HomeMy WebLinkAbout11-29-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF l U rn~p C Ia n COL~iTY, PEIVi\1SYLVANIA
Petitioner(s) tamed below. who is;'ar: 13 years of aQe or older, apply(iesi for Letters as specified beiou, and in
support thereof averl,s) the follo~,ving and respectfiill,i recuest(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: Ptar ~ ~a\g~•e~
a/k'a:
a/k/a:
a/k/a:
Date of Death: wee a3 , a p~
Decedent was domiciled at death in Cv~trn~ Cara, I
principal residence at ~y17r1 rr~cc3.rw ~ c~ C'_.~c~
File No• ~I ` ~,;,~ - , o` `-1 c~
(Assigned by Register)
Social Security No: ~.b?J ' ~u"N1~3-
Age at death:
p ~ (stare) with his/her last
~rloac~atndZ. Q A \"1b~lb Crw~t
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at ~VIO~~'~c~.ew ~ t~f\ C,~ ~QvJCu~~pt ~~>t~, ~P (~. l1p-(D (~,~,Mbe~,'~,,`~Q
Street address, Post Office and Ztp Code City, Township or Borough County State "',
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ 1 ~ (Q boo
If not domiciled in Pennsylvanla ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $ _
Value of real estate in Pennsylvania ......................................................... $ "1J t50 O
``TOTAL ESTIMATED VALUE.... $ .i D Z t r, o p `
Real estate in Pennsylvania situated at: ~~b~ ~~C W 1G~ C.'L ~e~U CwM be,C~pt,~,~ ~ ~ 1"lt~'1 D C~a+b¢C ~e-•t'~,
(Attnch additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township or Borough County
d A. Petition for Probate and Grant of Letters Testamentary r
Petittoner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated ~ ! a3 I (g~~ and Codicil(s)
thereto dated
State relevant circumstances (eg. renunciation, death ojezeattor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, 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
ad led; 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 (Ifapplicable)
c. t. u., d.b.n., d.b.n.c.t.u., pendente lite, durunte absentia, durunte minoritute
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 parry to a pending divorce proceeding wherein the grounds for divorce had bee established as defined
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated peen. ea ~
^NO EXCEPTIONS ^ EXCEPTIONS ~ ^' ~ ~
~.. O ft'I e-~
Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by tlte~ld'Rdn ous an ~
additional sheets, if'necessury): ~ ~ ~ Y~ $Ors (attach
z ~,, r- ~ --•t ~
rn
Name
Relationshi rn rn
f
~~ ~
c'1 O ~
~ n ~ ~ ~ ~
rL7 C.J t""' 1't'1!
~..i M
r 't7
"
Form RW-02 ,•ev. tn~l t~znu Page 1 of 2
.~
Oath of Personal Representative
COM~lO~~~VE:~LTH OF PE~NSYtV,a~;l,a }
p ; ss
") t. ~; T Y O F Cu.~b e c\~.~
RECO DED OFFICE bSF "Y
REG STER OF WILLS
2~~? ~ U 29 P~1 3 y~
`..fig a FaN1l°.\~~ ~'1~ ~r1 ~ off. Qtbld`~.rt~ ~~ 0"14
ND CO., PA
The Petitioner(s) above-gamed swear(s) or affirm(s) the statements in the foregoing Petition are tnie and correct to the best of the knowledge and belief
of Petitioner(s) and That, as Personal Representative(s) of the De~cepdent, the Petitioner will well and truly administer the estate accordin to law.
Sworn to or affirmed and subscribed before ~w~,.~ev~~. Date ~~I'Zq '~--0~2-
me 's ~ day of ~~,
BY' ~l l
For the Register ~--
BONDRequired:QYES ~O
FEES:
Letters ......................
( ~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
fO+fft11her
1/~ 111 ........
$ . Ud
-mac..-``~
Automation Fee ......... . .....
JCS Fee . .................... ~~ `.~
TOTAL ..................... $~'7FC =`
Date
Date
Date
To the Register of Wllls:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~(~.r ~ Re ~+-~~ File No: 2~ ._ ~ 2 -~~ Z
a/k/a:
AND NOW, ~ ~(ka p y~ Y ~~ , ~_ in consideration of the foregoing Petition,
satisfactory proof having been presented before tne, IT IS DECREED that Letters (~
are hereby granted to ~, I ~~ P ~- ~ ~ ~ ~ } -'-
in the above estate and (if applicable) that
the instrument(s) dated (~' " a ~
described in the Petition be
Fo,•,,, 2w-nz rev. rnillizni~
probate and filed of record as the last Will (and Codicil(s)) of Decedent.
egister of Wills ~ ; ~~~
t
Page 2 2
HIOS.ROS REV !9/I1)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 RE Ci 0 R Q E Q 4 F F ~ C ~ 0 ~ This is to certify that the information here given is
REGISTER 0 F WILLS correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
~~~~ ~~~ ~E~ ~~ ~ . ~~ certificate will be forwarded to the State Vital
Records Office for permanent filing.
P 18 614 8 0 9 CLERt< aouRT ~,~;~~ ~~N L2o~
Certification Number 1~fHAH3 C
CU~I~ERLAND CO., PA Local Registrar Date Issued
Type/Print In COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH • VITAL RECORDS
Permanent
_~
1. Decedent's Legal Name (First, Middle, Last, Suffix) yr ~ ^ State File Number:
2. Sex 3. Social Security Number 4. Date of peach (MO/Day/Yr) (Spell Mo)
Pearl Re later
Female 203 - 20 - 4722 June 23, 2012
Sa. Age-Last Birthday (Vrs) 56. Under 1 Vear Se
Under 1 D
.
a 6. Date of Birth (MO/Day/Vea r) (Spell Month) 7a, Birthplace (City and Stale or Foreign Country)
Months Days Hours Min
t
u
es AY 188, PA
4
June 20 1928 7b. Birthplace (County)
8a. Residence (State or Foreign Country) Sb. Residence (Street and Numb
I
l
d
er -
nc
u
e Apt No.) Bc. Ditl Decedent Live In a Township?
nn lvania
Ves, decedent Ilved in Lower A11en _ n,,,p
Bd. Residence (cpr.ncy) 1 Harwich Court
Cumberland Be. Residence (Zip Coda) ONO, decedent llvetl within limits of
city/boro.
9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married ~ Widowed 11
Su rvtvi
S
'
.
ng
pouse
s Name (If wife, give name prior [o first marriage)
Q yes ~ No Q Unknown Q Divorced Q Never Married Q Unknow
12. Father's Name (First, Middle, Last, Suffix)
'
13. Mother
s Name Prior to First Marriage (First, Middle, Last)
a ha =tens Habura
14a. Informant's Name
14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City
State
Zip Code)
G~ ,
,
o re Severn
r .
................. ..............
......
.
ar 21146
s
_
.
................... ........................._............,...p...L„:o..ace.°.....eiac...
.. .~ pn y, qne
If Death Occurred In a Hospital: LI Inpatient p If a
c
d S
` ~
~~ `
a
a
c
urrl
omewhere Other Than a Hospital
~t
HOSpice Facie
..................................
Emergency Room/OUipatlent Q Dead on Arrival ~ Decedent's Home
r
F
ilit
•
r
s
ac
y Other (Specify)
lSb. Facility Name (If not instltutlon, give street and number;
15c
City ou TOWn
St
t
L
d
.
,
a
e
an
Ip
Code
lStl. County of Death
S6a. Method of Dls 0w E!r 8n PA 1 Cumberland
position ~J Burla l
Q Cremation 16b
Date of Dls
ositl
Q
.
p
on 16c. Plare of Disposition (Name of cemetery, crematory, or other place)
Removal from State Q
DOnatl
Other (S
ecif
)
p
y
June 28,2012 Resurrection Cemetery
16d
Location of Dls
ositl
Ci
.
p
on (
ty or Town, State, and 21p) 17a. Sig F ral Service Licensee or Person In Charge of Interment 17b. License Number
H
i
P
arr
sbur
A 17112 FD 012 848 L
17c. Name and Complete Address of Funeral Facllify
a~
~
a emote F &CS Inc. PO Box 431 New Cumberland PA 17070-0431
18
D
'
.
ecedent
s Education -Check the box that best describes the 19. Decedent of Hispa nlc Origin -Check the 2D
De
d
hi
h
'
.
ce
ent
g
s Race -Check ONE OR MORE r es to indicate what
est degree or level of school completed at the time of death. box [hat best describes whether the decedent th
d
e
ecedent considered himself or herself to be.
~ 8th grade or less Is Spanish/Hispanic/Latino
Che
k th
"
"
.
c
e
NO
White Q Korean
Q No diploma, 9th - 12th grade box If decedent i
t S
~
s no
panish/Hispanic/Latino.
Black or African American Q Vietnamese
High school graduate or GEO completed ®No
t S
h
, no
panis
/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian
~ Some college relit, but no degree Q V
M
i
es,
ex
can, Mexican American, Chicano (] Asian Indian ~ Native Hawaiian
Q Associate degree (s
g. AA, AS) Q Yes
Puerto Ri
e
,
can
Q Bachelor's d! ~ Chinese ~ Guamanian or Chamorro
gree ( .g. BA, AB, BS) Q Ves
Cuban
,
Q Filipino Q Samoan
0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) Q Yes, other Spanish/Hispanic/Latino
Q Japanese Q Other Pacific Islander
Q Doctorate (e.g. PhD, EdO) or Professional degree
(Specify) Q Other (Sped
. MO DDS DVM LLB JD N)
21. Decedent's Single Race Sllf-Designation -Chick ONLY ONE to Indicate what the decedent considered himself
h
lf
'
or
erse
to be. 22a. Decedent
s Usual Occupation -Indicate type of work
(~ White 0 Japanese Samoan
~
Q Black or African American Korean
done during most of working life. DO NOT USE RETIRED.
C7 Q Ocher Pacific Islander
Q American Indian or Alaska Native Q Vietnamese Q Don't Know/Not Sure
Homemaker
Q Asian Indian Q Other ASian Refused
Q Ghlnes! Q Native Hawaiian Q Other (Specify) 226. Kind of Business/Industry
Q Filipino Q Guamanian or Chamorro
Dome s t ie s
ITEMS 23a - 23 MUST BE C MPL EO 23a. to Pronounced Dead Mo Da
y 23 b. SI
BY PERSON WHO PRONOV NOES OR ^ ~ r gnatu re of Person Pronouncing Death (On y w en appiica 23c. License Number
CERTIFIES DEATH ~[
23 ate 51 ned (M ~~ 2 of e~th_ _ ~~7
L
~~ 25. s Medical Examiner or Cor er Contacts Q Yes No
qn
CAUSE OF DEATH
Approximate
26. Part 1. Enter the chain of events--diseases, Inj urles, or complications--[hat directly caused the death
p0 NOT
.
enter terminal events such as cardiac arrest Interval.
respiratory arrest, or ventricular fibrillation w
l
thquf show(ng the etiology. DO NOT ABBREVIATE
Enter
nl
.
o
y one cause on a line. Add additional Ilnes if necessary Onset to Death
~
`
IMMEDIATE CAUSE ---------------> e_ \ F-lA ) ) ^ ~ / ~
"
C ] I C! C
~'~IaLL~-~
(Final disease of condition Due t0 (o se
r as a con
f
quence o
):
resulting in death)
b.
Sequentially list condltfons, Oue fo (or sequence of):
If any, leading fo the cause as a con
listed an Ilne a. Enter the
UNDERLYING CAUSE
Due to (or sequence of):
(d lsease or Injury that as a con
G Inma[ed the events reswung d.
~ In death) LAST. Due tp or as a ron
( sequence of):
26. PaK 11. Enter other s~i<a nt tlitl t ib ti t d h but not resulting In the underlying cause given in Part I
~ 27. Was an auto
pay pe-rtolmed7
Yea L~
~ No
28
W
.
ere autppsy findings available
to c
l
h
3' omp
ete t
e cause of death.
29. If Female:
E 30. Old Tobacco Use Contribute [o Death? Q Yes Q ryo
Q Not pregnant within past year 31. Manner of Death
'9 Q
Q Pregnant a[ time of death
~ Natural Q Homicide
b
~ Q No
Unkno
wn
Q Not pregnant, but pregnant within 42 days of death Q Q Accident Q Pending Investigation
Q Not pregnant, but pregne nt 43 days to 1 year before death 32. Dat! of In Suicide Q Could not be determ tned
jury (MO/Day/`Ir) (Spell Month) Q
Q Unk
if
nown
pregnant within the past year
33. Time of Injury
34. Place of Injury (e.g. home; construcTlon site; farm; school) 35
L
i
.
ocat
on of Injury (Street and Number, City, State, Zip Code)
36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How In
Ju
Oc
tl
ry
curre
:
Ves
Q Q Driver/Operator Q Pedestrian
Q No Q Passenger Q Other (Specify)
39a. fist (Check only one):
Cer[Ifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner sta[etl
Q Pron
i
ounc
ng 8< Cer<ifying physician - To the best of my knowledge, death occurred ai the time, date, and place, and tlue to the cause(s)
Q Metlical Examiner/Co
d
an
manner stated
roner - On b is of examination, and/or Investigation, In my opinion, death occurred at the time
date
antl
lace
d d
,
,
p
, an
ue to the cause(s) antl manner staged
Signature of certifier:
Title of certifler~ License Number:
39b. me, Address nd 21p
~^~~ of Person ompieting Cause of Death (Item 26)
~
\
V V r ~ Qn 39c. pate Signed (MO/Day/Yr)
Q'
40. Registra District Number 41, egistra is 5 Lure
42. Registrar File Date (MO Day r)
//
43. Amentlmants ~/°Z 7 /a O ~ Z
nicnn<INnn Prrm It Nn n 74C~ri 7/., Hlos-la3
~~c~~ ~i1I ~rc~ C~IPStttr~nt
I, PEARL REGISTER, of the Borough of New Cumberland, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this as and for my last will and testament, hereby revoking
all other wills heretofore made by me.
ARTICLE I
I direct the payment of my just debts and the expenses of my last illness and
the disposition of my remains from my estate as soon after my death as conveniently
may be done. All of the foregoing shall be considered expenses of the administration
of my estate.
ARTICLE II
I bequeath my tangible personal property to my husband, MOZELL REGISTER,
if he survives me by thirty (30) days. If he does not so survive me, I bequeath my
tangible personal property to my children, GREGORY A. REGISTER, LISA A.
REGISTER and JEFFREY A. REGISTER, to be divided among them by my executrix
with due regard to their personal preferences in as nearly equal ~res as ct~al~
Any unselected items shall be sold and the proceeds distributed as ~tmf my ~sid~r~
estate. ~'i ~ c~ c Cn a7
~' Z f~-5 N n~'T IYf
ARTICLE III ~ ~ cs ~ 'an
cac~ =~
y t~ r-- ~
I devise and bequeath all of the residue of my estate, togeth~ with the~ro~~s
of any insurance thereon, to my husband, MOZELL REGISTER, provided he survives
me by thirty (30) days. If he does not so survive me, I devise and bequeath the residue
of my estate in equal shares to my children, GREGORY A. REGISTER, LISA A.
REGISTER and JEFFREY A. REGISTER.
ARTICLE IV
I appoint my husband, iVIOZELL REGISTER, executor of this my last will. In
the event that my husband is unable or unwilling to act as executor, I appoint my
daughter, LISA A. REGISTER, executrix. In the event that both my husband and my
daughter are unable or unwilling to act as executor, I appoint my son, GREGORY A.
REGISTER, executor.
ARTICLE V
I direct that my executor, executrix or their successor shall not be required to
give bond for the faithful performance of their duties in any jurisdiction in which
they may be called upon to act, insofar as I am able by law to do so.
WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ day
of ~~ ~ Errs ~A/ 1983. 1 ~ _-~
f, .
~, ~ ~v
(SEAL)
Pnnrl Rcnietn
Signed, sealed, published and declared by the above-named Testatrix, PEARL
REGISTER, as and for her last will and testament, in the presence of us, who, at
her request, in her presence and in the presence of each other have hereunto subscribed
our names as witnesses.
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
No. 21--1~- )~~~
Estate of PQ0..~~ ~ CCU\5 ~e~ ,Deceased
UNAVAILABLE WITNESS AFFIDAVIT
I, 1-.\5~.~~\g~cC~' FQ`c1~~1~ being duly sworn according to law, depose and say
u
that I, the ^ Attorney Q'l~rsonal Representative in the above referenced Estate, declare that
~e.C.oC..ti ~~ ~ ~ \g~Q~ and ~`I t1~1~ ~ • ~\5~'e- ~
whose signature(s) appears as subscribing witness(es) to the O~Will or ^ Codicil of the above
Testator is/are not readily available to prove the signab~re to the Testator by reason of
~-.aw-~rirc~ •c1o ~t~rt\.ec ~n bu.S~ qt SS . ~ -}t~e9SltlJ "Kt~M a•~.
C~-c~b u,Y1 c~,i0 ~ e.. ~o }pG ~~C.Tt(~ M ~ n e a ~,v~ pt, l e ~~ e (~, , ~
Sworn to or affirmed a subscribed
Be ore me this ~ ~ day of
20 ra
Deputy for Register of Wills
(IVTust sign in Register's Office)
~ •-~ ~
Signature of Counsel/P rsc~l~epresen~tivem erns
~-~ ci ~q
mx~ ~ tnav
aD n ~-- N --{ C
p'~~ G~ ~Q
•~ ~ Ot7
o ~ ~ ~
~ `'' '"- m
a ~ urs O
OATH OF NON-SUBSCRIBING WITNESS
~~ ~Qc iS~~ and C~ ~ ice, ~ 1 ~
UJ s
(each) a subscriber hereto, (each) being duly qualified according to law, depose s) and say(s) that
he is/she is/they are familiar with the signature of the above Testator of the .$~ Will or ^ Codicil
presented herewith and that he/she/they believe(s) the signature on the ,~j Will or ^ Codicil is in
the handwriting of the above Testator to the best of hi er/their kno a ge an ~ f.
Sworn to or affirmed and subscribed
~~~ ~ ~~
Before me this ~Q day of Signatur f Non-Su ribing Witness
(' ,24}2
e f
• ~~~
~~ i ture of Non-Subs ng it ess
eputy~ for Register o Wills
(Must sign :n Register's Office)