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HomeMy WebLinkAbout02-01-13PETITION 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: THERESA F. LACERENZA File No: .~ ~ - ~ ~ j - (.1 ~ ,~. y a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 01/21/2013 Age at death• 81 Decedent was domiciled at death in CUMBERLAND County, pF.NNSYI.VANIA (State,) with his/her last principal residence at 317 JUNIPER STREET. CARLISLE 17013 BOROUGH OF CARLISLE CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at CARLISLE REGIONAL MEDICAL CENTER CARLISLE 17013 CUMBERLAND 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 $ 6,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ A If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ 6.000.00 Real estate in Pennsylvania situated at: (Attach additional sheets, iJ necessary.) Street address, Post Office and Zip Code City, Township or Borough ® 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 OCTOBER 29, 2012 thereto dated County and Codicil(s) 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(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS 0 EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.t.a. or db.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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS ~ EXCEPTIONS .., Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the fol~ving spouse (~,y) aa~he';Qs (attach additional sheets, if necessary): ~ p --r~, ~ ~ W Name Relationshi A e7 t~ ~ ~ ~ z rr: ~,, ; ~ r~T x~~ :~~ °nc~ ~ _,.t..~ ,Y> ,1~ ~ Form RW-01 rev. /0//I/?Dll Page 1 Of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } } ss: } Petitioner(s) Printed Name Petitioner(s) Printed ' J JANINE M. FOOSE 317 JUNIPER STREET CARLISLE PA 17013 ERK Cr •, The Petitioners) 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 P'~rsona! Representative(s) of the Decedent, the Petitioner(s~will well and truly administer the estate according to law. Swot-n to or affirmed and z ubscribed before ~,~~~~, ~1'' ~~~'°~ Date Z /i ~r~ me this I ,n pday of ~~ f/L~. i, ~~~ Date By: ~~j z~C`i .~~ l,Ll ~ ~1~~ Date F'or the Reu.st~r Date BOND Required: Q YES Q NO To the Register of Wills: FEES' Please enter my appearance by my signature below: Letters ...................... $ 45.00 ( 1) Short Certificate(s)...... 5.00 ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ WILL ........ 15.00 INVENTORY ........ 15.00 INH TAX RETURN ........ 15.00 Automation Fee ............... 5.00 JCS Fee . .................... 23.50 TOTAL ..................... $ 123.50 Attorney Signature Official Use Only RECOR~~~ ~~-~~;~ 0~ REGI -~'~" ~~ -~ c~~. Printed Name: ROGER B. IRWIN, ESQUIRE Supreme Court ID Number: 6282 Firm Name: IRWIN & McKNIGHT, P.C. Address: fi0 WEST POMFRRT STREET C'ARi.ISi.F., PA 17013 Phone: (717) 249-2353 Fax: ,1717) 249-6354 Email DECREE OF THE REGISTER Estate of THERESA F. LACERENZA File No: ~ I " ~~ ~ ~ ~- y a/k/a: AND NOW, , ~, inconsideration of the foregoing Petition, satisfactory proof having been presente before me, IT IS DECREED that Letters TESTAMENTARY are hereby granted to JANINE M. FOOSE in the above estate and (if applicable) that the instrument(s) dated OCTOBER 29, 2012 __ described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. r i~ Register of Wills ~ -, ro,-mRwoz Yeti,. io~~~~~ot~ Page 2 0 2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is iNlegal to duplicate this copy by photostat or photograph. RECORDED OFF;rE OF „ncnt~.-~_~ cc ,vJ u,n ceruucale. ao.(w~~~v1,~ 1 tK OF t~',~~~ ~~ This is to certify that the information here given is correctly copied from an original Certificate of Death ~~~3 ~~~ ~, duly filed with me as Local Registrar. The original t~1~ ~ QT certificate wi11 he t(n•warded to the State Vital CLERK ~~ Records Office tin- pe1•manent filing. ~~~~~ .~ ~~ ~~PHANS' COUF~ i L ~ixv~.~ ` _ ~_ JA 23 013 Certification Islumb . LAND CD,f P~4 Local Re~~istrar Date Issued Type/Print In COMMONWEALTH OF PEN NSVLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent Black ink CERTIFICATE OF DEATH 1. Da.-..d _.a•~ r e._~, .~--- .~.--- --.... - - - - -- - --. - --- -~~--. • ~ ~~ .....+v car e. Vnder 1 Da 6. Date of Birth (Mo/Da 8, Months Days Hours Minutes June 21, Sa. Residence (State Or Foreign Gou ntry) 8b. Residence (Sir<et and Number -Include Apt No.l PA 3'17 Juniper St_ 8d. Residence (County) Se. Residence (Zip Code) 9. Ever In US Armed Forces? 30. Marital Status at Time of Death ~ Married W Q Ves ~ No ~ Vnknown 0 Divorced Q Never Married 0 Unknown 12. Father's Name (First, Middle, last, Suffix) 1 William Maslowski 14a. Informant's Name 14b. Relationship to Decedent 1 arsine Foost= Dau titer If Dea[h Occurred in a Hos Ital: WW/r ---------••'•••'----"-'-""'••----••r•••--•: ••----•:--•••Ce•~....eat f P pt Inpatient - :If Death Occurred Somewh ° ~ Emergency Room/Outpatient Q Dead on Arrival Nursing Home/Lor 156. Facility Name (If not institution, give street and number; •15c. City or Town, State, ar LL_ 1 16a. Method of Disposition ~ Burial Cremation 16b. Date lDispo511tion m ~ Removal from State 0 Donation ~~• Doer (specify) 'I / 2 5/ 2 0 1 3 $ 16d. Location of Disposition (City or Town, State, and Zlp) 17a. Slgnatr of Funeral 5~ 0 0 -28-7 436 (January 21 20'I 3 Birthplace (City and State or Fo rer¢n Countrvl 1 93'1 mx r 7b. Birthplace (Cr Bc. Did Decedent Llve In a Township? Yes, decedent lived in ~No, decedent lived wlthin limits of name Prior to twp. for to First Marriage (First, Middle. Last) ly Sctloci)t r ant's Malting Address (Street and Number, City, State, Zip Gode) Juniper St_ Carlisle, PA "170'13 .~Y.....a 1.....~ ..............Ocher 5 ......-......a .... _ ier Th n a Hos Ital: ................. .-...-.........-......-..... P Hospice F cility ~ Decedent's Home Care Faclli ( pacify) ode 15d. County of Death l 70l 5 ltn7-~ rl nd 1 f DI p it (Name of cemetery, cr<matory, or other place) 11in er Funeral Home & Crematory I r Person In Charge of Interment 17b LI N ~ Mt _ Ho11 S rin S PA ~ 7065 l ~• ~i umber <ns E ~ 17c. Name and Complete Address of Funeral Facility HO 1 1 nq 507 N Baltimo e Fune r Home & ~ r ma D FD- '1 388'1 2 _ re Ave _ Mt _ 18. Decedent's Education -Ch k h H o l S rin P , ry, Inc _ 0 ~ eV ec t e box that best describes the highest degree or level Of school completed at the Hme of death 19 t A . Decedent of Hispanic OrIgInSCh eck 2 0 e Cedent's Race -Check ONE OR MORE . Q 8th grade or less box that best describes whether the decedent is Spanish/Hispanic/L ti h " " races to indicate what the decedent considered himself or herself to be. 0 No diploma, 9th - 12th grade HI h school 1Bt B graduate or GED l a no. C eck the NO box if decedenT Is not Spanish/Hispanic/Latino. ~ White ~] Korean ~ Black or Afri comp eted ~ Some college credit, but no degree ~ No, not Spanish/His i pan c/Latino ~ Yes Mexlca n Mexic A can American 0 Vietnamese 0 American Indian or Alaska Native Q Other Asian Q Asso<Iate de gree (e.g. AA, q5) ~ Bachel ' d , , an merican, Chicano Q Yes, Puerto Rican 0 Asian Indian 0 Native Hawaiian or s egree (e.g. BA, Ag, BS) Q Master's degree (e. g. MA, M5, MEng, MEd MSW MBA) ~ Yes, Cuben Q Chinese ~ Guamanian or Chamorro ~ Filipino S , , Q Doctorate (e.g. PhD, Ed D) or Professional degree ~ Ves, other 5 Panish/Hispanic/Latino ~ amoan ~ Japanese 0 Other Pacific Islander . MD DDS DVM LLB 1D (Specify) ~ Other (Specify) 21. Decedent's Single Race Self-Designation -Cheek ONLY ONE to Indicate what the decedent consltle red himself or herself to b White _ 22 ' [] Japanese Q Black or African Am erlcan Q Korean ~ American Indian or Al k 0 Samoan ~ Other Pacific Islander e. ~ a. Decetlent s Usual Occupation -Indicate t ype of wort done during most of working life. DO NOT USE RETIRED. as a Native Q Vietnamese Q Don't Know/Not Sure Q Asian Indian Q Other A i ~ s an ~ Chinese ~ Native H<wailan r [] Refused 22b. Kind of Business/Industry Q Other (Specs f ) P ~ FIII Ino Q Guamanian or Cham Y orro Home ITEMS 23a - 23tl MUST BE COMPLETED 23a. Date Pronou need Dead (Mo Day Vr) 23b. Signature of P<rson Pronouncing Death (Only when a BY PERSON WHO PRONOUNCES OR licabl CE RTIFIES DEATH 1 ~• + ~ rj pp e) 23c. License Number 1 ~21 ~ 13 23d. Date Signed (Mo/Day/V r) 24. Tim< of Death 1 1 ~~ 2 ' 25. Was Me ai Examiner Or Coroner Contacted? ~ Yes ®' No 26. Part 1. Enter the chain of t --diseases, inJu rtes, or compl respirato arr t CAUSE OF DEATH ications--that directly caused the death Approximate DO NOT t . ry en es er terminal events such as cardiac arrest , or ventricular flbrillatlon without showing the etiolo Interval: gy. DO NOT ABBREVIATE. Enter onl o IMMEDIATE CAVSE -------__.._____~ a y ne cause on a line. Add additional Ilnes if necessary '- Onset So Death AS`( 7~ ~ (Floe( disease or condition resulting in death) as a con -- Due to (or sequence of): Se b. qua ndally Ilsi conditions I'-\V 1T\O \26AN t=P.\1-V RE , if any, leading io the c e D t ( nsequence of). listed on line a. Enter the UNDERLYING CAUSE 4 ~ F, (d lsease or Injury that D t (or a5 a consequence of). - initiated the a n[s resulting d. e rn death) LAST. 26 P Due to (or as a copse - quence Of): 1. art II. Enter other si¢ntflca nt d'ti o t ib ti de C^ iO ' ' th but not resulting in the under) In Y B cause given In Part i ~ N 1c f `tTnA\ F t\s t-a I t-l~+.Z t o N 27. Was an autopsy performed? ~ M y,~. ST MCt.J~.~ GQsv1S O ~ sJ 26. Were autopsy flndl ng avallable EO 29. If Female: g] Not pregnant within past year t plete the cause of death? 30. Oid Tobacco Use Contribute to Death? n coo Yes ® No 31. Manner of Dea[h r. .r Q Pregnant at time of death 0 Not pregnant, but pregnant wlthin 42 days of death ~ Yes Q P;o ncbwn Natural ~] Homicide ® No ~ U k ~ Accident ~ Not ~ pregnant, but pregnant 43 days to 1 year before death U 0 pending Invests lion 0 Suicide ~ Could not be de ermined 32. Date of In M /D Ju ( Q nknown if pregnant within the past year o a /Yr) (Spell Month) y ry 34. Place of Injury (e.g. ho nnstruction site; Farm; school) 33. Time of Injury 35. Location of In Jury (Street and Number, City, State, Zip Code) fib. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes 0 Driver/Operator Q pedestrian 0 No ~ Passenger ~ Other (Specify) 39a_ Certifier (Check only one): Q Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated Pronouncing g. Ce rtifying physician - To the best of my knowledg<, death occurred at the time, tlate, and place, and due to the cause Q Medical Examiner/COr er - On the bass examin ti n and/or investigation, in (s) and manner stated / ...,6 my opinion, death o red at the tim<, date, and place, and due to the cause(s) and manner stated Signature of certifier: ~[ ) / f I ~ L Title of ce rtifler: {`~\ [~ 39b. Nam;, Adtlress and Zip de of Person Com lets License Number:"\fl L-\1\ (7'} ZL1 ANC.~~ t GA .S7 v RYE P ng Cause of Death (Item 26) 39c. Date Signed (MO/Day/Vr) 40. Registrar s OIS[rict Number ~ ~ \ / 2 L / j '3 41. Registrar's 5 lure 42. Registrar File Date (MO Day r) c~ \ - vim,\6 ~rel _ • e~t~1 ~<+e- l _ Disposition Permit No. V D ~ ~~ ~ H105-143 REV 07/2011 LAST WILL AND TESTAMENT I, THERESA F. LACERENZA, of North Newton Township, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix or Substitute Executrix, as the case may be, to pay all of my debts, funeral and administrative expenses as soon as convenient after my decease. Furthermore, I direct that all state, inheritance, succession and other death taxes imposed or payable by reason of my death and interest and penalties thereon with respect to all property composing of my gross estate for death tax purposes, whether or not such property passes under this Will, shall be paid by the Executrix or Substitute Executrix from my estate, and that none of the aforesaid taxes shall be prorated among those persons named herein or otherwise beneficiaries hereunder. 2. My Executrix or Substitute Executrix may, at her discretion, compromise claims, borrow money, retain property for such length of time as she may deem proper; lease and sell property for such prices, on such terms, at public or private sales, as she may deem proper; and invest estate property and income without restriction to legal investment unless r.. orw~ ~ ~' ~° to -~, ~ - ~? ..b provided hereunder. ~ ~ ~ r „ o ~ ~ ~ ~ ~ r-n ~, rr~ rn v, :v ~ w+ ~~ Q ~ ~ ~ ~ ~ z~ `.~ ,. ~ c~ r.;,, r,,,. rn ~ a• © cn o 3. I authorize and empower my Executrix or Substitute Executrix to sell any realty and/or personalty owned by me at my death and not specifically devised or bequeathed herein, at public or private sale or sales and to give good and sufficient deeds and/or bills of sale therefor, in fee simple, as I could do if living. My Executrix or Substitute Executrix is authorized and empowered to engage in any business in which I may be engaged at my death, for such period of time after my death as seems expedient to said Executrix or Substitute Executrix. 4. I give, devise and bequeath all of my estate of whatever nature and wherever situate to my daughter. JANINE M. FOOSE, and if she is not living at the time of my death, to my granddaughter, MICHELE M. ST. PIERRE. 5. I nominate and appoint JANINE M. FOOSE to be the Executrix of this my Last Will and Testament. In the event she has predeceased me, failed to qualify or is not able or does not serve for whatever reason, I then appoint MICHELE M. ST. PIERRE to be the Substitute Executrix of this my Last Will and Testament with the same powers as are given to the original Executrix hereunder. 6. No person shall benefit hereunder unless such beneficiary shall survive me by sixty (60) days. 7. No Executrix or Substitute Executrix acting hereunder shall be required to post bond or enter security in this or any other jurisdiction. 2 8. No beneficiary may assign, anticipate or pledge his or her interest in any income or principal held or distributable hereunder, and no beneficiary's creditors may levy, attach or otherwise reach any such interest. 9. I hereby suggest that my personal representative retain the services of Irwin & McKnight, P.C. as attorneys in the settlement of my estate. 2012. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 29~h day of October ~ , ~ THERESA F. LACERENZA Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in our presence, who, at her request, in her presence and in the presence of each other have hereunto set our names as subscribing witnesses. .- i ~~ .=. 3 ACKNOWLEDGMENT AND AFFIDAVIT WE, THERESA F. LACERENZA, MARTHA L. NOEL and SHARON L. SCHWALM, the Testatrix and 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 purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. F ifs i THERESA F. LACEREN~A z ~~ ~- ~-~, r' '~ r ." ~'~--'-~ MART A L. OEL ~~~1' c~G ox., r~ ~,~ SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by THERESA F. LACERENZA, the Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and SHARON L. SCHWALM, witnesses, this 291h day of October 2012. rJ /Notary Public IM EALTH OF PENNSYWAI Notarial Seal Roger B. Irwin, Notary Public Carilste Bono, Cumberland County ly Commission Expires Oct. 3, 2016 t, PENNSYWANIA 4SSOCIATION Of NOl