HomeMy WebLinkAbout12-14-06
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUd4'i3dtL,f"JO COUNTY, PENNSYL VANIA
Estate of
cJ ,,J /;:: ~ (tJ e~
SCA:" /(,/\./(1 L I
File Number
~\
DLD \\\\
also known as
, Deceased
Social Security Number / (; B-2 Y - Z 0/ A
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~ A. Probate and Grant of Letter Test ~e"nt~ry and aver that Petitioner(@are the E.-X E c. U TO f!...
last Will of the Decedent datedZ .... ( 9 2- and codicil(s) dated IV / A
.
named in the
(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 bom or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: /IJ IA
o :?5
o B. Grant of Letters of Administration ~;;f? ;;;, :~:!
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia. durrulr~i/i8{itate) iT'! ,_~' '::)
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Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the followingspoii;@fanY):m1d heip.::iu;?
Administratioll, c.t.a. or d.b.n.c.t.a.. enter date of Will in Section A above and complete list of heirs.) .) .J:,;.." ;c- .:..: !::'---j
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Name
Relationshi
Red,
:p '-j
e
::J!I:
~
W '-"
(List street address, towII/city, towllship, COUllty, state. zip code)
Decedent, then 7'7 years of age, died on I L-,/~/Ob
at
){? E'S' I f) e-/ll C f-
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(lfnot domiciled in PAl Personal property in County
Value ofreal estate in Pennsylvania
$ 2.c,O,l 00 t
$
$
$ /75; 000
situated as follows: !<tJI ;DOliCf' , /"lu'/LJ/h. /(,1,..))5 J C/!e(f;nJ(r ACCCI(/l-Ji I j/lt/i"JCJ dCce'uJS'
, ,. -, - --
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:
Typed or rinted name and residence
Forlll RW-02 rev. 10.1306
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
r llJY\6x' \cmul
SS
The Petitioner(s) above-named swear(s) or affirn1(s) that the statements in the foregoing Petition are true and con'ect 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
"'-")
Sworn to or affirmed and subscribed
before me the I Y. day of
~~\ ,~
,Al()~~~ '
For the RegiS~
administer the estate according to law.
ture of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
01\
w\\)\\'n:~d E..S~("' sno \\
Social Security Number: I \.o~ 61-\ ;;1lQ \ 8
AND NOW, ~'0<"'I~l\ \ J-\ , d~ ,in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters 0 -t' \~,-"J., ~~)-hn...-\
are hereby granted to \.)\ (\ CE:\\-1 C :=:::,)"{' ~~'I\(;::'\ \ ~)
and that the instrument(s) dated ~ \l,~,-\~.;{4 \~l~
described in the Petition be admitted to probate and filed ofrecor as the last Wil~ ( nd Codicil(s)) of Decedent.
File Number:
61o
\ \ \ \
Estate of
, Deceased
Date of Death:
l ~ \ 63\ciDDlo
in the above estate
FEES
Letters .............. . $ ~(foD .CfJ
Short Certificate(s) . . . . . . . . $ o'cD Attorney Signature:
Renunciation( s) ......... . $
~\~ $ \'S'C() Attorney Name:
$ )000
.~C Supreme Court LD. No.:
~-\-b $ ,::;-00
$ Address:
$
$
$
$ Telephone:
$
TOT AL ........... $ L}fi0'OO
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Form RW-02 rev 10.13.06
Page 2 of2
This is to cerlil\ that the infornution here gi\'en IS conedly copied rWl11 an Original certificate of death du I'lied \\ i\ll nil' a,
Local Registrar The origInal certificate will be fmwardeJ to the State Vital Records Office for perll_Ill,,'''t lin~,
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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P 12842025
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I REV, 0212006
'PRINT !N
tMANENT
~CK INK
a\- CJlo-\\l\
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH
CERTIFICATE OF DEATH (CORONER)
. VITAL RECORDS
1/30-400
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5. Age (lasl Birthday}
6. Dale of Birth Monltt, d
]. Birth ace Ci
4. Dale 01 Death (Month, day, year)
December 3, 2006
, _ Name of Decedent (First. middle, last, suffi~)
Winifred
E
Sgrignoli
77
March 2, 1929
Y~.
Mechanicsbur
ad. Fad~ty Ncme (If not institution. give street and number)
8b County of Death
Cumberland
817 Center Street
most 01 YKlf1Ii life 00 nol slale retired 12, Was Decedent ever in the
Kind of Business f Industry U,S. Armed Forces?
DYes ~o
13. Decedenfs Education (Specify only highest grade completed)
Elementary I Secondary (0-12) College {1-4 or 5-1-)
14 Marital Status: Married, Never Married.
Widowed, Divorced (Specify)
Widow
Did Decedent
Live in a
Township?
Decedent's
Actual Residence 17a. Slale
. 16. Decedenfs Mailiog Address (Street. city I town, slate, zip code)
817 Center street
Enola, Pa 17025
18 Father's Name (First. middle. last, suffix)
Pennsylvania
Cumh~rl <'Inn
17c. m: Yes. Decedenllived in
17d. 0 No. Decedent Lived within
Actual ltlTllls of
17b, County
Franklin
"','r- 19. Mother's Name (First, middle, maiden surname)
Martha E. Arnold
Denton F.
Residence 0 Other. Specify
10. Race: American Indian, BlacX. While, ate
(SpeCify)
White
East Pennsboro
Twp
City/Bora
21b. Dale of Disposition (Month, day, year)
20b Informant's Mailing Address (Sfr.eel, city I town, slale, zip code)
817 Center st., Enola, Pa 17025
21c. Place 0 Disposition (Name of cemetery, Cl'9matory or other place) 21d location (City I town, stale. zip code)
20a. Informant's Name (Type I Print)
Vincent E. Sgrignoli
Gate oE~H~aven Cemetery Mech, Pa
22c. N"",andAdd,essofFacilily Sulli van,Funeral Home
51 N. Enola Dr. 'Enola Pa 17025
. ~
23b, license-Number
23c. Date Signed {Month, day. year}
CAUSE OF DEATH (See instructions and examples)
Item 27, PART I: Enter the Qlimg~. diseases, inlurieS. or complicalioos .lh.at directly caused the death. DO NOT enter tenninal events such as cardiac arrest,
respiratrny arrest, or venlricular fibrillation without showing the etiology. list only one cause on each line
: Approximate interval Part II: Enter other sianificant condilions conlributina 10 dealt1
: Onselto Dealt1 but not resulting in the underlying cause giYen in Part I
26 Was Case Referred to Medical Examiner I Coroner for a Reason Other than Cremation or Donation?
~ Yes 0 N~
l!ems 24.26 must be completed by person
. who pronounces death
24 Time of Death Aprx.
5:00 A.
25, Date Pronounced Dead (Month, day, year)
December 3, 2006
:~d~:~~~t~~~; ~~~ disea~
Occlusive Coronary Artery Disease
Due to (or as a COfIsequence of)
NIDDM. HTN
~~ballylistCOndilioos,.ifany,
~nl~'~o ~~~J~~NG' ~AUSE
(disease or injury that initiated the
events resulting In death) LAST.
Due to (or as a consequence of)
Due to (or as a consequenc:e of)
3Oa. Was an Autopsy
Performed?
30b Were Autopsy Findings
Available Prior to Completion
of Cause of Death?
31, Manner of Death
~Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could Not be Delermined
DYes~o
DYes ONO
32d. Time of Injury
M
33a, Certifier (check only one)
~7:i:,~:~~~nn:~;~ d~~i~~c~~: ~fu~~~;;:~:;e~~Je~:~~:e~~'~:~~~ ~e~~ ~~ ~~p~e~_II:: 2~)_ _ _...... _ .. _ _ _.. _.. _ _ _.. Ll
~:~~u=~~~.= ~~=:~~~~:~~~~~ ~~ht:~:,n2~e=~.~~rtiZ~:gl~Ot:::~~~~t;~d manner as stat!d_ _ _.. _ _ _ .. .. _ ...... _ .. _ .._lJ
Medical Examiner I Coroner ~
On the basis of examination and I or investigation, in my opinion, dealh occurred at the time, date, and place, and due 10 the tau.e(.) and manner as stattd_ _-p..
28, Did Tobacco Use Contribute to Death?
DYes 0 Proba"y
o No 0 Unknown
29. If Female:
o Not pregnant within past year
o Pregnantaltimeofdealh
o Not pl'egnant, nul pregnant within 42 days
of death
o Not pregnant, but pregnant 43 days to 1 year
of death
o Unknown if pregnanl within Ihe past year
32e Place of Injury Home. Farm, Street Factory
Office BuHding, ete (Specify)
Coroner
33d, Date Signed (Month. day, year)
December 4, 2006
34. 'j..ffm~~ol pe "ff 6~!l"rJ~se e~~~'ITJ7t Type f Pnnl
6375 Basehore Roadl Suite 1/1
Mechanicsburg, PA 7050
35 egist~,Signalure and ?i~}N;~L_~:
II'" i.~7;YrL,.. / I ,., /;;;>1/,2.,.1.~/..IP.-~2--.
eX{ / I al /( I
(See instructions and examples on reverse)
\ \' ,
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t.,?\, L' ~.J
ICt$t Jmrill anv Qle~tctm~nt
OF 1'-.>
o g
WINIFRED E. SGRIGNOLI :~~ ~
j-o P1
..~~ n
BE IT REMEMBERED, that I, WINIFRED E. SGRIGNOLI ,~~~ma;; ied'-. (-)
-->-:::,'.:::.;-< -0 --} -'-"'j:"l
widow, of 817 Center Court, Enola,Pennsylvania, 1702~~ Bei~ o~~;~
U"" ';.~'
sound mind, me.mory and understanding do make, pUblishj;li=-rld deijar$~ rr-,
this as and for my Last will and Testament, hereby revokin~and
making null and void any and all wills and Testaments and writings
in the nature thereof by me at any time heretofore made.
ITEM 1: I direct that my hereinafter named Executor pay all
my just debts, my funeral expenses, and the expenses of the
administration of my estate. with this direction, I authorize and
empower my Executor to expend for my funeral expenses and interment
such amounts as he may consider necessary and proper, without
regard to any limit that may be prescribed by a court of law.
ITEM 2: I direct my Executor to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which
my estate or the transfer of any property passing hereunder or
otherwise passing by reason of my demise, may be subject and to
charge such taxes against my residuary estate, it being my
intention that none of the aforesaid tax.?s, eit.her federal or
state, on any property required to be included in my gross estate,
under the provisions of any state or federal law now in force or
hereafter enacted, shall be prorated among the persons interested
in my estate to whom such property is or may be transferred or to
whom any benefit accrues.
ITEM 3: I give and bequeath unto my sons, VINCE SGRIGNOLI
and RANDALL SGRIGNOLI, in equal shares, all property held by me in
the Franklin u.s. Government Security Fund, Account No. 101575
00975.
ITEM 4: All the rest, residue and remainder of my estate, of
whatsoever nature and wheresoever situate, whether it be real,
personal, or mixed, including property over which I have a power of
appointment, I give, devise and bequeath unto my children, VINCE
SGRIGNOLI, RANDALL SGRIGNOLI, and PATRICIA SGRIGNOLI, in three
equal shares, as they may agree. In the event that they cannot all
agree on the division of the property, the property shall be duly
appraised and then divided or sold at public or private sale as a
majority of my children shall agree.
ITEM 5: I nominate, constitute and appoint my son, VINCE
SGRIGNOLI as Executor of this my Last will and Testament. Should
my son predecease me, fail to qualify, cease to act, or renounce
probate, I appoint my son, RANDALL SGRIGNOLI, as alternate
Executor, this my Last Will and Testament.
ITEM 6: I direct that my Executor shall not be required to
give bond for the faithful performance of his duties in this or any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
~c:r-+h day of -.Jc::...-? v 0. r t.. , 1992.
,
, . I oi.
WI1IF~D/ir.fSGR~;N~AbJ
The preceding instrument, consisting of this and one (1) other
typewritten page, was on the day and date thereof signed, sealed,
published and declared by the Testatrix herein named, as and for
her Last will and Testament, in the presence of us, who, at her
request, in her presence and in the presence of each other, have
subscribed our names as witnesses hereto.
~:,~" --. Q;l. it; t/<
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OF
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OF
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF
We, WINIFRED E. SGRIGNOLI and r-?; c\n.l! ~ L. 14,-: ~ <.,
and LA..-A' 0 ' ~;~~ the Testatrix and the
witnesses, respectively, whose names are signed to the attached or
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, and that she executed 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 the Will as
witnesses, and that to the best of their knowledge, the Testatrix
was at the time eighteen (18) years of age or older, of sound mind,
and under no constraint or undue influence.
~~,/~ ~:
W NI Dr E'. SG G LI
-m~
_._._----------~- ._-..,.....,~.
SWORN TO AND SUBSCRIBED
BEFORE) ME THISe:> 1~AY
/'/ i
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.,' / i./i
/; NOT~Y
./;/L .J:j( /{ ;;(/,/ , 1992.
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PUBLIC
OF
Notaria! Seal
Judy N. Schrack, Notary Public
Di!!sburg Boro, Vork county
My Comrn;,osior, Expires June 13, 1995
Menloor, Pennsylvania Association of Notaries