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HomeMy WebLinkAbout08-03-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Marv Giornesto Neamtz File Number 21-11 - (° ;; ~.i l~ also known as ,Deceased Social Security Number 201-18-2810 John C. Neamtz 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 named in the last Will of the Decedent, dated and codicil(s) dated State relevant circumstances, e. g., renunciation, death of executor, etc. After the execution of the documents offered for probate: Decedent did not marry; was not divorced; 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); did not have a child born or adopted; was not the victim of a killing; and was never adjudicated an incapacitated person, except as follows: © B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pedente liter durante absentia; durante minohtate) 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 on Section A above 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: Name Relationship Residence John C. Neamtz Husband 42 Blue Mountain Vista Mechanicsburg, PA 17050 Steven J. Neamtz Son 14 Deer Cliff .. , ~ -,~ -~ _ ~, `7 _. (COMPLETE IN ALL CASES:) Attach additional sheets if necessary.-, ~ } ~t 4 Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principa+r~stc~et~ce at J, _.t,7 42 Blue Mountain Vista, Mechanicsburgt, Silver Sprinq Cumberland PA 17050 ~"- -° (List street address, town/cdy, township, county, state, zip code) ~~_~ --", -- ;--,-3 _~ -• "~ ~ Decedent, then ears of a e, died on --~ ~~ Y 9 07/11/2011 at 42 Blue Mountain Vista, Mechanicsburg Pennsylv~riia Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property (If not domiciled in PA) (If not domiciled in PA) Value of real estate in Pennsylvania situated as follows: $ _ 160.000.00 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 ~,~,>:/ 1 Personal property in Pennsylvania Personal property in County John C. Neamtz 42 Blue Mountain Vista Mechanicsburg, PA 17050 Form KW-OZ Rev. 12-26-2006 (interim form, pending action by the Court) Copyright (c) 2010 form software only The Lackner Group, Inc. Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } SS COUNTY OF Cumberland } 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. .~'^j _ ~ ,/ ,~'~ ,~ , ~ .. ~ Gam. .. '~ f ~ -- of Personal Representative John C. N Signature of Personal Representative ~ ~ ~ ,,,, ~=:•'t ~~ i Y"j "~~ ~"~ +t `~ t ---r ~ Signature of Personal Representative ~~. ~n ~ r. ~ ,~_ ~ -~ 'ti,-~ ~ . ~ . a .~ r ~•T ' ~ ry - ~n ~. a- File Number: 21-11 ~-~, ~~ r""~ . , Estate of Mary Giornesto Neamtz ,Deceased .~ Socia ~ curity Number: 201-18-2810 Date of Death: 07/11/2011 ~~~` AND NOW, , in consideration of the foregoing Petition, satisfactory proof having been presented before e, IT D CREED that Letters of Administration are hereby granted to John C. Neamti 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 .......................................... $ ~U/l-~. Short Certificate(s) ....................... $ ~~. Renunciation(s) ............................ $ r ,~ $ ~-2t~ . ~l $ $ $ $ $ ~ L TOTAL ................................... $ Form RW-OZ Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attorney Signature: Attorney Name Michael L. Bangs V Supreme Court I.D. No.: 41263 Address: 429 South 18th Street Camp Hill, PA Telephone: 717/730-7310 Sworn to or affirmed and subscribed before me this ~~ day of IJARNl~ta. I# is illega; #c~ ~sti~;~,ll ;~2€~ : f:, r r,Y .. ,y, :~t~~.ar~~s~~t ~~ ;:..,.. P__17557588 ,....i it .,, n ~ „nbc, 43 REV 11/2006 E /PRINT IN :RMANENi (LACK INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) __ __ _ _ C7 ~ : :~~ ~~C7 ~~ l `D4 I .._ . ~'} ~;,, _ :~y _> ~ . ,.t3 a r ~ -~ D ..._ ~~ d ~.T.? 1. Name d Decedent (Firs( middle, last, sulfixl Mary Giornesto Neamtz 2. Sex Female _ __ .__ 3. Social Securty Number 201 _ 18 _ 2810 __ 4. Date of Deem (Monts, day, year) July 11, 2011 6. Age (Last BiMday) Under t ar Under 1 De 6. Date of Binh Month, ~ , r 7. Bits lace end state a for ~ coon 6a. %ece of DeaM Check an one 90 "~"'"` °ay' "°"" Mk,~~ April 4, 1921 Broad Top City, PA "°apital o,her. YrS. ^ Inpefient ^ ER / Outpatient ^ DOA ^ Nursin Home kk~~II g Ip1 Resitlence ^ Other - Speciry~. Bb. County of DeaM &. City, Borc, Twp. of Deets 6d. Fadlity Name (If rat Insmutlon, glue sheet and number) 9. Was Decedent d Hispanic Origin? ~ No ^Ves 10. Race. American Indian, Black, White, etc. Cumberland Silver S rin p g Twp. °+yea, avecify cubes, (spalt/r 42 Blue Mountain Vista Mexican,PUanoRiran,mc.) White 11. Decedents Usual Occu anon KiM of work sore dud most of wo ~ kle. Dc rat state retire 12. Wes Decedent ever In Me 13. Decedents Education (Spedty Doty highest Bede completed) 14. Mantel Status: Manietl, Never Married, 15. Surviving Spouse (II wde, give maitlen name) Kind of Work KiM of Business/Indushy U.S. Armed Forces? Elements I econda 0-12) Colle Widowed, Divorced /SpedyJ ry ry ( ge (1~4 or Si) Homemaker Domestics rY ^ vea LFNd 1 Married Maj . John C. Neamtz 16. Decedents Mailing Address (Street, city I town, state, zip cads) Decedent's Did Decedent 42 Blue Mountain Vista AaualReaklence 1Ta.state_ _Pennsylvania mvenshi? ,7c.®rea,Dacedemu~edm- Silver Sprine Twp ° Mechanicsbur PA 17050 Lrved wnhin 17E. county Cumberland rid. ^ na aiu~ ~t o i city / eom 16. FaMers Name (Frst, middle, last suffix) 19. Momets Neme (First, mltlMe, maiden sumeme) Charles Giornesto Mary Palermo 20a. Infonnent's Name (type 1 Print) ZOb. InlonnanYs Meiling Address (Street, dry /town, state, zp code) Ma'. John C. Neamtz 42 Blue Mountain Vista, Mechanicsburg, PA 17050 21 a. McMOd of Dispos0ion f ^ Cremation ^ Donefion 21 h. Date of Dapodlbn (Monts, day, year) 21c. Place of Daposmon (Name d cemetery, crematory or oMer place) 21 d. Locatbn (City/town, state, zip code) aerial ^ RemovalfromState i WasCromNionorponetbnAuMOdzed ^ ~r. f EY IAedkN ExaminerlCorornr7 ^ ves^ No Jul 13, 2011 5' Rollin Green Cemeter 8 y L. Allen Tw p . , PA 17011 22a. Signaure of urerel Se Li (or person acting as such) 22b. License Number 22c. Name end Address of Facility FD 013 340 L Parthemore FH&CS, Inc., PO Box 431, New Cumberland, PA 17070-0431 ComQlete items Sec Dory when cerElyinq ¢ . To Me best of my knowledge, deaM occured et Me time, date end place stated. (Signature and Elie) 23b. Lkrense Number 23c. Date Signed (Monts, tley, year) physician is rot avaflable al Eme of death to certify cause ai death. Items 2446 must ba competetl by Darson 24. Tune of DeaM 25. Date Pronounced Dead (Monts, day, year) 26. Was Casa Referred to Medical Examiner /Coroner far a Reason Other roan Crematlon or Donatlon? who pronounces seam. 12:10 PM M, July 11 , 2011 ^ vas ^ Nn CAUSE OF DEATH (See inshuetlons and exempts) t Approximate Interval: Pan II: Enter other simifi~m condifions conMbutma tc death 26. Did Tobago Use Contribute to DeaM? Item 27. Pan I: Emer the chain of events -diseases, injures, or compicedons ~ Met drectty reused Me deaM. W NOT enter tenninel events such as cardiac anent t Onset to DeaM but not resultin n the untled In cause rven in Part I. 9~ Y 9 9 ^ Ves ^ Probabty respiratory anent or venfncular fibnllatbn without showing Me etidogy. List drily one cause on each lime. i ^ No ^ Unknown IMNEDUTE CAUSE (Final disease or J-,h r ^ /' / , ~y /~ o / condlfion reselling in deaM) t ~G eQ fi ~ 29. If Female. _~, a. V N V ` l~ l~ y , (..(/V . ^ N ~ Dee a (or e e coneegaenc• Pp: ot pregnant within past year $$eeppuentlelly list caMltions, A any, o i leadin b Me cause listed °n 16~e a ^ Pregnant al time of death ^ g . Due to (or es a come uence o Enter Me UNDERLYING CAUSE q 0~ Not pregnant, out pregnant wiMin 42 days (aeeese or Mjury Mat Inmates ire ~ ~ events resulting in death) LAST. m deem Due to (or as a consequence o0: i Not pregnant, but pregnant 43 days to 7 year d t r before deaM ^ Unknown if pregnant witrln Me past year 30a. Was an Autopsy 30b. Were Autopsy Findirgs 31 Manrrer of DeaM 32a. Date of Injury (Monts, day, year) 32h. Describe Hon Injury Occurred 32c. Place of Injury Home, Farts, Street Factory, Pertomred7 Available Prar to Completion ~ Natural ^ Fbmidde Omce Builtling, etc. (Speciry) of Cause of Death? ^ Ve ~' No ^ yes ^ No ^ Accidem ^ Pending Invesfigatbn 32d. Time of Injury 32e. Injury at Work? 321. If Transpodetion Injury (SpacAyJ 32g. Locatlon of injury (Sheet city /town, state) s ^ Suicide ^ Cald Not be Determinetl ^Ves ^ No ^ DnverlOperator ^ Passergar ^ Pedestrian M ^ other - spaary. 33a. CeMfrer (check Doty one) 33b. SgnaNre and a tier • Certllying physkien !Physician cenifyag cause of deaM when anomer pnysatian has pronounced deaM and completed Item 23) , ,1 ' To the best of my knowledge, death oauned due to the uuse(e) and manner ea stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Pronouncing and oertNying physlekn (Phyudan tots proraundng deaM and cerdtying to cause of deaM) To the best of my knowledge death oaumetl al the Nme dote end plea and due to tM ause(a) arts manner u sated ^ ~ ~•r'~ N ~~ M /1 33d. Date Signed (Monts, day, year) , , , , _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • kledkal Examiner/Coroner ~ ~ ~ Y • ~ L~ Z r., ^ I' . !iV On the Eris of exsminetlon and I or Inveetlgatlon, in my opinion, rMelh occurred tl the time, date, eM piece, and due to Me uuee(s) end manner n stated. ^ 34. Name eM Address al Person Who Completetl Cause of Death (Item 27) Type I Print ~ 35. Regatrals re and Dar' ar / ~ I ~I~I ~ I I ~ L~~ ~ 38. to latl ( M, day, ear) ~~ ~ ~ I/3 aryl Z T~,~ a r.~ ~ _ .• d // ca1M ~ PA I U Disposition Permit No ~"' I ~ ~~ r -l REV-346 EX (03-09) 3 4 6 ^ ^ ^ 712 ^ ESTATE INFORMATION SHEET pennsylvania FOR REGISTER'S OFFICE USE ONLY DEPARTMENT OF REVENUE County Code Yeas File Number DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the Department. 21 11 Decedent's Social Security Number Date of Death Date of Birth 201 18 2810 07 11 2011 04 04 1921 Last Name Suffix First Name MI NEAMTZ MARY G TYPE FILING: Enter mark (x) to indicate the nature of the return to be filed with the department. © Probate Return ^ Joint Assets Only ^ Non-probate Assets Only ^ Litigation Purposes (No Other Assets) LETTERS GRANTED: Enter mark (x) to indicate the nature of the proceedings at the register of wills office. (Attach additional sheets if explanation is necessary.) ^ Testamentary ® Administration ^ No Letters ^ Other (Please Explain) ATTORNEY /CORRESPONDENT INFORMATION: Enter all data concerning the attorney or other individual to receive all information and correspondence. Last Name Suffix First Name MI BANGS MICHAEL L Supreme Court I.D.# Telephone Number 41263 717 730 7310 First line of address 429 SOUTH 18TH STREET Second line of address City or Post Office CAMP HILL PERSONAL REPRESENTATIVE INFORMATION: Executor/Administrator Social Security Number Telephone Number 717 796 2155 Attorney / Corrrespondent's a-mail address: tO -r.: - .' - ,~? ,:;, ; =1 _ ~ ,~.1 - -- , _~ -z- State ZIP Code "-~ :. _," ~~ - Enter all data concerning the personal representative(s) _of the estatWr authorized by the Register of Wills. Last Name NEAMTZ First line of address 42 BLUE MOUNTAIN VISTA Second line of address OFFICIAL USE ONLY TRANSACTION COUNT City or Post Office State ZIP Code MECHANICSBURG PA 17050 Complete general estate information questions, and indicate additional personal representatives on reverse side. PLEASE USE ORIGINAL FORM ONLY Suffix First Name MI JOHN C Side 1 346DD^712^ 346DD^712D J 346^^^722^ Decedent's Social Security Number 201 18 2810 Decedent's Name MARY GIORNESTO NEAMTZ Co-ExecutorlAdministrator Social Security Number Telephone Number Last Name First line of address Second line of address City or Post Office Co-ExecutorlAdministrator Social Security Number Last Name First line of address Second line of address City or Post Office Telephone Number Suffix First Name MI State ZIP Code Suffix First Name MI State ZIP Code General Instructions: This form should be filed with the Register of Wills of the county of which the decedent was a resident at death Please be aware the correspondent identified will receive all correspondence from the department. It is the responsibility of the personal representative to notify the department if the correspondent contact information changes. The department is authorized by law, 42 U.S.C. §405 (c)(2)(C)(i), to require disclosure of Social Security numbers in connection with administering state tax laws. The department uses the Social Security number to identify the decedent and personal representatives of the estate. The commonwealth may also use the information in exchange-of-tax-information agreements with federal and local taxing authorities. State law prohibits commonwealth personnel from disclosing confidential tax information except for official purposes. Side 2 346^^^722^ 346^^^722^