HomeMy WebLinkAbout09-23-05
Register of Wills of Cumberland County
PETITION FOR PROBATE and GRANT OF LETTERS
Estate oL~ A-t:. 'E 1+. Q..MQ,rOtl i No.'~ J - OS - Of"5l{1
also known as To:
, Deceased.
Social Security No._\ "i... 2. c.t- e 8 ~2.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are l~ years ofa~e or older, and the execut~ named in the last will of the
above decedent, dated ~ ~" st , ,200 ~
and codicil( s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
County,
or
(list street, number and mu ipality
Decedent, then 1i years of age, died 'S~ ,0 , 20~, at ~ ~\ \\
Except as follows, decedent did not marry, was not divorced and did not have a c ild born or adopted after
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value ofreal estate in Pennsylva~ l6...v- c..l.u {CJ..
situated as follows: b11 ''''0 f I/' J,.., '/
$ 100. pOO. -
$
$
W tw'w\. \-4A., ~-t (~'~~. 0 0 A' -
. J ~-
WHEREFORE, petitioner( s) respectfqlly request( s) the probate of the last will and codicil( s) presented
herewith and the grant ofletters ~ >+0..
estamentary; administration c.t.a.; administration d.b.n.c.t.a.)
thereon.
~ ofPetiti5jer(S) .
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Residence( s) of Petitioner( s)
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYLVANIA
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ss:
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affrrm(s) that 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 above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or af~~~~scribed
Bef\!:e this l?t"} . \d~of
pt . , 20 C J
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Estate of \ , U fu.. (t'.(\.l'\.. ~'\..Q.'\l!:~ , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW . ~'et d'2> 20 [lS"' m oon,;de"tion of the petition on the reve",,;de
hereof, satisfactory pr ofhavmg been presented before me, IT IS DECREED that the mstrument(s), dated
~ " .l.c .- O~~ , described t..~erein be admitted to probate filed of recprd as the last will of
\'0cv .. (1 C' c- r, 1\ "~
U-<. t.A.'-. t~AO''>('o. 1 ; and Letters are hereby granted to ~ (Ll.U\ <.l2 ( .y~ ~
FEES
Probate, Letters, Etc. .........,...
Will............................. ....
~'~ '~ U:1b' . .
\,' t 0.1110(0 ~l\'~. 0 ~.~ < tf);C "
. RegIster 0 WIlls . . C'Q.u)T tf)c'pv_:~
... .
rr
Automation Fee...................
Bond.................................
Total
Filed q ~3
$ 3J() .cD
$ }~.()D
Renunciation... , . . . . . . . . . . . . . . . . . . . $
Short Certificates ( ), . . . . . . . . . . . $';;4 I l.X)
JCP.................................. $ I "'J ' e:tD
$ S;.ui)
$
$ ?:ivLf. tlU
2D.$~
"5~CJJ ~ W- ~+.
Address ~ ~-r\ .1 D Ii
---,hd\ , \' (7
17 el( 1- 't.l2. -r
., 1 7 - 7 '3?-o~ bY
Phone
Thi, is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Loc,t1 Registrar. The original certificate will be forwarded to the State Vital Records Offic~ for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 11840688
No.
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Fee for this certificate, $6.00
SEP 2 0 ?noJ.:
Date
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
[IPRINT
'N
'<(ANENT
.CK INK
CERTIFICATE OF DEATH
,--
I..
Yo;
Caneroni
Slo'lE FILE NUMBER
SOCIAL SECURITY NUMBER
3. 167 24
NAME OF DECEDENT (First. Middle, Last)
,.
AGE (lu' Birthday}
, 74
COUNTY OF DEATH
BIRTHPLACE (City and
Slate or F(),8tgn Country)
9.agus Mines, PA
A H
.,
~JO
rican Indian, Black. White. et
Ctmlber land
DECEDENrs USUAL OCCUPATION
(~~~ofllf~~~rir:1.=)1
". Laborer "b.
DECEOENrs MAILING ADDRESS (Street. CityfTown. State, Zip Code)
571 Poplar Road
,.. Hill PA 17011
FATHER'S NAME (First, Middle. last)
'8 Gerald
INFORMANrs NAME (TypelPrint)
20.. Clarence
METHOD Of DISPOSITION
Bunel 19 C'.molioo ~emov.1 from State 0 0
Oth... ISpedfy) 2
FVN~~EE OR PERSON ACTING AS SUCH
Com, ei'lems 23a-c only when certifymg To the best of my knowtedge, death occurred 81 the time. date and place stated.
ph~lC'ian IS no! available al time of death 10 (Signature and Title)
certify cavse of death 231;.
TtME OF DEATH
MARITAL STATUS - Married.
Never Matried, Widowed,
0Ml<ald (Spe61y)
...WidCMed
8b.
lwO
17b. Count,
Clmberland
17d.f] '::N~:~=of
Cam Hil~
crtylborQ
Gerg
Gerg
MOTHER'S NAME (First, Middle, Maiden Sumame)
'i. Anna Bauer
~~~~R~S~~Nm~ESS ~9u~IT~:;~ ~p ~e)
PLACE OF DISPOSITION. Neme of Cemetery, Crematory lOCATION
Of Other Place
15831
2'c. st.
15846
15857
Sequentiatty 1ts1 condihons { c..'
if _ny. leading 10 immediate
cause. Enter UNDERLYING
CAUSE (Disease or injUry
that tnitiated evenls
resurting 01'1 death) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAIlABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
~~(??HZt?/ J<-
DUE TO (OR AS A CONSEOUENCE OF):
C-e'J/U>,u>.
DUE TO {OR AS A CONS ENCE Of):
~[~.f.~~
_ ~ez- .ef"SJ~H"'"v
1~~t:7..:....)
to/1"~c
21.
: Apprcndmate
. ;nlervat between
: onset and de.th
PART II: ~:~~n~~=;:~:tj~~~ ~&~~~~
CPV~fr/,4,V ~~
{!A~ "-6It.-I'I.~f[)J/5
V"0
MANNER OF DEATH
~
o
o
DATE OF INJURY
(MonO'l.O.y. .,...,)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJU V OCCURRED
Natural
HomK:id,
o
o
JO.. JOb. M.
o PLACE OF INJURY. Al home. farm. street, ractofy. office
b.....ding. ele (Speclfyl
JOe.
Ve, 0 No 0
JOe.
Ves 0 No ~
Accident
Pending Investtgation
Could nol be determined
NoD
Suicide
2h. 28b.
CERTIFIER (Check only one)
"l~~J~F~~tGor~~~I;~~~e~~s~:rhC~~~J8dUUS: t~ r~:~.~:~(:r~~jr~~x~;. h:t~r~~.~~~~~..~~~.~.~~~~.~ .i.I~.~~.~.
2i.
"PRONOUNCING AND CERTlFYING PHYSICiAN (Phys,iCl8n both pronouncing death and certifying 10 cause of dealh)
To the best of my knowledge, death occurred at the time, dale, and place, and due to the causes(s) and manner lIS stated...
"MEDICAL EXAMINER/CORONER
On the basis of examln.lllon and/or Inv.stlgatlon, In my opinIon. death occurr.d at the 11m., date, and place, and due to the caus..,s) and
mann.ralllltaled. ...... ..... .............. .........................
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REGISTRAR'S SIGNATURE AND NUMBER
m a./~~'1~
LzI If I ::<l fl J:>t
.032. (Z-oc..-tl?C-DO Jt. e'H H
DATE FilED (Month, Day. Year)
/<<0
34.
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Of
MARIE A. CAMERONI
I, Marie A. Cameroni, of Fox Township, Elk County, Pennsylvania, 15846, being of
sound and disposing mind, memory and understanding, do make publish and declare; the
following as and for my Last Will and Testament, hereby revoking and making null and void any
and all Wills, Testaments or writings in the nature thereof by me at any time heretofore made.
FIRST: I direct that all my just debts and funeral expenses be paid by my Executors
hereinafter named, out of the first monies that shall come into his or her hands from any porltion
of my estate.
SECOND: I give, devise and bequeath all the rest residue and remainder of my estate in
equal shares to my brothers and sister hereinafter named as survive me, share and share aliMe to
wit, Jerome Gerg, Clarence Gerg and Kathleen Gerg Sorge.
LASTLY:
I hereby nominate, constitute and appoint my brother, Clarence Gerg to
be the Executor of this, My Last Will and Testament. In the event Clarence Gerg is unwqling
or unable to act, I appoint my brother, Jerome Gerg to be the Executor of this, My Last Will and
Testament.
I direct that my Executors shall not be required to give bond for the faithful performance
of his or her duties in any jurisdiction.
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In addition to all powers conferred by law, my Executors shall have the power 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 or leases without the necessity of obtaining prior leave of
court.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my last Will
and Testament, typewritten on these four (4) pages, this --1a- day of ILi Ld.:<-.i/2003.
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. a{?'~:{L ,,/' ( ";'::'?~f ;>r)"J~:7;:--':-' (Seal)
Marie A. Cameroni
Signed, sealed, published and declared by the above-named Testatrix as and for her Last
Will and Testament in the presence of us. Who have hereunto subscribed our names at her
request as witnesses thereto, in the presence of the said Testatrix and of each other.
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COMMONWEAL TH OF PENNSYLVANIA
ss
COUNTY OF ELK
We, Marie A. Cameroni, the Testatrix and Norbert J. Pontzer and David S. Pontzer,
witnesses, whose names are signed to the foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testatrix signed and executed the instrument a~ her
Last Will and Testament, that she signed the same willingly, and that she executed the
instrument as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix, signed said Will as witnesses and that, to
the best of the knowledge of each of the witnesses, the Testatrix was at the time eighteen (18)
years of age or older, of sound mind and under no constraint or undue influence.
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Testatnx: ,,/r:.-;;.v /7 l ,~:'}7:A:.;;_,/;7~
Witness:
Witness:
Subscribed, sworn to and acknowledged before me by Marie A. Cameroni, the Testatrix and
subscribed and sworn to before me by Norbert J. Pontzer and David S. Pontzer, witnesses, this
\0 -1:b day of A~ l),nL 2003.
~h~
Notary Public
Notarial Seal
Shannon R, Heindl. Notary Public
Ridgway Bora, Elk County
My CommiSSion Expires Mar. 6, 2004
Membs.r Pi?fll'1S'/hl;:.~ni:;'! "...,;,:.,..,.,,; ...+j"\,, "'>t ",/,')t,~dp~
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