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HomeMy WebLinkAbout07-11-08PETITION FOR P /ROIBMATEcOAN'lD GRANT OF LETTERS REGISTER OF WILLS OF ~ V I I ~ Y I~~/l N ~. COUNTY, PENNSYLVANIA Estate of r 1 ~ ' ~ G ~ File Number C3~1 ©~ ~~~~ also known as / ~/(~l ~ (. P/ z ~r~ fi~ (~~ ~ ~ ~~ ~ f ~ .p/~- ,Deceased Social Security Number ~ ~ ~ r~0 ~ / /~~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW.) ~, 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 (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) offered for probate, vas not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration (If applicable, enter: c. t. a.; d. b. n. c.t.a.; pendente liter durante absentia;~ante minorit~ __p «~ -, Petitioner(s) after a proper search has /have ascertained that Decedent lefr no Will and was survived by the followtng s~RO~e (if ~ and~~ttetrs ~/f Administrat~~on, c.t.a. or d. b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) _~ =~> r- r'- ~ _ ,- ~_ Name Relationshi 1t0side" r ~ ;- _ ;~ -iz ~ `,; ., -- .fi' (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~d~/~i ~' I I P~1 TQ.... ~ S `' ,~~ Decedent was domiciled at death iq ~ y `~`'~ ~ P/ tU ^ ~ C ty, PenLsylvania with his /her last principal residence at, (List street address, town/ciry, township, county, state, zip code`) z ~ / Decedent, then ~ years of age, died on J~ ~ C J U , ~~ O at ~ G1 /t d ~ ~ t~,/ P l ~ /`. ,P ~- I Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~U V t ~~ ~ ' (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Vaiilue o(~f real estate in Penffn~~sylvanlia / IJ D /~ t $ ~ ~Q, d a(J. ~ () situated as follows: I~-/ ~ ~lG7T~ i~ ~ ~ • `G'^^ Q [~ 1 ~ ~ 1 I~''' l7 ~ ~,~ Wherefore, P'etitioner(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: named in the CC ~tt~~~c>~y r~~~3 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA 1 SS COUNTY OF ~ ./ ~ ~ P~~ rn ~ 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, Petitioner(s) will well and truly administer the estate according to law. Sworn to cr affirmed and subscribed before meI thef r/~ n,,,da~y of For the Register Estate of File Number: I~ Gt I~~C~P Deceased Social Security Number: 2 U7 ' ~ ~ - 3 ~ 3 Z Date of Death: -~•~ / ~ P ~ v ~d(~ AND NOW, UU.- ~ , ~l~ , in cPnsi~deraf on of the foregoing Petition, satisfactory proof having been presented before me, IT~// DEC E tha Letters ~ ~!!~'/ are hereby granted to c~COYf" L. >~~e/~ ~~ ~ ~ • er in the above estate and that 'the instrument(s) dated ~-P brL~_CtiU s ~~ described in the Petition be ad mitted to probate and filed of record as the last Will and Codicil )) of Decedent. FEES - ~.~' ~ ~ G~ 1 / x,O ~\D Letters ..... ~? ?. ~ ..... $ Register of Wills Short Certificate(s) . ~S.... $ (90 Attorney Signature: Renunciation(s) .......... J ~' p $ $ ~~ Attorney Name: ~„ d V~) G ~ ~Q ~ -' 1 T U G C 1 ._. ~ ~ • • • $ ~ ~ s' Supreme Court LD. No.: ~ J „t ... $ Add ' () ~ dX ~ Z' $ ress: 1 / ... $ ... $ • • • $ ~) ~~ ~~~~ ~~ ~ Telephone: / ... $ TOTAL .............. $ `~~ 0.00 ~ N e~ C.. m Signa e of Perso Representative , ~ C , ~- -~~ ~ ., = ; -=rr~ ~r - r-~; ignature of Personal Representative - '~ } ~ -~, Signature of Personal Representative ---~ '• -, w a ~ ~8 038 Form RW-02 rev. /0./3.06 Page 2 of 2 105.805 REV (U(/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 ~.4~540~08 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Deat duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. z,,~, ~ d"` JUL/0 3~8 Local Registrar Q Date Issued C ~ - rv ca° ~ cb c. _ ;, , ~ °: ,, } ~ -rJy ~l.l~~ Wti ~• l 1, .- , ~J ~ ~ ~~ {~.t J ~ _ - ~~ ~ = . L r~' . •. 7 7 i REV 11noo6 COMMONWEALTH OF PENNSYLVANIA + DEPARTMENT OF HEALTH • VITAL RECORDS GJ "J 'PRINT IN cK"NINCT CERTIFICATE OF DEATH jj~~ ~ ((\\ j, (See instructions and examples on reverse) sTATe FILE NUMBER r(' ~~ V ~~ V ' 1. Name of Decetlenl (Flrsl, mkklle. teal, suBlx) 2. Sex 3. Social Securrly Number 4. Dale of Death (MD"In, day, year) Kathryn I. Rickert female 207 - 30 - 3132 June 30, 2008 5. Aqe (Last Birthday) Under 1 year Under 1 day 6. Date of Binh (MOnm, day, year) 7. Birthplace (City and state or loregn country) Ba. Place of Death (Check only one) Monms nays Hour rK Hospital: Other 68 y,, December 2, 1939 Klingerstown PA ^ ^ ^ . , mpahem ER /Outpatient DOA ®Nursmg Home ^ Resitlence ^Other - Specify. 6b. County of Death Bc. City, Boro, Twp, of Death Bd. FecBiry Name (If not institution, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^Yes 10. Race: American Indian, BWCk. Wnpe, etc Cumberland Camp Hill (If yes, specity Cuban, (Specify Manor Care Mexican Puerto Rican etc) , , white 11. Decedent's Usual (kc flee Kind of wok dale Bunn moss of workin life. Do riot slate retired 12. Was Decedent ever In the 13. Dacatlent's Education (Speciry only highest grade completed) 14. Marital Status: Marred, Never Married, 15. Surviving Spouse (If wile, give maitlen name) Kintl of Work Kktl of Business I Intluslry U.S. Armed Forces? Elementary /Secondary (0-12j College (1 ~4 or 5+) Widowed, Divorced (Specify State Government ^Yes'®No 12 divorced 16. Decedent's Mailing Address (Street, city I town. state, zip code) Decedents Did Decedent slak Pennsylvania u~ama 17c AdualReaitlence 17a DecedentLwedin Lower Allen ~Yes 1295 Strafford Road . . , Twp township? Cam Hi 11 PA 17 011 nn County Cumberland 17d.^ No, Decedent Livetl within A p , ctual Umhs of Ciry I Boro 18. Palher's Name (First, middle, last, suffix) 19. Mother's Name (First, middle, maiden surname) Elwood Maurer Tamie Clark 20a. Inlomwm's Name (Type ~ Pnn17 20b. Informant's Mailing Address (Street, Ciry I town, state, zip cotle) Scott L. Rickert 4 Cromwell Court, Mechanicsbur PA 17050 21 a. Method of Disposition ^ Cremation ^ Donation 21b. Date W Disposition (Month, tlay, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 tl. Location (Ciry I town, slate, rip cotlel ® Burial ^ Removal from State i Was Cremation or Donation Aumodzed • ^ omer speciry: hyMedoalExamineNCnrwier7 ^vea^Np July 3, 2008 Mechanicsburg Cemetery Mechanicsburg, PA 17055 22a. Sig of Funeral Sen~ice Licensee ads h) 22b. Lk:ense Number 22c. Name antl Address of Facility P FD 012 248 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland PA 17070 Comp a Items 23e-c only when cerdl}"n9 23a. 7o the best of my knowledge, death occurred at the lime, date and place stated. (Signature arM tiNe) 236. License Number 23c. Date Slgnetl (Month, day, year) physician Is trot avatlable at time of death to _ ceNy reuse of death. Items 2d-26 must be compleletl by person 24. Time of Death 25. Data Pronounced Dead (Month, day, year) 26. Was Case Referred ro Medical Examiner /Coroner far a Reason Other than Cremation a Comatlon? who pronounces death. 1 ~ ~ ~ M. ~,/ ^ Z , J L'.> '>,~ ^Yes ~No CAUSE OF DEATH (See Inatructlons and examples) r Approximate interval: Pan II: Enter other GgNficanl condilum conlribdind to tleath, 26. Did Tobacco Use Contribute to Death? Item 27. Pan I. Enter the gBalp of events - tliseases, injures, or complication - Ihel directly causetl dte death. W NOT enter terminal evenLS such as cardiac anesl. Onset to Death but not resulting in the untlenying cause given in Pen I, ^Ves ~Pr66ably respiratory crest, a ventricular fbnllation without snowing the etiology. List only one cause on each line. ~ t ^ No ^ UnNirown IMMEDIATE CAUSE (Final disease or de t condakn resulting m alb) ~ " ~ +':•• ~ ~" ~ , .r ^ -i " / A ' ^ C v ~ Q /1 p~ I 29. N Female: .. . _~ a. . L ! ~i l 1 U ' 1 ,( ' ~ rf./ P Cn U i ( ~ ' ~ ! r ~ ~ Dus to (pr as a consequence op' ~ OrPregnant wilhm past year Sequen6alty list conditions, if any, b. ~ ~~ ' ~'(~ x ~ 7~ :., ~, ~ i^ : n f `"- sT J i , r r ~ ^ Pregnam a1 ume of death ketlingg to me cause listed on line a. Due to or as a consequence of t Enter the UNDERLYING CAUSE ( )~ , r ~ I Not pr aril, out a rant within 42 da s ^ ~" pr g y (disease or injury that iniliatO~I the p, t events resulting m dealhj LAST r ~ °~ {+;,„? ^ ~ , ;sr.- ~ r•y°\ n • of tleath Due tp (or as a consequence of)-. r ~ ~•( ~ Not pre an ^ gn t, bw pregnam 43 days Ip t year d t , r ~ before tlealh ^ Unknown it pregnant within the past year 30a. Was an Autopsy 30U. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 326. Describe How Injury Occurtetl 32c. Place of Injury: Home, Farm, Street Factory, Pedortned? Available Prior to Completion ^ Natural ^ Homicitle ON¢e Building, etc. (Specify) of Cause of Deam~ ^ yes ~ No ^Ves ^ No ^ AceMenl ^ Pending Investigation 32d. Time of Injury 32e. Injury at Work? 32f. I1 Transportation Injury (Sperry) 32g. Location of Injury (Street, city I town, statel ^ Suicide ^ Could Not be Delertnined ^Ves ^ No ^ Driver I Operator ^ Passenger ^Pedestrian M ^Olher ~ Specify: 33a. Cenilier (check only oriel • Cenltying physician (Physician cenilying cause of deem when another physician has prorroureetl death and rAmpkled Item 23) 336. Signature antl Title of Cenilier ~~ C'~ 'v^ ,7 To the best of my knowledge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ® ~ ~ • Pronouncing one ceditying physician (PnyeiCien both proncuncwig deem and cenilying Im cause of tlealh) d d ti d t d l t h tl t le h d d d ^ 33c. License Number 33tl. Date Si ned iMamh, day , ea ) > / eath occurte et t a e, an p ace, an ue e cause(s) an manner as atate o the hest of my know dge, e me, o t _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ ' ~ s y , ' ~ ~ C a T9 f) ,~ ~ ~ ? I ~ /Coroner • Medical Examine On the basis of examinatlan and / or investigation, in my opinion, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated_ ^ 1 .- , 34 Name and Atl dress of Person Who Complefetl Cause of Death (Item 27) Type r Prmt Signature and District Num er 35. Reglstr 36. Da Ffied (Month, day, years ~ 1 (o •~ ^ ~ ~ -~x J ^ b rv~ ~ ~ ~ ..~ ` '" Disposition Permit No. (~2.2. (T.3~ 1 n _- O ~~ ~.t ~.~~ ~x~~ ~~e~z~rr~.rr~~ _~ ~ n F a ~, --~ -; ~. ~;r 'Cj-' ~~ J i-_ OF ~ =-n --~ y KATHRYN M. RICKERT BE IT REMEMBERED, that I, KATHRYN M. RICKERT, of 1295 Strafford Road, Camp Hill, Lower Allen Township, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof made by me at any time heretofore. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: I give the sum of Ten Thousand Dollars ($10,000.00) to my grandson, SPENCER L. RICKERT, and I appoint my son, Scott L. Rickert, as Financial Guardian thereof. ITEM 3: I give the sum of Ten Thousand Dollars ($10,000.00) to my granddaughter, LEXI E. RICKERT, and I appoint my son, Bret M. Rickert, as Financial LE~c'!A ~L R~ r Guardian thereof. ~k~l ° ° ITEM 4: I give the sum of Ten Thousand Dollars ($10,000.00) to each of my natural grandchildren hereafter born, and appoint their parent to be the Financial Guardian of this bequest. ITEM 5: 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 two sons, SCOTT L. RICKERT and BRET M. RICKERT, in equal shares per stirpes. In the WITNESS: v ``~ /~' ~~~~~-`(SEAL) KATH N M. RICKERT 1 ~,, ~, ~- _ ~- - .. -~ _,~ mar ~ ., - ~- event either of my sons do not survive me, then their share shall be given to their children, less the Ten Thousand Dollars ($10,000.00) bequest as set forth above, with their mother WITNESS: designated as financial guardian if my grandchildren are under age eighteen (18). ITEM 6: In the event that I am not survived by my sons, or any grandchildren, I then give, devise and bequeath my entire residuary estate unto BROTHERS and SISTERS, who are living at the time of my demise. ITEM 7: I direct my hereinafter named Co-Executors 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 taxes, either 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 8: I appoint my two sons, SCOTT L. RICKERT and BRET M. RICKERT, as Co-Executors of this my Last Will and Testament. ITEM 9: I direct that my Co-Executors, Guardians, or their successor shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this,~~day of February, 2004. .~ 7 . ., "` • (~ ~ ~ EAL) KATHRYN M. RICKERT 2 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS We, KATHRYN M. RICKERT, JAN M. WILEY, ESQUIRE and LINDSAY M. STRATHMEYER, 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 had signed willingly (or willingly directed another to sign for her), and that she executed it 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 this Last Will and Testament as witness 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. THRYN M. RICKERT ~^ 1 ESS C~-~J a^-,`'I~.t • ~,~-Imo--e,,. /~- ITNESS Sworn to and subscribed before me this,~~ay of February, 2004. ~_._- ~ '~ - ~ ~1 NOTARY PUBLIC MY COMMISSION EXPIRES: ir~l $eeail Eh#lsbur~ ~r4, Fork County 3 :oa~r~~sston Expires May 17, 2005 . ,~., ~ a;aar, PennBylvaniaAssociation of Notaries Noiaria! Seal S. Dawn Giaafelter, Notary Public Diiisburg 5cro, York County My Commission Expires May 17, 2005 Member, Pennsylvania Association of Notaries