HomeMy WebLinkAbout10-23-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of Jack F. Kelley File Number_ ~- ~ ~~}O v ~ ~~~
also known as
Late of South Middleton Township ,Deceased Social Securi~ry Number
DEBRA A. FIELD
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE "A" OR "B" BELOW:)
D A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are th~~ executor/trix named in the Last Will
of the Decedent dated April 21, 2005 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;
was not the victim of a killing and was never adjudicated an incapacitated person: Named primary executrix Lois A. Kelley died on October 3,
2008. Named secondary co-executrix Pamela S. Garrett renounced in favor of appointing Debra A. Field as executrix.
^ B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minoritate )
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and Sivas survived by the following spouse
(If any) and hells: (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.)C"
Name Relationship Resider#i~
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last lxincipal residence at:
9 Kitzsell Drive, Carlisle, PA, 17013 (South Middleton Township)
(List street address, town/city, township, county, state, zip code)
Decedent, then 75 years of age, died on October 3, 2008, at Chappell, Nebl
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property ......................
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County...........
Value of real estate in Pennsylvania .....................................................
TOTAL ...................................................................................
~aska.
.......................... $ 47, 500.00
.......................... $ 175.000.00
.......................... $ 222 500.00
Real estate situated as follows: 9 Kitzsell Drive, Carlisle and 56 Partridge Circle, Carlisle
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the
rant of Letters in the a ro riate form to the undersi nod:
Signature Typed or printed name and residence
~ ,(~~ Debra A. Field, 409 Lakeview Drive, Lititz, PA 17543
Form RW-02 rev. 10.13.06 Page 1 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 ~~~~~
~_~h /> j ,, , Sig at re of Personal Representative -DEBRA A. FIELD
the ~ day of ~ (K./~`'~~ 2008
(~-/ (l~~ ~ 1 Signature of Personal Representative - ~,__' ~,.:
r the egister ~ ~~ ~7
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Signature of Personal Representative - I ; ~ N
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File Number: ~ ~ ' ~ ~~ ~ -:
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Estate of Jack F. Kelley, Deceased, a/k/a
1 Social SI,eclurity Numbler: Date of Death: Octok~er 3, 2008
AND NOW, ~ 3r~ (~)~ ~~Y 1~~ ~ ~1~ , in consideration of the foregoing Petition, satisfactory proof having
been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Debra A. Field
in the above estate and that the instrument(s) dated April 21, 2005
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES ), '
Letters .................................................. $ ~~~ ~ ~ %% ' - / / ~ ~~
Short Certificate(s) ............................... $ ~O,(~l~ C Register of Wills ~``'
Renunclatl~n(s) ................................... S _ . ~ /j~J
~~ ( ) •~+l! .1.1.1 .............. $ ~ `.~ r ~l/
Automation Fee ................................... $ 5.00
-~1-~-R--.-- ................................................. $ ~A9~-
JCP Fee ............................................... $ 10.00
~ .............................................. $ X8-96-
..... $
..... $
.,... $
..... $
TOTAL .................................... $ ~7~(-p ~j.~~
Form RW-02 rev. 10.13.06
Attorney Name: Jahn R. Gibbel
Supreme Court I.C-. No.: 07501
Address: Gibbel I<ravbill & Hess LLP
10 South Broa~1 Street, Lititz, PA 17543
Telephone: 717 -- 626 - 0291
Page 2 of 2
RW-1
TATE OF NEBRASKA
WHEN THIS COPY CARRIES THE RAISED SEAL OF THE NEBRASKA DEPARTMENT OF HEALTH RNLI HUMAN SERVICES, IT CERTIFIES
THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEBRASKA DEPARTMENT OF HEALTH AND
HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOR VITAL RECORDS. t-.~
p ~-,
DATE OF ISSUANCE ~O~~Q~i~ ,~~~ '
~~JJ -~
STANLEY S. COOPER -==' ;- '
flCT 1. p 2008 ASSISTANT STATE RE~P~STRAR (. ~ __
DEPARTMENT OF HEALTI~AND ~-
LINCOLN, NEBRASKA HUMAN SERVICES '
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STATE OFNEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT t! ' `,~
CERTIFICATE OF DEOTH n-Q ~ fl'F~ ~
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- 1. DECEDENT'S-NAME (First, Middle, Last, Suffix)
2. SEX ~-~J y-J~.l~ ~ I-
3. DATE OF DEATH (MC., Day, Yc)
Jack F. Kelley Male October 3, 2008
4. CITY AND STATE OR TERRITORY, OR FOREIGN COUNTRY OF BIRTH 5a. AGE-Last Birthday 5b. UNDER 1 YEAR 5c. UNDER 1 .DAY 6. DATE OF BIRTH (MO., Day, Yr.)
(Yrs.) MOS. DAYS HOURS MINS.
Carlisle, Pennsylvania 75 June 24, 1933
7. SOCIAL SECURITY NUMBER Ba. PLACE OF DEATH
186-24-9192 HOSPITAL; ^ Inpatient 9IriE9 ^ Nursing Home/LTC ^Hospice Facility
Bb. FACILITY-NAME (If not institution, give street and number)
^ ER/Outpatient ^ Decedent's Home
Mile Marker 93 on Interstate 80 ^oo~, ~o9ter(speoify)Interstate 80
8c. CITY OR TOWN OF DEATH (Include Zip Code) Bd. COUNTY OF DEATH
Cha ell 69129 Deuel
9a. RESIDENCE-STATE 9b. COUNTY _
9c. CITY OR TOWN
Penns lvania South Middleton Carlisle
9d.STREETANDNUMBER 9e. APT. NO 9F. ZIP CODE 9g. INSIDE CITY LIMITS
9 Kitszel Dr. 17013 D6 YES ^ No
1 Oa. MARITAL STATUS AT TIME OF DEATH ~ Married ^ Never Married 10b. NAME OF SPOUSE (First, Middle, Last, Suffix) Ii wife, give maiden nams~.
yy
'3 ^ Married, but separated ^ Widowetl ^ Divorced ^ Unknown
°~ Lois Cook
- 11. FATHER'S-NAME (First, Middle, Last, Suffix) 12. MOTHER'S-NAME (First, Middle, Maiden Surname)
Charles Kelle Mildred Mentzer
~. ~.-:
' ~b 13. EVER IN U.S. ARMED FORCES? Give dates of service if yes. 14a.INFORMANT-NAME 14b. RELATIONSHIP TO DECEDENT
';~~ (Yea, no, orunka Yes Unk Pamela Garrett Dau hter
a.ta
~~~ 15. METHOD OF DISPOSITION 16a. EMB ER-SIGNATURE 16b. LICENSE N0. i6c. DATE (Mo., Day, Yr. )
'. ^Burial ^DOnation 975 October 6, 2008
~~_-~ ^
Cremation ^Entombment .CEMETERY, CREMATORY OR OTHER LOCATION CITY/TOWN STATE
' ,t
~
~
^
Removal
Other (Specify)
,~.
'''~~ Cumberland Valley Memorial Gardens Carlisle, Pennsylvania
~Fo-; t7a. FUNERAL HOME NAME AND MAILING ADDRESS (street, sty or Town, state)Hol echek FH, 1212 10th Ave, i dney, N Ot 17b. Zip Code
fix'' Hoffman-Roth Funeral Home 219 N. Hanover St Carlisle, PA 17013
~~'"~-"gdQ~f~„"f:. e
;'y;' 16. PART I. Enter the chain of events--diseases, injuries, orcomplications--that directly caused [he death. DO NOT enter terminal events such as cardiac arrest, ~ APPROXIMATE INTERVAL
respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Add additional lines if necessary. i
~ IMMEDIATE CAUSE: ~' onset to death
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~ IMMEDIATE CAUSE (Final _(a) ~ , ~~ Qt gj,~ ~of ~,Jt i *~ ~o ~c A
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.a_n diocese or condition reauking DUE T0, OR AS A CONSEQUENCE OF: I onset to death
in depth)
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Sequentially list conditions, if O ]~~n711~~.1 CC.1
b ,L~ ~ l~ ~'G/1
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any, leading to the cause listed DUE TO, OR ASACONSEQUENCE OF: I onset to death
on line a.
_ Enter the UNDERLYING CAUSE I
(diseaseorin)urythetinitiated (c) ~
- fheevent
tti
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_ aresu
ng
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eet
) DUE TO, ORASACONSEQUENCEOF:
~ I onset to death
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18. PART II.OTHER SIGNIFICANT CONDITIONS-Conditions contributing to the death but not resulting in the underlying cause given in PART I. 19. WAS MEDICAL EXAMINER
OR CORONER CONTACTED?
, YES ^ NO
L~ 20. IF FEMALE: 21 a. MANNER OF DEATH
^ N
l ^ H
t
i 21 b. I~,~1FCLTRANSPORTATION INJURY
D
i 21c. WAIT AN AUTOPSY PERFORMED?
^ Not pregnant within past year a
ura
om
cide r
W
ver/Operator
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^ Pregnant at time of death
~ Accident^ Pending Investigation ^Passen er
g ^ YES ~ NO
j. ^ Not pregnant, but pregnant within 42 days of death
^ Suicide ^ Could not be determined ^ Pedestrian
21d. WEfiE AUTOPSY FINDINGS AVAILABLE TO
€
I'~~( ^ Not re nant, but re nant 43 da s to 1 ear before death
p g p 9 y y ^ Other (Specify)
COf~PLETE CAUSE OF DEATH?
.
~ ^ Unknown if pregnant within the past year ^ YES ^ NO
,'
~' 22a. DATE OF INJURY (Mo., Day, Yr.) 22b. TIME OF INJURY 22c. PLACE OF INJURY-At home, term, street, factory, oflice building, construction site, etc. (Specify)
October 3, 2008 11:05 am Interstate Highway #80
~~- 22d.INJURY AT W
ORK? 22e. DESCRIBE HOWINJURY OCCURRED
yy
^YES LyNO Single Vehicle rollover accident
221. LOCATION OFINJURY -STREET & NUMBER, APT. N0. CfTY?OWN STATE ZIP CCDE
Mile Marker 93, Interstate 80 Cha ell, Nebraska 69129
23a. DATE OF DEATH (Mo., Day, Yr.) _ ~ 24a. DAT SIGNE (Mo., Day, Yr.) 24b. TIME OF DEATH
'
1 ~~ m
~~ 6 11:05 a
_
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23b. DATE SIGNED (MO., Day, Yr.) 23c. TIME OF DEATH d = k 24c. PRONOUNCED DEAD (Mo., Day, Yr.) 24d. TIME PRONOUNCED DEAD
-`= Eaz
~~p m E jai October 3, 2008 12:20 m
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~ 23d. To the best of my knowledge, death occurred at the time, date and place ~ Z ~
24e. On the basis of examination and/or investigation, in my opinion death occurred at
and due to the cause(s) stated. (Signature antl Title) • g'
~
o ~ ¢ U the time, da
te sand ce and due to the cause(s) stated. (Signature and Title)
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25. DIDTOBACC
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USE CONTRIBUTE TOTHE DEATH? 2fia. HAS ORGAN OR TISSUE
DONATION BEEN CONSIDERED? 26b. WAS CONSENT GRANTE ?
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^ YES bl NO ^ PROBABLY ^ UNKNOWN X
^ YES ~ NO Not Applicable it 2fia is NO ^ YES ^ NO
27.NAME, TITLE AND ADDRESS OF CERTIFIER (PHYSICIAN,CORONER'S PHYSICIAN OR COUNTY ATTORNEY) (Type or Print)
Doug Palik, Deuel County Attorney 171 Vincent Ave Cha ell, Nebraska 6912
2fia. REGISTRAR'S SIGNATURE
~ 26b. DATE FILED BY REGISTRAR (Mo., Day, Yr.)
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LAST WILL ~ ? -
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TESTAMENT OF ~ -'
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I, JACK F. KELLEY, of 9 Kitzsell Drive, Carlisle, PA, 17(113, South Middl'eto~Tow~ship,`
Commonwealth of Pennsylvania, being of sound and disposing mind, memory and ~~dersta~ding,
do hereby make, publish and declare this as and for my Last Will and Testament, :hereby re ~nking
any and all other wills and codicils heretofore made by me. c~
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be interred within my family's burial plot in
Cumberland Valley Memorial Garden in accord with my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath any and all tangible personal property owned by
me at the time of my death unto my wife, LOIS A. KELLEY, provided she survives me by thirty
(30) days. In the event she fails to survive me by thirty (30) days, I give, devise and bequeath all
said tangible personal property unto my daughters, DEBRA A. FIELD and PAMELA S.
GARRETT, in equal shares, per stirpes.
FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of
my death, unto my wife, LOIS A. KELLEY, provided she survives me by thirty days. In the
event she fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate
unto my daughters, DEBRA A. FIELD and PAMELA S. GARRETT, in equal shares, per stirpes.
SIXTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto
my wife, LOIS A. KELLEY, provided she survives me by thirty (30) days. In the event she fails
to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder
of my estate unto my daughters, DEBRA A. FIELD and PAMELA S. GARRETT, in equal
shares, per stirpes.
SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon
my estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
EIGHTH. I hereby nominate, constitute and appoint my wife, LOIS A. KELLEY as
Executrix of this my Last Will and Testament. In the event of renunciation, death, resignation or
inability to act for any reason whatsoever of LOIS A. KELLEY, I nominate, constitute and
appoint my daughters, DEBRA A. FIELD and PAMELA S. GARRETT as Co-Executors of this
my Last Will and Testament. I hereby relieve my Executrix from the necessity of posting
security in connection with her duties, as such, in any jurisdiction in which she may be called
upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I
authorize my Executrix, in her absolute discretion, to retain in the form received, and to sell
either at public or private sale any real or personal property owned by me at the time of my death.
NINTH. I have made, or may from time to time make, a written memorandum
expressing my desire to give certain items of personal property to specific persons. I urge my
Executor and beneficiaries to respect these wishes. Such a memorandum, if made, shall be
stored in conjunction with this Will.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, consisting of two typewritten pages this a / day of ~9f',q ~' 1. , 2005.
~! ~ ,
ACK F. KELLEY
Signed, sealed published and declared by the above named Testator JACK F. KELLEY as and
for his Last Will and Testament, in the presence of us, who, at his request, in his sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
1 \A A
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~1~0 ~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
. SS.
I, JACK F. KELLEY ,Testator whose name is signed to the attached or foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and
voluntary act for the purposes therein expressed.
ACK F. KELLEY
Sworn or affirmed to and
acknowledged before me, by
JACK F. KELLE~ this a~ day
of ~ '~'~ , 2005.
I~ F ~, ~ ~ ~--r ,n~ .. ~~. ~~~ n--~"
NOTARIAL SEAL
Kathy L. Mummert, Notary Public
Borough of Carlisle, Cumberland Co., PA
My Commission Expires Aug. 11, 2007
Notice Publi `-- ~ Z
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
:SS.
We, U~ i ~~~4~ ~` ~~ncC~Y~ and ~ccan~.. t~~Y~1S the witnesses
whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw JACK F. KELLEY sign and execute the
instrument as his Last Will; that he signed willingly and that he executed as his free and
voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the
Testator signed the will as witnesses; and that to the best of our knowledge, the Testator was at
that time eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
^~~ ~1~
~~.
Sworn or affirmed to and
subscribed before me by
~il~ium ~~.-~'~~uY1 and .~~z~.r l~ ~c~rn S ,
witnesses, this %~~ day of ~~ ~ , 2005.
•....•n~ stAL
Kathy L, Mummer Notary public
ough of Carlisle, Cumberland Co., p,
is My Commission Ex Tres Au .
P g 11, 2007
Renunciation
Register of Wills of Cumberland County, Pennsylvania
Estate of Jack F. Kelley, Deceased
Late of South Middleton Township
I, PAMELA S. GARRETT, named executor and daughter of the above Decedent, hereby
renounce the right to administer the Estate of the Decedent and respectfully request that Letters be
issued to DEBRA A. FIELD.
i /~/r~ ~
(Date)
(Signature)
56 Partridge Circle
(Street Address)
Carlisle, PA 17013
(City, State, Zip)
Executed in Register's Office
OR
Executed out of Register's Office
Sworn to or affirmed and subscribed
before me this day of
,20
Deputy for Register of Wills
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ForA#~W-06 rev.10.~13'06
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Before the undersigned personally appeared the
parry executing this renunciation and certified
That he or she executed the renunciation for
The purposes stated within on this t`p~- day
of ~~~-'~ , 20~_.
of P is
My Commission Expires:
(signature and Seal of Notary or other official qualified to administer
oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Kelly N. Lapp, Notary Public
City Of Lancaster, Lanpster Couniy
My Commission E~ires July 23, 2011
Member, Pennsylvania Association of Notaries