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HomeMy WebLinkAbout03-08-13 Reset 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: Rosemary P. Pankiewicz File No: , a/k/a: Rosemary T. Pankiewicz (Assigned by Register) a/k/a: a/k/a: Social Security No: 049-16-3998 Date of Death: 03/05/2013 Age at death: 87 Decedent was domiciled at death in Cumberland County, Pennsylvania (state) with his/her last principal residence at 43 Ridgeway Drive Mechanicsbure Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 442 Walnut Bottom Road Carlisle Cumberland Pennsylvania 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 $ 500.00 If not domiciled in Pennsylvania Personal property in Pennsylvania $ If not domiciled in Pennsylvania Personal property in County $ Value of real estate in Pennsylvania $ 146,400.00 TOTAL ESTIMATED VALUE.... $ 146,900.00 Real estate in Pennsylvania situated at: 43 Ridgeway Drive Mechanicsburg Cumberland (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County 91 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 10/25/2007 and Codicil(s) thereto dated NA State relevant circumstances (e.g. renunciation, death of executor, etc.) C'y, ?J G© MC-) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was n iMced, wasia a paw t§pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 33 gg~n"id norhave -,fhq born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. = ya. r- r.F I M Q NO EXCEPTIONS 0 EXCEPTIONS" e'-s q B. Petition for Grant of Letters of Administration (If applicable) CD c.t.a., d.b.n., d. b. n. c. t. a., pendente liter<A6 to absenzfta,, durct~e alnoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of-keir§0 ~ U-) 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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationship Address Form RW-02 rev. 10/1112011 Page 1 of 2 l Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s) Printed Name Petitioner(s) Printed Address David B. Proko 131 Route 25A Rock Point New York 11778 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, t Petitioner s) will well and truly administer the estate according to law. Sworn to or affirmed aid subscribed before Date ~I d~13 me t day of Date By: Date For the Register Date BOND Required: YES Q NO To the Register of Wills: FEES' , l Please enter my appearance by my signature below: Letters $ Quo Oy Attorney Signature: ( ) Short Certificate(s)...... •43C ( ) Renunciation(s)......... c ( ) Codicil(s) ( ) Affidavit(s)............ 73 G? c, Bond Printed Name: David B. Prokop~ Commission Supreme Court > r-q Ot4er ID Number: 42039 r" M cx) tl( 1CJ ~ . i" sue, 1 herl ce" t~• 1'~ Or) Firm Name: <7• 71 t Address: 131 Route 25A , , w Y~rS Rocky Point, New 1 1778 Phone: 631-821-1314 Fax: 631-821-1190 Automation Fee....... . JCS Fee 11:?? 50 Email: rlnrokope-g4optonline net TOTAL $ 35 J SL4-eer DECREE OF THE REGISTER Estate Of Rosemary P. Pankiewicz File No: 3 r (J a/k/a: Rosemary T Pankie(w icz n ~y AND NOW, - Ick r f1 C~,,A in consideration of the foregoing Petition, satisfactory proof having been -presented before me, IT IS DECREED that Letters Testamentary are hereby granted to David B.Prokop in the above estate and (if applicable) that the instrument(s) dated October 25, 2007 described in the Petition be admitted to probate and filed of re ord as the last Will (and Codicil(s)) of Decedent. ` Register of Wills Pa e 2 of 2 Form RW-02 rev. 1011112011 H105.K05 REV' (1)/) I I LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED 0,F ~71 4/ ~c 0 F Fee for this certificate, $6.00 R~~'~ ,rf 7h)" is to certify that the information here given is OF f . p~I" OF u f'' correctly copied from an original Certificate of Death 13~ J0 xo~~ duly filed with me a Local Registrar. The original 1 I ' / z 1 certificate %~ill he forwarded to the State Vital RT cords Office for permanent filing. P 19474791,R,""' ~~HANS' m ` -.,,rEti~ 0 11 Certification Number CllMBERLQ IC I'~ ! Local Rcaistrar Date Issued 1 y Ylnt In 3 COM,NWEALTH OF PENNSYLVANIA~• DE. ARTMENT OF HEAL iH • VITAL RECORDS ne" CERTIFICATE OF DEATH State File Number: ;Ink 3. Decedent's Legal Name (First, Middle, Last, Suff.) 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Yr) (Spell Me) Rosemary Therese Pankiewicz a ale 049 - 16 - 3998 March 5, 2013 5a. Age-Last Birthday (Yrs) Sb. Under I Year Sc. Under 1 Da 6. Date of Birth (Me/Day/Year) (Spell Month) ?a. Birthplace (City and State or Foreign Country) Months 1115 Hours Mmdres Bridgeport, CP 87 September 11 , 1925 71 Buthpla,e(County) Fair ie Ba. Resfdentt (State or Foreign Country) go. Residence (Street and Number Include Apt Nd.) gc. Did Decedent Llve In a Townshi ? Penns lvania 43 Ridgeway Yes,tle,edemb-d,n Si~ver Spring Be. Residence (Cdunryl geWaY Drive Q P Cumberland 8e.Rlrideme(Zipcpde) 17050 ❑No,decedentwedwrthinlimitsof city/bum. 9. Ever In US Armed Forces? 10. Marital Status at Time of Death 0 Married Do Widowed 11. Surviving Spouse's Name (lf wife, Slue name prior to first marriage) ❑ Yes W No 0 Unknown 0 Divorced 0 Never Married (j Unkno.vn L2. Father's e (First, Mltle, last, SufRx) 13. Mother's Name Prior to First Marriage IFfrst, Middle, Last) JoseNamW. Proelko Rose Elizabeth Duda 14a. Informant's Name 141. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, City, State, Zip Code) David Proko Nephew 1556 Grand Avenue Mattituck, NY 11952 ed Death c ec anyone If Death Occurretl in a Hos tal r pi ~ Inpatient II Beath Occurred Somewhere Other Than e HOS Ital. rPw+ aAsS p L Hospice Facility Decedent's Hame Emergency Room/Ompatient ❑ Dead on Arrival gg Nursing Hame/ang-Term Care Facility 0 Other j Specify) 15b. facility Name (If not institution, give street and number; 15c. Cry or Town, State. and Zip Code litl. County of Death Thornwald Home Carlisle, ''A 17013 Cumberland 16a. Method of Disposition Burial ❑ Cremation 161b. Date of Disposition LE, Place of plspozi[Idn (Name of cemetery, crematory, or other place) 0 Removal from State Donation ❑Dmer(Specfy) March 9 20.3 Cumberland vale Memorial Gardens 36d. Location of Disposition (City or Town, State, and Zip) 17a. 5jgas A of Funer a L/cens a or Person in Charge of Interment 17b. License Number Carlisle, PA 17013 C FD - 014889 171. Name and Complete Address of Funeral Facility Mal zzi Funeral Home 8 Market Plaza Way Mechanicsburg, PA 17055 18. Decedent's Education- Check the box that best describes the 19. Decedent of Hispanic Origin Check the 20. D-dent'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. 0 8th grade or less is Spanish/Hispanic/Latino. Check the 'No- Cg White 0 Korean O No diploma. 9th- 12th grade box if decedent is not Spanish/Hispani A,hno. O Black or African Amerlcan C]Vletnamese 0 High uhool graduate or GED completed (XN,, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian 0 Sdme college -dit, but no degree Yes, Mexican, Mexican Amerlcan, Chicano 0 Asian Indian 0 Native Hawallan 0 Associate degree (e g. AA, AS) ❑ Yes, Puerto Rican 0 Chinese 0 Guamanian or Chamorro 1] Bacheloes degree (e g. BA, All, BS) 0 Yes, Cuban 0 Filipino 0 Samoan Master's degree (e.g. MA, M5, MEng, MEd, MEW, MBA) 0 Yes, other Spanish/Hispa, is/Latino 0 Japanese ❑ Doctorate le.g. PhD, EdO) or Professional degree ❑ Other Pacific Islander (Specify) ❑ rnher (Specify) MO OpS, DVM LLB, 1D 21. Decedent's Single Pace 11on Check ONLY ONE to indicate what the decedent cnnsideretl himselforherselftobe. 22a.Decedent's Usual Olcupatlon-iMiutetypeofwork White 0 Japanese 0 Samoan done during most of working life. DO NOT USE RETIRED. 0 Black or African American 0 Korean 0 Other Pacific Islander Amerlcan indiandr Alaska Native OVietnamese ODOn't Know/Not Sure Regional Office Manager 0 Asian Indian 0 Other Asian ❑ Refused 221b. Kind of Business/Industry ❑ Chinese 0 Native Hawaiian ❑ Other (specify) _ Filipino 0GuamanianorChamorro Seed Company ITEMS 23a . 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO/Day/Yr) 23b. Sit iature of Person Pronouncing Death (Only when applicable 23c. License Number BY PERSON WHO PRONOUNCES OR ~/~/1~ Q CERTIFIES DEATH 446ZAvLL 23d. Date 5i d (Mc1 y/Yr) 24. Ti a "f Death /NA. "l. J s Q, a-e ~ I T-y AN~ 25. Was M,d-I Examiner or Coroner Contacted? ❑ Yes No CAUSE OF DEATH Approximate 26. Part I. Enter the chain of ev ts- diseases. Injuries, or cumpllcatidns- that directly cause,'-~, death. 00 NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventri ular librlllation without showing the etiology. DO NOT ARB-CIATE Enter only one cause on a Ilne. Add additional lines If necessary Onset to Death ;MME DIATECAUSE (Final disease or-dun.On Duerolor as acnse9 a ce on resulting In death) b. onain Due o for as a consc, .ence of): II any, leatlings[ocme cause listed on line a. Enter the UNDERLYING CAUSE Oue to for as a conse< once o/1. (disease or inldrY that initiated the events resulting & in eeaMl )AST. Due to (or as a consepuence of): 26. Part It, Enter other significant conditions contr but ng to death but not resulting In the underlying cause given in Part 1 27 . Was an autopsy Perfo m red? ❑ Yes No 128. Wer<autopsy findings available to complete the cause of death? 0 Yes 0 No 29. IfF ale: 30. Did Tore cco Use Contribute to Death? 31M~ neror Death Ndtpregnantwithlnpastyea r Yes Probably Natural C3 Homicide 0 Pregnant at time of death &,NO ❑ Unknown 0 Accident 0 Pending Investigation 0 Not pregnant, but pregnant within 42 days of death 0 Suicide 0 Could not be datermined 0 No[ pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (-/Day/Y,) (Spell Month) 0 Unknown if pregnant within the past year 33. Timedf injury 34, Place of Injury (e.g. home; construction sfe; Farm; school) 35. Location of Injury (Street and Number, City, Slate, Zip Code) 36. Injury at Work 37. It Transportation Injury, Specify: 38. Describe How Injury Occurred'. 0 Yes 0 DriwOOPerator 0 Pedestrian 0 No Passenger 0 Other(Spedfy) 39a. Certifier (Check only one): )S] Certifying Physician To the best of my knowledge, death occurred due to the cause(s) an aced 0 Pronouncing & Certifying physician To the best of my knowledge, death occurred at the t me, datesand place, and due to the cause(s) and manner stated 0 Medical Examiner/Coroner- On th~i1basis of examination, and/or investigation, In my opin. ~n, death occurred at the Ume, date, and place, and due to the cause(s) and manner stated Signature of ceruflr: V/6" ~ ] r"^-~ Title df teMt, ,ln:e Number r" aZ 2 4(C Lice... (to 39b Name, Address and Zip Code of Person Completing Cause of Death (item 26) 391. Date Signed (Md/Day/Y,) Geol. a. 3r~>1Swn.. d^ FY.D -1l Yvr.~gh. D~ln, C.Zrf.IJY.. PAIZ is 1~eF10. 5 X013 40. Registrar's District Number 141 `e t 's Sipe Vtu a 42. Registrar Ffle Date IMO Day/Yrl s .t I W {,rL 3 G f'r3 43.Amenemems 0819597 H105-143 Disposition Permit Nd. REV 07/2011 c7 c © w 70 e~ 2r-> M - n ' C1 Z Gd~'9,~i~z O QJ ,t 01 :a I, ROSEMARY P. PANKIEWICZ, of Silver Spring Township, C-uin1jerlan4'L'ourj~y, Pennsylvania, declare this to be my last will and revoke any will previously made by me. a ITEM I. I direct that all my just debts and funeral expenses, including my gravemarker T5 and all expenses of my last illness, and any and all taxes and assessments imposed by any governmental body as a result of my death, whether on property passing under this will or otherwise, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II. I give and bequeath the sum of FIVE THOUSAND DOLLARS ($5,000.00) to JANET PANKIEWICZ FISHER of Milford, Connecticut provided she survives my death by thirty (30) days. Should the said Janet Pankiewicz Fisher predecease me or be deceased on the thirty-first day after my death, this specific bequest shall go in equal shares to those of her issues, per stirpes, as survive my death by thirty (30) days. ITEM III. 1 give. devise. and bequeath all the rest, residue. and remainder of my possessions and estate of every nature and wherever situate in equal shares to the following: A. To my niece, KATHLEEN P. D[JFFY, provided she survives my death by thirty (30) days. Should she predecease me or be deceased on the thirty- first day after my death, her share shall go in equal shares to my nephews JOSEPH W. PROKOP, DAVID B. PROKOP and MICHAEL C. PROKOP. I Should any one of my nephews predecease me or not survive my death by thirty (30) days, then their share shall go to their issue, per stirpes. B. To my nephew, JOSEPH W. PROKOP, provided he survives my death by thirty (30) days. Should he predecease me or be deceased on the thirty-first day after my death. his share shall go to his issue, per stirpes. N C. To my nephew, DAVID B. PROKOP, provided he survives my death by thirty (30) days. Should he predecease me or be deceased on the thirty-first ' day after my death, his share shall go to his issue, per stirpes. D. To my nephew, MICHAEL C. PROKOP, provided he survives my death by thirty (30) days. Should he predecease me or be deceased on the thirty- first day after my death, his share shall go to his issue, per stirpes. ITEM IV. All of the interests of the beneficiaries hereunder shall not be subject to anticipation or to voluntary or involuntary alienation nor shall they be subject to any execution or attachment. ITEM V. I appoint my nephew DAVID B. PROKOP executor of this my last will. ITEM VI. In addition to the other powers and authorities granted to my personal representatives by Pennsylvania law and by the other terms and provisions of this will, I hereby give to my personal representatives the following powers and authorities effective without court approval and until actual distribution of all property: to compromise any claim or controversy; to make distribution in cash or in kind, or partly in cash and partly in kind, and in such manner as my personal representatives may determine and at valuations finally to be fixed by them; to invest in all forms of property, including any stock or other securities in any corporate fiduciary or its successor without restriction to investments authorized for Pennsylvania fiduciaries, as my personal representatives deem proper, without regard to any principle of risk or diversification; to retain any or all assets of my estate, real or personal, without regard to any principle of risk or diversification; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options for sales, exchanges, or leases, for such prices and upon such terms or conditions as my personal representatives deem proper; and to allocate receipts and expenses to principal or income or partly to each as my personal representatives deem proper in their sole discretion. ITEM VII. I direct that my personal representatives and fiduciaries shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this J" day of 2007. ROSEMARY P. PANKIEWICZ ` 3 The preceding instrument, consisting of this and THREE other typewritten pages, each identified by the signature of the testatrix was on the date thereof signed, published, and declared by ROSEMARY P. PANKIEWICZ, the testatrix therein named, 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. 4 COMMONWEALTH OF PENNSYLVANIA ) (SS: COUNTY OF CUMBERLAND The undersigned, being the testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, does hereby acknowledge that I signed and executed the foregoing instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. R SEMARY P. PANKIEWICZ Sworn or affirmed to and acknowledged before me by, the to tatr X mimed above this ay of C ( 2007. .'r.:i COMMONWEAL TH Oh~IPENN~A~`'~`~r'~ ) ( SS: COUNTY OF CUMBERLAND ) WE, 1 and _tlomrrs ICASS614 the witnesses whose names 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 she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; 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 or undue influence. - Sworn r affirmed to an acknowledged before e this day of l i 2007. ota Fi,biic CCU 1MbNWE TH F PENNSYLVANIA I Seal W y K. St nub, Notary Punic Lower Men Twp, Cum nd County My Cornrniss:w E? ires May 10, 2011 Pennsylvania Association of Notaries 5