HomeMy WebLinkAbout02-09-12 (2)r>~:~rrrluN r~ux cTxAly r ur~ L>~~r~r>~:x~
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: Robert W Flaccus File No• ~"~ ' ~ ~ ~~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 207-36-4610
Date of Death: January 23 2012 Age at death: 69
Decedent was domiciled at death in Cumberland County, Pennsvlvania (stare) with his/her last
principal residence at 824 Lisburn Road Room 106 Lower Allen Townshi p Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 824 Lisburn Road, Room 106 Lower Allen 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:
$
98
86
618
If domiciled in Pennsylvania ............................ All personal property ,
.
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ...................... ................................ ... $
TOTAL ESTIMATED VALUE. ... $ 86,618.98
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.)
Street address, Post Office 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/are the Executor(s) named in the last Will of the Decedent, dated September 9, 2009 and Codicil(s)
thereto dated _
State relevant circumstances (eg. renunciation, deatk 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 born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
O• NO EXCEPTIONS O EXCEPTIONS
^ 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 db.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.
O NO EXCEPTIONS O EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if an~nd heirs (attach
additional sheets, if necessary): C~ ~ -z-.~
y> J ~
?=n ~ "~ ~'
Name Relationshi Address
i
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~
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Date
For the Register
BOND Required: Q YES Q NO
FEES:
Letters ...................... $ ~~~ ~` . ~'y
( 1 ~ )Short Certificate(s)...... (~ •~'
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ••~•~~~ ~5 `'
........
Automation Fee ............... '~~'~ ~L'
JCS Fee . .................... ;~.~(.~
_,;,, ~ ;~ `Ili
TOTAL ..................... $
To the Register of Wills:
n~o.,~o o..rPr ...v anoearance by my signature below:
Attorney Signature: C~ r-.~ _,
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Printed Name: _ W
Supreme Court `; ~ ~ ;=~ ~..~.~
ID Number: r
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Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
-,_~
File No• .`i P _ ~ ~.~:
Estate of Robert W Flaccus
a/k/a:
~ ~t.t t ~,{ ~ t ' ,. ' ~ ~ , in consideration of the foregoing Petition,
.. ,~
AND NOW, 1
satisfactory proof having been presented befo me, IT IS~ ECREED that Letters t' ` ~ 'i "'a
arc hereby granted to ~ ~ t ~
in the above estate and (if applicable) that
the instrument(s) dated -
described in the Petition be
to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~';
t ~~C f. ~
Register of Wills ~±~~ j- (~ ~; f ~ ~ !. J~ t. ( l~ f ~~--t
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 ~cnowieage anu ucuci
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will ~ ell and truly administer the estate according to law.
' \ti ' ~ ' Date C7 L-
Sworn to• or affirmed and subscribed before ~ ~ '~~~ ' ~
~_ „ ,~ Date
me this ~ ~ ~~ day o~ ,tu., , , r '~ Date
H105.ftOj RI!V rt)I!0~1
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
W~l~i(I~I~C~~y~} ~~', ~' ~to duplicate this copy by photostat or photograph.
~,A~!i! ! C
CiE i~:.~• v ~ ~.
Fee for this certificate, $6.00 ~f3~2 ~~~ _~ ~~ 4a ~~
C~t~ERK (C~ ~ ~ ~
~{~~T t~U~lu liCli~;
P 18 0 815 8 ~ta~~"~ ~~ ~.,h3^ can . PA
Certification Number
This is to certify that the infonna~ion hire Liven i
coiYectly copied from an original ~'ertilir~ue of Death
duly filed with me as Local Registrar. The original
certificate wil! ~~~c forwarded to the State Vital
ecordv O~tice f~,r perm aril ink,.
_-__.1_~
Local Rc«isu-,rr Date ls~ur<:d
Type/Print In GOM MONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
Perman.n[ CERTIFICATE OF DEATH state Fne
ai
aq
O
k Ink
1.
Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Secu rlty Num er ate o ea o ay r pe
Robert W. Flaccus )Tta - _
ell Month) 7a. Birthplace (City and State or oreign Country)
/Yea r) (S
/D
h
M
S p
ay
(
O
a. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Untler 1 Da 6. Dale of Birt
Months Days Hours Minutes
N Tb. Birthplace (county)
69
n Country) Bb. Residence (Street and Number -Include Apt No.) 8c. Dld Decedent Llva in a Townahlp>
i
F
8 ore
g
a. Resld ante (State or
Q Ves, decedent Ilvetl in wP~
824 Lisburn Rd.
B d. fteaidence (cq.,nty)
No, decedent lived within limits o1 city/born.
C
d
o
e)
Se. Residence (Zip
t Time oT Death Q Married ~( Widowatl 11. Surviving Spouse's Name (tfi wife, give name prior to first marrlagej
t
l S
9 us a
ta
. r In US Armed Forces? 30. Marita
~ Divorced Q Never Married Q Unknown
k
$ nown
] Yes Q No ~ Un
13. Mother's Name Prior [o First Marriage (First, Middle, Las[)
1 2. Father's Name (Fl rst, Midtlle, Last, Suffix)
s Mall rig ss (Street and Number, CICy. 5 e, Zip Code)
I
14
1 n
c.
4a. Informant 14b. Relationship to Decedent
Name -
~ Rob L _ Ss
r
pna
.
q eat
... .°-°- ----
;y
. ...
.« o
a. ace
....------- -° ._ ....°° -- ... -• --------- .
:If Death Occurred Somewhere Oth<r Than a Hospital: ~( Hospice Facility ~ Decedent's Home
_ If Death Occurred In a Hospital: ~ InpatienS
l Nursing Home/Long-Term Care Facility Other (Specify)
A
i
va
rr
Emergency Room/OUtpatlent Q Dead on
antl 21p Code SStl. County of Death
State
T
n
i
.
1 ,
Ow
,
ty or
15c. C
5 b. F clliry Name (If not institution, gives eat antl number;
~ The Woods at C ar rematpry qr
c other place)
of Disposition (Name of cemetery
Plac
16
1 ,
c.
e
6a. Method of Disposition ® Burial Q Cre merlon 16b. Data of Disposition
Q Removal lrom Stale Q Donation
Other (Specify)
Signature of Funeral Service Licensee or Person in Charge of Interment 17b. License Number
17a
1
.
r Tow
6d. Location of Disposition (City o n, State, and Zlp)
`a/
$
-; Munc PA 17756
E 1 Jc. Name and Complete Address of Funeral Facility
e~ 1 8. D cedent's Etluca[lon -Check Lhe box that best describes [he 19. Decedent of Hispanic Origin -Check the 2 .Decedent's Race -Check ONE OR MORE races o Indicate what
o be.
st describes whether the tleced ant Che decedent considered himself or herself t
h
t b
b
~ h o
a
a
ox C
ighest degree or level of school completed aC Che Clme of tleath.
is Spanish/Hispanic/La[Ino. Check the "NO" ~ White Q K
0 8th gratle or less
erican Q Vle Cnamese
box If decedent is not Spanish/Hispanic/La[Ino. Q Blmck or Afrl<sn A
d
r
e
Q No diploma, 9th - 12th gra
lated )$J No, not Spanish/Hispanic/Latino Q A erican Indian o Alaska Native Q Other Asian
GED
co p
Hi h school tlua[e or
Q g gra Yes, Mexican, Mexican American, Chicano Q Asian Indian O Native Hawaiian
ree Q
de
b
ut no
g
Q Some college credit,
Chinese ~ Gua manfan or Cha mono
Rican
AA
AS) Q Ye
,
Q Associa Ce degree (e.g.
Q Filipino Q Samoan
s, Cuban
AB
BA
BS) Q V
'
,
,
s degree (e.8~
Q Bachelor
es ocher Spanish/Hispanic/Latino Q Japanese ~ Other Pacific Islander
MEng, MEd, MSW, MBA) Q. Y
M5
MA
ree (e
g
de
r
,
,
.
.
g
® Maste
s
Q D < (e.g. Ph O, Ed D) o rofesslonal degree (Specify) Q Other (Specify)
octora
r
~D DDS DVM LLB
JD n_
le Race Self-Designation -Check ONLY ONE to Indicate what the decedent consitlered himself or herself to be. 22a. Decedent's Usual Occu patio Indicate type of work
nY's Sin
d
DO NOT USE RETIRED
D
ki
l
f
f
g
e
.
ece
wor
ng
i
e.
21.
g] White Q Japanese Q Samoan done during most o
d
f
l
er
ic Is
an
rican A erican Q Korean Q Other K^cl
Q Black or A
t S
N
'
f
t w/
a
Q American ndlan or Alaska Native Q Vletna mesa ~ Don
ure usine
d o 2b. Kin of B ss/Industry
f
use
Q Asian Indian Q Other Asian Q Re
ecif
)
Oth
(S
y
er
p
Q Chines< ~ Native Hawaiian Q
electronics
Q Filipino Q Guamanian or Chamorro
ITEMS 23a - 23 MUST BE COMPLETED 23a. Dale Prono nced Deatl Mo Day/Vr) 236. Signature o Person Pronouncing Death Only when ap pitta bleJ 23c. License Number
BV PERSON WHO PRONOUNCES OR ` ~ ~ /1 ~ r ~J _ q (,
CERTIFIES DEATH 4TH ~~~'7/ ~}T Z
23tl. Date Signed (MO/Day/Yr) 24. Time of Oe th
Was Medical Examiner or Coroner Coniactatl] Q «~F o
~ ~ 25
3 p
.
GAU E OF DEATH Approximate
ter the h f --diseases, Injuries, or tom plicaYlons--that tllrec[ly caused the death. DO NOT enter terminal events such as cardiac arrest. Interval:
I
E
D
h
.
n
26. P rt
nset to
eat
O
es r ventricular fibrllla[lon without showing he etiology. OO NOT ABBREVIATE. Enter only one cause on a Ilne. Add atltlitlonal Tines if necessary
i
<
ratory aw
resp
l
~
/ K ~ '\r ` ~ O ~ J I-~VYI }~
---------------> a
IMMEDIATE CAUSE
Due to (or a a consequence of):
(Final disease or co nditlon
resulting In death) p ~ f~7 ~5 N "-r 1 ~ Z~ew~~
Seq uenilallY Ilsi c ntlitions, b Due to (or as a consaq uence of):
if any, leading to the c
e
listed on Ilne a. Enter the
UNDERLYING CAUSE Due [o (or as a consaq uence of):
s (disease or injury [hat
nitlated the ev n[s resulting d.
uence of):
nse
e
q
Due [o (o s a co
in death) LAST.
26. Part 11. Enter other i f' f tli 1 ib SI tl h but not resulting in the underlying cause given In Part I 27. Was an autopsy perform<tlT
O yea
~ 28. Were a topsy findings a ailable
~ Co mplete the c of death?
a
<q
_ o Yea
o
30. Did Tobacco Use Contribute io DeathT 31. Manner of Death
29. If F¢male: ural
hin Pas[Year Yo Q Probabl^ (~~i Q PHe mlcide
Q Not Pregn
Accident Q riding InvestlgaLion
n
Q Pregnant a of death ~~~ Q Unknow Q
time
t
Q Suicide Q Could not be determined
$' Not pregnant, but pregnant within 42 days of death
Date of Injury (MO/Day/Yr) (Spell Month)
h 32
d
I]
~ .
eat
N regnant, but pregna ni 43 days to 1 year before
33. Tima of Injury
Q Unknown If pregnant within Che past yeas
home; construction si[¢; farm; school)
f I
( 35. Location of Injury (Street and Number, City, 6Cate, Zip Gode)
njury
e.g.
4. Place o
36. Injury a< Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occu rr<tl:
Q Yes ~ Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (Specify)
39a. y~ iffier (Ch<ck only one): no ccur au anner s
sician - To the best qF my K wl<dg<, death o r<d due to the c se(s) and m [<d
h
in
~ rtif
g p
y
y
e o anner
rid duet Che c ze(s) and m stated
plac
onouncing 8< Certifying phVSiclan - To the best of my knowledge, death occurred at the [Ime, date, ac d
Q P
a
t
,
r
sus anner star
[f+e [Ime, tlaCe, and place, and due to the c e(s) antl m ed
In stigatlon, in my opinion, death a rred a
/or
nd
iner/Coroner- On the basis of examination, a
di
l E
Ve
xam
Q M<
ca
/
~
/
Title of certifier: wC f~ License N mbar: wJ ~ Cf' Z~( 4 ~3
Signature of certifier: - ' • ~
u
' `, )' cf
j ~
~)
!
nc) Corr Plet rig Cause of Dea3 (~
Address and Zip Cotle o4 Pe
N
6 etl ;MO/Day/V r)
39c
D 't~51
gn
ry~
~
TY; ~
~ ~
~
ame,
.
39
{'"s` --F~'~il C.I C9 T' 1"") o I
~r-a wt "Y~+t ~
`
z_
.
Registrar s Slgnatu re
b
' 42. Registrar File Oate (MO Day Yr)
er
40. R</gistrar
s DISL/r l'ct('Njum
/-~
T ~ - ~ 7 4 ~ J
43. Amendments
its .--. • I ~~ /r1 M
Will of Robert William Flaccus
Part 1. Personal Information
r.-
`~~
I, Robert William Flaccus, a resident of the State of Pennsylvania, Cumberlar~ ~punty,
declaze that this is my will. •,T, -~-- n ~'
r ~
- iL~
'i.
Part 2. Revocation of Previous Wills _: ~-; -, wy
I revoke all wills and codicils that I have previously made. ~ , . ~~ .
,
r> rv
_.._,
Part 3. Children
I have the following children now living: Robyn L. Cardamone and George Andrew
Flaccus.
Part 4. Grandchildren
I have the following grandchildren now living: Aidan J. Cazdamone and Logan M.
Cardamone.
Part 5. Failure to Leave Property
If I do not leave property in this will to any of my children or grandchildren named above,
my failure to do so is intentional.
Part 6. Disposition of Property
A beneficiary must survive me for at least 45 days to receive property under this will. As
used in this will, the phrase "survive me" means to be alive or in existence as an
organization on the 45th day after my death.
If I leave property to be shazed by two or more beneficiaries, and any of them does not
survive me, I leave his or her shaze to the others equally unless this will provides
otherwise.
My entire estate is all property I own at my death that is subject to this will.
I leave my entire estate to Robyn L. Cazdamone. If Robyn L. Cazdamone does not survive
me, I leave my estate to George A. Flaccus Special Needs Trust, Logan M. Cazdamone
and Aidan J. Cardamone in the following shares: George A. Flaccus Special Needs Trust
shall receive a 1 /2 shaze; Logan M. Cazdamone shall receive a 1 /4 shaze; Aidan J.
Cardamone shall receive a 1/4 shaze.
All personal and real property that I leave in this will shall pass subject to any
encumbrances or liens placed on the property as security for the repayment of a loan or
Page 1 of 4 Initials: ~''~ m f~ c. ~ ~ Date: / J
~~; Jn
~-~-~ ~.
~.. ~- 7
,.__~
- ~ -,
~~
-_ :-~:
~-~ o
--~-,
Will of Robert William Flaccus
debt.
Part 7. Ezecutor
I name Robyn L. Cazdamone to serve as my executor. If Robyn L. Cazdamone is
unwilling or unable to serve as executor, I name Richard M. Cardamone to serve as
executor.
No executor shall be required to post bond.
Part 8. Executor's Powers
I direct my executor to take all actions legally permissible to have the probate of my will
done as simply and as free of court supervision as possible under the laws of the state
having jurisdiction over this will, including filing a petition in the appropriate court for
the independent administration of my estate.
I grant to my executor the following powers, to be exercised as she deems to be in the
best interests of my estate:
1. To retain property without liability for loss or depreciation.
2. To dispose of property by public or private sale, or exchange, or otherwise, and
receive and administer the proceeds as a part of my estate.
3. To vote stock; to exercise any option or privilege to convert bonds, notes, stocks or
other securities belonging to my estate into other bonds, notes, stocks or other
securities; and to exercise all other rights and privileges of a person owning similar
property.
4. To lease any real property in my estate.
5. To abandon, adjust, azbitrate, compromise, sue on or defend and otherwise deal
with and settle claims in favor of or against my estate.
6. To continue or participate in any business which is a part of my estate, and to
incorporate, dissolve or otherwise change the form of organization of the business.
These powers, authority and discretion aze intended to be in addition to the powers,
authority and discretion vested in her by operation of law by virtue of her office, and may
be exercised as often as is deemed necessary or advisable, without application to or
approval by any court.
Page 2 of 4 Initials: ~"'~ m ~} ~% - C • Date: / V
Will of Robert William Flaccus
Part 9. Payment of Debts
Except for liens and encumbrances placed on property as security for the repayment of a
loan or debt, I direct that all debts and expenses owed by my estate be paid in the manner
provided for by the laws of Pennsylvania.
Part 10. Payment of Tazes
I direct that all estate and inheritance taxes assessed against property in my estate or
against my beneficiaries be paid in the manner provided for by the laws of Pennsylvania.
Part 11. No-Contest Provision
If any beneficiary under this will contests this will or any of its provisions, any share or
interest in my estate given to the contesting beneficiary under this will is revoked and
shall be disposed of as if that contesting beneficiary had not survived me.
Part 12. Severability
If a court invalidates any provision of this will, that shall not affect other provisions that
can be given effect without the invalid provision.
Signature
I, Robert William Flaccus, the testator, sign my name to this document, this
~~ day of .~~P~N-~X r , 07 ~ 10 , at
a A'
(city or co ty, and state)
I declare that I sign and execute this document as my last will, that I sign it willingly and
that I execute it as my free and voluntary act. I declare that I am of the age of majority or
otherwise legally empowered to m/ake a will, and under no constraint or undue influence.
Signature: ' ~ ~(`~~~ ~ ~K~' °~'~'~,
Witnesses
We, the witnesses, sign our names to this document, and declare that the testator willingly
signed and executed this document as the testator's last will.
In the presence of the testator, and in the presence of each other, we sign this will as
witnesses to the testator's signing.
////
////
////
Page 3 of 4 Initials: ~ ~"~t ~ ~ Date: l ~
Will of Robert William Flaccus
To the best of our knowledge, the testator is of the age of majority or otherwise legally
empowered to make a will, is of sound mind and is under no constraint or undue
influence.
We declare under penalty of perjury that the foregoing is true and correct, this
~~' day of / of b ~ ~ , at
CQ~ ~h4lffl°
(city or county, and state)
First Witness
Sign your name:
Print your name: jYl /~3 ~ ~ /~ /J;~ ~ r3 L' c~a3~v-o ~' 2-
Address: ~ ~ ~ P i~ e {-~~ S`fi•
City, State: CA-~6vn1 A ~~ ~~' 1~ ~u
Second Witness
Sign your name:
Print your name:
Address: ~~ Cern ~ ~ e11~ ~I~ i --
City, State:~1j'/e ~4!'/f~~~e . /~/~ - /~~'a /
Page 4 of 4 Initials: ~ • ~' °~ Y~'A C Date: ~~
Affidavit
ACKNOWLEDGMENT
State of Pennsylvania
County of: C ~ 1'Yl ~ r ~Q -°IC~
I, i~~ r.j- $0~ • Fja~'C ~[ S ,the testator whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will; and that I signed
it willingly and as my free and voluntary act for the purposes therein expressed.
Testator: ,i `(~.~~~ ~ ~~`t~''d
Officer: ~' ~ "
COMMONWEALT~=ENNSYLVANIA
NOTARIAL SEAL
SUSAN J. MILLER, Notary Public
Camp Hill Boro, Cumberland County
My Commission Expires September 19, 2013
Affidavit -Page 1 of 2
Affidavit
AFFIDAVIT
State of Pennsylvania
County o£ ~~G~yl.~Pr ( y1 t~
We, /t~(Q'-'~9 .A'Yifn CalG~rl~'YL4YlQ~nd ~~S CQrO~(,lY{2f~yt f', ,the
witnesses whose names are signed to the attached or foregoing instrument, having been
duly qualified according to law, do depose and say that we were present and saw the
testator sign and execute the instrument ashis/her Last Will; that the testator signed
willingly and executed it as his/her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the testator signed the
will as a witness; and that to the best of our knowledge the testator was at that time 18 or
more years of age, of sound mind and under no constraint or undue influence.
Sworn to or affirmed and subscribed to tbefore me by
Y ~~/1 ~(~'YG~Qi1~-tyleand ~IQYY?~S Cr~~G~C1.YYt.-tY'C~G ,witnesses,
this h day of Sp~~~ / , o? a ~ Z3
Witness: ~~"1.~-~a t~~.,.,.~ ~-4
Witness;
Officer:
C®MMCNIN~A6Tp_C~ ~~NN~Y6yANir
NQYAAIAL SEAL
SUSAN J. MILLEA, Notary Public
Camp HiII Boro, Cumberland County
My Commission Expires September 19, 2013
Affidavit -Page 2 of 2