HomeMy WebLinkAbout07-25-12Rese~
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: ROGER J. PLEVA File No: ~~ ~ ~ ~ a Ll~ ~ a
a/k/a:
a/k/a: (Assigned by Register)
a/k/a:
Date of Death: July 4. 2012 Social Security No:
Age at death: 73
Decedent was domiciled at death in Cumberland Count
principal residence at 1111 A le Drive Mechanicsbur pA Y, Pennsvlvania (Stare) with his/her last
street address, Post Office and Zip Code Borou h of Mechanicsbur Cumberland
City, Township or Borough County
Decedent died at 1111 A le Drive Mechanicsbur PA 17055 Borou h of Mechanicsbur
Street address, Post Office and Zip Code Cumberland pp
City, Township or Borough Count
Estimate of value of decedent's roe Y State
p p rty at death:
If domiciled in Pennsylvania ............... All personal property
If not domiciled in Pennsylvania ....................... .
~~•~••~• $ 500,000.00
If not domiciled in Pennsylvania. Personal property in Pennsylvania $
•••••••••••••••••......PersonalpropertyinCounty $
Value of real estate in Pennsylvania ............................... .
• $ 1 RO 000 00
TOTAL ESTIMATED VALUE.... $ 680 000.00
Real estate in Pennsylvania situated at: 3005 Market Street Cam Hill PA 17011
Borou h of Cam Hill r~'
(Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code CUmbel~td
City, Township or Boroug CJ r'`~Coun~-~ c~*'+~
A. Petition for Probate and Grant of Letters Testamentar ~~`'-_ ~ '`` `~
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ ~ { " !'"- ~~ ~~
thereto dated ~ ~ " ' an~dicil(s} ; '
State relevant circumstances (eg. renunciation, death of executor, etc.J - } t
.C7 _ 'A
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not m ~ -~ r _ t-m
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C S Wa3323divorced,~as not aparty~p~pend~
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. (g)' and did not have a c'l~l born or
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 endent l" d
If Administration, c.t.a. or d.b.n.c.~a., enter date of Will in Section A above and com rlete list of heirs re minoritate
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 left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, ifnecessary):
Richard C. Pleva
Daniel J. Pleva
Name
Son Address
965 Magothy Avenue
Arnold MD 21012
Son 304 Mountain Road
Daniel J. Pleva has renounced his right to
administer in favor of his brother, Richard C. Pleva
FormRW-02 rev. /0/1//20/1
Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
//'' } SS:
COUNTY OF (mac.( IY1 Ems- ~Q V~~ }
k _ _„ ~
Off ~. `tlY ' :~ ..x.
~~ f 2 JUL 25 P~ I ~ 3
Petitioner(s) Printed Name . t ,r ~
Petitioner(s) Printed Addres
. ~~ c. 7 EU~~ ~(~ v~, het !Lt~ d(~(a
l
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 Petitiarer(s) and that, as Personal Representative(s) of the Dece the Peti 'o (s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before ___~~-~~L~-- Date ~- ~ J ~ ~ .~.
me this ~ day of ,~~~ Date
BY~ .~ Q~ ,~ ~ /~ i1 Date
For the Register Date
BOND Required: ~ XES ~ NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters ..................... .
( I~- )Short Certificate(s).:... .
( ~ )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ,.,,,,,,
5 C~, ~.
.~
Automation Fee ............... .LA7~
JCS Fee . .................... :SCJ
TOTAL ..................... $ .~
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of 1~~ ~~l'- ~ ~~~~~- File No: o~~ - 1 ~ - Q~ ( a
a/k/a:
AND NOW, / ~ ~~1.-C, ~~
in const er t n of the fore oing Petition,
satisfactory proof having been present before me, IT IS D C ED that Lett s ~~ ,~,j y~`,rr*~ ~ .-~
are hereby granted to ~ ,~ ~ . ~i(~/~
in the above estate and (if applicable) that
the instrument(s) dated /J
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
egister of Wills ~ ~ ~~ ~
Fo,,,, Rw-nZ rw. ioit~nnir Page 2 of 2
nl ~~.n~~ KCV IY/11)
LOCAL ~T .
WAFtNIN ~~''-y' ~/° CERTIFICATION OF DEATH
~~~~~?~tp; pp icate this cop b hotost
~ ~ L_ : ,.; ,,,.~,~ Y Y P at or photagrapFi.
Fee for this certificate, $6.00
P 1 ~ E ~ ~~ ~~ ~. ~~__
Certification Number
~~TYPe/Prln[In
Permanent
Blsck Ink 433
1. Decedent':
Roger
Sa. Age-Last
~. ~ 73
Yes
J
Ir<hday (Yrs) sb. Ui
Mor
(State or Foreign Co
ylvania
co°n
anc~
med Forces?
No Unknown
~i~2 ~~~' ~`~ P~ ~ 'his is to tcrtif~~ ':i);(t the inti~rmation here <>
given is
c~urrecUy copied fr+n~( an original Certificate of Death
~. ~ ~ .
I_luly filed ~~a~ith m(~ t(; Local Registrar. The original
ORPN~,`S ,r~, ~~rtificate ~~~ill h(° ~~or~,~urded to the State Vital
~rUR~fl ~ ~ t~ecord.~ (Nfice ur ~,I.'rn-ianent filing.
f
---- _ ~~0 7 0~2
l.oc-(1 Regisu`tr L7ate sued
COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH .VITAL RECORDS
CERTIFICATE OF pEATH
_ast, Suffix) State Flle Number:
2. Sex 3. Social security Number
P lava Male a. DdT° (hno/Dav/Yr) (spec Mo)
¢ Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Mont9h8-30-0912(~Ity and sta e~u o sign Co°nt1,~y~ 4' 2012
r Days Hours Minutes
_ April 8, 1939 New York NY
1111 Apple Dr. IOYes,detedentlweerinaTpwnsblpz -----
Se. Residence f2ln r- ~ twp
f it 1st t t T r d d t II d i[hi 11 it f Mac
113Z]1CSbLlr
DI d Q N M I d Q U kQ Wid d li 5 I l g SP N (If if BI ¢ Prior to first ma..r~.er Ity/b
I nrormant's Name Kat`ii ~ -'f•-•^••'^gc Irrrst, Midtll¢, Last)
121c1"18rd Plev8 14b. Relationship to Decedent 14c. Informant's Mailin Address (~reet and Numb¢r, City, STate, Zip Cotle)
C Son
¢ If Death Occurred in a Hospital: sw """""""""• lsa. P ace o eate Ma O t[ i A
LJ In Patient ........................r.............
..................m
..... _
rw 21012
~ ~ Emergency Room/Out ? If Death Occurred So "' •- ec on y one
patient ~ Dead on Arrival ' where Other Than a Hospital: ~ • _
LJ Hospice Facility ~ ~~
u. 5 .Facility Name (If not InsHtuHon, B e/Long-Term Care Facility Other 5 fit D~ceden['s Home
~ 1 1 1 1 Apple Drive grye street and number; 16c. City or Town, State, and 21p Cptle ( ~`Ifi')
~. 16a. Method of Dis Me chanicsbur pA 1sd. County of Death -
vvv Q RempYalfrorTp,stlat~n Q Br,rial IIoqr cremaclpn 17 -cu~mberland
Q Donationt 16b. Date of Dlspositi 16c. Place of Dis r
Other (specify) Position (Name of cemetery, c m tory, or other place)
Z 16d_ Location pt Dlsppshmn a 07~09~2012 Hollinger C emator
( ty or Town, State, and Zip) 17a Lure of Fu al Serv Llcens r Pers In her y
Mt . Holly Springs , pA ge pf InTermenT 1]b. License Number
17c. Name and Complete Address of Funeral Faclllty O1(+819
ers-Hamer Funeral Hoene Inc. 1903 ~_
~ 1B. Decedent's Etlu<aHOn -Check the boz that bast describes the 19. Dec¢tlent of HM8rLeet .S t . Hill F'A 17011
highest degree or level of school completed at the time of death. box that best describes lwhOethler the de edent 20. Decedent's Race -
Q Bfh grade or less the decetlent considered h mOSelf or hersOelf to be, to Indicate what
Q No diploma, 9th - 12th grade Is Spanish/Hispanic/Latino. Check the "NO" While
~J Hlgh school graduat¢ or GED completed box if°d^cedent is not Spanish/Hispanic/Latino. Black or African American Q Korean
n Som¢ college credit, but no degree o[ Spanish/Hispanic/Latino Q gmerican Indian or Alaska Native Q Vtemamese
Q Associate degree (¢.g, qA~ qS) Q Yes, Mexican, Mexican Am¢rica n, Chicano Q Other Asian
Q Bachelor's tlegree Q Yes, Puerto Rican Q Asian Indian Q Na[Ne Hawaiian
Q Master's tle (¢ g BA, AB, BS) Q Yes, Cuban Q Chinese
gree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Filipino Q Guamanian or Chamorro
Q Doctorate (¢.g, PhD, Etl D) or Professional de Q Yes, other Spanish/Hispanic/Latino Q Japanese Q Samoan
. MD DDS DVM LLB )D gree (Specify) Q OTher Pacific Islander
21. Decedent's Single Race Self-D¢si Q Other (specify)
White BnaTlon -Check ONLY ONE to indicate whaT the decedent considered himself or her
Black or African American Q lapanas¢ Q Samoan calf [° be. 22a. Decedent's Usual Occupation - Intlicat¢
Q Q American Indian or Alaska Native Q Korean Q Other Pacific Isla ntl¢r done Burin [YP¢ of wort
y~^ Q Vietnames¢ g most of working life. DO NOT USE RETIRED.
Q Asian Indian Q Other Asian Q Don'[ Know/Not Sure Accountant
Q Chin¢se Q Native Hawaiian Q Refused 22b. Kind of Business/Industry
Q Filipino Q Guamanian or Chamorro Q Other (sp¢cify)
ITEM 23a - 3d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo Day Yr) 236. 51 PA State
CERTIFIES DEATH July ~, ~}, 2012
BY PERSON WNO PRONOVNCES OR gnatu re of Person Pronouncing Death (Only when applicable) C~3c.tLicense Number
23d. Date Signetl (MO/Day/Vr) 24. Tim¢ ol~gam~,
Found: 4:10 P.M.
25. Was Medical Examiner or Coroner Contac[etl'T
26. Part 1. Enter She h i f _ CAUSE OF DEATH Yes O No
respiratory arrest, or ven -diseases, Injuries, or compllcatlons--that directly caused th¢ death. DO NOT enter t¢rminal events such as cardiac arrest
tricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a Ilne. Add addtflonal lines if necessa Approximate
IMMEDIATE CAUSE ------________ Interval:
(Final disease pr cpndiLlnn ' a. Occlusive Coroner Arter ry onseTm Death
Disease
resulting in tleath) Due to (or as a consequence of):
Sequentially list contlitions, b
if any, leading to the cause Due [o (or as a co sequence of):
listed on line a. EnTer the n _
UNDERLYING CAUSE
W (disease or Injury that C Due t° (or as a sequence ot):
F Initiated The events resulting d con
in death)LAST.
Due to (or as a consequence of): __ -
26.Part11. Enter other sss~niflc t ditions
t Ib tl fh but not resulting In the underlying taus Iyen in Part I
_~ Diabetes eg z~.wasanaucops -
Me113tus Q Yes ypertormedz
26. Were autopsy Flndin No
29. If Female: gs available
E Q Not pre 3D. Dtd Tobacco Use Contribute [o Death? tO Plete The cause of death?
S Pr gnan[ within past year 31. Manner of Death COQ Yes Q No
~ Q egnant at time of death Q yes Q Probably
Q Not pregnant, but pregnant within a2 days of deatF Q NO Q Unknown ~'NdCV cal Q Homicide
~- Q Not pregnant, but pregnant 43 days to 1 year before deatF Q Accident Q Pandang Invests
Q Unknown tf pregnant within The 32. Date of Injury (MO Da /Yr 5 Q Suicide Q Could not b¢ deterimtned
past year / Y ) ( pelt Month) -
34. Place of Injury (e.g, home; construction site; farm; school) 33. Tama of Injury
35. Loca Tlpn of injury (Street and Number, City, State, Zip Code)
36. Inlury at Work 37. If Transportation In
Q Ves Jury, Specify; 38. Describe How In
Q No Q Drlyer/Operator Q Petlestrlan Jury Occurretl:
Q Passenger Q Other (Specify) _____-__
39a. Certifier (Check only one):
Q Certifying physician - To the best of my knowletl
p Pronouncing ~ Cenlfying physician - Br-'• death occurretl d¢u¢ to th¢ cause(s) end manner stat¢d
Medical Examiner/Coroner - To the best of my knowledg ath occurred aT the Lime, date, and place, and due to the cause(s) and m
t b it pf mi
Signature of certifier: -'- a ccur p
inyesTigation, in my opinion, death ° red at the Hme, date, and lace, and duerto Lhe~ ause
39b. Name, Adtlress and Zip Code of Person Completing Cause of Death (Item 26) TiTle pf ~emfler. Acting Coroner (5) and manner SLateo
Matthew S_ Stoner, 6375 Bas chore Road, License Number:
aD. Reglstra r•5 DI5LrICL NUmb¢r Acting Coroner Suite~~l 39=. Date signed (Mo/Day/Yr)
Mechanicsbur PA 17050
~ _ a1. Registrar's slg
.d a3. Amendments ~~ ~~ ul 5 2012
42. Registrar Fil ale (M Day r)
~ ~/7~~iz
Disposition Permit No. 07L{QfjO8
- - - _ - H105-143
- - - - - - - _ REV 07/2011
~~ :~}'~~
~(~
f`C ~3i ;.. LA;~~.i.~
l.~'EL ~~~ 2~ f ~i i' ~V
RENUNCIATION -,-
ClJMRtANDJv~h T
REGISTER OF WILLS C~" ~
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of ROGER J. PLEVA
Deceased
I, Daniel J. Pleva
(Print Name) , in my capacity/relationship as
son and next of kin of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Richard C. Pleva
July/3, 2012
(Date)
Executed in Register's Office
(Signature)
304 Mountain Road
(Street Address)
Arundel, ME 04046
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes s ated within on this J3~ day
of ~/ , --?151 Z
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Marlin R. McCaleb, Notary Public
Mechank~ur9 eo-o, Cumberland County
l"tY Commisston Expires Dec. 14, 2014
ME1~IBER, PENNSYIVANLI ASSOCIATION OF NOTARIES