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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: Angela M. Kramer File No: 1~~ ~~- ~,~ ~~~
a/k/a: Anne M. Kramer (Assigned by Register)
a/k/a:
tea' Social Security No:
Date of Death: 03/13/2012 Age at death: 82
Decedent was domiciled at death in Cumberland County, Pennsylvania (Stare) with his/her last
principal residence at 42 Kensington Drive Camp Hill Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at 42 Kensington Drive 17011 Camn Hill Cumberland pA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $_ 4 500.00
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ................................ ..... $ 149,000 ~(l
....................
TOTAL ESTIMATED VALUE.... $ 153.500 00
Real estate in Pennsylvania situated at: 42 Kensington Drive, 17011 Camp Hill Cumberland
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 01/25/2012 and Codicil(s)
thereto dated
["l --~,
State relevant circumstances (e.g, renunciation, death of executor, etc.) -~ ~ 7~ _ ; `, !'~
~ ' _ ~ <~;
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorcgd s pt a pa#~ to a pendi
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), ai~d9d5thave~hild boih'og7
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. -• ; ~ --, -
- 4! -';'1
Q NO EXCEPTIONS Q EXCEPTIONS `j ~ ?' ,. r '
B. Petition for Grant of Letters of Administration (If applicable) ~ ~t7 ~:•~ ~
c.t.a., d.b.n., d. b. n. c.t.a., pendente lite, durante absentia, du me 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.
Q NO EXCEPTIONS ~ EXCEPTIONS
Form RW-01 rev. 10/11/2011 Page 1 of 2
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
}
Official Use Only
;, '-~
Petitioner(s) Printed Name Petitioner(s) Printed Addre
Lisa D. Domene 20 Essex Road Cam Hill PA 17011 Rp~Uti',rj ~~~~'
Cl~~~~~ ~F~ ia,~~,~n ~~~1 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) wi11~ and truly administer the estate according to law.
Sworn to or armed a 7 subscr'bed before ~ ~ ~ > ti << ` ~ ~c~f,~-,.zee Date G"' ~/ ~~ - ~0 / :Z
me this ~ d f ~ , c~ Date
By ! ~ ~~ Date
r the Regis r
Date
BOND Required: Q YES Q NO
FEES:
Letters ...................... $ 260.00
( 6) Short Certificate(s)...... 24.00
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
........
Automation Fee ............... 5.00
JCS Fee ..................... 23.50
TOTAL ..................... $ 312.50
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
,-,
C~~ ,~~i~
Printed Name: Adam R. Deluca
Supreme Court
ID Number: 311738
Firm Name: Allied Attorneys of Central Pennsylvania
Address: ~l West T n ~ h r 4tr , Cartislg PA 17013
Phone: 7172491177
Fax: 7172494514
Email: ~rdelncaRS(n~anl cnm
DECREE OF THE REGISTER
Estate of Aneela M. Kramer File No: _ ~ ~ ~,.~/ ' ~~~)
a/k/a: Anne M. Kramer
AND NOW, ~~ `~ , in consideration of the foregoing Petition,
satisfactory proof having been presente before me, IT IS DECREED that Letters Testamentary
are hereby granted to Lisa D. Domene
in the above estate and (if applicable) that
the instrument(s) dated 01/25/2012
described in the Petition be admitted to probate and filed of cord as the las Will (and Codi '1 s)) of Decedent.
- ~
e tster o ills ! _ ~.~~ - ,~, / ,y/
~=~- r ~!~
Form RW-02 rev. 10/11/2011 ~- ~
Page 2 of 2
H LD5.805 RGV r9/I I i --- - - - - - - --
I ~ -4~~
LO , , I ,~G,ISTRAR'S CERTIFICATION OF DEAT`I~I
W ,';~ ~ ~}~cj~~to duplicate this copy by photostat ar hate ra h
- ~ ~J
Fee for this certificate. $6.UU I'a~ ~~.~, ~ ~`~tn, ±s to :~rtl~ ~ ;,~ chi ~:jiorm:jtr:~r) t,T ( ~~il (~)) i~;
~ F'r'y I?. ~
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ORP~tS ~n~1Rr };words ~)~ttte li ~: nll~l Irn[ IjfJn:*_.
P 18 3 317 ~~F~+R~~I ~n~~I ~~ . P>4. ,
---- --- ____ ~ 4~~c~, 31 ~S fez
Certification Number - - - -- - -- ------ - -- _ ._ ___
Type/Print In COMMONWEALTH OF PEN NSVLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
Permanent
1. Decedent's Legal Name (First, Mldtlle, Last, suffix) ~ r ~ a a State Flle Number:
2. sex 3. social security Number 4. Data of Death (MO/Day/Yr) (Spell Mo)
Angela Margaret Kramer
Female 086-22-1599 March 13a 2012
sa. Age-Last Birthday (Yrs) Sb
Und
r 1 V
.
e
ear Sc. Under 1 Da 6. Date of Birth (MO/Day/Yaar) (spell Month) 7a. Birthplace (City and State or Foreign Coun[ry)
Months pa
H
ys
ours Minutes
82
May 13, 1929 7b. Birthplace lCpunty)
Sa. Residence (state or Foreign Country) Sb. Residence (street and Number -Include Apt No.) 8c. Did Decedent Live in a Townshi
?
p
Pao 42 Kensington Drive $7ves
decedent Ilved In Low
All
,
er
en
gtl. Rasitlence (County) tw p.
Comber land 8e. Residence (Zip Code) 17011 QNO, decedent Ilved within limits of
city/born.
9. Ever In Vs Armed Forces? 10. Marital Status at Tlme of Death Q Married Widowed Il
survivi
S
'
.
ng
pouse
s Name (It wife, give name prior to first marriage)
Q Ves ® No Q Unknown Q Divorced Q Never Married Q Unknow
12. Father's Name (First, Mlddle, Last, suffix)
'
13. Mother
s Name Prior to Fint Marriage (First, Middle. Last)
William G. Deal
Yolanda G. Grieco
14a. Informant's Name 14b
R
l
i
.
e
at
onship to Decedent
Lisa D 14c. Informant's Melling Address (street and Number, City, slate, Zip Code?
omene Dau titer 20 Essex Road Cam Hill PA 17011
~ ......................................................... .........................................
If Death Occurred In a HosPltal: Q In dent
Pa .: eye P eat qn y on.
..... ..........................~~....... ....... ................... ...................................
If D
th
~
g
J
Q Emergency ROOM/Outpatient
sad
n Arrival
O . ...................................
ea
Occurred somewhere Other Tian a Hospital: ~(
HOSpice Facility ~]~ Decedent's Homa
X43 u
15b. Facility Name (If not Inteitu[len, giv a nd n mbar;
t ~
a atr Q N frsln~ Homa/Long-Term Cara Facility Other (Specify)
15e
City O To n
St
t
d Zi
C
~ .
,
e
s, an
p
ede 15d. County of Death
42 Kenain ton Drive C
am Hill PA 17011 Cumberland
16a. Method of DlsposRlon Q Bu Flal ® Cremation 16b
D
f
.
afe o
Dlspositlon 16c. Place of Dispesltlon (Name of cemetery, crematory, or ocher place)
Q Removal from State Q ponatlon
Other (Sped ) 3-16-2012 Cremation Society of PA
2 16tl. Location o/ Dlspositlon (City or Town, state, and Zip) 17a. sl
cosec
gnat of Fun r I Servlc r Person i Charge of Interment 176. License Number
`
Harr isburg~ PA 17109 l
FD 138312
17c. Name antl Complete Address of Funeral Facility Auer remat On erV ces O coney Van es nC.
' 4100 Jonestown Road Harrisbur PA 17109
~ 36. Decedent's Education -Check the box that bert describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indi
t
h
t
hi
ca
e w
a
ghest degree or level of school completed at the time of death. box that best describes whether the detttlent the decadent considered himself or herself to b
e.
Q 8th grade or less Is spanish/Hlspsnic/Latino. Check the "NO" ® White Q Korean
Q No diploma, 9th - 12th grade box if decedent is not spanish/Hispa nlc/Latino. Q Black or African American Q Vietnamese
® Hlgh school graduate or GED completed ®No, not Spanish/Hispanic/Latino Q American Indian or Alaska NaTlve Q O[her Asian
Q Some college credit, but no degree Q Ves, Mezi<a n, Mexican American, Chicano Q Azlan Intllan Q Nativ
H
ll
e
awa
an
Q Associate degree (w.g. AA, AS) Q Ves, Puerto Rican Chinese
Q Q Guamanl
Ch
'
sn or
amorro
Q Bachelor
s degree (e.g. BA, AB, Bs) Ves, Cuban
Q FIIIPIno
Q Samoan
Master's de (e.g. g, ) Q panish/His
Q gree MA, Ms, MEn MEd, M$W, MBA Ves, ocher s panic/Latino Q Japanese Q Oth
r P
ifi
I
l
d
e
ac
c
s
an
er
Q Doctorate (e.g. PhD, Edp) or Professional degree
s
if
(
pec
y) Q Other (speclly)
. MD DOS OVM LLB JD
21. Decedent's single Rece Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herseH to be
22a
Dec
d
t'
U
l
.
.
e
en
s
sua
Occupation - Intllcate type of work
® White Q Japanese Q Samoan d
d
i
one
ur
ng most o} working Il/e. DO NOT USE RETIRED.
Q Black or African American Q Korean Q Other Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not sure Cleric
Q Asian Intllan Q Other Asian Q Refused 22b. Kind of Business/Industry
Q Chinese
Q Native Hawallan Q Other (s Pacify)
Q Filipino Q Guamanlsn or Chamorro R8ls ton Purina
MS 23a - 23d MUST BE COMPLETED 2 a. Date Pronounce Dead Mo Day 23b
I
t
P
.
gna
ure o
erson Pronouncing Deat ( n y w en applicable) 23c. License Num e
BY PERSON WHO PRONOUNCES OR r
CERTIFIES DEATH
23 Date sig d Mo Da /Vr) 24. Time of Death L
'ner or oron
Z 25. Was Medical Exa er COntacted7 Q Ves No
CAUSE OF DEATH
gpproximate
i
26. Part 1. Enter the chain of events--diseases, inJurbs, or complications--that directly caused the death
DO NOT enter termin
l
.
a
events such as cardiac arrest,
Interval:
respiratory arrest, or ventricular flbriilatlon without showin
g the etiology.
D
O NOT ABBR
E
VIATE. Enter
nly
o
one cause on a Ilne
Add additional lines If n
O
.
ecessary
nset fo Death
g
_
l
f
'
_
~
t
IMMEDIATE CAUSE ----'----------> a. ~ C.a.~ ~C YY~ y ~ Q 1'OL IQ LA F-L VV~ 1 O~~
(Final disease or condition Due to r as s consequence of):
resulting in death)
b.
sequentlelly Ilst conditions, Due to (or as a sequence of):
con
if any, leading [o the cause
listed on Ilne a. Enter the
UNDERLYING CAUSE Due to (or as a consequence on:
(disease or Injury that
F Initiated the events resulting d.
~ In death) LAST. Due to (or as s consequence of):
26. PaK 11. Enter other alanifi t dl I Ib H d h bu< not resulting In the underlying cause given In Part I 27. Was an autopsy erfor edT
~ Yes
'~'~ 2B. Ware autopsy fin ngs available
to complete the uusa of death?
e: er Q Ves No
29. If Fa 30. Dld Tobacco Use Contribute to Death? 31. of Death
pregnant wet h
in Past Year Yes ~ ~{'
Q
Q Probably ~Qt Wef ur
l
~ o
a
Q Homicide
`-
Pregnant at tim f death Q No known /Q-Accident Q pending Investigation
Q Noi pregnant
but
re
n
nt
i
hi
,
p
g
a
w
t
n 42 days of tleath Q suicide Q Could 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 Vnknown 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 at Work 37. If Transportation Injury, specify: 3B. Describe Mow Injury Occurred:
Q Ves Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (specify)
39a. C rtifler (Check only one):
~Certif
in
h
i
i
T
.
y
g p
ys
c
an -
o the besx of my knowledge, tleath occurratl tlue to the cause(s) and manner stated
Q Pronouncin
6 Certif
i
h
g
y
ng p
ysician - To the bat of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner statetl
Q Medical Examiner/Cor
xa
oner - On t e eels of minatlon, antl/or Investigation, In my opinion, death o
ccurratl at the time, date, antl place, and due to the ce use(s) antl manner stated
ll
signature of certifier:
Title of certifer: Yt^ ~ Lic
N
b
~ r •32
5 I S
ense
um
er:
,
39b. Name, Address antl Zip Code of Person Completing Cause of Death (Item 26)
~ ~ ~ ~ ' ~D ~ t 39c. Date signed (MO/pay/Yr)
t:1 st~aLt,t 3°t z -rtr;.lf~~~ R~4 e4,ftr,
3 ) s 1
40. Regist ar s Dlstritt Num a 41
Re
istrar s
~ .
g
nature ~ 42. Registrar i e Dat Mo Day
r
43. Amendments /~~
~- - ~ -" ~ /S ~ ~Z~
~7C7~C F-f8, H105-143
Dlspositlon Perml[ No. CJ / J ( REV 07/2011
l~-~~5~
r
~~ ~~~~.~;~,,- .. `~ 'tit Cyr
,~.
LAST WILL AND TESTAMENT OF
ANNE M. KRAMER 4', ; ~ ~ ~~ ~ ''~ I "°'
h ~ , i ~, ~~ 16 F` ~.
CLERK Cr
ORPHAN'S CO', -i~T
I, ANNE M. KRAMER, of Camp Hill, Cumberland CQiai!~~~ ~ Y ~ ~~
~i~~' lv~ n ,
declare this to be my Last Will and Testament and hereby revoke all prior Wills and
Codicils.
1. I direct that all my just debts, funeral expenses and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death my body be cremated at Auer Cremation Society, Harrisburg,
\ ` ~ PA, with my ashes to be returned to my grandson, Jesse R. Domene-Hurley, to do with as
he wishes.
~.
2. I direct that my real and personal property shall be bequeathed as follows:
~~
~ (a) My grandson, Jesse R. Domene-Hurley, shall be given a life estate in
all personal property and real property situated at 42 Kensington Drive, Camp Hill, PA
17011, or elsewhere, that I own at the time of my death, except that:
(b) All jewelry that I own shall be distributed in equal shares to my
daughters, Leslie E. Oneglia, Laura D. Shelley, and Lisa D. Domene. Should any of
°. ~ these individuals predecease me, their share shall be distributed per capita.
(c) Upon Jesse R. Domene-Hurley's death, vacating of the aforesaid
property, or inability to maintain tax and/or mortgage payments on the aforesaid property,
the house and all belongings situated within shall be sold and the proceeds shall be
divided equally among my daughters, Leslie E. Oneglia, Laura D. Shelley, Lisa D.
Domene and my grandson, Jesse R. Domene-Hurley. Should any of these individuals
predecease me, their share shall be distributed per capita.
3. I appoint my daughter, Lisa D. Domene, as Executrix of this my Last Will
and Testament.
4. The Executrix or Executor of this Will shall have the power to distribute
my estate in cash or in kind, or partly in either.
5. I direct that no Executrix or Executor acting under this Will shall be
required to enter bond in any jurisdiction.
6. I recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C., to probate my estate.
Page 1 of 4
,,!!~-fti-
IN WITNESS WHEREOF, I have hereunto set my hand this Z'7 day
of , 2012. ; ~>
ANNE M. KRAMER
The preceding instrument consisting of this and three other pages was on the day and date
hereof signed, published and declared by ANNE M. KRAMER, as and for 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 subscribed our names as witnesses hereto.
,.
F.
fitness
i'%
__
Witness
Page 2 of 4
ACKNOWLEDGMENT
~:
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
I, ANNE M. KRAMER, the 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 and Testament; that I signed it
willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
,'
~ ~'~~- y-v~~_
ANNE M. KRAMER
Sworn or afFirmed and acknowledged before me by ANNE M. KRAMER, the
TESTATRIX, this ~~day of 2012.
otary ublic/Attorney
NOTARIAL SEAL
STEPHANfE E CHERTOK, Notary Public
Carlisle Bono, Cumberland Cou;>iy
My Commission E~lres March 24, 2015
Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
WE,~~ l ~~ and Shay,,. Sib `e ~~
the witnesses whose names are attached to the foregoing document, being duly qualified
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 subscribing
witness in the hearing and sight of the testatrix signed the Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
and ~~, __~ ~'~IOw+,',~
day of , 2012. ~=-r
this
NOTARIAL SEAL
STEpFLgN~ E CHERTOK, Notary pubnG
Carlisle 6oro, Cumberland C®unfy
MY Canmission ~~ Mach 24, 2015
Page 4 of 4