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Home My WebLink About08-23-07 ....~ '\ PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Charles E. Kisner also known as File Number :J1-D7-o7Q/ . Deceased Social Security Number 160-16-2298 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE ~' or 'B' BELOW:) IZl A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is 1 are the executrix last Will of the Decedent dated 08/31/2006 and codicil(s) dated NONE 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 born or adopted after execution of the instrument(s) otTered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: o B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite: durante absentia; durante minoritate) Petitioner(s) after a proper search has 1 have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c. t.a. or d. b.n. c. t.a., enter date of Will in Section A above and complete list of heirs.) ::') :0 'TJ ~~ --.i Name Relationship Residence :'::-~l (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. [: (") G'") Decedent was domiciled at death in Cumberland County, Pennsylvania with his 1 her last principal residence;~{: 200 North Front Street. Wormlevsburg, Cumberland County, Pennsylvania 17043 . ~" (List street address, town/city, township, county, state, zip code) . J (,:' .. r....) c..: . I -1:) Decedent, then 88 years of age, died on 08/18/2007 Ortenzio Heart Center, Holv Spirit Hospital. 550 N 12th Street. Enola P A 17043 at ~.i:J ~ c...) ... 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: :3,::.,;1St b-.t~ fcdfllle..v, t:';s1 Pel'/V\sho<o f{eu.r o~SCJI $ $ $ $ tJ tnJlq~' 195,000.00 ~;J,eee.86 S3,Oo().QO ['VIol q -P~ Wherefore, petitioner(s) respectfully request(s the undersigned: obate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to T ed or rinted name and residence Susan Stuart, 202 North Front Street, W ormleysburg, Cumberland County, P A 17043 Form RW-02 rev. 10.13.06 Page 1 of2 .. ~ -. Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF f.LUY\ trr ~Cl()L : 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 of Petitioner( s) and that, as personal representative( s) of the Decedent, Pe . . onere s) will well and tmly administer the estate according to law. Sworn to or affirmed and subscribed before me the (9.. 3 f d \~? '. ~~ ~~] .-. () -'~ . :-'-) ;.:::::'1 .~ ....... Signature of Personal Representative ~.:t Signature of Personal Representative . --'---1 '-- GJ 1'..) 0,) ---J Ii :S? I -~ '"" File Number: c!:2 / - 0 7 ~ 079 I Estate of Charles E. Kisner , Deceased Social Security Number: I (p () - I (p -:f- d-qq Date of Death: AND NOW, ;), 2/d Ql~l sf , Poo 7, in oo",id,nrtion ofth, In"gning P"ition, "rti,fuoto'Y pmof having been presented before me, IT I ECREED that Letters Testamentary are hereby granted to Susan Stuart and that the instrument(s) dated 08/31/2006 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. ..t\ttnda... ,1a1UWl JJt9flff,1 , '--' ~glsterofWllt's .-' -" pcrCj..~ 10d#'/~~~~/ . (V / / William C. Dissinger / FEES Letters Short Certificate(s) . . . . . . . . $ Renunciation(s) .......... $ \AJ L'U . . . $ ... Jrp . .. $ BlLi7:n1.Q 1l.ffy,-~ . . . $ . .. $ ... $ .. . $ ... $ .. . $ ... $ TOT AL .. . . . . . . . . . . . . $ Form RW-02 rev. 10.13.06 in the above estate $ ..~tO.DO 3~.OO Attorney Signature: /5.0n IO.ev 6.m Attorney Name: Supreme Court J.D. No.: 27737 Address: 400 South State Road Marysville, P A 17053 Telephone: (717) 957-3474 S72~ Page 2 of2 o/-C7- [;7~?/ LOC,AL REGISTRAR'S CERTIFICATION OF DEA",ot-l WAIRNING: It is illegal to duplicate this copy by photostat or photogr3ph" Ccrti ficatiun :\ul11her /"""=;;O;;;~ This is tu certi'\ Illl ire iI1furrnatio'l ,f~(~),llijJLe1~t;~ currectly cupied 11'1111 ,lil ur'gi:1~" Cenll 4"'~ ~2\: duly filed with J \I' ,I', [ucal R'~t"str<tl (fl:~i '~','.~\ certificate will l~ f,)rwarded :u the \~5~:}1 J~~ Recurds Office h)' !'crlrancnl filing, ~ * $ .' ~" ~; * ! ~1r~ENT~'~~~~"~ /1l ~'~'_~AU!WjZDD7 / ~,;..j,'!t" . __"':'/J/!;/ - . I ~~ Local Registrar [);:te Issuee here given IS cate of Death The original State Vital h~,~ hl!' Ih''..crtlficatc, ,,(l,()() P 13771895 () ~ ,} r-.,~) '.'..""'"....=) l.::"":> -, i ,'-- :::-. c.;:: G-~) f'.) <..-$ IJ -:J GJ l REV 1112006 I PAINT IN :MANENT i\CK INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) STATE FILE NUMBER 1, Name 01 Decedent (First, middle, lasl, SUffiXC H A 12. LD 5. Age (Last Birthday) 88 e K.l~NE~ -2298 y" 6. Dale of Birth (Mooth, day, year) 7. Birthplace (Ci 6/3/19 Other o Nursing Home 0 Residence OOther. Specify: 9. Was Decedent of Hispanic Origin? KJ No 0 Ves 10. Race: American Indian, Black, White, etc. ~~~;rt~~~:~.eIC'} ($pecif;1 White Bb. County of Death Cumberland . 16. Decedent's Mailing Address (Street, city { town, slate, zip code} 200 N. Front st. Wormleysburg, PA 17043 17b. County pennsvlvania Cumberland Did Decedent Live Ina Township? 17c. 0 Ves, Decedent Lived Wl 17d, rn :u~~~'o~od",lhin wormleysburg Two. 11. Decedent's Usual Occu lion Kind of work done du Kind of Work Plumber most of worki fife. Do nol slate retired Kind of Business I Industry Self-Employed myes DNo Decedeors AclualAesidence 17a. State 14. Marital Status: Married, Never Married, Widowed, Divorced (Specify) Widowed City/Boro 18. Father's Name (Rrst, middle, last su"lx) Boyd Kisner 19. Molher's Name (First, middle, maiden surname) Ida G. Maxwell 2Oa. Informant's Name [Type! Print) Susan L. Stuart 2Ob. Inlonnanfs Mamng Address (Street, city / town. state, zip code) 202 N. Front St. Wormleysburg, PA 17043 21c, Place of Disposition (Name of cemetery, crematory or other place) 21d, Location (City { town, slate, Z~l code) Evans Cremation Service 22c.Name'ndAdd"",ofFadlily Sullivan Funeral 51 N. Enola Dr. Enola, 23b, Ucense Number Leola, Home PA 17025 PI\. 23c. Date Signed (Month, day, year) IIams 24-26 must be completed by person who pronounces death. 24. Time of Death 25. Date Pronounced Dead (Month, day, year) % ;2() PM M 8' - \~-O'l 26. Was Case Referred to Medical Examiner J Coroner for a Reason Other ttlan Cremation or Donation? Dy" ~o CAUSE OF DEATH (See instructions and examples) Hem 27. Part I: Enter the ~ - diseases, injuries, or complications -that directly caused the death. DO NOT enter tBfTTlinal events such as cardiac arrest, resplralory arrest, or ventricular fibrillation without showing the etiolO!N. List only one cause on each line Approximaleinterval: Qnselto Death Part II: Enter other sillnificant conditions contribulina 10 death, but not resulting in the underlying cause given in Part I ~~~T~a~~~ d~~~~ dise:;. R '~ fu)~. Duelp~~tce~~ Due lo~r as ~ cooSBjluence of) t'AC>~ I{,. M e&o1ht 11'o-r-r1a Due 10 If as. a consEHIuence o't BSbt>,~1'e,.s. ~ PflWMO'Y'lI Q 28 Did Tobacco Use Contribute 10 Death? o Vas DPrnbably o No ~ Unknown 29. II Female: o N01 pregnant within past year o Pregnant at :ime of death o Nol pregnant, but pregnant within 42 days of death D Nol pregnanl, but pregnant 43 days 10 1 year before death o UnknOWll ilpregnantwilhinlhe past year 32c. Place 01 Injury: f-lome, FafTTl, Street, Factory, OffICe Building, !!tc. (Specify) Sequentially list conditions, if any, ~t~~~O ~D~~~~~:r~~ a. (disease or injury thai initlated the events resulting In death) LAST. DVes ~NO Dy" DNo 31. Manner of Death ~Natural D Homicide [J Accident D Pendingln....estigalion o Suicide 0 Could Not be Determined 32d.TImeoflnjury 3Oa. Was an Autopsy Perfonned? 3Ob. Were Autopsy Findings Available Prior to Compietion of Cause of Death? M 321. If Transporlalion Injury (Specify) D Drtver { Operator D Passenger DPedestlian DO'h"'Speci~ . - 33tl. Signature and Tille of C~fle^ 11.... ______ ~ '-I, 'i y \X./1'1 I 33d. Date Signed (Month, day, year) 32g. location of Injury (Slreet. city flown, stal(>) 33a. Certifier lcheck only one) Certifying physician (Physician certifying cause 01 death when another physician has pronounced death and completed lIem 23) To the best 01 my knowledge, death oc(:urred due to the cause(s) and manner as statecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ D :~~~u~c:~t~ ~:'fyl~~J:~~~~~;:;:~~ :hll=:~:.n;n~~~~~~~~~ot~:~:~:a~~~ manner as stated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ~~~:~;:~m~~:~~;f~::: and I or investigation, in my opinion, death Otcurred at the time, date, and place, and due to the cause(s) and manner as staled_ 0 33c. license Number Mf)44 ~.ty %-1<;'--07 35. Regi ~ ' I~I/I~I/ ( 34. Name and Address of Person Who Completed Cause 01 Death (11em 27) Type I Print iAPASD1:f' ~~i?- M~ HO l.. irllllT ~o~f'rr.,4 L Disposition Permit No - LAST WILL AND TESTAMENT f',,) OF (.) _.:J CHARLES E. KISNER . , .A' - j C,) I, Charles E. Kisner, of 200 North Front Street, Wormleysburg, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils heretofore made by me. ITEM I. I direct that all my debts and funeral expenses, including my cemetery lot and grave marker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my death as part of the expense of the administration of my estate. ITEM II. I devise and bequeath all of my estate of every nature and wherever situate to Susan Stuart. ITEM III. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my Will or otherwise, shall be paid out of the principal of my residual estate. ITEM IV. I appoint Susan Stuart, Executrix of Will and Testament. I relieve my Executrix from the posting security in connection with her duties as jurisdiction in which she may be called upon to act. this my Last necessity of such in any IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament, which consists of --L page~, to each of which I have affixed my signature this ..'3(Sf day of (LcL9L.L.St two thousand six (2006). d?~k/~^--, Charles E. Kisner , '. COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF PERRY We, Charles E. Kisner, and Lt Ll U Cltil c.. yj/~n )qfr', the -.J SUSCU-} L. 0fLlG crt and testator 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 testator signed and executed the instrument as his Last will and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witness and that to the best of their knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. 1 E Jd~0 ~- - ... /'ll/ d #' " c/(,c<.A: ~ cq?l,7 (' '7l.~~2-<-4- Witness ~ --- -..IM111M ..._ WMIe ....,~ IIi1JIIIWIU IQIaUIIt.... CCMNY ..,CQfNI~.....OClt 11."