HomeMy WebLinkAbout02-15-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of f) ,..'V11 e ~ \ ~
also known as
KaJ.) '~y
File Number
a \ D\ ()\~'1
, Deceased
Social Security Number 1,),,-.30 - I fa ~ t
Petitioner(s), who is/are 18 years of age or older, appIy(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
named in the
'--)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution ort~instrum~s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~:~ ;: ? r'~
~ Grant of Letters of Administration J 0 j
~ B. (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante ijlindritateJ.:.:;;'
(State relevant circumstances. e.g., renunciation, death of executor, etc.)
r'"<)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spoli~e (if any~d heirs: (ljl
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) -':: N
01
7:
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in County, Pennsylvania with his / her last principal residence at
C..r'1...-l1.sJ e... PI K ~ .it '7B C ri yo- , I CSIl'_ I P A- 110/6
(List street address, town/city, township, county, state, zip code) ~
&. J 'I.! 07
'7013
Decedent, then
'E'->
years of age, died on
at
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
w .
$"'! I
~ ,"/
$
$
$
iJ l..)
situated as follows:
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:
T
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF
r .-UJ'\\b(~cl
SS
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 representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
IS-
FeD(~ .awl
~ ,C\~
~r
day of
. J
Sworn to or affiI~ed and subscribed
Signature of Personal Representative
Signature of Personal Representative
(.-I.,
File Number: d.. \ D'l CJ \~1
~~\-e.,-" ~\ e\
\ . .
Social Security Number: (l d. ~D \ \...cd <..4
AND NOW, d,D te\)'().},cu~ ' ~I
having been presented before meK-.T_IS ?EC ED that Letters
are hereby granted to hX! ~ \ {I,\ CC \\..ili\.f' ~
r"<)
C\
Estate of
~-s
, Deceased
d\\\\O\
, ~
Date of Death:
, in consideration oft~e foreg,oing Petition, satisfactory proof
Adsn" 1('1 \ ~ -\ "Co.- ~ <S Y)
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of recor
Letters
$
tt s. 00
~O . (j)
ID.lj{)
\0 dJ
5.00
s the last Wi~ 0 Deced:nt,.
FEES
Short Certificate(s) . . . . . . . . $
Renu~iatiOn(S) .......... $
cV ...$
~m ... $
. .. $
.. . $
. .. $
.. . $
.. . $
.. . $
.. . $
TOTAL .............. $
Attorney Signature:
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
1DOU
Form RW-02 rev. /0./3.06
Page2of2
H105.X05 REV i/05
This is to certify that the information here given is correctly copied from an original ce11ificate of death duly filed with me as
Local Registrar. The original ce11ificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
"ff"""..';'~'
.,1' '( U OF "~'I
\"",'t~~\.\ WE,;,---.."-..
",'....~y ~~J'L.",
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!~'~I . aa.:~. ~\
if~/ '-o~ - - '\~~
(, .....,"'" ";l!:~
~c::tf rr#":' I-~
~'-'~, , -,'"d] , _ /=a::.~
"*~:~/*I
~ a..),.. '.' '. ~A~"
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"""-- ~111i;--" <. ~<,; "",
-...",:"EN1 \\, ",t'"
"'/"""11111/1
n.~ t\. ~~~~b..~
Local Registrar ''-\
Fee for this certificate, $6.00
P 13310708
FES 1 4 2e".'
Date
Ui
-'-:J
N
--'
H105-143 REV 11!2006
TYPE} PAINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FILE NUMBER
Sb. County of Death
ad. Facility Name (If 001 institution, give streel and number)
Sa. Place ot Death (Check only ooe)
Hospital: Other:
o Inpatient [1l.ER I Outpatient 0 DCA 0 Nursing Home
9, Was Decedent of Hispanic Origin?
{II yes, specify Cuban,
York Hospital Mexicao. Puerto Ricao. ok.1
13. Decedent's Education (~ify only highest grade completed) 14. Marital Status: Married, Never Married,
Elementary I Secoodary (0-12) College (1-4 or 5+) WIdowed, Divorced (Specify')
12 Divorced
PA S'.:'. ~odeOI 17c. [1';1 VOS. _ Uved io Middlesex
17b.County Cumberland Township? 17d.D No, Decedent Lived within
Aclual Limits of
1624
4. Dale 01 Death (Month, day, year)
February 11, 2007
1. Name 01 Decedent (Rrst, middle, last, suffix)
Daniel E. J.
5. Age {Lasl Birthday)
Kahley
6
6. Dale of Birth (Month, day. year)
68
Yffi.
7/10/1938
Bryn Mawr, PA
10. Race: American Indian, Black., White, elc.
(S_
White
York
7073 Leiby's Trailor Park, Lot 78
rlisle, PA 17013
Ha.Stale
Top.
City/Sol'\)
18. Fall1er's Name (FIrSt. middle, last, StIff'!>:)
John R. Kahley
19. Mother's Name (First, middle, maiden surname)
Rose Wiloox
2Ob. Informanfs Mailing Address (Street, city I town, state, zip code)
727 Woodbrook Lane, Plyrrouth Meeting, PA 19462
21c. Place of Disposition (Name of cemetery, crematOfy or other place) 21d.localion (City flown, slale, zip code)
- ~
Gard Carlisle, PA
Home, Inc., Carlisle,
23b. license Number
/t-t.o V3r8"12' JL,
Items 24-26 must be completed by person
who pronounces death
24. Time of Death
10: 45 A. February 11, 2007
CAUSE OF DEATH (See Instructions and examples)
Item 27. Part I: Enter the ~ - diseases, injuries, or complications -that direclly caused the death. 00 NOT enter terminal events suCh as cardiac arrest,
respiratory arrest, or ventricular fibriRallon wilhout showing the eliology. Usl only one cause on eact1 Une.
~ df."';"tif.4..e..
Approximate intBIVal'
Onset to Death
PartH:. Enter other sianilicant conditions contributinG 10 death,
bulnotresullingintheundertyingcause~ninPartl.
Sequen~allylis1 condilions, if a.ny,
~~oJ:=~~u~:a.
(disease or injury that iniliated the
events resuIIiOg In death) LAST.
D",l'(""a~"::j
~oz.-f .
~
rktJ~'
28. Did Tobacco Use Contribule to Death?
~Vos DProbably
D No DUo"_
29.11 Female:
o NotpregnantwilhinpaslY98f
o Pragnanlaitimeoldeath
o Not pregnant, but pregnant wiIhln 42 days
oldoa.
o Notpregoant, but pregnanl 43 days to 1 Y98f
beloredealh
o Unknown II pregnant wIlhin the past year
32c. Place ollnjury: Horne, Fann, Street, Fadory,
Office Building, ale. (Specify)
==~~S~~~~)<ise~
b.
Due to (or as a consequence 0#):
Due 10 (or as a consequence o~:
3Qa. Was an AUlopsy
Penormed?
d.
3ClJ.WereAlllopsyAndIngs
Available Prior to Completion
01 Cause of Death?
o Ves ,(l No
DVes ONa
31. Manner of Death
,q Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could Not be Delennined
32d. Timeo/lnjury
32g. Localionof Injury (Street, City I lown, stale}
M.
338.. Certifl&l" (check only (08)
~:~J:i:=c::==~~:t~::'~~:=h: ~=nc~_d~~_~.::n~~ ~e~~~_ _ _ __ _ _ _ _ _ _ __ _ _ __ 0 ...
~::u=:f: =~:~~=;::II::::;~~~~ioton:=~~~~ manner as stated_ __ __ ___ __ _ __ __ __ _ g
=~~~m::,~= and I or investigation, In my opinion, death occurred at the lime, dale, and place, and due to the cause(s) and manner as slated.. 0
z
C>
w
liJ
is
~
35. Reg
~
sralu"~.~~~~
l.a II I~ 1\ 10 I
34. Name and Address of Person Who Completed Cause of Deeth (Item 27) Type I Print
~\...'<:'<-:;"';""5!> 'f"-""'~ l'i fly Q c.h.:.<-
-:;0'> 'u \"c..lh""'C>;......A<.:.~ /'11.(.. ", .
Disposilion Permit No,
0\ '1.:;-z.{{ 0 if
RENUNCIATION
REGISTER OF WILLS
r.. \ L '
\""~\'(:)-er V:.'r\ d. COUNTY PENNSYLVANIA
,
--;;
:""j
"") "~;l
Estate of '] A 1'1 if L f: \ )(A-h L" 1
I, C! 10( I~ fMf\ Kqh Jc J
I , f' ~ . (Print Name)
d(VH5 fit~
administer the Estate of the Decedent and respectfully request that Letters be issued to
1',) Deceas ed
01
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
'tJ F) f)/ e L Krt h I y 1
~ -- \ '2>" 61
L h (bi-IJ er-)
/
(Date)
UJ~t. ~~ ~
(Signature)
063
(Street Address)
I~ 511c:e..J
/) )
~<Ii eye' rj- q...:VICl / ~.
(City. S te, Zip)
!q~C)6
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this ;' J rt- day
of rhldL( ru; , ~t20 1 .
f2L ~) 1:2 ~ it -
, . d. tZ 'A A~
Notary Public
My Commission Expires:
Deputy for Register of Wills
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06
mmo Ith f Pen
NOTARiAl SEAL
ROBIN A. BABILUS. Notary Public
Norristown Bora., County of Montgomery
My Commissi~~~.~:~:,ires AprilS. 2010
RENUNCIATION
REGISTER OF WILLS
C \.) ",,,'hQ.\ \t.\ r-. d COUNTY, PENNSYLVANIA
<..,)
(,Yi
."
-, -,
N
Estate of
IJA-f\ \ eL E ~'1le1
, Deceased
I, L. tl U (\ -c... .----2J \ \(A:- h \ e "I , in my capacity/relationship as
J .' (Print Name) /
~ (I 11 J v2.---t-eR..... of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
3JAl) \ "<-I ((AM Ie\.1
~-/~o_ 07
(Date)
cf~ ~ ~(~, ~
(Signature) ~
SZ2 /j 5heeJ-
(Street Address)
. ) ~
/t.:/JC: 'Dr WwSS//'l t;; J 9:Yc.? 6
I I
(City, Statl Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciati~or the
purposes sated within on this ~ day
of . , .., () 1 .
otary Public
My Commission Expires:
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
mm Ith f e
NOTARIAL SEAL
ROBIN A. BABILLlS, Notary Public
Norristown Boro., County of Montgomery
My Commission E)(~~.cs April 8, 2010