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HomeMy WebLinkAbout12-12-12Reset 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: Barbara E. Ptaszek a/Wa: a/k/a: a/k/a: Date of Death: November 29, 2012 File No: OL~ ~,,~ /~L>~~ (Assigned by Register) Social Security No: 208-24-4523 Age at death• 84 Decedent was domiciled at death in Cumberland County, pennSylvania (state) with his/her last principal residence at 5 Alliance Drive. Heritaee #202 Cazlisle. PA 17013 Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 503 North 21st Street Camo Hill Cumberland PA 17011 Street address, Post Office and T,ip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiclled in Pennsylvania ........................... . All personal property $ 500.00 If not domiciled in Pennsylvania ....................... . Personal property in Pennsylvania $ Ijnot domiciled in Pennsy!vania ....................... . Personal property in County $ Value of real estate in Pennsylvania ..................... ........................ . .......... . $ TOTAL ESTIMATED VALUE... . $ 500.00 Real estate in Pennsylvania situated at: NA (Attach additional sheets, i~necessap~.) Street address, Post Office and Zip Code Cily, 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 September 24, 2009 and Codicil(s) thereto dated NA State relevant circumstances lag. renunciation, death ojaecutor, etc.) Except as fol lows: after the execution of the instmment(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(8), and did not have a child bom or adopted:. 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., d.b.n., d.b.n.c.t.u., pendente tile, durante absentia, durante minoritate If Administration, c.t:a. or db.n.c.~a., enter date of Will in Section A above and c~mplete listE he'^ . ~~ r..> rr'1 Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for ~otipt had beep~tablet~s defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated pers~y. `~ r~ ~1> -v,~ rn s~ ~ _, t,°Y O NO EXCEPTIONS Q EXCEPTIONS -n ~ r- t.._+ r,- s-cv Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the fa~tt~ ispyuse i rt any) a~ h~rs (attach additional sheets, if necessar-v): °'- ~` _ ~ _,„t • rt '~ C> c-, -, -rt Name Relationshi A rEFs i--' r ~~ ~^ r- ~ Form RW-02 rev. 10/1Ii207 t Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } y ss: COUNTY OF CUMBERLAND y ~tEt~t?~;~~~ ~r'(;~ OF r . _ _ ~ ~' + 1 1 ti Petitioner(s) Printed Name Petitioner(s) Printed Address Robert S. Ptaszek 11 1 l 1 Adams Road Cazlisle PA 17015 ~~1j CEC 1 ~ ~f~ i 2 ~ ~; ~. ~ ~- ©Ri'N~PdS' G'`~= CllMBERLAi'~D Ctn., pq 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 theDe/cet, the Petiti Her(s) w 1 w I and truly administer the estate according to law. Sworn to or affirmed-and subscribed before / u-~~i'td~- ~ - ~~ Datc ~Z~Z~Zo I Z me this ~~ ~`~. day f ' ~~~_ rtr ~ ~-(, ti l~ ~ Date By: Date i~ Fol-Y~te~RegLrter j ~ v Date BOND Required: Q YES ~NO FEES: Letters .................... ~~ .. $ ' ( iC_~) Short Certificate(s).... .. __ ( )Renunciation(s)....... . . ( )Codicil(s) ........... . . ( )Affidavit(s).......... . . Bond ..................... ... _ Commission ................ . . O[her ...... . Ta the Register of Wilis: Please enter my appearance by my signature below: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: ........ Automation Fee ............... Lr- JCS Fee . .................... ~ ~.~ ~ TOTAL ..................... $ tr. ~.; U,g:glj Phone: Fax: Email: DECREE OF THE REGISTER Estate of Barbara E. Ptaszek Fite No: ,;%~ ~~- /•.~,~ a!kla: ~~ AND NOW, /~ ~ ~~ ~~1-1x" 2 /~ U/~ ,inconsideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS D CREED that Lettexs 7 r =>' ~~ ~~ ~ .~z ~r are hereby granted to L; h c'~~ ~t . ~>t ct ~ r>~ in the above estate and (if applicable) that the instrument(s) dated _ described in the Petition be ror,n Rw-oz rev. toirt~zar to probate and filed of record as the last Will (and Codicil ) . of Decedent. ~~ L~ , - ; gister of Wi s ~ ~ ~ ~~~ Page 2 of 2 nuls.al=kn ~„+ii~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNINGS It is illegal to duplicate this copy by photostat or photograph. RECORL~F;~ pc~~r,v / OF ((~~, (, I'CC' ~nl l~l l'~ ~CfUIICaI c. 'fib Uli REV157ti(~ ~ pp~~Uf (hl 1~ (() iU(11 (ha( f~IC III~OI'lll lClUn ilUC ~!IA'(Ln !S {Ifi~p~ si/rA, \ /ia~1^ '[,/~, ~ ron~LUy cop ~~ IiOm ul origin (I Cufifie )tr of Death (~j~ ~~~ '! ~ . `~l- (lul fl{e(1 ~~~((h nu n~ ~ Outl Rc *isUar. i'hc Original 1 rt ~ , I z,1 cernfiiate ~[ 111 he tul',~-aided tO the State Vital ~: ~ ~ Off ~~~ I v. , ~: a~~ Rculyd~ ,{ c 1~>l pel nlancnt tiling. *~' ~. - ~ i --~ P ~.. ~ ~ ~ ~ ~~ ~_ ~ oRPHarts ~~~P~r ~~ __ aE - 3 zo_rz ~ L'ITIC :IUuII ~'tl n]hl_'I ~~ "~"`R ~~1'(~ "~~~ ~ IIII(j1~1 11 r F Loc d R<r~,istr_u Uate Is,urd ~~ ~ Tvne/Print in COMMONWEALTH OF PENNSYLVANIA ~ pEFARTMENT OF HEq LTH ~ VITAL RECORDS Permanent ("F g1TI C~1rATC !lC gICATu \` Q _Sa a >ta[0 Yil¢ NV mbnY- 1. pecetlent'S 1 egal Nama (First Middle, Las[, Suffix) 2. Sa: 3. Social Security NUmbCr 4. Da[¢ of Death (MO/paVlYr) (Spell Mo) Barbara E^ PtaszeK emale 208-24-4523 November 29, 2012 Sa. Aga-Last Blrthtlay (Yrs) Sb. Under 1 Vaar SC. Untler 1 De 6. Data Of Birth (MO/Day/Near) (Sp¢II MunCM1) 7a. B bPlace (CItV d Stara nr For<Ign Country) M ~ S r ~t 84 ives omM1S pay, Hnn,s Minutes Nov 17, 1928 s i e, CA 7b. BlKhplacc (COUnry) 8a. R<51dy~nCe (Stara ur Gorelgn COUn[ry) 8b.s<zltl fStreG[ and Number- Includ¢ A tN ) YA b A~~lance D A t ~L 91 8C. pld DcCedanT l1Ve In a Township? r., p V py<b, d¢c¢a¢nt B.,¢a ln 8tl. R@sld¢nT¢ (County) _ twp' Cumberland 8<. Resld¢nca (21p Cotle) '~ 13 [~gJO, decedent IIV<d wltM1ln Ilntlts Of [^_.a Yl i C~I CRyJporo_ 'J. [Ver In US Armatl Forces/ SO. Marital Status at Time of Death O Ma[rl¢d Wldnw¢d 11. Surviving 3pous¢'s Nama (If wife, gIVC name prloY [o tlr6t marriage) Ves ® Nu Q Vnknown [~ Divorced ~ Never Nlarrled ~Unknow i2. F tM1e~ z (FirsC, Middle Last, SuNlx) 13. Mother's Nam< Pr or to fhs[ Marrlaq¢ (Firs[, Mlddla, Lastl Edawa ~r"Iet E l h l r oy is ng C-race Eve lena Grip iqa, Inf Nam¢ 14b. RalaTlomM1lp to De[edent 14c. Informant's Mailing AddrCSZ S[r¢¢t antl Number, Clty. 3[at¢ 2Ip Codef RO~rt Ptaszek son 111 d ~ pp_ A ams Rd., G arlisle, PA 17615 C~ Sa .............. P ace o Oca[ . . e¢ on on ¢ x = `~ , . .... y __ __ . . ... ......................... ......................................~.......... ... If Death Occurretl In a Hospital. Inpatient _If DnatN Occurretl Somewhere OtlTer TM1an a Hospital: Vy~ ~-~~--"""""""""'"""""' ~ Hospice Faclllty y Decedent's Home Q Emvr ency Room/OUtpaClen[ ~ Dead on Orr lval Nursing Home/Long-Term Car¢ Feclllty O[M1¢r (Specify) • 15b. Faclllty Nama (If not Institution, Ive scree[ and num6nr; Select Specialt I~os ital 15c. City nr Town, State, and Zlp Code 15tl. County of Dea[M1 y p Cam Hi11 PA 1701 ' 16a. MetM1Otl of Dlsposl[iOn ~ Burial Gr¢ma[lon SRb_ Date oT DISpV9itlon 16c. Place of plsposltlon (Name of cema[ely, crematory, Ur other pieta) pR¢mo..al r.nm state pDgnatlpn Diner (s aclTy) D 3, 2012 Hoffman-Roth Funeral Home & Crematory 16d. LocaCiOn of Dicpuzi[lon (City or Town, State, antl Zipl 12 . 51 ore of Funeral Servit¢ Licensee or Person In Charge oT In[ermant 176. LI<ense Number $ Carlisle, PA 17013 ~~" 013144E E 12c. Name and fornpla[a Atld rezz of FuneYal Faclllty Ho££man-Roth Funeral Home & Cremat 219 North Hanvoer Street Carlisle PA 17013 ' 18. Decetlent z Etlucaelnn -Check the box [hat br_•zt describes tM1e t9. Decedent of Hispanic Orlgln - CM1etk the 20. p¢[¢dent's Race - CM1eck ONE OR MORE rat<s to Indicate wfiat high¢st degree r level oY school co nple[<d a[ the time of daa[FI. box that bast tlescNb¢z wh¢thaY the tletedent [he decCdent tonsiderad hlmz¢If or herself [o be. ~ r Q BCh grade .l¢ss Is Spanish/Hispanic/Latino. Check the "NO" ~WM1ite ~ Knraan ~ No tllploma, 9th - 12[M1 grade box i(dacetlenT Is not Spanls M1/HlSpaniC/La[Ino. O B18ck or African Am<rlcan 0 Vietnamese Q lilgh school graduate or GEp cumpl<tetl q(NO, not Spanish/Hispanic/Latino p Am<rlcan Indian or Alaska NatlVe Q OtM1er gslan ~ Soma coll¢gn [redlC, buC no dEgi¢¢ ~ Yes, Maxlcan, Mexican AmeNCan, Ghlcano 0 Asian Indian ~ Native Hawallan Associate d68ree (e.g. AA, AS) Q Yes, Puerto RICan 0 CM1In¢se Q Guamanian nY CNamnrro ' ~ Bachelor s degree (e.q. Bq, qp, RS) 0 Ves, Cuban [] Glllpino Q Sam Van ' MasCer s tlagre¢ (e-g. MA, M5, MEng, MEd, MSW, MBA) [] Ycs, other SpanlsF/Hispanic/Latino Q lapanasc Q Other P<clflr Islander ~ Doctorate (e.g. PhD, Ed D) or Professional degre¢ (Spe[ifY) _.. ~ OtM1¢r (Sp¢clfy) . MD Op5 DVM LLB JD 21. Drced¢nt'z single Rgce Sa f-Designation Check ONLY ONE io Intllce [e what the tlecedent cnnslderetl M1lmself or herself to be. 22a. Oacatl¢n['s Usuel Occupation - Indlcafn type of work White ~ Japanese ~ Samoan done during must of workins Ilia. 00 NOT USE 0.ETIRED. Q Bla Tk or girlcan Anrrrican ~ Korean Q Oth P I l er a[Iflc .s antlar ==]VF_fntpZ-Y (Vlgr. [] American Indian Or Alaska Native Q Vt¢tnamnse Q pun'C Know/Not Surn [~ Asian Indian Q Other Asian [] gefused 226. Kind of Business/Industry Q Chlneze Q Native Hawallan ~ Other (Spe[Ify) __ p FuIPN.n p GuamaNan nr cNamnrrp N8V81 Supply Depot ITEMS 23a - 23tl MUST BE COMPLETED BY pER50N WHO PRONOUNCES OR fERTIFIES DEg TH 23a. Date PronoV need Dna Mo OdY r ~ a7 f~- 23 _ 3ignatUr¢ Of Parson PronoVncing O¢at (O~]lY When app ice la) // __ __ /~3L JV) A f~ K^~^ ~ / ~ C'YI'c'~ 3c. Ucensa Numbe[ (D 3 ~ O ~Q a 23tl. D to o>~ ay/Yr) 24. Time D tM1 `~ ~"r ~ .v ~~ O~ ' ~ ` ~ 25. Was M¢d(calE minGr or COronar COnCactedi ~ Yea No CAUSE OF DEATH Apprcxia eta 26. Part I. Enter the ~Naln oT e_~- tllsaases, InjUrles, or compllcaticns--[hat dlYectly caused tM1e tleatM1. DO NOT enter teYminal events such as rardlac arrest InC rv 1: rcz Plratory arresC, or VentYicular flbrlllation without showing [he etinloBY. DO NOl ABBREVIATE. En[¢r only one cause On a line. Add addltlonel lines if necessary Onset to Dee[h i - i IMMEDIATE CAVSE ------------s a. ~~_: sw ON\~ (Final dLseasa or Lonelnon Dup rr,cur ab a con:¢~L=f): - resaltmq In death) ~ J S \ ^ - l 'T- („L'Pe"G segpenuauY nbt ~n.,dmlons - - p a i - , ue to (or es rnr.b ante of): If any. leading to the taus ` 1' = r " 1`P ~ ~`a Rzted on Iln¢ Einar toes ___. ~O rl CL -T \ i' ~ ~ ~-- _ r~ ~ UNDERLYING CAUSE Dub 0[ (or ay a c iscquence Of): (disaasn nr Injury That F Inl[lated the ¢vr nts r¢sulting d. ~ In d¢a<N) IAST. Due to (or az a cons nee equ oH: 26, Part tl. Ent<r other sssgnlFlCan[ condlt o iH bu[ina [o death but not resul[Ing In the Vntlerlying cause gNen In part 1 22. Was an autopsy performed2 ~ Y¢z No m 28. Were autopsy Fln Ings ayallabin [or mplete tM1<c oT daatM1? suss r a E No Q Yes 29_ I Females 30_ Did Toba CCO Usa Con[ribu[¢ to Deaths 31. Mannar of Death ~[ pre nant whhln as[ <ar o g p y n Y~ Q probably ~ryatural ~ Homicide Q PraHnant a[ tlm¢ of death C •-'s• ~ Unknown ~ V Accident p Panding Investlgatlon ~ Not pregnant, but pregnant within 42 days of death Q SVlclda ~ Could not be determinetl Q NU[ pregnant, but pregnanC 43 daVS fo 1 Year before death 31. Dale of Injury (MO/Day/V r) (Sp¢II Month) [] Unknown if pregnant wI[M1in the past y<ar 33. Tim¢ of Injury 34. Plain u! In)ury (e.g. home; [onstrurtlon site; farm, school) 35. LocaHOn of Injury (St MCt and Number. City, STa[a, Zlp Cotle) 36. Injury a[ Work 37. If TYanspOrtatinn Injury, Sp<ci/y: 38. Dascrlb¢ HOw Injn.y OccUrr¢d: ~ Ycs ~ prlvar/Operator [] Pednstrlan n No Q Pa55¢ng¢Y O O[M1¢Y (Sp¢Lify) _ 39a Ca ar (Check only on¢): ortlHl^g PNVSlclan To the bas[ of my kn wledge, dp.rth o <Urr¢d dUa [o Shc caub a finer e(s) and m ~ stated [] P nouncing & ['nrtlfying pM1ysl Lian - To [he best of my knowledge, deatlC ocGUrrcd a[ the Cline, date, and place antl due [o the c s<(s) antl marine s[atetl r C] Medical Examiner/COron¢r- he b t ion, andjU stlgatton, in my oplnlon, death o etl at the time, p (~ /t date, and lace, antl dVe to thr c (s) and manner slated 1 r l 1t ' Slgnafurr of c¢YtlTler: _~/~-_~_~ ~ t/` Tltla of certlfler.~ ~ ^ Ucensa Number' 'mot [I Q r~ ~Z- `~ A 396, Namr, Address antl ZIp Co a nT ParspnlC~om Plating l'ausa oT Death Ilf¢m 26) C.!\ 39c. Date Slgnad (MO/D /VtV [ 4 R<HIS[rar's Ols[rla Number ql_ Reglz[rar'z - store i !" l 42. R Is[rar Flla Oa[a (MO pay Yr) ~ t - ago [~ ~e~ _~ ao ~a, 43. Amendmrntz DISPOSItIOn Permit Nn- o T 14~z,rr(.~ H105-163 REV OT/2011 WILL OF BARBARA E. PTASZEK /.~ /~~ I, Barbara E. Ptaszek, of Cumberland County, Carlisle, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: C7 C+^ 4~A r~, ~~- ~,_ t.L ~-~ ~ ~-., _.. . ~ C. j c> ~6~ ~ ~- A. I direct that my entire estate go to Robert S. Ptaszek and Thomas F. Ptaszek in equal shares. '' ~~=' F.... B. Should Robert S. Ptaszek predecease me I direct J ~+ =r; ~-, , that half of his share go to Thomas F. Ptaszek and = ~~ ~' - the remaining half to Robert S. Ptaszek's son, ~ - ~: !b Mitchell R. Ptaszek. R.. ~ iU ~ J ~ ~~, C. Should Thomas F. Ptaszek predecease me I ~ o ~ , direct that half of his share go to his wife Helen A • ~ , . Ptaszek and the remaining half to Robert S . Ptaszek. 4. I appoint Robert S. Ptaszek, as Executor of this my last Will. Should Robert S. Ptaszek predecease me or cease to act in such capacity, I appoint Thomas F. Ptaszek as alternate. 5. The Executor of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executor acting under this Will shall be required to enter bond in any jurisdiction. LAW OFFICES OP STEPHEN J. HOGG 19 S. HANOVER STREET SUITE ]Ol CARLISLE, PA 17013 IN,~1[IT~VESS WHE O e h reunto set my hand this day of ~p~"y^,a2~009. %'%L ~'~'~-rye ~ / ` ~-~ Barbara E. Ptaszek <~~~~ rs t ~~- The preceding instrument consisting of this and one other page was on the day and date hereof signed, published and declared by Barbara E. Ptaszek as and for her last Will in the presence of us, who at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. LAW OPFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE, PA 17013 ~L~~ WIy~S NESS ACKNOWLEDGMENT LAW OFFICES OF STEPHEN J. NOGG 19 S. HANOVER STREET SUITE I01 CARLISLE, PA 17(113 State of Pennsylvania County of Cumberland ss I, Barbara E. Ptaszek, the Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last Will; that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~, Barbara E. Ptaszek Sworn to or affirmed and acknowledg bef n Barbara E. Ptaszek, the Testatrix, this day of , 2009. I~ARIAL ~1L ' ~~ an s. ' ~'~` ~'~~ Notar~r'I'ublic/Attorney ~urrabortand ~a>. PA ;' ~~ ~zota AFFIDAVIT State of Pennsylvania ss County of Cumberland We, `~ r~ and S ~ ,the witnesses whose na es are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; 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 undue influence. S rn to or aff~Fi'ne ubs lbed to before me by witnesses, this ~~day of , 2009. --- ~~'f~1RlAL 3F~,L tary`Public/Attorne 3taphan J. Slogg, Notary Public Cari'l>!le tea, Gumb®rhnd Co. PA tsly Ca+ge~iealon ~ 3, 2075