HomeMy WebLinkAbout04-15-15 REGISTER OF WILLS
CUMBERLAND COUNTY PENNSYLVANIA
SMALL ESTATES AFFIDAVIT
For Insurance Proceeds O F 1 C E OF
NOT to be Used for Settlement of Small Estates undig RP&g
Li\ vl
(Original Death Certificate Must Accompany this Form)
5 APR 15 PM 3 16
Deceased Gilda E. Fenili DockeYNb.
also known as Social Security 1ttf07,,3;1440537
Before the Register of Wills of said County personally came Theresa A. Heistand 004?Aides
at 1274 Sandy Lane, Boilinq Springs, PA, 17007 C1 I M BF Rtb0holdlPsw4irr'i,
deposes and says that Gilda E. Fienili ,age 93 ,a resident of
121 Walnut_Bottom_Road,_Shippensburg, PA 17257 __
in said County,departed this life,at 121 Walnut Bottom Road _ on the _26th_ _ day of
Febr � , A.D.20 1.5 _ 2:55 o'clock . P M.,possessed of personal
property estimated to be of the value of$ 2,158.58 ,and possessed of real estate,the estimated value
and the location of which is as follows: No Real Estate National Guardian Life Policy# NPL0226471
Except as follows.Decedent did not marry,was not divorced,and did not have a child born or adopted after execution of any
testamentary writings whether or not offered for probate;was not the victim of a killing, was never adjudicated an incapacitated
person,and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as
defined In 23 PA CS.section
3323(g):
The totni amount ofinsumnce proceeds payable by National Guardian Life does not exceed SI1,000 and 60 days have elapsed
since the death of the insured.The undersigned agrees payment cannot be made under this Affidavit if a written claim for same has been
made by it Personal Representative of the estate and no other heir(s)having prelerence exist or have released their benefits to the
undersigned.
That said decedent left a spouse—whose name and residence is
and the following as next of kin: (use additional sheet F required)
NAMES RELATIONSHIP RESIDENCE
Carol Anne Raffa Dau hter
That the above named are the spouse&and all the known next of kin of said decedent,to the best of my knowledge and
belief.
Your Petitioner avers there are NO KNOWN PROBATABLE ASSETS that would require an estate proceeding.
77ierejore,NO ESTATE WILL BE RAISED,AND LETTERS ARE NOT NECESSARY.
Signed
By:
worn and subscribed to before me this
ay of
120 _ Register of Wills: }meq
M Kindly enter appearance in the above case this
— 'v'avL - -- day of I ------ '20
- I.D.No. —
Recjtst�cra-f wit IS Attorney
Uc►v-14 of br9kYans Cpuy}--
BEITREMEMBERED,that as of the day of ,A.D.20
There has been NO ESTATE PROCEEDING RAISED FOR THIS DECEDENT AND NO LETTERS HAVE
BEEN ISSUED BY THIS COURT.
Lisa M. Grayson, Esq.
Register of Wills&Clerk of Orphans'Court
My Commission Expires 1-irst Monday,January,2018
REGISTER OF WILLS
CUMBERLAND COUNTY PENNSYLVANIA
SMALL ESTATES AFFIDAVIT 1G�
For Insurance Proceeds d NOT to be-used for Seftlement of SmAll Estates. EW . , p 'F I C E OF
S'
(Original Death Certificate Must Accompany this Form)
?((Nb
� PPR.:15 � l 3 16
Deceased Gilda E. Fenili Docket .
also known as Social Security Nt.Lj0p:K1@40537
Before the Register of Wills of said County personally came Theresa A. Heistand n R.HA'(;00'. aides
at 1274 Sandv Lane, Boiling Springs, PA. 17007E1`I:KIRFFbLbA1h liQyPs�v&A,
deposes and says that Gilda E. Fienili ,age 93 _ ,a resident of
121 Walnut Bottom Road,_Shippensbur9, PA 17257 w ____
in said County,departed this lite,at 121 Walnut Bottom Road _ on the 26thday of
February _ A.D.20 15 _ 2:55 o'clock . P. M,possessed of personal
property estimated to be of the value of$ 2,158.58 i and possessed of real estate,the estimated value
and the location of which Is as follows: No Real Estate National Guardian Life Policy#NPL0226471
Except as follows,Decedent did not marry,was not divorced,and did not have a child born or adopted after execution of any
testamentary writings whether or not offered for probate;was not the victim of a killing, was never adjudicated an incapacitated
person,and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as
defined in 23 PA C.S.section
3323(8):
The total amount ofinsurance proceeds payable by National Guardian Life does not exceed S11,000 and 60 days have elapsed
since the death of the insured.The undersigned agrees payment cannot be made under this Affidavit if a written claim for same has been
made by a Personal Representative of the estate and no other heir(s)having preference exist or have released their benefits to the
undersigned.
That said decedent left a spouse—whose name and residence is
and the following as next of kin: use additional sheet! re wired)
NAMES RELATIONSHIP RESIDENCE
Carol Anne Raffa Dau hter
That the above named are the spouse&and all the known next of kin of said decedent,to the best of my knowledge and
belief. _
Your Petitioner avers there are NO KNOWN PROBATABLE ASSETS that would require an estate proceeding.
Therefore,NO ESTATE WILL BE RAISED,AND LETTERS ARE NOT NECESSARY.
Signed
By: P4�CPi a4"e,;A
worn and subscribed to before me this
H�Iay of ,20 Register of Wills: �- q
Kindly enter appearance in the above case this I -
—Q) — — day of 20 _
Recjisf-cra-f WAIS Attorney
0e-c �F,brpt_rns(1111MR
I .j Z;vL ,A.D.20%)
BELT REMEMBERED,that as ditheThere has been NO ESTATE PROd'k9l)tII CG HIS DECEDENT AND NO LETTERS HAVE
BEEN ISSUED BY THIS COURT. A G
.-t ZT 8 W8 R
co Lisa M Grayson.. ES
ca rr: .S�l l 4 M .��' `�3 1 S 1 C 3�! 3' � 1
_ � E Li- � C _C I A 0 Q 3 C U d C 3 Register of Wills&Clerk of Orphans'Court
U— ty d rn r� t,,, f My Commission Expires First Monday,January,2018
CD `^ Ci - =
Q or Q) W
W W GV —J. Q. tix
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C> t1J
POWER OF ATTORNEY
I, CAROL ANNE RAFFA, residing at 39 Blue Mountain Vesta, Mechanicsburg,
Pennsylvania, do hereby name, constitute, and appoint THERESA HEISTAND, residing
at 1274 Sandy Lane, Boiling Springs, Pennsylvania as my true and lawful Attorney-in-
Fact for me and to act in my name, place, and stead hereby revoking all Powers of
Attorney previously made, given, or executed by me, and I do grant to my Attorney-in-
Fact the following powers and authority:
1. To ask for, demand, sue for, recover, collect, and receive all sums of
money, debts, dues, accounts, legacies, bequests, interests, dividends, annuities, and
obligations whatsoever as are now or shall hereafter become due, owing, payable, or
belonging to me, and to use all lawful ways and means for the recovery thereof and to
compromise and agree to the same and give releases or other sufficient discharges for
them;
2. Whether or not such real property is specifically identified herein or
whether or not it has been acquired by me after the execution of this Power of Attorney,
to make, seal, and deliver all deeds and other assurances for any interest in real property;
to bargain, contract, agree for, purchase, receive, and take possession of any interest in
real property; and to lease, bargain, sell, remise, release, convey, and mortgage any
interest in real property upon such terms and conditions and under such covenants as my
power of attorney deems proper;
3. To make, do and transact all and every kind of business of whatsoever nature
or kind, including the receipt, recovery, collection, payment, compromise, settlement and
adjustment of all accounts, legacies, bequests, interest, dividends, annuities, demands,
debts, faxes and obligations, which may now or hereafter be due, owing, or payable by
me or to me;
4. To deposit and withdraw for the purposes hereof, in either my said attorney's
name or my name or jointly in both our names, in or from any banking institution, any
funds, negotiable paper, or moneys which may come into my said attorney's hands as
such attorney or which I now or hereafter may have on deposit or be entitled to;
5. To bargain and agree to buy, sell, mortgage, and in any and every way and
manner deal with goods, wares, personal property whether tangible or intangible, causes
in action, and other property in possession or in action, and to make, do, and transact all
and every kind of business of any nature whatsoever.
6. To sign, seal, execute, deliver, and acknowledge such deeds, releases,
mortgages, bills of lading, security agreements and financing statements, bills, bonds,
notes receipts, evidences of debt, releases, satisfactions, and other instruments in writing
of any kind as may be necessary or proper;
7. To make gifts; to create a trust for my benefit; to make additions to an
existing trust for my benefit; to disclaim any interest in property; to renounce fiduciary,
elected, and appointed positions; to withdraw and receive the income or corpus of a trust;
to engage in real property transactions; to engage in tangible personal property
transactions; to engage in stock, bond and other securities transactions; to engage in
commodity and option transactions; to engage in banking and financial transactions; to
borrow money; to engage in insurance transactions; to engage in retirement plan
transactions; to handle interests in estates and trusts; to pursue claims and litigation; to
receive government benefits; to pursue tax matters;
8. To appoint a successor Attorney-in-Fact should any original or successor
Attorney-in-Fact be unable or unwilling to act 'under this Power of Attorney because of
death, resignation, renunciation, or any other reason, or to delegate one or more powers
hereby granted to my Attorney-in-Fact, to such person or persons as my Attorney-in-Fact
may designate;
9. To receive and open my mail whether delivered by governmental agency
or private organization;
10. To grant, bargain, sell, and convey all of my real property, or any part of
it, which I may own, for such price and on such terms as she shall deem proper and to
collect the proceeds of any sale; to enter into any contract to the sale of the real estate, or
any part of it, with such persons and on such terms as she shall determine; to execute,
acknowledge, and deliver such deeds or conveyances, with such covenants and
conditions as she may deem proper as well as any other documents which may be
required to affect such a sale or conveyance;
11. To enter into any safe deposit boxes maintained by me in my name alone
or jointly with any other persons and to remove the contents thereof or to make additions
thereto;
12. To receive confidential information and to perform any and all acts that I
can perform (including the power to sign tax returns and the power to receive refund
checks) with respect to any and all tax matters before any federal, state or local taxing
agencies or authorities, including specifically the Internal Revenue Service.
13. To have full access to all medical information or other records relating to
me maintained by any provider or supplier of health care services and to consent to the
release of such information to such persons or agencies as my Attorney-in-Fact deems
proper;
14. To authorize my admission to a medical, nursing, residential, or similar
facility and to enter into agreements for my care; and to authorize medical, dental,
psychiatric, and surgical procedures not inconsistent with any Advance Life Directive
and Declaration for Healthcare executed by me;
If and in the event that THERESA HEISTAND, does not survive me or is unable
to perform her duties under this Power of Attorney, then and in such event, by these
presents, I do make, constitute and appoint my granddaughter, JENNIFER LYNN
DOUGLASS of 49 West Keller Street, Mechanicsburg, Pennsylvania 17055 as and for
my true and lawful attorney, for me and in my name and on my behalf generally to do
and perform all matters and things, and transact all business with full power as stated
hereinabove.
This Power of Attorney shall be effective immediately upon the execution hereof.
GIVING AND GRANTING unto my said attorney full power and authority to do
and perform all and every act, deed, matter and thing whatsoever in and about my estate,
property, and affairs as fully and effectually to all intents and purposes as I might or
could do in my own proper person if personally present, the above specially enumerated
powers being in aid and exemplification of the full, complete, and general power herein
granted and not in limitation or definition thereof; and hereby ratifying and confirming all
that my said attorney shall lawfully do or cause to be done by virtue of these presents.
AND I hereby declare that this power of attorney shall not be affected by my
disability or incompetence but shall continue in force and be fully effective and exercisable
even though I may subsequently become mentally incompetent or disabled.
IN WITNESS WHEREOF, I have signed this Power of Attorney on this
day of June, 2006.
WITNESS:
C"'G, C. A cc1�✓� 12 9�.�,�
CAROL ANNE RAFFA
C °`
3-. n..
SS
COUNTY OF CUMBERLAND
On this, the a 3 f4ay of June, 2006, before me, a Notary Public in and for said
County and Commonwealth, the undersigned officer, personally appeared CAROL ANNE
RAFFA, known to me (or satisfactorily proven) to be the person whose name is subscribed
to the within instrument, and acknowledged that she executed the same for the purposes
therein contained.
IN WITNESS WHEREOF,I have unto set my hand and official seal.
G�2t.l� ,Q
NOVOK sm N Public
MARION A ORUCA
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MV ConMMplon'bVhG Nav 1.2007
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77
ACKNOWLEDGEMENT
I, THERESA HEISTAND, having read the attached power of attorney and am the
person identified as the agent for the principal. I hereby acknowledge that in the absence
of a specific provision to the contrary in the power of attorney or in 20 Pa. C.S. when I
act as agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on
behalf of the principal.
/a3 /o b
THERESA HEISTAND, Agent Date
ACKNOWLEDGEMENT
- ver �•,.:�,�,h 4 dei'. .
I, JENNIFER LYNN DOUGLASS, having read the attached power of attorney
and am the person identified as the agent for the principal. I hereby acknowledge that in
the absence of a specific provision to the contrary in the power of attorney or in 20 Pa.
C.S. when I act as agent:
I shall exercise the powers for the benefit of the principal.
I shall keep the assets of the principal separate from my assets.
I shall exercise reasonable caution and prudence.
I shall keep a full and accurate record of all actions, receipts and disbursements on
behalf of the principal.
ERS
OU GL SS, A t D e