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HomeMy WebLinkAbout06-01-12PETITI0~1 FOR GRA1vT 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 "afollowing and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: John Zarichansky a/k/a: alk/a: a/k/a: Date of Death: March ?~,-,?012 File No• ~ / " ~ ~ " ~; (Assigned by Register) Social Security No: Age at death: 86 Decedent was domiciled at death in Cumberland County9 Pennsylvania (state) with his/her last principal residence at 1000 West South Street, Carlisle Borou4h, Cumberland County Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 1000 West South Street, Carlisle Borough, Cumberland County, Pennsylvania 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 $ 13,000 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.... $ 13,000 Real estate in Pennsylvania situated at: None (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township ar 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 July 26, 1989 and Codicil(s) thereto dated Mary Ann Zarichansky died December 21, 1999 State relevant circumstances (e.g. renunci¢tion, death of executor, etc.) Except as follows: a$er the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pendin8 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. 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, durante minoritate If Administration, c. t. a. ot• rl 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 survivedby the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationshi Address Form RYV-02 r-ev. 10/11/2011 Page 1 Of 2 Uath of Personal representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CLT~IBERL~ND c~ ,~ Petitioner(s) Printed Name Petitioner(s) Printed Addres ^'' ~ ~' . ~ Mark Paul Zarichansky turf ~ -- 391 tiiountain Road, Boiling Springs, P.A 17007 ; t ; ~ _ ~~:~ 7~ `~~ ?- ..~ . - The Petitioner(s) above-named swear(s) or aff rrn(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 e Decedent, th titi ner(s/)~will well and truly administer the estate according to law. Swotn to or affirmed and subscribed before -~ "-~~ ~-~ ~" Date ~ l ~ Z me This !~~'` ~ day o~ .(1 ~ Date gy; _ Date F ~ Register Date BOND Required: Q YES ~NO To the Register of Wills: FEES' Please enter my appearance by my signature below: Letters ..................... . ( 2) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ C~o~m~mission ................. . vL'f~ ....... Automation Fee . ............. . JCS Fee . .................... T O'T A L .................... . $ ~ ~• ~'©l V oCi Attorney Signature: -~ , Printed Name: Robert G. Frey Supreme Court ID Number: 46397 Firm Name Address: Phone: Fax: Email: Frey & Tiley ~ South Hanover Street Carlisle. PA 17013 717-243-5838 717-243-6441 rfrey@freytilev.com DECREE OF THE REGISTER Estate of John Zarichansky a/k/a: File No• ~/ - ~~ '~ AND NOW, ~_ /.,/ /7 ~ , ~~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to ~'Iark Paul Zarichansky _ in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of rec FormRYY-02 rev.IO/]1~'2011 the last Will (and Codicil(s)) of Decedent. Register of Wills a>~e 2 H 105.905 RP.V.(8/11~~ ~~ _~~ This is to ceru y~that thi is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. C7 ,y ~ ~ ~ y ~ ~1 ~ i.~ :~ ~ x i ., =,,;.. ~ i<~. ~-~ _~_ ~ r 9008 ~~ ~ _ - ~ c7C: ~'" No. Marina O'Reilly Matthew State Registrar MAR 3 0 2012 Date ~~ :v _ TYP¢/Print In COMMONWEALTH OF PENNSYLVANIA ~ OEPARTM ENT OF HEALTH ~ VITAL RECORDS Permanent CERTIFICATE OF DEATH 01 k I k 5t ~_ .~`` ,, Ll l S I l J n l. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/V r) (Spell Mo) John Zarichans March 2, 2012 Age-Las[ Birthday (Vrs) Sa Sb. Under 1 Vear Sc. Untler 1 Da 6. Date of Birth (MO/Day/Near) (Spell Month) 7a. Birthplace (Cit d State or Foreign Country) ~ . Months DaYS Hours Minutes A Wa11, l S6 November 27, 1925 Zb. Birthplace (cou ntY) A11c hen 8a. Residence (State or Foreign Cou Wiry) eb. Residence (Street and Number -Include Apt No.) Bc. Did Deceden( Live in a Township? PA S h St 1r T ~ O Ves, d¢cedeni lived in SwP~ 8d. Residence (County) _ t _ OU . 1 ~~~ ~~.ERL ~ rlaT1G1 He. R silence (Zip C e) o, d¢cetle nt lived within limits of C a. r 1 1_ S 1 e ty/boro. c 5. Ever In US Armetl Forces? 10. Mar ital Status at Time of Death (] Married ~CWidowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) [Yes O N ~ Unknown ~ Di vorced O N er Married O Unknow 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior t0 First Marriage (First, Mltltlle, Last) Jan Zarichans Katharine Zamiszcalt Relationship (o Oeceden[ Informant's Name 14 b 14a 14c. Informant's Mailing Address (Street d Number, City, State, Zip Code) ~ . Mark P_ ZarichansKy won 391 Mountain Rd. Boiling Springsr PA 17007 C lSa. Place o D¢at Che<k only one ........ .................................... ................................... r m s _ _____ in a Hos If Death Occurretl pital: ~] Inpatient ] Hospice Facility ~ Decedent's Home Death Occurretl Somewhere Other Than a Hospital: [ If. _ Q Emergency Room/Outpatient Q Dead on Arrival _ ' ~§ Nursing Home/Long-Term Gare Facility 0 Other (Specify) lSb. Facility Name (If not institution, give street and number; 16c. CRy or Town, State, d Zip Cotle 16tl. County f Death orial Home n Sarah A. Todd Ma !Carlisle, PA 17013 Cumberland q ~ 16a. Method of Disposition ~yaBUfial ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) m ~ Removal from State Q Donation - /9/201 2 New Catholic Cemetery St Patric] c ' s - p Omer (specify) _ 16tl. location of Disposition (City or Town, State, and Zip) ra er,s Q.or~erso harge of Interment t ~w tr ~ 17a. Signatur C s / _ ' SZb. License Number Carlisle, PA 17013 ~ C/./ ~/ C-/ FD 012633 L o SZC. Name and Complete Adtlress of Funeral Facil" y ~.ing Brothers Funeral Home, Snc_ 630 S_ Hanover St_ Car1i e, PA 17013 18. Decedent's Education -Check the box Shat best describes the 19. Decetlent of Hispanic Origin -Check She 20. Decedent's Race -Check ONE OR MORE ra es to indicate what highest degree or level of school completed at the time of tleaxh. box that best describes whether the decedent the decedent considered himself or herself [O be. Q 8th gratle or less is Spanish/Hispanic/Latino. Check the "NO" White ~ Korean Q No tli ploma, 9th - 12th grade "f decedent is not Spanish/Hispanic/Latino. b Q Black or African American ~ Vietnamese High school gratl ua[e or GED com pletetl r -v( yes ..o not Spanish/Hispanic/Latino ~ Amer can Indian or Alaska Native ~ Other Asian i 0 Some college credit, but no degree Q Y s, Mexican, Mexican American, Chicano lndian Q Native Hawaiian ~ Asian ~ Associate degree (e_g. AA, AS) ~ Yes, Puerto Rican Q Chinese Q Guamanian or Cha morro ~~ Bachelor's degree (e.g. BA, AB, BS) ~ Yes, Cuban Q FIIfplno ~ Samoan ~ Master's tlegree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spa Wish/Hispanic/Latino ~ Japanese Q Other Pacific Islander ~ Doctorate (e.g. PhD, Edo) pr Professional degree (Specify) 0 Ocher (Specify) . MD, DDS, DV M, LLB, JD) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered Himself or herself to be. 22a. o cedent's Usual Occupation -Indicate Lype of work ~Nhite Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. 0 Black or African American Q Korean ~ Other Pacific Islander 0 American Indian or Alaska Native Q Vietnamese ~ Don't Know/Not Sure 5011 SC12nt.1 St ~ Asian Indian ~ Other Asian ~ Retusetl 22b. Kind of Business/Intlustry Q Chinese ~ Nailye Hawaiian ~ Other (Specify) 5011 Con SerVatlOn SerV1CP Filipino ~ Gua manlan or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced D¢ad (MO/Day/V r) 23b. Signature of Person Pronotmcing Oeath (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR ` - CERTIFIES DEATH V-IJC~v~ ~ ~U ~ ~(~d~~,~~~C W ~ ~1Z `~ - tl. ate Signed (MO/Day/Yr) .Time of Death ~/~R, y/L }/~ ~]~ '~^)~ `~av ~ 25_ Was Medical Examiner or Coroner Contac ed7 ~ Ves No CAUSE OF DEATH - Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complications--that tlirectly <ausetl the tleath. DO NOT enter terminal events such as cartliac arrest - Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death IMMEDIAti ~A~sE --------> a. P^~a-• i n E+~rza~ v fps cc~La-vi_ D, sf~s E i _y n_ (Final dis ondition Due to (o as a consequ nee of): m e r¢..,hine .. dee ) b. _ _ - S¢quentially hst contlitions, Due io (or as a consequence of): If any, leading to the cause Ilstetl on line a. Enter the _ _ UNDERLYING CAUSE Due to (nr as a consequence of): (msease or iniury max -_ iaa¢d me eyenss re~wting d. ~ deatn> LAST. Dne m (o as a co nsequ nre of): in .g n[ributinP To death but not re ulting in th d lying cause given in Part I 26. Part Il. Enter other sienificant c ndit' s 22. Was an a opsy performed? _ v1(Z~J SCY~S1S' ~~JT T-EiJ E~° </lJ tiC~ C~u ia•' 'i ' O Ves g . .. - (f ? f > 28. Were autopsy findings available m f-iy (~i@-O L'. ~c Fti{~Lt'E-x to complete Lhe cause of death? ~ Yes ~ No ~ 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manne of Death o ~ Not pregnant within pass year Q Ves 0 Probably ~-NaFural Q Homicitle (] Pregnant at time of death ^ L~'V o ~ Unknown 0 Accident ~ Pending Investigation m 0 Not pregnant, but pregnant witnin 42 days of death ~ Suicide ~ Could not be determined [] Not pregnant, but pregnant 43 days to 1 year before death 32_ Date of Injury (MO/Day/Vr) (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 Injury (Stre¢t and Number, City, State, Zip Code) 36. Injury at Work 32. If Transportation Injury, Specify: 38. Describe How Injury Occurred: ~ Ves ~ Driver/Operator Q Pedestrian 0 No ~ Passenger ~ Other (Specify) 39a. Certifier (Check only one): a C~ rtifying physi - To the best Of mY knowledge, death n ed tlue to the c e(s) and m tested date land pia nd du me e(s) and m rated - To the best of my knowledge, death o red a the t Q Pronouncing 8 Certifying physi ~ c h and pia nd due to the cause(s) and m ne sated tlate . and/or invesiigationr in my gPinio ~ death occurred at the time ~ Medical Examiner/Coroner ~~- b ~ 0-Q 4 4 ~ ~ 4 -~ ~4 ~ \~~1 \~ License Num er: Title of certifier: Signature of certifier: 39b. Name, Adtlress antl Zip Code of Person Completing Cause of Oeatn (Item 26) - 39c. Dale Signed (MO/Day/Yr) < t.:- PY<ti1 S ,Art FT-sh f1-N. ~4 % ~ Y 2 2 c .S~P f2//1/ ice. 12c"~~ny~ ~ 14-/r- ~-. S'L.6 i 1~ /3 (-7 O i "3 ~J .S ~ Z l"7 (2- '~~ 40. Registrar's District Number 41. Regis ra ~~ ~a[u~re ! 42. Registrar File Date (MO Day r) 3. Amentlments Disposition Permit No.~' 1_~I~ `t~~ H 105-143 REV D7/2011 OATH OF NON-SUBSCRIBING tiVITNESS(ES) REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of John Zarichansky ,Deceased Mark P. Zarichansky and Robert G. Frey (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with John Zarichansky and am/are familiar with the handwriting and signature of the decedent, and that the signature of John Zarichansky to the foregoing instrument purporting to be the Last Will and Testament/Codicil of John Zarichansky is in his/her own proper handwriting. (~ 1~ l," ~~ ignature) 391 Mountain Ro d (Street Address) Boiling Springs, PA 17007 (City, State, Zip) Executed in Register's Off ce Sworn to or affirmed and subscribed before me this `~f day of , ~i / I Z.e~ , ~~ /~- for Register of Wills 5 South Hanover Street Carlisle, PA 17013 (City, State, Zip) ,~ ~ ~ ~ rn ~ ~ ~~ 3 ~ ~,~ c == ?= ~ ~ ~:~ rn ~~ cn u'~ Form RGb'-)=t rev. 10.1:.1)6 w - ~' N ~,~ ~ t"` ~--~. J 'l. 'r ~ t.. ~., ,. " r ~ - • ~ _ ,',~ ~~ ' `.~ ~ ~ "" ~: ~ ~ .... G~~ LAST WILL AND TESTAMENT I, John Zarichansky of Antrim Township, Franklin County. Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare the following as and for my Last Will and Testament, hereby revoking any and all Wills heretofore made by me. ITEM I: I direct my Executrix or Alternate Co- Executors hereinafter named, to pay all my just debts, funeral expenses, transfer inheritance tax, Federal Estate tax, if any, and other just charges against my estate out of my estate, as soon after my death as is convenient, this in order that there may be no deductions of any kind from legacies and benefits herein given. ITEM II: By way of explanation, the bulk of our personal property and real estate is in the joint name of myself and my dear spouse, Mary Ann Zarichansky, and we understand in the event of the death of either of us, the said jointly held property which has been accumulated by both of us will vest in the surviving spouse and that is my will. ITEM III: All the rest, residue and remainder of my estate, real, personal and mixed, I give, devise and bequeath absolutely unto my dear spouse Mary Ann Zarichansky. ITEM IV: In the event my spouse should predecease me, I do then and in that event give, devise and bequeath all the rest, residue and remainder of my estate real, personal and mixed, in equal shares, as follows: A. One share unto my son, Mark Paul Zarichansky, or in the event he should fail to survive me, then to his issue per stirpes. B. One share unto my son, John Michael Zarichansky, or in the event he should fail to survive me, then to his issue per stirpes. C. One share unto my daughter, Ann Marie Zarichansky, or in the event she should fail to survive me, then to her issue per stirpes. U. One share unto my daughter, Christina Joanne Sechrist, or in the event she should fail to survive me, then to her issue per stirpes. ~- ~~-,r fC~~~s't -- i ohm"~ichansk ITEM V: I do hereby nominate, constitute and appoint my dear spouse, Mary Ann Zarichansky, as executrix of this my Last Will and Testament. In the event my said spouse should predecease me or for any other reason be unable or unwilling to assume the responsibility of executrix of this my Last Will and Testament, I then constitute and appoint Mark Paul Zarichansky as Alternate One. In the event both my spouse and Mark Paul Zarichansky should predecease me, you appoint John Michael Zarichansky as Alternate Executor. I authorize my Executrix and Alternate Executor to sell any real estate or interest in real estate I may own at the time of my death at public or private sale as they see fit and to give to the purchaser or purchasers thereof good and sufficient deeds or acquittances for the same. I further authorize that no bond of any kind be required of my personal representatives for the faithful performance of their duties by reason of the fact that they may be living outside the Commonwealth of Pennsylvania, all in accordance with the Probate, Estates and Fiduciaries Code. IN WITTIESS WHEREOF, I, John Zarichansky, above named Testator, do set my hand and seal to this my Last Will and Testament which consists of two (2) typewritten pa es to each of which I have affixed my signature this~,~~rlday of ~;~~ 1959. ohn~ ` richansky~ ., Signed, sealed, published and declared by John Zarichansky, the above named Testator, as and for Last Will and Testament, in the presence of us, who at request, in his presence and in the presence of each other, all being present at the same time, have hereunto subscribed our names as witnesses. ;~ •. 2