HomeMy WebLinkAbout07-25-13 �1
PETI ItJN FC3R GRANT Cl �'LETTERS
REGISTER C�F WILLS OF����,�_!L!11�r `���!1�L��—' COUNTY,PENNSYLVANIA
Petitioner(s} named below, who is/are 18 years of age or alder, appty(ies} far Letters as specified below, and in
s�ippart thereaf aver(s)the foliowing and respectfully request(s)the grant of Letters in the appropriate farm:
Decedent's Informatian , / r� �j/�
Name: ..7G' / �d�,/�r5��t�J�"'— File Na: /.—� ��� �`0 1!�
alkla: (Assigned by Register)
a/kla: /
a/k/a: Social Security Na: ��Cv � —,7��L�
Date of Death: ' „� Age at death: ���
Decedent was danniciTed at death in �� � County,��/���� �{stute)with hislher last
principal residence at '`1 � �L. ,j�j,�
Street address,Post Offce and Zip Code City,Town �p or Barough County
Decedent died at y�r� r,��1�,��- ��,��,�,� ��r�s�e r�tr�� �/!'i�td:�ii4'';�'".l��
SkreeE address,Post Office and Zip C4de City,Tawnship or Barough County State
8stimate af vatue of decedent's property at death: ,,r}
If domiciled in Pennsylvania............................ All personat praperty $ � F ��e Q�r�
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $ .�Z
Value af rea!estafe in Pennsylvania......................................................... $
Tt?TAL ESTIMATED VALUE. ... $�7 �(�d. (�jZ
Real estate+n Pennsylvania situated at:�!Y� /�./,�`.,�j�� G"—�i�� �'7�7�
(Rttnch additional sheets,if necessary.) Street address,Post Offce and Zip Code Ciry,Township er Bqrougb County
� A. Petition for Probate and Grant of Letters Testamentarv / �/ �y �"
Petitianer(s}aver{s}he/sheJthey is/are the Execntor(s}named in the last Wilt of tl�e Decedent,dated .�f °"' J Z'T�7��1 ar�i Codicil(s)
thereto dated f�,fi� C"a :��`�
—_.� � � _ �
� �
State relevant circumstances(e.g.renunciation,death ofe.zecutor � ` ; - `,-;
� - �� _ '
Except as follows:after the execution of the instrument{s)offered for probate Decedeni did iiat marry,w3�o�s�ivorced,}h7�s�not a parCy to a pending
divorce proceeding wherein the grounds far divorce had been established as defined in 23 Pa.C.S.§!3323{g};and diiYnot have a clii3d born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an ineapacitated person„- �' . , . �=' `
�Nt�EXCEPTIONS ❑EXCEPTIONS ` -
❑ B. Petition for Grant of Letters of Administration {ffapplicab�e) - F
. __
c.t.u.,d.b.n.,d.b.n.c.t.u.,pendente ltte,durunte abs�enlia,duranteminoritute
• �.--�
If Administration,c.t.a. or d.b.n.c.t.a.,enter date af Witl in Sectian A above and compiete list of heirs.
Except as foilows: Decedent was not a parry to a pending divorce proceeding wherein the graunds for divorce had been established as defiraed
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever ad}udicated an incapacitated person.
❑1Y0 EXCEPTIOIYS �EXCEPTIdNS
Petitiauer(s),after a praper search haslhave ascertained that Decedent left na Will and was survived by the foitowing spouse(if any}and heirs(attuch
aclditionul sheets,if necessury):
Name Relationshi Address
Form RW-02 irv.10/ll/2011 �5�8 1 O��
� �
Uath of Personal Representative off�;ai us�oa�y
COMMONWEALTH OF PENNSYLVANIA }
} ss;l�'ji'�{�'���3
CCIUNT Y(?F�.LL�� /�lt�f� }
Petitioner(s}Printed Name Petitioner(s)Prinzed Address
�l� ,��b�ir t7f '<�� �� � .�/�'' ,� .- � l � c�
�
The Petitioner{s)above-named swear{s)or affirm(s)the statements in the foregaing Petitian are mze and correct to the best of the knowtedge and betief
of Petitioner(s)aud that,as Persanal Representative;s}of the I}ecedent,tile Petizioner s}wili well and tr�ty administer the estate according to Iaw.
a
Sworn to o�firmed a ubscribed before /���j���i���'"��.f�Q'/ �� �ate 7'��1.3
-day qf n��2��� Date
y; Date ,
For the Register D3te
BOND Reqaired: 'Q To the Register of WiUs:
FEES• Pfease entes my appearance by my signatnr.e below:
�� E-� �.^.; ✓
Letters . . . . .. . . ... . . ..... . . .. $ . Attorney Signature: �� '
{ )Stiort Certi�cate(s}. . . . . . � � -� J � =�
� . � — � �`
( )Renunciation(s)... . . .. .. , ; ' �'
� )Codicil(s}. . .. . .. . . .. . . - ; _. i��� ..'.
:` : . :._
Aff"tdavit � �
t ) {,).. ... .. .... . '��,_. .
, .- ..
Rond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: -- „ . ., _
Co�nmission. . . . . . . .. . . . . . . . . . Supreme Court ``' ' —� �'
Otl�er T .. ... . ID Number: F ;�
..
�_
< . -
../�.. .. . . �,S�C� : .;�
�.t... . . y 'r--'�. Firm I�iame: � �..z _ �
� ---� '
. . . . . . . . �. Ad�ress: ��
. . . .. . . Phnr.z:
Autornation Fee. . . . . . . . . . . . . . . �� Fax:
JCS Fee. . . . . . . . . . . . . . .. . .. .. • 17 Email:
TOTAL. . .. . . . . . .. . . . . . . .. . . $ —
DECREE 4F THE RE�ISTER
�'�; Estate o;_ ���� �����.4I � ,� 'p No: ��'��.�"'���
a%k(a:
AND NOW, � � ,�����1��'in cansidera 'on of the fore oin Petition,
satisfactory praof having been presented before m IT I DECREE th t Lett
are hereby granted to �i �
in the above estate and(if applicabie}that
the instrument{s}dated ��(�
described in the Petition be admitted to probate and fiIed o r ord as the last Will�d Codicil(s)�o� ecedent. ��
egister of ilIs f
Forn:RY�-�2 rev. If7/11l2�I7 �1�0�
.._T _�.v.�-_ .,. �.�f. ,.N._�,.�.�.,����-,��,�-_$_�.<...,�.� . . _: ,��.��,-�..�,.,,„„�T..:.���,�, ,« _,�rri��,,.�,,.�.��..���a;�,_.
FIZOS.805 REV(4tt i}
Lt3CAL REGISTRAR'S CERTIFICATtON OF DEATH
WARNING; It is illegal to dupiicate this copy by photostat ar photograph.
n x� , 3°.. a \r P"' . . . .
Fee for this certificate, $6�b-��' ' - �� n 4� This is to certify that the information here given i
,,n„rks„���
, •f�, �,o��'tip,�ZH QF Pf,y correetly copied from an original Certificate of Deat�
�..:� ,;i :>,� � ,' �
�
- t��b�`�-_ _'_ `��__ duly �led witt� me as Local Registrar. 1fie origina
� � r r�� �r� �� certificate wilI be forwarded to the State Vita
�'i� ���- �� ' �� � �'� �° � ' b� Records Of�ce for permanent filing.
y \
_ * ` . ��1
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� �..� � L t� � Q � � � '�eSo�Al ,� ��A�?,, �'�aanc�.�.��s�+��ae�r- .1 U�I 2 3�2 013
a , ; ;�; --.A1ENT OE ,
Certificatian Namber e"` �f r,i�� .1�_, . r.1 � ,,,,,,,.,,uJtf''��
Local Registrar Date Issued
., _ j , ,
n t. C,�,1 ., r"t .�, ^� c „ . . ._ . ...
/� iJ��'���L� 1 L t�t I'k LF "•,t>_,�,� t i,
!� Type/Print in COMMONWEAL7H OF PENNSVLVANIA��EPARTMENT OF HEALTH•VITAI.RECORDS
� p°'"'""e"` CERTlFICATE OF DEATH
BIaCk ink $tate File Number.
1.Dec�tlent's Lagal Name(FIrSt,Middle,Last,Suffix) 2.Sex 3.Social Security Number 4.Date of Doath{MOJOSyjYf}{Speii M4)
JoAnii K. Rabitaill� �u�..l� 'i 86 24 776d June 2'I r 20l 3
' Sa.Age-La5t 6irthday(Yrs) Sb.Untler 1 Year Sc.Under 1 Oa 6.Data of Blrth(Mp/Day/Year){Spell Monih) 7�BIKhplyrce{City artd State or FprNgn Co�try)
{ Manths oaYs Hc*urs Minutes � �� � �� � 3Y'r1.SOIIFJ�,ir � , Vir in a � �
b 83 3anuary 3. 1 930 �n.so-cnaim�e cco��cv� 'I�7at atrailab e
Sa.Residence{State or Foreign Countryj 8b.Residence(Sireet and N4m6er-inCi�de Apt No.} �8C:61d Decedent tiv¢in a To FI 7 � �� � �
P'A 82 Lixlda. Dz''� . =�ot 32 L�3v�s,de�eaenc iwed i., �i�v�x' ^�pring cwv.
Sd.Resldence(COUnty) �.. � � �� . � .
�-'�`tm1}�.�11`1'-nG�� 8e.Restdence(21p Codej � d No�deCmdent Ilved wfthin Ilmits of -� city/boro.
9.EveY In US A�med Fqrcem7 30.Marltai Status at Time oP Death �Marrled W I owcd 11.SurvN{rig Spo�se's Nbme S�f wife,g{ve name p�lor to first mat'riage}
�j Yes 7pCNO O Vnknown C� DiVOrcOd C1 Ngvar Married �Unknow
12.Father'9 NanYe(F�YSt,Middle,Last,Suffix) 13.Mother's Name Pfior Yo FIrsS Marriag�{First,Mtddle,La5t}
A1Er�d S. Stc�idl� Ova. Lexza Dic}cson
14a.Informant's Name 14b.RelaHOnship to de<edent 14c.Informant's Mailing AddrasS(Street Sntl Number,City,State�.Zip Cade}
� David A. Robitaill� Son 82 I:inda 27r. . Lot 32. M�ct'a2��.icsbur PA
, f'„� _ ,� �, . � �„. .. . 1 a.PaC_ Q�eat � C ec.�on�one � . . .: .. .
'c IF Deakh Occurred in a Hospitak�� i C1 Inpatient � �If peath pccurr0tl Somewhera Qther Tt�an a Hobpital: [�Mosplce F34litty y �60cedeM's tlome
� � Emergency Roomfoutpatierst (;,� Oead oe1 A�rWai t �;'ry��sing Nbmf/Long,.Tarm-CaY'e FMCtlity� Q qiher(Speclry) �� � �� �� �
156.Faclfliy Name(If noi�nstitution,give street antl n�mber) i5c.City oF Tbwn 5taT@,and ZIp�COde iStl�_.GOUnTy nf D att9
� M.=inoz-Car� H�altlh Servic�� Carlis�.a. PA 17015 Ct.unb�r�and
�, 16a.M4chpd of pisposltion Burial Q CremaCion 16b.DaYa of 6ispasitlon 16c.Place of Oispaslfion(Nam.e of�emetery,crTmatory,o othar piace}
�. p�ftemo�af frnm State p Donatlon � � � � ��
p oxne.tspcary 6/25/2013 Ashl�a.n�d-py��Ceg�,t�ne�.te
�� 18tl:.LaCatton of Olsp4sltian�(Clty or Town,State,and Zip} 17a�.Sign02ure of Funera!Scrvtca ltcen`._.�- so �fiarge 4f intermerrt 174-licartsz Number
C �
G:�ra.isle, PA "1�01 3 FD 01 2633 L
� 17t.Nam�pfid Complet�Address of Funiera!Facfitty
� �in Br ther �ux°i.er 1 zno_ 6 O S. Hanov�r St. Carlisle PA 1 701 3
� 19.DeCedent's Educatlon-Check thm box that best describez the 19.OeCedmt of Hispanle QrYgin-Cliack Yhe 20.DecadenYs Rac4-Chatk ONE OR MORE race5 xa FndFCatc what
t- htghest dtgree or Ievei of schaai compFeted at tha ttme 4f death. box that besC de5cribes whether the decudeM 2ha tlecedent considared himself or hers�H io be.
p Sth gr8de or less Is Spa�ish/Hisparrlc/tatina. Check the"No" �'Whlte Q koreAn
[] No diploma,9th-12th grade box}t decedent is nat SpartishJHispanicjlatino. Q Biack or Afr�can Amcrican Q Vtetnamese
� High SGhoot graduste or GED tompteted �'No,not Spanlsh/HlSpanic/LaHno O American Intlian or Alaska Na�Ne
[� Some college credlt,but no tlCgree j]Ye5,Mexican,Mexlcan American,ChiCano � Clther Aslan
'f� Assodita dcgrea{e. AA,AS �Astan ind}an Q MaSlve HaWa3ian
B� Y O Yes,Puerta Rlcan Q GhInBSe
� Bachelor's degree(e.g.BA,A0,BS) � Ve5,Nban � pillpinp � S m�^�an or Chamorro
� Masier's degree(e.g.MA�M5�MEng,MEd,MSW.MBA} Q Ves,other Sp�nishJHispan#CjLatino Q lapaneze Q f3ther Paciftc Istender
0 DOCtorgte(t.g.Ch�,EdD)or Professionei deg�ee (SpaeiYy) �Other(Specify)
.Mp Oo5 DVM 11.0 Jd
22.DccetlenYs Singie Race Salf_Designation-Chcck 4tVtY ONE to tndicate whai thc dacedent consi[Iered himseif ar herseif to be. 22a.04CedeM's Usuai OccupaHOn-Indicate type of work
^�Whice �JaPanese � Samoan dpne dur(ng most af working fffe. 00 NOT ClSE RETiRED.
� 61»ck or A4r5can Amwrlcan Q Korc,Bn � Qther Pac(fiC istander S•��r�,t$
q �Amer(Can Indian or Alaska Native 0 V7etnamese � Don'i Know/Not Sure Yy �
7i p q�ian Indian O Clther Asian p Refused 22b.K�nd of Bustness/industry
p Chinese �Maiive Hawa3tan C� Ocher(Speclfy}
� (3 F�awno p ��an,a���n o�cn,�„o�ro Carli�lc, A Ccxcanex'ct�
r�r3 Cham�r c3f
7T�M5.23a-23d�NfUS 8E C M i_ET D 23a.Oate Prpnaunced Dead{MO �ay r} 29 .Signature o Person ronOUncing Death(On�y When app ica6 e} �.� 23c.License Numder-���
BY PER50N Wi{O PRON04NCES OR � �u�Q r� �1� . . ..
CEHTIFIHSD�ATN �� oc � � fj � � . . � �J1j��'"7a7e`� �.
23d.-l�tt SF$ned Ma OayfYr) 23.Time f Dcath � .� �/- '�""*���'. � � �
J 25.Wms Medical mtrur or Coroner Co�tacted7 �� [] VeS�� �.No
.. � +CAiJSE OF�EATti �a� � � ' APp�oximatc
26.pirt 1. Enter tha�chain of avents--diseasgs,Injuries�or Compllcatiqns--ihat directly caused thG death. DC!NOT enker ferminal avCn(s such as cartllaC arre5C, � InYerval:
respiratory arreat,or ventrtcular flbriilation wlthout shpwing the�tFOtpgy. DO NO7 A68REVIA'7'E. EY�t�r only One Cauze on a Hna. Add addikionat iine5 if ngcessary. � Onset to beath
IMMEDIATE CAUSE a. C.C� - O .S f ` +•-Q-- �� �` L .�.._S.? �
_"""'_""'_s �
{Finai dis&as�or condiiibr� aua ta tor as a cons�quancc Wj: i
resvlting in daathy � � �
� b. � �.r- `z�..:.._. f� � . . , � .
5eq��w.r�tiaiiW itst condittatts, . ue 20(Or gs a cpnsequenCe af):. - �� � �� .. � � - � � �
If any,leading to the tause � . � . � � . . . � _ . � .
IlsSetl on Ifrte a. Ente�the � �� . � � �
UMDERlY7NG CAUSE Due to(o�r as a cons�quence of): � � �: �
� (diseau or in/ury thst � . � � . . .. . . . ..
� Inttiated the eve�ts resuki�g d. �
� .tn.aeath}�psr. � . oue co tor ac a�<ansequenca oi): � � � � � � , {
-, �.'j- �26.Pbrt ii.�.Enttr other ig iff a t diti t!b tf t d [h buY not rBSUtting In che underiying cause given in Part 1. . � 27.Was an autop5y perfo med7
� . . . � . . . . . . � S� Yas �Na
�, . . . . . . . � . � � 28.Wer6 e�stoPSY findlnBS availabl�
m � � � � . . � �Yo Complete tNe cauxe of tleath7
v . .. .. � V�es
� 29.ff Fe! le: 30.Otd TobacCO Use Contribute to Oeakh7 31.Mann r Of DeaCh
' s ,,,�8 Not p�egn8nt within past yezr [� YCS � PYObably atu�al
� PregnanY at ilme o9 death Q Unknown d Homic�da
.�' � Not pregnant,bart pregnsnt wRhin A2 days af d¢eth �- � AcCident � Fending I�wastlgatlon
p 5uicitle [] could not be detQrmined
`- O Not pregnant,but pregnanc 49 days to 1 year before tleaih 32.Oete of lnjury(Mo/pay/Vr)(Spell Mo�th)
0 Unknown If pregrtant within Erie past year
33.Time of inJury
34.Place of Injury(e.g.home;construCtlon site;farm;school) 35.Location ot In}ury(5treet and M�mber,C3ty,Coun2y,State,Zip Cade}
36.InJury af Wark J7.If Transportatbn In}ury,Spc<ify: 38.Descrkbe tiow Injury Occurrect-
O �'es [�Driver/4peracor O Pedestrian
� � No [] Passen6er Q Other(Spttify} �
� 39a.Ca -phy8ician�certifietl nur5e pr0ctifion me4ical Gxaminer/GOrone�(Check only o�e):
�+� ertlfying only-To the 6esk af my knowledge,rtleaih accurred d�e to the cause{sj and manner sLaLed.
� � Pronounctng 8.Certifying-To the best of my k�awiedge,death accurred aC ttre time,date,and place,and due ko the cause(s)and manner sCaied.
� CI Meqical ezaminer/COraner- #he b�sis af examinac�on and/or invesilgation,In my opinion,death occurred at the time,dat�a,antl ptace,and�IUe to Lhc o�use(s}and manner stat�tl.
StgnaYUrB of cerCiffeY: Titlw oT.certlfler.__�,y�� �C`�1 - Llcerts�t NUTber.��6"rQ.�'��"� -t
39b,!�eme,Atldresa a�d Zip Co Person Completing Cause pf D�eath{�tem 26J � �� �r � 9c.6ate 5ignatl(MoJOeyJYr)
I✓�Atf.S"" .f /- � d_ ..�M� �..�/7� ef' C" ' ..'¢ .v-'rt' m �.z' e� f�- �.S
� 40 R glstr s D{str ct umbgr � 41.ReglStrAr'S ignature � . ��� 42. eg Steat F e 4ake{Ma Oay �
1 �ifi3 �.,s�.'�.�d,.�s.,aae�r- u ,� 3 �,�}�� ,-
� 43.Amendments .
�
2
Dlsposition Permik No.. \ !QH'.1"h�� Hint-+a.a
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LAST �1�ILL AN1? TESZ'��E � - `-�-; ��� �
�..���
.� �.�, . . _ _ .
I, JO ANN K. ROBTTAILLE, of 1428 Etradley Drive, Unit J-112;�Carlisle, G�umberland
County, Pennsylvania 17013, da hereby make, publish and declare this to be my las�� will and
testament, hereby revaking all wills heretofare made by me.
1. I direct my personal representative to pay all of my debts, funeral, administrative
expenses and inheritance taxes as saan as canvenient after my decease.
2. Subject to the provisians of paragraph three below, I authorize and empower my
personal representative to sell any realty andlor persanalty owned by rne at my death and not
specifically devised or bequeathed herein, at pubiic or private sale or sales and to givs good and
sufficient deeds andlor bills of sate therefor, in fee simple, as I cauld do if living. My
representative is authorized and empowered ta engage in any business in which I may be engaged
at my death, far such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all af my estate af whatever nature and wherever
situate to my children, share and share alike, the child ar children of any deceased child taking the
share their parent would have taken if living.
4. I nominate and appoint David A. Robitailte to be the personal representative of my
estate, ta serve without bond. If he cannot or does not serve, then I appoint Robert K. Robitaille
and Joseph M. Robitaille to be the substitute co-persanal representatives, alsa wi�hout bond.
5. I suggest that my persanal representative retain the services af Harold S. Irwin, III,
Carlisle, Pennsylvania in the settlernent of my estate.
IN WITNESS WHEREQF, I have hereunto set my hand and seal this �`'`�� day af
November, 1995.
;
'�"�.�C, (SEAL}
K. R08ITA LE
Signed, seated, published and declared by the above-named persan as and far a last will
and testament, in our presence, who at said person's request, in said persan's presence and in the
presence of each other have hereunto set our names as subscribing witnesses.
r° '
il����l��S.�1"' P 1/ /�G:'G.6�`�it-/vt,�rl
N
at
AC`KNO i�T��E�G��ENT AN� ,�1F�'�DA �T'
WE, JU ANN K. R(}BITAIGLE, H�ATHER A. BARBCIUR and GAY L. IRWIN,
the testatrix and witnesses respectively, whose names are signed to the foregoing instrument,
being first duly sworn, do hereby declare to the unde�signed authority that the testatrix signed and
executed the instrument as her last will and that she had signed willingly, and that she executed it
as his free and valuntary act for the purpose herein expressed, and that each af the witnesses, in
the presence and hearing of the testator, signed the will as a witness and that ta the best of their
knowledge the testatrix was, at that time, eighteen years af age or older, af sound mind and under
no constraint ar undue influence.
� �
f r
"�++"^'� �.
JO A .ROBITAILL
���� =-';[1'?�` ,,�j . �����.
HEATH A. BARBO
� �
AY L. IN
CflMM01��1WEALT�3 OF PENNSYLVANIA
:ss:
COLJNTY OF C'UMBERLAND :
Subscribed, swarn to and acknowledged before me by JO ANN K. ROBITAILLE, the
testatrix herein, and subscribed and sworn ta befpre me by HEATHER A. BARBOUlt and
GAY L. IRWIN, witnesses, this�day afNo ember, 1995.
Notary Public
otarial Sea!
Haro girwin 111,Notary Public
CarUrlo Boro,Cumberiand Cnunry
My Commfsalon�xpires Sept.�a,i s�s
ii+M1R14�ri�1tt�t�+�ar�eAcr�ciation c�f Notari�