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HomeMy WebLinkAbout12-07-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF 1. G, yrt~Ef ~ d h ~ COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/arc 18 years of age or older, applyfies) 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 1 Name• _ ~1-[~ lit` 1 'C G ~~a SY1 ~P a/k/a: a/k/a: a/k/a: Date of Death: Q - 1'3 ` 2D 1 oZ Decedent was domiciled at death in C V mb~~~]~,n a Coui principal residence at ii. Fe,e ts~ pp~ [~~~q~_t Street addressPost Office and Zip Code ~~ Decedent died at File No: ~ ~' ~~ ~~~~ (Assigned by Register) Social Security No: 1q 3 - ~ l4 - DS ~ `~ Age at death: '~ Q Cily, Township or Borough Stree[ address, Post Office and Zip Code 1 City, Township ar Borough Estimate of value of decedent's property at death: /jdonticiled in Pennsy[vania ............................ All personal property ljnot domiciled in Pennsy[vania ........................ Personal property in Pennsylvania IJ'not domiciled in Pennsy!vania ........................ Personal property in County (Stare) with his/her County State Value ojrealestatein Pennsylvnnia ......................................................... $ _l TOTAL ESTIMATED VALUE.... $ '~ ~ 'Z t9D_ -• Real estate in Pennsylvania situated at: lV a 1~ t _ (AUach ndditionnt sheets, ijnecessary.J 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 mare the Executor(s) named in the last Will of the Decedent, dated ~ ~~ and Codicil(s) [hereto dated Stale relevant circumstances (e.g. renunciation, death of executor, etc.) r.,, n '_'' .Z1 Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was notQSLo~c d, was not a partyROg~yding divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323}, ymd did note a c~d l`arn or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person, 07 ~ ~ ~ ~ ©NO EXCEPTIONS ^ EXCEPTIONS %0 b f ~~-t m ^ B. Petition for Grant of Letters of Administration (If applicable) z ~ ~ 0 ~ c. t. a., d. b. n., d.b.n.c.t.u., pendenteli~e, c~-uN~ ntirt.~rant~ti~itute rJ ~ '-- ~ If Administration, e.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and coAfple2e list of,~tojrs. ~ `, m Except as follows: Decedent was riot a party to a pending divorce proceeding wherein the grounds for dive had been e~lishec~ as d~e~ined 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, iJ'necessary): Name Relationshi Address LS• ~ r lnl i 11~ S o0 Fornt 2N'-01 rev. l0/fl/201! PagO I Of 2 Oath of Personal Representative COM~lO~1WEALTH OF PENNSYLVANIA } \ } SS: Olficial t;sc Only Pe:i:ioner(s; Painted Dante i Per;icner!si Pru;ted .Address i7.i n ~ ~ I col ~@ l'1 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best ofthe knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of die De ent, the et~itiorne~r(s ill well and Truly administer the estate according to law. Sworn to or affirmed~d subscribed before ~ J, i~,~~? ~ Date 1.~.. ' ] " /1 methi$ ~' ~a~''/xi~~~~~r', G.c_.,~G~" _. __ _ Date J/~ ~~ Letters ...................... $ ~~.~/ (,y~ )Short Certificate(s)...... ( )Renunciation(s)........ . ( )Codicil(s) ............. _ ( )Affidavit(s)........... . Bond ........................ Commission .................. _ Other Automation Fee ............... tx~ ]CS Fee . .................... ~ ~j.f TOTAL ..................... $ ~~iCl . SZ~ To the Register ojWi!!s: `-.,,; c`~-_''~'- ~ Please enter my appearance b y my ~epttature bel ~ ~ ~ rr1 r*1 c~ Attorney Signature: ~ ~ ~ _ G'J p ~ ~] ~ ~ ~ ~--i n"7 ~xr ~ '~p`~ °`' `~ r ^1 r~tn Ys.7~~p° ~c7 +,,,_ ~ ~~ c'n -r'S -rt Printed Name: ~ ~ `~ c~Q ~? ',,, <' r.y Supreme Court iD Number: © C ~ %n -a - N"'I ~ +"' r,-t ~ G~ C~ 'p ~ ..n Firm Name: ~ 1-- Address: Phone: Fax: Email: DECREE OF THE REGISTER i~/ Estate of _ ~i~~f~~ (' ~ ~j~ p~' File No: ,i%~ ~ j y' /v~~~ a/k/a: AND NOW, / ~(~ ("(i~/d}F'~ ~~ ~CJ/ ~ , in considerati n of the oregoing Petition, satisfactory proof~ia'ving been presented before me, IT I5 D~CREED that Letters 'l"~ ~ >>,°~a ~ are hereby granted to ~ ~~,,, / " ~ O-}{~ ~" /~ in the above estate and (if applicable) that the instrument(s) dated ~ ~ ~~ ,a~iSt~ described m the Petition be admitted to probate and filed o ref cord as the last Will (and Codicil(s)) of Decedent. 7 e ister of Wills / F' g ~ `V ~ ~ '';~' ~%' Fo,,,, aw-nz ,e~. rniunnu Page 2 of 2 i BOND Required:~YES ~NO FEES: _ ___ ,. This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with ,. / the Viral Statistics Law of 1953, as amended. ~~ ~~~ ~,~ No. 1 F Date p¢/Pant M COMMONWEALTH OF PENNSYI VPNIG ~ pEPn RTMfNT OF HEHLTH . VITAL RECORVS 089462 CERTIFICATE C]F t7FATf-1 ]- DerCde nt zLegal Name (flr5t Mltldl¢ 1. t Sufflxl 2. SC% 3- 5 I Sc - - y t O f D h (MO/Day/Vr) (Spell MO) ~ M3[32'it3 ()t L0 pun OKE N ma~.P I. )3 )L 064H $ pL 1J r 13, 2012 Sa. Aqe L35t grtM1tlaV IVrzl Sb. VntlCf 1 V ar 5 U d 3 DaV 6. Date of Etirth (MO/D y/'Gar) (Spell Murrtl) > fM1pl c (CI y tl 5 a F Ig COUnCry) Months Uayi Houfa Minutes - C- 1 1e PA Ts _ .rt,iv za, 193s ~r R - 1 _ (~t,~„t.;~ ct,mte-[ lava Sa. Residence (state or Fo -Rn CounCN) 15b. Resltlence (StfeeT and Number- Include Apt NO.1 ___ _ gc. Did Urrrden[ L ve 'r e Tuwnsh'p? ~-- Yennsylvanis C7 vez, ara.:etlent Ilvetl in twp Bd. R nee (county( 613 Whishe S rtn s Roaa . ----- - CumUerlan[3 Be. Resldenc@. - 1~2 U7 .-..-._-. _ _. -__- -... ®NO, de edent Ilvetl witnin limits of Ho=11f1K SVr3n{i,s LI[y/bu c 9-EVpf In us m _.-- ned Fof¢es? 10 Marital Status at Tl of DeaCF [] aF~ d ~ Wltlowed 11. Surviving SpnucP's Narne (Il.vifr, Give na a prlOr to first marriage( o ~V¢ ® NO []Ilnkn ® DW ed (_] 5 -nwn nrL a rrr own Nev rMa ¢d ~'lnkn ___ ~ - __. 12. FatF¢~ 5 Na T¢ (First. Mltldle, Last, suffix) 13. Mother's Narnr~ Pr rot to F-irzt Marriage (Ells[, Mldap, La52) 4 ~ Arlin Otto, Sr. Ida L1 yd / \ - 1nalnforman[SName ]4. r. Rala[onznlp [O edent 14c. Inform 'z M311ing Atltl 55 (S[fect anb NUmb¢~'C ty. State Zip COdel ~ o r Mr_ Aain l)tto, ]r. _ _ -_ -j3rDther - 5:13 Wh See Sp ltgs Roaa, HoillnK Syr3ngs, PA 1-JOO~ C _ __ _______ __ lsa. Place of Dea[M1 (CM1¢ck only onCl ----- - - ~g __ _ __ currCd In a Hpsp ial. f-1 InOa[-e nt 'If Death Occurred Snrn 1 fl~1r.- TI ~ ~-"-~ f VeaCh Vc an a Hospital ~ Hospice Facility rf UCCetlent's Home Em Orge ncy Rpom/O r[patlent n Uaad On Afnval ® Nursing Home/Long-Term Care Farilny ~ Other (Specif Y) • ___ 156. Facility Nam¢ (If not Inz[i[utlo n, giv s r ntl numbeF 15c- Clry or Town. State. nd Zip COtlP 15[1. [u rtY of (teat M1 a a - Forest Yarlc Nursing 6 Reh___ab_ __ c.arli sje PA 17U13 C.umberlana 16a. Mo<h Od Of UlspoSitlon r] Burial ~ CfCma[ion 166. Uate Of Disposition 16c. Place Of DicPnsitinn (Narne of cemetery, crema[Ory, or Otnef placel p] Rrmuval from State ~ nurravun v - LJ Other lSPecifv).. Septe bet-IS 2U i.J Anatomy Gi£r•5%Regi-s try _.__ _ 16d. I. - -o f OI p - ion (CriY or Town, S[a[e, and Z pI 1/ of Fune I I p/5 L cep ~ o CI o£ Ir lurme^[ ]>6 L'cense Number _ H MU 2]U)6 - ~ ~'~ ~ L l%- rte e FU 138'l53 o ' `- _ _ _ > Na • a I f rnplere A IJr eaa of F! ncral Fac l Cy e v Asset Crc:mation Services o£ Pennsylven-ia, lnc_, 41C]O .]Dnest-nwn 4 a Si stuz g, YA 17109 ra i m` ] g. Ucceden['s Etl ucatiOn Check Fn0 box [het beat tlescribes the 19. Decedent of Hizpanir ClAgin - Clrauk !hc 20. Decetleni'S Ra Le - CheckVN[ C]R MORE O wbat racese Intlica[e ogre n cl u! acnuol mmpl~Cetl at the clme of death. bo Cha t tle crlbe whc[he a tle Ctle t tha Ce ede r[ consider ed hlrnaelf ur I rl( t0 be- I ` n e Q Bth gfatlc r Ic s $p sh/Hlspa r/I. r Char-la !he ® Whlie ~ Kp e r ¢ a Nn r1i V1!rrr .4 r-1.2[Ir gratle box lf tlecedent l n Spanlsh/Hlzparrlc/LU[InU. ODlack or African Amarianri (] Vie[namesa l ($f Ii IRh 5 00l gfa ch om not I-rro meflcen I tlua[i pr GEU c VI¢t¢d ® NO. Spanish/Hislr^^i!/I nr ~ A ndlan or Alaska Na[I~re t~ O[hef Asian [] Srrrrre e. ullaye ireJiL LuL nu degree Q Y¢5, Mexican, Mexican AMCn Ca n. Chlca n0 [] Asian Indian ~ Na[lue Hawillan ~] A O late degfce (C. g. AA. ASf ~ Ves, Pua'rtn Ri[an Q Chinese ~J Guamanien Of ChaMOffo ac e Q 6 h lor'S dcyr¢c (c g BS) a Y¢s. Cp6an ~ Filiplnp Q $a ma>an [] M stet s degree (ng. M -r R, MEd. MS W. MBA) ~ Ves, other Spanish/HiSPa nit/I atlnrr ~ Japanese 0 Other Pacl[IC Islander poctorate (e.R. Ylru, ttl Ul or YrofezzrUn al tl[+.yree ISpeclfyl [] Other (Specify) -- (e--MU, UUS. VVM. LLB,JO) 2t IleteJen L's Single Race Self-Oezignation-Check ONLV ONE[O lntlicete wha[[he deCCdCnt considered himsC.f pr herself en be J2a pe!r•.Jent's IJZUaI Occupation-In[IiLate type of wOrlt ® wM1rfc L] lapane~e ~ Sarnonn dune dunng most of working life. DO NOT L15E RFTm EO. cen Amcncen r¢a [ ~r Pa I Rlatk ur Afii Q Ko r [~ O[he. elfl< slantlE ~Anrvflcan Indian ur Alaska Native ~ VieCnamaSa Q purr'L Knuw/Nut Sure n16lY1Ct ManagE sla 1 11- n n rr n. an ("( Other Asian n HCfn sed ?21r. Kinl of ensinezs/Indt.Srry [7 cnlne5e O Naeye Hawaiian p Dore, (sp¢~IryJ _----.-..-..-. _ YuLriOt Nees " o EillPlnp o G I a, nr ram r a Newspspe Dis LriUuitOn ITEM523a -23tl MVST BE COMPLE I"EO 23a. Va[C PfonOUnced Ueatl (MO/Day/Yfj 236. SIg^ature of PP.!cnn Pf!rrruuncing DeatM1 (Only when applicablel 23c- Llcens¢ NUmb¢f BY PERSON WHO PRONOUNCEi OR S`r t`L.+1I `_~ /.3 .ZV/ ~ CERTIFIES DEATH n r ~~f N / 23tl. Dale' $iH d (MO/Day/Yrj 24. Time of (] rh ~ C.~ L" L.L ~vstC1/ {.iN ~ ~-'j L S- - L S- . f t - L / -r, ~C /' / j ] L,x j _ ~l S-S ,:1 25. Waz Metlical minef Or Coronc-r Lpn[a Ctcd? 0 Yes ® Ne a CAUSE OF DEATH App.p% 26. Pa l 1 En Che cl f r __ - 1" Irrjr. mpL [ tllfectly C etl [M1C dCalh. VO NOT ¢nte L al P idle C r r In aIH e s ` c ¢ `S r f r fezplrelury Lfrest, of venlflcula r nbrlllat on wltlrou[ ShOwl n g Lhe etloloyy- DO NOT A9HHF\/IGTE. Entar only one cause Una IlneP /\Jd atldltlonal IU `LCSSary Onse [to Dea tn I~~ l EDIATE CAUSE --~ a. __ V ~j1 / ~,(^L,lYL!'? _N _ _ _ _ _ _ __ _ IF- dlaease of cundt r„ p~tet az a Conseq! enC¢ 4f): rrcr L Jaya n) 6. _ _ .- Sp 10f a5 - ____._.._...-_ 5¢yu ally Its r. r r ro a Oue a con. r-nCC cqu oY): Ir ol¢ nR to [6c L a tl nJ r r rr En tlrnr l Ilal ~ _ e. ttr c. ___ V NUERLYING CAVSE ~ ~ -- Uire Lo (or as a consequence Uf): (dlx a rrjury Jra _ ¢d the a nt. re..ulting d. _____ v` irr rlvn Ir) la Sl UU[1 to (or a5 a oC nse9 uence uf): ~ - Q w 26 Part IL Fnfesr rrrhs si,.~riflc ndit__ [~I~gtO drrath but no[ resulting In SM1p untlerlying cause gixen rn Part I 2/. Wa an aU[O pSy p rf Gtl? r an[ co ions con s a Of }}44 ~ yes ~'No ~ _ 28. were autopsy fl ntlings available [U a. mpleie ttrerf of atni o ~ U Ves ~- --- FO ! ~ 29. If Female' 3D. DidTy cu eCOn ribu[ Due -- (_] Not PragnanC wil hln V zL Year B~, a2h? Ir31 Ma pf DeaiM1 ~ I HOrTrC dC n PfeR f C f d "tl x us(_I FfobablY Q No n LJnknow (J A 'd [] Perrd'rg lnu¢ztlga[lon ' m ~ [~ No g b p g 1- '1-y- of death ~ 5 J ~] Lould nOt Le tl¢CCrmin¢tl [~ No p g b p g - 1 Y r b!_YOre death 32. Date of Inlury (Mn/Day/Yr) (Sp II M h) ® Vnl -f & -Y 't V -~ 3 I fl I~!Y 31. Place of Inl try (e. a- nn LUnstrUCt p s'to, farm; school) 35. Location of Injury (street and umber. C xv. ~[a[e. Z'p Code) i6. Inlury at Work 3>, If Transportation Injury. 5p"-Lify: 38. Oescrib0 tlOw [rred: Inlury OCtr - ---- 0 Y [, U et/Operator n Pctl CStrlan 0 No [~ FaSSenHar Q Otlr r (S Vecfly)_ i 39a. Ce let (Check only o te): - - I rtifyln p6YSitran - To [he best rrf my knowledge, death o rBd tlU¢ t0 the < Se(s) and m S[a[etl e C U ¢ on n Cf P lr g fL Cnri fY ^g PIiYS cle the bcz f my know. ledge, death Ocr.u -re < 1 r J- ip, - tl pl and tl h zcls) ar tl man t d tl Mud c I E n net/GO(f°~I pp Lla CI _ of exa on ar tl/ - e gatlOn, In my oV I ) a h~ 1 a[[he 1- n! I aue ertl d g f f ¢f[ f er- ~(-t~ ?1 ~~ 1 Cle of certlfl Y~ _ ( 1 rrd Man of stated ~~~~ ~ ~l~,n ~. L;~a„SeNr,nb,. ~on5 ~rt~~_ -- ~l e, 39 4tltlre5 d Zlp Cptle of Perspn Completin Cause of Dea h Item 26( ^ 39c- Date d (Mp/Day/Yr) ~ ~~ ~ 7 ~ 1 T ~ 4,~ , u) VI,LI-c 1 - - ~ ~ ~-_ ' - nD. a g tar s 13 zt- rr r h!-f n1- Registrar s s-gn e - n2. R sl -ar Ile Lt to I o/Day/Vrl 43-Amen tlr~ents WAR~~#~~~I~p~~due~tcate this copy by photostat or photograph. REG-ST~~t OF 'b~1~.' S ~L'~2 CEO 7 Pal i? `1'~ o ~~'-~~~ Marina O'Reilly Matthew G L E R K fl }- State Registrar ORPHANS' GGUR 7 ~ 4 ~ ~iERLAND Cfl.l N~V ~ 2 2012 u5 oi~ltcnnlE NO_ 00159x(] H10S-]n3 LAST WILL AND TESTAMENT OF MAURITA OTTO SNOKE I, Maurita Otto Snoke, of Middlesex Township, Cumberland County, Pennsylvania, declare this to be my last Will and Testament and revoke all Wills and Codicils previously made by me. ITEM 2: I direct that my legally enforceable debts and funeral expenses, together with the expenses of the administration of my estate, shall be paid from my residuary estate as soon as practicable after my decease, as a part of the expense of the administration of my estate. ITEM II: I devise and bequeath all of my estate of every nature and wherever situate, unto my brother, Adin L. S. Otto, Jr., provided he shall survive me by thirty (30) days. Should my said brother, Adin L. S. Otto, Jr., predecease me or die on or before the thirtieth day following my death, I devise and bequeath all of my estate of every nature and wherever situate unto my sister-in-law, Donna M. Otto. ITEM III: All Federal, State and other death taxes payable because of my death, with respect to the property forming my gross Estate for tax purposes, whether passing under this Will or otherwise, including any interest or penalty imposed in ~` a ~ ~~~ ~'" ~t ~ C' O q' ci U ~ ~ ~ j 7 LF'„ C ~ Q ~ / / . ~ 1A..1 du N W ..,1 J C L~ ~_ cc :n v ~ U Q W Q V, w O ~ ~ ~~ ~ ~ ~ V C7 rJ connection with such taxes, such be considered a part of the expense of the administration of my Estate and shall be paid out of the principal of my residuary estate without apportionment or right of reimbursement. ITEM IV: I appoint my brother, Adin L. S. Otto, Jr., Executor of this my last Will and Testament. Should my said brother fail to qualify or cease to act as Executor, I appoint my sister-in-law, Donna M. Otto, Executor of this my last Will and Testament. ITEM VI: I direct that all fiduciaries acting under this Will, whether or not named. herein, shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, this of ~ day of April, 2007. ~ [SEALI Maurita tto Snoke The preceding instrument, consisting of two (2) other typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Maurita Otto Snoke, the Testatrix therein named, and for her last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, subscribed our names as witnesses hereto. ~~~~ ~ ~ as have ~~~ ~~ COMMONWEALTH OF PENNSYLVANIA __ SS COUNTY OF CUMBERLAND We, Maurita Otto Snoke, Dale F. Shughart, Jr., and Lincoln E. Allard, the Testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her last Will and that she had signed willingly, and that she executed it as her free and voluntary act for. the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by Maurita Otto Snoke, the Testatrix, and subscribed and sworn to before me by Dale F. Shughart, Jr. and Lincoln E. Allard, witnesses, this ~~ day of April, 2007. Notar ublic BONNiE L tCO^Yt.E~, NO ~ pUBUC BORO OF G4RUSlE CUMBE MY COMMISSION IXPIRES Rt.9N0 CO. PA OCTOBER 17, 2010 iw~-~ ~-- Witness