HomeMy WebLinkAbout12-18-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYL VANIA
Estate of Celia J. Klutz
also known as
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File Number
. Deceased
Social Security Number 199-12-6965
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
IZI A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last WIi1l of the Decedent dated and codicil(s) dated
named in the
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not many, was not divorced, and did not have a child born 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:
o B. Grant of Letters of Administration
(Ifapplicable, enter: c.La.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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Petitioner(s) after a proper search has / 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.) r-..;)
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(COMPLETE IN ALL CASES:) Attach additiolUll sheets if necessary. '-..
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County, Pennsylvania with his / her last principal resid~-al
Decedent was domiciled at death in CUMBERLAND
1700 Market St CamD Hill PA 17011
(List street address, town/city, township, county, state, zip code)
Decedent, then 91
years of age, died on 12/11/2007
at 1700 Market St Camp Hill PA 17011
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Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsy Ivania
$
$
$
$
150,000.00
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:
Form RW-02 rev. 10.13.06
OEi li
Page 10f2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
TIle 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.
Swom to or affirmed and subscribed
befofll me the \ g day of
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or the RegIster
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Signature of Personal Representative
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Signature of Personal Representative
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File Number:
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Estate of Celia J. Klutz
, Deceased
Social Security Number: 199-12-6965 Date of Death: 12/ll/2007
AND NOW, ~~~" t~ ,~tb l , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters ~\..<:;.", ~~^--l
are hereby granted to ~ "- T ~ \ u.... "r \
in the above estate
and that the instrument(s) dated ~ y\e...""" 'b..r \ cicJ::J S-
described in the Petition be admitted to probate and filed of record as the last Will
FEES
Letters ....\ ';3:;:::\.o~ $
Short Certificate(s) . . .;>. . . . $
Renunciation(s) .......... $
G::':>i\\ ... $
...)<...2 ... $
'~.\0 ...$
...$
... $
... $
... $
. .. $
... $
TOTAL. . . . . . . . . . . . . . $
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Attorney Signature:
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Attorney Name:
Supreme Court J.D. No.:
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Address:
Telephone:
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Form RW-02 rev. 10.13.06
Page 2 of2
H105.805 REV i01/07)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14124501
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
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'~Registrar , r
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Date Issued
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H1QS.1H REV 11,'2006
TYPE PRlN11N
PERt.1ANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
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1 Name of Deced&ol: (Flrsl. m!dd1e, las!. SUtlIX)
Celia J. Klutz
5 Age ila!>tBcrthda'l\
13 Decedent's Education (Speedy only highest grade completed)
Elementary '12ondary (0-121 College (1-4 Q( 5~)
6. Oa\e 01 Birth (Monlh, wy year)
91
December 30, 1915
Glen Lyon, Pennsylvania
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Sb. Coull1y "I Death
Cumberland
Bd. Facdily Name (If 001 instilullon, give street and numberl
Holy Spirit Hospital
11, Dew1ents Usual Occu 'lion Kind of wOfk done durin most of worl<.in ute Do ClOt slate retired
Kind 01 Work Kind 01 Busin.ess/lnduslty
Homemaker Own Home
12, Was Decedenl ever in Ihe
U.S, Armed Forces?
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Decedent's
AclualResidence 17a.Slale
PA
Cumberland
. 16, Oecedenfs Mailing AIXlress (Slieet. city l lawn slate, Zip code)
1700 Market Street
Camp Hill, PA 17011
,7b. Counly
19 Mother's Name (First mddIe, maiden surname}
Eleanor Slavinski
16.fathec'sNamelfirst.mi(ldle,!aSl.sufllxj
Peter Mioduski
3. Social Security Number
199 - 12 - 6965
Sa Place 01 Death (Check only onel
HOSpila1 Other:
~ Inp"tlt<nf D EA I Outpatienl DooA 0 Nur:>lng Home 0 AeSldeoce l101hel. SpIh:III'
9,~~~~~~~Oligin'J IilhO DVes \0, Race: Arnerican lOOan, Black,WhIle, elc
Mexican, Puerto Rican. ele,) (Speclfyl White
14. Marital Status: Married, Never Married
Widowed, Divorced (SpecIfy)
Widowed
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Did Decedent
Uveioa
Township?
17c.O Yes, DecedentlivedN1
17d. \)4 No. Decedenllived Within
Actuallimilsol
Camp Hill
CII, 'Sofo
20a tnlormanl's Name rrype 'Print)
John Klutz
2(b. lntormanfs Melding Address (Streel. city Ilown. stale, Zip code)
904 Cocklin Street Mechanicsburg, PA 17055
21d, locatton (City 1 town, slale. Zip code,
Mechanicsburg, Pa. 17055
21c. Place 01 Disposition (Name of cemelery. crematory or oIher place)
Gate of Heaven Cemetery
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22c Name and Address of Facdily
Myers Funeral Home, Inc. 37 East Main Street Mechanicsburg, PA 17055
:)Ja Cef1illel (chec"onJy cnel
Cenitying physician (PhySICian c"rulYlllg cause 01 iJeJUl \\ht'n ilnolt,er physlc,an h;i~ proXlouJlCtld death and completed Item 23) ..
To lhe best of mv knowledge, death oc:curre<l due 10 the cause(s) and manner.. slated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - 0
. Pronouncing and cer1ilylng physician (Phy:>icl"n both prunounril19 death and certlf)lng 10 cause 01 death) JI('j' 33,:; license Number
To ~e best 01 my knowledge. death occurred at the lime, dale. and place, and due to the cause(s) and manner as stated_ - ~ - - - - - - - - - - - - - -.rUol ty\ 0 tJ -4.. ~- J
. ~~il~::::~~e~:;,;:, and I or investin;otlon, in Ill' oninion. death occurred ill the lIme. date, and place, and due 10 Ihe C<'I,l~..Jli) ilnd nlanRer as stated_ 0 - . ~
.... r ~ 34 NJflleartdAddreS\OfPersonwhocompleledcau~.eofOeath(ltem271 Typelfr' .
c... e"^ A. C. Ie c.,re... ,
<;o;a !S,,,,,-,Otre 5>"'u2.~ /1
IV ",,;J Lv /Y'&.L~4'L~P, /-;+ /71
24, rime 01 Deafh '-;:1 S- PM 25. Dale Pronounced Dead (\~ay..:rl 1 t _ 0 YJ
CAUSE OF DE:ATH (See Instructions and examples)
lIem 27 Piu11 Enter Ihe ~.2t tool~ - diseases. in(uries. or complications - Ihat directly caused Itoe death. 00 NOT enter l.enml\<,\l e~erus such i:\.S cudiac ,nrest,
lespiratorl arresl, or 'Oenlficular librillalion wi(hout $hawing IIle eliology Uslonly one cause on each hne
Slc:...~ >P"lll.> >~NJ~
0.. ~f<. h J-fV\'ril
It~~ 24-26 must be COlTlJ,leted by person
I'.l1oprDr\OlJn<:es aealh
Approximateintef'fal
Onsel10 Dealh
=~;i~~S~ ~~~~)di:>e:;.
Sequetllialy b:it condi\loos, it any
l"adillQ to the couse .sted on hne a.
En1..-! ile UNDERLYING CAUSE
ldlseaseor rniufy IhJI il"llll,lfedfh.:
evenls resulllng "1 death) LAST.
Due to (or as a cOflseque.nce of): ^ \
b ( f. " r (. '-r:.fA.('
Due 10 (or as a consequence 01):
Due 10 (or as a consequence 01)
3Qa. WasNlAul<lps~
Per1orm.:d?
',J,(Ib Wenl ,A.\iI~y Frongs
AVat/ilbl" PriOl10 Compl€1ion
01 Cause 01 De..lh?
31.Mafmf:lolDea\tl
~NitlUral 0 Homicide
o ACCloknt 0 Pending lnve~lIgallOn 32d Time of InjUry
o SUlCule 0 Could Nol be Delerrmm:d
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L71
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DISpo51110f\ PitHnil No 0 [) c:; 8 CJ 0 q
23b. lil;:ense Number
23c D;ue SIgned (Month. day, year)
26. Was Case Referred 10 Medical Examiner I Coroner lor a Reason Other fhan Cremation or Donallorl?
Dye; '8"" '
Part II; EnleroUler~~~~ 28 QidTobac,oUseCoollibu!e 10 Dea1h?
but nol resuJling in the undertying cause: gi~en ill Part f 0 Yes 0 PrOOabIy
o No 0 Un~rrO\\'n
29, II Female
o Nolprfl~lGnl...ithinpast)~ar
o Pregnant at ttme 01 dedlh
o MeA Pfegnarn, bill pe-gilaM 'o'flI\)m :.2 days
01 dtalh
o Not p\li:gn;.rll bIJI. plegnam ~3 ~jS Ie 1 yeal
before aeath
o Unknown d pregf\ant wIlhin the paSl ~eal
J2c. Place 01 Injury: Home, Farm. Street. Factory,
Office Bui/dtog elc (Specify)
32g location of Injury lSl.reel,city-'town, stale)
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LAST WILL AND TESTAMENT OF
CELIA JACQUELINE KLUTZ
I, CELIA JACQUELINE KLUTZ, of Cumberland County, Pennsylvania, being
of sound and disposing mind, memory, and understanding, do hereby make, publish and
declare this as and for my last will and testament, hereby revoking all other wills and
codicils heretofore made by me.
FIRST
I direct the payment of my debts and expenses of my last illness and memorial
service from my estate as soon as after my death as conveniently may be done.
SECOND
I direct that all of the estate, inheritance and succession taxes on property passing
on account of my death, whether under this Will or otherwise, shall be paid out of the
principal of my general estate to the same effect as if said taxes were expenses of
administration, and all legacies, devises, and other gifts of principal and income made by
this Will, or by any codicil hereto, shall be free and clear thereof
THIRD
I give, devise and bequeath all tangible personal property owned by me at the time
of my death, together with all insurance policies thereon in equal shares unto my children,
JOHN THEODORE KLUTZ, PAULETTE LENORE BORK, and JOSEPH PETER
KLUTZ, share and share alike.
FOURTH
I give, devise and bequeath all the rest, residue and remainder of my estate unto
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my children, JOHN THEODORE KLUTZ, PAULETTE LENORE BORK, and JOSEPH
PETER KLUTZ, if they survive by thirty days. If any of my children fail to survive me by
thirty days, but have child( ren), I give, devise and bequeath all the rest, residue and
remainder of that respective share unto those child(ren) in equal shares.
FIFTH
I nominate, constitute and appoint my son, JOHN THEODORE KLUTZ, as
Executor of this my last will and testament. In the event of the renunciation, death,
resignation, or inability to act for any reason whatsoever of my said named Executor, I
nominate, constitute and appoint my children, PAULETTE LENORE BORK and
JOSEPH PETER KLUTZ, or the survivor thereof, as co-personal representatives of this
my last will and testament. In the event of the renunciation, death, resignation, or inability
to act for any reason whatsoever of all of the above named personal representatives, I
nominate, constitute and appoint the Citizens Bank to serve in their place and stead.
I hereby relieve my personal representative( s) from the necessity of posting
security in connection with the duties in any jurisdiction in which my personal
representative(s) may be called to act insofar as I am able by to do so.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this
document, containing my last will and testament, consisting of three total pages, the first
two of which bear my signature in the margin for the purpose of identification this I
day of
S","A1-e-.b~...../ , 2005.
I
~~/~. a
'LIA JAC UELINE UTZ
Signed, sealed, published and declared by the above named Testatrix, Celia
Jacqueline Klutz, as and for her last will and testament, in the presence of us, who, at her
request, in her sight and presence, and in the sight and presence of each other, have
hereunto subscribed our names as witnesses.
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WillCJK/RAG
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Celia J. Klutz
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, Deceased
fbu1effe... fSorlc... and Tchn F Ro.k..
(each) being duly qualified according to law, depose(s) and say(s) that she / he / they was / were well-
acquainted with Celia J. Klutz and am/are familiar
with the handwriting and signature of the decedent, and that the signature of Celia J. Klutz
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
Celia J. Klutz is in his/her own proper handwriting.
1~ CZ'I5.~
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5"2.,9 4't""l-.)~ ,1),
(Street Address)
J11rc4r;n,cSblN1J ,(J4 /7tJ50
(City. State, Zip) . I
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ignature)
5:Z2Q fYIe",Jo'^'hYy':4<..
(Street Address)
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fYlet/"pn;(:>P Vy? ~;q
(City. State. Zip) U I
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E~ecuted in Register's Office
Sworn to or affirmed and subscribed
before me this \ ~ day
of ~Q..N"'\bJ') , ~Obl .
Form RW-04 rev. 10.13.06
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