HomeMy WebLinkAbout02-16-12PETITIO:~i FOR GRANT OF LETTERS
REGISTER OF WILLS OF t_u.h6erlQrl,~ COUNTY, PENNSYLVANIA
Petitioner(sj named below, who is,'are 18 years of age or older, apply(ies) for Litters 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
~-- l
Name: Sr. File No: `
~PQU.t W. C.,n rael . O< < o~+ ~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 17l ~ Z8-/Gry
Date of Death: ~ ate. ~.R ~ 3,0 ~ a. Age at death: r 7 xis.
Decedent was domiciled at death in Ca~,6erfgnd County, ~ennsvlvan a. (Stare) with his/her last
principal residence at p p BAY iy I A Cash M i1 S+ t~o~t Its New K,~~slo 'r, 5'+lyer~5 Plfa. Ct,rla~d
Street address, Post Office and Zip Code City, Township o Borough County
Decedent died at //oi~ 5~;i,~ ~aes~~al l7 o tt (~,„,~l-l,'l/ G.~mb~rlanA pp
,---r--
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
Ijdonticiled in Pennsylvania ............................ All personal property $ N f W .S~• O i'
If not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $
If nol domiciled in Pennsylvania .......................: Personal property in County $ '--
Value ojreal estate in Pennsylvania ......................................................... $ ---
TOTAL ESTIMATED VALUE.... $~ ! ys. ~ i'
Real estate in Pennsylvania situated at: 1118
(Attnch additional sheets, ijnecessary.) Street address, Poat Office and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he~i /they tare the Executor(s) named in the last Will of the Decedent, dated ~Ta ~ . !.3 r 14 ff y and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death of executor, ertc.J
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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. Ei 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.
NO EXCEPTIONS ^ 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, durance minoritate
If Administration, c.t.a. or d.b.n.c.t: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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
^NO EXCEPTIONS ^ EXCEPTIONS
c,.~
Petitioter(s}, after a proper search has/have ascertained that Decedent left no W ill and was survived by the follo~virigsp~e (if any) and ~s (attach
odditional sheets, iJ'necessaty): - t"' ~C?
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Name Relationshi
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Address
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F~„» Rw-nz rw. ~niltiznil Page 1 of 2
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Oath of Personal Representative ~~- fftCial' se OhlyT
COMbIONWEALTH OF PENNSYLVANIA } :'}'!2 ~ ~~ 1 ~ ~~'' ~ ~' `'~~
} SS:
COUNTY OF } ~~V( (~
I Petitioner(s) Printed Name I Petitioner(s) Prinr.~l ANI ! [ 1 ! f~ I
I. 1~6nnn.. ('. .Ill~.l1P. laia. I~P~~nP-~ ~Je. I-~r~1~s~vr~, ~'.~t_ ~SZZ
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, t etitioner(s) 'll ell nd t y administer the estate according to law.
Sworn to or affirmed nd ubscribed before Date ,2 - ~~ -Z~/~
me this da ~ ~ ~' Date
$y; Date
For t e Register Date
BOND Required: ~ YES O
FEES:
Letters ...................... $~
( ~' )Short Certificate(s)...... ,Y~
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. . -~
Other ~ t ~>• ........
Automation Fee ...............
]CS Fee ..................... c,~~
TOTAL ..................... $~ ~ - ~7
To the Register of Wil[s:
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 ~Cl~ ( ~ , , ~/yl 17^~ ~ ~ ~ File No: G I ~ o~C
a/k/a:
AND NOW V` `C oC~/ i °~"' , in coti ider tion of the foregoing Petition,
satisfactory pros ing been pres me before me, IT IS DECREED tha Letters ~ w~-.fir' _
are ereby granted to ~,~ ~ ~ ~ c7
~ / in the above estate and (if applicable) that
the instrument(s) dated _
described in the Petition be
FonnRW-01 rev. l0/(I/1011
[ to probate and filed of record as the last ill (a:nd Codicil of Dec de~n~t.~ ~
~~
R gister of W' is Z
Page 2 of
HIU5.805 REV 19/17)
LOCAL`j GISTRAR'S CERTIFICATION OF DEATH
VI~I~~ ~ ~ ~to duplicate this copy by photostat or photograph.
r ~~rr
Fee for this certificate, $6.00
2(112 DES 16 AID (1 ~ 4 $
CLERK 41=
ORPHAN'S C{}tJRT
P 18 2 0 5 5 ~~.aN~ tx~., p~
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Recordis Office for permanent filing.
L.'~.~a~cvt.~~t-®ac~ci~,l,~rza~c~ ~gfN 3 ]/ 2012
Local ][registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA _ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permane`t CERTIFICATE OF OFATH
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t_~_
~_
1. Decedent's Legal Name (FIrsY, Middle, Lazt, Suffix) 2. Sex 3. Social Security Number _ 4. Date of Death (MO/Dsy/Vr) (Spell Mo)
Januar 29 2012
Sa. Age-Lest Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Data of Birth (MO/Day/Yaa r) (Spell Month) 7s. Birthplace (City and State or Foreign Country)
Mpnths Days Nours Mlnu[es
'
'
7
7 March 1 4 1 934 76. Birtt.plsca (County)
Ba. Residence (State or Foreign Country) 8b. Residence (Stre¢t and Number -Include Apt No.) Bc. Did Decedent LIYe in • TownshlpT
1 -A East Main St _ ~Ses, decedent llvetl In Si l VBT SDr
i il
e
~
g
Bd. Residence (cpl,nty) New Kin stown PA
8e. Residence (Zip Code) '~ '] Q No, decedent INed within limits of Gty/boro.
9. Ever In VS~ ~Ar~m"ed Forc<sT 10. Marital Status at Tlme of Death ~ Married Widowed 11. SurvlYing Spouse s Name (If wife, give name prior to first marriage)
Q Yes tr~:VO Q Unknown Q Divorced Q NaYer Married Q Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First karriage (First, Middle, Last)
14a. Informant's Nama 146. Reirtionshlp to Decedent 14c. Informant's Malling Address (Street and Number, City, State, Zlp Code)
G ..............................•---...........:......... _.._.................-•--------..........,............a:....'.C°.3....~•.~... ep pn y one _
If Death Occurred in
Hos
ital ~ I
ti
`
- p
a
npa
ent :If Death Occurred Som where Other Than a Hospital: [~ Hospice Facility ~
Dec<dent's Home
Emergency Room/Outpatient Dead on Arrival ! Nursing Home/Long-Term Care Facill Other (Specify)
~
l Sb. Facility Name (If not Institution, giY< street and numb<r; 15 c. City or Town, Stat<, and Zlp Coda lSd. County of Death
Hol S irit Hos ital Cam Hill PA 17011 Cumberland
16a. Method of Disposition Q Burial Cremation 16b. Date of Disposition 16c. Place of Dlspositlon (Nam¢ of cemetery, crematory, or other place)
Q Removal from State Q Donation
Other (Specify)
Feb _ 1 , 201 2
Hollinger FH(/Crematory, 2nc _
Z 16d. Location of Dlspositlon (City or Town, State, and 21p) 17a. SI re of Funeral Servl a Lice r Person In Charge of Interment 176. License Number
Mt_Holl S rin s PA 17065 _ FD-011932-L
17c. Name and Complat< Address of Funeral Facility
' oil S s PA 17065
~ 1g. Decedent's Education - Ch<ck the box that best descrl es [he 19. Decedent of Hispanic Origin -Check the 20. cedent's Race -Check ONE OR MORE races to Indicate what
1- highest degree or level of school completed at the time of death. box the[ best describes whether the decedent t e decedent ronsldered himself or herself to be.
Q HM grade or I<ss Is Spanish/Hispanic/Latino. Check the "NO" White 0 Korean
Q No diploma, 9th - 12th grade box If decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnameae
~ High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q Amerlcnn Indian or Alaska Nature Q Other Asian
Q Some college credit, but no degree Q Ves, Mexican, Mexican American, Chicano ~ Asian Indian Q NafiYe Hawaiian
Q Associate degree (e.g. AA, AS) Q Ves, Pu<rto Rican
Q Chjneser ~ Guamanian or Chamorro
Q Bachelor's degree (e.g. BA, AB, BS) Q Ves, Cuban Q FIIIPino Q Samoan
Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino Q lapane::e Q Other Pacific Islander
Q Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) Q Other (Specify)
. MD DDS DVM LLB lD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22s. Decedent's Usual Occupation -Indicate type of work
$] White Q Japanese Q Samoan done during most of working Iifa. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Natye ~ Vietnamese Q Don't Know/Not Sure
]cer
Q Asian Indian Q Other Asian Q Refused 22 b. Kind of Business/Industry
Q Chin<se Q Native Hawaiian Q Other (Specify)
Q Filfplno O GuamanlanorChamorro AMP Snc _ /T co Inc .
ITEMS 23a - 29d MUST BE COMPLETED 23a. Date Pronounce Dea Mo Day 2 Signature o Person ncin Death Only w <n applicable 23c. License Num er
CERTIFIES DEATH PRONOUNCES OR ~ ZN IL
`'
23d. Dat<Signed (MO/Day/Vr) 24. Time of Death ~1ry J (P 0 ~t~
1 ~ ?.ri 25. Was Medical Examiner or Coroner ContsctedT 0 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 terminel ey<nts such as cardiac arras[
Interval:
.
respiratory arras[, or ventricular fibrillation without showing [he etiology. DO NOT ABBREVIATE. Ent<r only one cause on a Ilne. Add additional Ilnes if necessary Onset to Death
IMMEDIATE CAUSE > ~ Q~~ S ) (~ '
1
(Final disc ondition Due to (o a consequa c of):
resulting In death)
n
~
b. j
Sequentially list condltlons, Due to (or as a consequence of):
If any, leading [o the cause
listed on line a. Enter the
UNDERLYING CAUSE Due to (or as a consequence of):
L'c. (d lsease or Injury that
Initiated the events resulHna d.
in death) LAST. Due to (or sequence of):
as a con
,~ 26. Part 11. Enter other signiflca nt condltlons contributing to death but not resulting In the underlying cause given In Part 1 27. Wes a autopsy p NormedT
~ o yea ~p
2g. were autopsy findings aval4ble
"~' to com plate the cause of tleafh7
~ Ves Q No
E 29. If Female:
Q Not pregnant within past year 30. Did Tobacco Use Contribute to Dea[hT
Q yes
P
b
bl 31. Ma~~Per of Death
as
'
Q Pr<gnant at time of death ro
a
y
Q
~ Q Unknown Natural Q Homicide
Q Accident Q Pending Inyestlgailon
$ Q Not pregnant, but pregnant within 42 days o7 death Q Sulclde ~ Gould not be determined
~ Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of InJury (MO/Day/Vr) (Spell Month)
Q Unknown If pregnant within the 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 aY Work 37. If Transportation Injury, Specify: 3g. Describe How Injury Occurred:
Q Yes Q Drlvar/Operator 0 Pedestrian
Q No 0 Passeng<r Q Other (Specify)
39a. SPrtifler (Check only one):
C
rtif
i
h
i
i
T
h
b
f
k
l
e
y
ng p
ys
c
an -
o t
e
est o
my
now
edge, death pcc red due to the cause(s) and manner stated
Q Pronouncing 8. Certifying physicla - To the best of my knowledge, death o red at the time, date, and place, and tlue [o the cause(s) and m stated
Q Medical Examiner/Coroner - On th asls of axaml atlon, and/or investlgationr in my opinion, death oc
rr
cu
ed at the time, date, and place, and due to the cause(s) and mann stated
/~
^
A
Signature of certifier: Title of ceKlfler: 'v I U Ucensa Numbar~ ~ )~7 L'1 ~ (GZ~,
39b. Name, Adtlress and 21p Code of Perso plating Cause of Death (Item 26) 39<. Date Sign d (MO/Day/Vr)
lF'rrv~nd G4Pta .1"j~ So3 ^/, 2t s-` S-t~'eer CGfrlp!-'T`l(, 'AA ( -7vr. % /30 / 2012
40. Ragtstrsr's District Number 41. Raglatrar sSlgtfature 42. Registrar Flle Dete Mo Day r
aI -a I o ~
(~ (,mll~l,~.
43. Amendments
Dlspositlon Parmlt Np. C7 bQt~ tp~~ H105-143
REV 07/2D11
LAST WILL AND TESTAMENT
OF ~ `~`'
PAUL W. CONRAD, JR. f''.~r~
_~
~'
I, PAUL W. CONRAD, JR., of Silver Spring Township, Cumberl unt~~
Pennsylvania, being of sound and disposing mind, memory and underandin~ d
,t`
hereby make, publish and declare this as and for my :Last Will and Testar>~t,
~:~ ''''~
"j i:,~
hereby revoking and making void any and all wills by me at any time heretofore
made.
1. I direct that all my debts and funeral expenses be paid as soon as
practicable after my death by my Executrix hereinafter named.
2. All the rest, residue and remainder of my estate, real, personal and
mixed, and wheresoever the same may be situate, I give, devise and bequeath to
my wife., THELMA E. CONRAD, her heirs and assigns, provided my said wife,
E. CONRAD, shall survive me by a period of sixty (60) days.
3. Should my said wife, THELMA E. CONRAD, predecease me or fail to survi
me by the aforesaid period of sixty (60) days, then in such event, all the rest
residue. and remainder of my estate, real, personal and mixed, and wheresoever
the same may be situate, I give, devise and bequeath to my daughter, DONNA K.
DUKE, her heirs and assigns. Should my daughter predecease me, I direct the
share which she would have received shall pass to her issue surviving me per
stirpes.
4. I hereby nominate, constitute and appoint my said wife, THELMA E.
LAW OFFICES
SNELBAKER,
MCCALEB & FLICKER
CONRAD, as Executrix of this my Last Will and Testament, but should she predece se
me or fail to qualify, then in such event, I nominate, constitute and appoint m
daughter, DONNA K. DUKE, 212 Beisner Avenue, Pittsburgh, Pennsylvania, as Execu
trix of this my Last Will and Testament, and I further direct that no person
serving as Executrix shall be required to post any bond to secure the faithful
performance of her duties in the Commonwealth of Pennsylvania or in any other
.„
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last
Will and Testament written on two (2) pages this ,Q3 day Jp~(rj~¢~y ,i
1984.
~~ct~G~ ~~ (SEAL
Paul W. onrad, Jr.
Signed, sealed, published and declared by PAUL W. CONRAD, JR., the Testat r
above named, as and for his Last Will and Testament, in our presence, who, in is
i presence, at his request, and in the presence of each other, have hereunto sub -
scribed our names as attesting witnesses.
Sfa,~~tfs:~~~
LAW OFFICES II
SNELBAKER.
McCALEB & FLICKER
-2-
COMMONWEALTH OF PENNSYLVANIA)
. SS.
COUNTY OF CUMBERLAND)
We, PAUL W. CONRAD, JR., E. ROBERT ELICKER, II and SUSAN A. McCOY, the
Testator and the witnesses, respectively, whose names are signed to the attach
or foregoing instrument, being first duly sworn, do hereby declare to the i
undersigned authority that the Testator signed and executed the instrument as
his Last Will and Testament and that he had signed willingly, and that he execu
it as his free and voluntary act for the purposes therein expressed, and that
each of the witnesses, in the presence and hearing of the Testator, signed the
Will as witness and that to the best of his or her knowledge the Testator was
at that time eighteen (18) years of age or older, ofd sound mind and under no
constraint or undue influence.
!/l~/ ~l~r ~Sl~.
Test or
~~~~~~~C4..c.f~
Witness
~~ G
Witness
Subscribed, sworn to and acknowledged before me by ]PAUL W. CONRAD, JR., the
Testator, and subscribed and sworn to before me by E. ROBERT ELICKER, II and
SUSAN A. McCOY, witnesses, this ~{.~~`~ day of ~a-r;ua~=~ 1984.
v
-,
<:
LAW OFFICES ~I
SNELBAKER,
McCALEB & ELICKER
ted