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Home My WebLink About01-31-13PETITION 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 requests the grant of Letters in the appropriate form: Margaret L. Maas Decedent's Information Name: Anthony E. Maas, Jr. File No: 21 •-~ /~ ~•~ ..~- a/k/a: (Assigned by Register) a/k/a: a/k/a: Date of Death: 01/21/2013 Decedent was domiciled at death in Cumberland Social Security No: Age at Death: 43 County, pq (State) with his/her last principal residence at 482 Woodcrest Drive, Mechanicsburg 17050 Hampton Cumberland Stn~et address, Post Office and Zip Code City, Township or Borough County Decedent died at Apt. 11, 855 Hamlet Court, Monroeville, PA 15146 Monroeville Allegheny 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 $ If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $ ffnot domiciled in Pennsylvania ................ Personal property in County $ Value of real estate in Pennsylvania ................................................................... $ Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) TOTAL ESTIMATED VALUE ; Street address, Post Office and Zip Code 20,000.00 City, Township or Borough ^ A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated 0.00 20,000.00 County and Codicil(s) State relevant circumstances (e.g., renunciatron, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not ma ,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 om or adopted; 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 Administraton (lf applicable) c.t_a., d.b.n., d.b.n.c.t.a., pedente lite, durante absentia. durante minoritate If Administration, c.ta ordb.n.c.ta., enter date of Will in Section A above and comole list of heirs. Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ® NO EXCEPTIONS ~ EXCEPTIONS k'-=~ ~;::;~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the follow ~guse (if anyj and his ach additional sheets, if necessary): ~~A c. _- k; ~ ,*_.M ,, ~ Name Relationship Address ;~~ e_"a' f ;-~ ~„ • Margaret L. Maas Mother 482 Woodcrest Drive = ~ ~~~~ Mechanicsbu PA 1 ~ r"~' .-, ,.. .... i .,~. ~ Form /~iN-~2 n:v. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 ~~\V ,. _~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Offiaal Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address Margaret L. Maas 482 Woodcrest Drive Mechanicsburg, PA 17050 i ne t~etltloner(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 $~i/e/~Decedent, Petitio/ner(s) will well and truly administer the estate according to law. Swom to or affirmed and,subscribed before `~', /~~~~~ ~` ~ ~ ~~ ~t ~ Date l >~ .3 met ' .~ day of ;~ Date By: ~~ 1."i.t ~l~1rl P i~' _ E--~~~1' ~y G j "L,,- Date For the Register ~~ BOND Required? ~ YES ~X NO FEES: Letters . ......................................... ( ~~ )Short Certificate(s)......... ( )Renunciation(s) .............. ( )Codicil(s) ........................ ( )Affidavit(s) ...................... Bond ... .......................................... Commi ssion .................................. Other ~~1~~~ ~ ~"- 1(~~.. _ ~t 1\+ l~_It'lthr ~-~ Automation Fee. JCS Fee............ TOTAL .............. Date ~r~.L(, ~`~ (~` J. ~ (r ~`s i:_ ~ ~Ji~• ,L To the Register of Wills: riease enrer my appearance oy my signature pe~ow: Attorney Signature: . _ _ ~~~ ~. ' s~-v C v.,.r r' B'"~ ~ ~~ c;;"~ w Printed Name: Neil E. Hendershot fas~iq. ~-- ~~°;7 ;~ - , ~~ Supreme Court r'r, ~-: ~~ . ' ~~~ , ID Number: 23316 "'~'~, ,.._ .., ~~ '~ ~ Firm Name: Serratelli Schiffman 8 ~r~~~yywn P.C. ~Y~~ ~ x Address: 2080 Linglestown Road w Suite 201 ."'rte ~ .. ` - .° `~"t Harrisburg, PA 17110 Phone: 717-540-9170 Fax: 717-540-5481 E-mail: nhendershot~Dssbc-law.com DECREE OF THE REGISTER Date of Death: 01/21/2013 Social Security No: Estate of Anthony E. Maas. Jr. File No: 21 ~- ~ ~ / {! a/k/a: AND NOW, ~~ ~ ~ ~ ~ (.~ 1 ~. '~ satisfactory proof having been presented ,~ P ~ , in consideration of the foregoing Petition, me, IT IS DECREED that Letters of Administration are hereby granted to Margaret L. Maas in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. ~_ ~~~, Register of Wills ( !) , ~ r - ° Y Copyright (c) 2011 form software only The Lackner Group, I c. ~' ~ , "~ t • ~ ~ ^ '~~ ` ~t 1 Pa e 2 of 2 ! g 'ar a t > ~ , "I "`' ~~ F ~ JAN 2 7 2013 1-E i. i s~, r e ti..~ a,~ ~~~ Type/Print In COMMONWEALTH OF PENNSV LVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent CERTIFICATE ClE 1'~EATF-1 L~~ W `~ O ~~ .~.. 0 0 z 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Numbery 4, Date of Death (MO/Day/Yr) (Spell Mo) Anthony Ernst Maas, Jr. JANUARY 21. 2013 Sa. Age-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Day 6. Date of Birth (MO/D ay/Year) (Spel l Month) 7a. Birthplace (City and S tate or Foreign Country) Months Days Hours Minutes Harrisbur , PA 43 February 4 , 1 969 76. Birthplace (county) Dau hin 8a. Residence (State or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Sc. Did Decedent Live in a Township? Penns lvania QYes, decedent lived in tw Sd. Residence (County) 955 Hamlet COUrt , Apt _ 1 1 p. Allegheny 8e. Residence (Zip Code) 15146 ~No, decedent lived within limits of Monroeville city/born. 9. Ever in US Armed Forces? 10. Marital Status ai Time of Death Q Married Q Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) Q Yes ~ No Q Unknown Q Divorced [~ Never Married Q Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) Anthony E. Maas, MD Margaret Lampley 14a. Informant's Name 14b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) o Margaret L. Maas Mother 482 Woodcrest Drive, Mechanicsburg, PA 17050 w ....................................... ............. .... .. .................................... ... ...... ........ lSa_Place of Death (Check only one) ° If Death Occurred in a Hospital: Inpatient : ; .................__........................ _............................ . If Death Occurred Somewhere Other Than a Hospital: Q Hospice Facility ~ Decedent's Home Emer enc Room Out atient Q g Y / p Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Q Other (Specify) 156. Facility Name (If not institution, eve st eet and number; 955 HA7NTET CT A~'T ~11 15c. City or Town, State, and Zip Code 15d. County of Death LL _ MONROEVILLE~ PA 15146 ALLEGHENY 16a. Method of Disposition Q Burial ~ Cremation 16b. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, or other place) Q Removal from Stale Q Donation Januar 25 ' Q Other (Specify) 2013 Evans Crematory 16d. Location of Disposition (City or Town, State, and Zip) 17a. Sign atu rg of Fyne I Serv" Licensee or Person in Charge of Interment / / 17b. License Number Schaefferstown, PA 17088 ~~ IY FD 013 340 L ~ 17c. Name and Complete Address of Funeral Facility Parthemore FH & CS, Znc_ P.O. Box 431, New Cumber land, PA 17070 ° 1S. Decedent's Education -Check the box that 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 time of death. box that best describes whether the decedent the decedent considered himself or herself to be. Q 8th grade or less is Spanish/Hispanic/Latino. Check the "No" ~) White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Q Black or African American Q Vietnamese Q High school graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college credit, but no degree Q Ves, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro [~ Bachelor's degree (e.g. BA, AB, BS) Q Yes, Cuban O Filipino Q Samoan Q 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, EdD) or Professional degree (Specify) Q Other (Specify) (e. MD, DDS, DVM, LLB, JD) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occupation -Indicate type of work [}~ White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Q Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native QVietnamese QDon't Know/Not Sure FOOd Service Manager Q Asian Indian Q Other Asian Q Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Chamorro Food Service ITEMS 23a - 23d MUST BE COMPLETED BY PERSON WHO PRONOUNCES OR 23a. Date Pronounced Dead (MO/Day/Yr) 236. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number CERTIFIES DEATH 23d. Date Signed (Mo/Day/V r) 24. Time of Death 3:50 PM 25. Was Medical Examiner or Coroner Contacted? Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or com piicatio ns--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary Onset to Death IMMEDIATE CAUSE ---------------> a. HF.PATTC: ('.TRRH(7STS (Final disease or condition Due to (or as a consequence Of): resulting in death) b . Sequentially list conditions, Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c. UNDERLYING CAUSE Due to (or as a consequence of): w (disease or injury that initiated the events resulting d. ~ V in death) LAST. Due to (or as a consequence of): 0 26. Part II. Enter other significant conditions contributive to death but not resulting in the underlying cause given in Part 1 27. Was an autopsy performed? ~ 7~Yes Q No DILATED CARDIOMYOPATHY 28. Were autopsy findings available to complete the cause of death? Ves Q No o 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death . Eo Q Not pregnant within past year Q Yes 0 Probably '~' Natural Q Homicide ~ Q Pregnant at time of death ~ No Q Unknown Q Accident Q Pending Investigation Q Not pregnant, but pregnant within 42 days of death Q Suicide Q Could not be determined 0 ;-- Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) Q Unknown if pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Ves Q Driver/Operator Q Pedestrian Q No Q Passenger Q 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 Q Pronouncing 8, Certifying physician - o the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Medical Examiner/Coroner - xamination,.and Lo~.iqu~tigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner stated ll~yllff~~KK 11 1111VV Signature of certifier: Title of certifier: SR- =NVEST~iGATOR License Number: 39b. Name, Address and Zip Cod of Person C pleting Cause of Death (Item z6JpFFZCE OF THE P~DICAL Z?xA7~T 39c. Date Signed (MO/Day/Yr) OF ALLEGHENY COIINTY - 1520 PENN AVE_ PITTSB PA 15222 JANUARY 22, 2013 40. Registrar's District Number 41. Registrar's 5' ture 42. Registrar File Date (MO/Day/Yr) ..~ - // ~ ~/-~s/aoi~ 43. Amendments //~~QQ CC H105-143 Disposition Permit No.VU ~ JS~~ _ REV 07/2011