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HomeMy WebLinkAbout08-11-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNS :1~LVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of MARTHA B a/k/a: a/k/a: a/k/a: SS NO: 193-18-0745 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ^ 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 aforementioned Letters _ under the last Will of the above-named Decedent, dated _ 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(8): ~ B. Grant of Letters of Administration (u applicable, enter d.b.n., pendent lice, durance absentia, durance minoridrte) C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by the following spouse (if airy) 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(8), except as follows: NONE. MICHAEL G. SGRIGNOLI z130 Lambs Gap Rd., Enola, PA 1zoz5 xelauonsm to uecea~ Husb~j .~ Q `~~ -C ~ ,`~~; nt ~~ T, ; -~-, --,.-'~ l SE ADDITIONAL SHEETS IF NECESSARY ~~~ c..7 THIS SECTION MUST BE COMPLETED: c.'..r.~ _ ~ t _: ~ __ Lecedent was domiciled at death in Cumberland Count Penns lvania with his/her last famil or "J` - Y> Y y p~il~stpal resi~nce ~ ~, ; -~ ; At _1700 Market Street Camp Hill Borough Cumberland County Pennsylvania 17011 v' _ ~ % ;-~ (Sheet address with Post Office and Zi Code, Munici alit fownshi Borou h, Cit C ~~ P P Y P, ~ Y) Decedent, then 87 years of age, died 5/20/2011 at Camp Hill, PA 17011 (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA If not domiciled in PA _If not domiciled in PA _Value of Real Estate in Pem~sylvania All personal property Personal property in Pennsylvania Personal property in County Total Estimated Value Location of Real Estate in Pennsylvania: (Provide full address ifpossible.) NONE. Signature(s) „ l $ 5,000.00 $ -- $ --- $ 5,000.00 Na malc\ R, Maa: A.1.1.... ~i,.,,~ Phyllis L. Sgrignoli, 2130 Lambs Gap Rd., Enolei, PA 17025 Interim Fnrm R W-m ,P~~~N~ ~? v, t n t,., r~~..,tio.a...,a r,..,..... _.._.,:__ ..-•--- , . , ,. Yage I o1 Z SGRIGNOLI Deceased ESTATE NO: 21- ~~ I ~ - '~l_.i'_l.l' OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioner(s) herein named swear or affirm 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 affirrrn~d and subscribed ,~~ before me this ___~~_ day of ~~~ _x ~~~ ~ :~j~. ~ - -- ;=~ ~.~> ~-i For the Register - _-~ r-,-, ___ :.. DECREE OF PROBATE AND GRANT OF LETTERS ~ ~1> `-~ ,~_ J i _' Estate Of MARTHA B. SGRIGNOLI ,Deceased File Number: 21-~J ; ( T' /_~~,t,~/~ ~-. e: AND NOW, this ~_ day of ~ `~ ~~ ` C' ' , in consideration of the Petition on the reverse side hereon, satisfactory proof havil been presented before me, IT IS DECREED that Letters -Testamentary X of Administration are hereby granted to: pf applicable, enter c.[.a., d.b.n., d.b.n.c.t.a., etc.) PHYLLIS L. SGRIGNOLI _ in the above estate and that instruments(s) dated described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. i ~~~ ~ ~ " ~ ~__' ~/~ Glenda Farner Strasbaugh Register of Wills ~i'_ r FEES: Letters ....................$ l_i ~'.T Will ........................ Codicil(s) ................. (~) Short Certificates ( )Renunciations....... ~ o (1~' I k ~ Bond ............................. Other ............................. ................................. Automation FEE......... 5.00 JCS FEE ................... 23.50 ~ ~ ~v TOTAL ................$ ~tgna>•ure of t,ounsel Kequired to~nter Appearance t Atty's Signature ~n~._ ,_____.., PRINTED Name A MARIE COYNE Supreme Court ID No.: 53788 Address: 3901 MARKET STREET CAMP HILL, PA 17011 Phone: 717-737-0464 Fax: 717-737-5161 Interim Form R W-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2 I!)~ SZI I`; 121\' rll l:ll' LOt~AL REGISTRAR'S CERTI~IC;A1'1~-C~ CAF' =~°1"~~ l~il~,F3NING: It is. illegal to dupiicatC~ this ~c>~ayr b~, pt~~tc~>~;~t r~~(~ ~.19ir,tC3~~ ~,,)- ~rc fin- thu krrtl(irat.~, ~;h+u. P 173n0171 Certitl~atiun '`.umh,•t" TEEM # ~ 9 SHOULD READ AS FOLLOWS: .~~~"r. ~~~~ ; ~ r~ ; ;~ ~ ~, _ 1 h:_ _u., ~ ~ I ~~ b ~:1 \'"~ fl ~ ,G ,. , t J. 1 :I:. J v~ r b' I 'Ft. 'i'. •I'll- ` q~ ~` ~ aL / MAY,2 3 2111 G n ~. ~~~ ~~ --- r. ;~,.~ ~,- -'~ x-• ~- <-, ~-~ ~ __ ~ .1 (~- V --~.m ~ ~ -- _-- _ c; ~ T7 G':: ia3 REV 11rmD6 COMMONWEALTH OF PENNSYLVANIA a DEPARTMENT OF HEALTH a VITAL RECORDS E /PRIM IN 'ERMANEM BLACK INK CERTIFICATE OF DEATH rsa. inntrrrettnne e.,.t uvnronle,n ,....e.._- " STATE FILE NUMBER 1. Name d tyeudent (Flrsl, middle, lest, suKx) 2. Sex 3. Social Secunry Number 4. Date o1 Gleam (Momh tlay yeaq , , Martha B. S ri noli female 193- 1$ -0745 May 20,2011 5. Age (Last BhdMay) Under 1 er Under 1 de 8. Dela of BiM Monm da r 7. Bi ace C' and state or faei count fte. Place of Dum Check one 87 ~ynlha Deya Hoare Mnmea Sept. 8,1923 Conemaugh PA Hospital: Other. , Yrs. ^ Inpatient ^ ER I Outpetlent ^ DOA Nursing Home [] Resitlerrce ^ Omer ~ Specify 6b C d D . . ounry eem fic. Chy, Boro, Twp. of Deem Ad. FadMy Name (If oat instllutlon, ghre strut and nanbed 9. Wu Decedent of HispaMC Odgin? [~ No ^ Yes 16. Race: American Indian, Black, White, etc. Cumberland E. Pennsboro Hol olyea,apacifycuba^ S irit Hos y , (s p p. Mexican. Pueno Rican, etc.) h 1°~"e 11. Decedent's Usual fiu KiM of work dou du' reel of ~ frte. Do not stela re 12. Wu Decedent ever m the 13. DBcedenYa Education (spechy Doty highest grade canpleled) 14, Marital Stetu: Marde4 Never Mariad, 1;i. Surviving SDOUSe (If rote, gh'e maiden name) Kind of Work Kind of &ffiiues/ I U S Armed Forces? . . entary /Secondary (f}12) Col Witlowed. DWorced (Specrly) clerk Common e th I~('d°rs.) Michael ~. ^ '~~ Yea Np married ;;grignoll 16. DecedenYS Melllrg Address (Street, city /town, slate, dp code) Decedents Did Decedent 2130 Lambs Gap Rd. ActuelRuidence 17a. State PA Tw 17o ^Yes, Decetlenl Lived in_ T sh ' wp n i + n l a PA 1 7 0 2 5 nb. Ccunry C't 3 m fie c l a n ri nd. C No, Decadent uvad wim n pCamp Hill dual Limhs of Ciry I Borc i6. Fathers Name (Flrd, middle, IasL suffix) 19. Mother's Name (First, midda, maiden sumeme) Michael Bitsko Mary Kamech 20a. Infamem's Nama (Type! Pnnt) 20b. Informants Meiling Address (Street, pry /sown, state, np coda) Michael G. Sgrignoli 1700 Market St. Camp Hill, PA 17011 21 a. Method d Dlaposicon ^ Cremation ^ Donatlon 21 b. Date d DisposNon (Manor, day, year) 21c. Place d Disposkion (Name of cemetery, crematory or other pace) (' em • N D 1 21tl. Laation ICi (town, state, EI code f ~ 1 Buda) ^ Removal h St t om a ' ~ 4 e naDOlaedon AUUIDNUd May 25, 2011 oly Trinity Byzantine Chur h C'onemaugh, PA ^ Oma-S lbdkel aminerl Coraror7 ^ Yu^ Na e 22a. ra of service Ucenue r chJ 22b. Lk»nsa Number 22c. Nero and Adrlreu a FadlRy - 011248E Musselman FH&CS Inc. 324 Hummel Ave. Iremoyne,PA Complete hero 23ec any wfxan cencying 23e. Tome y knowledge, Beam oaurted et the core, date and plea slated. (Signature and trtte) physiden is na avalWble at time of deem to 23b. License Number 23r,. Date Sinned (MOnm, day, yur) certlry cause d deem. Items 2426 must he completetl by person who pronounces door. 24. Time of Deem J 2 ~ L~ (J vm 25. Date Pronoarced Deatl (MOnm, day, yur) ~ ' 26. Wes Case Referatl to Medical Examiner /Coroner for a Reason Omer man Cremation or Donatlon? M. ~ ~ 2O ~ ~ ^ Vu ~ Na CAUSE OF DEATH (Sea Instrudtlone end melee) r Approximate interval: Item 27. Pen I: Enter me chain devents - deeeses, njudu, a canplkatlons -met directly ceased me deem. W NOT enter terminal events such as cerdac ertut Onset to D m Pen II: Emer other SlpniAranl condPoonx m Mho Inp t deem ~ 2A. atl Tobecce Use Conlnbule to Dum? , u respiratory arrest, a ventrk:ular fibrillation without showing the ecology. List Dory one ceuu on each Ina. but not resulcn in the undo 9 crying cause given in Pan ^ Yas ^ probably ~ IMMEDIATE CAUSE 1Final disuu or I _ ~ p^ ~ fld lc n d , No ^ Unknown ~ ~~ ( ~ caK on ruu rg eaml /,,fl./JII l~ ~ ~~ '~ `K -~ a. r 25 1h Female . Due to (a u e consequence oft. ~ - . I . gq ip, Nat pregnant within past year uutlelN lot conditions, c any, b i to the eauu Ibled m liu a. ~~~~'~O gn ^ Pre ant el lima of death En UNDFAIYING CAUSE Due to (a a consequence oQ: I ~ (dlaeese a H oral niaetatl me x ~ ' ^ Not pregnant, but pregnant wihin a2 days a Q 1! 1'L~ 1 0 events reeuPong In deem) usT. Q ~I') /s7 ~ of deem Due to (or u a consequence o(): ~ d , ^ Nol re nanl, but p g pregnant 43 tleys to 1 year . I 30e. Wu en Aaapsy 30b. Were Autopsy Flndngs 31 Me ur of Dum 32a. Date of I 'u Monm, de , Pedomed7 ry ry ( Y Year) 32b. Describe How Injury Occure0 before death ^ Unknown it pregnant within the past year AveilaWa Pnor to Conplefion of Cauu of DutM Nefarel ^ Homidde 32c. Plea of Injury'. Home, Farm, Strut, Factory, Office Building, etc. (Spedly) ^ Yes ~No ^ Yes ^ Ne ^ Accident ^ PeMing Investigelbn 32d. Time of Inury 32e. Injury a1 Work? 321 11 Trensponecon Injury (Specify) 32g. Location of injury (Street. c hy! sown slate) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ DrtverlOperator ^ Paeserger ^ Pedestrian , M ^ Omer ~ Specrty. 33a Cer6flar ( ~ ~) CertMying physlcten (Physiden certifying cauu of death when anomer physnian has praquncetl duM and compntu Item 23) To the heat of my krawledq, dam accurted due to 1M ceuso(a) sod manner as aUlcd _ _ _ _ _ _ ^ • Pronoundn acct Cenlf i h l te _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 33b. Signature and Tlce of Certifier _~ ~ / - p y ng p ys c n (Phyaidan troth pronouncing dam and certlfyng to reuse o/ deem) To Me heat of my Imowtedgs, death occurred K the time, date, end plea, and due to the oase(s) end manner es ahted 33c. Licenu Number ~ 33d. Dare Signetl (Month. deg Vear) _ _ _ _ _ _ _ • Madksl Esammer/Coroner _ _ _ _ _ _ _ _ _ _ _ O M b ~ ^ t ` „ ~ ' f (~.(~ ©~- ~ ` ' n t ole of exsminetbn end! or InveeUgetbn, In my epinlon, death oauned et the dme, dale, and place, end due to the pose(s) and manor u sated_ ^ 34. Nar~n j nd Atl drus o 1 P arun Who m pl ete d Caw e of De am (I em 2717yi~e /Prim Ragiaure s' . istnd / ~ ~ ~ I ~I I" I I I 36. Dete,Fi (Madh, ,Year) // S~ ~~ ' t ~ I c.~ A l ~ n p / ~ ~ ~-}/ 7 ~ ~ ~ A I"N'~~" ~ ~^'~ \Wt e"~ ;jam J ' " °~' 15t `-A'I \ cy 1 V - . v ~ ~ c~mPrN~ l~ I ~rx I . ) o I Dispositan Permh No. V <D I ~ of RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of MARTHA B. SGRIGNOLl I, MICHAEL G. SGRIGNOLI (Print Nnme) Deceased in my capacity/relationship as HUSBAND of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to PHYLLIS L. SGRIGNOLI 8 ~~ii/ 1Dnte) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of `~ '~3eputy~for Regist@r of Wills ,~ -- ~ `! t.~_. _ u-C:c: c~:~~~ ~' cn :~ C~ _., ,_ t. 'a L j Lr `~ `- Y ~~. ~~~ ~._ Form RW`-YI6 rer~. 10.13.0 .a (Signat e) 2130 LAMBS GAP ROAD (Street Address) ENOLA, PA 17025 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated ,thin on this _~_ day Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Comrnission.) ~" iiA QNVilEA6'FN:OF pENNSy'LVAMIA NOTARIAL SEAL Lisa Merie Coyns. Notary Public Ftarttptdfn Township. Cumberlart~! County M,y Coinrtnissi'b~n Eiji` ss Jutne t Q X0'13