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HomeMy WebLinkAbout08-19-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Estate of GRACE A. KAIN also known as Deceased Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE A' or 'B' BELOW:) File Number ~ ~ ' ~ o o ~~~ Social Security Number r--,~ ® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~„~ iaamed in the last Will of the Decedent dated and codicil(s) dated ~'='~ j - 1.b7 (State relevant cirevnrsta»ces, e.g.. renunciation, death of erecnurr, etc.) . _,` ` _ ~ Except as follows. Decedent did not marry. was not divorced, and did not have a child born or adopted after execution of the it~strixtiient(s}=t3ffered ,~.- for probate, was not the victim of a killing and was never adjudicated an incapacitated person: =' ""' y C'~ S. Crant of Letters of Administration ~ (Jfappiicable, enter: c. t. a.: d. b. n. c.t.a.; pendenteGte; duranteabsentia; durance minorNate) Petitioner(s) after a proper search has !have ascertained that Decedent left no W ili and was survived by the following spouse (if any) and heirs: (/f Administration, c. t. a. or d.b.rzc.t.a ,enter date of Will in Section A above and complete list ajlveirs.) Name Relationshi Residence RAYMOND KAIN SON 6337 N. POWDERHORN RD, MECHANICSBURG, PA 17050 W. BARRY KAIN SON 207 HILLCREST LN., EL[ZABETHTOWN, PA 17022 (COMPLETE IN ALL C9SES:) Attach additional sheets if necessarP. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at 100 MT ALLEN DRIVE MECHANICSBURG, UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY, PENNSYLVANIA 17055 (List street address. torvn/city, township. county, srate, zip code) Decedent, then 92 years of age, died on DECEMBER 17, 2007 at MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG UPPER ALLEN TOWNSHIP CUMBERLAND COUNTY PENNSYLVANIA 17055 Decedent at death owned property with estimated values as follows: ([f domiciled in PA) All personal property $ 77.372.27 (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 fol Fornr Rft'-01 rev. 10.13.06 Page 1 Of 2 CUMBERLAND COUNTY, PENNSYLVANIA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Wi11 and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 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, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me the "l~ ~ h day of ~ r .~~~f For the Register Si~nann e of Persona! Represenla~ive File Number: •~ ~ • Q 0 ' ~ ~~ ~ ~? -j` :`~ _. ~,,;:.. Estate of GRACE A. KAIN , Decease'd~~ ^~~ "~ _ ~~ d ;% (..:~ Social Sre)curity Number: Date of Death: DECEMBER 17. ?007 AND NOW, ~ G~'" ~~-o,+, CA1 ~_ ' Ll~ (,fJF. , Z00 ~( , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters OF ADMIN[STRATION are hereby granted to W. BARRY KAIN and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will FEES Letters ......... ...... $ ~~L~. ~~~ Short Certificate(s) ........ $ ~• ~n Renunciation(s) .. ........ $ ~• ©l1 ~, ... $ (~. C~ ... $ ... $ ... $ ... $ ... $ .. $ ... $ TOTAL ...... ........ $ ~~~ l^t.~-A-AA- in the above estate Codicil(s)) of Decedent. -~ r:~ C~ ' i." ~~ iT . . 4CX~~ Attorney Signature: ~1~/~ Attorney Name: AN"CHONY T Supreme Court I.D. No.: 53T?9 Address: Telephone: 407 NORTH FRONT STREET F[RST FLOOR HARRISBURG, PA U101 717-238-3686 Fornr R w~-nz rer. 10.13.06 Page 2 of 2 Srgnahn e of Personal Represervatire nw cn: urn .~, ~,- LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. ~6.UO F 14124 a'~ Certification ~mber - • F- ~t Lr_ .~ , ~x __ E 34_ - ... t ' ~ ..!' . _• -__. ....~, t_ _ '' " F ~" ~ ' .;,: r_ w~ ~1`: ~~ C.~J This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me us Local Registrar. The original certificate will he forwarded to the State Vital Records Office for Fernurnent filing. Local Registrar Date Issued rnoj-u3 Rev nrzoob COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TVPE~PRINT IN PERMANeIdT CERTIFICATE OF DEATH ~', ('~ ~^ / BkA^K INK ISee instructions and examples on reverse) CTATP F„ R N„If,RFR ~ ` • (~ rc • X ~l ~T t Nanre d Decadent (Fell mrdtlle last sumxl 2. Sex 3 Soul Secairy Number 4. Dale of Deatn IMonm, day. Years Grace A. Kain Female 197 - 07 - 1003 Dec. 17, 2007 > Aye ILasl Bmhtlayl Under I year Under t day 8- Dale of Blnh (Manor, day. year) 1 Blnhplace IGry arld slAle a loreiyn c«rnlryl Ba Place of Duam (Check Dray oriel tl~:nm o..r~ ~~,,,> Nv`-^~+ Fbspdal: O,-ln,/ 1915 Bowmarrsdale, PA Nov 4 - ^om S t []R 92 ^ . , ar peo y L aaidanc¢ DOA L)s rvu'srny Rome ]Inpanenl ^ER, oatpati¢nt Ys 86 County of Death A~. Qly, e«o. Twp. of Oea1h Bd. Facihly Name 111 not Insbtulion. grve sveel antl number) 9 Was Decedem of IMSpamc Origin? ~ No [] Yes 10. Race. Amerman moan. Black, Whee etc Clvnberland Upper Allen Trap. .;II yes, spacily Cuoan, 15paciq•) /fl j/<~cl MexkanPuanoRroanalcl Whlte I I Decedent's Uswl (kcu Iron INUq of work done dune moil of work Ida. lkr rxN slate reUreO 12 Was Decadent ever rn the la Decedent's Iron (SPeoN only hghesl grade cumpbletll 14. Marital $IaWS: Merited. Never Married 15. Burvmng Spouse (II wde, glue ntei0en names WiOOwed Divorced (Specrlyl ' Kind of WVrk Kurd W 8usuress I bMuslry U 5 Armed Fosrrc es ! Elementary / Secondary (0121 college (l-4 or 6.1 Widowed Hook Binder Publishing ~ ^Y¢a n3 No 12 Ifi Decndenls Marking AtlJress (Street nlylbwn. state, zip code) Decedent's Pennsylvania ° a°nee ~M Ip~ UP[Jer Allen TK. d t l d m p 17 '( D Allen Drive 100 Mt ive c (~} es, ece en Actual Residence 17a. Stele Tawnamp? . Mechanicsburg, PA 17055 vb cevMy Clunberland 1Td ~ No,DaradeMGVedwnnu' GI Bin Actual Lunns of Y 18 Father's Name IFusl, nibde. us't. aunixl 1y. Mother's Name (Ertl, midJle, maiden surname) Ra rid B Smith Nan rman 20a Inlormanl's Nama (Type / Pnnl ( 20D Inlamanl's Malnng Address (Steel racy /town, sPole, sW code) PA 17050 Mechanicsburg Powderhorn Road 6337 N Ray Kain , , . 21a Helsel of Drspnsnion I ®Cr¢mahpi r]DUnalien 216-Dale«Disposdwn (Alonln, day, year) 21c. Ptaw of Dispovn(.m lNanre of Cemetery. crematory orolherplacel 21d L«ehon (City llown.sWte,zlp urJel ^ Banal [] NeinuvellmniSlale WasQemalionorDOnalionAuthoruedr~/ 1 pec 2007 18 Hollinger Crematory Mt. Holly Springs, PA [] DIMr - Spz.+ry 1 by Medical Examirwr/ Coraner7 Ids Ya5 LJ No • , 22a Srgr Fuser wk:al asses for person acting as such! 22b License Number 22c. Narre altlAd«ess W fatil4y r e aZd ay ~ ~- ~ : - FD-014889 Mal zzi Funeral HorTre Mechanicsbur PA 17055 Corn 3a< oMy car cenilyng 23a. To the best of my knowledge, tlea cared at me lime, dale aa1 place slated ISpnalure arm line) 2311 License Number 23c Dale Siyrwd IMMIIn, day, Year) ie rxN avdildLla al le of dedill lu la r ~ /L ~- ~ ~-L ~ ceNry aused death fC ~.eG )`G' l.ln-.y/ /G -"" ~T / 2a Tima of Death 25. Dale Promiarced Dead (Honor, day, Year) Z6. Was Case Referred Medical Examiner /Coroner br a Reason Other Man Cremafron a Donafron? Items 2426 mull be ccmplelaa by person ^ Yes wen pronou¢es loam. ~ 4:40 P M • CAUSE OF DEATH (See Instructions and exam lea) r Approxunale interval: Pan 11. Enter aner ~$n11SiG.gq)Qrt~S.eaar~wno to 9U30, 28 Did Tobacco U Conrcoule to Deam1 Item <] Pan I Enter me ><nyldln €vanL' -diseases, intones. or [anplieali0na -mat tiredly caused the deem. DO NOT Bnlel terminal events sW:n as cardiac arrest, Ansel la Deam but not restating in me undedyrng caua0 yven m Par14. ~] Yas ~obady respxdlory arrest. a veMncular IibnlbLOn wilrqul showing the ¢Irology list only one cause an each aria. [] No ~ Unknown IMMEDIATE CAUSE 1Fwl bsease « ~ d2 y 5 condaion rasunmg m Deam) aro b a~h/ e ~ ru u rYLO I2C G . ~ld S~"tC 4.L- e h/o~L_ - - 29. II female: ~jd nanl carotin ear sI ~. _ _ _ _ a_ Due tt (« a consequence oQ: ; O~ S/Y ~ d > Y Weg w [] Pregnant al Yore of deem r n any sequemraly kst caaMlons n 1 X a S r- Q / . . . I¢a0up to me cause Msled on One a Due m (or es a consequence oD. k ^ Not pregnant, buI pregnant waNn 42 days f n Enlar Bre UNDERLYWG CAUSE msease m m n>at n,n,alw ma c ~ `Y~µ,y{yR Cn ~ - S ~a(G- ~ o aeal ¢venls rewlung n tlajm) LAST ~ 1 ^ N« pregnant, but pregnant 43 days b 1 year Due l01or as a consequence oQ: d. 1 ~~ / u l ~~"~F ~ ~'~ Galore death ~ UMrwwn d pregnant wrllrin Inc pM1SI y9ar 30a Was an Autopsy 3no Were Autopsy Findlrgs 31 Mannar a1 Deam 32a. Dale of Injury (Honor, day, year) 32b Deacrme lbw Injury Oavrred 32c. Peace of Injury: Nano Fann Steel, Factory, OlFice eullanq, ale (SpecdyY Pedorrnad? AveileblaPror to Completion Y D YQ Natural I,] Noiniade of Cause o Calh7 [] Acnuent [] Pnndmy Invesliy;llrun 32d. Time of Irywy 32e. Injury aI Woh? 321 U hanslwnalion Injury (SpBary) 329 L¢cation of nryry ISlreel. Gly /town, stale) Tes [~ Nu ~] vts [r~.'•/o r b mJi ld N O t d ~] C ^ Yes ^ No ~] Orw« (Oq+rata ~] Passnnger ^Pedeslnan o a a w Sw7Je ou e M ]Omer ~ SVecrly. 33a camtrer (rneak Dory a,el 336. signature and nne nl wrlarer .~ /~ • CeM1Uying phyLCian IPnrs¢mn eeniying ceu>a of Jemn canes another physigan has pionouncad Ooeln and wgipleled Item 231 - r cbted a d h d a ~ / ~ / /J . _ . _ _ _ _ _ _ ., _ ,. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _.. _ _ _ nne e cause(s) an m as ue to t To me Wal of mY knowkdga, death ucuned t cause of death) d n d nn 33c lkense Number 33d Dale Bigned (Honor. day. years s an ce ymg o ea 9 Ta Inc best of my knollymq phYCiGan (PnTSroan burn prolrourK.rng wledge. death occurred at Inc lime, date, orb place, and due to IM cause(s) and manner as atatod_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - n MU /( ] Imo- /~ ~~ V 7 !/f J 7 /'a ~' O~ ~JO~ O ~C • Medical Examiner /Coroner On ttrc basis o7 axamfnation one! or Invesliyation, in my opinion, deals occurred at the time, dale, antl place, and duo to the cause(s) and marine( as Ualed_ [] y,. Nam yy~~AJ~tlr,ess_of Person Wtro Cum(Neled Ca a of Deeln Item zTl 7y~ ~ Prep( %t/ /Jf/ ~ t /VOOaeI,~~4 ~MfG.4-f 3j Re sU 's kyraWe a:rd Dc{~ ~I N•,r I I~ I ~ I "3, i I- ~ d Dale Fikd IMonln, da years ~~ ~~~ 7 ~ v ~ T~ r f .~]0 ~r»-~' ~j.j,y~/~ y tiR W ~~ / ~oS~ c mV v . > t er~ILl3er est.4. ~ 3 D~sposiUUn P¢rmil No J O ) kt~: ~ t ~ ht's ~~•~~~~~~ kllil~likt)t ~Illlti ( I ~~dtil kl ,~NI) t't 11 rN i 1'- I'I:'VNtiI l V 1N1.1 :._~: o -,~ _ _ ~ i ;'.i- ti7 _t ~% -., ~~. ,:a j l~J ~~. l.•aatr ~+I (i1Z 1l'I .1. 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