HomeMy WebLinkAbout10-23-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PEN~JSYLVANIA
Estate of Lois A. Kellev File Number ~~ ~ ` ~~~' 1
also known as
Late of South Middleton Township ,Deceased Social Security 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 tl'le 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 executor Jack F. Kelley died on October 3,
2008. Named secondary co-executrix Pamela S. Garrett renounced in favor of appointin 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 ~~vas 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
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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 ~~rincipal residence at:
9 Kitzsell Drive. Carlisle PA 17013 (South Middleton Township)
(List street address, town/city, township, county, state, zip code)
Decedent, then 73 years of age, died on October 3, 2008, at Chappell, Nebraska.
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All ersonal roe .. $ 47 500.00
p p p rty ..............................................
(If not domiciled in PA) Personal property in Pennsylvania .........................$
(If not domiciled in PA) Personal property in County .....................................$
Value of real estate in Pennsylvania ...............................................................................$ 175 000.00
TOTAL ............................................................................................................. $ 222 500 00
Real estate situated as follows: 9 Kitzsell Drive, Carlisle and 56 Partridoe 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 ned:
//,, Signature Typed or printed name and residence
U . ,/i,p 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
the ~~ ti~ day of ~'~~ ~4-~^~ 2008
Si ature of Personal Representative: -DEBRA A. FIELD
Signature of Personal Representative - r ,
F e gister ' ...,
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l Signature of Personal Representative - '~~ ~~
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File Number: - ~ D ~ ~~ - - T'
-~. { ~ ~ ,
Estate of Lois A. Kelley, Deceased, a/k/a o
d
Social Security Number: Date of Death: Octot~er 3, 2008
AND NOW, ~~~t~ ~}~ ~~~~~ ;~~ ~~_, 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 ........................................ $ • Q a
Short Certificate(s) ............................. .. $ ;~-~.).~~
Renunciation(s) .....................:............ .. $
~~ , d~
_
Automation Fee ................................. .. $ 5.00
J.2.Pr .................................................. .. $ -~6@-
JCP Fee ............................................. .. $ 10.00
.... . $
.... . $
.... . $
.... . $
TOTAL ................................... . $ - ~~
Form RW-02 rev. 10.13.06
Register of Wills ~
Attorney Name: John R. Gibbel
Supreme Court I.D. No.: 07501
Address: Gibbel Kraybill & Hess LLP
10 South Broad 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 A ~ ~~~~'.~
THE BELOW TO BE A TRUE COPY OF THE ORIGINAL RECORD ON FILE WITH THE NEB14ASk;4 DEPARTMENT OF
HUMAN SERVICES, VITAL RECORDS OFFICE, WHICH IS THE LEGAL DEPOSITORY FOF' VITAL REDCORD,S',N SERVICES, IT CERTIFIES
HEALTH AND
DATE OF ISSUANCE
OC I ~. ~ ZuV~ STANLEY S. COOPER
ASSISTANT STATE REGISTRAR
LINCOLN, NEBRASKA DEPARTMENT OF H
NTH AND <_
HUMAN SERVICES c.___ ``~
?.7 C7
'I C:
STATE OFNEBRASKA- DEPARTMENT OF HEALTH AND HUMAN SERVICES FINANCE AND SUPPORT -1 ,
- CERTIFICATE OF DEATH ~ ''~
1. DECEDENT'S-NAME (First, O ~~,.~ ~~ i
Middle, Last, o ~ ~~~ ~1?
Lois A. Kelley s°rfix> 2. SEX ~ ,
4. CITY AND STATE OR TERRI70RY, OR FOREIGN COUNTRY OF BIRTH 5a. AGE-Last Birthday Sb. UNDER 1 YEAR Sc. UNDER 1 D4Y 3 DATE OF DEATH (Molpay,-yr.) = -
Female October 3 ppg ~}
Carlisle, Pennsylvania (Yra.) 6. DATE OF BIRTHjw1o:-~ay,Yr,) 3
MOS. DAYS HOURS MINS. _ _
7. SOCIAL SECURITY NUMBER 73 ~ ~
9~ 210-26-9190 October 1, 1935
Ba. PLACE OF DEATH
,'a
8b. FACILITY-NAME (It not institution, give street and number) HO ITA ^ Inpatient
Q41ER ^ Nursing Home/LTC ^ Hospice Facility
Mi 1 e Marker 93 on Interstate 80 ^ ER/Outpatient ^ Decedent's Home
-~:~ 8c. CITY OR TOWN OF DEATH (Include Zip Code) ^ 004 y~
Al other(specify)Intarstate 80
C h a p p e 11 6 9129 Bd. COUNTY OF DEATH
9a. RESIDENCE-STATE Deuel
9b. COUNTY
Pennsylvania South Middleton ~CITYOR70WN __
~~ 9d. STREETgND NUMBER Carl i s 1 e
9 Ki tszel Dr. 9e. APT. NO 91. ZIP CODF:
10a. MARITAL STATUS AT TIME OF DEATH M '1 Og. INSIDE CITY LIMITS
yy Marrietl ^ Never Married tOb. NAME OF SPOUSE (First, Midtlle, Last, Suffix) If wile, give ma deD 13 ~ YES ^ NO _
^ Marrietl, but separated ^ Widowed ^ pi
vorced
^ Unknown
11. FATHER'S-NAME Jack F. Kelley ~
(First, Middle, Last,
John CQOk Suffix) 12. MOTHER'S-NAME (First,
Pearl Casey Midtlle, Maiden Surname)
13. EVER IN U. S. ARMED FORCES? Give dates of service if yes. 14a. INFORMANT-NAME
(Yes, no, or unk.) No
Pamela Garrett 14b. RELATIONSHIP TO DECEDENT
15. METHOD OF DISPOSITION
i 6a. EMBA ER-SIGNATURE' DdU hter
^ Burial ^ Donation /C/~~ ~ 16b. LICENSE N0.
16c. DATE (Mo., Day, Yr. )
^Cremation ^Enlombment EMETERY,CREMATORYOROTHERLOCATION 975 October p
yy CITY/TOWN 6, 200$
ru Removal ^Other (Specify) ~ STATE -
17a. FUNERAL HOME NAME AND MAILING ADDRE1SbSe(Stdata, C,tydor Va 1s12'yHo amp kj aH Gd2 den S .
Hoffman-Roth Funerai Home 219 N. Hanover St. Carlisle, Pennsylvania
10th Ave Sidney, NE For 17b. Zip code(9162
`~~~~~~~~' ~ Carlisle PA 17013
,
: i PAR71 Enter the chain of vent -diseases, injuries or complications--that tliractly caused the death. DO NOT enter terminal events such as cardiac arrest,
respiratory arrest, or venVicular fibrillation withoutshowing the etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Atld additional lines if necessary. I ' w
APPROXIMATE INTERVAL ~I
IMMEDIATE CAUSE: I
IMMEDIATE CAUSE(Final (a) - YY~ r ~` (~ r-..~.
I onset to death
dlseaseorcondition resulting 1l_L_ ~7~ ~~~- f n f 1 4 t ~ ~ .
in death) ue i u OR AS A CONSEpUENCE OF: ` L~SK~ I
~ onset to death
Sequentially Ilst uronddiona, if (b)
any, leading to the cause Ilated h'b~ ~ Ic H C~ r ~~ ~-- I
on line a. DUE TrS na acwtNCE OF ~ I
EnMtlle UNDERLYING CAUSE
(disease or injury thatinitlatetl (c) i onset to death --~1
tfro events resuPong in death)
LASE DUE T0, OR AS A CONSEQUENCE OF:
(tl) ~ onset to death
18. PART 11.07HER SIGNIFICANT CONDITIONS-Conditions contributing td the death but not resulting in the underlying cause given in PART I.
19. WAS MEDICAL EXAMINER
OR CORONER CONTACTED?
20. IF FEMALE:
y, 121a.MANNER OF DEATH ~ YES ^ NO
Gl Not pregnant within past year 21 b.IFTRANSPORTATION INJURY 21 c. WAS~4N AUTOPSY PERFORMED?
^ Natural ^ Homicide
^ Pregnant at time of tleath M NN^,, Driver/Operator Vy~
~Accitlent^Pending Investigation Wr Passenger ^ YES pl NO
0 Not pregnant, but pregnant within 42 days of death
^ Not pregnant, but pregnant 43 days to 1 year before death ^ Suicide ^ Could not be determined ^ Pedestrian -'- I -
21 d. WERE AUTOPSY FINDINGS AVAILABLE TO
^ Unknown if pregnant within the past year ^ Other (Specify)
COMPLETE CAUSE OF DEATH? -
__~__-- ^ YI=S ^ NO
22a. DATE OF INJURY (Mo., Day, Yr.J 22b. TIME OF INJURY 22c. PLACE OFINJURY-At home, farm, street, factory, office building, construction site, etc. (Specify) ~I
October 3, 2008 11:05 am ----
22tl.INJURYATWORK? 22e.DESCRIBEHOWINJURY000URRED Interstate Highway 8p
^ YES ~ NO
Single Vehicle rollover accident
22f. LOCATION OFINJURY -STREET 8 NUMBER, APT. N0.
'~ Mile Marker 93, Interstate gp crryaowN
~F ~~ ~~ ZIP CODE
~~:L ~5 i 23a. DATE OF DEATH (Mo., Day, Yr.) Chappel 1 , Nebraska ~
69129
U Z ~- 24a. DATE SIGNED (Mo., Dpay, Yr.) 24b. TIME OF DEATH
aUZ ~Q
~. y = T 23b, DATE SIGNED (Mo., Day, Yr.) 23c. TIME OF DEATH ~i } O 11:05 a (p
E8 2 i 24c. PR NOUNC DDEAD (Mo., Da,Yr. p
-~'~ ~' ~ ~ !T1 a a a ~ Y ) 4d. TIME: PRONOUNCED DEAD
-;},. $ ~ 23d. To the best of my knowledge, death occurred at the time, date and place ~ w ~ p O C t° be r 3 , 2008 12 : 1 D
i~~° ~ ~ and due to the cause(s) stated. (Signature and Title) ~ Z ~ 24e. On the basis of examination and/or investigation, in my opinion tleath occurred at
:as
~ e time, date and lace and to the use(s) stated. (Signature and Title)
-$`Y. U o`
'f,' 25. DID TOBACCO USE CONTRIBUTE TO THE DEATH?
26a. HAS ORGAN OR TISSUE DONATION BEEN CONSIDERED? 26b. WAS CONSE~GRA~~ ?
^ YES ~ NO ^ PROBABLY ^ UNKNOWN ~~
27. NAME, TITL NN DADAE DRESS OF CERTIFIER (PHYSICIAN,CORONER^S PHYSICIAN OR COUN'fYJgTTORNEY T eor Print
Pa 1 i k Not Applicable if 26a is NO ^ YES ^ NO
Doug Deuel County Attorney i71 cYp )
28a. REGISTRAR'S SIGNATURE Vincent Ave Cha ell Nebraska 69129
I 28b. DATE FILTED BY RpEGLSTRAR (Mo., Day, Yr.)
~ A/J~ OC I O ~~D~U
HHS-61 11/03 (55061)
~~ 1 -1. ;~ 7 f; `~(1
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LAST WILL -
'::;;
& " -? {~
TESTAMENT OF ~~
1 `,
. ~~:
I, LOIS A. KELLEY, of 9 Kitzsell Drive, Carlisle, PA, 17013, South Middleton.:: .~,
Township, Commonwealth of Pennsylvania, being of sound and disposing mind, m~hior~ anc
understanding, do hereby make, publish and declare this as and for my Last Will and-~iestam~r~~,
hereby revoking any and all other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be p~iid 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 famil}~'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 husband, JACK F. KELLEY, provided he survives me by
thirty (30) days. In the event he 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 husband, JACK F. KELLEY, provided he survives m.e by thirty days. In the
event he fails to survive me by thirty (30) days, I give, devise and beque~~th 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 husband, JACK F. KELLEY, provided he survives me by thirty (30) days. In the event he
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 husband, JACK F. KELLEY as
Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or
inability to act for any reason whatsoever of JACK F. KELLEY , I nomi~late, 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 Executor from the necessity of posting security
in connection with his duties, as such, in any jurisdiction in which he m~iy 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
Executor, in his 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 a1 day of ~0.~,,~, , 2005.
LOIS A. KELLEY
Signed, sealed, published and declared by the above named Testatrix LOIS A. KELLEY as
and for her Last Will and Testament, in the presence of us, who, at her rf;quest, in her sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
~~~~~,~-
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
. SS.
I, LOIS A. KELLEY ,Testatrix 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 signesd it as my free and
voluntary act for the purposes therein expressed.
~r ~ ~.
LOIS A. KELLEY Z~ C~
Sworn or affirmed to and
acknowledged before me, by
LOIS . KF~LLEY this ~\ day ~ NOTARWLSEAL
of ~tl` \ , 2005. r Kathy L. Mummert, Notary Public
~?UrQ€rgh of Carlisle, Cumberland Co., pq
try Commission Expires Au41.11, 2007
,~
ry P bl
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
We, w~ti~tm R 1~,~1.cc~h and ~,~, ~ ~~(;t,,vv~S 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 LOIS A. KELLEY sign and execute the instrument as her
Last Will; that she signed willingly and that she executed as her free and voluntary act for the
purposes therein expressed; that each of us in the hearing and sight of thE; Testatrix signed the
will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen
(18) or more years of age, of sound mind and under no constraint or undi.ie influence.
~~ G~~~~~
Sworn or affirmed to and
subscribed before me by
~; j ~G.~~ t-1 ~~n~ca(~ and
Jcc~~`~ ~ ~Y.~~"Y~ ,witnesses,
this / ~` day of ~~,~ , 2005.
Kathy L. Mummert, Notary public
Sorough of Carlisle, Cumberland Co., P.
My Commission Expiros Aup.11, 2007
Renunciation
Register of Wills of Cumberland County, Pennsylvania
f_.,
Estate of Lois A. Kelley, Deceased No. ;~-~ ` ~~ ' ~ ~ S C.0 ~~,~ ~
>> ---.
Late of South Middleton Township ~ c
-,--
-._1 r~<~
, ..
Y ~
I, PAMELA S. GARRETT, named executor and daughter of the above Decedent, hereby
renounce the right to administer the Estate of the Decedent and respectfi>lly request that Letters be
issued to DEBRA A. FIELD.
~o~/o ~
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day of
20
Deputy for Register of Wills
Form RW-06 rev.10.13.06
OR
S' ~~
(Signature)
56 Partridge Circle
(Street Address)
Carlisle, PA 17013
(City, State, Zip)
Executed out of Register's Office
Before the undersigned. personally appeared the
parry executing this ren~.unciation and certified
That he or she executed the renunciation for
The purposes stated within on this (off day
of ,OC~fi~he~~ , 20 ~~~ .
i~ ~/l~/~~~. ~; ~
Notary li / y
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
Cit)i Of Lancaster, Lanpster County
My Commission Expires July 23, 2011
Member, Pennsylvania Assocfatlon Of Notlflet