HomeMy WebLinkAbout07-24-08~ r~
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
CUMBERLAND
Estate of Marian T. Kerin
COUNTY, PENNSYLVANIA
File Number 21--00 •-l~3
also known as
,Deceased Social ;security Number
Tina A. Middleton _
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 named in the
last Will of the Decedent, dated and codicil(s) dated
State relevant circumstances, e.g., renunciation, death or 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, was not the victim of a killing and was never adjudicated an incapacitated person:
QX B. Grant of Letters of Administration
ap Ica e, en er. c..a.; ..n.c..a.; en e i e; uran e a sen ra; uran a mmon a e
Petitioner(s~ after a proper search has/have ascertained that Decedent left no Will and was survived by the fallowing spouse (if any) and heirs: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date of ill in Section A above and complete list of heirs.)
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Name Relationship Residence ~ ~.-~ _ _
Tina A. Middleton Niece 11 Walnut Lane ~_~~ ~
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Camp Hill, PA 17011 ~ ~r_ ~? r-
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. -~ ~~ r~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his !her last principal residence at ~
801 Hanover Street, Carlisle, Cumberland County, Pennsylvania 17013
(List street address, towNCity, township, county, state, zip code)
Decedent, then 84 years of age, died on 05/2212008 at Church of God Home, 801 Hanover Street, Carlisle, PA 17013
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) $ 7,000.00
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows: N/A
All personal property
Personal property in Pennsylvania
Personal property in County
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:
Typed or printed name
Xis ~~. ~~~eR~~
11 Walnut Lane
Camp Hill, PA 17011
Copyright (c) 2006 form software only The Lackner Group, Inc.
Page 1 of 2
t ...
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
couNTY OF Cumberland }
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true srnd 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 tc or affirmed and subscribed "~"VT' ~
Signature of Persona/Representative Tina A.Midldleton
before me this ~_ day of
`` ` ~~ ~ ~~ n / Signature of Personal Representative
For the Register Signature of Persona! Representative
,Deceased
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Social Security Number: 19.8-14--2952 Date of Death: 05/22/2008 ;',-~~
in consideration of the foregolrr~ I~et(t~n, satl~ctory~prodf
AND NOW, ~ l~~-1 L.lt ~ '' I
having been presented before me, IT IS DECREED that Letters of Administration ~~-~ ,; `, ~.,,, t -
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File Number: 21- Q ~ • ~"~ 3
Estate of Marian T. Kerin
A/K/A
are hereby granted to Tina
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~ ==+ in~he above estate
and that the instrument(s) dated j~ ar
described in the Petition be admitted to probate and filled of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters
$
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........................................
~ .... , Regishar of Wlls
.......
Short Certificate(s)......... ... $ ~ .
Renunciation(s) ......................... .... $ Attomey Signature: ~ ~~~_
J C~ $ ~~. ~ Attorney Name: Jennifer B. Hipp
$ 5
E~
s . Supreme Court I.D. No.: 86556
Bogar and Hipp Law Offices
$ Address: 1 West Main Street
$
$ Shiremanstown, PA 17011
$ Telephone: 717-737-876'1
$
$
TOTAL ................................. ... $ ~ . ~./`J
Form RW-OZ Rev. 10-132006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
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LOCAL REGISTRAR'S CERTIFICATION ~~F DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fec filr this certiiiratc. ~f~.OU
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~a~~~ ofpftiry i'hl~ Is to certifti that the Information here given is
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inal Cextifieate of Death
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' Multi filed ~~~ ith me a, Local Registrar. The original
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z~ rertlllratc will he forwarded to the State Vital
~; y~'; 'a;( Rcckn-ds (>l~ficr 1<n~ ~crn)anent filing.
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g9j!61ENT OF~~`~j1'
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iixx/Ill Local Re~~i,~nar Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
1. Name of Decedent (First. middle, IasL suffix) 2. Sex 3. Social Security Number 4. Oale of Death (Month, day, year)
Marian T. Karin Female 198 - 14-2952 May 22, 2008
5 4ge (Last Bitlhtlay) UrWer 1 year Under 1 day 6. Date of Binh (Month, day, yeaQ 7. Blnhplace (City and stale or foreign country) fie. Place of Death (Cneck only one)
Monms Days Hovrs Niwtes HosDilal. Other
8 4 via 9 / 14 / 19 2 3 C ry s t a 1 Lake Scranton ^ mpabem ^ ER / ompanem ] DoA ~] Nursing Hpme ^ Rasidanee ^omer _ spepiry:
fib. County of Death 6c. City, Boro. Trop. of Death 8d. FacilAy Name (II not institulipn, give street and number) 9. Was Decadent of Hispanic Ongm? ~ N° ^ Yes 10. Race: American Indian, Black, While, etc.
(It yes, specity Cuban, (SpecilyJ
Cianberland GarllSle Q1llrC11 Of God Home Mexican. Pueno Rican, ecc.) White
11. Decedent's Usual Occu anon Kind of work d one d un oast of workin tile. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Specify only highest grade compl eted) 14. Marital Stzlus. Mametl, Never Married. I5. Surviving Spo use (II wile, give maiden name)
Kind of Work Klnd of Businessl Industry U.S. Armed Fomes? Elementary /Secondary (012) College (1-4 or 6.) Widowed, Divorced (SpedhJl
Secretary RCA ^Yea g7Np 12 1 Widaaed
16. Decedem's Mailing Address (SlreeL city r Town, state, zip code) Decedent's Dld Decedent
PA Live in a 17
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801 N. Hanover St. c.
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T°w°shi°? nd;~l No
oepadamu•adwilnin Carlisle
Carlisle PA 17013 ,
,7bcounry CL~tberland andpalumilapl city.Bpm
tE. father's Name (First middle, last, suffix) 19. Mother's Name (First, middle, maiden surname)
Peter Tellep Frieda Wenning
20a. Informant's Name (Type; Print) 206. Informant's Mailing Atltlress (Street. city I town, stale, zip cote)
Tina Middleton 11 Walnut Lane Camp Hill, PA 17011
2t a. Method of Disposition ^ Cremation ^ Donation 21 b. Date of Dispositbn (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other ftlace) 21 d. Location (City l town. stale, zip codel
~i] Burial ^ Removal hom State ;Was Cremation or Donation Authorized T,.{.,,, 28
200 Rollin
Green CmfeCer Inwe Allen 'Ita
PA 170 I 1
^ Other - Specity i by Medical Ezaminer I Coroner? ^Ves ^ No ,
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22a. Sgnawre o~Funeral Se ' a icensee (or person acting as such) 226. License Number 22c. Name and Address of Facility
- ~ ~ FD 012774-L Richardson Funeral Home Inc. 29 S. ETw1a Ik. Enola, PA 17025
Complete Items 23ac only when cenilying (Signature and title)
23a. NSest °f my krawledge, death xcurren7'~1 fhe time to and place stated. 23b. Cleanse Numtrer 23c. Date Signed (Month, day, year)
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physician is not available at lime of death to n
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_ cenily rouse of death. '
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Items 2426 must be completed by person 2d. Time of Death 25. Dale Pr need Deatl (Month, day, year) 26. Was Case Referred to Medical Examiner I Coroner for a Reason Cher Than Cremation or Donation?
wlw pronounces death. Z` ~~ ~ M. \ ~2 Z ~ ^ Yes ^ No
CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Pan II: Enter other SiMificanl conditions conMbulmq to death, 28. Did Tobacco Use Conln6ute to Death
Iles 27. Pan I: Enter the Chan of events -diseases, injuries, or CompliCallOns -that directly Caused the death. DO NOT enter le Trial evenla such as cardiac arrest, Onset l0 Death but not resulting in the undedying cause given In Pan I. ^ Yes ^ Probably
respiratory arrest, or ventricular fibrillation without showing the ellology. List only one cause on each line. t
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IMMEDIATE CAUSE Final disease or ~J
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rondtion resulting in death) -~
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Due Io (or as a consequence off: i ot Dregnanl within past year
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Sequenbaky list rontlkions, it any, b.
^ Pregnant al lime of death
leadingg to the cause listed pit line a. r
Enter Te UNDEflLYING CAUSE Due to for as a consequence oil ^ N°I pregnant, but pregnant within 42 days
(disease or injury That Initiated the
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in deem) LAST
s 01 death
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Due to (or as a consequence oQ:
^ Npi pregnant, but pregnant 43 days to t year
tl before deem
^ Unknown II pregnant wihin the pall year
30a Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month. day, year) 32b. Describe Haw Inlury Occurred 32c. Place of Injury. Home Farm Street. Factory.
Pedormetl? Available Prior In Completion
of Cause of Deam~
^ Natural ^ HomicWe OHlce Building, etc. (Sped/y)
^ Yes ~o ^Ves ^ No ^ Accident ^ Pending Invesligalien 32tl. Time of Injury 32e. Injury at W°dc? 321. II Transppnalion Injury (Specify) 32g. Location of Injury (Street city f lawn. slate)
^ Sdicide ^ Could Ndl be Determined ^ Yes ^ No Dines 0
e ator Passen r ~ede5lm
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33a_ Ceniller (Cheek only one)
f 33b. Signalure and T41e n'I'
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Certifying physician (Physicia cen
ying cause ea pyscia~ ra pranou pe
• of tl th when enpmer h I s need death and cam I led Item 23) ~ %
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To the best of my knowledge, death occurred due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~ .~ '
• Pronouncing and cenifying physician (Physiaan noN pronouncing tleaN and cenilying to cause of death)
Tothe hest of my knowledge, death occurred al the lime, date, and place, and due to the cause(s) and manner as slalad_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Medical ExaminerlCOroner 33c. License Number
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` 1 ~ C~ 33d. Dale Ski nQd (Month. dy, year) [ ,-
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On the basis of examination and I or Investigation, in my opinion, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated_ ^ _
34. Name and Address of Person Who Conpleletl Cause of Deatn foam 27) Type; Pnnl 1
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35 Pegis'.r ignalureandD ictNurn
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Q-111TC11 of God Home 801 N. Hanover St. Carlisle, PA 17013
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a Dlsposibon Permit No. - (,,,/~(~`^.~ -~ ~ ~