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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: ASSUNTA M. PINTI File No:
a/k/a. (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 201-18-3863
Date of Death: 02/6 ~2o/Z Age at death: H6
Decedent was domiciled at death in CUMBERLAND County, nFin.TCVr vANIA (State) with his/her last
principal residence at 730 MANOR ROAD CAMP HILL PA. 17(111 CUMBERLAND
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 361 ALEXANDER SPRING RD 17015 CARLISLE CUMBERLAND PA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death: $ 3800.00
!f 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:.... $ !/.~ 8~0
Real estate in Pennsylvania situated at: 730 MANOR ROAD 17011 CAMP HILL, PA, CUMBERLAND
Street address, Post Office and "lip Code City, Township or Borough County
(Attach additional sheets, if necessary.)
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named m the last Will of the Decedent, dated
thereto dated
08/07/2001 and Codicil(s)
State relevant circumstances (e.g. renunciation, death ojexecutor, ere.)
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 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, durante absentia, durante 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(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 s ~~if~_any) and~eirs (a
additional sheets, if necessary): _
Name
Relationsh
Address ~~ ~ -" ' r
~7OQ ~ -..
_7~t pp r=
Page 1 of 2
Form RW-Ol rev. 10/11/2011
4
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
}
Official Use Only
(/ r. ~ r
Ft~.(_ l : Ii_ ~ ~~~ I C
Petitioner(s) Printed Name Petitioner(s) Printed Address
MICHAEL A. PINTI 6i 3carG25cr 2iu~ CLERK CF
rt~cctaasrrg~,¢ P,a. moss CIJMR~R!..~-1fd~? t^C~ PA
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 Petitioner(s) will well and truly administer the estate according to law.
Sworn too affirmed and subscribed before ~ cl~ia.~C Q~,~.~• Date O of Za ~ z-
me thi day f o f a Date
By: Date
F r t e Register Date
BOND Required: ®YES ~ NO
FEES:
..
$
Letters .................... ..
G[ ~(il../
(~ )Short Certificate(s).... .. u~~--'
( )Renunciation(s)....... . .
( )Codicil(s) ........... . .
( )Affidavit(s).......... . .
Bond ...................... ..
Commission ................ . .
Other (A ~~~ `\
Automation Fee ............ ...
JCS Fee .................. ... _
TOTAL .................. ... $ ~~,50.66'
To the Register of Wills:
Please enter my appearance b;y my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ASSUNTA M. PTNTi File No: ~'I - ~ ~...~ a6 6
a/k/a:
AND N'
satisfactory
the instrument(s) dated SS / ~/ ~^
described in the Petition be admitted
'rah ~ , ~, in co tiideration of the foregoing Petition,
ire me, IT IS DECREED that Letters ~~~~u~-
granted to h(1'~ ~ `„ ~.. a 0 ~_Q,_,~-~~
in the above estate and (if applicable) that
probate and filed of record as the last W X11 (and (:R~tctt(s~) of iJe
Register of to ,
Form RW-02 rev. IOiII/ZOl! L~ " "~ Page 2 of 2
Hios sos acv ryii u
LOCAL G STRIAR'S CERTIFICATION tJF DEATH
WARNING~f~g~ll ~~~(~ate: this copy by photostat or photograph.
Fee for this certificate, $6.00 This is to certify that the information here given is
t ~~? ~ ~ ~~~ ' ~ ~i~ ~ correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
~~~~K ~~ certificate will be forwarded to the State Vital
Q~~,S ~d~~ Records Office for permanent filing.
P 1819 4 6 4 9 _ cu-~~~~~_ ~~~ c;t~ . ~ ~~. ~ a~/ ,~~ /
Certification Number Local Registrar Date Issued
xpdnt In COMMONWUl1N OF pENNEYLVANIA • OEpARTMENT OF NEALTN • VOAI RECORDS
Mnt fCQTICIfATF AC nCATN _ _....
~a'nl. DecetleM's la{u Name IFInU kaMdb, last, Eu1M) 3. Sea 3. Sadal Secudry Number a. Date of DMM IMO/Day/yrl lipell MRI
Assunta Marie Pinti Female 201 - 19 - 3863 16 2012
Sa. A{eias[ BIrtIMry ~Yn) Sb. Under 1 YeN Sc. Under l 6. Due of BMh (MO/IAy~'/orl ISpell Month) ]a. Mrth CRY arM Sn F>reyn Coumry)
~
~~
$ F
Month DaYf IIrIK Mbutes ~~
86 F'ebruar 2 1926 7h. Blrthpnw Ifalmh') Da ~ n
1p
p. (Stan «FOnipl CounVy) Bb. Rnklenu IStnu arM.Number- IrvduM Apt No.l k. Old DuMent LNe b a T
~9
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[$Y.f, e.nMnt nv.a b F t Mp.
lvania
730 M33nor Road
w. Ic«rMr)
C.UUberlaEld r. Refld.M.12q todel ^ N0, ewarx Ilved wlMb umw a arylborO
9. Ever n US Armed F«naT 10. Markel States K TNM 0/ GaM ^ MRMed WWowed 11. SurvMry Snrru4 Name of wNe, tdw Mme pd« n nt marrlye)
^ rn ®No ^ ultbawn ^ Olvornd ^ Never M.rrbd ^ udnuvn
Il. F s Namf (FNrt, MkMe, w4 SuRh) 13. MolMr's Name Prbr t0 First Mrda{e (Flrrt, Mbdla, uu~
JoBeph 61311age Sarah Tarasi
faa. I s Name Sob. RNUbnslllp n Decedent lac. InbmwnYf MNllry AMrer IStrwt and Number, CRY, Eon, Ilp CaMI
Mi 1 A. Pinti 614 Slxnerset Drive Mechanics PA 17055
I pr pv .. ......
I Oe~ Ommd in a lbapbl: to InpubM :If DeaM OCNrretl Somesvlure Other TMn a NoapMl: L,1 N«pke fadbry r, DecedentY Name
'
a RaoMOYtpuwd Mad on ANMI NursM IsomeFlari{-Term GnFadRty OMr(SpcIFF)
yyy ISb.F NameMMt bultutlon,{M rtreet rid number. fie.Ory Or TOwn, spec. and 34 Cade 15d. CODUY Of DeaM
lisle ional Medical Center 1
IW. aDbpeWwr eudN enm.ebn IW.DneorDbpnRbn IBC.vlanorgfpoNtbntnameofnmee.ry.uem.t«y.«otherwan)
^ n.mpa,l ham stm ^ opnatbrl
other 21 ra01 ?iol Cross Cemet
IBd. laatlan of Obpwltlan Itaty r rtwm, Snta, one lbl v.. pr w «p.nen b Gar{e or IntMnant Iro. lxeMe Npmbr
7111
Harrisburg, PA 1 FD - 014889
aE
F.~t~
~ lda+re 2~Ftu a al Hrnla S Market 2a We Met, cs PA 17055
~ IB. DMdeM's EduaMn-l]Iad Du boa tlwt but MwlBw tlN 19.Oecedant o! NbpaMC Q'I{In - Chadt tlr 30. DewdenCf Race - (]Ted ONE ON MORE nlNS n kvllnte who
~ hldrst da{m «bvei M uhpol wmpwed a the tlme of death. bw Mu best Maulbn vAwMer Me de«denl the decadent nnMered hhnwM «MrfeN to ba.
^ BM {rah or ter Is Spanifh/Nbpank/latM. Deck Me'NO• ~ Whtte ^ KOnan
^ No dkN«M, 9M - IZM {rWe bm N decdnent Is not Spallbh/Nbpank/IaNM. ^ Bled a Ahinn AmrkM ^ VwMmex
~NI{h sY3ad padWnrGED C«npwed QQ NO, MtSwnbh/NlapankJlatlno ^Amrlranlndbn «Awb NetMl ^OIMrAMn
SpIM colM{e uadR, bu M de{m ^ YM McRlun, Meaban Amerkan, Ch1uM ^ Adan IM{an ^ NatM Wwa{an
Aftacbte dgree (a.{. AA, AS) ^ YRU Puerto Rican ^ ChIMU ^ Gwmanbn or [Mmoue
~ BrAUpYS degree (e.{. BA. AB, Bs) ^ Yes, CuW n ^ FlIIpIM ^ SarMan
^ MuteYS Ogres 1e.4 MA, Ms, MEry, MEd, MSW, MBA) ^ Yes, uhr SWnbAMbpank/nikw ^ lawnese ~ UMr pacNk Maher
^Ooct«atele.{. FhD. E0D1«FrahsNOnu degree (EpeclW) ^O[MrlEpacNYl
. MD DOS Dl'kl LlB ID
31. Oetedent's Siryb Rre SeN-Dasynatbn -Chad ONLY dlf t01nd1nM who Me decedent cenfidered himull or herxN n be. 33a. DecMant's Uswl Ocapubn - Irkkate type of work
Whtte ^ AWanew Q Lmoan dorm dodo{ mot of wditlry Me. DO NOT UEE RETIRED.
^glad rAfrksn Amedan ^{onan ^Other pacific blaMr 1'1~Daker
Amerkan Indian «Anda NatM ^ VwMmew ^ Don't Rnow~N« Sun
AMn Indbn ^ Other AWn ^ Refused 32b. EMd of BuslMSS/Indus[ry
p OdMU ^ Native wwalbn ^ ocher Ispedry)
CWn H~
p FipplnO ^ GvamaMan «cnamorTp
BE pLF7E0 33a. Date pranou DeM r) 3 . Signature ei boon pr«au n{ OeaM en appXu 33c Numbx
BY Of~ pnO110UMQ3 p1 O Z /(, ~ / _- ~
/h b " cw gSi'/t
s
33d. Gan Elgned IMO h la. nme m DeaM
~3• ZC/L ~ ~ 0~ ~~ 35. Was Madkal Eaaminer« tMetl7 ^ Yes Mo
cause of oeAn+ ! ApprarhMte
3g. M 1 Emr Me Mob Of events-dluases, bludo, «cemplkubns-thH dlnctN nosed Me tleath. DO NOT enbr terminal ewntl such as oMlac arnrt Innnu:
Emer only one cause on a TIM. Add addttbnal Iknf N neuswry i Onwt to peaM
respiratry Guest, «ventrlaln RbrMlatbn wlMou[ Mowlry tM Nbbgy. 00 NOT ABBREVIATE.
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IMMEDIATE UUSE ----> a. _(,7 •L~PSQQr Y~Q'V M LI. (la V- N j
(FNal tlbeau «tonditbn Due color asaconseR eon:
rnultlry b Muh)
s
S
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s _
b.
Due to l«asacon
SequembM Ibt eenditbns, ~ uquenn On:
N alry..lwdlryntM now ~
/t 7 (,~1/YLO /Ls s.L
IbtN an {ne a. En[x the
ubbgRIYINY Ut15E Dw m 1« of a nMeeuenw pn:
Idq.Me r bJury Mu i
ktltlwaethe awMf rewttlry d.
btleaMltArt. own(«raoxMOUann On:
~
in Me undMylry auw Nan In part l 3]. Wr an auwpsy 7
Riry
36, pre R. Ennr oUrr but Mt rou
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29. M Fem
~ 30. Db Toba<n Uw [oMdb«e n DeaMi
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bl
b 31~. MaJir R~`~,r of Danh
M [J Homklde
pra{nant wRMn part nn
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O'Flo ^ UnkMwn o7 "-`V
^ Itckent [J perMln{Imestlptbn
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] hgMnt at
me o
a
Nu prgnant, but pregnant Mthb a3 den of MGM ^ Suklde [] COUId n« M duermMW
~
but pugMnt 13 den n f ywr belan Math
N« Ixa{Mnt 33. Date of Innlry (MO/OaY/Yrl (spell Month)
,
uMuwwn N pngnan[ wMUn Me wet par 33. nme or ln)ury
3I. hue Of IrNury le.{. home; coMtnMbn sbe; farm; fdwpn 3E. lacrtion of Inlury Iitreet and Number, Ory, Snle, Pp CaM)
36.Inlury at WOd 37. tlTnnsp«tllbnlnNry. SOed1Y: 36. DesWbe NOw Inlury Otcurre0:
Q Yr 0 Drber/Opent« ^ padeftrbn
No ^ hswryer ^ OMer (Specify)
39a. CMI1Mr lauxt onM oMl:
phYNClw - TO tM bert of frry knoWedge, MeM aram0 due to tM would aM nynrw anutl
«M{ L Certllylry phyNCIM - Ta bat of my knowled{e, MaM ouwud at tM thne. Mte, aM plea, arM due to the rauulsl aM manrwr anted
Q Madkal Eeaminar - On t n, antl/« Inwsthatbn, In my opnbn, Math ed at eM time, den, arM place, and tlw to Me cwalfl and manner anted
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er.
s4Mtun of urtiMr: TIM of nnMer:
39b. me, M and 21p curM W penOn ry e u MnA Ittem 36)
- 39c. Date l /Yd
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Dispoflebn permit Np. 0729346 REV o7no11
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I, ASSUNTA MARIE PINTI, of 730 Manor Road, Camp Hi11, Cumberland County;
Pennsylvania, being of sound and disposing mind, memory, and understanding, do hereby
make, publish, and declare this to be my Last Will and Testament and hereby revoke all other
Wills and Codicils, if any, that I have made.
FIRST: I direct that all my just debts and the expenses of my last illness and funeral
shall be paid from the assets of my estate as soon as practicable after my decease.
I authorize my personal representative to expend funds from my estate, in such
' amounts, as my personal representative I shall consider necessary and desirable, for the
disposition of my remains in accordance with the instructions I have provided to my Executor.
I~
N SECOND: All of my Estate, of whatever nature and wherever situate, I give, devise,
and bequeath in equal shares to my four children, MICHAEL ANTHONY PINTI, ROBERT
LEE PINTI, DIANE MARIE CLINE, and ANTHONY JAMES PINTI, so long as they shall
survive me by thirty (30) days, per stirpes.
THIRD: All interests of any beneficiary in the income or principal of this Estate, while
undistributed and in the possession of my Executor, even though vested and distributable, shall
not be subject to attachment, execution or sequestration for any debt:, contract, obligation or
liability of any beneficiary and, furthermore, shall not be subject to pledge, assignment,
conveyance, or anticipation.
FOURTH: All inheritance, estate, and succession taxes (including interest and any
penalties thereon) payable by reason of my death shall be paid out of and be charged generally
against the principal of my residuary estate without reimbursement from any person.
FIFTH: I nominate, constitute, and appoint my son, MICHAEL ANTHONY PINTI,
as Executor of this, my Last Will and Testament.
I direct that no representative named above shall be required to post security for the
faithful performance of his duties in any jurisdiction insofar as I am able by law to relieve him
of such obligation. Any of my representatives shall be entitled to reasonable compensation for
the performance of the duties set forth here.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ day
of ~ , 2001, on this, the second of two typewritten pages. I have also signed
the left-ha margin of the first of these pages for purposes of identification only.
ASSUNTA MARIE PINTI
SIGNED, PUBLISHED, and DECLARED by the Testatrix, ASSUNTA MARIE PINTI,
as her Last Will and Testament, in the presence of us, who at her request, in her presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
/Sot l3/u0~ ~ ~
~~ ~~~ a~ ~~ ~P~
f~' 4)CJNG- 5j~l~I~Cz-S, f
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
,~,
We, AUSTI~1 F. GROGAN, ESQUIRE, and ~e~~~ ~-• --G~~• the
witnesses whose names are signed to the attached instrument, being duly qualified according to
law, depose and say that we were present and saw the Testatrix sign anal execute the instrument
as her Last Will and Testament; that ASSUNTA MARIE PINTI executed it as her free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the
Testatrix signed the Will as witnesses; and that, to the best of our knowledge, the Testatrix
was at that time 18 years of age or older, of sound mind, and under no constraint or undue
influence
~`(~ L-
Sworn or affirmed to and subscribed before me by AUSTIN F. GROGAN, ESQUIRE
and 'I~~-'~-~' ~-'• ~~Z~~-= ,witnesses, this ~~ day of~c_~~~"" , 2001.
NOTARY PUBLIC (J `~
Notarial Seal
Rhonda D. Rudy, Notary Public
Camp Hill Bono, Ctunberiand Cour~tY
y Commission Ex~res qug.12, 2 2
P41emh~ ~r Pennsylvania Association Ot Notaries
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, ASSUNTA MARIE PINTI, Testatrix, whose name is signed to the attached
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my Last Will and Testament; that I signed it willingly; and that
I signed it as my free and voluntary act for the purposes therein expressed.
ASSUNTA MARE PINTI
Sworn or aiffirmed to and subscribed before me by ASSUNTA MARIE PINTI the
Testatrix, this '~~<~. day of .u ~' , 2001.
~~r
L
N ARY PUBLIC
Notarial Seal
D. Rudy, Notary Pudic
Hid f3oro, C:tp'res ~ 1202
My fission Expi
Member, Pennsyivani: 4ssociatfon of Notaries