HomeMy WebLinkAbout04-23-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF t'~L!/JJ/9EX1~iU~ COUNTY, PEN~~~"I~~~P~I?~ ~~ (~ t I ;.,
Petitioner(s) named below, tivho is'are 18 years of age or older, apply(ies) for Letters as speci " and in
support thereof aver(s) the following and respectfitlly regt:est(s) the Brant of Letters in the approp ~~ T
~ f ~ cuui~
Decedent's Information ~ ~ ^(` PA
/ e,/irJOiJi~a 114~~FR~ AI`~t~l t, .~
Name: File No• ,,Z/- /~ - o C~ t~~
a/k/a: {Assigned by Register)
a/k/a:
a/k/a:
Social Security No:
liate of t~eatn: Age at death: 9
Decedent was domiciled at death in Cu/~ t6G/-~aitg~ County, ~C/7/~Sy.~~i7~ytr4 (State) with his/her last
principal residence a[
Street address, Post Office and Zip Code City, Township or Borough /! County
Decedent died at _ ~/ar~~,0~7f ~~l/tsi/JU /~O/.VC, /DOO C~~/CIJIO/l~~i~ ~~s~C (~/~pJ~y~-'/~tltR~
Street address, Post Office and Zrp de City, Township or Borough County State
Estimate of value of decedent"s property at death: // ~~// !
If domiciled in Pennsylvania ............................ All personal property $ /~sS 7/lr~1l /~Ot~O.l~
If trot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ - a .-.
Ijttot domiciled in Pennsy!vania ........................ Personal property in County $ _ e _.
Valtre of real estate in Pennsylvania ......................................................... $ _ p
TOTAL ESTIMATED VALUE.... $ l!3 11 S OrOifJ~ Od
Real estate in Pennsylvania situated at:
(Attack additional sheets, ijnecessary.)
Street address, Post Office and Zip Code City, Township or Borough
^ 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
thereto dated
State relevant circumstances (eg. rentu~ciation, deatk ojezectttor, etc.)
County
and Codicil(s)
Except as follows: afrer the execution of the instmment(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 lite, durante absentia, duranteminoritate
If Administration, c.t.a. ord.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), afrer a proper search has/have ascertained that Decedent lLefr no /Will aLn_d_wJas survived by the followings ouse (if any) and heirs (attach
aclclitianal sheets, ijneces•sary): (I/~ ~1hs~~s~/ 6~, //~/, RpsQavrq ~~„ A/C4, l1 CG,fi~L~~C
Name Relationshi Address
LDl~f/S ~, I~ELA9oN/CO
~1~RG/jiPE'T Al. .!]EZJJIDrf//G'D SaN
d4Lr ~'r °~~e.Drs~e~~~ tSuite ~f°~L 3 706- 5069
~ E. F~o~t/aid St
e stet s r ~ /7oSS'
Fo,-n,nw-n~ ,~~.lnilvzntl Page 1 oft \
~~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
coLN`rY of CUlNd3E~LfFN~ }
r
~tgtt~;EjJ l'Jsg4nlyr-,~-s, ,C
i~~~2~ ANE~~ i
Pai.ionerls)Printed~iame Petitioner(sjPrintedAddress ~`
I19A~i+~RET /lr. DEL/1foN/Co 308 ~: ~.5~ /1IC~1isrl~CS ul~, ~,Q {~f 1
F,
~N~~G'/~TiA1/ ~6 Qlo1~Y~X !s i¢ ~8..1'lro~wCO y ~,v P.oovr0~-D
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition a to and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, ~e Petitioner(s will ell nd t~ttly adminispter~the estate accordin to law.
Sworn to ~f~irmed a subscribed befor~ f 1 Date /~
me thi~ aylo ;~ i Date
aL. A n Y n, n ,
the
Date
Date
BOND Required: Q YES ~O
FEES:
Letters ..................... .
( 5) Short Certificate(s)..... .
( ~) Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
$ ~~,•(~
Automation Fee ............... ~ }" ~~tJ_
JCS Fee . .................... .--~-. ~
TOTAL ..................... $ ~
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
G.
Printed Name: (~.fl?r~ F 1S/JiC~~
Supreme Court
ID Number: 3~S13
Firm Name:
Address: ~,
d? ~, !7a sS
Phone: 7/.7 7~i(a '77iZ09
Fax: 7 .S'- c
Email: t?e ~D/~l~s ~ ~
DECREE OF THE REGISTER
Estate of ~~a/Q ,~, ~Q~,/tjphj(,p File No: ~/-/Z._ (~ ~ ~~~
a/k/a:
AND NOW, ~-1~1~ ~ ~~ ~ l~ , in consideration of the foregoing Petition,
satisfactory proof hay ing been presented before me, IT IS DECREED that Letters ~~p/~ij~~s,~.a~on
are hereby granted to ~p~/jlG/lie'
~ to the above estate and ['if applicable) that
the instrument(s) dated N~~
described in the Petition be admitted to probate and filed of reco:c as the last ~T~'ill (and Codicil(s)) of Decedent.
Re ister of Will$--~~ ~ i ~ J i ,,~d~
Form R6V-02 rev. !0/!1'201! L~~~ ~ Page Of
LOCA~~~I~~~~R'S CERTIFICATION OF DEATH
WARNIyy~::ft js itl~ga,~;ldjduplicate this copy by photostat or photograph.
Ti:., . - -
Fee for this certificate, 56.00 `'~1~2 J~?~ ~~ Q~~ (~' ~ ~ This is to certif} teat the informa~ion lie-e ,riven is
correctly copied from an (r.-igint)1 Ci~rtifia:a~ie c-f Dl~~ith
a.E~K ~~ duly filed with 111e ,.1~ Local Registrar. The original
certificate will he forwarded to I:he S~tatt~ y'ital
~R~~ ~ vQ~~T Records Office for t~c:rlruil)ent film;;.
CU-~BERI_~'~ t,~ , PA -
Certification Number
•/Prlnl In
Nklnks
T
' 1_ocal Regis ~f~ Date lssueil
COMMONWULTH OF pENNSYIVANIA • DEPARTMENT Of HEAITH • VITAL gECORD$
CERTIFICATE OF DEATH ,,,,f,
s"'^w Z. Sev 3. Sock) Secunry Number a. Date of Death (MO/Day/Yrl lSp<II Mol
Ali9a L. DeLronico Female 181 - 36 - 1143 April 16, 2012
Sa. Age-last Birthday (Yn) Sb. UntlH lYnr Sc. Under 1 Da B. Wte of Birth (MO/Dry/Yearl (Spell MonMl )a. BlrthPpbce I antl Stall or foreign Country)
Months Dari Nours Minutes LC711F7aLYl~a Ztal
94 ril 18 1917 )b elrthpbte lCOUnryI
8a. Rubena State ar Foreign Country) Bb. Refidence Is[rcet and Number ~ InHude ADt No.) 8c. Did Decedent Live In a Township)
Pelulsy vania ^Ylf
a«adantRaadln
ad.Refbence(Caunry)
308 Fast Portland Street ,
ewp.
Qanberland a.. ReNtlena ulpC de) 17055 [Y++D,dDtldent raved wgmn um¢sor Mechanicsburg tiry/bara.
9. Ever In US Armed Fomui 10 Markel Sutus at Tlme of WaM ~ Married Widowetl 11. Sunrlving SpoueN Name (If wife, give Mme Prior m Rnt mardagal
Yes ~ No ^ Unkrgwn ^ OHwratl ^ Never Married ^ Unknown
l2. Fathers Name (Fhst, Mitldk, Last, SuNkl 13. MoMei s Name Prior to Flnt Marrtge lFint, Mitldk, left)
Bout i Di is Fregnia
lea. Infomunt's Nama ]ab. Reletbnshl0 to Wcetlent lac. InfomuM's MRlling Addnu (Street all Number, Ory, State, Zb Coded
ffi hter
308 Fast Portland Street PA 17055
a
a 1( Death Oaumtl M a Hospital: Lf Inpa[leM ;N DNM Oesvrretl Somewhero OMer Than a Hwpkal: 17 Hwpke fadliry Y"I Deced
t'
H
O en
s
ome
E Roam/drtpeHent Dead on Artival Nuning Noma -Term Gro Fxllky Other (Specify)
]Sb. FMliry Name LI(nM kuMUHOn
hr f VM arM r
mb
; ~
5
, g
w
er
1
c. Uly w Tlswn, State, all Zip Cade ISd. CwMy pf Death
ClaraElont Nursi Eiane Carlisle PA 17013 CLnnberland
ifia. Method M Disposkbn ~ gurkl ~ Crematbn )fib. Date M dspakbn 16c. Pixe d Dkposkbn (Name of cemeury, crematory, or other pkal
~ RemwN from Stwe ^ Donatbn
onter(speHry) 19 2012 Most Precious Blood Cemetery
Z l6d. LOCaHOnMdfposkbn (OrywTOwn, State, and 2lal l] naluro /F wPerson In Charye at Interment 1]h. Lkenu Number
~ Hazelton, PA
~ / FD - 014889
1) N and CompkHe Addroff el Funeral FaeRky
Mal zzi Funeral Htxne 8 Market lazy Wa ics PA 17055
~ ]g. DecMent'f Edueallan -Cluck the hov Mat best dexHbu the 19. Deotlen[ M Hlfpank Origin ~ Outk Me 20. DetadeM's Raft -Check ONE OR MORE noes to Intllate what
h
M
d
lg
st
grx or keel of fchool compktetl at the time of deeM. boa Hut best Oexdbu whether the decedent Me tleCedeM consWered hlmxN or herxll to Dc.
^ 8th gradewkss IsSWnish/Nhpank/Lxlno. Check the •NO' ~' Whke ~ Korean
^ No dipoma, 9M ~ 12th gratle bu N dawdent is not Spankh/Hispanic/laHno. Q Black or Afrkan Amerkan ~ Vk[namese
^Hlgh schod gradwte orGEDCOmpkted ENO, not Spanhh/Hispanlc/latlrw ^Amarltm lndlan or Alaska Na[Ne Other Allan
^ Some tollep tteM[, but rro degree ^ Yes, Mevk'an, Meelan pmMan, Chlano ^ Asian lndlan ^ NatNe Hawaiian
^ Auoclate degree Ie.1. pA, AS) ^ Yas, PueRO Rican ^ CAlnex ^ Guamanian or Chamorro
'
^ Bachebr
s dgroe (e.g. BA, AB, BS) ^ Yef, Cuban ~ Filipino ^ Samoan
Master's degree (e.g. MA, MS, MEry, MEd, MSW, MBA) ^ Yes, other Spanish/Hlfpank/latlna ^ Japanese ^ Other pxMC Islander
0 DaRwa[e (e.g. PhD, FtlOI w Prohfslonal dgrce ISpecNy) ^ Othw (SpecNy)
.. MO DDS OVpR LLB 10
21 DecedeM's Sigle Rxe SeH-WNgnatbn -Check ONIy ONF to indkate whw [he decedent canNdentl himxll w herself to be. 22a. Decedent's Ufual Occupatbn ~ Indkate type of woM
'
~
Whke ~ Japanese ^ Sartwan done duH
gmost of woridq lNe. DONOT USE RETIRED
.
^8lackwAMcan Amerkan ~KOrcan ^OMer Paciflt Islander
^ Amennn Indian ar Alaska Na[He ~ Vletnameu 0 Don'[ Know/NOt Sure HQILE4IIakEr
^ ANan lndlan ^ Other Allan ^ Pehsetl 22b. KIIM o/8usinesf/Indusiry
^ Chlruse ^ NitNf Hawaiian ^ other (sDecMl
^FIRpro ^GUamanknorChamono ~1 11(xne
REMS 28a-13d MUST BE COMPLETED 13a. Date PronouMad Dead Mo ay r 23b. Slgnatweo Parxn Pronouncing Death lpnN when apPlkable) 23c. UCeMe Number
gY PERSON Ia1110 MONOUNCFB OR
CERTIFlES DFATN ~ (~ Z
23d. Date Signed (MO/DKYA'r) 2a. me of peach 1-F `t'r~~'t /1s~~.. Lc /~J /~/.Y ~ ~ /(S (s ~ - ~
r J_U L CQ' 25. Was Matlka Eraminw or Coroner onucted) ^ Yes No
CAUSE OF DEATH
aoaavimate
2G.PM 1. Enter the Maln of evenls~~dbews, inlurles, or compiunons-that dircttly caused the death. DO NOT enter terminal events such as cardiac arrest Interval:
respiratory arrert, or ventricukr flbHilatlon without showing the etiology. DO MOT gBBREVMTE. Enter only one cause on a line. Atltl adtlitlonal Ilnes H necnxry Wut to DeaM
IMMEdATE UUSE -~~---~-~-----> a. ~~QU\k\O
IFlnal dluax or rondklon Due to for as nsepaence oN.
resultlntMdeath) ~a v~~~~(~
h. L
seaaennally use candebnf, W<eo for as a conseROence oq:
II any, kadlM to the crux
lifted on Ilne a. EnM the
UNDEgLYINfi GUBf Oue to (or u a consequence ofl:
Idhaafe or in)ury Mat
F InIW[etl the events rewiltlry tl.
b tle.M) LAST. We ro (w of a conxaaente oq:
sS Zfi. hR 11. Enter other 1 Hka 1 Mkion Nbu[I rod th but not resukiq in Ma uMeHylq cwu ghen In Part I 2). Was an autopsy pM ed)
~ ^ Yes Mo
28. Were auropry flrMigs avalkbk
8 to rompkte Me coax al tluth)
^ rn No
ZB. IfF ale:
9 30. Old Tobacco Use Contribute to WaM7 31...M/anner of Death
~NOt pegnant wkhln put yew ~ Yes ~ ProbabM ty Natural ~ Homkka
Pn
naMwti
f d
h
~ g
me o
eat
~Na ~ Unknown ~ Accbent ^ Pentlhy lnvunganon
^Nat wagnanC but
n
nl
khl
al d
(d
a
w
n
wg
ari o
eatt ~SUklde ~COVbnot be htttmined
N
^
w prgnaM, but pregnant a3 den W 1 yew Mon tleaM 32. Wee of Inlury IMO/Dey/vrl (SpNI Month)
^ Unknown ll prgnan[wlthin the psst yeaf
33. Time of Inlury
30. Place of Inury (e.g. home; conwnxebn site; farm; xhoW) 35. loatlon of Inlury (Street and Number, [Iry, Sute, Zip Code)
36. Inlury at Work 3). I/Tnnspsrtanpn Inlury, SpMN: 38. WSeribe HOw Inlury OCCprretl:
^ Yes ^ Driver/Operotw ^ PMesVian
Q ND ~ Pburyer ~ Other (SDedfY)
3 9a. Cerkfler (Check onN one):
^ fertilYMSg phriickn - To the but of my knowledge, deaM occunetl due to Me auu(sl and manner slated
~ Prorlountlng B CertBylq phriklan ~ To the best of my knowleMge, death ocanetl at Me time, date, and pea, antl due to Me auxlsl aIW manner sated
^ Medical Evaminer/Coroner - On t
h//e~/basliys~M 1 tlon, aM/or Imrertlg~tbn, M my opinion, des[
'h ouurted at the time, daft, arM place, all tlue to thena
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Signature of certkkr:~Qq ,\„S,EJ~ MC ~N /~ a (_ s s L 'F~•7kle of nrtifler: 1 Ucenx Number: l/) ~ s/ i)> ~ 3/ 3 " 1...
3 9b. Name, Addnu antl 21p Coda o/ Person Com tiryMMCaux d DxM (kem 26) '
39c. Da)~
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el1gbt/nrs dstrltt/ Number al, q ftra f Signature J
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O'CXA`VI LCIIA.A. h-3.-i.,. c~.(,tJLC ~ ~X ~Zl , ~,] J U ~ ~..
3.Amendments !
Dlspofaian Pe.ma No. 0693637 Hlas-la3
REV O)/2011
,-. I
~'-~ ~ t~ 4 X'.
-~~_
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`L ~~II G~ H~ I i • r w
RENUNCIATION
Zr~ERK ~~;
ORPHP:N'S ~~ ^tJRT
CUMP,~~I AC,~~, ~. ,~ PA
REGISTER OF WILLS
C uMBER[AN.D COUNTY, PENNSYLVANIA
Estate of
I,
ALD~ L. DEZ/no~~~v
Lok~s ~. ,~~'Y.mo~vlcv
Deceased
in my capacity/relationship as
(Print Name)
so//~/yi~YR of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
_~ y S/~sTE~ ~ /I1~4~2G~1-AFT /h. DE'~It~oN~c a
~r;l ao. Zv1Z. x
(Date) ( azure
a ~o /off Ty .¢i~ Sai~' yo!
(Street.4ddress)
T~EhSu~E /S[AND, ~~ 3 37~-Sd6B
(City: Stare, Zip) ~ t--~
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the ~
purposes state within on this ~D~y days
of --~~ -, ~A/L .c
U
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration ofNotary's Commission.)
~ U N
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FormRW-06 rev. /0.13.06