HomeMy WebLinkAbout11-14-05
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Mary C. McKillip
also known as
No. 21-05- 0 C;q (p
, Deceased
Social Security No. 174-20-1560
Lana Provazzo
Petitioner(s), who is/are 18 years of age or older, appl(ies) for:
(COMPLETE 'A' or 'B' BELOW)
I!I A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated 04/05/1985 and codicils dated
Decedent's husband, John L. McKillip predeceased her
Executrix
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
none
o B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following sp~e (if any) an~irs:
--. (') 2S:~
Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with hislher family
or principal residence at 10 Brian Drive, Borough of Carlisle
(list street, number, and mUnicipality)
Decedent, then --1L years of age, died 09/18/2005 at Hershey Medical Center, Derry Township, Dauphin Co., PA
Decedent at death owned property with estimated values as follows: (Location)
(If domiciled in PAl All personal property $ 3,000.00
(If not domiciled in PAl Personal property in Pennsylvania $
(If not domiciled in PAl Personal property in County $
Value of real estate in Pennsylvania $ 80,000.00
situated as follows: 10 Brian Drive, Borough of Carlisle, PA
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
of letters in the appropriate form to the undersigned:
ignature
Lana Provazzo
Typed or printed name an residence
26 Old Stone House Road
Carlisle, PA 17013
Prepared by the Pennsylvania Bar Association
Copyright Ie) 2004 form software only The Lackner Group, Inc.
Form RW-1 (1991)
IOSXO' REV 1,0, , . . c9 I-C.b -ty::(tff- . .
This is to cettify that the information here given is correctly copied fron: an ongmaJ ce:~lflc~te (.f dc~ dul~. ftled wIth
Local Registrar. The original certificate will be forwarded to the State Vttal Records Offtc for permanent filmg.
me as
WARNING: It is illegal to duplicate this copy by photostat or photo~lraph.
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Fee for this certificate, $6.00
SEP~2 1 2.Q05
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Date
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ITEM
SHOULD . READ AS fOllOWS;.
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l Rev. 2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATE FilE NUMBER
NAME OF DECEDENT (Firs:, Middle, Last)
1.
AGE (Last Birthday)
MlVl.
UN R 1 DAY
Hours Minutes
SEX
SOCIAL SECURITY NUMBER
DATE OF DEATH (Month. Day. Year)
4. Se.pte.mbvr. 78, 2005
BIRTHPLACE (::Ity end
State or Foreign Country)
ROIja.f.ton,PA
2, Fe.ma.f.e. 3. 774 - 20 7560
PLA F -: h eln tinono
HOSPITAL:
Inplltie"1 I2f ERIOutpallenl 0 DOA 0
Ba.
Resident_ 0 ~;~fy) 0
RACE. American Indian, Black, Wnlte, at .
(Specify)
Dauphin
Be,
Derry Twp.
10.
Wh-i.te.
Bb.
DECEDENTS USUAL OCCUPATION
(C:~inO~~~ ~~u:r1/~~r~t
lla. Bank..ing llb. TJr.ll-6t CO.
DECEDENrS MAILING ADDRESS (Street. CltylTown. State, Zlp~) DECEDENrS
ACTUAL
RESIDENCE
(See instructions
on other side)
KIND OF BUSINESS IINOUSTRY
AS DECEDENT EVER IN
U.S. ARMED FORCES?
YesO NO~
12.
MARITAL STATUS - Married.
Never Married. Widowed,
Dlvotced (Specify)
14. W.idowe.d
SURVIVING SPOUSE
(Jfwlf., give maiden name)
17a. State
PA
i7e. D Yes, decedent lived in
twp.
70 BJr..ia.n VJr..iVe.
16. CiV1..f..i.6.f.e, P A 7 70 7 3
17b. COUIlI:v
Did
decedent
live in a kJ.'
Cumbe.Jc.tand township? 17d')Q ~~~e;~~7\i~I~~ of
MOTHER'S NAME (First, Middle, Maiden Surname)
lB.
INFOR!cIANr~ MAjLlNG ADDRES~ (Street, CitylTown, !jtale, Zip Coej,el.
20b.;::6 U.tl1 Stone. HOll-6e Road, CiV1..t-Ul.f.e., PA 77073
PLACE OF DISepSITION- .lo!ame of CllI""telJl. C~~atory LOCATION - CltylTown. State, Zip Code
o/OtherPlace cJr.e.mauon ':'OCA.e.-t.!1
21c. 0 P A CJr.e.matOJr.
NAME AND ADDRESS OF FACILITY 11
22e. CJr.e.ma.t.<.on Svr.v.ic.e.-6,
LICENSE NUMBER
CiV1..f..i.6.f.e.
citylboro.
L.e.Oljd F. COV/J!.ad
Lana. PJr.ovazzo
The.fua M. GJr.O-6-6
24.
PA 77709
77709
Items 24~26 must be completed by
person who pronounces death.
27. PART I: Engr the dlhu.a, Injun.. or complicatIon. which eau..a the de.th.
Ust only on. c.u.. on ..ct'lllne.
26.
: Approximate
I interval between
: onset Bnd death
Other significant conditions contributing to death, but
not resulting in the undertying cause given in PART l.
IMMEDIATE CAUSE (Final
disease or condition
resulting if" death)----
a.
*1e~C\ry-,tl'Je,
Sequentially list conditions b.
if any, leading to immediate !
cause. Enter UNDERL Y1NG
CAUSE (Disease or injury : c.
that initiated events
resulting on death) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
cue TO (OR AS A CONSEQuENCE 0F)'
Yes 0 No idl
Yes 0
MANNER OF DEATH
Natural ~ Homicide 0
Acadent 0 Pending Investigation 0
Sulade 0 Could not be detennined 0
DATE OF INJURY
(Month, Day, Yllar)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
28a. 2Bb.
CERTIFIER (Check only one)
*l~~~~:tGor~~~~.u~hl.~~ ~~i~~J~: t':: r~:~.~:~(:r~~3rrf~x~~a~sh~r.~~~~~.~ .~~~~. ~~~ .~~~~~~~.~.~~ .~~~........ ..... .... 0
29.
30a. 30b. M.
PLACE OF INJURY - At home, farm, street, factory, office
buIlding, IIle, (Spllcify)
30..
Yes 0 No 0
30e.
REGISTRAR'S SIGNATU~~ NUMBER
33 ~
~v4'i'r'11
17033
NO~
.P-rOO~~:~I:'G~N~;;I~~~:'::~H~~U~~: 1~~i~::,ne~~~t~~~~~~,d:ri~h cfued t~eg,'Zi~~u~.~~r:~~ dr::~J.r at stated. ......, .............. 0
.MEDICAL EXAMINERlCORONER
~:~~:rb::I:,:~~~~.":.I.~~~I~~. .~~~~~ .I~~~~~~~~~~~.~: .l.~. ~~ .~:.I~~~: .~~~~ .~~~.~~~.~. ~.t. ~~. ~I.~~:. ~~~:. ~.~~ .~~~.~~'. ~~~ .~.~~. ~~ .~~. .~~~~.~~.(.~~ .~~~.. 0
31a.
34.
"l / 0?t:J tJ s'"
/
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) or affirm(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 Decedent, Petitioner(s) will well and truly administer the estate according to law.
J<M<-' ~~IJD
Lana Provazzo
Sworn to or affirmed and subscribed
before me this 14~ J..-; day of
~w.emk>~/\ ,d005
b~~~"" 9ih1k>~b-
F ~ ~~R'W-
No.
21-05- ~l1 V
Mary C. McKillip
, Deceased
Estate of
also known as
Social Security No: 174-20-1560
Date of Death:
09/18/2005
AND NOW, ~/)
/L-j
, rjOfJS
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 00 Testamentary 0 of Administration
are hereby granted to
Lana Provazzo, Executrix
(c.I.a.; d.b.n.c.l.a.; pendente lite; duran~ apsentia; duran~inoritate)
-~ ,.-, ~::.;)
, / C-~n
t.".:J
-r'<t
~=t ') r:tl
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in the above estate and that the instrument(s) dated
4/5/1985
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described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
~4 FmNfS~
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George F. Douglas III
1 ----i
c:::;
FEES
Letters.......................................... $
&10
/~,
Short Certificate(s)...................... $
Renunciation............................... $
Attorney:
I.D. No: 61886
Said is, Shuff, Flower & Lindsay
Address: 26 West High Street
Affidavits ( )...........................$
Extra Pages ( )......................$
CodiciL... ................... ................... $
JCP Fee.......................................$
/()~ D D
Carlisle, PA 17013
Telephone1 (717) 243-6222
Inventory...................................... $
E-Mail:
Witl
Other... ......................... ........... ..... $
IT1f1l)
TOTAL. ....... ... ..... ..... ....... $
15": CD
~'Ct
~5a, 66
Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form FlVV-1(1991)
..
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LAST WILL AND TESTAMENT
I, Mary C. McKillip of the Borough of Carlisle, Cumberland
County, Pennsylvania, being of sound and disposing mind, memory
and understanding, declare the following to be my last will and
testament, hereby revoking and making void any and all wills
heretofore made by me.
Item I. I direct my executor to pay my debts and funeral
expenses.
Item II. I devise and bequeath all my property, real and
personal, to my husband, John L. McKillip, providing that he
survives me, with the understanding made between my said husband
and me, that if he survives me, he will leave in his will
one-half of all of our property to my side of the family, as I
have hereinafter set forth in this will.
Item III. If my husband does not so survive me, I devise
and bequeath all my property, real and personal to Lana Provazzo,
my cousin, who lives in Mechanicsburg, Pa.
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Item IV. I nominate, constitute and appoint my husband,
John L. McKillip, as my executor. In the event that he is unable
to serve, I appoint the aforesaid Lana Provazzo as my executrix.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this the S'
(SEAL)
Signed, sealed, published and declared
by the above named testatrix as and
for her last will and testament, who
at her request, in her presence, in
our presence, and in the presence of
each other, have hereunto subscribed
our names as attesting witnesses:
7~' ;7:',-<--
a~,--,^-m ~.~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We, and {Z/l~-^- ""- '/7J ci!.-~ ,
the witnesse Owhose 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 Testatrix sign and execute the
instrument as her last will, and that she signed willingly and
that she executed it as her free and voluntary act for the
purposes therein contained; 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 to and subscribed before
me this ..s-day ~
1985~~ (J ~
,
Notary ANNE M. COX. Notary I'tJbIW
Carlis!e Cumbo Co. Penna..
My Commission E~;p:rcs July 14. 11'fJ-
~
COMMONWEALTH OF PENNSYLVANIA)
COUNTY OF CUMBERLAND
I, Mary C. McKillip, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to
law, do hereby acknowledge that I signed and executed the
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.
~ff
Ma y . McKlll.
Sworn to and subscribed to
::forez;p;
'-~~~
.j""""
day
,1985.
Notary
1\NNE M. COX. Notary PubfR!
Carlisle Cumbo Co. Penna.
My Commission ~xpircs July t4. '11j--