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HomeMy WebLinkAbout03-13-13 PETITION FOR GP--INTL OF LETTERS REGISTER OF WILLS OF ~rnbf )~1C1 COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are IS 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 Name: 3 IGia ArNl CjLe.N5w File No: 09 13 2Q a/k/a: fbktt;c to Onn Sf cllfVan (Assigned by Register) a/k/a: a/k/a: Social Security No: Qq1- 30 - 31 Date of Death: :3A0 X013 Age at death: '14- Decedent was domiciled at death in C'umbw)z!, cl County, (state) with his/her last principal residence at q1C*q {Noxf Cre* W- ,~,(QG rz mph ` TmIQ~arrj Street address, Post Office and Zip Code City, Township or Borough County Decedent died at ! usj spi r-, p qj It Lt c.!"641aM PA Street actress, 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 $ 1 t 000• t9° If not domiciled in Pennsylvania Personal property in Pennsylvania $ If not domiciled in Pennsylvania Personal property in County $ [value of real estate in Pennsylvania $ apt 000.-0 TOTAL ESTIMATED VALUE.... $ z-50 t ;00-f Real estate in Pennsylvania situated at: -469 lt'I~oocictim+ Dr . M( cyza►n/C~purr_ CU.rnba~ (Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code City, Township o orough County 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, datedo 0b t a~©~ and Codicil(s) thereto dated State relevant circumstances (e.g. renunciation, death of executor, etc.) :Y7 Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, ~no,~ivorced, w not a P'tt yV ypending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. nw, and diTAt haM tali born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated persottrl =a Gn NO EXCEPTIONS E] EXCEPTIONS rn-, ,.t Grp ~.ra ❑ B. Petition for Grant of Letters of Administration (If applicable) cv - 1 c.t.a., d.b.n., d.b.n.c.t.a., pendente'Ute durturleabse4a, durante,Ainoritate If Administration, c. t. a. or d. b.n. c. t. a., enter date of Will in Section A above and cot plete lifNf heirs. i"Y+ c11 C-> Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds €dr divorce had bar estabYiihefgs 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 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, i/'necessary): Name Relationship Address Form RW-n7 initrnnrt n....,, i ,.r11 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OFt1 ` l Mbe -f- kG~(' } Petitioner(s) Printed Name Petitioner(s) Printed Address C iA t 1G.i 5 C_ T, C t tS \4 'z l l 1 l~ G to iSo l t3C~C~ LCc rl Ctn cV ~c {4 i-l SO 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 w4 and truly administer the estate according to law. Sworn to or affirmed and ubscribe before G~ . _.c/L~ • Date / , 3 me thi th aYi a "AbAvu Date / / 3 ao/ 3 By. Date qg~ or a Register Date BOND Required: Q YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature bglo}v: 1410 ~j Letters S l O~ D~ Attorney Signature: © M n n (j )Short Certificate(s)...... DD ap ~yry =XD G ,f..~._ M 17 V' rti ( ) Renunciation(s)......... C) ( ) Codicil(s) y,. rn f-. l..ry..tl i 'tl ~cr-r-- ( ) Affidavit(s)............ ts- U3 Bond Printed Name: :y r > ~.3 ...,..t t Commission Supreme Court C"' c Other ID Number: n~ r C.,'l CJ7 C> -tljI t Firm Name: 171• r7 Address: Phone: Automation Fee Fax: JCS Fee Email: -40 TOTAL $ ~-$6V DECREE OF THE REGISTER Estat File No -~L -~Q~ a/lc/a: j inconsideration of the fo egoing Petition, AND NOW, 1 _?2 tj M ar-ch satisfactory proof having b presented before me, IT IS DECREED that Letters are hereby granted to in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to prob to and filed of record as the last Will (and Codicil(s)) of Decedent. ) 0 1 VJA_ ( - bfim A~) Form RW-OZ rev. roillizoii Wegister f W Page 2 of 2 111 OS 8o5 REV (9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.0 0 RECORDED OFFICE OF - l hr , is to certify that the information here given is REGISTER OF M, ~ihDfP; ' correclk, copied from an original Certificate of Death V (Rul%'rl d with ni 15 Local Re-ist ir. The original l '413 W 13 PA certificate ~Nill be forwarded to the State Vital Records Office for perm lent filing. GLERKCj~~, P 1947481 6 _ ORPHANS' COO ENT 0 Certification Number CUMBERLAND C 1 i/~} {pwfA Lot: u. ReLrstrar Date Issued not ~Otd)110~W FRITH Oi PENNSYLVANIA rent DEPARTMENT Cl HEAIiH • VITAL RECORDS Black III, CERTIFICATE OF DEATH State File Number 1. Decedent's lI& Name (First, Middle, fall, SuMx) 2. Sex 3. Soual Secant, Number 4. Date of Death (MO/Day/vrl (Spell Mol Patricia A. Gleiser femal 097-30-3118 March 6, 2013 Sa. Age-last Birthday (Y,,) Sb. Under i Year 5c. Under 1 Da 6. Date of Birth (Mo/DPY/Year) (Spell Month) ]a. Birth@glacg (City and State or Foreign Country) 74 Months Days Hours Minutes BUfralof W an uary 14, 1939 ]b. Birthplace (County) Be. Residence (State or Foreign Country) Bb. Reddence(Streetand Number- Include Apt N,.) Erie 8c. Did Decedent Live In a Township? PA 469 Woodcrest Drive INYef,decedentweeln Hampden 8d. Reedence(County) twp. Clunberland Be. Resdence(ZIP Code( 170550 ❑ No, decedent lived within limit, of clt,/boro 9. Ever In US Armed Forces? 10. Marital Shtus at ""1 of Death ❑Marrisd )M Widowed 11. Surviving Spouse's Name (If wife, Burs name pull to first marriage) ❑ Yes RN, ❑ Unknown ❑ Divorced ❑ Never Manned ❑ Unknown 12. Father's Name (First, Middle, Last, S.M.) 13. Mothers Name PH., to First Marriage (First, Middle, Us[) Daniel Jose h Sullivan Eleanor Faulhaber 19a. Informant's Name 141. Relationship m Decedent 14c. informant's Mailing Address (Street Inds Number, Ciry, State, Zip Code)) Dawn Zervanos daughter 1198 Knackl Farms Ct. Harris ~~111 g 15a. P ace p Death In one If Death Occurred In a Hospital: Inpatient _ _ _ _ _ _ _ Ilt Death Occurred Somewhere Other Than a Hospital ❑ Hospice Facility Decedent's Home ❑Emergency ROOm/OulPatlent ❑ Deadon A,iwal ❑N1 Ing HOmLong -Te,m Care Facility ❑ Other (Specify) 1v 156. Facility Name(if not Institution, give street and number) t15<. Ciry prtown,State,e/and Zlp coda 151. Count, of Deal Holy Spirit Hospital CaMP Hill PA 17011 Ctmiberland 16a. Method of Disposition ❑ Burial I$ Cremation 16b. Date o(Disposltlon 16c. Place o(Dlsposi[lon (Name of remetery, crematory, or other place) ❑ Removalfrom5tate ❑ Donation ❑ Dd,f r (Specify) March 11, 20 3 Hollinger crematory, Mt. Holly Springs Z 16d. Location oDispositnon (City or Town, State, and ZIDI 1]a. Signature of Funer I se Ice Licensee or Person in Charge of Interment 1]b. Lkense Number Mt. Holl S rings PA FD 011667 L E 1]c. Na dCorpplete AddressotFuneral Faclllry 9 Ma~pezzi Funeral Home 8 Market Plaza ay, Mechanicsburg, PA 17055 m 18. Decedent's Education -Check the boa that best describes the 19. Decedent of Hispanic Origin Check the 20. Decedent's Race Check ONE OR MORE races to indicate what 12 highest degree or level n/school completed at the tlme of death. box that best describes whether the decedent the decedent considered himself or herself to be. ❑ Ithgrsde or less Is Spanish/Hispanic/Latin,. Check the"No" White ❑ Korean ❑ No diploma, 9th-12th grade boxifdecedent is not Spanish/Hispenic/Latino. ❑ Black or African American ❑ yletnamese ❑ High schoolgred,steor GED-Pleted Ani-t5panlsn/Hispanlc/Utlno ❑ American Indian or Alaska Natve ❑ Other Asian IS' Some college credit, but no degree ❑ Yes, Mexican, Mexican American, Chicano ❑ Asian Indian ❑ Native Hawaiian ❑ Asso-te degree(e.g. AA, AS) ❑ Yes, Puerto Rican ❑Chinese ❑ Guamanian or Chamorro ❑ Bachelor's degree (e.g. BA, AS, BS) ❑ Yes, Cuban ❑ Filipino ❑ Samoan ❑Master's degree(e.g. MA, MS, MEng, MEd, MSW, MBA) ❑ Yes, other Spa nish/Hispanic/Latino ❑lapanese ❑ Other PacnHClslander ❑ D-rate(e.g. PhD, EdD) or Professional degree (Specify) ❑ Other (Specify) e..MD DDS "M LLB 1D 21.Decedent's Single Race Sel(-Designation- Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a.Decedent's Usual Occupation Indicatetypeofwork lg White ❑lapanese ❑Saln,an done during mostofworkingllfe. DONOTUSERETIRED. ❑ Blackor Afric-American ❑ Korean ❑ Other Paciflc slander r 1St ❑ American Indian or Alaska Native ❑ Vietnamese ❑ Don't Know/Not Sure eg ered nurse ❑ Asian Indian ❑ Other Asian ❑ Refused 22b. Kind of Business/Ind,stry ❑ Chinese ❑ Nat , Hawaiian ❑ Other (Specify) ❑ Flliplno ❑ Guamanian or Chamorro education ITEMS 23a - nd MUST O COUNCES MPLE OR TED BY PERSON W" PRONO 23a. Date Pronounced Dead (MO/Day/Y,) 23b. Signature of Person Pronouncing Death (Only when applicable) 23c. License Number CERTIFIES WNO CERTIFIES DEATH 23d. Date Signel (MO/Day/Yrl 24. Time,, Death 10:40 Ar't 2S. Was Medical Examiner I, Coroner COntac edi ❑ Yes N, CAUSE OF DEATH I 26. Part 1. Enter the chain of events--diseases, Injuries, or compll-Ions--that directly caused the death. DO NOT enter terminal events such as cardiac arrest, : Aims-1. respiratory arrest, or ventricular fibrillation without showing the eti,ll,p DO NOTTA•BBAREVIATE. Enter only one cause on a line. Add additional lines if necessary. I Onset to Death IMMEDIATE CAUSE a. Cardiac ar-re4/ (Finaldisease atcondition Due to (or as ac D; re,anim; ng In death) n UDD Ve ~ ~QGk b. /erh;c sequentially list condl,lunf, Due to (or as aconsequence on: If any, leading t, [he cause y7,. 1 listed on Bne a. Enter fns //IQ I ✓P aaas~ro~nfz f/rta UNDERLYING GUS! qj)e to (or as a consequence on: w (tlis<afe or injury that Initialed the events resulting d. In death) LASE. Due to (or a, a consequence on, S 26. Pert 11. Enter other significant condibo -tribUtest to death but not resulting in the undedyingcause Shen In Part 1. T an autopsy perf Yes Cautopsy findings available plete ❑ Lne resIt seat,? Yes 29. If Fe Noof 30. Old Tobacco Use ConMbute to Death? 31. MyalFr o/peach S regrum nantwithin past Year ❑ Yom' ❑ Probably Natural ❑ Homicide ❑ Pregnant at Hme of f death No ❑ Unknown ❑ Accident ❑ pending lnvestlga[bn ❑ Not pregnant, but pregnant within 42 days of death ❑ Suicide Could not be determined ❑ Not pregnant, but pregnant 43 days to l year before death 32. Date of Injury (Mo/Day/Yr) (Spell Month) ❑ Unknown If pregnant within the past year 33. Tlme of Injury 34. PlElnstruction struction site; farm; school) E 35. Location of Injury (Street and Number, Ciry, County, State, ZIP Epee) 36. Injortation Injury, Specify: 38. Describe How Injury Occur red: ❑ perator ❑ Pedestrian ❑ er ❑ Other (Specify) 39a. CMIRer- Physician, certified rune practitioner, mellcal examiner/coroner (Check only one): ❑~~aA~,RRfylIS only- To theben my knowledge, death occurred due to the cause(s) and ma nnerstated. B-P,o1m ,ring & CMltyln the best of m knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated. ❑ Medical Examiner/C -On lexami or invesbgatnon,in myop,n,,,, death oCCU-datthe time, date, and place, and due to the cau/se(s r~~d~.fm~anne'jr/iftatel. Signatureof caft le , Title of certifier Lice: nse Numbe / r: A/ ~•+x./ 39b. Z1ame, Adl essa 21 oeof Person Completing Cau ea/DeatM1(Item2 1701 39c. Da1<51 /pa,r/yr) gt 3d3 x/.57` 3 /3 40. Register's District Number 41. ReglS[rads 51 42. Regl tray File are (MO pay r) gala +w' 3 s Ire 43. Am<Mmenis Disposition Permit No. 0 D / "J a) 7 J ec105 ,143' f LAST WILL AND TESTAMENT t~ C\J U) c' G'i ¢ raq OF LU _ , N r s,- F- PATRICIA A. GLEISER I,..J F*.1Lr' icia A. Gleiser, now a resident of Cumberland o y, R Sylvania, declare this to be my Last Will and U.J r 'Tes"ament. v I revoke all my Wills and Codicils that I may have made previously. Article I My Executor shall pay my just debts, and all expenses related to my last illness, my funeral, and the administration of my estate, from the principal of my residuary estate as soon as may be done after my death. Article II My Executor shall pay all inheritance, estate and succession taxes (including interest and penalties, if any, but not including any generation skipping tax) payable by reason of my death, out of the principal of my residuary estate, without reimbursement from any person. Article III I give, devise, and bequeath all my estate, whether real or personal or mixed, including my home located at 469 Woodcrest Drive, Mechanicsburg, Cumberland County, Pennsylvania, to an irrevocable trust to be created by my Executor, for the benefit of my children, Timothy M. Gleiser, Beth Ann Gleiser, Dawn M. Zervanos, Cindy A. Clodfelter, Kevin M. Gleiser, Jeffrey J. Gleiser, and 04'~ Page 1 of 3 Pages PAG a Daniel N. Gleiser, and their children (my grandchildren), and any children who may be born to any of them in the future, with the restriction that the trustee shall make no disbursement to any beneficiary who is eligible for SSI or Medical Assistance, if that disbursement might cause the corpus to the trust to be considered to be a resource or income that would render that beneficiary ineligible for that governmental benefit, in accord with federal and state law applicable at that time. My Executor shall select an appropriate trustee, who may be the Executor himself or another person or may be a corporate fiduciary or a combination, as the law permits and as the Executor chooses. This Trust shall cease and terminate upon the death of my son, Timothy M. Gleiser, and thereupon the Trustee shall distribute any principal remaining in the Trust to my children, per stirpes. If an heir under this paragraph has not attained the age of thirty (30) years at the time of Timothy's death, the share of that heir shall be held in trust for the benefit of that heir, until he or she shall attain the age of thirty (30) years. Article IV I nominate, constitute, and appoint my daughters, Beth Ann Gleiser and Dawn M. Zervanos, as Co-Executors of my Last Will and Testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of either Beth Ann Gleiser or Dawn M. Zervanos, the other shall serve alone as my Executor. In the event of both Dawn and Beth Ann's renunciation, death, resignation, or inability to act for any reason whatsoever ` Tl~ Page 2 of 3 Pages PAG t i as my Executor, I nominate, constitute, and appoint my son, Kevin M. Gleiser, to act as my Executor. I hereby relieve my Executor, whether original, substitute, or successor, from the necessity of posting security or bond in connection with his/her duties as such in any jurisdiction in which he/she may be called upon to act so far as I am able by law to do so. My Executor shall receive reasonable compensation for services rendered to my estate. IN WITNESS WHEREOF, I have hereunder set my hand and seal to this my Last Will and Testament consisting of three typewritten pages, the first two of which bear my initials in the margin for the purpose of better identification this day of 2009. A-11eL-e n) (SEAL) PATRICIA A. GLEISER Signed, sealed, published and declared by the above Testator to be her Last Will and Testament in our presence, who at her request and in her presence and in the presence of each other, we believing her to be of sound and disposing mind and memory have hereunto subscribed our names as witnesses. fLU G1 ~J- of J-& P Page 3 of 3 Pages PAG G7 w ;to M M 70 C~p rn C-> ' y OATH OF SUBSCRIBING WITNESS(ES) ~ m n REGISTER OF WILLS Ct MbWlanA COUNTY, PENNSYLVANLk _..,1 v its Estate of Pab-j G6 Ann G (e~-<~t,- , Deceased Dawn M . Ze-rvat ipc), StAk7 AG lsw , (each) a subscribing witness to (Print Nmne/s) the 3 Will ❑ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that she / he / et' was / ere present and saw the above Testator Testatrix sign the same and that she / he / tto signed the same and that she / he Q et' signed as a witness at the request of the Testator / estatrix in her his presence and in the presence of each other. (Signature) (Signature) V Z, ~7 (.Jtk~~ / Cres 11V 4bCfz Vrl carrns cam. (Street Address) (Street Address) / z.~~s ~Urc P14 ~~SC ~do-ri - f;A' O1 I J (City, State, Zip) (City, State, Zip) Executed in Register's Office Execrated out of Register's Office Sworn to or affirmed and subscribed Sworn to or affirmed and subscribed before me this th day before me this day of of , putt' for Register of ',ails No' rv Pu')iic My Co : r:issior. Expires: (Signature and Seal of Notary or other qjuah`-~ to administer oaths. Sho~c date of expiration o: Notaq's commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time o` notarization. Form RW-03 rev. 10. 13.06