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HomeMy WebLinkAbout10-02-08PETITION FOR PROBATE fAND GRANT OlE' LETTERS REGISTER OF WILLS OF ~~~~IbC~l~d COUNTY, PENNSYLVANIA Estate of __ /~. ~~.~~~ ~~},~.yY_J File Number ,~ / ' ~J 2S -' ~~ ! ~ 1 also known a~ ,Deceased Social Security Number ~~~ "~~.5!- ~~ 9~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (CONtPLETE '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 ~-.j - /9 y3 and codicil(s) dated i a- - i 9' ;~ecr (State relevant circumstances, e.g., renunciatiar, deaf/~ 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 insttument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of (Ifapplicable, enter' c. t. a.; d. b.n.c.t.a.: pendente lire; durante absentia; durance mirtoritate) Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) atrdslleirs: (If Administration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) [_~ c-• `-->~ G ~' Name Relationship Reside~c~_',--, ~~ - _; r- -`` R, it_ -- (COMPLETE !N ALL CASES:) Attach additional sheets if necessary. a~ =~ fV Decedent w domiciled_ at death in ~ Countx, Pennsylvania with his /her last principal residence at Q~ ` (List street address, town/city, township, county, state, zip code) Decedent, then ~ years of age, died on l ~~ $ at Jr: 020 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ U (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 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: j~ Signature Ty ed or rioted name and residence ~ !~-•• ~ etr t 1 'r ~/s3 Statz' ~~u: ~~~~ fug;%vre~..i?~ l'7~~•s Form XW-0? re~c 10.13.06 Pabe I Of 2 Oath of Personal Representative COMiVIONWEALTH OF PENNSYLVANIA COUNTY OF ~LGY!'L~i~~~ SS The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hue and con•ect 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 an subscribed before~me the ~( y~n 'day of - v - . I~ , r ,ri .~ ~- r the Register __! Signature ojPersonal Signature of Personal Represenmtive n c~ cA C~ o >-~, c~ S:g,z: tore ojPersonal Represe,rtntive `'-" _~ ~; ;i ~• _~ t\7 !~ .. File Number: ~~ -~ O -;~ GG i,~ -.J Estate of ~ • ~~ °'~~ %LU~~~/ > Deceased Social Security Number: ~8~ y ~7 ' / ~o ~1~o Date of Death: ~ ~/ ' •~ l.~08 AND NOW, ~~ ~_, O~l, , in consideration of the foregoing Petition, satisfactory proof having been presented be ore me, IS DE~REED that Letters ~e~ ~(rU are hereby granted to ~ __- in the above esta~e and that the instrument(s) dated ~ L~ Q ~ ~ ~~ - ~-~~~~~ described in the Petition be admitted to probate and filed of recor as the last Will (and Codicil(s))~of QD/e~edent. FEES L1.-~tl `~ Register of Wills ~'" Letters ............... $ V• Short Certificate(s) ...... .. $ u • ~ Attorney Signature: Renwlciation(s) ........ .. $ .t ~' $ ~ S ~ Attorney Name: t ~-I ~ . .. $ ~S. ~ Supreme Court LD. No.: $ ~ ~ Address: . .. $ . .. $ . .. $ • • • $ Telephone: . .. $ TOTAL ............ .. $ . Q r-~,.n Rw-na rev. lo.r3.o~ Page 2 of 2 IIL %115 RCi\ if1i10'~ ~ ~ ~J ~ ~ ~~r~ LOCAL REGISTRAR'S CERTIFICATION C)F DEA'>rH WARNING: It is illegal to duplicate this copy by photostat or photograph, Fee for this certificate, $6.00 ~ 14~411~7 Certification Number 7EV 11200fi PRINT IN ANENT ;KINK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATF FILE Nt1MRER t. Name of Decedent (First. middle, last. Suffix) 2. Sex 3. Social Secunly Number 4. Dale of De3m (Month, tlay, year) J. Wesley Kugler Male 186 -24 _ 7696 7/9/08 5. Age (Last 8inhday) Under 1 year Untler 1 day 6. Dale of Birth (Month, day, year) 7. Binhplaca (City and stale or foreign country) 6a. Place of Death (Check only one) namra Days Hears Mmvtas Hospital: Omer. ecif Home *~;Residence ^OMer S l ^ DOA ^ Nursin ti t ^ ER ! o ti ^ I 7 4 l 1 3 1 9 3 3 P i b p y en g npa en urya Yrs. J u Ha r r s u r a 6D. County of Death tic. City, Boro wp f Death Bd. Facility Name Qf rrot inslimtion, give street and number) 9. Was Decedent of Hispanic Origin? ~ No ^Yes 10. Race: American Indian, 81ack, While. etc. (If yes, spedty Cuban, (Specih~ Cumberland E. Pennsboro 453 State Rd, West Fairview,P Mexican,PpenoRican.et=) White 11. Decedent's Usual Occu lion Kintl of work d one Bunn most of world Itle. Do rat slate retired 12. Was Decedent ever in the t3. Decedent's Etlucalion (Specify only highest gratle compleletl) 14. Marital Status: Marred, Never Married, 15. Surviving Spouse (II wile, give maiden name) Di i! d S KIrM of Work Kintl of Business I Industry U.S. Armetl Forces? Elementary 1 Secondary (012) College (1-4 or 5+) vorced ( }~ Widowe , pec ualit Control Water Co. Yes ^Np Sara C Ridle 16. Decedent's Mailing Atltlress (Street. city I town, stale, zip code) Decedent's Ditl Decedent Actual Resitlence 17a. Stale P e n rl s v 1 V a n l a live in a 17c. ®Yes. Decedent Lived In East Pennsboro Twp. 4 5 3 State Rd Township? 17d ^ Ne, Decedem Lived whom Cumberland 17b Cron t F irview Pa 17025 Actual Limits of Cityf BOm ry 16. Father's Name (First. mitltlle. last. suAix) 19. Mother's Neme (First, mltldle, maitlen surname) Alfred K. Kugler Dorothy Armstrong 20a. Informant's Name (Type! Pnnl) 20b. Infomant's Mailing Address (Street, city I sown, state, zip code) Sara C Ku ter 453 State Rd. West Fairview Pa 17025 21 a. Melsotl of Dispositon ^ Cremation ^ Donation 21 b. Dale o1 Disposaion (Month. day, year) 21 c. Place of DlsposNOn (Name of cemetery, crematory or other pl ace) 21 d. Locator (City !sown, slate. zip code) }~Bunal ^Removal from Stale :Was Cremation or Donation AuUorized 7/15/08 Rolling Green Mem Park Cam Hill Pa ^ Other ~ Speciy j by Medical Examiner I Coroner? ^ Ves ^ No 22a. Sgna e o u ervae Gcenaee,nr rson actin ouch) 22b. License Number 22c. Name and Atltlress of Facility S u 11 va n Fune r a ~ Home • - e ,~ ~ ~- FD011897-L ~ 51 N. Eno a Dr. Eno a Pa 17025 Conrplele Ile s 23a-c Doty when certitying 23a. To the best of my knowledge, tlealh occurred al the time, dale and place stated. (Sgnalure and title) 23b. License Numher 23c. Dale Signed (Month, day, year) physician Ls rat available al lime of deaU to certity cause of tlealh. Items 24-28 must be completed by person 24. Time of Death 25. Date Pronounced Dead (Month, day, year) 26. Was Casa Reterretl to Medical Examiner /Coroner for a Reason Other than Cremation or Conation7 who pronounces death, 5 2 0 P. M. 7/ 9/ 0 8 ^Yes ~~o CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Pan IC Enter other sianifroant corldkions conlributine to deals, 23. Dltl Tobacro Use Cwlnbule to Death? Item 27. Pan P. Enter the chain of events - tliseases, injuries, or wmplicaBans -that directly caused the death. W NOT solar lenninal events such a5 cardiac arrest, i Onset to Death but rat resultng in the urdenying cause given In Pan I. ^Yes ^ Probady respiratory anent, or vemricular Ilbrillaaon withod showing the etidogy. List only one cause on each line. ^ No ^ Unknown I) r IMMEDIATE CAUSE (Final tlisease or ~ ' ' ~ ' ° ~~ ~ 29. I1 Female. ~/Jf' r condition resulting in eathl ~ a ' fiL~ "~/ 1/ """V ~ L' ~ ith t t t ^ N r Due to (or as a c nce of)~ L pregnan w in pas year o ^ Pregnant at lime of death Sequentially M1sf wrMitions, if any, D leatllnq to the cause listed online a. i ^ Nol pregnant, bN pregnant within 42 days Enter the UNDERLYING CAUSE Due to (or as a consequence ol): of death (tlisease or injury that initialetl the n events resulting in death) LAST Due to (or as a consequence op. N t I, out am d3 da s to 1 ear ^ o pregnan pregn y y before death d ^ Unknown II pregnant within the pest year 30a. was an Autopsy 30b. were Autopsy Flndmgs 31. Manner of Death 32a. Date of Injury (Monts, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Injury. Home, Fann, Street Factory, Pedomed'+ Available Prior to Completion of Cause of Deaths rI "~' ~yatural ^ Homaide Odae BuiMing, etc. (SpacityJ ' ^ Accident ^ Pending Investigation 32d. Tme el Injury 32e. Injury al WorN? 321. II Transponalion Injury (SpacityJ 32g. Location of Injury (Street. city I sown. state) ^ Yes ~.NO ^Yes Cj No ^ Suicitle ^ Could Nat be Determined ^Yes ^ No ^ Driver! Operator ^ Passenger ^Petlestnan M ^Other- Speciy~ 33a. Certifier (check only me) r onounced death and com leletl Item 231 f tl lh h th h i i n has i i Ph c ni i 330. SignaWre a ills of rifts ) ' ^~ p p w en ano e ys c a pr an ( ys ian ce ty ng cause o ea • Certifying phys c To the best of my knowledge, tlealh occurred tlue to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ - ~ ~ ~' • • Pronouncing and cenityinq physician (Physician Doth pronouncing tlealh antl certifying to rouse of tlealh) ^ 73c. Licens N r r + \ 33d. Dale Slgnetl (Month, day, yearf To the best of my knowledge, death occurred at the time, date, antl place, antl due to the cause(s) antl manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ • Metllcel Examiner /Coroner ~. (,_( ).~ ~~~~ J G .vW ` ~ /`' ~ L/ On the basis of exeminalion and / or investigation, ~n my opinion, death occurred at the time, dale, and place, and due to the cause(s) antl manner as stated_ ^ , 34 Name antl Atltlress of Person Who Completed Cause of Death (Item 271 Type' Print ^ ~" tme antl Distri 35 Re istrar's 36 Dal Ie0 Ih. tlay, yeap 'r 7 ~ ~- ~ s ~ C ~( g g • This is to certify that the informat-ion here given is correctly copied from an original CFrtificate of Death duly filed with me as Loca] Registrar. 'Che original certificate will he forwarded to the State Vital Record~~ Office for pe~nnanent filing. ~~ Local Registrar Date Issued rte. ~ n `_. C_~O ~-. _ ~r `3 ~ ) ~_, r- ,tT'l 1 `r i \ t - (._i Ti • ')-' (` -, __i .. ~~ Disposition Permit No. ~ ~) d ~wl , ~~~~ ~tll Mlta ~P3tc`i11LPlt~ OF J. WESLE7 YiTGLEx I, J. Wesley Bugler, of the Borough of Weat Fairview, Cumberland ty, Pennsylvania, hereby declare this to be ~ last Will aad revoke all Wills which) 'I have previously made. 1, I direct my Executor to pay the expenses of my funeral and last illness as soon as convenient after my death. 2. All of the rest, residue and remainder of m;~r estate I give, devise and bequeath to my wife, Sara C. angler, absolutely and forever. 3. If my wife, Sara C. Bug~].er, should predesestse me, or should we both die in a common accident, then I order and direct my Executor hereinafter nerved to sell all the rest, residue and remainder of my rea]'. sad personal property at either public or priarsobe sale and convert the same into crash, the net proceeds derived therefrom to be divided into three equal parts or sP~aress_ (A). One part or share thereof I give and bequeath to my daught Debra Louise Yugler. {B). One part or share thereof I give and bequeath to my daught Vicki Lyna Kugler. (C). The remaining part or share thereof, I give and bequeath to my daughter, Renee Lnaane Bugler. 4. I appoint my wife, Sara C. Yugler, Executrix of this Will. Should she, for any reason, fail to qualify, or cease to act as suci~, I appoint qty daugl~ ter, Debra Louise Bugler, Executrix of this Will. IE WITNESS W~REOF~ I have hereunto set my harm and seal this ,;; ~~ day of Augast, 1973. .---~ -~ ~~~ -~~ ~ (S~,L) SIGNED, SF.~AI~D, PUBLISHED AND DECLE~BE by the a ve d J. Wesley bugler, as and for his. last Will and Testament, in the Aresence of us, who, at his request, in his presence and in the presence of each other heave hereunto subscribed cur names as witnesses. ~''~ ~ _ ? 1 ~- ,.'~ FIRST CODICIL TO LAST WILL OF J. WESLEY KUGLER I, J. WESLEY KUGLER, of the Village of West Fairview, East Pennsboro Township, Cumberland County, Pennsylvania, declare this to be the first Codicil to my Last Will, dated August 30, 1973. Item 1: I hereby revoke Item 4 of my Last Will and in lieu thereof pr~~vide as follows: I appoint my wife, Sara C. Kugler, Executrix of this my Last Will. Should my wife, Sara C. Kugler, for fail to qualify, or cease to act as Executrix, I appoint my three daughters Debra Kugler-Bretz, Vicki Kugler- Edwards and Renee Kugler-Simpson as Co-Executrix of my estate. I further direct that my personal representatives serve without posting fiduciary bond. Item 2: In all other respects, I hereby ratify, confirm and republish rr~y Last Will, dated August 30, 1973, together with this sole Codicil, as and for my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand this ~ ~~ day of 2000. ,C ~ J. WE EY KUGLE Signed, published and declared on the date thereof by the above named J. WESLEY KUGLER as and for the sole Codicil to his Last Will, dated August 30, 1973, in the presence of us, who, at his request, in his presence, in the presence of each other, have subscribed our name°s as witnesses hereto. -__ ~-~ residing at ~ ~ ~ ~ ~ ~ 7 dam/ ~.~~ 2 2 -7 \ residin at ~ ~?~ g ~~' ~! l' ~ ~~~' C ~ / ~~iS ,.S ~.,~ ~j c~ (^ c--~ s © C-J ~.,r ~ ~ _ 'r ~ i_.~ r i'T '..j ~t -Z _-- _ N - - -- -, _._,~_ ~ ~ C ~,. JJ ~ -. ~~ O a, COMMONWEALTH OF PENNSYLVANIA ) ss: COUNTY OF CUMBERLAND ) We, J. WESLEY KUGLER, ~ ~ ~ ~ f1 E, and ~ (!1 C ,the Testator 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 Testator signed and executed the instrument as the sole Codicil to her Last Will, dated August 30, 1973, and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Codicil as witness and that to the best of his or her knowledge, the Testator was at the time eighteen (18) years of older, of sound mind and under no constraint or undue influence. Subscribed, sworn and acknowledged before me L.rs,q /1'f>4-e,,= (!~~ by J. WESLEY KUGLER, the Testator, and subscri d and sworn to before me by ~= - and !7 ~ - ~t c i ~, the witnesses, this /C/~ -f--~ day of t1 L Qr , 2000. Nota Public (SEAL) NOTARIAL. SEAL. LJBAMARIE COYNE~ l~Mrt~pden 1Mip.~ Cimberland Coin C.omrnie~ion Juno T ~OO~t L' ~-~~ fitness OATH OF NON-SUBSCRIBING WITNE',SS(ES) Estate of GISTER OF WILLS m N ~ COUNTY, PENNSYLVANIA .2 ~- ~~~C~~'N 2 Deceased _ ~j. ~ ~ and i ~cn~°.~-!~ ' 4 n (each) being duly qual'ifi`ed according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with ~ ~c_S ~e-V ~ ~ 2 fz- and am/are familiar with the handwriting and signature of the decedent, and that the signature of ~ ~~' 11L~~._ to the foregoing instrument purporting to be the Last Will and Testament/Codic;il of • ,UeS~ t'y ~~tlQ ~ e K is in his/l~r own proper handwriting. (Sf i,ature) ~~ ~~ "~~f~~ 1 (Street Address) (~ (City, Stnte, Zip) Execccted in Register's Office Sworn to or affirmed and subscribed before me this O~ nd day e~^ • - Deputy for Registe f Wills ,- , c~ `~=" -- o t== '._~=tr c c ~ .' m t _, l _.. %~ - =~ o ~.: Form RW-04 rev. 10.13.06