HomeMy WebLinkAbout07-18-06
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This is to certifv that the inf,mnation here given is correctly copied from an original ccrtificatc of death duly filed with mc as
Local Registrar. Thc original certificate will be forwarded to the State Vital Rccords Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Local Registrar
Fee for this certificate. S6.00
JUL 0 6 2006
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12625246
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1 Name of Decedent (Firs!. rriddle, last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
&1, Facility Name (11 not institution, give street and nurrber)
Other
o ER/OtJI alieni 0 DOA Nursm Home 0 Rosidence 0 Other. S ci :
9. rSN~ec~en~~~ ~1~::;~o~r;~Uban, 10. (i~ American Indian, Black, WMe, etc
Moxicen. Puerto Ricen, ele.) Whi t e
3. Soc~1 Security Nurrber 4 Oalo 01 Doalh (Monlh, day, year)
. 84
18b. County 01 Dealh
I Cumber land
.
Yrs.
183
_ 18
July 4, 2006
Marian
5 Ago (Lasl b,rthday) .-
7. Date 01 8ir1h Monlh, da , ear 8 Sinh lace (City and slate or foreW;Jn counlry)
Camp Hill,PA
Upper Allen Twp. !,rle ~s '( Q~ \J ~ \ \ ctC?e..
= 1-1. Decedent's Usual Occ: atien Kind 01 work done durin most of workin life; do not stale retired
.- Lab T Ki~q 01 Wort< . H ~11l~inessllnduslry
; ecnn1C1an OSpL~aL
-; 16. Decedent's Mailing Mdress (Slree!. citynown, stale, zip code)
J 100 Mt. Allen Dr.
J Mechanicsburg, PA 17050
12 Was Decedent ever in the US
Armed Forc.f)?
DYes ejI No
~~~~;~:k!ence 17a. State P A
13. Decodent's Eduealion 5
EklmenlarylSaeondary (0.12)
i on hi hest rade co Ieled
4 College (1-4 or 5+)
D~ Decodenl
Live in a
Township?
14 Marital Status: Married, Never married, 15. Surviving Spouse (II Wife, gIVe maiden name)
W f(fO\tt~'aeed (Specify)
17e. ~ Yes, DocodonlllVed YPp~~ A en_
___ Twp
17b. County
Cumberland
17d. 0 No, Decodenl Livod w~hin
Aclual Limits 01
CilylBoro
18. Falher's Name (FIfSI, rroddkl, Iasl)
J. C. Lester Holler
19 ~afrrarr'~dle~~'1rs"ITli th
2Ob. Informanl's MaiHng Add,... (Streel, eilyAOWQ, stale, ziP eOOe~ b PA
43 Roun~ Ridge Ra., Mecnanics urg,
17055
21b, Dale 01 D~pos~ion (Monlh, day, yoar)
21c. Place of Disposition (Name of cemelel)', crematory or other place)
21d. Lacal,m (CilyAown, stale, zip eOOe)
oiling Green Memorial Park Camp Hill,PA
22e. Name and Address 01 Facilily Myers-Harner Funeral Home
1903 Market St. CHill PA 17011
. Corrplele hem> 23a-c onty when certifying
--; physcian is nol avai\ab(e altime of death to
~ certify cause of death
lIIIllerns 24-26 musl be cofTllleted by person 24 Time of Death
~ who pronounces doath j g S'S M
23b. License Nuntler
230. Dalo Signod (Monlh, day, yoar)
25. Dale Pronounced Dead (Month, day, year)
'7 -L/_ 0 '-0
26 Was Case Referred 10 a Medical Examiner/Coroner?
o Yes rNO
d.
3Ob. Were Autopsy Findmgs
Availab4e Poor 10 Complelien
of Cause of Death?
o Yes 0 No
31 Manner 01 Death
32a. Dale 01 Inlury (Monlh, day, yoar)
DYes ,., No
Part II; Enter other sianificant conditions conlributina to death, 28. Did Tobacco Use ConlrDule to Death?
but nol resuning in the underlying cause given in Part I. 0 Yes 0 Probably
o No ,zrUnknown
29. II Femakl:
% Not pregnant within pasl year
o Pregnant at time 01 dealh
o Nol pregnanf, but pregnanl within 42 days
of doalh
o Not pregnant, but pregnanl43 days 10 1 year
belore death
o Unknown if pregnant within the past year
32c Place 01 Injury: Home, Farm, Street, Factory. Office
Building. etc. (Specif)j
CAUSE OF DEATH (See Instructions and ex.amples)
hem 27. Part I: Enter the chain 01 events - diseases,lnPJnes, or CO"lllications -that directly caused the death. DO NOT enter lerminal events slXh as cardiac arres!.
respiratory arrest, or ventrcular fibrillation withoul showi1g lhe etiology. 00 NOT abbreviate. Enter only ona cause on a line
IIIIIEOIATECAUSE(Finald~oaseor -;J?f ~ . /} l /l /. ~~,(J A?1 /l! /"'.., ~(J
condAlOnresulllrlglndoalh) ---7 a _~~.Y"t'.,I.J L<.. dV/ &r- ~~ ~
Due 10 (or as a eonseqd'ence oQ' Cj U
= Sequenlialty list conditions, if any, ~ _ ~
! :I~;~~ ~~D~~~~~~c~~~~e a Due 10 (or as a consequence oQ v
.i (disease or injury Ihal in~ialed Iho e. Due 10 (or as a consequence oQ:
-I events resufting in death) LAST.
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~ 308. Was an Autopsy
Performed?
)I( Nalural
o Aceidenl
o Suicide
o Homicide
o Pending Investigation
o Could Nol Be Delerminod
32d. Time 01 Injury
~eJO& If-lf-~ 33d ~~;z;y, yoar)
Name and Addressrerson Who ~letet?alJSe of D,\ath ~~em 27) TypeIPrint
Je./J/J/ t ~/ VU.e.~;L (,a-u
/CiV ;n I- 41/..R.F1 dK. /JUt:..'~L&".4d_s6t..r
328, Injury at Work?
DYes 0 No
321 32g. Localion (Slreel, eilyAown, slale)
M
~
33a. Certifier (check only one)
Certifying physician (PhysICian certifying cause of dealh when another physician has pronounced death and corTJ;lleted Item 23)
To fhe best of my knowkKtge, deafh occurred due to the cause(s) Ind manner as stlted .....,............,...........................,..........,....._....
Pronouncing and certifying physician (Physician both pronouncing death and certifying to cause of death)
To lhe best of my ~nowledge, death occurred at the lime, dale, and place, and due to thecause(s) and manner a. stated.
Medical examinerlcoroner
On the basis of eumination and/or investigation, in my opinion, death occurred at the time, date, <lnd place, and due to the cause(sl and manner as sbted ........,0
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(See instructions and examples on reverse)
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PE!ITIO~ FOR PROBATE and GRANT OF.LET!~1}S
Estate of Marian H. Sarlano No.:~ 1- t! l,,-- () ~J J
also known as To:
Register of Wills for the
, Deceased. County of Cumberland in the
Social Security No. 183-18-6878 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older and the execut rices named
in the last will of the above decedent, dated Februarv 12 1991
and codicil(s) dated NONE
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 130 Reeser Rd. Camo Hill Hamoden Townshio PA
(list street, number and municipality)
Decedent, then 84 years of age, died Julv 4 2006
at
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: NONE
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 of real estate in Pennsylvania $
situated as follows:
130 Reeser Road, Hampden Township, Cumberland County, Pennsylvania
'-00. OD 0 . 00
IS'O.Of)fL 00
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WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentarY
thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
3019 Harvard Avenue
Camo Hill
43 Round Ridge Road
Mechanicsbura
PA 17~11
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA } ss
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 ofpetitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affi.lrmed a.nd subscribed { 1&~~~
before, mj thiS! ~y of , 1fJ~ c:.
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No. I~ (. 00rOu ?/0
Estate of Marian H. Sariano , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW , in consideration of the petition on
the reverse side hereof, tisfact proof having been presented before me,
IT IS DECREED that the instrument(s) dated 2/12/1991
described therein be admitted to probate and filed of record as the last will of Marian H. Sariano
and Letters T estamentarv
are hereby granted to
Nina G. Hess and Jana J. Furst
~3 fu ()
Probate, Letters, Etc.. . . . . . . . $ __
Short Certific.ates (~. } . . . . . . $ :J '-f
ReflWlei"j"('p rA 1~i1)' . . . .: : ~
I I TOTAL - $ 4(~
Filed.1.1~()..QOlt............ .
. 'FEES
Debra K. Wallet, Esq.
23989
A TTORNEY (Sup. Ct. l.D. No.)
24 North 32nd Street
Camo Hill
PA 17011-2917
ADDRESS
(717) 737-1300
PHONE
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:-~":"il
LAST WILL AND TESTAMENT
OF
MARIAN H. SARIANO
C'~\
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I, MARIAN H. SARIANO of Hampden Township, Cumberland County, ~ennsYI- I
vania, declare this to be my Last will and Testament, hereby revoking
any will previously made by me.
I - I direct the payment of all my just debts and funeral
expenses out of my estate as soon as may be practical after my death.
II - I bequeath certain articles of my tangible personal prop-
erty as follows:
A. I bequeath my sterling silver to my daughter, Nina G.
Hess.
B. I bequeath my antique settee and chair to my daughter,
Jana J. Furst.
C. I bequeath a marble top table to each of my said
daughters.
D. My daughters shall determine which of them is to
receive my antique china closet desk at its value as
appraised in my estate, and the share of the one who
receives it shall have its value charged to her share
of the residue of my estate.
III - I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate unto my daughters,
Jana J. Furst and Nina G. Hess, in equal shares, the share of a deceased
II
child to be paid to his or her issue per stirpes.
ARNOLD & SLIKE, ATTORNEYS-AT-LAW, 2109 MARKET STREET, CAMP HILL, PA 17011
c1 1--0 Ie ,0 (0l)
- .
IV - I appoint my daughters, Nina G. Hess and Jana J. Furst, Co-
executrices of this, my Last will and Testament. Neither of my personal
representatives shall be required to post bond in this or any jurisdic-
tion.
the
IN WITNESS WHEREOF, I
j,;{ ~ day of
have h~peunto set my hand
:Yo
/4~ 'I ' 1991.
and seal on this
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) )<, 7 i (/;,'(// "-, _j ~'(' / . f{. Ie ("
Marian H. Sariano
(SEAL)
signed, sealed, published and declared by MARIAN H. SARlANO, Testatrix
therein named, on this and one (1) other sheet of paper as and for her
Last Will and Testament, in our presence, who, in her presence, at her
request, and in the presence of each other, have hereunto subscribed our
names as attesting witnesses.
-ik~ P ~L
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( Addres
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d'd~ss
II
Page 2
ARNOLD & SLIKE, ATTORNEYS AT-LAW, 2109 MARKET STREET, CAMP HIl.L. PA 17011
COMMONWEALTH OF PENNSYLVANIA)
SSe
COUNTY
OF
CUMBERLAND)
WE, the undersigned, the testatrix and the witnesses, respectively,
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 as her Last will and Testament and
that she signed willingly (or willingly directed another to sign for
her), and that she executed it as her free will and voluntary act for
the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the testatrix signed the will as witnesses and
that to the best of their knowledge the testatrix was at that time
eighteen years of age or older, of sound mind, and under no constraint
or undue influence.
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Testatrix
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Subscribed, sworn to and acknowledged before me by the tes~~rix, and
subscribed and sworn to before me by both witnesses, this /.x " day of
;te/;....;_~_i.~l.t. .~'; , 1991.
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Notary Public
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NOTARIAL SEAL
THEU",1A S, McCAUSUN, Notary Public
Camp H::;, 1-,\ ::':umber\ZJ'1d Countv
flAy COj'''"l'i;:;;;ic,'! Expires July 3, Hi92
- -
ARNOLD & SLIKE, ATTORNEYS'AI'LA\\<. 2109 MARKET STRnT. CA:"lP HII 1.. PA 17011