HomeMy WebLinkAbout11-16-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~~,~j ~ r,z ,~~u ~ COUNTY, PENNSYLVANIA
Petitioner(s) mined below, who isiare 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 /j j
Name: ~//!J ~L~ ~r ~G'r' ~~°l~~'!T/ File No: ~' _ , ~-- '//~,1
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: _~~~~ - / 7%
Date of Death• ~~1, ~ ~„ ['} / " Age at death• ~~
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Decedent was domiciled at death in Cf.//h /~ t'~ ~,~~ County, ~,~ (Stare) with his/her last
principal residence at ~~j ,~ / ~j' ~'~~ ~~~~zC`~~ ,~ /~1 /f "/C ~ r.~ r l" p~'~ L
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Street address, Post Oftce and Zip Code City, Township or Borough County
Decedent died at ~~ ~ ~.~.~~/t""c~ ~~ ~ /~.l~~G"'' .~~/C L~ , /~/}~ ~C%/7l ~f~ ~/,~J.~ ,~/~"
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 $ ~ 0r d~~
If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $
If not domiciled in Pennsy!vania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ ; ~; ~*~~
Real estate in Pennsylvania situated at:
(Attach additional sheets, if necessary.)
Street address, Post Office and Zip Code City, Township or Borough County
~ "' 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 ~_~~ and Codicil(s)
thereto dated
State relevant circumstances (e.g, renui:ciation, deaf/i of execertor, 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
adop ;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.u., d. b. n., d.b.n.c.t.a., pendente lite, durante absentia, durante 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 party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
i~123 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 W ill and was survived by the following spouse (if any) and heirs (attach
additional sheets, if~necessary):
Name Relationshi Address
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Form RW-02 rev. 10/!1/201!
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
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CO[. ATY OF
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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) ill well and truly administer the estate according to law.
Sworn to a~f rmed a ub cribe bee~j ~' Date ~
me th~s c~ax of l ~ JS~% Date
BY~ ~.~'~~ Date
o Resister Date
BOND Required: ~ YES ~ NO
FEES:
L etv~`/s ........... .
p.~~ .
( )Short Certificate(s)...... ' ~ ~'
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Automation Fee . ............. .
~o
JCS Fee . ....................
TOTAL ..................... $
To the Register of Wills:
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 !- ~~G~/ 1 ~ 1T ~/~fi/^/ t ~ File No• ~ ~y
a/k/a:
AND NOW, /~ `) ~ ~t,~ ~~ , in consideration of the fore oing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~5t~ ~~ ~~l/-
are hereby granted to (,Z /'j ~t %7 ~„ L7!' ~ ~~
in the above` tate and (if applicable) that
the instrument(s) dated , C .~'
described in the Petition be admi ted to probate and fil
f record ~ the last Will (and Codicil(s)) of Decedent.
Register of Wills
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/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL R ECORDS
manent CERTIFICATE OF DEATH ~._._~.,_.,.._.__.
1. Decedent's Legal N
November 3, 2012
Sa. Age-last Birthday (Vrs) Sb. Under 1 Vear Sc. Under 1 Da 6. Date of Birth (Mo/D ay/Vear) (Spell Month) 7a. Birth lace 1City and S tate or foreign Country)
Months Days Hours Minutes ne 19
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1928 Pigtsbur h Penns lvania
84 u
, 76. Birthplace (County) A en
ga. Residence (State or Foreign Country) 8h. Residence (Street and Number -Include Apt No.) c. Did Decedent Live in a Township?
S
Pennsylvania 100 Mt. Allen Drive y
L~Tyes, decedent rued in ___ Upper Allen twp.
Sd. Residence (County)
C77IfIbeL-laIld Be. Residence (Zip Code) ^ No, decedent lived within limits of city/born.
9~ver in US Armed Forces? S0. Marital Status at Tme of Death ^ Married Widowed 11. Surviving Spouse's Name (I(wlfe, give name prior to first marriage)
yes ^ No ^ Unknown ^ Divorced ^ Never Married ^ Unknown
12. Father's Name (First, Middle, Last, Suffix) 13. Mothei s Name Prior [o first Marriage (First, Middle, Last)
Giuseppe Monoriti Saveria Romano
14a. Informant's Name 14b. Relationship to Decedent Sbc. Informant's Mailing Address (Street and Number, City, State, Zip Code)
0
Marianne Morgano Niece
1290 Lakt~nont Drive, Pittsburgh, PA 15243
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Sa. Pace o
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eath
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nly one
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If Death Occurred in a Hospital d Inpatient llf Death Occurred Somewhere Other Than a Hospital a Hospice Facility b Decedent's Home
~ ^ Emer enc Room/Out a[lent ^ Dead on Arrival I
g y p }~ Nursing Home/Long-Term Care Facility ^ Other (Specify)
a lSb. facility Name (If not institution, glue street and number) SSc. City or Town, State, and Zip Code lSd. County of Death
Messiah Villa e Mechanicsbur PA 17055 Cumberland
r 16a. Method of Disposition Burial ^ Cremation 16h. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place)
m
~ ^ Removal from State
^ Donation
OV. 7
2012
Calvary Cemetery
;~ ^ Other (Specify) ,
~ 16d. Location of Disposition (City or Town, State, and Zip) 17a. Signa r uneral Service ~ nsee or Person in Charge of Interment 176. Ucense Number
Pittsburgh, PA 15217 ~~ FD-138630
E 17c Name and Complete Address of Funeral facility
Malpezzi Fluieral Home 8 Market laza Way, hanicsbur , PA 17055
m 18. Decedent's Education -Check [he box [hat best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to indicate what
~ highest degree or level of school completed at the hme of death. box that best describes whether the decedent the decedent considered himself or herself to be.
^ 8th grade or less is Spanish/Hispanic/Latino. Check the "NO" White ^ Korean
^ No diploma, 9th - 1Zth grade x if decedent is not Spanish/Hispanic/Latino. ^ Black or African American ^ Vietnamese
^ High school graduate or GED completed ~
No, not Spanish/Hispanic/latino ^ American Indian or Alaska Native ^ Other Asian
^ Some college credit, but no degree ^ Yes, Mexican, Mexican American, Chicano ^ Asian Indian ^ Native Hawaiian
^ Associate degree (e.g. AA, AS) ^Ves, Puerto Rican ^ Chinese ^ Guamanian or Chamorro
^ Bachelor's degree (e.g. 8A, AB, BS) ^ Yes, Cuban ^ Filipino ^ Samoan
}~ Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ^ Yes, other Spanish/Hispanic/latino ^ Japanese ^ Other Pacific Islander
^ Doctorate (e.g. PhD, EdD) or Professional degree (Specify) ^ Other (Specify]
e.. MD, DDS, DVM, LLB 10
21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what [he decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work
White ^ Japanese ^ Samoan done during most of working Ilfe. DO NOT USE RETIRED.
^ Black or African American ^ Korean ^ Other Pacific Islander Lieutenant Colonel
^ American Indian or Alaska Native ^ Vietnamese ^ Don't Know/Not Sure
^ Asian Indian ^ Other Asian ^ Refused 226. Kind of Business/Industry
^ Chinese ^ Native Hawaiian ^ Other (Specify)
^ filipino ^ Guamanian or Chamorro U • S • Army
ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (Mo/Day/VrJ 23b. Signature of Person Pronouncing Deat .fOnly fn pplicable)
t 23c. License Number
BY PERSON WHO PRONOUNCES OR
CERTIFIES DEATH > 1~.e J
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23d. Date Signed Mo/Day/Yr)
24. Time of Death -
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'/' J ~ rX•c.' ,~ C{ ~ /- ~ 25. Was Medical Examiner or C ro r Contacted? ^ Ves No
CAUSE OF DEATH
I Approximate
26. Part I. Enter the chain of events--diseases, injuries, orcomplications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest, I Interval.
respiratory arrest, or ventricular fibrillation without showi
n
g the etiology. DO NOT ABBREVIA
TE
. Enter Doty one cause on a line. Add additional lines if necessary. I Onset to Death
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IMMEDIATE UUSE --•------------> a. /~~J~~j:~c, {6/I\I r-Y~t ~~t ~ls< I
(Final disease or condition Due to (or as a consequence of): I
resulting in death) ~~ nn ( I
b. {Vt ct''~G~3..~,~'~I~C 5t,r5/V(YIA y'ft~\J ~"~~t G't~J•"'htl NllJ 1
I
Sequentially list conditions, Due to (or as a consequence of): I
if any, leading to the cause I
listed on Ilne a. Enter the c. I
UNDERLYING UUSE Due to (or as a consequence qf). I
(disease or injurythat I
- initiated the events resulting d. I
~
V in death) LAST. Due to (or as a consequence of): I
~
g 26. Part II. Enter other significant conditions contributing to death but not resulting in the underlying cause given in Part I. 27. Was an autopsy performed?
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^ Ves ^ No
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Y
1 28. Were autopsy findings available
to complete the cause of death?
$ ^ Yes ^ No
d 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death
a
E
^ Not pregnant within past year
^ Yes ^ Probably
~ Natural ^ Homicide
u ^ Pregnant at time of death ^ No ~ Unknown ^ Accident ^ Pending Investigation
^ No[ pregnant, but pregnant within 42 days of death ^ Suicide ^ Could not be determined
^ Not pregnant, but pregnant 43 days to 1 year before death 32. Date o(Injury (Mo/Day/Yr) (Spell Month)
^ Unknown i(pregnant within the past year 33. lime o(Injury
34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, County, State, Zip Code)
36, Injury at Work 37. If Transpgrtation Injury, Specify: 38. Describe How Injury Occurred:
^ Yes ^ Driver/Operator ^ Pedestrian
Q No ^ Passenger ^ Other (Specify)
39a. Certifier -physician, certified nurse practitioner, medical examiner/coroner (Check only onej~.
Certifying only-TO the best of my knowledge, death occurred due to the cause(s) and manner stated,
^ Pronouncing & Certifying - To the best of my knowledge, death occurred at the time, date, and place, and due [o the cause(s) and manner stated.
^ Medical Examiner/Coro
ner
- O
n the basis o
f
examination and/or investigation, in my opinion, death o
ccurr
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d at the time, date, and place, and due to the cause(s) and manner stated.
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Signature pf certifier: VI~.L(
~~LL~i.1f~ Title of certifier. ~
License Number: L~S ~
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396. Name, Address and Zip Code of Person Completing Cause of Death (Item 261 39c. Date Signed (Mo/Day/Yr)
IM 1~~1F'1i L r11MS /1C CC> LGI'f ir11~1 -rt i rlk'° Lilt fr_~NC VV IC ~ i.f'4''j ,/: }L'~~-
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40. Registrar's District Number 41. Regi rar'z Signature 42. Registrar file Date (Mo/Day/Yr)
43. Amendments
H 105-143
Disposition Permit NO. 0819445 __ _ __ Rev D7/zolz
LAST WILL AND TESTAMENT
OF
ELIDIO J. MONORITI
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I, ELIDIO J. MONORITI, of Cumberland County, Pennsylvania, being of sound mind, memory
and understanding, do make publish and declare this to be my Last Will and Testament, hereby revoking
and making void all wills by me heretofore made.
FIRST: I direct that all my just and legal debts, funeral expenses and expenses in connection with
the administration of my estate be paid as soon as practical after my death.
SECOND: I give, devise and bequeath, absolutely and forever, all the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever kind and wheresoever situate, in posession and in
expectancy, including all property over which I may have power of appointment, remaining after the
payment of estate, inheritance, succession, legacy, transfer and other taxes of the same nature which are
payable because of my death (hereinafter refel-red to as my "Residuary Estate") to Iny sister, Frances M.
Barack. If Frances M. Barack shall not be then living, then the Residuary Estate shall be distributed, per
stil-pes, among her children, Joseph Barack, Anthony Barack and Marianne Morgano or their issue per
stirpes. If there be no then living descendents of such predeceaced beneficiary, then the share of such
predeceaced beneficiary shall be distributed equally among the remaining Residual Beneficiaries, or their
living descendents, as the case may be.
THIRD: I have on this date drafted and signed a letter containing my wishes and desires as to
certain personal matters. The letter will be kept with this, ~r1y Lash Will and Testament, and maybe
amended from time to time. I direct my Executrix to follow the express wishes outlined in such letter.
While not legally binding, the letter. expresses my desires to be followed to the extent possible and
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practical.
FOURTH: I nominate, constitute and appoint my neice, Marianne Morgano as Executrix of my
this, my Last Will and Testament. I direct that no bond. or security of any kind be required in any
jurisdiction of my Executor or his substitutes or successors, the same being specifically waived hereby.
FIFTH: Whenever in this, my Last Will and Testament, it is provided that any person shall benefit
hereunder if such person shall survive me, such person shall be deemed not to have survived me if he or
she shall die withid thirty (3 0) days after my death.
IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and "Testament this _
~.
~ day of 1'~`? r y,!? ,~"t ~~ ,h ,~ 2012.
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ELIDIO J. MONORITI ~ ~
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Signed, sealed, published nd declared by the above-n =~ TI, as
and for his Last Will and Testament, in our presence, who in his presence and in the presence of each
other, at his request have hereunto set our hands as attending witnesses.
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COMMMONWEALTH OF PENNSYLVANIA )
COUNTY OF ALLEGHENY )
I, ELIDIO J. MONORITI, being the Testator whose name is signed to the foregoing instrument, having
been duly qualified according to law, do hereby acknowledge that I signed and executed the said
instrument as my Will, that I signed it willingly and that I signed it as my free and voluntary act for the
purposes therein expressed.
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ELIDIO J. ~VIONORITI
Sworn to and acknowledged before me, the undersigned Notary Public, by the said Testator,
this day of ~ ,~; ~ ~: , 2012. ..
1MD~A~ ~.
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Public
Notary Public T i0llp - CUM8EAt1iM0
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF ALLEGHENY )
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We '`~--~''~-~`~' ~ ~ ` ~r ~.-L-s~t,~ ..~ and ~ ~'' ~"~. ;;~~
the witnesses ~vvhose-dames are signed to the foregoing instrument, being duly q ~~ red according to law,
do de~ose and say that we were present and saw the Testator therein named sign and execute the said
instrument as his Will, that he signed willingly and that he executed it as his free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of the said Testator signed the Will as
witnesses; and that to the best of our knowledge the said Testator was at that time 18 or more years of age,
of sound mind and under no constraint or undue influence.
Sworn to and subscribed before me, the undersigned Notary Public, by the said witnesses,
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this ~_ day o ~ , 2012.
Notary Public Ti ~~
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