuy: Home, Fartn, Street Factory, d Cause d Death? NeNrel ^ Fiorrwade Office Buikkng, etc. (Specify) ^ Ya ~ No ^ yes ^ pip ^ Accident ^ Prtrtdrg Invesdgatbn 32d. Time of Injrxy 32e. Injury at Work? 32f. d Transportation Injury (Specify) 32g. Location of Iryury (Street, rdty I town, crate) ^ Suicide ^ Couk! Nd be Determkred ^ Yes ^ No ^ Driver I Operet« ^ Pas .Pedestrian 33a. Certifier (check only one) _ ._ -~- 33b. Signature and T Qf'l';BfSt ~-- '~ C_._._ ' ~Ying PAYsklert (PhY~~ 9 cause of death when arwther ptrysiraan has prarrouriced deem era completed ttem 23) To tM b t f l k t ' t ~ a o my now edge, rkaM oaurred due to the dose(s) and manner a sated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Pronouncing and carlifyin h skian (Ph sician Ddb ronou dn th tl d if i ~ ; ~ ~ _" g p y y p g n ea an cert y ng a duce of deem) _ - _ ~ To }hs best of my krrovAadge, desfh oaurred at the tlme, date, antl ,and due to the tau place se(a) and manner as stated_ _ _ _ _ _ _ _ __ _ _ _ _ _ • Medial Examiner I C 33c. License Number .1~ _ ~ '~ ~ S 33d. Date Signed (Month, day. year) 7 f arorwr On tyre basis of examination and ! or investi atio in l b d th i ? (© ~ ~ ~ g n, my op n n, ea occurred at the t me, date, arW place, antl due to the dose(s) and manner as stated_ ^i 34. Name and Address of Persa~ Who Completed Cause Death (Ite ~ m 27) Type 1 Pint 35. Re is Signature isfripl N D t F M _~, ~ G i~f "~/ T ~ ~ I ~!. ~ I~ ~ ~ !~ 1 a e ( oab, day, year) ~ j/ ~~~ ~~Q. ~ ~U Disposition Permit No. d ,7Q (J )(~ ~ ~LL `l ~ ` ~ J ~ / 1 - C.~~ T4 ~7 i~ p ~7 ~? _,~ `"' Tl`~7 ~-:-- r "`"~ ~~ LAST WILL AHD TESTAMENT ` ' ' ~' ~ ~ -~ - r ~. T""` , ~._y ~ -c.:. _:~J Cf ,..... ,_ ~„~ c ~ _~ ~t~~ ~~ I LOTTIE F. REBOVICH of Camp Hill Cumberland County Pennsylvania do heck make ;-- ; - , , , , , ,,, _ , publish and declare this to be my last will and testament hereby revoking all wills I~retofore -~~ ~~~~ , r. made by me. 1. t direct my personal representative to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. I direct that all inheritance taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property, whether or not such property passes under this Will, shall be paid by my personal representative out of my estate. 2. I authorize and empower my personal representative to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefore, in fee simple, as I could do if living. My representative is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said representative. 3. I give, devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. My residence and the furniture and contents thereof, located at 31 Sussex Road, Camp, PA 17011 to my daughter, Patricia L. Rebovich; and all the B. Rest, residue and remainder to my children, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint Mary Ann Hopper and Patricia Rebovich to be the co-personal representatives of my estate, to serve without bond. 8. I suggest that my personal representative retain the services of Harold S. Irwin, III, Carlisle, Pennsylvania in the settlement of my estate. . ~ ,~„ IN WITNESS WHEREOF, I have hereunto set my hand and seal this 5th day of September 2007. ~S 41~•z h • ~t ..a ~ (SEAL) LOTTIE S. REBOVICH Signed, sealed, published and declared by the above-named person as and for a last will and testament, in our presence, who at said person's request, in said person's presence and in the presence of each other have hereunto set our names as subscribing witnesses. _ _ - __ _. T AClO~IOWLEDGMENT AND AFFIDAVIT WE, LOTTIE S. REBOVICH, SARAH A. HARDESTY and JANE E. ADAMS, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly »worn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her last will and that she had signed willingly, and that she executed it as her free ~ind voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the will as a witness and that to the best of their N;nowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~~.s?,~-~ovc-c~ LOTTIE S. REBOVICH COMMONWEALTH OF PENNSYLVANIA :ss: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by LOTTIE S. REBOVICH, the testatrix herein, and subscribed and sworn to before me by SAR H A. HARDESTY and JANE E. ADAMS, witnesses, this 5T" day of September, 2907. COMMONWEALTH OF PEl`(NSYLVANIA Notary P u b l i c NOT~4I~.IAL SEAL Harold S. Irwin iii. Esq, Notary Public Carlisle, Cumberland County My commissiKx~ expires February 06, 2011