Loading...
HomeMy WebLinkAbout05-04-12Reset 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: JOHN G. DELLO IACONO File No: 2 ~ " ~ ~ ~ J l Z a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 067-26-3097 Date of Death: 04/07/2012 „~~T Age at death: 86 Decedent was domiciled at death in Y~IE ~ /`~Js`ti~~ Count y, PF_.NNSYL.VANiA (State) with his/her last principal residence at ~ ~~ F e roar=~==~-Tnr=,r ~ d*,~D _rz=rr = , mot„ 1 ~ n m=pro=I1 mn~SHIP 2 V-+TrsI! I-1T. Street address, Post Office and Zip Code ~<<veK S~,r,,,)1 ~~ty, Township or Borough C v/~~IQcUO'~+t County Decedent died at EMERITUS AT CREEKVIEW MECHANICSBURG G~q 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 $ 200,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 140,000 00 TOTAL ESTIMATED VALUE.... $ 340.000.00 Real estate in Pennsylvania situated at: 104 FAIRVIEW DRIVE CAMP HILL 17011 FAIRVIEW YORI{ (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 JUNE 30, 2005 and Codicil(s) thereto dated State relevant circumstances (eg. renunciation, death of executor, etc.) Except as follows: after the execution of the 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 bom or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Q 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, 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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ®EXCEPTIONS 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): Name Relationshi Address 7 `._' ~_- f y` ~Sn ~' - .. ~~ ~ -~~_ ' -,~r-~ zic~ ~-c :; C~ ~.; ~~ T..~ _R _: ~.~ r, Form RW-03 rev. 10/11/301 / Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use Only ~ ~~ fir. ~ _ ;; ._i -~-_ r Petitioner(s) Printed Name Petitioner(s) Printed Address ° °~~= ~ .~-- KRISTA N. CREEKPAUM ~.a ~ 127 APPLEWOOD LANE SLIPPERY ROCK PA 1605.7-, %-a'-~ --~ --- _ . -' -1 ~-- T't ..J The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are tme and correct to the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Dece~Cient, the Petitioner(s) will well and truly administer the estate according to law. Sworn to or of trmed bbsc~ribed be or/e , ~' ~~ ~ G~ ~,~,~.w- Date S - ~~ - /.~- me~thl •t~y„of a~~~~~i_'L__-_~ ~~/ ~ ~ Date Register Date Date BOND Required: Q YES ~ NC FEES: Letters ...................... $ 360.00 ( 3) Short Certificate(s)...... 12.00 ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ WILL ........ 15.00 Automation Fee ............... 5.00 JCS Fee . .................... 23.50 TOTAL ..................... $ 415.50 To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: ~~~ ~-'6 ~ .~ . ~-~c~:.~ Printed Name: RQ R B. IRWIN, ESQUIRE Supreme Court ID Number: 6292 Firm Name Address: Phone: Fax: Email: IRWIN & McKNIGHT, P.C. (717)249-2353 (717)249-6354 DECREE OF THE REGISTER Estate of JOHN G. DELLO IACONO File No: 2/' ~ z ~ ~Z Z a/k/a: AND NOW ~f~ ~Z , in consideration of the foregoing Petition, satisfactory proof having een p sented before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to KRISTA N. CREEKPAUM in the above estate and (if applicable) that the instrument(s) dated JUNE 30, 2005 described in the Petition be admitted to probate and filed of re~o}~d~s the last Wi~i (and Codicil(s)1 ofJ~ecedent. Register of Wills Form RW-01 rev. !0/Il/301 / 2 ~- I~~.~~~-~ I ~A~~~~r~: ~t ~~._~f~~~k~E ~tr~ ,~, . ~ ilk Fie 4~ur thi, cc)~tjiil~cai~. 5fiilU P y~~8~4~~ 1. "crtiti<<,tiun ~(II~~~.I~ Type/Print In Permanent '~ 1 '~J V ~.~ 1-. _4 CLERK ~~F ; ~ ~~~~~~.~.. ~~~ o ~ 2a~2 COMMONWEALTH OF PEN NSV LVANIA DEPARTMENT OF HEALTH VITAL RECORDS CFRTI FIC'ATF AG (IFATI-J 1. Decedent's Legal Name (Firs<, Middle, Last, Suffix) 2. Sex 3. Social Secu riiy Number) a 4, Date of Death (MO/Day/Yr) (Spell Mo) John G. Dello Iacono Male 067 26 3097 A ri1 7 2012 6a. Age-Last Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months Davs Hnurs Minutes On Shi in Atlantic Ocean to U 86 October 23 1925 ?b. Birthplace (county) 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt NP.) 8c. Did Oecede nt Llve in a Township? Penns lvania 104 Fairview Drive Yes Decedent lived in Fairview 8d. Residence (County) , wP. Z'OrIC 8e. Residence (Zip Code) 1 7 01 1 Q No, deceden< livetl within limits of city/born. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death 0 Married 0 Widowed 11. Surviving Spouse's Name (If wife, give name prior To first marriage) (] Ves ~ No (]Unknown Q Divorced ® Never Married ~ Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Dr_ Biagio D. Dello lacono Georgina Howden 14a. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code? o Krista N. Creekpaum Daughter 127 Applewood Lane, Slippery Rock, PA 16057 C .......................................................... ..........................-.--........ ......... SSa. P ace o Death C eck only one) ...................................... s ° If Death Occurred In a Hos Pita l: ~ In patient ...........................-.. ...................................... .--......................-........... ilf Death Occurred Somewhere Other Than a Hospital: ~] Nospice Facility ~ Decedent's Home Q Emergency Room/Outpatient ~ peed on Arrival . Nursing Home/Long-Term Care Facility 0 Other (Specify) 156. Facility Name (If not institution, give street and number; 15c. City or Town, State, and Zip Code 1Sd. County of Death Emeritus at Creekview Mecbanicsbur PA 17055 Cumberland 16a. Method of Disposition Burial ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from State 0 Donation ~ Other (Specify) April 14, 2012 Rolling Green Cemetery 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signatu of ral Se a Licensee or Person in Charge of Interment iZb. License Number Camp Hill, PA 17011 FS 012 849 L 0 17c. Name and Complete Address of Funeral Facility PartYlemore FH & CS, inc., P_O. Box 43 New Cumberland, PA 17070 18. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE r o indicate what t ~ highest degree or level of school completed a[ the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. 8th grade or less is Spanish/Hispanic/Latino. Check The "NO" [$~ White Q Korean ~ No diploma, 9th - 12th gratle box iF de edent Is not Spanish/Hispa is/Latino. n ~ Black or African American ~ Vietnamese Q High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native Q Other Asian ~ Some college credit, but no degree ~ Yes, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hawaiian Associate degree (e.g. AA, AS) 0 Yes, Puerto Rican Chinese Q Guamanian or Chamorro O Bachelor's tlegree (e.g. BA, AB, BS) 0 Ves, Cuban Fili ~ Pino 0 Samoan Q Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) 0 Ves, other Spanish/Hispanic/Latino ~ Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) Q Other S ( pecify) . MD, DDS, DVM, LLB, JD 21. Decedent's Single Race Self-Designation - Gheck ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work Q White ~ Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American ~ Korean Q Other Pacific Islander 0 American Indian or Alaska Na<iYe ~ Vietnamese 0 Don't Know/N Ot SU re Engineer Asian Indian ~ Other Asian ~ Refused 22b- Kind of Business/Industry Q Chinese 0 Native Hawaiian Q Ocher (Specify) (] Fili Pino ~ Guamanian or Chamorro En ineerin ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounce Dead (MO/Day/Vr) 236. Signet re of Person Pronouncing ath (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH -~ 7 O ~ ~Z._ ~ _ 23d. D a/le ignetl (MO/Day/Yr) 24. Time of nD~eath ~ v1 /c--~ ~Z.S Q, Zt ~ `-[ ~ ZeJr Z_ ~ '~N~ LJ ~ C~ 25. Was Medical Examiner or Coroner Contacted? ~ Yes CAUSE OF DEATH Approximate 26. Part I. Enter the chain of events--diseases, injuries, o mplications--that directly caused the death. DO NOT enter terminal a uch a ardiac arrest Interval: _ respiratory arrest, or ventricular fibrillation wi t k out showing the etlo logy. DO NOT ABBREVIATE. Enter only one cause on a Iinee Add additional Ilnes if necessary Onset to Death w n `~ ~ ' r 2 rp,~~G~ ~ ~ v ~ IM MEDIATE CAUSE ---------------> a. I-`J (Final tllsease o ndition pue to (o as a consequence of): - resulting in death) b. Sequentially list conditions, Due to (or as a consequence of): if any, leading to the cause _ listed on line a. Enter the UNDERLYING CAUSE Due to (p as a consequence of): (disease or injury that - ni[la[ed the ¢ nts resulting d. ¢ In death) LA6T. Due to (o as a consequ nce oF): S_ 26. Part 11. Enter other significant co ntlitio ontributing to death but not resulting in the underlying cause given in Part I 27. Was an autopsy performed? O Yes ~ No ~(~~~ /~ X C rGY/1 Q ~.~ Q C ~ 7~ 28. Were autopsy findings available m v o t plate the c of death? co a Q No O Yes - 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death o ~ Not pregnant within pass year 0 Yes Q Probably ~ Natural Q Homicide ~ Pregnant at time pf death Q No 0 unknown ~ Accitle nt ~ Pending Inves<igation m ~ Not pregnant, but pregnant within 42 days of death ~ Suicitle ~ Could no[ be determined ~ 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Uafe of Injury (MO/Da Vr 5 y/ ) ( pell Month) 0 Unknown if pregnant within [he 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: 38. Describe How Injury Occurred: (] Ves (] Driver/Operator ~ Pedestrian Q No ~ Passenger Q Other (Specify) 39a. Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due to the c se(s) and m r stated ~ Pronouncing 8 Certifying physician -TO the best of my knowledge, death occurred ai [he time, date, and place, and due to the c se(s) and m fated Q Medical Examiner/C - On the ba I of examin/Lion, and/or~vestigation, in my opinlo n, death occurred at the time, date, and place, and due to the cause(s) and manner stated ~I ~ Signature of certifier: ~~/~f-~~ / CAS-~ \ ~'~ ~--~ 11.•--~ Title of certifier: 'n'"~ License Numbe r:M~ ~7 (~ ~ ~ ~ E 39 b. Name, Address and Zip Code of Person Completing Cause of Death (Item 26) 39c. Date Signed (Mp/Day/Yr) ,~ o,~,-, e s F~ ~ c... ~ ~ G t, 0 1~ a 'i~-, ate- Pte: t -~ `, o ©4 l z c~ r ~ 40. Registrar's District Number 41. Registrar' 42. Registrar File Dace (MO/Day/Vr) 43. Amendments ITEM # ~ rs -~ ~` ` In ~G~. ~ UC- SHOULD RF,AD Gt- Disposition Permit No. ~~ l V~"7 ~9 H105-143 REV 07/2011 LAST WILL AND TESTAMENT I, JOHN G. DELLO-IACONO, of Fairview Township, York County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death, and not specifically devised herein, at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate to my three (3) daughters, KRISTA N. CREEKPAUM, ANNE G. EBERSOLE and MERRIL H. BUCKHORN, share and share alike, the child or children of any deceased child taking the share their parent would have taken if living. 4. I nominate and appoint KRISTA N. CREEKPAUM to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint ANNE G. EBERSOLE as substitute Co-Executrix, also to serve as such :7 r- , , ~-. without bond, with the same powers as are given herein to my Executrix. ' ~ r ~~`' , -.__ ~-~~ ry -'' y rte- ~ _= _~" --~ r-r-; .~. ~. _. , ~~ -- '^~ 5. I hereby suggest that my personal representative retain the services of Irwin & McKnight as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 30`'' day of June, 2005. t~ ~~~~~'~ti~~EAL) JOHN . DELLO-IACOrlO Signed, sealed, published and declared by JOHN G. DELLO-IACONO, the above- named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have subscribed our names as witnesses hereto. ~~ n n 2 ACKNOWLEDGMENT AND AFFIDAVIT WE, JOHN G. DELLO-IACONO, CHERYL L. CLELAND and SHARON L. SCHWALM, the Testator and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament, that he had signed willingly, that he executed it as his free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of their knowledge the Testator was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ,JOHN G. D LLO-I,A . ONO ERYL L. CLELAND yy , SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by JOHN G. DELLO-IACONO, the Testator herein, and subscribed and sworn to before me by CHERYL L. CLELAND and SHARON L. SCHWALM, witnesses, this 30`'' day of June, 2005. Public LUMMUNWEAILTFi OF PENNSYLVANIA _. Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2008 Member, Pennsylvania Association Of Notaries 3