HomeMy WebLinkAbout10-12-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of f7 ~/~"L+t-S C~~1~~L~~/N ~ ,~, ,Deceased
a/k/a:
a/k/a:
a/k/a:
ESTATE NO: 21_ ;f ~ 1 C ~, ~. 1~.'
SS NO: ~~ ~ _ l "~ '' ~~
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 Calso)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters o ~ ,S/,r ~ l` ~'~ j ~~j,;;~-'~ E under
the last Will of the above-named Decedent, dated j 1 z '~ ~y~G _ and codicil(s) dated _~~ ~ _
(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 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
(If applicable, enter d.b.n., pendent life, durante absentia, durante minoritate)
C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by th.e
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(8), e:ticept as follows:-
Name
4ddrecc
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y
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WY. AvUI t WNAL JHCl;1S IN~ NECN:SSAKY
THIS SECTION MUST BE COMPLETED:
Decedent wa domiciled at death in Cumberland County, Pennsylvania, w~t~i his/her
At _ T'/~iz~v~r/~4-~ ~J /~o~~. ~ ~ z~ /~//.k,ti,..~ '/~~7T~h,~.
._A3 .".
D - ...
ily or principal es
~~
f':
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`~
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(Street address with Post Office and dip Code, Municipality: Township, Borough, City) ~ ~
Decedent, then ~~ years of age, died l ~ ~g ~Ol/ at ~/~~l.l S Lai ~~-
(Month, Day, Year of death) (City and State where eath occurred)
~rEstimated value of decedent's property at death:
J~.If domiciled in PA All personal property $ _
(r ~_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/ $ ~ ~
Location of Real Estate in Pennsylvania: (Provide full address if possible.) T~ C9-~~>¢yeh,l ~G{ " ~~if%~' ,~l z~G!S ~~-
~~"~ Sig u~re~ Name(s) & Mailing Address(es)
'~ ~ `/~d
f
shi to Deceijent
mcenm roan nw-u~ revises ~[.Lb.IU by Cumberlantl County pending action by the Court Page I oft
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 represe;ntative(s) of the
Decedent, Petitioner(s) will well and truly administer the e according to law.
,,~
Sworn to or affirmed and subscribed
be~ore me this ,~ da of ~~> - - z~
,~
to,~ ~ I ~~ ~r ~ r, =~
__ _ -~:
For the Register i -~ '~'
DECREE OF PROBATE AND GRANT OF LETTERS ~~ ~~
~.
Estate ofd' (~1~ j" {':(: (~ ~~ (~ 4 Y ~ ~~~ (~C't I`V' ~) 5 ,Deceased File Number: 21- ~(, l ~ -
AND NOW, this ~ day of _(~L-~-{~~~{~ ( ~ ~- (~ , in consideration of the Petition on
the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters
~' Testamentary of Administration are hereby granted to:
(If applicable, enter c.t.a., d.b.n., J.b.n.c.t.a., etc.)
the above estate'and that instruments(s) dated ! ~. /.
admitted to probate and filed of record as the last Will
described in the petition be
Codicil(s) of Decedent.
s
Glenda Farner Strasbaugh,
Register of Wills ~~.~ ( ~ `-J~ %~ ~{.,~. i_)C i ;! Cam'-~'~
FEES:
Letters ....................$ t L ~, C (.
Will ........................ 1 ~> ~ G(;
Codicil(s) .................
( `])Short Certificates 7~ ~, ~ C L'
(~) Renunciations....... !~ t) y
Bond .............................
Other .............................
.................................
Automation FEE......... 5.00
JCS FEE ................... 23.50
TOTAL... . La:'wa.a.... $ 1 ~ ~ J(~
Signature of Counsel Required to Enter Appearance
in
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Phone:
Fax:
Interim Form RW-02 revised 12.26.10 by CumUerland County pending action by the Cow~t Page 2 oft
OCAL REGISTRAR'S CERTIFICATION OF DEA'1CIM
WARNING: It is illegal to duplicate this cagy by photostat or photograph
Fec for this certificate. 56 O!)
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Certification Number
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H105~143 REV 112006
TYPE /PRINT IN
PERMANENL
BLACK INK
0
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instruct(ons and examples on reverse)
1. Nacre d Decedent (Frsl, middle. last, sufix)
2. Sex
3. Seal Security Number ~ ~ -- ~ _...
_4. Date of Deelh IMOnth, day, year)
Geraldine M. Adams Female 203 - 10 - 9098 10/08/2011
5. Age (Last Binhaay) llntlar 1 ear UMer 1 d0 6. Date d BiM Monm, tle , ear 7. BiM ce Brld dale or br ei Corm qg. PleCe of Deem Check on wle
Mmms OeYe Hwrs MiMea Hasphal: Omer:
92 vra 10/ 11 / 1918 Carlisle , PA ^ Inpatient ^ ER /Outpatient ^ DOA ~ Nursing Home ^ Rasitlerlce ^ Omer - Spedly:
flb. Coudy of Deam &. City, Baro, Twp. of Death fid. Faaliry Name gl not iretilutkn, giro street aM number) 9. Was Decedent of Hispanic Origin? ~No ^ "es t0. Race: American Inaan, Blade, White, em.
Ctmlberland Carlisle Boro. (II yes, specify Cd,an, (Spar,Yy»
Thornwald Home Mexican, Puerto Rican, ek) White
71. DecedenYS Usual atbn IGnd d want tlme Mon most d Ilfe. De not state retire 12. Wes Decetlenl ever in dre 13. Decedent's Etlucelian (Spedty mty highest grade compreletl) 11. Marital Srenm: MartiBQ Never Merced, '. 5. Surviving Spwse (II wife, give maiden name)
Kira of Work Kind d Bluffness/Industry
nit Secretary Carlisle Hospital U.S. Armed Forces? Eleme 1 SecorMary (012) College (t-4 or 5t) Widowed, Drracetl (Speclh)
^Yaa~XNa ~~ Widowed -
• 16. DecetlenYS Maililg Atltlress (SbeeL my I lawn, slate, zip cotle) Decedent's PA Did Decedent
635 Anthony Rd. Actual Residence 17e. Slate Live Ina 17c. ^ Yes, Decedent lived in _ 7
wp.
• East Berlin
PA 17316 Township?
,7b.caanty Ctanberland rid. C~o
Da~paem~Neaw4min Carlisle Boro.
, e
cirylB«a
16. Fethefs Name (First, mitldle, last, suffix) 19. MdheYs Neme (Flrsl, middle, maiden sumeme)
James S. O'Brien Mabel - Thrush
20a. InformenYS Name (Type !Print) 206. InrennanYS Meilirp Address (Street, city /town, slate, zip catle)
Timoth M. Adams 635 Anthon Rd., East Berlin, PA 17316
zaa. Metrbtl of DNposilbn ^ cremation ^ Dorlaaan z,b. Dare d Diepoenkn (Monm, ae ,
y year)
27c. Place a Disposition (Name d Cemetery, wemarory w Omer place)
27tl. L<ralion (City/town, state, zip catle)
Burial ^ Removal Irom Stele i Was Cremetbn a Donetlon Aumarlmd
^ Omer- ' by MedcM Exaraner/Coroner? ^ Yes^ Nn
• 10 13 2011 Ctunberland Valle Memorial Garde s Carlisle, PA
22e. Sigh Fuse Se ' licerlsae (or pe mg 22h, license Number 22c. Name aIM Address a Facillry
• - FD 012633 L Ikain Brothers Funeral Herne, Inc., Carlisle, PA 17013
complete Xems 23a-c onty when certllydrg 23a- To Ins bast d my kmxletlge occurred at me tlme, tlare and (dace stelae. (SignaMe and title) 23b. License Number 23c. Data SI
greed (Monm, daY
year)
pnyawaan w na aYaaaae sl rkne of loam m
oemy oaaee a seam. -y ~~~ D~ L .
l1~ ~~ /
Aems 24-26 mull be completes by parson 24. 7'mee of Deem 26. Data Pmrounced Deed (Monm, day, r) 26. Was Case Refe
rre
dlp Medical Examiner I Cwsner far a Reason Other man Cremation or Donation?
who Drorlounces deem. p M.
D _ Z ~ ` ~
/
^ yes 11[J No
CAUSE OP DEATH ( InatrucYlOns arM examples) i Approximate interval:
hem 27. Pan I: Enter the drain devents -diseases, Injuries, or complicetbns -met directly caused ma deem. W NOT enter tertniral events suds as rardlac ertest, ' Onsal to Deem
' Pan IL Enter amer gjnlf m omnaaons mnmrxmno t~ Deai)1,
bm rml resulting in dre ulMertying Cause given in Pan'. 2B. Ditl Tooacco Use Contli6ure re Deem?
^ y
s ^ P b
respuarory arrest, er ventrkular Abril~gp
p,ytUtaul s rig me etlology Llsl one cause each Ilne. '
(/
IMMEDIATE CAUSE Fmel di
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~
l e
ty
^ ryo ~ UnWrown
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sease w
T/l~jV~ f~~
(/
condltlon rewlting In I~am)
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~
G(iy-e (~ // „' ' _
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~rt
~ 29. If Female:
~~'
~ ,
_-~
~
,
C~ (i ;
_
~
.
GG ll.lV !""""«< ~~
j~'
rice ~.
~or as Not pregnant w6hin peel year
Y
, ~ `,; `
Sepuentlellyy fat CdMtlbns, a arty, b .
Iee&g ro tM reuse Nstetl on Xne e. J I_ Pregnant al tlme d deem
^
E me UNDERLYING CAVSE Du o as a coreaguence dl:
o - NoI pregrua, bd pregnant wimF, 42 days
(dsease or iryury mat miliated the
events resuaing m dean) LAST. C of deem
^
Due to for as a Consxluerme on: Nol pregnant, but
pregran143 days l01 year
d.
- bafara deem
^ UnFnown A pregnant within me past Vear
30e. Was an AUlopsy
Pedomled? 30b. Were Adopsy Findings
Available Prior to Completion 31. Manrgr of Deem
'll 32e. Date of Injury (Monm, day, year) 32b. Describe How Injury Occurted 32c, Place of Injury: Home, Farm, Street, Factory,
'
~1~~y
rCANelural ^ HwnFitle OAice Building, ek. (Spea
y)
of Cause of Deam?
^ Vas '~ No ^ Ves ^ No ^ Aaidant ^ Pending Invastigalbn 32d. Time of Injury 32e. Injury el Work? 321 II Transpwlafim Inl ry lBcec/hl 32g. Locefmn of injury (Seeal, mY I Imm, stale)
^ Suicitle ^ Cwltl Not bo DelemFned M ^ Ves ^ No ^ Driverl0peretor ^ Passenger ^ Petleslrian
Omer ~ Spedy
a3a. camfrer Iona x only ana)
• CMIryIrg plrysiaen (Physiden ceNtyinq cause a seam when ananer pnyeiden nos
ronowmee seam ana wm
kl
a Ite
z3 aw. synen,re',a T m a cay6
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~
p
p
e
m
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To the beet a my knowlstlge, death acurrM due to tlb arua()
e end manner sa alaMd_________________________________ /
/
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'
• Pronwmdng arW oxtey4rg pNyslelan (Physician both prmwndry deem aeq cenaykp to Ceuae d tlaam) 33c. Lken. Nu'Mer 33d. Crate Signed (Monm, day, Year)
Ta the bntamy knowredge,dumrxcurrad atthetlma,date, and pWCe, and due to tna rause(eJ erW msnnar e6emetl__________________^
• Neakal Exsminary COroror ~0 ~. 5~~~..~
`.J 1.1-, Lle'~I_ II
0
On the beau a examinsllon aM I or Investlgadon, In my opinion, deem oewnatl al tte Ilme, data, aM place, end due to ttre ceu9e(s) end manner as ebad_. ^ 34. Name aek Aadress of Person Who Congleletl Cause of Deam (Item 271''YPa/'riot
1
36. RegsVel lure aM D
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1r=-I'Y Lx-I ~c~~111C IS r (T~117
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Dlsposalon Permit No. s G ~.~~ (~ V
RENUNCIATION
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
~ __ -
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Estate of ~ ~Lr~ c~ ~,~~ o ~ L ( ~mt~ ,Deceased
I, ~ ~ .L ~ .
~ (Print Name)
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
1c~~t~2- 11
(Dare)
Executed in Register's Office
Sworn to or affirmed a d subscribed
befor me this ~ ~ ~ l ~ day
Deputy for ilegister of Wills
t-e-- ~ -:rc.rt_.c.~2
(Signatu eJ
X95-;~- -~-~~~-~-„~ 2~2
(Street Address)
(ctry, s te, zips
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 within on this _ day
of
~_
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Farm RW-06 rev. 10.13.06
~~~~~ ~~li ~z~ c~e~t~me~tt
I, GERALDINE M. ADAMS, of the Borough of Carlisle,
Cumberland County, Pennsylvania, declare this instrument to be my
last will and testament, hereby revoking all wills and codicils
heretofore made by me.
I. I direct my executrix to pay all of my debts, funeral
and administrative expenses as soon as convenient after my
decease.
2. I authorize and empower my executrix to sell any realty
owned by me at my death, and not specifically devised herein, at
either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. If the property which I own jointly with my son, Thomas
M. Adams, in West Pennsboro Township, should become wholly mine
because of the prior death of Thomas, I devise this property to
my son, Timothy M. Adams.
4. I devise and bequeath all the rest, residue and
remainder of my estate of every nature and wherever situate to my
five children, Rogene C. Rosasco, Calvin J. Adams, Timothy M.
Adams, Thomas M. Adams and Joy L. Gray, share and share alike,
the child or children of any deceased child taking the shams `-='
_ _x
their parent would have taken if living. _`'~n `.
-.,,i _
5. I nominate and a ~~'' ? ~;~ -
ppoint Rogene C. Rosasco to be iT~~==';
_; ~7 -~ --
executrix of this my last will and testament, she is to serveL:~s~ ~~ ~'~
_ ,_ , c_~
c. -
such without bond. Should she die before my death, renounce or
refuse to serve for any reason or die leaving any of my estate
unadministered, I nominate and appoint Timothy M. Adams, or if he
cannot serve, Calvin J. Adams, as substitute executor, without
bond and with the same power as is given to my executrix.
5. I suggest that my personal representative retain the
services of Irwin, Irwin & McKnight, as attorneys in the
settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this ~'9'~ day of December, 1986.
EAL)
GERALDINE ADAMS
Signed, sealed, published and declared by Geraldine
M. Adams, the testatrix above named, 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 subscribed
our names as witnesses hereto.
2
ACKNOWLEDGEMENT AND AFFIDAVIT
WE, GERALDINE M. ADAMS, BETZI A. MORRISON and
KATHLEEN M. KENNEY, the testatrix antl witnesses respectively,
whose names are signed to the foregoing instrument, being
first duly sworn, do hereby declare to the undersigned autho~~rity
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 and voluntary act for the purpose he!^e in
expressed, and that each of the witnesses, in their presence and
hearing of the testatrix signed the Will as a witness and that
to the best of their knowledge the testatrix was, at that time,
eighteen years of age or older, of sound mind and under no
constraint or undue influence.
~iC ~
GERALDINE M. ADAMS
~U !'
B T RISON
K THLEE M. K NEY
COMMONWEALTH OF PENNSYLVANIA:
ss.
COUNTY OF CUMBERLAND .
Subscribed, sworn to and acknowledged before me by
GERALDINE M. ADAMS, the testatrix, and subscribed and sworn to
before me by BETZI A. MORRISON and KATHLEEN M. KENNEY,
witnesses, thi s
day of December, 198b.
~ ~~ ~~ ' ~_
_...___.___~.~~JTI~'~'JZ ~ _._._
CARtI~t;'~Qk~, CUB?3f&~.AND COUNTY
MY G'~}~4§!cSing; ~~;pi?fS OCT. 3. 188