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HomeMy WebLinkAbout10-31-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of HILMA L KOVLAK File Number 21 11 ~ ~ ~ 1 also known as HILMA LORRAINE KOVLAK Deceased Social Security Number 045-20-5082 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW.) a A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EX TOR named in the last Will of the Decedent dated 11/27/2006 and codicil(s) dated NONE (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 instrument(s) offered for probate, was not the victim of a killing, was never adjudicated incapacitated, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): B. Grant of Letters of Administration ~ ~ u~~~~~u~ae, eraer: c.c.a.; a.o.n.c.t.a.; pendente Cite; durante absentia; durante minoritate) 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: (Ij Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list ofheirr-) Decedent, then 82 years of age, died on 10/13/2011 at HOLY SPIRIT HOSPITAL oST PENNSgORO T~":P CUMBERLAND CnL1NTV CAM HILL PA 17011 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 985 000 00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ 0 00 NONE situated as follows: Wherefore, Petitionec{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 DANIEL L. KOVLAK Form RW-02 rev. !0. /3.06 Page 1 Of 2 ti~ ~1 - ---- - -- -. • ~..... a.~a000.~ n«ucn aauu~onae sneers y necessary. , ;~, -~-- Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his /her last principa`~residence at ' '~ M rHOnIir4Rl IRS PA 170~,R ` (Lcst street address town/city toxnshep county, state, zep code) 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. Sworn to or affirmed and1subscribed ~~~~] before me the day of '~~~ ~ / ~- / -~ - 1~. l~;~r he Register Signature of PersonalRepres~ntative DANIELLE. tOVL - --_ T ;_ ~, Signature of Personal Representative "~" 1~ __. ,, . Signature of Personal Representative `" File Number: 21 ' / ~ - ~ / ~t / Estate of HILMA L. KOVLAK ,Deceased Social Security NumbJe__r: 045-20-5082 Date of Death: 10/13/2011 AND NOW, y~'~~ ~C fC'' UI ~ ,~` // , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to QANIEL L. KOVLAK in the above estate and that the instrument(s) dated 11 /27/2006 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of pecedent. fir, ~. i . ,'~ FEES Letters ............................. $ ( ~~' Short Certificate(s) ............ $ ~(,~, (-°(~'! Renunciation(s) ................ $ .... $ .... $ .... $ .... $ .... $ .... $ TOTAL ............................. $ ~ . C~? Attorney Signature: _~ f_ Address: 54 E. MAIN STREET MECHANICSBUR 1?A 170. Telephone: 717-697-4650 Forn Rw-o~ rev. to.l3.06 Page 2 of 2 Supreme Court I.D. No.: 24849 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat ar phot=~g~maph Fee ti>r this Cv11'~I~irt,[c. ~~6.U(l P 17645552_ Certific~=til)1; ivumber l7-b ~.~irt b~~I~.u ~ X17 ~ --. '~Ir~~SN Of~,~/- ~ ~I hip iti ) , ,t°j, n;)t t ac nt~1 to .u ~' ,~f :° .~ ~)~ . ,,t`~`'r_- ~ !Y~y~,, ~t~rrrL~tl~ L~ 1>).~. I >;~i t w. , lir~~fn s! l~tfl. ~atie f1 I>c~ar~ r~,~ I f~:~ll 1`c I~rr.) lhr slut: ~/ y tcrrili~ j ~ (i ~ u~cl~(3 ,,t °,,)L~ ~iat~ Vi1~ ~: a'. I~l .(~ri1~ r)1 ~,. ~,,~) s I,),'I?1 un . O~~ ._ ._: ~~% q9 ~ ~. P ~ ~~~,` "K`,< 1 .__._ _ „.,d±Sri t _L;>:~tl R~~i~-n;i(~ __ 1..1ti I:,1)~~,f ~. ~ _- - `~ r" -z ; --- ~~, y ,__ _ ,.. i T~ ,... _. ._ ,. l . ~. Ht ryPE /PRIM I~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH .VITAL RECORDS PERMANENT CERTIFICATE OF DEATH BIACK INK (See instructions and examples on reverse) ~r•_~ ~„ ~I 0 ,.~,F ~, ~~"r"~ ~~~~ww. ~~ aacel _ _- '+M a Date a Deem (Monet, day, rear i m~ v r~~ ~~z~ K~v !c~ K 2 ~ex F- 3 s~ ~a Namur , ors -ao -5vb~ ~~ i3~~20// A 5 t BIMtl (L ga . as aY) Untler 1 ar Under t da 6. Date of Bkm Month, ~ , 7. Bi antl state or tae pu fie. Place o7 Deam Check an one xbnms Days Hours Mi t n nu es HosDnal Omer. g a Yrs. ~/a /i 9a y I~ r i d e P c rT, C T DMpatient ~ „~~m ^ Ep / ^ DDA ^ Narex,g Home ^ Reaidenp ^ Deter - eh. County of DeaM Bc. Cny, f3oro, Twp. of Deam 6d. FarAiry Name (If na institution, give street ant number) 9. Was DeceTknl of Hispanic Ori inz ^ Vas ~~ vn be+~ ~ a,~d E a s-r ~ nosh o ro ~~ 1 y S ; r; f ~S ; f2 / g ~ 10 Race: Ameixan IMian, Blade, Write, etc. (If Yes, spedty Cuban. (SDedM (' l~ / Mexican, Puerto Rican, em.) (/ll 1 t. Decedents Uswl tan KiM of vrork dale du' most of workin I6e. Do rat state refi t2. Was Decedent era m me 13. Decedent's Edup[an (Spedry tray higrest grade rnfpleted) H. Marital StdNS: Martied, Never Marred, 15. Surviving Spouse (If wife, give maiden name) KirM M Wod KiM W Busness/Irtdrstry U.S. Amwd Forces? Wb 01~• Divorced (Speayl Elementary /Secondary 1o-12) College (1d or 5+) m~m~c ~~v t7om~sri L ^ Yaa ®Na I:~ 3 /,ci ~du we~1 16. Decedent's Mating Address (Street, dN /town, state, zip cotle) ~~SO) rDl'1-TQY)CL I_t<rl~ Decedents Dtl Decalenl AcaalResidence,7aBfate maY tat-~~{ Livema „a ^ Vas Decedent Lnetl in ~ q (7zttther-sbur~, tmD aCfi~ l , T . TownsN '+ ,7b.~„nNVYlcnt~Q~nrnert~- P t7d.®NO,DecedentLivetlwiNin,(~1.+-~`,~I ~~~r Actual Limits d t~ L'~ C~/~ eJ 1 B. Fathers Name (Flrsl, middle, last, suffix) 19. Momers Nana (Prat midtlle. maitlen sarwne) ~YQnK ~}. S-~ei^ binsK ~ l2vs~~ o (; d 13 ~~f ~K .m - ~ ~1s e.r ce n 20a. nfomam's Name (Type I Pn t1 20b. Infartnants Mailing Aetlress (Street, city /Town, state, zip pda) n ~Ctniz.l L Kov ~~t1~ ~ 18501 Fo)~t~civlct La,ne,G-a(+helrsbary,~l); av8 79 2, M f a. ethod o Disposition ^ Cremation ^ ~~ 21 b. Date d Disposition (Monet, tlay, year) 2tc. Place of Disposifan 1 opt mrre~tery, crematory or aher pace) 21 d Locatim (City/mwn, state, zq cWe Burial ^ Removal from State ~ Was Cremation a Donation Aumtxized I (,') ~ ] ~ [~ I I ~a ~ K ~l-.I s {e~~ ~r' ~ ~ ( ~ ~t ^ Other- ~ by Abdkel ExamoerlCoronaT ^ Ves^ No G~ Ol 'f ,~ v~ ~ ~'W ) 22a. ore f Purer $emp Lisa (or a5 2L2~D-License Number 22<. Name ant Atldress d Fdci6ly /~ ~ 1n, ~ f ~ ~Io~1LIg L 111yZYS- I~jI,l1'lri~ ~n~rE-~ ~OYIt; "~U"ZIVICL'~YI~-/ 37 ~- I~u0.1F1 Sfir tlr~E~l1r I~ 1 ~~ S ~ compem gems 23ac onry wren z3a. ro scot my krawtedge, loam oaurred a, me time. date are pace slated. (sigpm,e are mle) z3e. uaerkse Number phywa. ¢ rat available at bete of loam to ( 7 23c. Defe l simee IMmm. day, yaad ;; ' C ~ prtiry peas nt Beam z ~. `-L; ci ~f- 1= I - . ' . r i~ti u: I~ C ~~-i / 1 }. ~'L~t I J 1 J(. l- i I Hama z4-zs moat be aompeod W persm ~ who praaunps tleam. 24. Time of Deem ~ • 1'1 ~~ n ~ 26. Dale Prarmurwretl peed (Mmm, daY• Year) ~ C' I ~ ~ l 26. Was Case Referted la Medal Fxamna / Canner by a Reason Odter man Cremation or Donation? - ' . r i 11 fi ^ Ves ~ No CAUSE OF DEATH (See lnatru ctlons antl examples) Ap roxur~ interval P t I I E ' ' t p : Item 27. Part I: Emer me chain of events- diseases, injures, a pmplicefions - mat diredN caused ma deem. W NOT enter terminal events such as prtliac arrest t Onset m D m ar I nter omer siatifiram md h m m aore 26. Dkt Tobacco Use ContrbW to Deem? ea respiramry artest a vemdcular bbrillafxm w4lwuf showing me etiology. Ust ardy are cause on each Ire. i but rat resuph n the u 9 i nrkdYitg cause gMen ro Pan I. ^ Vas ^ PrppaWy gAMEDIATE CAUSE fFnal disea~ /~C6 ~ ~ ~ pndtion resuning in de~m)r ~C ^ No nFnmvn a . , ~ . C ~ ~ ~ ~ "'e•~'•~r ~~~ 29 1f Female: Qy a consequence op' SequentialIy f t Caxlilione, d ~C I y m d b' u ~'Sf ~^~~~ ~ ~~~ ~ ~ ~ ~ ~A PreQtanf wimin Paat year ^ Pre pnt t u ea np te pose listed on li ne a. Enter 81e UNDERLYING CAUSE Due m~ a rAnsequenct of): !~.• .( ~Sia a { ~~ ~~ r"ja g a me of dean ^ Nd Pregranf, but pr t min agnanwi 4zmys nt ~ h m i Due C0^s~~^re °g: r ~ ^ Na P'ePiant, Oin pregnant a3 pys fo 7 year t d. ~ ~ I~ ~ ~ t ~ 30 W betas deem ^ Unknown N pradnarrt within dte past 9ar a. aa an Autopsy 30b. Were Au Fmd ~Y trigs 31. Manna of 32a. Date W Injury (Monet, day. year) 326. Descrip How Injury Oaurretl Penormee? Availade Prig m Completion feral ^ ll iotl y . 32c. Place of Maury: Home. Farm, Street, Factory, om e d Cause d De e m? ryl Odip ~~. em. /~ ^ Yea ~'IQo ~~, ~~~ yyy ^ Yes ~NO ^ Axieem ^ Pendng Investigation ~tl. Tme of Injury 32e. Injury at Work? 321. M TransponaEOn In WN (SPao'y) 32g. Lncaf of injury (Street, d ry I town, sfaM) ^ Suicitle ^ Caum Not be DBtennrttetl M ^ Yes ^ No ^ Driver/Operdta ^ Paeserger ^ Petlesfnan Omer - Speciyy 33a. carder (drecx omy Orel • CMHying physalan (Physican reNlyng cause of tleam wren arether physician has proneuncetl deem ant completed IOem 23) To me heat m my knowledge, tlenn occurred sue to me cease(.) and manna as erered_ --- -- _ -- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Pronourtdng and anit in n sicMn Pf i p et a3b. signs rid vets of cares„ Cf 4~~ +~~~ r ~~ y g p y I aysa an o prmounang deem era certifyktg o pose m deem) Ta tl1e beat a my knowksdgq deem occurred al tM time, date. antl plate, ant tlue to the puea(5) and manner ae slated_ _ _ _ _ _ ~ _ _ _ _ _ _ • 33c. License Number 33d. Dale Si goad (Ma,m. day, ypr) - _ _ _ _ _ Medial Exemmer/Coroner On The basil of axaminaUOn sra I or inveatigMmn, In nh opinion, deem aoaurred at fife tlme, tlak, antl Mp, antl tlue to the p D uce(e) ant manner as rat d ^ ~~ ^ Y 2 S ~, l d ~ f~ ~` e „ C ~ % ause of (tte ~~ m 27) Type /Print 36. s Sgnafure era Olslect N mbar- ~ a Q.r~C j , { I' ~~ < I ~ 36. Date Filed (MOmm, daY. year) < .1Q c ~ U Disposition Pennn No. D ~ -I 1 IO ~ () v - ',9 LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, HILMA L. KOVLAK, a resident of Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL AND TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am not married, my beloved husband VINCENT M. KOVLAK, having predeceased me and that I have two sons, DANIEL L. KOVLAK and VINCENT M. KOVLAK, JR. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I give, devise and bequeath all my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my sons, DANIEL L. KOVLAK and VINCENT M. KOVLAK, JR., in equal shares, per stirpes. V I nominate, constitute and appoint my son, DANIEL L. KOVLAK, as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, HILMA L. KOVLAK, have set my hand to this ,_ ,z, LAST WILL this ~ 7 day of ~ ' , 2006. ;-~ -~, - JJ 'j~/y{ ~ ~ __~_ ~~ HILMA L. KOVLAK ' - ~ ~'~ ~~" -- -;~-~ -~i.7' J C' -. -r --1 . . Signed, sealed, published and declared by the above-named HILMA L. KOVLAK, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. f,- r.. ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ~ ss. COUNTY OF CUMBERLAND I, HILMA L. KOVLAK, Testatrix, whose 1f edeaccording to law adocherdeby foregoing instrument, having been duly qual acknowledge that I signed and executed the ins oses therein expressed L' that I signed it as my free and voluntary act for the pure ~~.~ -~ HILMA L. KOVLAK Sworn or affirmed to and acknowledged before me by HIL2 AOOL. KOVLAK, Testatrlx, this } R Y v Notary Public nns ~v nia ! NOTARIAL SEAp. i,ublic DEBORAH L. RYAN, NotaofX,umberland Mechanicsburg Boro., Coen Jung. ~ t 2010 My Commission Exp _ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND - _~. ~~ ~ ~ ~ ~ ~ v~'/1 ~-;~~'/'r ` ~l and /~i~~i~~k ,ft ~ , ~rr~,~}i-~ , We, ~ ~~:~ c~rG the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL, that HILMA L. KOVLAK signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best orfiilnd knowledge, the Testatrix was at the time 18 years f a or r~ore,'of sound, and under no constraint or undue influence. ~` . %' ,' /~ ~" L- / .-- 1 ~'i ~ C Sworn or affirmed to and acknowledged before me this ~ ~~day of `~C ~~ r~=~-- , 2006. '`~ ?lam ~ `U~ ~ ~ ~~. Notary Public ,,,,wealth of F'ennsv~vania r NOTARIALSEAL DEBORAH L. RYAN, Notary Public Mechanicsburg i3oro., County of Cumberland My Commission Expires Jung- 1 t , 2010