HomeMy WebLinkAbout03-18-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~ ~ ~ ~ (~~ , ~ ~V c-cL ~ ~~ , ,Deceased ESTATE NO: 21- "~' ~ ~ ~ ~ ~`~..~~
a/k/a:
a/k/a:
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as
a . plicable:
A. Probate and Grant of Letters Testamentary or ^Administration c.t.a., or d.b.n.c.t.a. (complete Part C also)
and aver that Petitioner(s) is/are entitled to the aforemen Toned etters under
the last Will of the above-named Decedent, dated 1 ~ ~~~ f~ ~ and codicil(s) dated
(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 the
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a
party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as defined in
23 Pa. C.S.A. § 3323(g):
^ B. Grant of Letters of Administration
(If applicable, enter d.b.n., pendent lite, durante absentia, durante minoritate)
C. 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 and complete list of
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce
proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except as follows:
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Name Address nshi to ITecedent -~- : ,z~
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....
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USE ADDITIONAL SHEETS IF NECESSARY ,,1 --~ ' ~ ~. -'
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THIS SECTION MUST BE COMPLETED: 1~ ~~" J =
Decedent was dom` iciled at death in Cumberland County, Pennsylvania,iwith his/her last famil or principal residence
(Street address with Post Office and Zip Code, Municipality: Town p, Borough, City) ~-
Decedent, then ~~ years of age, died l '~ (~ at ~.~,w ~ ~ ~~ ~~ ~ ~~
(Mon ,Day, Year of death) (City and tate where death occurred)
Estimated value of decedent's property at death:
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 $
Total Estimated Value $ ~ 3 i1, U l~ (~ U C)
Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ ~ ~ ~ . ~': ~,.~ t\ ~ ,~ ~ . (~t~ ~ ~ c\ ~'L~~Wri ti" A ~ 7 ~;-1
Signature(s)
Name(s) & Mailing Address(es)
~ CS ~~
~ - ~ .~;:
~~-Q%.~- -~ ~~ r~Q~~ fir; r - c~ ~- • e~ ~ ~ ~ ~ ~~ ~ x K
,rncnm rorm rcw-v~ rev~sea i~.lb. iu uy c;umneriana county pending action by the Court Page i of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are time 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 tl,P estate according to law.
Sworn to or affirmed-and subscribed
before i;ie the. ~ _ day of
For the Register
"~.s~~-~_ ~- S
Signature of Persona! Representative
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~. _ _~
Signature of Personal Representative
Signature of Personal Representative
_._
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File Number: -
Estate of ~~ 1 - t - ~ i~,~ r ~,.~ ~ ,Deceased
Social Security Number 4 a " ~~ '~ ~~ p Date of Death: [~ ~ - ~ L`~ ' ~~ ~
AND NOW, ~,~,~~ ~. ~~ ,~, in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~ ~ ~ C ~ ~~ 1~l
are hereby granted to _ ~CQ. ~~~ ~ ~ L ~ ~ hC.(n ~ r
__ in the above estate
and that the instrument(s) dated Q) - ~ A - ~(~ u
described in the Petition be admitted to probate and filed of record as the last Will (and C.odicil(s)) of Decedent.
FEES
Letters ........... .. $ ~~Q. Q - ~-Q Registe,~- of wills ~~. ~ •~ n /'y,1 ~ p
Short Certificate(s) .~~~.... $ ~ ~ ~ - b~
Renunciation(s) .......... $
~J V ~ YVI~' ~ oYl ... $ y ~
... $
Attorney Signature:
Attoi-~iey Name:
Supreme Court I.D. No.:
Address:
... $
... $
... $
... $
Telephone:
... $
TOTAL .............. ~~ L"
Form RGV-Q? rev. l U. I3.0( Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph,
E~r~e I~~'( this. ~-~ertific~-te, `~(i.t)O
P 17_,02-9_5~.~___
C~ rtii-ication ~iin7~her
Tl~-is is to certify th.-t the information here ~~iven is
correctly coded fron) an original Certificate of Death
dul}~ filed with me ,-s Local Registrar. The original
certificate ~~ill he f~)r~~~al~ded to the State Vital
>Zecords Office for l~c~rn~~a~nent filing.
,~,
~~ ~~ ~~ti ~1~'r ~~-
Lt)cal Re«istr~-r Date (slued
H105.143 REV 112008
TYPE r PRINT IN
PiAC~c~Ar i~
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse) CTATC FII F Al11eIRFR
1. Name of Detederd (First, ntodde, kmt srdoc) 2. Sez 3. Social Ssaairy Number 4. Date d Death (Month, dsy, year)
Nada M. Navratil Female 209 - 12 - 5368 January 14, 2011
_ 5. Age (Last BiMday) lkzler 1 Under 1 6. Data of BiM 7. C and state « 8a fzlaa of Oeelh Cheek an one
~ Hews l ~ - O i 92:3 Granville, Pennsylvania Hospital. Deter.
87
9l
^
^
^
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^
^
Nursing Home
Residence
Other - Spei
y
DOA
ER / Ouq>etient
rpetient
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Bb. County of Dean Bc. Cdy, Soro, Twp. d Dean 8d. Faciily Name (M not kmtiaa1011, gne street and number) 9. Was Decedent d Ftieperwc Odgkr? ~j No ^ Yes
r~ 10. Race: Mbrican kr6en. Blade While, etc.
Cumberland East Pennsboro Holy Spirit Hospital (~ s R~iao, ~.) ( White
11. Decadent'a Usual W vgrk d one mat d Yh. Do not state re' 12. Wes Deaderto ever n the 13. Deadent's Education (Spedly onty higlNet grade oortpl eted) 14. MarRal Status: Married, Never Married,
p 15. Surviurg Spo use (8 wife, give maiden name)
u/r
~es
os
s U.S. Armed races? ElemeniarY / (0-12)
'l" Copege (1-4 « 5+) widaved, Divorced (sp•
Nl
Widowed
an
ta
H
te
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18. Decedent's Meikrg Address (SUeet dry ! krwn, state, zip code)
837 North Walnut Street
Did Decedent
Decedenra
Aeu,al Reddens 17a. state PA ~ 17c. ^ Yes, Decedent Lived m Twp.
Mechanicsburg, PA 17055 ,7b.ce„ny Cumberland ,7d.J~ tol~ad~trwn Mechanicsburg ~/~
18. Famefs Name (Fist, rtiidde, last, suffix)
Daniel Watts 19. Moriels Noma (First rtiiddk, maiden sumeme)
Elnora Fisher
20a Mfortnant's Name (type / Pdnt)
Terry Shaner _ 20b. Inbrtnanrs Mailing Adrkees (Street pN !town. state, zip code)
23 Edgewood Drive Mechanicsburg, PA 17055
21 a. k4etlroe of Diapodtion i ^ C1QfAfl6y, ^ Donation 21b. Date d Dlepodtim (Month, day, year) 21 c. Ptaa M Disposition (Name of arriebry, crernmory «orier place) 21d. Loation (Cdy/ bwn. state, rip cods)
-B«at. ^ Rsnavelfamstab ;wasCraniatlortaDonatlortAum«iaad 2011
January 17 - Grantham Memorial Park Grantham , PA 17027
^ Oyy, - i by Ysdleal ExarnYrrlCororteR ^ Ysa^ No ,
~ 22a. of Funerd aiding es aud+) 22b. Lianas Number 22c. Name and Address of Fadtiry
~ FD-012662-L Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
c ariy when ardh4n9 23a. To d my krawbd9e, dean oawred at ris time, date and plea stated. (Si9rteAxe and title) 23b. Liarme Number 23c. Date Signed (Monri, day. year)
pnydcian is rat avaiabb at time d death b
artily arms of dean.
IYrrr 24-28 must a arnpNtsd by person 24. Tune d Death
~ 25. Dab Prorata>ced Dead (klonMr, day. year) 26. Was Case Referred tg. Med'ical Exenwrer / Coroar for a Fa~asan OCpr Man Crertratbn « DoraUon?
~
^
Mho Ixaaraaes deem. - (~ ~", M. _J ~ N U A 2. t' ~ v~ (% I ~ No
tea
CAUSE OF DEATH (Sae Instnictlons and axampNs) i Approxirtieb interval:
DO NOT enter tenriid events sacs ac cardiac arrest
Onset b Death
d
ari
t 6
d ri
li
ti
h
tl Part II: Errbr Drier '
o rie urderykg corms given in Part I
bU not resultin 28. Did Tobacco tJss CoriUibute b D.ari?
^ Y
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b
bl
a
.
rsc
y see
e
~
a
oa -t
a
tlem 27. Part I: Elver the l~91te~ - 6asases, i^liatee, «comp
reapvabry arrest «vsntrieuler Ibdtiation witliad showing me eliobgy. List only oro arms on each tie. , .
g es
ro
a
y
^ No ^ llnkrarwi
YIffDIATE CAUSE (Fnd daease « ~
ariditicri rgirltlrrg in deem) a a ~ ~ f J I ~ , 29. d Female:
^ Nat
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ant'a~itl~r
mt
at
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~,to mob(«esa~: C~~ g,'L~tST c-R~s1S ;
o
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^ Pregrram at Ere a deem
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b puae Bsled an F
ie a.
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Enter UNDERLYti4fi CAUSE Due b (« as a rarmequerc• on: i Nd pregnant, but pregnant vtoriin 42 days
d deem
(daeoa « kr)rry riet ird8e6ed rie r
c
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t
b
t
^ N
to 43 d
b 1
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events reetilkrg n dean) LAST.
Duero (« u a coreequerce of): i o
preyerit
u
pregar
year
ays
before sari
• d
~ ^ Urtooiown d pregwto witlton the pest year
.
30e. Was en Aubpay 30b. Were Autopsy Frd'rgc 31. Marrrrer d Dam 32a. Dak d kry'ury (Monet. day. year) 32b. Describe Flow Injury Oaurted 32c. Plan of kyray: Florae, Farts. Street Factory.
Olrge Buildxg, etc. (Sperry)
Performed9 Avakade Prior b Completion
of Cauea d Deem? ~ ~~ ^ ~~
^ Yes ~ No
^ Yes ^ No ^ Accident ^ Pen6rg lnvastigaCOn 32d. Tea of Injry 32e. Injury at Work? 32t. H Tranaporhtlon Injuy (spaclyJ
er ^ Pedestrian
erat« ^ Passen
^ D^YBrlO 329. Location of injury (Street, dly I rows, state)
^ Suicide ^ Could Nd be Debrniirred M ^ Yes ^ No g
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Orix - Sysdly:
33a. Certirwr (check orYy ore) 33b. SigriaMe and Title of Certifier
• C~NYInY PhY~ (~Y~•rr cMtilyn9 sues d dew when BratlNr ptrysicien nee pronotnced dean end cortpbted Ibrn 23)
TotMbwolmyknoMtoadp
dwnoceunWdrrtotlwcatrys)rdmennsrrsuad ~ / / -'f
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33c. Lianas Wmber
igned (Monri, day, Year)
33d Date s
Rottotwalni ~ ~~q Phy~rn ( bdh proriotackig deem and artllykg b awe d deem)
To the beat d my brwMt4s, dean oawrad d ma 1Mte, data. and plea, and due b the eauaslsl std nwinar as ahMd_ _ _ _ _ _ _ _ _ _ _ - - _ ^
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f>n the htlh W aaaniwtlori and / a invptlgatfon, N my opkfbn, deem occtand N IIM tlma, dal, and plea, and Gre b the awl(s) and irwiner w ataretL ^ 34. ysrrre a~Addrea_e,d r Cave of Deeri (hem 2n Type I Prkd
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" .Date Fled (Morton. day, year) f
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LAST WILL AND TESTAMENT OF - ~- ' ~ ~ '
NADA M. NAVRATIL - ` ' =
I, NADA M. NAVRATIL, of Mechanicsburg, Cumberland County, Pennsylvania, do
hereby make this my Last Will and Testament, revoking any former Wills and Codicils made by
me.
FIRST: I was married to ROBERT NAVRATIL, SR., and am now widowed. I have
three (3) children: TERESA L. SHANER (born 10/5/54); JOHN B. NAVRATIL (born 8/15/50);
and ROBERT NAVRATIL, JR. (born 5/14/46). These persons and any children born to or
adopted by them are described in this Will as "my issue." Provided, however, no adopted person
shall benefit hereunder unless the order or decree of adoption is entered before such adopted
person attains the age of twenty-one (21) years.
SECOND: I give my tangible personal property and all casualty insurance that I am
carrying on said tangible personal property to such of my children who are living at my death to
be divided equitably among or between them as they may determine, or, if they are unable to
agree, as my Executor shall determine, after considering the wishes of such children. I have
complete confidence that my children or my Executor will honor any written instructions that I
may leave with regard to said tangible personal property. Any such property not so distributed
shall be sold, and the proceeds added to my residuary estate to pass as hereafter described.
THIRD: I give, devise and bequeath all the rest, residue and remainder of my property of
every kind and description (including lapsed legacies and devises) wherever situate and whether
//M .N/
acquired before or after the execution of this Will, absolutely in fee simple to my three children
in equal shares to be distributed as follows:
(1) The shares for TERESA L. SHANER AND JOHN B. NAVRATIL will be
distributed to them, or if they do not survive me to their issue, per stirpes;
(2) The one-third (1/3) share going to ROBERT NAVRATIL, JR. shall be
held in an irrevocable trust, the trustee being TERESA L. SHANER, or if she fails
or refuses to act, to JOHN B. NAVRATIL. The funds shall be held in a money
market account or similar account with a monthly payment to ROBERT
NAVRATIL, JR. in the amount of $400, until all funds are paid. The funds held
in trust shall not be subject to levy and the payments shall not be permitted to be
anticipated. It shall be held as an irrevocable, spend thrift trust for the sole benefit
of ROBERT NAVRATIL, JR. At the time of his death, if any funds are
remaining in the trust, they will be distributed to the issue of ROBERT
NAVRATIL, JR., namely ROBERT L. NAVRATIL and AMY J. NAVRATIL, in
equal monthly shares of $200 per month, until all principal and interest has been
distributed.
FOURTH: If all the beneficiaries described in Article Third above are deceased and no
other disposition of the residue of my estate is directed by this Will, then and in that event only, I
give, devise and bequeath the rest, residue and remainder of my estate, real and personal, to those
persons living at the date of my death who would be my heirs, their identities and respective
shares to be determined in accordance with the law in effect in the Commonwealth of
Pennsylvania at my death, as if I had died intestate.
2 /L iy~
FIFTH: If any person under the age of twenty-one (21) years shall become entitled to any
share hereunder, then such share shall immediately vest in such beneficiary, but notwithstanding
the provisions herein, my Executor may distribute such beneficiary's share to any adult person
standing in loco parentis, or to a legal guardian of such beneficiary, or to a custodian (to be
selected by my Executor) under the applicable Uniform Transfers to Minors Act, without
requiring bond of such adult person, guardian or custodian. The receipt of such adult person,
guardian or custodian shall constitute a full release of my Executor for any property so
distributed.
SIXTH: No person shall benefit hereunder unless such beneficiary shall survive me by
thirty (30) days.
SEVENTH: (1) I name my daughter, TERESA L. SHANER, as my Executor. If she is
unable or unwilling to serve, I name my son, JOHN B. NAVRATIL, as my Executor. I direct
that my daughter, herein referred to as my Executor regardless of number or gender, serve
without bond in any jurisdiction in which called upon to act.
(2) Except as otherwise provided herein, if all of the above persons should fail
to qualify as my Executor hereunder, or for any reason should cease to act in such capacity, the
successor or substitute Executor shall be some attorney or bank or trust company with trust
powers, which successor or substitute Executor shall be designated in a written instrument filed
with the court having jurisdiction over the probate of my estate and signed by my daughter,
TERESA L. SHANER, or if she fails to act, signed by or on behalf of my son, JOHN B.
NAVRATIL, or if he fails to act, by the court having jurisdiction over the probate of my estate.
(3) My Executor shall receive reasonable compensation for services rendered.
3 ~~. N;
EIGHTH: (1) I give to any Executor named in this Will or any Codicil hereto or to any
successor or substitute Executor all of the powers enumerated in this Will and all of the powers
applicable by law to fiduciaries in the Commonwealth of Pennsylvania and in particular through
the Pennsylvania Probate, Estates and Fiduciaries Code, as effective and as in effect on the date
of my death, during the administration and until the completion of the distribution of my estate. I
direct that all such powers shall be construed in the broadest possible manner and shall be
exercisable without court authorization.
(2) My Executor is authorized and empowered to acquire and to retain, either
permanently or for such period of time as my Executor may determine, any assets, including the
capital stock of any closely held corporation, whether such assets are or are not of the character
approved or authorized by law for investment by fiduciaries and whether such assets do or do not
represent an over concentration in one investment.
(3) My Executor is authorized and empowered to disclaim any interest, in whole
or in part, of which I, or my Executor, maybe the beneficiary, devisee, or legatee, by executing
an appropriate instrument (in accordance with section 2518 of the Internal Revenue Code of
1986, as amended, or such similar section as may then be in effect).
(4) My Executor is authorized and empowered to sell at public or private sale, or
exchange, and to encumber or lease, for any period of time, any real or personal property and to
give options to buy or lease any such property. Additionally, my Executor is authorized and
empowered to compromise claims, to borrow from anyone (including a fiduciary hereunder) and
to pledge property as security therefor, to make loans to and to buy property from anyone
(including a fiduciary or beneficiary hereunder); provided that any such loans shall be adequately
secured and at a fair interest rate.
(5) My Executor is authorized and empowered to allocate property, charges on
property, receipts and income among and between principal or income, or partly to each, without
regard to any law defining principal and income.
NINTH: All estate, inheritance, succession and other death taxes imposed or payable by
reason of my death and interest and penalties thereon with respect to all property comprising my
gross estate for death tax purposes, whether or not such property passes under this Will, shall be
paid out of the residue of my estate, as if such taxes were expenses of administration, without
apportionment or right of reimbursement. I authorize my Executor to pay all such taxes at such
time or times as deemed advisable.
IN WITNESS WHEREOF, I have set my hand and seal on this my Last Will and
Testament this ~~j~'day of G~ , 2004.
(SEAL)
N A M. NAV TIL, Testatrix
SIGNED, SEALED, PUBLISHED, and
DECLARED by NADA M. NAVRATIL,
as and for her Last Will and
Testament, on the day and year
last above written, in the
presence of us, who, at her
request, in her presence, and
in the presence of each other,
all being present at the same
time, have hereunto subscribed
our names as witnesses:
~~,, , ~„_
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5
SELF-PROVING AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF .,~,.~..~_~~,~
WE, ~~yrz.--and ,
~~. `~ ~ ~,:._. n.lc-- ,and NADA . NAVRATIL, the Testatrix and the
witnesses, respectively, whose names are signed to the attached or foregoing 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 that she had signed willingly (willingly directed
another to sign for him/her), and that she executed it 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 witness and to the best of his or her knowledge the Testatrix was at
that time eighteen (18) years of age or older, of sound mind, and under no constraint or undue
influence.
NADA M. NA RATIL, Testatrix
Wit ess
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Witne s
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fitness
Subscribed, sworn to, and acknowledged before me by NADA M. NAVRATIL, the Testatrix,
and subscribed and sworn to before me by ,
~~ ,andi~ ~~, t \ U; r,1C.- ,witnesses, this ~ ~f'~--day
of , 2004.
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~~~
Nota Public
COMMONWEALTH OF PENNtY1.VAN1A
NOTARIAL SEAL
.CYNTHIA J. RULE, Notary Public
Camp Hill Boro., Cumberland Cota~-
6 Commission Ex 'ret F 3, ~p06