HomeMy WebLinkAbout02-13-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~ J~>>,C~CiZI.~.w ~
COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is; are 18 years of age or older, apply(ies) for Letters as specified below, and '
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
to
Decedent's Information
Name: ~/t)~ Tr~<.ir~ ,~'?~.~,,~ o -i
a/k/a /~~ ,~ •~~c,~ciira,y FileNo• ~ - i ~,,~. 1 l t.~
_L!L_/ul Jl/C .T .t`J/~ r11JE/r_ ~ ~J ~`~ ./
a/k/a: D ,~,~ _ ~- ~~~ 1 Ec' (Assigned by Register)
a/k/a: 7~.,~.1~r/c- u<-i~ ~--
Date of Death. ~~~s ~-~U~~ Social Security No:
%% 9--~`---~~ ~-=
Decedent was domiciled at death in ~ Age at death: ~ ~
principal residence at ~ y s-7,~ " ` ~t~~c~~~n ~~ ~ County, ;,~-~i_ ,t~n15 ~Vn ~;
.~ J,.3 ~~ _ ~ F,r ~~ ~ F~Srate) with his/her last
Street address Post Office and Zip Code ~ .~ 3 ~`~ ~" Fi j7GS`Z:
n"1y dNtx- G-~,~cr~ City Town h'
`~ ~ 'Gc
c...edent dteu at ~ ~ s rp or Borough
OC i) ~~- // County
~i `ii n7 ' .ViL~ f-~r' ~~Gj
Street address, Post Office and Zip Code ~~-'»~f'a~ta,~?,~i J ~
City, Township or Borough ~
Estimate of value of decedent's property at death: County State
Ifdomieiled in Pennsylvania... .
If trot domiciled in Pennsylvania ........................ Personal property inn Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County ~/ c,:> °~~ ~ c
Value of real estate in Pennsylvania .......................... .
TOTAL ESTIMATED VALUE.... $ f~
Real estate in Pennsylvania situat d
e at. ,~/jy
(Atrnch additional sheets, ijnecessary.) Street address, Post Office and Zip Code
City, Township or Borough
County
^ A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated
State relevant circumstances (e.g. renunciation, death ojexecrrtor etc)
_ ast~odicil(s)
r" ~ r -r r 3
~~~ cL~ -~C~7
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not ma
ny, was not divorced~w~~ part pending ~:~
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. 3323 ~ /
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
§ (g), and ~jl~tQt~ve a child boni or '~;:~/
^ NO EXCEPTIONS ^ EXCEPTIONS ~ > ~ ~"-~> ~ .- -i~•,;
~'~ r ~~ ~~
®' B. Petition for Grant of Letters of Administration (If applicable) ~ ••-- `'~
b
e.t.a., d. b. n., d.b.n.c.t.a..pendentelite, clurunteubsentia, durunteminoritute
If Administration, e.t.a. ot• d5.~t.t•.t.tr., enter date of ~~'i11 in Section A above and cam fete list of
Except as follows: Decedent was not a party to a pending divorce proceeding wherein die grounds for divorce had been esablished as defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
[[~'!CO EXCEPTIONS [~ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent lefr no Will and was survived by the following spouse (if any) and heirs IotJo~ h
adclitiatul sheets, iJnecessur)~):
Form RW'-02 rev. 10/!1,'201!
Page 1 of 2
Oath of Personal Representative
CO~1~tONW'E,~LTH OF PENNSYLVANLa
COUNTY OF ~~,,7 ~~ f SS:
~ ' c~~,v
-----. r
Petitioner(;) Printed Name
Official Use Only
Petitioner(s) Printed .~dciress
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(;,) and that, as Personal Representative(s) of the Decedent, the Petitioner(s) will well and truly administer the estate according to law.
Jwocti to r affirmed d srabscribed before X.
me ~ ~'~ zJ L~~.~
-~x daY o , Date ~ / `" o?c~ i' .~
13~ Date
-For the Re„ister Date
-~.
Date
BOND Required: ^YES ~NO
FEES:
Letters ...................
( ~
Sh ... $ .:' C% ~ ~' U-
)
ort Certificate(s)... ... ,~ ~, -
( )Renunciation(s)...... .. .
( )Codicil(s).......... -~-
...
( )Affidavit(s)......... ... -~-
Bond ............ ~-
......
Commission ...........
....
Other
..... .. .
----
...
~
......
....
Auzomation Fee.
....... _
..
.. ~-
~-
.
JCS Fee -----=~ ` C
. .......... . .
TOTAL v!- 3 .5~,_
................... .. $ (_--~-
To the Register of Wills:
Please enter my appearance by my signore below: '~`_
Attorney Signature: '-~"~
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Printed Name: ~`.V-
-
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Supreme Court ~ ~
ID Number ~ '1 .. 4~
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Firm Name
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of
a/k/a:
File No:
AND NOW,
satisfactory proof having been presented before tne, IT IS DECREE tters onsideration of the foregoing Petition,
are hereby granted to
the itistrttment(s) dated in the above estate and (if applicable) that
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
Register of Wills
Fornr RG~-p7 rev. !0/IIiZO//
Page 2 of 2
.„„
This is,to certify that this is a true copy of the record which is on file in the Pennsylvania De artme --
the Vital Statistics Law of 1953, as amended.
,t, , ~ P nt of Health,, in ac~ rdance with
-~~l {`t~. ~ ~ t ~-11
.. I ~ I ,,; ; rya ,
j ;r(,Mt 4RNING: It is illegal to duplicate this co
pY by photostat or photograph.
CLERK QF ~~•~ ~' ~~ `~
Q~~,~r n~}l ~4T Marina O'Reilly Matthew
~' `''" _'' State Re istrar
657;?789 p~222011
No.
Date
H706-743 AEV 112006
PEAMANEM
TYPE /PRIM IN COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH .VITAL RECORDS
BLACK INK CERTIFICATE OF DEATH
(See instructions and examples on reverse) 109310
1. Name of Decedent (First, middle, last, suffix)
STATE FILE NUMBER
Diane Julia Aharonian 2. Sex 3. sodat secarkY Number
4. Date of Death (Month, day, year)
. 6. ~ (last Y) under t r under t d s. Data of BiM Monet, ua , Female 193 - 24 - 98 2 0
~ fraurs Minutes
Manus 7.BiM lace Ci andstateafaei coon be. place of Death Check one November 25 2011
' 80 yrs. Jul 21 Hospital:
1931 Philadel hia Other:
6h. County d Death &. City, Born, Twp. of Death PA ^ Inpafiem ^ ER / Ou tienl
• Bd. FacilAy Name Qf not instihfion, give street and mrmber) ~ ^ DOA ~ Nursing Home ^ Resttlence ^ Other - Spedty:
I Cumberland 9. Was Decedent of Hispanic Orgin? ®No
Camp Hill Boro Manor Care DfY~~spedfyCuban, ^Yes 10. Race: Americanlndan,Black,Whfle,etc
1 11. Decedent's Usual bon iM of work done dud most of file. Do not state retl Mexican, Puedo Rican, eh.) (
Krttd of Wark 12. Was Decederu ever in the 13. Decedents Education (Spedty onty highest grade to Wll l t e
Kind afBusiness/IMuslry U.S. Armed Forces? ~ 14. Martial Sktus: Marred, Never Married, 75. Survivin S
Bookkee er Auto Elementary /Secondary (012) Oop~ (1-0 or 5+) widowed, DNorced /Spdr7y/ 9 Wuse Qf wde, give maiden name)
16. Decedent's Mailing Address (Street, city I town, state, zip code) ^Yes ly No 12
64 Ashbur Decedenra Divorced
g Drive, Apt, 217 Ac1aalReaidamce t7a.state Pennsylvania Did Decedent
tiveina 17c.~i]ypsp~entlivedin Silver Spring
Mechanicsbur PA 17050 11h.Counry Cumberland Townah'ry?
18. Father's Name jFirsi, mmdle, ias4 sufrncj 17d. ^ No, Decedent LNed wflMn Twp.
Adual Limtls of
Ral h Sauer 19.MWher'sName(FrsLmtrklle,maitlensumame) Ciry/Boro
20a.lnformant'sName(Type/print) An eta DeLuca
Arden Walt 206. Informad's Maigrg Address (SbeeL city/taxn, state, np coda)
21a.MethodofDispostlion 41 Johns Drive Enola
^crematia, PA 17025
o ^ Burial rat Donation 216. Date of Dispostiion (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or olherplace)
w • ^ Other ^ Removal from State i Was Cremation or Donaton Authorized
m 21d. Lorauon (Cityltown, state, zip code)
~ by Meth aminer/Coroner? t~
22a.Signature FunerelService orpersona ~ 1p Yes^N0 November 30, ZO1 Anatomy Gifts Registry
) 270. License Number 22c. Name and Address of FadAty Hanover , MD 210 7 6
- ~ ~~ FD-138753 ,9uer Cremation Services of Penns lvania
C s23a~contywhencetfitying 23a. rlhebestofm 100 Jonestown Road b Y Inc,
physician isnatavaiWbleallimeofdeathto ~ 7 ~9e~deathocarredatthetime,dateandplaceslated.(SignatureaMtitle) x Harris urg, PA 17j09
cefity cause of death. `~(//fj/( ~yy -., 236. License Number 23c. Dak Sgned (Month, tla
U,J~ n , y, year)
• Items 2426 must be cenpleted by person 24. Tune of Death 25. Date Pronounced Dead (Mont day, year) / (J ~' L- /
• who pronounces death. Z6. Was Case Refened to Medical Examiner /Coroner for a Reason Other Ihan Crematbn or Donation?
M.
CAUSE OF DEATH (See instruMions and examples) l ^Yes o
Item 27. Pan I: Enter the c m s - dseases, injuries, or complications ~ that directly caused the death. W NOT enter terminal evenly such as cardiac anesL i
- respretory anest, or ventricular fibdNation wilhoW showing Ute etbbgy List Doty one cruse on kce t APProximate interval: Pan II: Enter olber ~ n" n Mons centnbidino to death 26. Did Tobacco Use Canlr~ute to Death?
i Onset fo DeaN but not resulting kt tite underlying cause gNen in Part I.
IMMEDIATE CAUSE (Final disease or ^Yes ~propahly
cendilion resulting n athl <
~ e. i ^ No ^ Unlmown
Due to (or as a cons rica oQ: 29. II Female:
3equenh~ayy list mndtiws, b arty, b i
lea to the cause 6sled on M1ne a. i witlan past year
Enter ~e UNDERLYING CAUSE Due to (or as a consequence oQ: ~ ^ Pregnant at lime d death
' Idsease ar irqury that initiated the t
• events restating in death) LAST. c. ~ ^ Nol pregnant, but pegnant within 42 days
Due b (or as a censequerice : ~
°~ i of death
d. ~ ^ Not pregnan4 but pregnant 43 days f° 1 year
~ before deaU
30a. Was an Autopsy 30h. Were Autopsy Findings 37. Manner of Death ~
Performed? Available prior to Completbn 32a. Date o1 Injury (Month, day, year) 32b. Describe How Injury Occuned ^ Unknown if pregnant w9hin Ne past year
,--,/ of Cause of Death? Natural ^ How 32c. Place of Injury: Home, Farm, Street, Fadory,
^ Yes f/~ No ~ Yes ~ No ^ Acddent ^ Pending Imestigalion 32d. Tutce of Iryury 32e. Iryury al Work? 32L If Transportation I ' g amine Bukling, etc (Specrlyl
ry°ry (/ 329. Lacetan of injury (Street, city! town, state)
^ Suidde ^ Could Not be Determined ^Yes ^ Driver/ eretor
M ^ N° OD ^ Passenger ^ pedestrian
33a. Certifrer (check only one) ^ Other - Speply
• Certifying physician (Pnysician certifying cause of death when arwther physti7an has 33b. ignature and ' O
i
To the best of my knowledge, death occurred due to the cause(s) and manner as stMedwced death and cempleled Item 23)
F Pronouncing and certifying physician Ph ~ "'---------------------- ~____ ~ •
P 33c. License Number
~ To the best at my knowledge, death oceurretl at the imedate, antl lace antl duel o the cause(~and manner as stated_ _ _ _ _ _ _
,~, Medcal Examiner/Coroner --^ 33d.D ~ed (Month, year)
On the basis of examination and I or investiga n, i my opinion, death occurred at the time, date, and place, and due to the cause(s) antl manner as sfaled_ ^ ~ +~
~ 35. Registml ore Di tr r 34. Name and Address of Person Who Completed Cause of Death (Item 2 Type /Print
- ~ . ~ 36. D^` JDMonth, day, year)
l~ ` r ~~~
Disposition Permit No. 06 954 78