HomeMy WebLinkAbout03-19-12PETITION 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 requests the grant of Letters in the appropriate form:
Joanne Patricia Alexis
~~~edent's Information File No: 21 12 - ~~~
Name: Sophie Alexis (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 188-12-3874
a/k/a: Age at Death: 87
Date of Death: 0311212012
County, PA (State) with his/her last
Decedent was domiciled at death in Cumberland Carlisle Cumberland
principal residence at 100 Conway Street, Carlisle 17013 City, Township or Borough county
Street address, Post Office and Zip Code Cumberland PA
Carlisle
Decedent died at 100 Conway Street, Carlisle 17013 City, Township or Borough county state
Street address, Post Office and Zip Code
Estimate of value of decedent's property at death: $ 20 000.00
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 VALUES 20,000.00
Real estate in Pennsylvania situated at
(Attach additional sheets, if necessary.) City, Township or Borough County
Street address, Post Office and Zip Code
® q, p Ion for Probate and Grant of Letters Testamentary 0510112008 and Codicil(s)
Petitioner(s) aver(s) that 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 of executor, etc.)
Except as follows: awhere n the grounds foe divorce hadsbeen established as definedent23 Pa. C.S r§73323(g) land did Holt have a chl d boen oprending
divorce proceeding
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitate person.
®NO EXCEPTIONS ~ EXCEPTIONS
(If applicable)
c. t. a., d.6.n., d.6.n.c.t.a., pedente lite, durante absentia. durante minonta e
8. o •I,tlnn fer Grant of Letters of Administration
~ ~•ru In Sprtion A above and co oletR list of heirs.
If Administration, c.t.a or d.6.n.c.t.a., ~ ~a g
Except as follows: Deced and was neitheath tvictim of a kllll~ng noroeverdadjudlcated ane neapac,tated peorSOnhad been established as define
in 23 Pa. C.S. § 3323 (g)
NO EXCEPTIONS' EXCEPTIONS
.,e~ ac~rrh has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach
Page 1 of 2
Form RW 02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc.
Oath of Personal Representative official use only
COMMONWEALTH OF PENNSYLVANIA } rir ` `. -' ~. ~. t •r t1t=
SS. I r,, 1,I~
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COUNTY OF Cumberland } '
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Petitioner(s) Printed Name Petitioner(s) Printed Address •~. <, _
Joanne Patricia Alexis 100 Conway Street ` ~
Carlisle, PA 17013
RPHwN'S COUR T
_ .... _, _ _ ___ _~ a_ a~_ ~__a .l aL~ 1,.....I.J-.. ....J
The Petitioner(s) above-named swear(s) or amrmtsl me swtemerns ~„ ~~~C wl~y~llly r-~~L1..1~ alp ,1,.~ o,,...,.,,,,.,,. •~ •~•~ -•--• •-• •••- •-••--••--~- - -
belief of Petitioner(s) and that, as Personal Representative(s) of Decedent, P tloner(s) will well and truly administer the estate according to Iaw2 0 ~ Z-
Sworn to or affirmed and subscribed before ~ Date 3
me this day of ,~~' Date
B ~ 10 ~ 1 ~- Date
Y~
Date
For the Register
BOND Required? ~ YES ~ NO
FEES:
Letters .......................................... $
( 3 )Short Certificate(s).........
( )Renunciation(s) ..............
( )Codicil(s) ........................
( )Affidavit(s) ......................
Bond .............................................
Commission ..................................
Other
~1~ - ll l~,
Automation Fee ............................
JCS Fee ....................................... ,
r
L
TOTAL ......................................... $ ~Z.~~~
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature
Printe Name: Edward P Seeber
Supreme Court
ID Number: 76084
Firm Name: James Smith Dietterick & Connelly, LLP
Address: Suite C-400
555 Gettysburg Pike
Mechanicsburg, PA 17055
Phone: 717-533-3280
Fax:
E-mail: eps@jsdc.com
DECREE OF THE REGISTER
Date of Death: 03112/2012
Social Security No: 188-12-3874
Estate of So hie Alexis File No: 21-12
a/k/a:
~~ ~ C ~1 ~ ' ~ ~-- , in consideration of the foregoing Petition,
AND NOW, '
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Joanne Patricia Alexis
in the above estate and (if applicable) that the instrument(s) dated 05/0112008
described in the Petition be admitted to probate and filed of record as ~I~st Will (and Codicil(s)~of Decedent.
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egister of Wills ~ ~1 in h ,~1
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S Type/Print In COMMONWEALTH OF PEN NSV LVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS
Permanent CERTIFICATE OF DEATH
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:k Ink Z. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo)
Suffix)
last
Middle
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s Legal Name (
. Decedent
March 12r 2012
F
So hie Alexis
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a. Age-Last Birthday (Vrs) 56. Under 1 Vear Sc. Under 1 Da 6. Date of 61rth (MO/Day/Year) (Spell Month) 73tiBi SLOn(rI 1 JaSSte or Foreign Country)
t30
" ( Months Days Hours Minutes
1 925
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8 a. Residence (State or Foreign Cou n[ry) Bb. Residence (Street and Number -Include Apt No.) Bc. Did Decedent LiYe in a Township?
QYes, decedent lived in LwP.
PA
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Residence (County) 1 00 lAliZwC~1 Street
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151
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L'ar~
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city/born.
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C,~artberlancl Se. Residence (tip Code) 1 701 3 [~NO, decedent Ilyed within limits of
Marital Status at Time of Death Q Married Widowed 31. Su rviying Spouse's Name (If wife, give name prior to first marriage)
US Armed Forces? SO
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9 .
n
. Ever
Q Ves ®No Q Vnknown Q Divorced Q Never Married Q Unknown -
1 Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Las[)
2
.
Charles Belcas An ela Janavaris
e 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Clty, State, Zlp Codej
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14a. Informant
Alexis Daughter 100 Conway St_ Carlisle, PA 17013
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Joanne
__ isa. P ace o Dea[ c. ec on_y one .. ... ... ........ ...... .... ......'.' ...' •....° ..°..... "..'
............................... ............................................
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f Death Occurred in a Hospital: ~ Inpatient =If each Occurred Somewhere Other Than a Hospita
atient Q Dead on ArriYal Q Nursing Home/Long-Term Care Facility Other (Specify)
Room/Out
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Q Emergency
156. Facility Name (If not institution, give street and number; • 15 c. City or Town, State, d Zip Code lsd. County of Death
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100 Conwa Street Carlisle, PA 17013
16a. Method of Disposition ~ Burial Q Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
Q Removal from State Q Donation Westminster Manorial Gardens
3/ l 6/201 2
Other (specify)
16d. Location of Disposition (City or Town, Slate, and Zip) 17a. Signafu re of Fu ral Service license harge of Interment 17b. License Number
FD 012633 L
Carlisle, PA 17013 _
E 17c. Name and Complete Address of Funeral Facility PA 1 701 3
Hanover St_ Car1i
630 S
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8 _
nc_
cgne,
Ltvin Brothers Funeral
indi
te what
R MORE
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races
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s Race -Chec
ONE O
Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent
18
.
ree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be.
st de
hi
h
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Is Spanish/Hispanic/Latino. Check the "NO" White Q Korean
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ess
Q 8th gra
9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q black or African American Q Vietnamese
di
loma
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,
Q
o
aduate or GED completed ~ ,not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian
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",E~Hig
ree QYes, Mexican, Mexican American, Chicano Q Asian Indian Q Natiye Hawaiian
but no de
dit
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,
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Q Some co
AS) QYes, Puerto Rican Q Chinese Q Guamanian or Cha morro
AA
,
Q Associate degree (e.g.
BS) Q Ves, Cuban Q Filipino Q Samoan
BA
A0
'
,
,
s degree (e.g.
Q bachelor
MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Ja panes¢ Q Other Pacific Islander
MS
MA
g
Master's degree (e
,
,
.
.
Q
Q Doctorate (e.g. PhD, Edo) or Professional degree (Specify) Q Other (Specify)
. MD DDS, DVM LLB JD
whaC the decedent considered himself or herself [o be. 22a. Decedent's Usual Occupation -Indicate type of work
i
di
t
e
n
ca
21. Decedent's Single Race Self-Designation -Check ONLY ONE to
gQ/hite Q Japanese Q Samoan done during most of working Ilfe. DO NOT USE RETIRED.
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Q Black or African American Q Korean Q Other Pacific Islander ~~-ler/Operator
'
f Know/Not Sure
Q American Indian or Alaska Natiye Q Vietnamese Q Don
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ness
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ry
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Bus
Q Asian Indian Q Other Asian Q Refused 22b. Kin
Q Chinese Q Native Hawaiian Q Other (Specify)
Q Filipino Q Guamanian or Chamorro ReStallrant
ITEMS 23a - 23d MUST BE COMPLETED 23 to Pronounced Dead (MO Day/Vr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number
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BY PERSON WHO PRONOUNCES OR n n .. / / ~7 X1/1 / ~l
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CERTIFIES DEATH L(
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24. Time of D ath
23 .Date Signed (MO/Day/V r)
n
Ol ~~~ ~ P/'~ 25. Was Medical Examiner or Coroner Contacted? Q Ves Q/1rI0
CAUSE OF DEATH Approximate
Enter the chain of events--diseases, injuries, or complications--that directly caused [he death. DO NOT enter terminal events such as ca rdlac arrest. Inie rval:
Part 1
26
.
.
or ventricular flbrl llation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary Onset to Death
arrest
irato
,
ry
resp
~~
~~~/n .
IMMEDIATE CAUSE -- ------------> a.
`
(Final disease or condition /~ Due to (or as a / //e~que nce of):
-L~~
resulting in death) ~~
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Sequentially list conditions, Du o (or as a consequence
if any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Due to (or as a consequence of):
(disease or injury that
W vitiated the ey nts resulH ng d.
e
F Due to (or as a consequence of):
In death) LAST.
Ifi t dit t 'buts nr. So death but not resulting in She underlying cause given In Part I 27. Was an autopsy performed?
,j 26. Part 11. Enter ocher
o Yes
° 28. Were autopsy fin ings a ailable
to complete the cause of death?
_ Q Ves Q No
ale:
If FF
e
m
29 30. Did Tobacco Use Contribute to Dea[h7 31. Manner of Death
'
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.
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~ 1. of pregnant within past Year robably
P
Q Yes Q Natural Q Homicide
nant at time of death
Q Pre ~~
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Q No ~ vnknOWn Q Accident Q Pending Investigation
g
nant within 42 days of death
re
but
t Q Suicide Q Could not be determined
p
g
,
Q Not pregnan
before death
1
d Date of Injury (MO/Day/Yr) (Spell Month)
32
~ year
ays [0
Q Not pregnant, but pregnant 43
Q Unknown if pregnant within the pas[ year . 33. Time of Injury
'~ 34. Place of Injury (e.g. home; construction sne; farm; school) 35. Location of Injury (Street and Number, City, State, 21p Code)
i~
36. Inju Work 37. If Transportation Injury, Specify: 3H. Describe How Injury Occurred:
Ves Q Driver/Operator Q Pedestrian
No Q Passenger Q Other (Specify)
39a. C~~~~ttifler (Check only one):
O'Certifying physician - To the best of my knowledge, death occurred due [o the cause(s) and manner stated
anne
m e, dace, and place, and due to the cause(s) and m r stated
Q Pronouncing /g CertiNing Physician - To the best of my knowledge, death occurred at the tl
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ti/on, and/or inves[Igatlon, in my opini n, deaf~lJ~~ d at the Cime, dace, and place, and due to t
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License Number:
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Signaiu re of certifier: ~_~/ lye r~'• ( `+~--~ Title of certifier: /'~
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Address and Zip Code of Person Completing Cause of Dea h (Item 26j
Name
39b 39 ~te S~nesi (MO/Oay/Yr)
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ict Number 41. Registrar s afore
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40. Registrar
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43. Amendments ~ '
Disposition Permit No. REV 07/2011
LAST WILL AND TESTAMENT
~~ ~- ,=:T ;ate
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...
~~~~
SOPHIE ALEXIS ~'' `~ ~° ~ ' ~_'_-'
~~-;, -
_:. ,-.
I, SOPHIE ALEXIS, of 100 Conway Street, Carlisle, Cumberland Counter; ~ ~`~`
Pennsylvania, being of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament, hereby revoking and
making void any and all former Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses
and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be
conveniently done after my death, out of my residuary estate.
SECOND: I have made a list, which I will keep with this Will, of jewelry
and personal property, which I wish to give to specific members of my family. I request
my Executrix to honor this list and to consider it to be incorporated as a part of my Will.
THIRD: I give all the rest, residue and remainder of my Estate to my
two children, DEAN G. ALEXIS, of 58 Luz del Mundo, Santa Fe, New Mexico 87508, and
JOANNE PATRICIA ALEXIS, of 100 Conway Street, Carlisle, Pennsylvania 17013, in
equal shares. If my son, DEAN G. ALEXIS, fails to survive me by thirty days, t give his
share in four equal shares to his wife, CYNTHIA J. ALEXIS, and his three children,
EMILY ALEXIS, ELENA ALEXIS, and RYAN ALEXIS. If my daughter, JOANNE
PATRICIA ALEXIS, fails to survive me by thirty days, I give her share of my estate to my
son, DEAN G. ALEXIS.
LASTLY: I nominate, constitute and appoint my daughter, JOANNE
PATRICIA ALEXIS, to be the Executrix of this my Last Will and Testament. In the event
that my said daughter, JOANNE PATRICIA ALEXIS, shall be unable to serve as
Executrix for any reason, I appoint my son, DEAN G. ALEXIS, as Executor. No Executor
or Executrix shall be required to file bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~~ f' day of ~~'~~`~.--~ , 2008.
--' C
;~
,,f ~ ~~ ~,Q.~ L~__
Sophie Alexis
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
z
4 t
'° ~ (0,
2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
I, SOPHIE ALEXIS, Testatrix, 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; that I signed it
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me, by SOPHIE ALEXIS,
i ~ , 2008.
the Testatrix, this ` day of
f
Sophie Alexis, Testatrix
NOTARIAL SEAL
MERLENE J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 2010
3
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
We, ~~rK~~.~~~n1J~-~h (I and
the witness (whose names are signed fo Qhe attached or f~going instrument, being
duly qualifie according to law, do depose and say that we were present and saw
Testatrix sign and execute the instrument as her Last Will; that she signed 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 Testatrix signed the Will as witnesses; and that
to the best of our knowledge the Testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by .Q,p ~ ~~
and this (q~ of ~ ,
2008.
Witness
'~ ' A
Witness
NOTARIAL SEAL
MERLENE J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 2010
4