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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 betters as specified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate forme
Decedent's Information
Name: Andrew T. Danish File No: ~~-~~~ -~~ ~e~
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: May 9, 2012 Age at death: 90
Decedent was domiciled at death in Cumberland County, pennsvlvania (state) with his/her last
principal residence at 504 Brandt Avenue 17070 New Cumberland Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Holy Spirit Hospital 17011 Camy 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 $ 360,000.00
If not domiciled in Pennsylvania ....................... . Personal property in Pennsylvania $
If not domiciled in Pennsylvania ....................... . Personal property in Counry $
[value of real estate in Pennsylvania ..................... .................................... $ 140
0(1(1 00
,
TOTAL ESTIMATED VALUE.... ~ 500.000.00
Real estate in Pennsylvania situated at: 504 Brandt -r New Cumberland Cumberland
(Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough ~ County
Q 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 Wiit of the Decedent, dated February 12, 1992 and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death oferecutor, 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(8), and did not have a child born 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 life, durante absentia, durante 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(8) 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 left no Will and was survived by the following spouse (ifany) and heirs (attach
additional sheets, if necessary):
Name Relationshi Address
Andrew G. Danish Son 506 Terrace Drive C7 ,
New Cumberland Pa 17070 `' C? wI
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of 2
Oath of Personal Representative
COM1~10NWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
'r
Official Usc Only
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ry `.. ~
~ ._
Petitioner(s) Printed Name Petitioner(s) Printed Address r~ `•~-= - -
Andrew G. Danish 506 Terrace Drive, New Cumberland, Pa 17070 ~~ ~ -- ~_r
r"'
-~
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 Petitioners wrll well and truly administer the estate according to law.
Sworn to or~~~ firmed an ubscribed before ~`~- ~~-~-- C' • }-~ ~,~-~ ~ Date ~ ~ ~ - ~ ~-
me thi~ day of , ~_
n__~
F r t `e Register
Date
Date
Date
BOND Required: Q YES Q NO
FEES:
Letters ..................... .
( ~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond .. ......................
Commi ssion ................. .
O~~t~h~e~ r .. ,
S lrl~ 0p
•Ob
rtease enter my ap~~~nce by my signature below:
Attorney S
Printed Name: Barbara Sumple- Sullivan, Esquire
Supreme Court
ID Number: 32317
Firm Name: Barbara Sumple-Sullivan, Esquire
Address: 549 Bridge Street
.New Cumberland, Pa 17070
Automation Fee . ..............
JCS Fee . .................... Od
TOTAL ..................... ~ $8A-
(717)774-1445
(717)774-7059
~h~rhar~-hccec ~(pwPri~nn nPt _
O/•~J
DECREE OF THE REGISTER
Estate of Andrew T. Danish File No: ~~ " ~~~/~
a/k/a:
AND NOW, ~,~~/`,1 ~ I~ ~;~, , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Andrew G. Danish
in the above estate and (if applicable) that
the instrument(s) dated 2/12/1992
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) o~Decedent.
Register of Wills
To tl:e Register of Wills:
~l~
Form R6~ 02 rev. 10/Ili?01 / ~ ~ Pabe 2 Of' 2
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u~f~~~i~~/ ~~~'l~(~~ ~+ ~,, ~rT,,c
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Fee fur tl)it L~er~iiieaur,. '~~r).(}iy
P 183~9~~7
Ceriiti~ +'i(~n \ ll'ta ~ __
Type/Print In
Permanent
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CIJ~~BERi ~,~D C~) , PA
COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
- ~ - - ~ ~ State File Number:
1. Decedent's Legal Name (First, Middle, Last, Suffix)
2. Sex 3. Social Security Number 4. pate of Death (MO/Day/yr) (Spell Mo)
- Andrew T
D
i
h
_
an
s
Male May 9, 2012
Sa. Age-Lass Birthday (Yrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (MO/OaY/Near) (Spell Month) ]a. Birthplace (City and State or Forei
n Count
)
g
ry
Months Days Hours Minutes G1•i lka s-Barre PA
90 October 22 , 1921 ]b
Birth
l
c
.
p
ace (
e~nty) Luzerne
8a. Residence (State or Foreign Country) 86. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township?
Pennsylvania
pYes, decedent eyed In
Sd. Residence (county) 504 Brandt Avenue twp.
Cumberland Se. Residence (Zip Code) 1 7 Q 7 Q ~Nq, decedent lived within limits of New Cllmbarland
city/boro.
9. Ever in US Armed Forces? 30. Marital Status at Time of Death 0 Mauled Widowed 11. Su rvlving Spouse's Name (lf wife
give name prior to first marria
)
Y
,
ge
es ~ No Q Unknown ~ pivorced ~ Never Married Q Unknow
12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First
Middle
Last)
,
,
(unknown) Johanna (unknown)
14a. Informant's Name 146
R
l
ti
h
'
.
e
a
ons
ip to Decedent
A
d 14c. Informant
s Mailing Address (Street and Number, City, State, Zip Code)
o n
rew G_ Danish Son 506 Terrace Drive, New Cumberland, PA 17070
ac
° .......................................................... ............................................. 15 a. Place o Death Check only one
If Death Occurred in a Hos tai- ............................... .(. .. -- -.. .. ---- .......- - ........ - - .--- -- ..... __
.....-
p~ - Inpatient ;If Death Occurred Somewhere Other Than a Hospital: ~ Hos
i
F
ili
~~~~
~
'
p
ce
ac
ty
[
Decedent
s Home
~ Emergency Room/Outpatient 0 Dead on Arrival 0 Nursing Home/Long-Term Care Facilit
0 Oth
S
f
y
er (
peci
y)
156. Facility Name (If not institution, give street and number; •16c. City or Town, State
and Zip Code
,
15 d. County of Death
Hot S irit Hos ital Cam Hill PA 17011
°' Cumberland
16a. Method of Disposition 0 Bu rlal ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemet
ery, crematory, or other place)
Q Removal from State ~ Dona io
~ M
14
2
}
'
other (specify)~(1
ay
7~m bn
lPrl
,
012 Rolling Green Cemetery
Z 16d. Location of Disposition (City or Town, State, and Zip) 1]a. SI F ge of Interment 1]b. License Number
gn Service Licensee or Person in Char
Camp Hill, PA 17011
0 FL 012 848 L
1]c. Name and Complete Address of Funeral Fa ciliiy
Parthemore FH & CS lnc_ P.O. Box 431 New Cumberland PA 17070
'
18. Decedent
s Ed ucafion -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE ra indic
to
t
h
~- a
e w
at
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
_
Q 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" ® White Korean
N
di
l
~
o
p
oma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. 0 Black or African American 0 Vietnamese
[~ Hi
h
h
l
g
sc
oo
graduate or GED completed [~ No, noT Spanish/Hispanic/Latino ~ American Indian or Alaska Native 0 Other Asian
~ Some college credit
but no degree (
,
~ Ves, Mexican, Mexican American, Chicano ~ Asian Indian ~ Native Hawaiian
Q Associate de
ree (e
AA
AS)
g
.g.
,
Q Ves, Puerto Rican
~ Chinese 0 Guamanian or Chamorro
h
'
Q Bac
elor
s degree (e.g. BA, AB, BS) Ves, Cuban
~ Q Filipino 0 Samoan
'
Master
s de
~ gree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Ves, other Spa nls h/Hispanic/Latino Q Japanese Q Other Pacific Island
er
~ Doctorate (e.g. PhD, Ed D) or Professional degree (S
ecif
)
p
y
~ Other (Specify)
.MD DDS OVM LLB, JD
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be
22 a
Decedent's U
l O
.
.
sua
ccu patio -Indicate type of work
Q White ~ Japanese ~ Samoan d
d
i
n
one
ur
ng most of working life
DO NOT USE RETIRE U_
~ Black or African American Q Korean 0 Other Pa clfic Islander
Q American Indian or Alaska Native ~ Vieina mese Q Don't Know/Not Sure PhOtO E11 raver
~ Asian Indian ~ Other Asian ~ Refused 226
Ki
d
f
.
n
o
Business/Industry
Q Chinese 0 Native Hawaiian ~ Other (Specify)
Q Filipino ~ Guamanian or Chamorro
Newspaper
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 236. Signature of Person P ncin
Death (Onl
wh
li
bl
g
y
en app
ca
e) 23 c. License Number
BY PERSON WHO PRONOUNCES OR A l G'~
CERTIFIES DEATH „mil
Z
~ t
_ /~ -
23d. Date Sign d (MO/Day/Yr) 24
- ~ i"W ~ Z~Z~C~
Time of Death
.
_
(~Z ~ Z ~ PM, 26. Was Medical Exam or Coroner Contacted? ~ Yes ~No
CAUSE OF DEATH
Approxim at
e
26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval
:
respiratory arrest, or ventricular fibrillation without showing [he etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add addiTional lines if necessary Onset to Death
IMMEDIATE CAUSE > ~ _~.~~ t S -
(Final disease or condition Due to (o as a co nsequ rite of):
r e
resulting In death) /~
~
b. "C -P \ ~~~ f--~ ~ G"1-~-
Sequentially list conditions, Due to (or as a consequence of):
if any, leading to the cause
listed on line a. Enter the
UNDERLYING CAUSE Oue to (or as a consequence of): '
(disease or Injury that
= vitiated the a nts resulting d. -
e
In death) LAST.
Due to (or as a consequence of):
S 26. Part 11. Enter other significant cond'i'o ontr'butin t d th but not resulting In the underlying cause given in Part I 27. Was an autopsy performed?
~ O Yes No
28. Were a opsy findings aila ble
to complete the cause of death?
v
^~ D Yes Q No
29. If Female: 30
Did T
V .
obacco Use Contribute to Death? 31. Manner of Death
0 Not pregnant within past year 0 Ves Q Probably Q Natural 0 Homicide
Q Pregnant at time of death ~ No ~ Unknown ~ Accident 0 Pending Investigation
N
m
f- ~
ot pregnant, but pregnant within 42 days of death 0 Suicide ~ Could not be determined
~ Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month)
Q Unknown if pregnant within the past year
33. Time of Injury
34. Place Of Injury (e.g. home; construction site; farm; school) 35. Location of In'u Street and Number, Ci
J ry ( ty, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred:
0 Yes 0 Driver/Operator 0 Pedestrian
~ No ~ Passenger ~ Other (Specify)
39a. Certifier (Check only one):
Q Certifying physician - To the best of my knowledge, death o red due to the cause(s) and m Led
Q Pronouncing g. Certifying physician - To the best of my knowledge, death occurred at the time, date sand place, and due to the cause(s) and manner stated
Medical Examiner/Coroner - On t basis of exa minatlon, and/or investigation, in my opinion,
death o rred at the time, dale, and place, and due to t
h
e c
a use(s) and m er stated
c
(
~
f
..t
Signature of certifier: - Title of certifie r~ I \~ I
y Cl ( G ~'~"~ ~ Ucense Number: 1 `!J ~~~
39b. Name, Address and Zip Code of Person o- Ling Cause of Death (Item 26)
39c. Date Signed (MO/Day/V r)
I-• UL ~ ~o N- ~1~ Cam tf
il "P1~
~o
t
,
+
+
5 +o +
40
Re
lstr
is Di
t
i
t N
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.
g
a
s
r
c
um ~ 41. Registrar
s 57gn}tu re 42. Regist~ r File Date (MO/Day/Vr)
43. Amendments
Disposition Permit No. ( I I'-F(~ tYC) ! H105-143
REV 0]/2011
-.
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; . _ _
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_
' _ ~ 4~ 1 ~_
_~ '-'~-~ LAST WILL AND TESTAMENT
a :_:° ~ OF
'
~ ,
.~=..
_ -T.-
- -
, ; ANDREW T . DANISH
-- ?
~.-~. v
I, ANDREW T. DANISH, of Cumberland County, Pennsylvania,
do make, publish and declare this to be my Last Will and
Test ament, hereby revoking all Wills and Codicils by me at any
time made.
ITEM I: I direct that all inheritance
and estate taxes becoming due by reason of my death, whether
such taxes may be payable by my estate or by any recipient of
any property, shall be paid by the Executors out of the property
passing under ITEM III of this Will, as an expense and cost
of administration of my estate. The Executors shall have no
duty or obligation to obtain reimbursement for any tax so paid,
even though on proceeds of insurance or other property not passing
under this Will.
ITEM II: I direct the Executors to pay
the expenses of my last illness and funeral expenses from the
property passing under this Will as an expense and. cost of
administration of my estate.
ITEM III: (a) I devise and bequeath all
the rest, residue and remainder of my estate of whatsoever nature
and wherever situate, together with any insurance policies
thereon, to my son, ANDREW G. DANISH. In the event my son should
predecease me, his share shall be paid to his issue, per_ stirpes.
In the event my son dies without issue surviving, my estate
shall be paid as follows:
(a) FIFTY PERCENT (50%) to my daughter-in-law, Donna
Danish;
Page 1 / ~
(b) FIFTY PERCENT (50%) to my brother-in-law, John
Roselli.
If either. of the aforesaid persons should predecease
me, the full estate shall be paid to the survivor of them.
ITEM IV: In the settlement of my estate,
my Executor shall posses, among others, the following powers:
(a) To retain investments I may have at my death,
as long as the Executor may deem it advisable to my estate to
do so;
(b) To sell either at private or public sale and
upon such terms and conditions as the Executor may deem
advantageous to the estate, any or all real or personal property
or interest therein owned by the estate;
(c) To pay all costs taxes, expenses and charges
in connection with the administration of my estate;
(d) to compromise controversies; and
(e) To do all other acts in the Executor's judgment
deemed necessary or desirable for the proper and advantageous
management, investment and distribution of the estate.
ITEM V: Any person who shall have died
at the same time as I shall have, or in a common disaster with
me, or under circumstances that the order of our deaths cannot
be established by proof, or within thirty (30) days of my death,
shall be deemed to have preder_•eased me.
Page 2 ,
ITEM VI: I hereby nominate, constitute
and appoint my son, ANDREW G. DANISH, to be the Executor of
my Estate. In the event my said son cannot act or refuses to
act as Executor for any reason, I nominate, constitute and appoint
my brother-in-law, John Roselli to act as Executor in his place.
The Executor is specifically relieved from the duty or obligation
of filing any bond or other security.
IN WITNESS WHEREOF, I have hereunto set my, hand and
seal this ~ day of ~~~;,~,~v~-- _, 1992 , to this
and the preceding two (2) pages, and I have also placed my
initials on each preceding page for better identification and
greater security.
1 ~
r ~ (SEAL)
DREW T. DANISH
We, the undersigned, hereby certify that the foregoing
Will was signed, sealed, published and declared by the above-named
Testator as and for his Last Will and Testament, in the presence
of each other, have hereunto set our hands and seals the day
and year first above written, and we certify that at the time
of the execution thereof, the said Testator was of sound and
disposing mind and memory.
,.-.,
e ,.
...
_, _.~m ,~ Residing at ~~f~ ~.' ~b r _;~~,
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Residing at ` y~~ ~~,~ ~`
Residing at .~Ga c~~l/l~-c~~~
Page 3
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
I, ANDREW T. DANISH, Testator, 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.
i-
(~!r ( SEAL )
DREW T. DANISH
Sworn to and subscribed
before me this ~~day
of ~i~ 1992.
,~'.
-,
~- ~'"' NOTARY PUBLIC ~~'
tw;ta; ~a! :,~%a!
Barbara Sumpie~5u!irvan. N,ntary nublic
New Cumbenan!i t3aro, C.umr.~-;nand !,runty
M y Commission E x p i r s : My Cann ~t;,ion Expi; es Gc. 5, , ~:=,5
Mernbar, fittilSAyMt9nr~1 !ati~n ~f Netane.
(SEAL)
Page 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND ,
,~
and ~ /ALA /~ y jJ/¢,~G~-/ the Witnesses whose 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 Testator, ANDREW T. DANISH, sign and execute the instrument
as his Last Will and Testament; that Testator signed willingly
and that he executed said Will as his free and voluntary act
for the purposes therein expressed; that each of us in the hearing
and sight of the Testator signed the Will as Witnesses; and
that to the best of our knowledge the Testator_ was at that time
eighteen (18) or more years of age, of sound mind and under
no constraint or undue influence.
~. ,
~_._.~--~.~..~ ~.~.___..~~ ~ r-''~ ~ /
Witness Witne s ~'~ !
Witness
Sworn to and subscribed
before me this /~~ day
o f L!~~~~" =~, 19 9
ii'
-~~~
~~ NOTARY PUBLIC
My Commission Expires:
fVGt.il;al Seel
( SEAL ) 5a~a SUm~CE',,U;!~vc.~~, Nofary Put~lic
New Curr,.x3r!~~rKi F~tnv. Gum~:r'c::ras ! ~~~~~fy,
MY Crsmmir~aor± ~xtairps: c"k,. 9, , ~3:~
~ ~ 8nr7Jylu gg~~jen ref ~(o[ares
Page 5