HomeMy WebLinkAbout03-08-13
PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/arc 18 years of age or older, apply(ies) for Letters as specified belo%~. and in
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form:
Decedent's Information _ J
Name: ~i17 File No: 4
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ~yz may. ✓f~ 7
Date of Death: Z Z 7/-Z 0Z Age at death: 7
Decedent was domiciled at death in ea /7) e,- 4,., d County, _ (State) with his/her last
principal residence at y/ 7 411,- ,dr. , 2 7e-c he, r, . sbu r 2 6e, Z~;
Street address, Post OtPfce and Zip ode City, Township or Borough County
Decedent died at e, ~~7f 4//r-r) z2- A,19 c her, z -6 - -Gr r ~u rn 6(,- r`~4
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 $
I(rtot domiciled in Pennsylvania Personal property in Pennsylvania $
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania $
TOTAL ESTIMATED VALliE.... $ Z/ U O 0
Real estate in Pennsylvania situated at: y~ 7 e-, Cu
17
(Attach additional sheets, !(necessary.) Street address, Post Office d Zip Cod City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentary J /3
Petitioner(s) aver(s) hqg'eRheyoare the Executor(s) named in the last Will of the Decedent, dated and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death ojexecutor, 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.
NO EXCEPTIONS ❑ EXCEPTIONS?
rrt
❑ B. Petition for Grant of Letters of Administration (If applicable)
e.t.a., d.b.n., d.b.n.c•.t.a., pendenjifitt~uwyte a siRtia, er"inoritate
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above a =c~t to listof hrcirSJ-
f
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds divbreehad be" estashexdlas defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated~pe~rsCg' (s
❑NO EXCEPTIONS ❑ EXCEPTIONS f..., 'b
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by following spouWif any anth ins (attach
additional sheets, if necessary):
Name Relationship Address
Forni Rw nz rev. lnitl/1n11 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s) Printed Name Petitioner(s) Printed Address
ZL'A
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 Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirrried a ubsnc~~tbed Date 1
me day of liV Date
gy Date
For the Register Date
BOND Required: Q YES Q NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters $ Attorney Signature:
( ) Short Certificate(s)...... i
( ) Renunciation(s)........ .
( ) Codicil(s) .
( ) Affidavit(s)........... .
:4Y
Bond Printed Name: CD
Commission Supreme Court Q~7 u~7
Other _ ID Number: OD ~a
t Firm Name: M t~"e rat
lt'~. Address:
c ~R
C'7 CS -x R-„- -rl
Phone: -0
Automation Fee G3.CIYD Fax: 3> '►I
JCS Fee 3. SG) Email:
TOTAL $
DECREE OF THE REGISTER
Estate of File No:
a/Wa:
AND NOW, S. 441 Y I , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED tha" et rs ~ (
are hereby granted to a (1 r,-l _I
in the abov 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 Codigil(s)) of Decedent.
dkdct (V~I JNZhi,
egister of IN ~ f ^
Fonn RW-02 rev. 10/11/2011 OXe 2 of 2
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
Lr~76~r /~q COUNTY, PENNSYLVANIA
Estate of /~~'r Deceased
rr~ y c~i^
and
(each) being duly qualified according to law, depose(s) and say(s) that she / he they as / were well-
acquainted with lelle,2 1'_ ~aZ`~.'r) and arn/are familiar
with the handwriting and signature of the decedent, and that the signature of Z//e-r> 1711,124'e-
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Z! 11&12 /7)1-, is in his/her own proper handwriting.
( 'gnature) (Signature)
(Street Address) (Street Address)
ate /70'5D
(City, State, Zip) (City, State, Zip)
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C13 -U cy)
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Executed in Register's Office
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Sworn to or affirmed and subscribed > Cn CO
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before me this day C-> CD
r, ^ l -3 F r- !11
D -1 r
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Deputy for Register o i s
Form RW-04 rev. 10. 13.06
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H105,80~ REV (9/I1,
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
REGORGED O I'' ~
Fee for this certificate, $6.00 OF OF Thi,, is to certify that the information here given is
REGISTER OF Vr'••2~ S ~t,la~- Pyy correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
. j~ 11{) pm ~ rl rOficatc mill be forwarded to the State Vital
11~~ RL cords Office for permanent filing.
t'
-1
P 13474735 CLERK Ct°`~9~T-,-^'}((F~~~~%
mz/ 13
Certification Number ORPHANS'GGl1RT [y ~~••aa L,)Cal Rc~zistrar Date Issued
/Print In C U M B E R L A N D Clar;NVpALIL10F PENNSYLVANIA • DEPARTMENT OL HEALTH • VITAL RECORDS
sck lnkt r j.~ CERTIFICATE OF DEATH State File Number
1. 9d nt's Legal Na First, Middle, Last SUH'v) 2. 5 3. SOCIaI Securlry Number ~ a. ate of Death (MO/Day (Spell Mo)
i - ~U Uc~~ X013
511. Age-Last Birthday (Y,s) St. der 1 Year 51. Under 1 Da 6. Date 11 1111 IMO/Day/Yearl (Spell Month) 1 BI a Try and Stale ar Fo nt )
~1 Months Days Hours Minutes
Tinuorv i/'1 ra xc ,
} J ]b. Birthplace (f ry)
811. esidence (State or Foreign Country) St. Residence (Street antl Number Include A No.l 11, Did Decedent Uve In at
4 /h~lp/2y On~j- R vv
Bdl Residen e(Counry) qI/7 or e 1es,decnhrmIi-d,n ( R,L'1 I lll(y two.
11 Be. Residence 12i ode) G l•• [I No, decedent (Ned wthm limits of city/boro.
9. Ever In US Armed Forces? 30. Marital Status at Time of Death Monied Widowed 11. SuMWng Spouse's Name Ilf wile, give name prior ro first marriage)
❑ Yei ENO Unknown C3 Divorced ❑ Never Married ❑ Unknown
111, F Usn's me (First, Mid le, Last, SuHiv) 13, oMer's Name Prior It/o Finn Maniag First, Middle, Last)
~ It
N-,i J nn Cie.
1411 r n's Na 14b. Relationship to Oecedent 34c.I Info, nt' Mailing Addrc (Street and Num b r, City, Slate, Zip Cody
11s. Place p Death C eck pn Yon _ _ _ _
r
II Death Occurred Ina Hosplbl: LJ Inpatient Of Death Occurred Somewhere Other Than a Mospltal d Hospice Faclllty T] Decedent's Home
❑Emergency Roam/OUtpatlenl ❑ Deadon Arrival Ly(Nursing Home/Lang-Te,m Care Facility ❑ Other (Specify)
11 Frllry Name ((not in k ton, give street and number) lSC. Iry pr Town, State, and 2lp Code G 15 County (Death
C ^ I G r .AC~ f71~ I
t 1611. Method of Disposition rat ❑ Cremation I66. Date 11 isposItbn 16 of
Disposition (Name of cemetery, crematory, or other place)
Removal from Stale ❑ Donation
/~/'~j 4~f 'I
❑ Other (Specify) IC.I,-.( F,Anll.,~1~lit
Z 16d. location of Disposition (City or Town, State sod Zip) 1711. Si a of Fu rat SeMce Ucensee or Person in Charge nte,ment 17b. LkensNumber
VPt jljEhzQ, 3 G
an/ mpl tea 1FUne, F 11
m Q I t M I 1 IDS,
18, edent's Educatbn - C k Me box that best tlexribes the 19. Decetlenn of HIS nic Origin - Check the J. eden s Pace ~ fhecM ONE OR M ces to Indicate what
highest degree or level of school completed al the time of d,,M. bov that best describes whether the decedent the ~~K►cedent considered himself or herself to be.
❑ elh grade or less Is Spanish/Hlspanic/tatinp. Check the 'No' [iJ•CVis" ❑ Korean
Po diploma, 9th-12th grade bovJ'~decedent is not Spansh/HISPacac/LatIr,. ❑ Black or African American ❑ Vietnamese
High school graduate or G ED Completed [sYNo,_Spanish/Hlspanic/Lathro ❑ American lndlan or Alaska Native ❑Other Asian
❑ Some college credit, but no degree ❑ Yes, Mexican, Mexican American, Chicano ❑ Asian Intllan ❑ Native Hawaiian
❑ASSOCIate degree(e.g. M, AS) ❑ Yes,PUerto Rican ❑Chinese ❑ Guamanian or Chamorro
❑ Bachelor's degree (e.g. BA, AB, BS) ❑ Yes, Cuban ❑ Flinkno ❑ Samoan
❑ Master's degree Ie g. MA, MS, MEn, MEd, MSW, MBA) ❑ Yes, other Spanish/Hispanic/Latino ❑ Japanese ❑ Other Pacific Islander
❑ Dectuale(e.g. PhD, EdD) or Professional degree (Specify) ❑ Other (Specify)
Le.. MD DDS OVM LLB JD
21. 0§~edent's Singk Race Self-0esgnaHOn - Check ONLY ONE to indicate what the decedent considered himseg or herself to be. 2211. Decedent's Usual Occupation - Indicate type of work
[Li White ❑ Japanese ❑ Samoan d duAng most of working Ilfe. DO NOT USE RETIRED.
❑ Black or African American ❑ Korean ❑ Other Pacific lsiamse, 1L_-tvn lyY„~N~y (ln
❑ American Indian or Alaska Native ❑ Vietnamese ❑ Don't Know/Not Sure I I~.1 I I u(
❑ Asian Indian ❑ Other Asian ❑ Refused 22b. Kindof Business/10dustry
❑ Chinese ❑ Native Hawaiian ❑ Other (Specify)
❑ Filipino ❑ Guamanian or Chamorro Rf yi[,
ITEMS 23a - 23d MUST BE COMPLETED 2311. Oate Pronounced Dead (Mp/D]Y/Y,) 23b. Signature o1 Panon Pronouncing Death (Only when applicable) 23c. Ucenze Number
BY PE". DE, PRONOUNCES OR Ys
CERTIFIES DEATH e < 1 ~V t.3 :~p n'
23d. Dah Signed (MO/Day/Yr) 24. Time of Deatn - I-p' V"~ ,LS..-.ec 7vv I O zy W 21~~
as ~ F' m 15 Was Medical EVaminar or Coroner Contacted? ❑ Yes No
CAUSE OF DEATH I APProvimale
26. Part I. Enter the chain of events -diseases,.nlurles, or complications-that directly caused the tleath. DO NOT enter terminal events such as cardiac arrest, 1 Interval:
n spiratoryarrest, or v,ntri,ul,, fibrill,con with,ut,h-rg the ecology. DO NOT``A\\BBREVIATE. Enter onlyone cause on a line. Add additional Tines if necessary. I Ons'et to Death
IMMEOIATECAUSE --------s a. ~\T`A1P4 '~H `TVa V('I f'Vf
(Final disease or condition Due to for as a con-equence ol):
resulting in death)
b.
5eque VAR, list conditions, Due to for ai a consequence Q.
if any, leading tp the cause
listed online a. Enter the
UNDERLYING CAUSE Due to (or as a ronsequence of): I
(disease or Inlurythat
F Initiated th...... sulting d.
in death) IABT. Due to (or as a consequence on.
S 26.Part It. Enter other slanficant conditions contrlbutim to death but not resulting in the underlying cause given In Part 1. IJ. Wasanautopsy rt medi
(9K1S~1C~1n149II'nJtt KIeEd J .s;+s ul Kt^4kon' ❑ YeF Nq
28, ware autopsy findings available
PDiCON aka`y ra a!'IfYPY NI 'F r•s:
co complete the cause of death?
11 prp•t4n^ Cyt ❑ Yes ❑ No
A 29. If Fe ski • 30. Old Tobacco Us, COntdbute to Death? 31~..rManner of Death
Not pregnant within past year ❑ Yes ❑ Probably W Natural ❑ Homicide
❑ Pregnant at time of death ❑ No R Unknown ❑ Accident ❑ Pending Investigation
❑ Not pregnant, but Pregnant within 42 days of death ❑ Suicide ❑ Could not be determined
❑ Not pregnant, but pregnanl43 days to 1 year before death 32. Date of Injury (M,/Day/Y,) (Spell Month)
❑ Unknowns) 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, County, State, Lip Code)
36. Injury at Work 3J.IITransponation Injury, Specify: 38. Describe How Injury Occurred:
❑ Yes ❑ Driver/Operator ❑ Pedestrian
5z No ❑ Passenger ❑ Other (Spendfiv)
3911. Certifier - physician, certified nurse Practitioner, medical examiner/co er(Check only one):
(gl Cer[lfying only -TO the best of my knowledge, death occurred due to the cause(s) and manner stated.
❑ Pronouncing B Certifying- To the best of my knowledge, death occurred at the time, data , and place, and due to the cause(s) and manner stated.
❑ Medical Examiner/Coro1n.=- (/x~,,I,,,Il*nand/or investigation, in my opinion, death occurred at the time, date, and place, and due to theccauuse(s) and manner slated.
Signatureofcenifi-{r~s wv - Title of certifier License NUmber:l~(VnLLD6gL
39b. Name, Address and Zip Code of Person Com,pele'ting Cause of Death fitem 26) .~a~ 39c. Date Signed (M,/D,Y/Y,)
VA,CtVitt SMYrV bc) 'N* Y41IEN VJ#V£ VUFGLig1,sL`c5LDK'4/ Vjn t~.ms PIt}IowAR 2+- ~P13'
40. Registrar's Olstrkt Number al.gi tr Ignature I42. Registrar File Data (MO Oay r)
rf •~Ia W a as%'r3
43. amendments 5.143
H102
Dlsccullon Permit NO. 1 j_. I- j - j0 REV 07]/201
/201
LAST WILL AND TESTAMENT
OF cs
ry]
rat
ELLEN J. MARTIN t VJ-3
a r, `s' c
co
IN THE NAME OF GOD, AMEN C)
I, ELLEN J. MARTIN, of the Townip of P;enri4ken,
N rt
Camden County, New Jersey, being of sound and disposing mi4ad,
memory and understanding, do hereby make, publish and declare
the following to be my Last Will and Testament, hereby revoking
and making null and void any and all previous wills, writings
testamentary or in the nature thereof by me at any time hereto-
fore made, that is to say:
FIRST: I order and direct that all of my just
debts and funeral. expenses be paid and satisfied as soon as
reasonably ma77 be done following my decease.
SECOND: All of the rest, residue and remainder
of my estate, real, personal and mixed, of whatsoever nature and
wheresoever situate, I give, devise and bequeath unto my beloved
husband, FREDERIC E. MARTIN, absolutely and forever.
THIRD: In the event my said husband, FREDERIC E.
MARTIN, should predecease me, or in the further event that he an
I should perish in what is usually termed a common disaster, or
under any other circumstances wherein it would not be possible
or practical to determine with certainty who shall have survived
the other, then and in either of such events, I give and bequeath
all of the rest, residue and remainder of my estate, real,
personal and mixed, of whatsoever nature and wheresoever situate
unto my daughter, BARBARA E. BARRY and my son, KURT F. MARTIN,
LAW OFFICES in equal portions, share and share alike.
JOSEPH W ZAMPINO
PENNSAUKEN sNE W JERSEY 08110
- 1 -
In the event my daughter, BARBARA E. BARRY shall not
survive me, I give and bequeath her one-half share unto her
children living at that time.
In the event my son, KURT F. MARTIN shall not survive
me, I give and bequeath his one-half share unto his children
living at that time, if none, his one-half share I give and
bequeath unto his sister, BARBARA E. BARRY.
In the event my grandchildren shall be under the age
of eighteen (18) years at the-time of my death, I give and
bequeath their respective share unto my Trustee hereinafter
named, in trust nevertheless, for the term of their minority, to
keep, hold, invest and reinvest the same in such legal invest-
ments of trust funds under the Laws of the State of New Jersey
at the time when such investments are to be made, and after
deducting all taxes, expenses and commissions, to use and apply
so much of the income therefrom, and the principal thereof, as
may in the absolute and sole discretion of my said Trustee be
necessary for the support, education and maintenance of my said
minor grandchildren, during the term of their minority.
When and as my said grandchildren shall respectively
attain the age of eighteen (18) years, my said Trustee shall
thereupon pay over, transfer and deliver to my said grandchild
the undistributed trust estate created for him or her here-
under, together with all accumulations thereof, if any,
absolutely discharged and freed of the trust hereinabove created.
FOURTH: I nominate, constitute and appoint my
said husband, FREDERIC E. MARTIN, as Executor of this my Last
Will and Testament, and in the event he is not living, renounces,
or fails to qualify, or for any reason is unable to serve and
W OFFICES
°SpBHEWED^MNUN° complete his duties, I nominate, constitute and appoint my
PENNSAUKEN, NEW JERSEY -1.
daughter, BARBARA E. BARRY, as Executrix hereof, hereby giving
- 2 -
and granting unto my said Executor/Executrix, to the extent that
the same may for any purpose be required, full and complete
power of sale of both real and personal property, and I do
further order and direct that my said Executor/Executrix shall
not be required to enter bond or other security in this or in
any other jurisdiction for the faithful performance of duty.
In the event a trust becomes necessary, I hereby
nominate, constitute and appoint my son-in-law, JOHN BARRY, as
Trustee for my minor grandchildren, and direct that he shall
have the same powers, provisions, obligations and duties here-
inabove given to my Executor/Executrix, with equal force and
effect to him, and he likewise shall not be required to furnish
bond in the performance of his duties as Trustee.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this day of November A. D. 1984.
r
~ ,y; J ai t f ` -(SEAL)
;~;'d~ Ellen J. Martin
SIGNED, SEALED, PUBLISHED AND DECLARED BY ELLEN J.
MARTIN, tree above nailed Testatrix, as and for her Last Will
and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other have hereunto
subscribed our names as witnesses thereof.
/ i
LAW OFFICES
JOSEPH W ZAMPINO
PENNSAUKEN SNEW JERSEY 08110
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