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Home My WebLink About01-07-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND , Deceased COUNTY, PENNSYLVANIA File Number ~ (- 09 ,... Jj) H-ItA- Social Security Number 176-34-926~ Estate of Kunkleman also known as Charlotte A Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE ~' 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 00 B. Grant of Letters of Administration r--> \) S Co = p'- .: :0 '-:n :) ~, =i2 ::J ::J:> C :,;- :) ..c::;,. -', _!_J '! -~:-r.- _-:; (State relevant circumstances, e.g., renunciation, death of executor, etc.) , ~ 53 ~ r-:"i (q \",J' J ........ .. __..... Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executio~:6fthf instrument(s}o.~d ~'. \..... -" .. . "-"j for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ or: ~ ,~{~ =$ --i rr~ ," (If applicable, enter: c./.a.; d.b.n.c./.a.; pendente lite; durante absentia; durante minoI4lilte) 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:(lf Administration, c./.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Name Relationshi Residence child PA 17257 child PA 17257 child PA 17257 (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his / her last principal residence at 42 Kunkleman Lane Shi ensbur PA 172 7 Southam ton Tw Cumberland Coun (List street address, tClWn/city, township, county, state, zip code) Decedent, then 63 Straban Townshio years of age, died on 12/19/2007 at Genisis Healthcare Center Adams County PA 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 PA) Personal property in County Value of real estate in Pennsylvania $ $ $ $ 210.000.00 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: Signature Typed or printed name and residence David Kunkleman 42 Kunkleman Lane Shi Brian KunkJeman 1295 Priv te Oak Lane Shi Guy Kunkleman 34 Kunkleman Lane Shi PA 17257 PA 17257 PA 17257 Form RW-02 rev. 10.13.06 Page I of2 Oath of Personal Representative COMMONWEALTH OF PENNSYL VANIA : SS COUNTY OF CUMBERLAND The Petitioner(s) above-named swear(s) or affmn(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. Sworn to or affmned and subscribed before me the {'-111 day of () ';;0 unklematl~ C") '-~r- -~:7 rn .-- '.; --:J . C/..! :,:", ~:: :~~ (~~ " :lJ --l f'.) = c:::> c:a _0 :-_!-.) ~()~flf) r the Register :x:- z I -.J File Number: 11-1- O~ " B-O ~ -a. ~D --, ~~ ""---'-1 '"_../ (','_-J CJ . "'::;-:'1 ..:.._, '.C) . f 1"-1 Estate of Kunkleman Charlotte A , Deceased r:'Y CJ1 W Social Security Number: 176-34-9262 Date of Death: 12/19/2007 AND NOW, Januarv 1fYl ,2008, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administation are hereby granted to Guv Kunkleman. Brian Kunkleman and David Kunkleman and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) 0 Decedent. f1 in the above estate TOTAL ............................. $ 2j(), ttJ $ ~OD $ $ ~O. {)O $ ,5.f1L $ $ $ $ $ $ $ $ 3~?CO V!:..gister of Wills ~ Attorney signatlli<:>>----l ~~ FEES Attorney Name: H. Anthonv Adams Supreme Court J.D. No.: 25502 Address; 49 West Oranae Street Shiooensbura PA 17257 Telephone: 717-532-3270 Form RW-02 rev. 10.13.06 Page 2 of2 H 105.805 REV (01/07) '~ I~Og/ OJ'JlO LOCAL REGISTRAR'S CERTIFICATION OF DEATti WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14007318 Certification Number 1'jE'M# 3 . -.-.Sb.f,)4td (eQ.-;[}L-L76~ 39 - fI~6r 'ti~tD ---..142.0/67 Hl05.,.3 REV 1112006 TYPE I PRINT IN PERMANENT BlACK INK 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 .Re s Office D permanent filing. egistrar ~~ .,.0 . ".:J:J .I=D :l; r~~ ):~~ ~ ) ;,.>< COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) ) l 13. _', Educallon (Spoclly ony ~ grade completed) Elementary I Secondary (0-12) College (1.... or 5+) 12 th Fa. 6. Date of Bir1h (Month, . a 7.1liIt~ 63 Februazy 16. 1944 Yro. sl::urg PA. Bb. County 01 Oealh BdFadilyNamelffnol_gj,e.........nu_) AdEms CDImty Genesis HeaJ.th Care Get.t:ysOOrg CeRt:er 12. Was Dececsent ever in the U.S. Armed Forces? Dy.. KlNo Decedenl's Actual Residence 171. Slate 42 Kunkl.eman lane, Sh:ifpensl:urg Pa. 17257 17b. County ClIrberlarrl ~ ~ -.I. 18. F8tler's NIrne (Fnt, mldlIe, . suffIX) D3vid Stouffer 201. I_rd', Name (Tjpe I PlintJ Qly W. Kunkl.eman Jr. 21..1otethodolDlspooition g]Buriai D_IIomSlaIe o OOhar. SpscIfy.' ~ 22a uneral 18, Mother's Name (rl'Sl., middle, maiden sumame) Olarlotte Cramer 211>. wonnanrsllailing_ (Slraet.dty/_. -.1\>-) 34 Kunkl.eman lane Shifpensb.lrg Fa 17257 210. Placa 0/ l>sposlion (Nama 0/ _, .....1lXyll( _ place) STATE FILE NUMBER -., t~_. ) , , /;f /-1&/127 ( "'-> Date Issued = = = <- ):10 :z I -.J -0 ::x N U1 w ) .. .') 4. Dale 01 Death (Month. day, year) IJeceoher 19. 'XXJ7 14. MariIaJ &atus: Married, Never Married, -. DMltcad (SpeciI)j Wi.ci:7.Ied Old~rtt u.... T_' DOther.Speci~ 10. Race: American Indian, Black, Wh~e, etc. (SpeciI)j \'hite 17e.1iI Vas, _lived. Sout:.hao:Dta1 Two. 17d.DNo,_lived_ AcluaIlinllso/ Twp. atylBoro 21d. localion (Cily I town, slale, zip code) ClIrberlarrl 0:>. Southanpym Twp. Bd.dter F\1nera1 Hane Inc. 112 West r hems 24.26 must be ~ by peISOll who prtIf'IOOOO8S death. tlM. "- \.... \:..; CAUSE OF DEATH (See Instructions nd eX8mptea) tIem 27. Part I: Enaer the ~ - dseases, i';uries, or ~ions -that chcIIy caused the death. 00 NOT Mer terrnnaI evenlS such as caniac arrest, =~~~;);;'*":'-f:~~rNA;~;7li-t::;~e~f el, ~ '4.e Due to (or as a consequence of): I Approxima!einlerval; : Onset 10 Death , I I . I I I I , I I , I , I ;( ".") ::~~ =listoonr:itions,Kany, 10 the cause listed on line a. E~ UNDERLYING CAUSE ~re:..~m~~re Due 10 (Of as a consequence 00: b. Due 10 (or as a consequence of): d. 3Ob. Were AioIo!lsY Fincings AvaflablePriorlo~ 01 Cause d Death? 308. Was an Autopsy PeriOlllled? 31. Manner 01 Death B'Natural 0 Homicide 0- Dpen<lngk1vesligallon D~ D"",,"NolbeDelermiled Dyes Dyes DNo 32d. Trneoftnjury Fa. 17257 23c. Dale Signed (Month, day, year) ~-L~~ 61 26. Was Case Referred to M8dica1 Examiner I Coroner for a Reason Other than Cremation or Donation? Dy.. IilNo Part": ErierothersianilicanlconditinnsconlrillJlinnlodAAlh, bulnol resu.ng in the IIlderIyilg cause ljven in Part I. 28. Did Tobacco Use ConIribtie to Dealh? Dy" Dp"""!>/y DNa ~_ 29.~~le; L:f NoI pregnam wiII1in past year o PR9'llnl allime 01 death o Not pregnant, but pr8!,1lanl within 42 days 01 death o Not pregnant. but pregnanl43 clays to 1 year beloredealh o Unknown if pregnant within the past year 32c. Place of Injury: Home, Fa~, &reel, Factory, DnlceBuilding, etc. (Specify) "1:: U 338. Certilier (check only one) Certifying physldln (Physician cer1ifylng cause 01 death when another physician has pronounced dealh and ~ed tIem 23) To the best of my knoWdge, death occurred due to the caU8e(s) and manner as stated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ ;:=~a~=t~-:C=:::~~~~=~~mamer8&1IIIed__________________ D MediclI EXaminer I Coroner I On (he basis of examlnaUon and I or Investigation, In my ~nlOn. dtath occurred allhe time, date, and place, .nd due to the cause(s) and manner 85 .stated.. 0 321.11 T_,;oo ,,*,ry (Spedty) Donv..14>eoatll( DPassellQCf DPadestrian Other. Spedty.- :fll. strTfJre r TiI~ Cerldier ~ / C/V. ("Lw.r) M. ~ ~ ~ o w ~ 35. Re{Pstrar'SSignalurea ~ Disposition Permit No. 32g. localion of I~UJY (&reet, city 110Wl1, stale) 33<1. Dale 5iM (Month, day, year) 'L(lf(~ 7