HomeMy WebLinkAbout08-21-08PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of _
also known as
Deceased
_ COUNTY, PENNSYLVANIA
File Number ~ / .~~~~~
Social Security Number
Petitioner(s), who is/aze 18 yeazs 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 EXECUTRIX
last Will of the Decedent dated December 26. 2007 and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the_t~~~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B Grant of Letters of Administration
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(If applicable, enter: c.t.a.; d. b. n. c.t.a.; pendente tile; durante absentia; durante~ivtinoritate) ~..
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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.)
~ Name Relationship Residence I
(COMPLETE /NALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at
1 EAST MANOR AVENUE ENOLA EAST PENNSBORO TOWNSHIP CUMBERLAND PA 17025
(List street address, town/ciry, township, county, state, zip code)
Decedent, then 59
years of age, died on JULY 18, 2008
at HOLY SPIRIT HOSPITAL
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 20,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 95,000.00
situated as follows: 1 East Manor Avenue, East Pennsboro Township, Cumberland County, PA
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:
Sienature Typed or printed name and residence
SHIRLEY I. KEYS
694 NORTH FRONT STREET
WEST FAIRVIEW, PA 17025
REGISTER OF WILLS OF
LINDA A. ROUKE
CUMBERLAND
named in the
Form RW-01 rev. !0. /3.06 Page I of 2
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 - r~ day of
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Signature of Personal Representative 3 = j C
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File Number:
Estate of LINDA A. ROUKE
Deceased
Social Security Number: Date of Death: JULY 18, 2008
AND NOW, ~~~ , 4~C_> in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT I ECR D that Letters TESTAMENTARY
are hereby granted to SHIRLEY I. KEYS
in the above estate .
and that the instrument(s) dated DECEMBER 26, 2007
described in the Petition be admitted to probate and filed of rec r as the last Will (and Codicil(s)) of Decedent.
FEES
Register of Wills l . (``
Letters ............... $ F~'ti"
Short Certificate(s) ........ $~'2.Ob Attorney Signature: Cf~
Ren nciation(s) .......... $
... $~~
... $ .~O
... $
$
...
$
...
$
...
$
...
... $
... $
TOTAL .............. $ 2
Attorney Name: RICHARD W. STEWART
Supreme Court I.D. No.: 18039
Address: Johnson, Duffle, Stewart & Weidner
301 Market Street, P. O. Box 109
Lemoyne, PA 17043-0109
Telephone: (717) 761-4540
Form RW-02 rev. 10.13.06 Page 2 of 2
105.A05 REV (01/07)
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 14541530
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.
,,', o,,..~ JUL 120
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Local Registrar Date Issued
=v 11r2oos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
NII"M" CERTIFICATE OF DEATH
:INK
(See instructions and eXBmp ea on reverse STATE FILE NUMBER
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1. Name d DecetlerN (Rrd, middle, Wsi suffix) 2. Sex 3. Social Secuny Number 4. Dale of Deam (Month, day, year)
Linda A. Rouke Female 195 -38 = 9390 July 18, 2008
5. Age (Last Birmday) Under t year Urger 1 day 6. Dale of Binh (Month, de , a) 7. Birmplace (City and state ar to ~ n count) Be. Place of Deeth (Check onl one)
Y4onms pay, rburs µn,~s HO
spital: Other.
5 9 Yra. 2 / 2 3 / 194 9 Washington D. C • y
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}J Inpatient ^ ER ! Oulpetienl ^ DOA ^ Nursing Home ^ Residence ^Oiner Spedty
Bb. County of Deem Bc. Ciry, Ebro. 7wp. of Deam Bd. FecNiry Name (If rid instnNien, give shed and number) 9. Wes Decedent d Hiepenk Origin? No ^ Yes 10. Race: American Indian, BWCk, Wh4e. dc.
(If yes, specity Cuban, (Specl)'j
CLmberlaT3d East Pennsboro •Itap. Holy Spirit Hospital Mexican, Puedo Rican, etc.) White
11. Deceden's Usual lion Kkd d wok d one ~ mod of ~ Ina. Do rat slate relhed 12. Wes Decedent ever in the 13. Decedents Education (Spedty ady higheal 9reA comp bted) 14. Madtel Status: Married, Never Married.
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' 15. Sumuing Spo use (II wife, give maiden name)
Khd d Wod NiM d Buakiass I Indslry U.S. Armetl Forces?
Elementary 1 Secondary (0-12)
College (1-4 or 5.) d• Divoroed 1~
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Claims Processor Higi'miark Blue Shield ^vee ENO 12 2 I}ivorced
1fi. Decedents Meting Adders IStreel, dry! town, state, zip catlel Depedem's Did Decedaru East Pennsboro Ttop.
PA Llve b a 17
d n T
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1 East Manor Avenue ve
wp.
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ece
en
Actual Reaiderae 17a. Slate
c. F~ l
rownanq? na ^ N
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Enola, PA 17025 o,
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17b, ca,nty CL3mberland Adue, Um;lsd aryrl3Pm
y8 Famer's Name (Fhst. mkk4, lest, sorb) 19. Homer's Name Fird, Mdde, meMen sumeme)
Julian Kramer Lillian de
20a. Informant's Name (Type / Pnnq 2W.1n1onnanYS MaBmg Address (Street dryltam, elate, nD code)
Shirley Keys 694 N. Front Street West Fairview, PA 17025
21e. Memod of Dieposnbn ^ Cremehon ^ Donation 21b. Date d Dieposilbn IMOnm, day, Year) 21c. Place d Disposition (Name d cemetery, cremetay a omer dace) 21tl. Locetkn ICM I town, state, zp ccdel
® &Inel ^ Removal hoar Stele ! Wa Cremdbn a Dorradon Autlanzad
^ other - Spedly ~ br Hedkd ExamMer r CoronMt ^vaa ^ NP
July 24 , 2008
Rolling Green C®etery
Camp Hill , PA 17011
22e. Signature d Furrrd Service Licarsee la person acnrq as such) 22b. Lkenae Number 22c. Name and Adders d FedNhy
~ ~ ,~, FD 012774-L Richardson Funeral Home Inc. 29 S. Enola Dr. Enola, PA 17025
Canpleb Items 23et any wmen cerelykig 23e. best of my knoMedge, deem oaaned et the time, dale and place anted. (Sigreture and tme) 23b. Lkense Number 23c. Dale Signetl (MOnlh, day, year)
phyaidan s rid avedebk et lime d deem to
only ~ d seem.
perm 2428 mist be wnpleled by person 21. Tmie of Death ,(?
' 25. ProrauaW Dead (MOnlh, day, yea)
~ 28. Wes Case Refened yMedkal Exeminer I Coroner for a Reason Other than Cremation or Donation?
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who pronowaec Beam. ~ Aj
~ D M. U , O U ^ Yes
L
J
No
CAUSE OF DEATH (See Instructions and axe s) r Approximate Interval: Pan IL Ener ama ' ~ 2B. Did Tabaao Use Contribute b Oeam?
rem 27. Pan I: Enter tts dtairl d evens -diseases, kqunes, a mrriWiranors -met drectly caused ns deem. DO NOT enter temrinel eveds such as raniac arrest r Onset to Death but not resulNg m Bs undertying cause gNen in Pen I. ^ Yes ^ Prababty
reagrelary arres4 a venhiaaar fihrie ~ wiraul showing the dblogy. List Doty as cause on each lira. ~
r ^ No ^ Unknown
~resu ag o ~ emj~eB~ a -C
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29. If Femde:
ithi
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Due b ( oorsegue ~ r r,
~e1y Isl Candtiau, N arty b. ~
b Dregnant w
n pall year
o
^ Pregnant al errs of deem
the reuse fisted on tine a. r
Im
Due to or as a nose ^ Nd pregnant, but Pregnant wnhm 42 days
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EnNr UHDERLYgMx CAUSE
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of deem
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dseasa a in flat iriliatap me
n d
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LAST
c.
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resu
ag i
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Due io (or as a consequence of): r ^ Not pregrenl, WI pregnant 43 days l0 1 year
r before death
d. r ^ Unkmwn if pregnant within the past year
30e. Was an Aubpsy 300. Were Aulapay Fndrgs 31, Harmer of Deam 32e. Dale d Injrxy (MOnm, day, yea) 32b. DeecMe How Injury Occurred 32c. Place of Injury: Hama, Fann, SlreeL Factory,
Pename0? Available Prior a Complelan
^ NaNral ^ Homicide Oflae Building, ek. (Spsrdy)
d Case d Death?
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^ Yes L
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^ Vas ^ No ^ Accitlenl ^ Pendrg Imrestigelbn 32d. Tme d Injury 32e. Injury al Work? 321. r Trarspalation Inury (SDedHI 32g. Loratkn of Injury (Sired, dry I town, slate)
J ^ Suickfe ^ Codd Not be Determined ^ Yes ^ No ^ Dmer / Operate ^ Passenger ^Pedeslnan
M Otha ~ Speciy:
33a. Certifier (cned~ only one)
skien cer5lyirg cause d deem when anaMr physician nos Monwncad deem and completed item 23)
aieW (Pn
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h 33b. Signatae and TdH d Cernl'sr /~ a.~
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To the bad d my IDawbdge, deem occurred due to me eauee(a) end manror as elated.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _' _ _ _ _' _ _ ^ ,
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• Pronouncing end cemiYln9 physblen (Physkaen both Dronamdrq deem and cenmyk,g to reuse d deem)
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d day, year)
. Lice r 33d. Dale S
act
( th
manner es elate
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• To IM brit d my kriowbdge, dMh occured at Uwe lime, date, end plett, arse due to tM uuae(n) an
l Examiner /Coroner
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lM the beds d ezamNatbn and I a inwetigatlon, In my opinbn, McIA occurretl al iM time, dab, and pHs, and due to the uuae(s) aM manner as statetl_ ^ ;,
.
34, Name and
s d Person
Wh
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o~Comjpl~ete
Az
em~ 271 Typel~W~m1 /7~1
Registrar's Dill' /
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V 38. Data F' ed (MOnm day, Year) ~
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LAST WILL AND TESTAMENT ~ ~ -° ~ ~ '
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LINDA A. ROUKE _~, ~ ~.`."
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I, LINDA A. ROUKE, single, of the Township of East Pennsboro, Cumberland
County, Pennsylvania, being of sound mind and memory, do make, publish and declare
this to be my Last Will and Testament, hereby revoking any and all Wills and Codicils
heretofore made by me.
ITEM I. I direct that all my just debts and funeral expenses be paid
by my Executrix, hereinafter named, as soon as possible after my decease.
ITEM II. All the rest, residue and remainder of my estate, real,
personal or mixed, I give, devise and bequeath as follows:
(A) One-half of same I give and bequeath to my nephew, Matthew D. Keys.
($) One-half of same I give and bequeath to my nephew, Edward L. Keys, Jr.
ITEM III. My personal representative shall have the following powers
in addition to those vested in her by law and by other provisions of my Will, applicable to
all property, whether principal or income, exercisable without court approval and
effective until actual distribution of all property:
(A) To retain any or all of the assets of my estate, real or personal,
without regard to any principal of diversification, risk or
productivity.
(B) To sell at public or private sale any real or personal property for
such prices and upon such terms or conditions as she deems
proper.
(C) To compromise any claim or controversy.
(D) To exercise any option, right or privilege granted in insurance
policies or in other investments.
ITEM IV. I appoint my sister, Shirley I. Keys, the Executrix of this
my Last Will and Testament.
IIN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ (C~ day
of L~c~r, 2007.
fitness: ~~
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(SEAL)
Linda A. Rouke
,~,.
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS.
On this the day of ~ t,2 , 2007, before me, the
undersigned officer, personally appeared Linda A. Rouke, know to me (or satisfactorily
proven) to be the person whose name is subscribed to the within Last Will and Testament
and acknowledged that she executed same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
'~~~ _ ~~.
Notary Public
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Colleen Bkrne, Notary Pt~lic
FlarnFxlen Twp., CurrtberlarxJ Gotnty
My t^.ommis~on Fires ApA t3, zoos
Menb~r, P~nntylvanis Asaocl~tlon of NotaAes
OATH OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
Estate of LINDA A. ROUKE
SHIRLEY L KEYS
and
(each) being duly qualified according to law, depose(s) and say(s) that
acquainted with LINDA A. ROUKE
Deceased
she / he /they was /were Well-
and am/are familiar
with the handwriting and signature of the decedent, and that the signature of
LINDA A. ROUKE
to the foregoing instrument purporting to be the Last Will and Testament/Codicil of
LINDA A. ROUKE
is in his/her own proper handwriting.
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this s~rr~~,,~~~~day
of ~ ,~_..Sd.l~•
Deputy for Register of lls
lure
694 N. FRONT STREET
(Street Address)
WEST FAIRVIEW, PA 17025
(City, State, Zip)
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Form RW-04 rev. 10.13.06
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OATH OF SUBSCRIBING WITNESS(ES) ±_~~
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REGISTER OF WILLS -':=~ `
rv
CUMBERLAND COUNTY, PENNSYLVANIA _~
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Estate of LINDA A. ROUKE
CONNIE L. WERTZ
Deceased
(each) a subscribing witness to
(Print Name/s)
the ~ Will ~ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and
say(s) that she / he /they was /were present and saw the above Testator /Testatrix sign the same
and that she / he /they signed the same and that she / he /they signed as a witness at the request of
the Testator /Testatrix in her /his presence and in the presence of each other.
(Signature)
(Street Address)
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of Wills
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(Signature)
113 POWELLS VALLEY ROAD
(Street Addressf
HALIFAX, PA 1703?
(City, State, Zip)
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this ~~' day
of ~~ .
Notary~ublic
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or c~IVYV np ~(s~.~t tOF PENNSYLVANIA
rty` HN~I Seal
L VNieeerrtan, Notary PubNc
Form RW-03 rev. !0.!3.06
Lamoyrre Bono. Currrberlartd Cotrtly
MY C~nrnies(on fires Nov. 15, 2008
Mr+mber, Pennsylvania Assoclatlon Of Notaries