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HomeMy WebLinkAbout05-07-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERI-AND 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 ~ ~ = QJ~~ 7 Name: MADLYN G. ORLOUSKY File No: 21- a/k/a: (Assigned by Register) a/Wa: a/k/a: Social Security No: 125-14-8412 Date of Death: 4/28/12 Age at death: 88 Decedent was domiciled at death in CUMBERLAND County, PA (State) with his/her last principal residence at 442 Walnut Bottom Road Carlisle Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 442 Walnut Bottom Road 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: 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 .............................................................. $ TOTAL ESTIMATED VALUE.... $ 200,000.00 Real estate in Pennsylvania situated at: (Attach ndditionnl sheets, ifneeessnry.) 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 6/23/97 and Codicil(s) thereto dated Norie State relevant circumstances (e.g. 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 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 (lf applicable) c. t. a., d.b.n., d. b. n. c. t. a., pendente life, durante absentia, durante minoritate If Administration, c.za. or d.b.n.c.La., 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 lefr no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name ~ Relationship Address ~ _ r 4 [~ ~ l _ ~, ~.._ _ ( L _ _ 1} _~ ~^ .-_ "yl Form RW-02 rev. 10/11/2011 Page 1 Of 2. Oath of Personal Representative Otlicial Use Only COMMONWEALTH OF PENNSYLVANIA } C7 } SS: ~ O ~. z COUNTY OF CUMBERLAND } ~n ?~. Petitioner(s) Printed Name Petitioner(s) Printed Address ~' r:n 3~ "-~ 435 Criswell Drive , ~ a `;-; ._, . Thomas Orlousk Boilin S rin s ~- PA ~-' 17©`07 _ 406 Glenn Avenue _ ~: " i _ ~~ ` ;~' Theresa Riskis Boilin S rin s PA , 1'07 i~ r=, r-t 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 Pe>itioner(s) will well~and truly administer the estate according to law. Sworn to r affirmed a sus _ ibed befA re ~ '~ ~ ~ ,~ `/ , l ~ Date ~^ 7 ~ ~-~ me this ~ ay. - L ~ 1~6' _ ~~ Date ~~~ 7 ) Z By: ~ /~~~~~~~~3' Date For the Register Date BOND Required: ^ YES ~l NO FEES: " ~ ° ~~ Letters ....................... $ (F )Short Certificates(s) ...... ( )Renunciation(s) ......... . ( )Codicil(s) ............. . ( )Affidavit(s) ............ . Bond ......................... Commission ................... . Other ~ / ......... Automation Fee ................. JCS Fee ....................... ~. (~ G TOTAL ......................$ To the Register of Wills: Please enter my appearance by my signature below: Attorney Sig re: i~ Printed Name: George B. Faller, Jr., Esquir Supreme Court ID Number: Firm Name: Manson Law Offices Address: l0 East High Street Carlisle PA 17013 Phone: (717) 243-3341 Fax: (717)243-1850 Email: fag Iler(c~martsonlaw.com DECREE OF THE REGISTER Estate of MADLYN G. ORLOUSKY a/k/a: AND NOW, a ,~ , in consideration of the foregoing Petition, satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Thomas Orlousky and Theresa Riskis in the above estate and (if applicable) that the instrument(s) dated June 23 1997 described in the Petition be admitted to probate and filed of record as the last Will (and,Codicil(s)) of Decedent. File No: 21- ~~ ~ ~~ ~ Register of Wills ~ ~( JIB{J~j Harm aw-oz rw. ~o;»~zon ~ -. aye 2 of ~,-~2~~ ~~C ti)r tt)i_, LtrUi~jL~tl~(' `^`.~.i)±~ F~ ~8487~~3 TYPe/Print In Permanent Black ink ~J O Z Ck.ER~; n~: ,,. C~ J~R~?~ ia' r ~i P~, ~~~xve. ~~e~.c~,.x ~p~~a,~' A P42 3 0;` 2 012 COMMONWEALTH OF PEN NSVLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS CFRTIFI~ATF AF f]FATH 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (Mp/Day/Yr) (Spell Mo) Madlyn G_ Orlousky F 125 14 8412 April 28, 2012 Sa. Age-Last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/D ay/Near) (Spell Monihj 2a. BIct1w lac¢ (City an to or Foreign Country) sJ ~ Months Days Hours M inutes N' Imp ra r 88 April 21 l 924 26. Birthplace <co~nty) Ct-l~lt7x1 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live in a Township? tlRe OYes, decedent lived in wp 8 sidence (County) 1 68 )/' _ POMP ret St _ . Cumberland Se. Residence (Zip Code) 1 701 3 ENO, decedent lived within limits of Y1 l ~1 city/born. 9. Ever in US Armed Forces? 30. Marital Status at Time of Death Q Married ® Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) r ~ ~ Ves t,t'NO (] Unknown ~ Divorced ~ Never Married ~ Unknow _ 12. Father's Name (Fl rst, Middle, Last, Suffix) 13. Moth er's Name Prior to First Marriage (First, Middle, Last) Tho)nas H. Dean >;11en Quinn 14a. Informant's Name 146. Relationship to Decedent 14c. Informant's Mailing Atltlress (Street and Number, City, State, Zip Code) Thomas H_ Orlous Son 435 Criswell Dr_ Boiling Sprin s, PA 17007 Ci ......................... ...................__. .__................................ ` ' ........ 15a. P ace o Deat Check on .................................._...t..............Y.pne1......... .. _ If peath Occu rretl In a Hospital: ~,j Inpatient - i _ _._.___........... lf Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility (~ Decedent's Home ° ~ Emergency Room/Outpatient 0 peed on Arrival -_ ~NUrsing Home/Long-Term Care Facility ~ Other (Specify) 15b. Facility Name (If titufion, glue street and number; ~ 15 c. City o Town, State, tl Zip Code 1Stl. County of Death Thornwald Home Carlisle, PA CLanberland 16a. Method of Disposition ® Burial ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) 0 Removal From State ~ Donation other (specify) May 4 , 201 2 St _ Patrick Now Catholic Cemetery 16d. Location of Disposition (City or Town, State, and Zipj 12a. Signature of F rvice Licensee or of Intermen< 176. License Number s Carlisle, PA 17013 ~ FD 012633 L E 1ZC. Name and Complete Atltlress of Funeral Facility 7121 Brothers Funeral Homo, Snc., 630 S_ Hanover St_, Carlisle, PA 17013 18. Decedent's Education -Check [he 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 at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. (] 8th grade or less s Spanish/Hispanic/Latino. Check the "NO" ~Nhite ~ Korean Q No diploma, 9th - 12th grade box tf decedent is not Spanish/Hispanic/Latino. 0 Black or African American ~ Vietnamese g High school graduate or GED completed f~'No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian Q Some college credit, but no degree 0 Ves, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawaiian Associate degree (e.g. AA, AS) Q Ves, Puerto Rican Q Chinese ~ Guamanian or Cha Morro ~ Bachelor's degree (e.g. BA, AB, BS) 0 Ves, Cuban 0 Filipino ~ Samoan ~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Ves, other Spanish/Hispanic/Latino 0 Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Ed D) or Professional tlegree (Specify) Q Other S ( pecify) . MD, DDS, DVM, LLB JD 21. D e c e dent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occu Patton -Indicate type of work ~ . . l " ~ vvhite ~ Japanese 0 Samoan done during moss of working Iifc. DO NOT USE RETIRED. Q Black or African American Q Korean 0 Other Pacific Islander 0 Americ n Indian or Alaska Native ~ Vie a 0 Do t Kn w/Not Sure o Homemaker 0 Asian Indian ~ Othe ASian 0 Refused 226. Kind of Business/Industry 0 Chinese ~ Native Hawaiian ~ Other (Specify) ~ Filipino ~ Guamanian or Cha Morro Her OWn hOITte ITEMS 23a - 23d MUST BE COMPLETED 23 a. Date Plo pounced Dead (MO/Day/Yr) 23 b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH A ~LZL _Z 8~ /i -zL~~ _y - _ ~ /~ ~ ~ _ Rif ~SI ~ 90 -- L 23d. D lIate Signed (MO/Day/Yr) 24. Time of Deafh t- ~-~~- G-GCXI . O ~ , /~-l- /Z /.G- -Z~ Z-~ ~~-- ` ©/ ~ /1 l~-~~ 25. Was Medical r Coroner GontactetlT ~ Ves No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or com plications--that directly caused the death. DO NOT enter terminal a ents such a ardiac arrest Interval: y respiratory arrest, or ventricular fibrillation without sho ing the etiology. DO NOT ABBREVIATE. Enter only one cause on li . Add dditional lines if necessary Onset to Death a a (//2 _ /~ // v .o' ~ /f~~ ~ IMMEDIATE CAUSE ----- - - --> a. `-/~P ~ ~~~1~'~ G i % Q-~'~ !~~3~/ l '/fit-' ~J'~-L ~ ~ i '+ J = - c (Final tlisease o nditipn Due [p (or as a <onsequ nce of): - resulting in death) b . Sequentially list conditions, Due to (or as a consequence of): if any, leading t the c e listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury that F initialed the events resulting d. In death) LAST. Due to (or as a consequence of): .g 26. Part 11. Enter other si¢nifica nt conditions contributin¢ to d eath but not resulting in xhe underlying cause given in Part I 27. Was an autopsy pe rfo rmed2 .- y Q Yes ~p No ~ 28. Were autopsy fintlings available m to mplete the c of deathT oO Yes a0 No a 29. If Ff male: 30. Did Tobacco Use Contribute to Death"t 31 per of Death o ,e] Not pregnant within past Year j~ Yes O Probably ~Natu ral 0 Homicide ~ Pregnant at time of death R( No ~ Unknown ~ Accident ~ Pending Investigation 0 Not pregnant, but pregnant within 42 tlays of death ~ Suicide 0 Could not be determined ti ~ Not pregnant, but pregnant 43 days to 1 year before dea th 32. Date of Injury (MO/Day/V r) (Spell Month) ~ Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 3S. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Ves ~ DriVer/Operator ~ Pedestrian No Q Passenger Q Other (Specify) 39a. Certifier (Check only one): Certifying physician - To the best of my knowledge, death o ccurred due to the cause(s) and manner stated Pronouncing /L Certifying physician -TO the best of my kno wledge, death occurred a[ the time, date, and place, and due fo the cause(s) and manner stated ~ Medical Examiner/Coroner - n the b of examination, a nd/or Investigation, in my opinion, death o red at the time, date, and place, and due to the c se(s) and m r stated c e af o ' ` ~ M ~ O3 S 7°~ ~ Signature of certifier: Title of ce rtifler: License Number: p 396. Name, Address and Zip Code of Person Com pletin Cause of Death (Item 26) ( ~ ~.il it 3 M ~ 39c. Da[ Signe (MO/Day/Yr) .303 /1/• (3~LQ~r.-a-t c )- ~ 1r~, ~'V! ~ f{a / / S ~- ,/1 j t7 b !i s b ~f 3 o d o) a-- 40. Registrar's DistricC Number 41. Regis rar s 42. Re is r F e Date (MO Day Yr) ~\ -~ O ~~i-s~.c- r ~~~0 D 1a 43. Amendments Disposition Permit No. V ~1 ~ V~~ ~ H105-143 REV 07/2011 F:\FILES\DATAFILE\WILLS\8746-W.WIL ' LAST WILL AND TESTAMENT I, MADLYN G. ORLOUSKY, of the Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils by me made. 1. I direct that all my just debts, funeral expenses, testamentary expenses and all inheritance taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. If he shall survive me by thirty (30) days, I give, devise and bequeath all of my estate, both real and personal property, unto my husband, JOHN F. ORLOUSKY, absolutely. 3. In the event my said husband, JOHN F. ORLOUSKY, shall predecease me or fail to survive me by thirty (30) days, then I give, devise and bequeath all of my estate, both real and personal property, in equal shares, unto my children, JOHN ORLOUSKY, MARY ORLOUSKY, MARGARET HILL, THOMAS ORLOUSKY, MARK ORLOUSKY, PATRICK ORLOUSKY, MATTHEW ORLOUSKY, ELAINE LEINHEISER, and THERESA RISKIS. Y. I nominate, constitute and appoint my said husband, JOHN F. ORLOUSKY, as Executor of my estate. In the event he is unwilling or unable to so act, then I appoint THOMAS H. ORLOUSKY and THERESA RISKIS, as Executors of my estate. 5. tl_ "- I direct that my Executor(s) shall not be required to file a bond to secure the faithful v,_ ~ ~_ ,_. ... _~ 1_ - . ~ `s L. - _ - ~ I ~,_ M.G.O. =< ~ ~.. ~~ ,,~ ~ ; ~~ `"~ o J Page 1 of 3 Pages `~ - ~ performance of their duties in any jurisdiction. 6. I authorize and empower my Executor(s), in their sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in regard to any or all property of any kind forming a part of my estate for such terms and such prices as they may deem advisable; to borrow money for any purposes connected with the protection and preservation of my estate; to mortgage or pledge any real or personal property forming a part of my estate or to join in or secure the partition of same; to compromise any claims or demands of my estate against others or of others against my estate; to make distribution in kind and to cause any share to be composed of cash, property or undivided fractional shares in property different in kind from any other share; to employ agents, attorneys and proxies and to delegate to them such power as my personal representative considers desirable and to pay reasonable compensation for such services as may be rendered by such agents, attorneys and proxies; and to execute and deliver such instruments as may be necessary to carry out any of these powers. In addition, I direct that my personal representative shall have the power to conduct an inventory of any safe deposit box necessary to the administration of my estate. cC IN WITNESS WHEREOF I have hereunto set my hand and seal this ~.3 C day of ~~n c ,199 7. EAL) Madlyn .Orlousky SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto subscribed our names as witnesses thereto, in the presence of the said Testatrix and of each other. ~~ ~ .~J i Page 2 of 3 Pages COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. I, Madlyn G. Orlousky, 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. Madlyn G. ousky Sw rn or affi ed to and acknowledged before me by Madlyn G. Orlousky, the Testatrix, thisa3 ~~day of , 1997. Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Corrine L. Myers, Notary Public Carlisle Boro, Cumberland County f"y'~ommission Expires May 27, 1999 SS. ___._._ -- __.., COUNTY OF CUMBERLAND We, ~,.~ La C~ ~ ~ .~ C., ~ • 1~ CC.~ tr ~>'t ~ ~ ~ J`s ~ . ~ e e-~1 cra c, the witnesses whos names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Madlyn G. Orlousky, the Testatrix, sign and execute the instrument as her Last Will; that the Testatrix signed willingly and that the Testatrix 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. ;le~~/ ~dd~s ~~ ~ aS',er' ~r~a ~ya~ Address _~ ~/ ~~~ ~'~~- ; r,el- Sworn or affirmed to and subscribed before me this c~3 day of ~~'t~-w[`_ , 199'7. Notary Public Notaria! Seal Corrine L. Myers, Notary Public p Carlisle Boro, Cumberland County Page 3 of 3 Pages ~ p,~y ;~ omrnissior? Expires Play 27, 1999 ~