HomeMy WebLinkAbout08-29-12PETITION 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: CATHERINE R. GIORGINI
a/k/a:
a/k/a:
a/k/a:
Date of Death: July 3, 2012
File No: ~,C. /- / %~ _- ~ C~~
(Assigned by Register)
Social Security No:
Age at death: 95
Decedent was domiciled at death in Cumberland County, pA (State) with his/her last
principal residence at 333 Erford Road East Pennsboro 17025 East Pennsboro Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Harrisburg Hospital Harrisburg Dauphin 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
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:
(Attach additional sheets, if necessary.)
$ 2,000.00
2 000 00
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 February 1 1, 2002 and Codicil(s)
thereto dated N/A
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
ado ted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS Q EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c. t. a., cl.b.n., d.b.n.c.t.a., pendente lite, 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.
NO EXCEPTIONS Q 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, if necessary):
Name Relationshi Address n ` ~
- ~
'
-, (
~
i f~ • ~
U
,~
Form RW-02 rev. 10/I1/?011 Page 1 Of 2
~J~~~-
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
} SS:
f
~ i~Use Onlyr~~ ~~
~~
~' 7.~» r-s.t ~,
,C' ...~
~ ~ .,.
~.._.~ ~ -
~~:r ~ .
Petitioner(s) Printed Name Petitioner(s) Printed Address ~ `-=; ;, r,.~ i-r
ROBERT A. GIORGINI
907 S. PROVIDENCE ROAD WALLINGFORD PA 19086 .fi ~~
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 Petitioner(s) will well and truly administer the estate according to law.
Sworn to , r affirmed subscribed b fore ~/
c Date ~~e a
me thi '- Ada o~,..~ ,~G~ ~ Date ~~~~~
By; `' .~'~.' Date
F`o h~ Register Date
BOND Required: ~ YES ~ NO
FEES:
Letters ........... ~`"
~.-,~~;. f ~;
( 2) Short Certificate(s)...... ~'~ ~=
,~;
( )Renunciation(s)........ .
( )Codicil(s) . ........... .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ...... ,
Automation Fee . .............. ~;J
JCS Fee . .................... _ ,~
~~;?
TOTAL ..................... $ 9...98-''
:t
`r~_J~)
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
cif-~r~L
Printed Name: CHARLES E. PETRIE
Supreme Court
ID Number: 29029
Firm Name: CHARLES E. PETRIE
Address: _3528 RRiSRAN TRF,RT
HARRiSRIJRCT, PA 171 1 1
Phone: (717) 561-1939
Fax: ,717) 561-4121
Email: PetrieT,awn.A(~T,_c~m
Form RW-02 rev. 10/11/2011 Page 2 of 2
Oath of Personal Representative
C\OIvIMONWEALTH OF PENNSYLVANIA }
} SS:
COU TY OF }
itioner(s) Printed Name
The Petitioner(s) above-named swear(s) or a rm(s) the statements in the foregoing Petition are
of Petitioner(s) and that, as Personal Represent ~ve(s) of the Decedent, the Petitioner(s) will
Sworn to or affirmed and subscribed befor
me this day of
By:
For the Register
BOND Required: ~ YES ~ NO
FEES:
Letters ...................... $
( )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( ) AfEdavit(s)........... .
Bond ........................
Commission ................. .
Other
/.......
Automation F e .............. .
1CS Fee. ................. .
IOTA .................... $
Official Use Only
e and correct to the best of the knowledge and belief
and truly administer the estate according to law.
Date
Date
Date
Date
To e R egister of Wi!!s:
Please nter my appearance by my signature below:
Attorney Si ature:
Printed Name:
Supreme Court
ID Number:
Firm Narne:
Address:
Phone:
Fax:
Email:
DECREE OF THE ~LEGISTER
V ~~
~- _~ , -~ ~
..
..
r~•~ _t.. _
......
~-- ~_
~ %y
'
.
'~.J .-... .._..
~ L... ,
~.~: ° ~.:.,
_ r~,
~
=-=-
.~
:~ ,
r_
`~
{~
~~
-
~'
~~.,
Estate of ~;1 ~ ~/`~ ~ j1~ j ~/` ~ ~ File No• ~ ~ ~-~ ~~ - ,~ ~ ~
a/k/a: ;
AND NOW, , in consideration of the foregoing r~etition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~ t'S1~~ /"l~~t~l~ ~%
are hereby granted to (~ -t~.i- ~ '~
in the a ove es to and (if applicable) that
the instrument(s) dated ~~%~ ~^
described in the Petition be admitted to robate and filed of
_ Petitioner(s) Printed Address /
rec~r~i, s the last Wil~and Codicil(s)) o~,Decedent.
Register of Wills
./ " `^
Font RW-tl2 ,•ev. lnil1i1n11 Page
<) .
~~
I_ ... , . ~ __,~,~
't'it' liii ikliti ~'1:i~3flt~~}iL`. .`~t'~i.ii~,l
~.~'_'I'ffll~~lii(iI`s ."til(s`i'.~"?,."
.~_~ ~ ~ ~~~G 2 9 Ps ~ ~ ~ S d
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
rtes-r~c~~`ATC r1C flCAT4a _. _ _.. _. --'----.
Type/Print In
Permanent
RI
v
V
r~~
~\ ,
V
O
2
ack In
Sex 3. Social Security Number 4. ate of Death (Mo/Day/Vr) (Spell o
k
2
.
1. Decedent's Legal Name (First, Middle, Last, Suffix)
Birthplace (City and St or or gn Country)
ll Month) 7a
S
.
pe
Sa. Agc'LdsL Birthday (Yes) Sb. Under 1 Year Sc. Undor 1 Da 6. Date of Birth (Mo/Day/Year) (
~~ 17'1 QN~
Months Days flours Minutes
~ S ~ ~' / 9 i 7 7b. Birthplace cCOUnt ) /vorth::>•.. -
8a. Reside ace (State or Foreign Country) 8b. Residence (Street and Num er -Include Apt No.) 8c. Did Oecedr=nt Livn in a Township?
twp.
~~T ~ A/i
%r ~ O
E
~ V
~
-_--.
.
~.S
. ~~~,5 1 ~~ Y~ ~' yes, decedent lived in
- a r 1~0 A~
3 3 3 ~
Z ~
sd. Residence (County,
Cudc) 1-~1 U (~ QNo, decedent lived within limits of city/boro.
(Zi
c
id
R
p
en
e
es
~~~ N Se.
Marital Status al Time of Oedth Q Married Widowed I1. Su rvivfng Spouse's Namc (If wife, give name prior to hest marriage)
10
.
~J. Ever in US Arnred Forces?
Q Yes ~ No Q Unknown Q Divorced Q Nr_yer Married Q Unknown
12. Father's Name (First, Middle, Las[, Suffix) 13. Mother's Namr Prior to First Marriage (Firs[, Middle, Last)
C
d
~~ o
e)
14 b- Rela [ionsfrip to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zrp
'
I s Narne
14 a. Informant
. ' so,v ~' o ~ S ~- ~.~- ~ . wp , ~.. Ord ~ ~ _ Y~
t .v
r
•
.............__..........._.......,
..
.....................r._.......---....._~r..... 1 a _ P ace: u oat r C rrc un Y unr
... ... ......... .. ... .... ... ........... ~ ece eat s Home ......
..... .. .. +~.y
th Occurred Somc-where Other Than a Hosplta l: Q Hospice Facility u D ...d
If D
a If Deatlr Occurred in a Hospital: Inpatient , ua
Q Other (Specify)
Care Facilit
T
Q Emergency Room/Outpatient Q Dead on Arrival
. y
erm
Q Nursing Home/Long-
County of Death
i5d
¢
z 1Sb. F cilicy Name (If no[ institution, five street and number; .
15c. City ur Town, State, and Zip Code
r ~ ~7 i ~ Q v ~ i t./
~
~- as
16a. Method of OisposiCion Burial ~ Cremation ra i:.r
16U. Date of Disposition 1 c. Place of Disposition (Ndmu of crmetc ry, ere rnatory, or other place)
c Q Removal from State Q Donation •~~ m
~~ ~ ~~ • • 1~ '~ ~ ~ 2R
~ Other (Specify)
1(,d. Location of Disposition (City or Tuwn, State, and Zip) 17a. ign~ lure of I Service Licenser or Person in C arge of Interment 17b. License umber
E 17c. Name and Complete Address of Funeral Facility ~ , , ~ 3
h
'
r
~ at
s Race -Check ONE OR MORE races to Indicate w
Check the box that best de ibes [he 1`J. OeceJent of Hispanic Origin -Check the 20. Decedent
18. Decode nt's [ducation -
r= highest degree or level of school completed at the time of death. box that best describes whe Uir=r the decedent the dccedunt considered himsc-lf or herself to be.
Q 8th grade or less is Spanish/Hispanic/Latino. Chreek the "No" '~ White Q Korean
Q No diploma, 9th - 12th grade boz if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese
Q High school graduate ur GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian
Q Sumr college credit, but no degree Q Ves, Mexican, Mexican American, Chicano ~ Asian Indian Q Native Hawaiian
Associa [e degree (e.g. AA, AS) (~ Ves, Puerto Rican Q Chinese Q Guamanian ur Chamorro
Cuban Q Filipino Q Samoan
Q Yes
'
,
s degree (¢.g. BA, AB, BS)
Bachelor
Q Mastc: is degree (e. g. MA, M5, MEng, MEd, MSW, MBA) Q Ves, other Spanish/Hispanic/Latino Q Japanese Q Other Pacific Islander
Q Dnctora to (e.g. PhD, EdD) or Professional degree (Specify) _ Q Other (Specify) ___ __
c... MD, DOS, DVM, LLB, JD
2l . Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation - Indicate type of work
White Q Japanese Q Samoan done during most ul wur king life. DO NOT USE RETIRED.
Black or African American Q Korean Q Other Pacific Islander i,~-
I
C' r
a
'
.
'
t Know/Nut Sure
Q American Indian or Alaska Native Q Vietnamese Q Don
[] Asian Indian Q Other Asian ~ Refused 22b. Kind of business/Industry
0 Chinese Q Native Hawaiian Q Other (Specify)
Q Filipino Q Guamanian or Chamorro O~1 ~ ,
ITEMS 23a - 23d MUST BE COMPLETED
BY PERSON WHO PRONOUNCES OR 23a ate Pronounced Dead (Mu/Day/Yr)
/~ / 23b. Signature of Person Pronouncing Dnalh (Only whin applicable) 23c. License Number
CERTIFIES DEATH c/
23d. Datu Signed (Mu/Day/V r) 24. me of D~: th •
//
/
25. Was Medical Examiner or Coroner Contacted? Q Ves
Q Nn
CAUSE OF DEATH Approximate
2F,. Part 1. Enter the chain of events--diseases, InJunes, or complications--that directly caused the death. DO NOT enter terminal eve n[s such as cardiac arrest Interval:
OT ABBREVIATC. Cater only one cause on a line. Addadditiuridl lines if necessary Onset to Ueath
respiratory arrest, or vrnrrlcillar fibrillation without showing the etiology. DO N
1
IMMCDIATE CAUSE _______________> a. ~-~~~ _I_L ~_Q,, L'-t. C L~/ 7 _('Y~
(1=final disease or condition U [o (or as a cainseyuence ol):
resulting in death) L ,^ , ^
b. ~iY"t-~C [1 ti-CG~ LCr~1 C~- ~L.-~"~L~tf~L<..~ ~"~-2~L"vl.> c,t, C r V~ o i~ti1 U /v I~ ~ ~~'-x t G_~-l,~/~L~-aJ
T
Sey uentially list conditions, Due to (ur as a consequence of):
l
di
[
th
it
ea
ng
o
e c ~
any,
listed on liar a. Enter [hc c. -__-__- --
UNDERLYING CAUSE Due [o (or as a consc yue_nce of):
(disease or injury the t
LiaLCd thL' CVCn[5 fCSUlting d
In
~
t:r . _ __... ____
I
Due to (or as a copse uence of
In death) LAST. y )
S 2t;. Part 11. Later other sl¢nihca nt conditions contribut_n2 to death but not resulting in the underlying cause given in Part I 27. Was urr autopsy performed?
0
Q Yes O
~
m L....-~ Y1l"7"1 CV'r~~~J-. '~Zw-l,~ L~-C.-3-e iC ~t-Z-
l~L"\. ~ 28. Were autopsy findings available
to com plere the cause of death?
(j Q Ves No
29. If Frrnalu: 30. Did Tobacco Use Contribute to Death? 31. M nee of Death
i
id
~
t
o ~Vo[ pregnant within past year Q Yes Q Probably c
e
V
atural Q Hom
m Q Pregnant at time of death
~) Nut pregnant, but pregnant within 42 days of death ~ No Q Unknown Q Accident Q Pending Investigation
Q Suicide Q Could not be dete rrnined
~ Q Nut pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/[lay/V r) (Spell Month)
Q Unknown if pregnu nt within [he past year J 33. Tirne of Injury
34. Place of Injury (e.g. borne; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, "Lip Code)
~.
36. Injury ar Work 37. If Transportation Injury, Specify: 38. Describe Ilow Injury Occurred:
Q Ves Q Driver/Operator ~ Pedestrian
~g NO Q Passenger Q Other (Specify)
39a. ~T'tiher (Check only unr):
Certifying physician - To the best of niy knowledge, death occurred due to the cause(s) and manner stated
Q Prunuu acing K. Certifying physician - Tu the best of my knowledge, death uccu reed at the time, dart', and place, and due to the cause(s) and manner stated
Q Medical Examiner/Co er - On lhr basis f exa minatiun, and/ur investigation,~in my opinion, death occurred the time, date, and place, and o the use ) an anner stated
n
~
~ /'L"~.-t-C ~'/~ Title of ce rtitier: ~~1 License Nu
Signature of certifier: ___., ~~- +~_
.i cJ a ,Address c Zip ode of ~ rson omple~
Cd e of ,eath (Ilene 26L , / /
/ /
/ u
y
~
L Dale Sig nod (MO/Day/V r)
~
•
~
/O /
J• ~el
/~/
[
~ 6 J /
40. Registrar's District Number 41. Registrar's Signature Rngisar r Filr Date (Mu/Day/Yr)
43. Amendments
f-fir ~ Q /i ~ H105/143
Disposition Permit No. / R[V 07 2011
LAST WILL AND TESTAMENT
I, CATHERINE R. GIORGINI, of 333 Erford Road, Camp Hill, County of
Cumberland, Pennsylvania, do hereby make, publish, and declare this to be my
LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in
manner following, that is to say,
FIRST, that I direct that my Personal Representative shall pay all of my
just debts and funeral expenses as soon as this shall be practicable.
SECOND, that upon my death I direct that my estate shall be divided
into four (4) equal shares. I give, devise, and bequeath one share to each of my
sons: ROBERT A. GIORGINI, DAVID J. GIORGINI, and ARRIGO J. GIORGINI,
per capita; that is, if any of my sons have predeceased me, then his share shall
pass instead to my surviving sons. I give, devise, and bequeath the fourth
share to be divided equally among the following grandchildren: CHRISTOPHER
SUTTON, MARYANN SUTTON, and PETER Z. SUTTON.
THIRD, that I hereby direct that the share of my estate that shall pass to
my grandchildren, shall be held IN TRUST, in accordance with the following
provisions:
a. I direct that a separate trust account be set up for each
grandchild.
b. I hereby appoint my son ROBERT A. GIORGINI as the
Trustee. I direct that no bond shall be required in this or in any oth~x rT
jurisdiction. _ ~
~- -
r__ . :...
r"
_
~-'
...z-..
i
C.''f ~'~
c. I direct the Trustee to pay to each grandchild the sums of his or
her trust account upon his or her twenty-first (21St) birthday.
FOURTH, that I hereby appoint my son ROBERT A. GIORGINI as the
Executor of my Estate. I direct that my personal representative shall not be
required to post bond in this or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
eleventh day of February, 2002.
CATHERINE R. GIORGINI ~` ~~"'
WITNESS
`,~ .
WITNESS
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, CATHERINE R. GIORGINI, testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law,
do hereby acknowledge that I have 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.
Sworn or affirmed to and acknowledged before me by CATHERINE R.
GIORGINI, the testatrix, this eleventh day of February, 2002.
CATHERINE R. GIORGI I
-, 1
TARY UBLIC
P, p(~~ a
III C~oa~~
AFFTT)AVTT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
WE, CHARLES E. PETRIE and ROBERT A. GIORGINI, 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
testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT;
that CATHERINE R. GIORGINI signed willingly and that she 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.
Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE
and ROBERT A. GIORGINI, witnesses, this eleventh day of February, 2002.
L:s4.~.-~. Lr~.vo
WITNESS
WITNESS ~'"
rr
/7 ~ (~F
~ L '/
l~ ARY BLIC
~~
Nam Seat
P (---
,~~~m