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HomeMy WebLinkAbout02-15-13 rte.;. rnrn PETITION FOR GRA~1T OF LETTERS trn "° ~ ^'' ~ ~ Q' ~"' ~, REGISTER OF WILLS OF Petitioner(s) named below, who isiare 18 years of age or u support thereof aver(s) the following and respectfully requests j Decedent's Information Name: ~~~~ ~ ~i~ ~ ~I~ ~ 1 a/k/a: a/k/a: a/k/a: ~v ~ r f--j ~ rn COtINT~ct'"'P~~ff~L~C,A~NIA~ ~' ~` ~ Z ~ ~'c Q '"r1 Eder, apply(ies) for Lettea~?speed low and in the grant of Letters in~e proprta~e. ~ormr:... File No• (Assigned by Register) Date of Death: d ~ ©~~ ~_n / ,~3 Social Security No: ~ ~ ~ ~~ ~~ ~~ Age at death• ~;~ Decedent was domiciled at death in ~G~/Yj~,~ ,C~-,~~ County, ~~1 (Srare) with his/her last principal residence at Street address, Post Office and Zip Code City, Township or Borough County Decedent died at ~ 'ZI N~ /~T~ ~T , CR/r~ till ~ ~ /'7D / / l'~~ ,•G1 !3 ~~ ~,y-/~1~ ~~ Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: Ifdomiciled in Pennsylvania ............................ All personal property $ Ijnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ ~6 i a ~ O Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County [v~A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/the is./aj~ the Executor s) named in the last Will of the Decedent, dated and Codicil(s) thereto dated ~ /" cZ ~ State relevant circumstances (eg. renunciation, death ojexeartor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced, was not a parry 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 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 Administration (If applicable) c.t.u., d.b.n., d.b.n.c.t.a., pendente life, durunte absentia, duratTte 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 parry 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. ^ 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 (uttuch uclclitionul sheets, if'necessury): Name Relationshi Address Fo,•,» Rw n1 rev. 10/l1/1011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } SS: } Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address ~e ~ cti~~l~ ~. G~slt'f3~ a~ /~ ~~~ N~ ~~7rX 5T ~~~ ~~' ~~~ ~~ ~ ~~` 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 Petitio r ) wil well and ruly administer the estate according to law. Sworn to or affirmed and subscribed before ~ Date ~o `~ ~~ me thi ~~day of fe C/Gtr ~%3 Date BY~ Date the Register Date BOND Required: ~ YES Q NO FEES: Letters .............. ..... . ( c7 )Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other .,.,,,, $ 310°° j ~' b ADD Q1~ ./lt ....... ~ c~ Automation Fee . ............. . JCS Fee . ................... . TOTAL ..................... i~.oa $ -x°66" / d~-~D To the Register of Wills: Please enter my appearance by my signature low: ~ Attorney Signature: G O ~ ~ rn ~ ~ [~" Z Crri -r1 ~ C.!'1 fY1 ~-~, ,~ C ~ a ~ ~ 2 ~ 7C ~ '~ Printed Name: ~ ~ C3 ~ ~ ` i Supreme Court C Q ~j " ID Number: ~ f--~ " 1't'1 t" ~ ~ `~ Firm Name: ~' --~ Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of /~-~ ®r1u~ ~ ~ a/' Q C i ~ File No: ~I " /.3 ' ~~ 9~ a/k/a: AND NOW, ~ u C!i' ~ , ~0 i , in consi~ration of the foregoing Petition, satisfactory proof having been esented before me, IT IS ECREED that Lett rs { f Cl ~I'~~'~ ~ C~ are hereby granted to ~j G A~~ ~ q ~, ~ In the above estate and (if applicable) that the instrument(s) dated c/2 ~~ a ~ described in the Petition be admitted i Form RW-02 rev. 10/11/2011 z probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills v Page 2 2 H105.805 REV (9/11) Z /~ /~ ~ / LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this EOpy by photostat or photograph. ~fe4R~E~a o fi~-,~~ Fee for this certificate, $6.00 R~GiST~R QF ~~~~-~~ This is to certify that the information here given is P ~.9398~69 Certification Number Type/Print in Permanent ,,,Il'''`a~ _ Ny =_ correctly copied from an original Certificate of Death ~~~3 r EU I S `~~~`' ~ __ __ , `~~_; duly filed with me as Local Registrar. The original ~_ ~-_, °-. s certificate will be forwarded to the State Vital ALE = ~ yam= a~ Records Office for permanent filing. _ _ ~ *,~~ ~R~'R~~1S ` _ - ~~~~'~~ ~G~ FEB 0 8 13 I ~~~$ERLd~yp ~_' T o~,~tltll s~ ~~ """ Local Registrar Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS /^C~T~L~f^ATC Ar' r•~I• ~ - - - - - - - -` ~ State File Number: 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4 O . ate of Death (MO/Oay/Yr) (Spell Mo) Ra nd R Februar 8 2013 Sa Age-Last Birthda (Y ) Sb U d . y rs . n er 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Year) (Spell Month) 7a. Birthplace (City and State or Foreign Country) h 83 Mont s Days Hours Minutes H$Zleton A November 20 1929 f 7b Birthplace (Count ) . y z 8a. Residences State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) 8c. Ofd Decedent Live in a Township? Penns 1Van1a )Yes, decedent lived in Hampden t,~,p 8d. Res id e nce (County) 107 r11 Dr 7 ~ ~ Ciumberland Se. Residence (Zip Code) Q No, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death Q Married ~j Widowed 11. Surviving Spouse's Name (If wife give name rio t fi , p r o rst marriage) Q Yes ~ No O Unknown O Divorced O Never Married O Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, last) Francis A Garbacik . Nellie V. Skitzki 14a. Informants Name 14b R l ti hi D ' g . e a ons p to ecedent Richard J. Garbacik Brother 14c. Informant s Mailing Address (Street and Number, Clty, State, Zip Code) 221 North 17th St. Hill PA 17011 ¢ ° _ _ _ _ _ _ 15a_P ace o eat ec on Lr one _ _ _ If Death Occurred in a Hospital: d Inpatient ~If Death Occurred Somewhere Other Than a Hospital: ~ Hospice Facility ~ Decedent's Home D Emer e R g ncy oom/Out atient ~7 f p Q Dead on Arrival 1 Q Nursing Home/Long-Term Care Facility ~~Other (Specify) SSb F ilit N . ac y ame (If not institution, give street and number) SSc. City or Town, Staie, and Zip Code 15d. County of Death 221 N th 17 h ~ ' or t St. Cam Hill Cumberland ~„ 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 State O Don ti a on p Other (Specify) 02/14/2013 Hollinger Crematory S6d. Location of Disposition (City or Town, State, and Zip) 17a. ture of Funeral Service nsee o rson in Ch erment 17b. License Number ~ Mt. Holly S rin s PA 17065 p g , 014819 E 17c. Name and Complete Address of Funeral Facility s M ers-Harper Funeral Home inc. 1903 Market St. H:i ll PA 17011 r~ 1-° . 1S. Decedent's Education -Cheek 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 com leted t th ti f d p a e me o eath. box that best describes whether the decedent the decedent considered himself or herself to be. ~ Sth grade or less is Spanish/Hispanic/Latino. Check the "No" ~ White ~ Korean ~ No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino Bl k f . ac or A rican American ~ Vietnamese High school graduate or GED completed No, not Spa nlsh/Hispanic/Latino O American Indian or Alaska Native O Other Asian Same colle e credit b t d ~ g , u no egree Yes, Mexican, Mexican American, Chicano ~ ASIan Indian ~ Native Hawaiian ~ Associate degree (e.g. AA, AS) p Yes Puerto Rican , Q Chinese ~ Guamanian or Chamorro ~ Bachelor's degree (e.g. BA, AB, BS) 0 Yes, Cuban ~ Fili i p no ~ Samoan O Master's degree (e.g. MA, M5, MEng, MEd, MSW, MBA) O Yes, other Spanish/Hispanic/Latino Q Japanese ~ Oth P ifi l er ac c Is ander ~ Doctorate (e.g..Ph D, Ed D) or Professional degree (Specify) O 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 ~ Samoan done during most of working fife. 00 NOT USE RETIRED. Black or African American O Korean Q Other Pacific Islander O American Indian or Alaska Native ~ Vtetna mese Q Don't Know/Not Sure Electrical Contractor ~ Asian Indian Q Other Asian p Refused 22b_ Kind of Business/Industry ~ Chinese O Native Hawaiian O Other (Specify) Q FIIIPtno Q Guamanian or Chamorro Electrical Services ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day/Yr) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number BY PERSON WHO PRONOUNCES OR ~r ~~ A , CERTIF E ~~ ~O I S DEATH z-L.7 t~ ~ ~_ `~~ ~~~~ 23d. Date Signed (MO/Da /Yr) 24. Time of Death N ~E$R'~Q' ~Q ~~ ~ ~ ~lYY~ 25. Was Medical Examiner or Coroner Contacted? Q Yes No CAUSE OF DEATH I I Approximate 26. Part 1. Enter the chain of events--diseases, Injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: , I respiratory arrest, or ventricular fibrillation without showing the etiol DO(~tOT ABBREVIATE. Enter only one cause on a line. Add additional lines If necessary. 1 Onset to DeAth IMMEDIATE CAUSE ---------------> a. 1` Q SAII lA ~ ~ Y ~ r / V ~ 'Q.. ~ (Final disease or condition Due to (or as a consequence of). 1 (l resulting in death) b ~I~ ~ S~ /1~G ~ I1 r9 O I ~_ Saquentla lly list conditions, Due to (or s a consequencj a o~~ 1 If any, leading to the cause I ~ listed on Tine a. Enter the c. '~ dL ~ ~>' ~~ I ~~ I _ UNDERLYING CAUSE Due to (or as a consequence of): W , (disease or Injury that ~ F 1 Initiated the events resulting d. I a c ~ in death) LAST. I Due to (or as a consequence of): $ I T6. Part 11. Enter other si¢nificant conditions contributlna to death but not resulting in the underlying cause glVen in Part 1. 27. Was an autopsy performed? • •~ ~ ~ ~ ~~ O~ ~~ S Q Yes No m 28. Were autopsy findings available to complete the taus of death? 29. If Female: ~ Yes No a Q Not pregnant within past year 30. Did Tobacco Use Contribute to Dea[h? 31. Manner of Death ° ' Q Pregnant at time of desth Q Yes Q Probably p No ~ Unknown ~ Natural Q Homicide A id ~ Q Not pregnant, but pregnant within 42 days of death cc ent Q Pending Investigation Q Suicide Q Could not be determined ~ ~ Not pregnant, but pregnant 43 days to 1 year before death ~ Unknown if pregnant within the t 32. Date of Injury (Mo/Day/Yr) (Spell Month) pas year 33. Time of 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 Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Yes Q Driver/Operator Q Pedestrian ~ No p Passenger ~ Other (Specify) 39a. Certifier - physician, certified nurse practitioner, medical examiner/coroner (Check only one): Certifying only - To the best Of my knowledge, death occurred due to the ea use(s) and manner stated. P i ronounc ng !Z< Certifying - To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated. D Medical Examiner/C oner - On the ba examination and/or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and ma n ner stated. l r r Signature of certifier. t Title of certifier ~ • ~ + License Number0 S ~ D ~C } Tj ~~ 3 sme, dress Zip ode of P rson Completing Ca se of D ath (Item 2 ) 39c. Date 51 ned Mo ay/Yr) ~a~~ . ~ pro ~o So ~r ~...~-. ~~ c~t'~e~- (..- r-'.o ht ~ ~- fwd ~-f 3 e .a.-~o ~ .L© c3 40. ReglStra r'S District Num er / 41. Registrar's 51 re ~ 42. Registrar FI a Date Mo/Day/Yr) 43. Amendments Disposition Permit No. Q d ~SS^c~ -SI H105-143 - REV 07/2012 r'-..a ~rn ~~ ~ ~~ r"n = ~ a' to a ~vrr ~ z ~ ~ cn ~m ~,- ~- . Last W111 and Testamer ~tn ~ -~ ~ ~ . ~~ . ~~ OF ~' ~ "--~ r~~~ m ° ~ rya cn - n RAYMOND R. GARBACIK I, RA~'MOND R. GARBACIK, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or C.,odicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II SPECIFIC BEQUESTS I direct my Executor or Successor to sell all of my shares of stock in Wachovia Bank and it• cliri•~c,.v.._>ry wn.~ m,~ e~-i,~.~c?n n~ros,};~.- , ~A~~,~,,+~. SAD s~ nor sharps of stock in Allied Irish Banks, p.l.c. presently held in my brokerage account with Manufacturers and Traders Trust Company, account number AZD-318999, into which account I have placed the above-mentioned securities which my wife inherited and which she gave to me when she passed away in 2005 (or the then traceable proceeds thereof if I should sell some or all of such securities after the date of my Willj, and to distribute the proceeds as follows: A. ONE-HALF (1/2) thereof unto my brother, RICHARD J. GARBACIK, provided he survives me. If my brother, RICHARD J. GARBACIK, predeceases me, I give and bequeath his share unto my brother, EDWARD M. LESNY, and should he also predecease me, then unto his then-living issue, per stirpes; and B. ONE-HALF (1/2) thereof, in equal shares, one such share unto each of the following who survives me: EMILY BLAIR BUCKBEE, Shiremanstown, Pennsylvania; GARRETT JACOB BUCKBEE, Shiremanstown, Pennsylvania; BRENDON ROBERT JONES, Camp Hill, Pennsylvania; MARGARET BLAIR WILCOX, Clearfield, Pennsylvania; and AVA HALEY, Glenshaw, Pennsylvania. ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my Estate, of whatever nature and wherever situate, unto my brother, RICHARD J. GARBACIK, provided he survives me. If my brother, RICHARD J. GARBACIK, predeceases me, I give, devise and bequeath the same unto my brother, EDWARD M. LESNY, and should he also predecease me, then unto his then-living issue, per stirpes. ARTICLE IV [~ NTFC'~RM TRANSFERS FOR MINORS In the event any beneficiary of my Will has not reached the age of twenty-five (25) years at the time for distribution of his or her share, distribution of said share may be made in the discretion of my Personal Representative after considering the age and needs of the beneficiary, either directly to the beneficiary or to a Custodian for such beneficiary until age twenty-five (25) under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq., or the applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of 2 residence of such beneficiary as the case may be. My Personal Representative may designate as such Custodian any institution or person, including my Personal Representative, qualified to act as a Custodian for such beneficiary under such Act in effect at the time such distribution is made. A receipt for any payment or distribution so made shall be a full discharge therefor to my Personal Representative, who shall not be responsible to see to, or be liable for, the application of such proceeds thereafter. ARTICLE V TAX CLAUSE I direct that all estate, inheritance, transfer all other taxes of similar nature payable by reason of my death,. together with any interest or penalties thereon, and imposed with respect to any property disposed of by this Will, shall be paid out of the residue of my Estate, as an administrative expense of my Estate. I direct that all such taxes imposed with respect to non-probate property shall be paid by the respective beneficiary(ies) or transferees thereof. ARTICLE VI PERSONAL REPRESENTATIVE I name, constitute and appoint my brother RICHARD- J. GARBACIK, Executor of this ;y i.ast ~,'il a~~ci Tes~a.~r:er~t. Should rrry bru~lYe~~, RiCiIARD J. GARBACIK, fail t;, qualify cr cease to so act, I name, constitute and appoint my brother, EDWARD M. LESNY alternate Executor to complete the administration of my Estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this ~ ~ 2 `- day of ~ 2009. ,.. (SEAL) OND R. GARBACIK Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence and in the presence of each other, have hereunto subscribed our names as witnesses. 4 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : ss. COUNTY OF CUMBERLAND ; We, RAYMOND R. GARBACIK, E~/hG~~%~ ~~ />'I y~~s and __~_~,~-~ L_.~~ C ~ SS /~ `~ _. the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Witness Witness Subscribed, sworn to and acknowledged before me by RAYMOND R. GARBACIK, Testatrix, and subscribed and sworn to before me by ~ ~ ~'~le-~ ~; . ~'1 ~/~ s and !'~?IC~AL`C ~f C'~-SS /b Y ,witnesses, this ~ ~ da of y 2009. r fl ~~ 1 Notary P,,~>~lic :281441 v3 COM N TM F PENNSYLVANIP- Notarial SCI Manganet E. Ruff, Notary Public t:emoyne Boro, Cumberland Cody ~1Ay Commission E~ires May 3Q, 20'11 Member, Pennsvtvani~ A~sr~c!ation of Notaries