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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: Janet D. l:assi File No: _ t~ I ~ `~ - d~~~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 124-22-6345
Date of Death: 02/04/2012 Age at death• 80
Decedent was domiciled at death in Cumberland County, pennsylvania (state) with his/her last
principal residence at 306 April Drive. Camp Hi[I. PA i 7011 Cam Hill Cumberland
Street addreu, Post Oflke sad Zip Code City, Township or Boroagit Coaaty
Decedent died at 306 April Drive. Came Hill. PA 17011 Camp Hil( Cumberland PA
Street address, Poat Ofllee aed Zip Code CHy, Township or Borough CoaHty State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvanio ............................ All personal Pr'oP~Y $ 7.200.00
If not domiciled in Pennsylmnia ........................ Personal property in Pennsylvania $
If tee dotwiciled in Patnsyb~anta .......... . ............. Personal property in County $
Vallee of rod estate in Pennsylwenia ......................................................... $ 1'i5,(1<10 O(1
TOTAL ESTIMATED VALUE.... $ 142 200.00
Real estate in Pennsylvania situated at: 306 April Drive, Camp Hill PA 17011
(Attach additional sheers, if necessary.) Street address, Post OtYice sad Zip Code CIty, Township or Borough ca,aty
® A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) helshe/they is/are the Executor(s) named in the Last Wiil of the Decedent, dated September 4, 2010 and Codicil(s)
thereto dated
State rdevsat dreassstaatcs (ea renrwdiaion, dedlY afexert~r, etc)
Except as follows: after the execution ofthe 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.
O NO EXCEPTIONS Q EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durance absentia, durante minoritate
If Administration, ctn. or db.n.Gta., 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.
Q NO EXCEPTIONS Q EXCEPTIONS
Petitioner(s), after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any} and heirs (attach
additional sheets, if necessary):
~~
Name RelatioHShi Address. ns
C7 W
f'
~
rZ
.:
'r~ix W
~._
-t N ~._ t'ii
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Fornr RW-01 rev. 10// (/1011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
}
~~~ ; , `ter' ,y;n~
t~ l` 2 FHB f 3 f'f`f 2~ 2 I
Petitioner(s) Printed Name Petitioner(s) Printed Add
Peter Lassi 200 Fineview Road Cam Hill PA 17011 vdURT
.. ,
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 Decedent, the P oner(s) will well and truly administer the estate according to law.
Sworn to or affitrned ubscribed before ~~ ~' ~~ Z - _r 3 - i Z
me this day o ( ~
By: ~ t
For the egister
Date
Date
Date
BOND Required: ®YES Q NO
FEES:
Letters ..................... .
(5 )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other w ~ ~ \ ....... .
$ "_
~4C?'-'
~S ~
Automation Fee ............... ~"
JCS Fee .....................
TOTAL ..................... $ ~ 4:99"
~ ~23_~
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number.
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of Janet D. Lassi File No: ~ I - ~ ~ -- ~ ~
a/k/a:
. ,
AND NOW, Ua, ~~., in consi~ierat on of the fore oing Petition,
satisfactory proo ing be n prese ted before me, IT IS DECREED that Letters
are hereby granted to L(~~.
in the above estate and (if applicable) that
the instnunent(s) dated ~-
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
of
Form RW-0? rev. ioiilno~~ I Page 2 of 2
N/n5 Rne R, t%~' sole I
LOCA ~ ( 'S CERTIFICATION OF DEATH
WARNI ~ r,~l I ~ uplicate this copy by photostat or hoto ra h.
~~~v. Cfi~ ~.~ ~ ~, 1 p 9 p
Fee for this certificate, $6.00
P 1816033
Certification Number
Yype/Print In
Permanent
80
~0lZ F~FB I3 PM 2~ 2 This is to certify that the information here given is
correctly copied from an original Certificate of Death
~,~~{t ~~ duly filed with me as Loca] Registrar. The original
certificate will be forwarded to the State Vital
~~IS COURT Records Office for permanent filing.
Cl1MR~Rl ~E~C) f;~ , f'A
F 0 71011
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH __ _.. __
Yes [~NO Q Unknown 1 ~ Diyorted ~ Never
g reLer LHSSi
C ................................. ... ..................... ...Pa.............
s If Death Occurred In a Hospital: ~(~ In [lent ~~~ ~~~~
~ Emergency Room/Outpatient Q Dvad ron Arrival
15 b. Facility Name (If not Institution, glye street and n mbar;
306 A ril Dr.
m 16a. Method of Disposition Burial ~ Crematlor
~ Removal from State ~ Donation
Other (Speclty,)
16d. Location of Disposition (City or Town, State, and Zip)
Mechanicsbur PA 17050
17c~yam and Cplnplete Addr of Funeral
July 19, 1931
td~N~umber -Include Apt No.)
LL
th ~ Married WI of
+Iarried Q Unknown
4
~•~ ..~..vuenc crv . a I ownsnip?
Yes, d<cedent Ilyed in
No, decedent IlYed within limits of
Prior to First
Amelia Valente
to Decedent 14c. Infor ant's Malling Address
m
200
Fineview R
step eat, «tpnypne __
J
d
h
~~~~
ccurre
Somew
ere Other Than a HOSpltal~
V uraing Home/Long-Term Care Facility O O
or Town, State, and 21p Code
Hill PA 17011
. of Disposition 16c. Place of Olsposition (Nam
1/2012 Gate of HeavaJ
'
° yers- rner
~ineraf ~ome, Inc. 1903 Market St.
C
rb
t- ,
SH. Decedent's Education -Check the box that bast dascrlbes the 19. Decadent of Hispanic Origin -Check the
highest degree or level of school com
leted
t th
i
p
a
e t
me of death. box that best dascrlbes whether the decedent
~ eth grade or less
Q No diploma, 9th - 12th grade is Spanish/Hispanic/Latino. Cheek the "No"
Q Htgh school graduate or GED completed box if decadent is not Spanish/Hispanic/Latino.
Q No
not S
ani
h/Hi
,
p
s
spanic/Latino
~ Some colleia credit, but no degree ~ Ves, Mexican, Mexican American, Chicano
Q Associate de
gree (e.g. AA, q5) ~ yes, Puerto Rican
Bachelor's degree (e.g. BA, AB, BS) ~ yes
C
b
,
u
an
Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q yes, other Spanish/Hispanic/Lati
no
~ Doctorate (e.g. PhD, Ed D) or Professional degree
(Specify)
. MO DDS DVM LLB JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent consltlered himself o
'[~1Nhlt
r
e 0 lspanese ~ Samoan
~ Black or African American ~ Korean ~ Oth
P
ifi
E~ er
ac
c Islander
Q American lodlan or Alaska Native 0 Vietnamese ~ Don't Kno
/N
7j' w
ot Sure
~ Asian lodlan ~ Other Asian 0 Refused
ese ~ Native Hawaiian ~ Other (Specify)
a FIB In
i
~ P no Q Guamanian or Chamorro
`
ITEMS 29e - 29 MUeT ge rrsua. r.~.. .,.,_ .,__ _ _ _ _
H111
name orior
[wp.
nP Hi 1.1 , PA 17011
20. Decedent sRace -Check ONE OR MORE races to Indicate what
the deeede nt considered himself or h erself to be.
$] WFrlte Q Korean
Q Black or African American ~ Vietnamese
~ American Indian or Alaska Na[iy! ~ Other Asian
Q Asian lodlan Q Natlye Hawaiian
Q Chinese Q Guamanian or Chamorro
Q Filipino Q Samoan
Q Japanese Q Other PaclFlc Islander
0 Other (Specify)
self to be. 22a. DecedenS s Usual Occupat,o -Indicate type of worl
done during most of working Ilfe nD0 NOT USE RETIRED.
23d. Date Signed (Mo/Day/Vr) 24. Time of Death r -
t-~ "- t'7 '~ V ~ ~ . f"t 9 /4 I'1'\ 25
. Was Medical Examiner or Cor oner Contacted? 0 yes 0 No
CAUSE OF DEATH
26. P!K 1. Enter the chain of,~nt,.__diseases, Injuries, or compli
res
ir
t cations-that direct)
Y caused the death
DO NOT
t Approximate
p
a
ory arrest, or Yentrlcular fibrillation without showing .
en
er terminal events such as cardiac arrest. Interval:
the etlolo
gy. DO NOT ABBREVIATE
Enter onl
IMMEDIATE CAUSE ---------__~ . .
y one ca
~ ~~__ use on a Ilne. Add additional lines if nec<ssary ~ Onset to Death
(Final disease Or condition
resulting in death) Due to (o sequen of):
r as a con ce
b.
Sequentially list conditions,
if any, leading to the cause
as a con
Due to (or sequence of):
listed on Ilne a. Enter the
UNDERLYING eAUSE
(disease or Injury that Due to 0
( r es a consequence of):
F Initiated the events resulting d.
~ in death) LAST. D
t
ue
o (or as a con
sequence of):
a 26. Part 11. Enter other 1 Ifl t ditl Ib tl t t h but not
l
i
-
-
resu
t
ng In the underlying cause given in Pa rt 1
z7. wa
f
o
~ PSY Per
o~oed?
~ Yes
28. Were autopsy findings available
29. If Female: to complete the c of deaths
a
E
0 Not pregnant within past year 30. Did Tobaeco Use Contribute to Death? 31. Manner of Death O V
O N
's
°
; Q Pregnant at time of death Q Yes ~ Probably
~ No
U
k ~ Natural Homicide
~
.: .~ Not pregnant, but pregnant within 42 days of death n
nown
~ ~
Accident ~ Pending Inyestigatlon
~ ~ Not pregnant, but pregnant 43 days to 1 year before death
~ V nknown If pre
nant
ithi
h 32. Date of Injury (MO/Da
Y/Vr) (Spell Month) ~ Suicide ~ Could not be determined
g
w
n t
e past year 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 at Work 37. If Transportation Injury, Speelty:
Ves
0 Q DrlYer/Operator ~ Ped
t
i 38. Describe How In
Jury Occurred:
es
r
an
~ No ~ Passenger ~ Other (Specify)
3 9a. Certifier (Chock only one):
Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stat
Q Pro
d
i
e
nounc
ng 8. Ce Kitying physician o the bast o y knowledge, tleath o red at the time, date
and place
~ Medical Examin
and d
/C t
h
,
,
er
x
oroner - On th bass Jnatlon, and/or inyestigatlonr In my opinion, death occurred at th ue
o t
e c se(s) and m rated
ti
Signaturo of certifier: ' e me, date, and place, and due to the c
e(s) and manner stated
3 Title of certifier: OLL L ~ /
9b. Norma, Address and Zip Co Person Com rin
Causa
} D _ License Number: / ~ ~0
g
_o
ea
~ `/~rp_
aN th (Item 26)
39c. Date Signe (MO/Day/Yr)
4
0. Registrars District Num e
41
Re L
.
~ / atU~g7
~~C/
42. < ist
r File Date. Mo Day
4 3. Amendments ~j
e~ / ~r,37/J/~
Disposition Perm It No.~/ ~~~~~ H305-143
_. _ _. _ _ REV 07/2011
.~ r..~
N
Will 8v Testament ~~ r i ~ n
~zc~ cs~
Of =~~~ c..~ ~~~-`
Janet D. Lassa ~;~ 1~~ ~;
-
"
. --
---, N ~
t
a
D ~ ~~
I, Janet D. Lassa, of 306 April Drive, Camp Hill Borough, Cumberland r
County, Pennsylvania, declare this to be my last will and revoke any will previously made by
me.
ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker
and all expenses of my last illness, and any and all taxes and assessments imposed by any
o governmental body as a result of my death, whether on property passing under this will or
otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a
part of the expense of the administration of my estate.
ITEM II. I give and bequeath all of my household goods, automobiles, jewelry, and all
other articles of household and personal use, equipment and ornament, together with all
insurance thereon and relating thereto, to those of my issue, per stirpes, as survive my death by
thirty (30) days.
ITEM III. I give, devise, and bequeath all the rest, residue, and remainder of my
possessions and estate of every nature and wherever situate to those of my issue, per stirpes, as
survive my death by thirty (30) days.
ITEM IV. Should any of my issue entitled to a share of my estate not have attained the
age of twenty-five (25) years at the time for distribution to him or her, I devise and bequeath the
share of such issue to my hereinafter named trustee, IN SEPARATE TRUSTS, to hold, manage,
invest, and re-invest, the shares so received, and the accumulation of income thereon, and to use
and apply from time to time such portion of income and principal thereof .as my trustee thinks
proper for the comfortable support, maintenance, health, welfare, and education of the issue or to
make payment for such purposes, without further responsibility, directly to such issue, or directly
to any person taking care of such issue. Any principal or income not so applied shall be
distributed to such issue when he or she attains the age of twenty-five (25}years, or if he or she
dies prior thereto, to his or her personal representative.
TI'EM V. I appoint my son, PETER LASSI, trustee of the trust or trusts created by
0
this my last will. Should Peter Lassi predecease me or otherwise fail to qualify or cease to serve
as Trustee of this my last will, I appoint my daughter, AMELIA LASSI, trustee of the trust
or trusts created by this my last will. In addition to the other powers and authorities granted to
my trustee by Pennsylvania Law and by the preceding paragraph of this my last will, I hereby
give my trustee the following special powers and authorities:
A. To retain any or all of the assets of my estate, real or personal
(including any stock or securities of any corporate fiduciaries), without any regard
to any principle of diversification, risk, or productivity;
B. To invest and re-invest in all forms of property without :restriction to
investments authorized for Pennsylvania Fiduciaries, as my trustee deems proper,
without regard to any principle of diversification, risk or productivity;
C. To sell at public or private sale, to exchange or to lease, for any period
of time, any real or personal property and to give options for sales, exchanges, or
2
leases, for such prices and upon such terms or conditions as my lrustee deems
proper and in the best interest of the beneficiary or beneficiaries of said trusts;
D. To allocate receipts and expenses to principal or income or partly to
each as my trustee from time to time deems proper in its sole discretion;
E. To compromise any claim or controversy;
F. To exercise any option, right, or privilege granted in insurance policies
or in any other investments;
G. My trustee may accumulate the income from this trust during the term
~`
\ thereof but may, from time to time, distribute from current income or from
~
0~ accumulated income or from principal such amounts as my trustee, in its sole
discretion, deems advisable for the education, welfare, and comfi~rt of the trust•
beneficiary .
ITEM VI. All of the interests of the beneficiaries hereunder shall not be subject to
anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or
attachment.
ITEM VII. I appoint my son PETER LASSI executor of this my last will.
Should Peter Lassi predecease me or otherwise fail to qualify or cease to serve as executor of this
my last will, I appoint my daughter, AMELIA LASSI, executor of this my last will.
ITEM VIII. In addition to the other powers and authorities granted to my personal
representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby
give to my personal representatives the following powers and authorities effective without court
3
approval and until actual distribution of all property: to compromise any claim or controversy;
to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as
my personal representatives may determine and at valuations finally to be fixed by them; to
invest in all forms of property, including any stock or other securities in any corporate fiduciary
or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my
0
personal representatives deem proper, without regard to any principle of risk or diversification;
to retain any or all assets of my estate, real or personal, without regard to any principle of risk or
diversification; to sell at public or private sale, to exchange, or to lease for any period of time,
any real or personal property and to give options for sales, exchanges, or leases, for such prices
and upon such terms or conditions as my personal representatives deem proper; and to allocate
receipts and expenses to principal or income or partly to each as my personal representatives
deem proper in their sole discretion.
ITEM IX. I direct that my personal representatives and fiduciaries shall not be required
to give bond for the faithful performance of their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand this
a-~~~-~; 2010.
~J' ~ aG !~-~.~1~~
JANET D LASSI
`~'~ day of
4
The preceding instrument, consisting of this and FOUR (4) otlxer typewritten pages, each
identified by the signature of the testator was on the date thereof signed, published, and declared by
JANET D. LASSI, the testator therein named, as and for her last will, 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.
~~~/
\ `
a
5
it
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
( SS:
The undersigned, being the testator whose name is signed to the attached or foregoing instrument, having
been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument
as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
~-<~.:
JANET D. LASSI
Sworn or affirmed to and acknowledged
before me by the testator named above
this ~ day of ~u 4(ajF~P~ d1-2010 .
~~
C NWEALTH ~ PENNSYLVAIWA
NOTARIAL SEAL
CHARLES A. HAi~BOI•D, Notary Pubic
Catry HiM Boro, Cumberla~M County
Ny Comtwis~ivn Expires Dec. 30, 2010
COMMONWEALTH OF PENNSYLVANIA )
( SS:
COUNTY OF CUMBERLAND )
WE, `]Vt ~.,(1 ~ ~Q.~ ~ and ~ ~y~D r I the
witnesses whose names aze signed to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the testator sign and execute the instrument as her last will; that she
signed it 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 testator signed the will as witnesses; and that to the best of our knowledge, the
testator was at that time 18 or more years of age, of sound min and under no constraint or due influence.
Sworn or affirmed to and acknowledged
before me by the testator named above
this~~'day of $'(~;,~„gr~p,~ 2010 .
NOTARIAL 5~~;1_ _~A
CHARLES A. HARBOI:D, Notary 1'uia9ic
Cartt~ Hid Boro, Cumberland County
My Conta~ission Expires Dec. 30, 2010