HomeMy WebLinkAbout08-17-12Reset
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: Nick Brussese Jr.
a/k/a:
a/k/a:
a/k/a:
Date of Death: Julv 31, 2012
Decedent was domiciled at death in Cumberland County,
principal residence at 810 Meadow Lane
Street address, Post Office and Zip Code
Borough
_ County
Decedent died at Holy Spirit Hospital, N. 21st Street East Pennsboro Tp Cumberland pp
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's propetty at death:
If domiciled in Pennsylvania ............................ All personal property
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... .
Real estate in Pennsylvania situated at: 810 Meadow Lane
(Attach additional sheets, if necessary.) Street address, Post Office and Zip Code
$ 33, yS~
$ ,~.~'~ ~ v s~ 0 00
J~,.~
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 March 2, 1978 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 born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS O 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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
O NO EXCEPTIONS 0 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
~ r.~
~_... ~n -
-~ C r;~c
D ' --e W '-" j-t=t
,f~" ~~ CJ
.t^ ~'i
File No: a ~ ~" ~ - ~'
(Assigned by Register)
Social Security No: ~ ~~/ - ~ ~ - ~p j ,~
Age at death: 84
(State) with his/her last
Form RW-02 rev. 10/11/2011 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
}
~~
[` r ~ f ~
F~' ~ ~ I
_ ,7,.~~
~~sl: AUG 17 PP4 3~ 44
Petitioner(s) Printed Name
Nick Btussese
J__.
Petitioner(s) Printed Address
421 Fox Lane Harrisbur PA 17112 ~utJ~i
The Petitioner(s) above-named swear(s) or affirm(s) the stateme in eg g e66o a true and correct to the best of the knowledge and belief
of T~etitioner(s) and that, as Personal Representative(s) of the eced t ner( 1 well and truly administer the estate according to law.
Sworn to or affirmed ~ su_bscr'bed before .n Date ~ ~ ~ 7 < / 7
me t ~ da~Y o ,~- Date
B l' % ~ ,,
Date
or the Register
Date
BOND Required: Q YES ~ NO
FEES:
Letters .................. .... $ c . ~f~~
( S )Short Certificate(s).. .... ~ ~ `
( )Renunciation(s)..... ....
( )Codicil(s) ......... ... .
( )Affidavit(s)........ ... .
Bond .................... ....
Commission .............. ... .
Other
....
Automation Fee . ..........
JCS Fee . ................ ....
.... ~ ~ ,
....
TOTAL ................. .... $
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: Karen M. Balaban
Supreme Court
ID Number: 28160
Firm Name: Karen M. Balaban LLC
Address: 223 State tr r - ~ ,itP inn
Pn Rnx R21
Hamsbur~, PA 17108-0821
Phone
Fax:
Email:
717-232-3708
DECREE OF THE REGISTER
Estate of Nick Brussese Jr. File No: _~ ~ - ~ ;~ C~ ~~
a/k/a:
AND NOW, ~ 'C ~ ~~ %~=~~ , ~l"~. , in consideration of the foregoing Petition,
satisfactory proof havin en presented be rof a me, IT IS DECREED that Letters Testamentary
are hereby granted to ~ ~ , (',k (V( ~~~~~,
to the above estate and (if applicable) that
the instrument(s) dated
[lPCrr,hari ,.; the P„t.t..,,. b., a.~':~;;,«~-u ~o prcba~e and filed of record as the last Wtll (and Codicil(s)) of Decedent.
~ ~~ ~ ~
egister of Wills -- `-'
Form RW-02 rev. 10/11/2011 I/ " " ~ ~ ~/
Pa e
HIOS.ROS REV 19/i Il
LOCAL ~~~~~~ CERTIFICATION OF' DEATH
WARNING~~~;i~egalfi'Q~'!(d~licate this copy by photostat or photograph.
r5 a'
Fee for this certificate, $6.00 ~~~~~ i*i~~ f 7 P~ 3' ~ ' -~-a ~.
P~~~~~~~~~~
Certification Number
type/Print In
F~
2
ur, (ti ~o L-etlliv rt)a1 tr~)c )nlonnaUon he~e given 1s
rurrertly copied fr<~)11 an original Certificate of Death
. ~ ~ caul} filed +~ith n1c a>, Loral Registrar. Tle original
~~' ~ c~rCwficate ~~~ill hr tor1~'ardcd to Cho tote Vital
~ ~.~~l;1~ kcc.>rds rJffice ioE G~i°rmanent filing.
CUMBERLAND CO.,
1 Deal Re~~i~~tra;~ I~)•ite .slued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS s
rcermarwr
Suffla) State Flle Number.
1 (>tudent's Legal Name (first, Middle, last
,
2. s« 3. Social Security Number a. Date o(Deeth IMO/Day/Yrl (Spell Mol
Nick Brussese Jr
.
male 209-12-8055 July 31, 2012
Sa. 4ge-last Birthday IYrij Sb. Under 1 Year Sc. Under 1 Da 6. Dale of Birth IMO/Day/vearl ISpell Month) ]a. Blrihpl Lary and State or Foreign Countryl
84 Months DiYa Noun Minutes r'•elJrlldry 23, 1928 Harri PA
]b. Birthplace I[opnryl Dau in
g
R
id
a.
es
ence IState or Foregn Countryl Bb. Resltlence (Street and Number Include Apt No.l &. Ditl Decedent Live In a T nshgw I
p~
TT
^-
ed Paeenpe Icennryl 810 Meadow Lane ~vea, d«edent lived in t1"rr'!^-ac+a twp
~113Dberland e
R
d
e.
esi
ence Inp cede! 1701 1 ^Np, aeadem erved wttnb Dmas or urv/born.
9 E
i
ver
n US ArmM Forces? f0 Marttal States at Time of Oeath ^MaMetl ^ Wldpwetl 11. SUN1VIn{Spouse iName(Ilwife
glue name
rior to R
t
i
,
p
n
marr
age!
Yes ^NO ^Unknown ^Oivorcetl ^Never Married ^Unknown
t1 fa)Dar's (iarr~ Iflrst, M~See, Lart, Suffla) 13. Mothei s Name Prior to First Marriage IFint, Middle
Lastl
1 ISLUS
,
h]dT,id Mailil~
a
14a Inbr tit's Name 14b. Relationship to Decedent 14c. In/ormant's Melling Address (Street and Number, [ky, State, 21p Coeel
Ni M. Brussese
a
o '
421 Fox Lane Harr> bur 7112
A 1
G
n
a ......................................................... ....................._
1sa Paup Deae
II De th Occurred ina NOSptat_ ...~,.. ...... r ..........................................K..°..^....~.^.a............................... ......... .... .. ....... ............ .......
C9'b nom ;IroeahatpmeasomewnereomerTnanaH
n
l
"""'
~ ~~~~
~~
~~~
~ Oap
a
Nospece Faclllt
y
Decetlent's HOme
C1
Emeryenry REOm/Outpatient ^ Dead on Arrival ^NUrung Nome/Lon
Term Care fa
ilk
{
c
y aver lslaenlryl
lSb ry N (If ^Vt Ms tbn, t t arM number: ~ ISC
CR
•
TOwn 5 a e
a
d Il
C
d
s
~~
~
.r
~
mm
,
n
p
o
e 1~~~i
t
pirit
1
y
ospi~a~ `-.a.rY' Hiif
PA 17011
y 1
~
,
16a. Method of Dispoflnon ®Burtal ^ Cremation 16b. Date o/ Disposition ific. Place of Olspositlon (Name of cemetery, crematory
pr other
lace)
~ ,
p
^ Removal from State ^ Donatlan
otnerlspepefyl August 4, 20 2 Gate of Heaven Cemetery,
16a. Locanpn or aapontbn Lary or town, st,ta and n
PI 11a. Signature pf fu er ke Licensee or Person In Charge of Interment 31D
Lkense Number
.
MeehaniC$burq
PA 17055 ~,(
,~~ FD 011
a r
667 L
I]c. Name and Complete Address e/FUneralFKlliry ~
U Mal zzi Funeral Home
° 1g. Decedent's Educxbn -Cheri the boa that best dexHbes the 19. Decedent of Hispanic Orl{In ~ Check the 20. Decedent's Race ~ Check ONE OR MORE nm t
I
di
o
n
cate what
highest degree or IevN o/ uhod completed at the time pl deaM. boa that bast descdbef wheMer the tleudenl the decedent wnsbered himself or herself t
b
o
e.
^ 8th grade or kss Is SpanlshMlspani4latino. Check the "NO" White
^ Korean
^ No dipbma, 9th - l2th {rode boa If decedent Is not Spsnish/ylspanic/LRnnO, ^ Black or gfdcan American ^ Vetnamese
i
h
g
^ N
school graduate or GED COmpktee No, not Spanlsh/Hlspanlc/Latenp ^Amerlunlndlan o. Alaska Native ^ Other Nkn
Som
lk
d
e co
ge me
ic, but rro ee{rce Yes, Meakan, Mnican American, Chkano ^ paean Indian ^ NRUVe Hawallan
^ Assorl
t
d
a
e
ryree le.g. M, A51 ^ yea, Puerto Rican ^ Chenese ^ Guamanian
Ch
'
or
amorro
^ Bachebr
s degree le.g. BA, AB, BSI ^ Yes. Cuban ^ Filipino Samoan
^ Marter's degree le.{. MA, M5, MEnw MEd, MSW, MBAI ^ Yes, other Spanbh/HlspanlUlatinp ^la
anese
p
^ Other Pacifl[ Islander
^ Doctorate leg. PhD, EEDj or Professional degree
S
f
peci
(
y) ^ Other ISpeciry)
e.. MD DOS OVM LLB 10
21. DecMent's Single Race Sell~Deslgnatbn ~ Check ONLY ONE to IMlcate what the deudent consltler<d himself or hersNi to be. 22a. Dxetlent's Usual Occu
a[lon ~ Indk
[
f
p
a
e type o
work
Fl. Whtte ^lapanese ^ Samoan done duri
f
ng most o
working II(e. DO NOT USE RETIRED.
^ Black or African American ^ Korean ^ Other Paclflc Iskntler
civil engineer
^ Amenun Indian or Alaska Native ^ Vietnamese ^ Don't Knaw/Not Sure
^ Asian Intlean ^ Other Asian ^ Relused
22b. Kind of Bpsenefs/Indusiry
^ Chinese ^ Na1Ne Hawalkn ^ Other (SPMfyI
stat
e 40~ernma-tit
^ Filipino ^ Guamanian or Chimprro
ITEMS 23a-23d MUST BE COMPLETED 23a. Date Prpnounced Dead lMO Day/vrl 23b.Si[nature of Person pronouncing Death (Only when applicable) 23c. Lkense Number
BY PERSON WNO INIONOIMCES OR
CERTIFlES OEATM C1IL I 2c)I r
l
23d. Dag Syrsed (MO/Day/Yr) 24. Time of Death
n
I T 25. Was Medical Eaaminer or Coroner COn[ac[etl7 Yes ^ No
CAUSE OF DEATH
Approalmate
2fi. Part I. Enter th! Chain of !vents--diuases Inlurles, or complkatlons~~[hat directly caused the death. DO NOT enter terminal events such as cardlx arr
t I
es
nterval.
respiratory arrest, or ventricWar Rbrillation without showing the etiology. DO NOT ABBREVIATE. Enter onN one cauu onaline gtld additional lines it nettssary Onsetro0eath
IMMEDIATE CAUSE --~~~~-----> a O IREJ~
/~ -
1
~
.
~
~~5.
(Fimldiaeneorcondmo^ Duamlor as, con;e4llenca oq. ---_-
reamnn{ in eeatro
b
seR~emianY Rat commons. Doe rolpr asaronsepuence ore.
.-.. ~.. -- - .
.
d any, leaden{ to one cause
listed on Ilne a. Enter the
c
UNDERLYING GUSE
Oue to fora nsepuence oft
slco
(disease or Injury that II 1
Inhktee the events resulting e. _LI lM(~.C~,v P'13.~/
~
7 , ,
.
~ `xt p
i
~
y
~ ~
. - .
,
In death)tA51. ~
~~ Dpet aw
n p ~
s°i 26. Part ll. Enter other ikniflcant csNMitlons con[rib rte t d Ih b
t
u
not resulting In theuMeMAng cause given in Pertl 2]. Was an autopsy pert99^^^^ed]
F ^ Yef ®No
28. Were autpmY Mdings wallable
[o compkte [he cauu of death]
4 29. II Femak: ^ yes ^ No
30. Did Tobxco Use Contribute to DeaM] 31 Ma er o/Death
JJ~~
^ Not pregnant within past year
^ Ves ^ Probably
~Naturcl Homkide
^ PrHnant at time of death ~'No
^ Unknown ^ Accident ^ Pending lnvenl{ation
^NOtpre{nant, but pregnant within 42 days of death
pwlpme ^Coultl not be determined
^ Not pe{rant, but pregnant a3 days to 1 year before death 32. Date of Inlury IMO/pay/Yr) (Spell Month)
^ Unklsown If prcgnanl within the Wst year
33. Time of Injury
3 a. mxe of Inlury (e.g. home; conseruetbn site; !arm; xhoW) 35. Laa[Ipn Ot Inlury (Street aM Number, City, State, 21p Cotlel
3 6. Inlury at Work 3). If Transportatlon Inlury, SpeNfy 3g. Describe Now Injury Occurtetl:
^ Yes ^ Driver/Operator ^ Pedeftrlan
^ No ^ Pasunger ^ Other lSpeuly)
3 9a. Certifier IDhepk only one):
^ Certifying physician ~ To %%best of my knowledge, death occurred due tp [he causels) and manner stated
^Pronouncing&Certl Physickn~TOlhe best of my knowledge, death occurred at the tlme,drte, and place, and due to [he causels)antl manner stated
^ Medi
l E
ca
xaminer/C er ~ On the balls of eaaminatbn, and/
or I
rn
ertlgatlon, In my openbn, death occurred t the [Imo, date, and plxe, and due tp the causels? aM manner
t
l
d
t
'
s
a
e
'
Signature of certlfle ~ ~ ~ ~ /K ~ Ti
l
f
~ t j
3 t
e o
certifier.
license Number: ~ 7
9b. Name, gdtlrcs tie 21p Cotle of Peron Com etiry Cause of Death (Item 261
l 39c. Date SI{ned IMO/Day/y'rl
aUbi ' 7/ y ~'
a L ~
O. Registrars srkt NUm d1
strar'
Si
. ~
s
[~re 4l. q
h
trar Fi
Date (MO ay r)
4 3. Amendments ~
~
r
Disposition Permll No. L~~` / /~'J ~ H105143
REV w/zov
_ _
H105 X05 RF,V Ur~S _ - _. _- - _ - - -_ - -
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
No.
Local Registrar
~l~- rt ~ ~~, ~acS
Date
,!
r~
p. f^~.l
~.J ~`~ `~
T
h ), ~ Y f
( ~~ ... t l.`1
T
r
Cl .l ~ , t
(~^i
~~' "' ~
OC Ct
~ : ,
~~ -n
~' t
i
n ~' W _
r
Fn
~ s
.c-
TYPE/PRINT
IN
PERMANEN
BLACK INK
w
~~
h
h
t L
\~
J
W
O
U
w
O
w
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFiCOTF nF nPeT1a
H705.143 Rev. 21ST
STATE FIIE NUMBER
NAME OF DECEDENT (Fins, Middle, Last)
SEX SOCIAL SECURItt Nl1MBER DAT DEAT
H (Hoorn, Day, Year)
,_ Betty Mae F(russese
female
201 - 1 6 - 2995
(
2
,
4. ~/f// a
~, aC105
AGE (Lear BkNday) R t A N
A GATE OF BIRTH BIRTHPLACE ^City and
MonMS Deys Hours Mnuln (MOnrn, Day, Year) Stale or Forelg Country) HOBPI u~
OTNEB:
79 Yn x/21 /1925 ~[lola, PA eip"i°^`~1 EPIOuIpM4nl ^ DOA Q
8
Qa,.r
„~~ ~ N°~~~
Ibwr•NI
' COUNtt OF DEATH
CITY, BORO, TWP OF DEATH FACILITY NAME (If not inbdlutlon, give arrest and number) WAS ECEDENT OF HISPANIC ORIGIN7 RACE - Amerkan Milan, Slade, While, at
Cumberland
+
~
Pen[LSbOro y ^D" No~Yea ~ Ii yes, apedrr Cuban, (SPocihJ ,
•L / ~ Qsa/ ~!y / Me~~~~~~aaaaaannnnnn, Pue Rrcan, ek. W~]lte
• ~ 8w y ^!' Sd. ~~.) /
~ ~ /
,
.
10.
DECEDENTS USUAL OCCUPATION KING OF BUSINESS I INDUSTRY A3 DECEDENT EVER IN DECEDENTS EDUCATION MARITAL STATUS - Maniod, SURVIVING SPOUSE
~
(d1tO
"s °f `YOn` dO"° "1OY
a
w
O
U.S. ARMED FORCES7 Iswah o
W. mnq ies, rwl u
u r~e ..sal wnwlwnl Never Married. Widoved, Ir wit., w+. m.d.n gyn.)
Il h~~ Yas ^ No ~ El.m.nMrvlb•cnnd•ri tea's. DFrorced (Seedy)
,2. 13 ,.. married ,s.Nick Brussese
DECEDENTS MAILING ADDRESS (Street, City/TOwn
SWIe
Zip Cotle) DECEDENT
,
,
S
ACTUAL 17•. Slal¢3A Did 17c. ®Yes, decedent Nved in Hampden
810 Meadow I,a[le RESIDENCE decedent Ilv'p-
(See InsWdwns We in • No, decedent lived
,a. Hill PA 17011 a, soar awe) ,T6. cqunty CLIIRberland bwnerlip9 nil. ^ widlkl sews wrw a
dymerD
FATHER'S NAME (Elect, Middle, Lasl)
'
MOTHER
S NAME (First, Middle, Maiden Surname)
,`. Ben'amin heckler
,g. Caroline r
INFORMANTS NAME (Type/Prinl)
INFORMANTS MAILING ADDRESS (Street, Chy/Town, State, Zip Code)
:oa. Nick Brussese Jr
. :06. 80m MeadaJ Lane Hill PA 17011
METHOD OF DISPOSITION
1I--~~ DATE OF DISPOSITION PUCE OF DISPOSITION- Name a Celrelery, Gemabry LOCATION - Ciy?own, State, Zip Coda
• Donaeon ~ Burial ®Gemadon L.)temoval from Stale ~ (MOnM. D•y, Yur) or Other Place
e 2,a, od,er(spedh) ~ :,6A 28 2005 21e. Gate o~fHeaven Cemetery 2,~PPer Allen 4'wp., PA
'
SIGNATURE FUN S RV OR ERSON ACTING AS SUCH LICENSE NUMBER NAME AND ADDRESS OF FACILITY
22. 226. 011667 L 2:J~7a1 zzi Funeral Home Mechanicsbur PA 17055
omp dmrla 23ac only n
g To rho best of my knowledge, death occurretl e1 the rime, date and plats stated. LICENSE NUMBER DAT SIGNED
phyckian is oat avaaable at lime of tlealh to (SignWUre and Tide)
caniy cause d death. (MOnlh, Day, Year)
23a.
236. 23c.
Ilerrls 24.28 mutt he canplered Dy TIME OF DEATH GATE PRONOl11NCED DEAD ( ontll, Day, Year) WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER7
person who pronounces death. ,
~y / ~ A / / ~ C ~7 ^ p
24. l M. 28. " / / CT L) L~ 28. Vas N
2T. PART I: Enwr IM tl4••w•, M1lPrM• a compNeWOn• wMCe c•u•W dw d•• . Da not •nbr IM mod. of dYinp, •uch •• wdl•c or rNPlnlory •n••4 .hock or Merl fW w•.
up only ww c•w• en .•c
p~
Urr. ~ Approcimate PARTS: ODwr signifraa condigons con6ibutirp ro deaDl, Du1
~
J
IYYEDIATE CAUSE (Fklal ~KLU f.Y~'6LL ~- ~ onsaaend deaN na resubing n Die urWedying cause given in PART I.
disease a cmditbn ~ ~ I LULL ~ ~~YY~LL_- ; y
resulDny in death)-~ •. X111
DUE TO (qi AS A COHSE W ENCE OF):
Saquentrafiy fist conditrons D.
dally, leading rD imrtlediale WE TO (OR AS A CONSEQUENCE OFI:
cause. Eller UNDERLYING
CAU8E (Diceasa a injury o
• Mel initialed evenlf DUE TO (OR AS A CONSEQUENCE OF):
rowlling on Oeatll) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME Of INJURY INJURY AT WORK7 DESCRIBE HOW INJURY OCCURRED
PERFORMED? AVAIUSLE PRIOR TO
.
(Monet, D•y, vr)
COMPLETION OF CAUSE Natural ,® Homicide
OF DEATHI
Accident ~ Pentling Invesrlgadon Yes ~ No
~~jj
Yes ~ No~ Yes ~ No ~ Suicide ~ Could not be determined ~ 30a' 30b. M. 70c. 30d.
PLACE OF INJURY - At home, term, ctreet factory, LOCATION (Street, CiyROwn, Sble)
Pvaarp, em. Iswoyl
28a. 28b
2
B
.
30•' 30/.
CERTIFIER (Check only one)
SI TUR TITLE OF CERTIFIER
'CERTIFYING PHYSICIAN (Physkian cemtying cause d dead) when angther physician has orenouneatl tlealh and completed item 23) ~~~~
~____
o Na beat of my rrowledge, death occumd dw Lo Iha uusas(a) and manner a stabd... .................................
• ~
............................ ]1b.
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physician Dodl prawuncing death and wnitying to reuse of death) LICENSE NU R 7 r DATE SIGNED on O
ay
, Year)
To the boat of my knowlW
a
de
th
d
g
,
a
occum
,
s
al Iha Ilme, data, and place, and due to Dla cauwa(a) antl manner as aWad ............... .....~ itc Q> ~ J L. 71d. pl7 ~ .7
•YEDICAL EXAMINERICORONER NAME AND RESS OF PE SON WHO COMPLETED CAUSE DEATH
(Ibm 27) Type nt ~,y/®b/
d
• On Ma basis o/ aaaminNlon arWlor Inveatlgallon
In m
o
inio
d
N
°~
,
y
p
n,
a•
occumd al Ne time, daY, and place, and dw to IM cauaea(a) arM
manner as s41•d .................................
............................................................................................. ^ QG f ~~tii / , ~~
cn
71s. .............................. 72.
Z
_
R GI S & NATU A r1ABER
DATE FI
L
ED (Mont
D
Y
,
ay,
aery)
`J // n
37. ~~'~ ~/
~
]
2 1
~
~
I
T
(. l
34. IT7r/
I ~d~y
~
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 21- ('~ ~~_
Estate of ~ ~ i ~ ~~, ~~j ~j ~ ~~~ ~ ~~~ ~ ~' ,Deceased
UNAVAILABLE WITNESS AFFIDAVIT
I, ' ` ~ C'/~ ~ 4 ' ` ~y ~ ~~~~ being duly sworn accordin to law de os
,,~~ LL g p e and say
that I, the ^ Attorney ~Yersonal Representative in the above referenced Estate, declare that
f ~ ~ L ~'l~ ~ • ~~ E~ 7`Z and ~ U 7t-~ (~ • ~ 1-~ E ~7Z..
whose signature(s) appears as subscribing witness(es) to the !~ Will or ^ Codicil of the above
Testator is/are not readily available to prove the signature to the Testator by reason of
Sworn to or affirmed and subscribed Y ,~
fore me this ~~ day of Si atu e of C nsel/P rso al epresentative
n b ~ ~O
~ ~~...
~~
eputy for Register of Wills ~'
(Must sign in Register's Office) per': ,
~~~
a3
r ' OATH OF NON-SUBSCRIBING WITNESS v
~ and ~' U ~~ ~ ~/ `[~~S F ~~-
(each) asubscriber hereto, (each) being duly qualified according to law, depo~se(~s and say(s) that
he is/she is/they are familiar with the signature of the above Testator of the L~ Will or ^ Codicil
presented herewith and that he/she/they believe(s)
the handwriting of the above Testator to the best o
Sworn to or affinn.e~ nd subscribed
B fore rie this day of
_ __, 201 ~
1 ;
(~ ' ° ° ~~ it ;
eputy for Register of Wills
(Must sign in Register's Office)
Sigrfature of
on the Will or ^ Codicil is in
kn 1n,~belief.
fitness
;~ ~
~~
i
ignature ofNon-Subscribing Witness
(~4,J
iV .3-7 '.T7
C ~} ~.,:~
~ ~.~
~ -. f_~
~';~ ~~' IC'T"1
.~ ~~ a
r ~,
LEST h II.L AIuD Tr~STAM~T OF irICK B%USSESE, Jr,
I, Trick Brussese, Jr., of iiampden Township, Cumberland County, Pennsyl-
vania, hereby declare this to be my last Will and revoke all vrills which I have
previously ;Wade.
1. I direct my Executor to pay the expenses of my funeral and last ill_
Hess as soon as convenient after my death,
2. All of tiie rest, residue and remainder of my estate I give, devise
and bequeath to my wife, Betty Mae Brussese, absolutely.
3. If my wife, Betty Mae Brussese, should predecease me, or should we
both die in a com;~non accident, then I order and direct my Executor hereinafter
n~:med to sell all the rest, residue and remainder of my estate at either public
or private sale and convert the same into cash; the net proceeds derived theee_
from to be divided into three equal parts or ahares:-
A. One part or share thereof I give and bequeath to my son, I;ick
ivY. Brussese.
B. One part or share thereof I give and bequeath to my son, Steven
l Brussese.
C. The remaining part or snare thereof, I give and bequeath to my
daughter, Beth bun Brussese.
4, I appoint my wife, Betty Mae Brussese, Executrix of this will. Should
she, for any reason, fail to qualify, or cease to act as such, I appoint my son,
nick i~I. Brussese, Executor of this Will.
Iii PIITNE.SS 'nHEitEOF', I have hereunto set my nand and seal this ~~day of
Tvlarch, 1978. -, ~'/ ~
%..._
(5~:
SIGNED, SEEiI,ED, PiiBI,ISHED r~1~TD DECZ,~I~EL by the above named Mick Brussese,
Jr., as and for his last Will and Testament, in the presence of ue, who, at his re_
quest, in his presence and in the presence of each other h~.ve hereunto subscribed oui
names as witnesses.
/:~ ~~~~;