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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: Carol L. Novosat
a/k/a: Carol Louise Novosat
a/k/a:
a/k/a:
Date of Death: January 9, 2012
File No: ~ ~ - ~:,~= ' (' f `t
(Assigned by Register)
Social Security No: 189-34-5482
Age at death: 66
Decedent was domiciled at death in Cumberland County, Pennsylvania (Stare) with his/her last
principal residence at 220 Brian Drive, Enola, 17025 East Pennsboro Township Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 403 North 21st Street, Camp Hill, 17011 East Pennsboro Township Cumberland PA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ 3,000.00
If not domiciled in Pennsy[vania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsy[vania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $ 9~,(l(l~_(l~
TOTAL ESTIMATED VALUE.... $ 93.000.00
Real estate in Pennsylvania situated at: 220 Brian Drive, Enola, 17025 East Pennsboro Township Cumberland
(Attach additional sheets, if necessary.) Street address, Post Oftce and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named in the last Will of the Decedent, dated September 14, 1989 and Codicil(s)
thereto dated Renunciation of William L. Novosat and Beth A. Novosat
State relevant circumstances (eg. renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child bom or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ~ EXCEPTIONS Decedent was divorced from William L. Novosat
B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate
If Administration, c.t.a. or d.b.n.c.~a., enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ~ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) at~)leirs (attach
additional sheets, if necessary): ~ "" :.~-?
,._ ~ r-a -t-Z -
Name Relationshi Address ~~ '' ~ ° -
- r~ 1
:7 U `r'+ r
~^
-D .:.r
C3
Form RW-02 rev. 10/11/10// Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland
Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
William B. Novosat 351 Sam le Brid e Road Enola PA 17025
The Petitioner(s) above-named swear(s) or affirm(s) 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 D~ec~e~d~eny~ the Petitioner(s) wi ell and truly administer the estate according to law.
Sworn to or affirmed ands bscribed before `~'`~"-~1.~ ~ //`~ Date Z-l 3li 2
me t~iis ~1'~ day f , '~ , • ' C-/_ Date
By: ~ 1 ~ ~ { ~ ~ ~`},~..--~- Date
For the Register Date
~_~
~,
BOND Required: ®YES A NO To the Register of Wills: '^~ -;~+ ~~
Please enter m a earance b m si na4~elow: ~~ i' i ,.-
FEES: y PP y y g r•°~ -
\ ~ r-
Letters ...................... $ ~~~%-(-~ Attorney Signature: ~> _ ~ ~ -
( Li )Short Certificate(s)...... /~ ~ ~ T
( ". )Renunciation(s)......... y•G`L- (~ ~ ~C~ z~
( )Codicil(s) ............. L , ~,`>Q"''' ~~'
-1 S f. .
( )Affidavit(s)............
Bond ........................ Printed Name: lyse E. Rogers - D 4,y `' ~
Commission .................. Supreme Court '
Other ........ ID Number: 41274
I.L',~1 ...... i~•EX
........ Firm Name: Saidis, Sullivan & Rogers
........ Address: 635 North 12th Street, Suite 400
........ J emoyne, PA 17043
....... Phone: 717-612-5801
Automation Fee ............... Fax: 717-612-5805
JCS Fee. Email: Prngers ssr-attnrneyc cnm
TOTAL ..................... $ ~ 1
DECREE OF THE REGISTER
Estate of Carol L. Novosat File No: ~ ~ ` I ~-= ` ~~ ~ ~L)
a/k/a:
~ ~ f ,
AND NOW, ,'~~ ~~ ~ ~:. ~~4~'I,t-~~. ~L~,~ ,~~~ ~-- , in consideration of the foregoing Petition,
satisfactory proof having be 'presented before ~ , IT IS DECREED that Letters Testamentary
are hereby granted to William B. Novosat
in the above estate and (if applicable) that
the instrument(s) dated September 14 1989
described in the Petition be admitted to probate and filed of/'r~e~cror~/d as the last Will (and Codicil(s)) of Decedent.
/ " lam/ ~ ,.t. i ~~. y ~ ~ ~„ `} i ~ / ~f l
R~~e-glister of Wills ~; ~Z f~ (t ;; , (~~t ~~~ _ T
'~
Form RW-02 rev. ~oiuizn~i - Page 2 of 2
Ltd ~i~ REGiS~'RA~ ~ "~ ~=~`~~~~ ~~-t..~"
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c~~~K of x
~~-~vfs cauR~ a ~ ~~ _
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Type/Print In f;- COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permanent /n
l_~- f COT~C~I^ATC A
~~
O
- -~ ~ ~ ~ State File Number:
1. Decedent's Legal Name (Fl rs[, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Dale of Death (MO/Day/V r) (Spell Mo)
Carol Louise Novosat Female 189-34-5482 Janua 9, 2012
6a. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Near) (Spell Month) ]a. Birthplace (City and State or Foreign Country)
66 Mgnins oav~ Hqurs Minces May 4 . 1945
]b. Birthplace (County)
ga. Residence (State or Fore lgn Country) 86. Residence (Street and Number -Include Apt Nq.) 8c. Did Decedent Live In a Township2
220 Brian Dr1 V@ OS~es, decedent Ilved in F. _ ppnT al-x1rr1
Sd. Residence (County) - - twp.
Cumberland 8e. Residence (Zip Code) Q No, decedent lived within limits of city/boro.
9. Ever in US Armed ForcesT 10. Marital Status at Time of Death Q Married Q Widowed 11. Surv(ving Spouse's Name (If wife, give name prior to first marriage)
Q Yes ~] No Q Unknown Q Divorced ~ Never Married Q Unknow
g
G 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior [o Ftrsi Marriage (First, Middle, Last)
Lego niel Sutton Abbie Frances Ludwi
14a. Informant's Name 14b. Relationship [o Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code)
William Brett Novosat son 351 Sam 1e Brid a Rd., Enola 17025
z
°
m
- ......................................................."- '-- ----°--............-°'-'--"-.-'--..,...-..-. isa, P ace o.,Dea[ .. ~. e5.. °^.Y. _
one
If Death Occurred in a Hospital: ~Inpatie nt ---'-' '----'""" "' ' ••-------•• -- -•• --• --- --- µy __
:If Death occurred Somewhere Other Than a Hos ita l:~ --- - '
p Nosplce Facility LJ Decedent's Home
Q Emergency Room/Outpatient Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Q OLher (Specify)
15 b. Facility Name (If not institution, give street and number; • 15c. City or Town, State, a d Zip Code 16d. County of Death
Hol Spirit Hospital Camp Hi11, PA 17011 Cumberland
16a. Method of Disposition Q Burial [$ Cremation 166. Date of Disposition 16<. Place of Disposition (Name of cemetery, matory, o other place)
p Rempval srgm slate p Opnacinn Hof fman-Roth Funeral a Homo r & Crematory
other (specify) Jan _ 12 , 201
16d. Location of Disposition (City or Town, State, and Z(p) 1]a. atu re of Funeral Service Licensee or Person In Charge of Interment 1]b. License Number
Carlisle, PA 17013 ~~ 013144E
o 1]c. Name and Complete Address of Funeral Facility
m
~ 16. Decedent's Education -Check the box that best describes the 19. Decedent o Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate what
highest degree or level of school completed a[ the time of death. box Shat best describes whether the decedent [he decedent considered himself or herself fo be.
Q 8th gratle or Tess is Spanish/Hispanic/Latino. Check the "No' White Q Korean
Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese
High school graduate or GED completed No, not Spanish/Hispanic/Latino ~ American Indian or Alaska Native Q Other Asian
Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian
0 Associate tlegree (e.g. AA, AS) Q Yes, Puerto Rican
Chinese Q Guamanian or Chamorro
Q Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban Q Filipino Q Samoan
Q Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, other Spanish/Hispanic/Latino Q Japanese ~ Other Pa<Iflc Islander
Q Doctorate (e.g. PhD, EdD) or Professional degree
(Specify) Q Other (Specify)
. MD, DDS DVM, LLB JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupatio -Indicate type of work
White 0 Japanese Q Samoan done during most of working Iifen DO NOT USE RETIRED.
Black or African American Q Korean Q Other Pacific Islander Homema7cer
Q American Indian or Alaska Native Q Vietnamese Q Don•t Know/Not Sure
Q Asian Indian Q Other Asian Q Refused 226. Kind of Business/Industry
Q Chinese Q Native Hawaiian Q Other (Specify) Owt~ Home
Q Filipino Q Guamanian or Chamorro
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day/Yr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
BY PERSON WHO PRONOUNCES OR ^ ^ O ~ Z
CERTIFIES DEATH cj L L ~ -S l"' r~~ ~ ` - ^ ` ~ ~~ ~~
23d. Date Signed (MO/Day~Yir) 24. Time of Dea h ~ _ ~ M1 U U~'t~-~-~
t~ 25. Was Medical Examiner or Coroner Contacted? Q Yes No
CAUSE OF DEATH
Approximate
26. Part 1- Enter the chain of events--diseases, Injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval:
respiratory arrest, or ventricular fibrillation with
o
u
t
showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary Onset to Death
f
~
/
t
IMMEDIATE CAUSE > , e 1 l~ ~~' ~ R~ ~ )~ A 1 1 ~ ~ Q
(Final disease or condition Due To (or as a consequence of): ~"1
resulting in death)
b. S~PTtc- SF-fo
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on Ilne a. Enter the ~ 3 -~ ~ ~1 ~ ~' N ~ ~ S
VNDERLYING CAUSE Due to (or as a consequence of):
(disease or injury that
_ initiated the events resulting d.
in death) LAST. Due to (or as a consequence of):
°
~ 26. Part 11. Enter other slgnifica nt conditions contrib t' a t d th but not resulting in the underlying cause given in Part I 27. Was an autopsy performed?
O Ves No
m 28. Were autopsy findings available
to mpiete the cause of death?
rp
d
^~ O Yes Q No
29. If Female: 30
id
b
o
m
~- . D
To
acco Use Contribute to Death] 31. Manner of Death
Q Not pregnant within past year Ves
Q Q Probably ~ Natural Q Homicide
Pregnant at time of death Accident Pendin invests
Q Nat pregnant, but pregnant within 42 days of death Q No Q Unknown ~ Q g gation
Suicide Could not be determined
Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Vr 5 Q Q
Q Unknown if pregna ni within Che past year ) ( Pell Month)
33. Time of Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code)
36. Injury ai Work 37. If Transportation Injury, Specify: 38. Describe How in
Jury Occurred:
Q Yes Q Driver/Operator Q Pedestrian
Q No ~ Passenger Q Other (Specify)
39a. Ce rtifler (Check only one):
Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and m r stated
Q Pronouncing ffi Certifying physician - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated
Q Medical Examiner/Coroner - On the basis of examination, and/or investigation, in my opinion,
death occurred at (he time, date, and place, and due to the cause(s) and m nn r stated
/
Signature of certifier: -/~ Title of certifier: y-t 0 ~Q `-~~ ~ ) ST L,~ense Number. ~ }-~ 4 4 O 470
39 .Name, Address and Zip Gode of Person Completing Cause of Death (Item 26) 39c. Date Signed (MO/Day/V r)
~ ~ G a ~_ O (~~_ ~ ~ ! o r ~- ! - O
40. Registrar's District Number 41. Registrara~ ~~ 42. Registrar Flle Date (MO/Day/Vr)
43. Amendments
Disposition Permit No.
"' ` 1 C ,~ oc.105 '143
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I . y t...+...!t;i;i.l.. ti:'_5:i.+~:)i..E EW :;: 7 • Y°{~•-3 ~ NOTARIAL SEAL
i:.
GAIL E. l E ' c~. Notary Fublic
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NflTAR!AL SEAL
GAIL E. LESSER, Notary Public
Lock Haven, Clinton County, Pa.
My Commissi®n Expires Aug. 20, 1990
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Carol L. Novosat
Deceased
I, Beth A. Novosat , in my capacity/relationship as
(Print Name)
daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
William B. Novosat
(Date) ~ (ignature)
i~
~ ~~ t~.v,r~ ~
(Street Address)
I'Yl-~ - ~,~ ~ ~ ~'Yl ~ ~ 177 I
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
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
purpose stated within on this 3 ~ ~ day
of `~~-~~ ~ ~~ o ~ ~.
Not~y Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
i y ~~ J L
C~,~i~~i~l ~ ' 'w~ "3
(, ~ry ~F~,
~~ r~yr~e ~'~, o ~ ~~ 7..
~ ~~~ Gti~T1i`% Gil ~_____.._---
«,,.a
.~
.~
~- ~. ..,5 ~-
43L
~,
~~ `x'
m :
,~
n~
c~
~,
~~ ...
~
~~ ~
.:~ r. ~;
.T7 (~ r
=~;
c:.~
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-T..
RENUNCIATION
REGISTER OF WILLS
CUMBERLAND
COUNTY, PENNSYLVANIA
-..~
;:.:~ ~~
~: -~ , ; n
-T, ~ r =~f
r:'r c~
~ ~'
~ ~ -:
~. _
_~=
~ ..~'
" cnc~
c,a -~
Deceased
~~~
_~,
~_~~
~ ~ c?
:~ _
~ -1
Estate of Carol L. Novosat
I, William J. Novosat
in my capacity/relationship as
(Print Name)
former husband of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
William B. Novosat
(Date)
,~
(Signature)
'yh J i~-J,. wN 1-c,~-~ ~.
(Street Address) '
)~j•L~ ~~ T. ~~~ 1`7751
(City, State, Zip)
Executed iu Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Wills
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 o2 day
of F~ C3 ..p Qy ~, ~y i ~--
Notary bhc t/
My Commission Expires: io - ~ Z - ~ ~ ~'
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06
COMMONWEALTt~ CiF (,E ~lN5Yt_VF:ii1~
~lotarial Sea" ~
Margaret L Johnson, two'tary ?lab6i%
Bald Eagio Twp., t<I~;nto~~ G'o:,nt~~ M
My Commission ExptrFS Oci 1 ?, X03
~Vl~nlht+r F~dhnkylvu +ia F1t:at rl axe r, 0. d 1*ies ;~
/~