HomeMy WebLinkAbout11-14-08PETITION FOK PROBATE A~TD GRANT OF LE T TERM
REGIS`T'ER OF WILLS OF
COt~~TY, PE~`NSYL VANI?.
a~ ~~ ~~~~
Esta*.e of :. / ~ File Number ~ -
~ , 1~ ~~
a,so kno~.vn as ~ Z
Deceased Social Security Number /~ ~ ~ ~ ~ - ~ YZ
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO;bIPLETE 'A' ar 'B' BELOW':)
^ A. Probate and Grant of Letters Testa entary and aver that Petitioner(s) is /are the ~ ~ named in the
last Will of tine Decedent dated "~ `" Q and codicil(s) dated -
(Stn:e releva~it cu~cumslnnces, e.g., renunciatio~i, depth ojexecutor, 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:
B. Grant of Letters of Administration
(Ijapplicable, enter. c.l.a.; d.b.n.c.t.a.; pendente lire; durmrte nbsentia; durmit~ineri!ntej O
~ D
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spous'if anv) an`eirs
Adn.~urisrration, c. t. a. or d. b. n.c.t a., enter date of Will in Section A above and complete list of heirs.) ; ; -LF~~ C`]
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(CO~YIPLETF. LV ALL CASES:) Attach additional sheets if,,~~ne99cessary. N
Decode 1t was domiciled at death in ~ ~` ~'l.~ Count ~, P ~vlv ^ia with his / her,J,~st rincipal residence. at_~~~__
(List sb'eet address, town/city, for ns p c unh~, state, p odes
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Decedent, then ~_ years of age, died on ~~ ~-~' at J't ~~~ /~ ~5•~_
~{2 f4iU I<l. ~ N ,
Decedent at death owned property with estimated values as folloGVS:
(If domiciled in PA) All personal property $.
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in Cowity $
Value of real estate in Pennsylvania $
situated as follows:
~~, c~0 d
~/here Fore, 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
tF,e undersigned:
~S
hor», Rev-m_ ray-. !0.13.06 Page 1 of 2
Oath of Personal Representative
COM?dON~'JEALTH OF PENLSYLVANI_-~
COC.'yT~' OF
SS
'~Cire Pe~itioner(s) above-named swear(s) or affirn7(s) that the statements in the foregoing Petition are true and con~ect to the best of
the laiowledge and belief of Petitioner(s) and that, as personal representative(s) ofthe Decedent, Petitioner(s) wilt well and truly
administer the estate according to law. ~/-'*. ,
Sworn to er affirmed,~and subscribed
before nee the i / ~-~da~y of
~ ~ ~`
i%c% , .~--~_
' For the Register
tore ojPersonn!
Sijnciture ojPersonal Representative
SiRnutw~e ojPersonal Representative ~- ~ c~
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File Number: ~ ~ ~~ iZ J~ ~
Estate of 1 ~ 7 ~' t 1C~ ~ K,//ylfc~ C~,/tCt; C,lZe~ ' '" ~ _, Decd N
~E
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Social Security Number: ~~ ) e~~ ~n~~ ~ Date ofDeath: /~ ~~~~ 8 p,~j
AND NOW, ~~ ~~ ~~~~~" , ~(~~ , iu consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters l ~ ~ ~11~~'l- "
are hereby granted to ~~~4 ~ ~~ rn2S
in the above estate
dud thaC the instrument(s) dated =~-~u
described in the Petition be admitted to
PEES
Letters ... ~yt U{iC>.... $ Cl (~
Short Certificate(s) ....~.... $ Z~
Renunciation(s) ........ - . $
~,t~l ... $ i5
~-% ... $ S
... $
.. $
... $
... $
... $
... $
t~,
TOTAL .............. $ /'-f ~`"
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and filed of rec rd as the last ill (and Cod~cil(s)) of Decedent.
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Register of Wilts
Attorney Signature:
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
F~,~„~ Rw-n_ rw ro.l~-or Page 2 of 2
.O~A~w ~iEGISTR~F~' ~~~°~1~i~ATIC)iV C3~ ~~~~'
id11ARNING: It is iiiegal to d+.lp?icaie t~s cag~e~ ~y pF~atastat ar phatagrari~.
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL R ECORDS > i'~F't ±
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CERTIFICATE OF DEATH _ _ ~~
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(See instructions and examples on reverse)
STATE FILE NUMS~q ,- -
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1105-743 REV 112006
TYPE / PRIM IN
PERMANEM
BLACK INK
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1. Name of Decedent (Rrsl, mklae, last, suRa) 2. Sex 3. Social Secudy Number 4: Oglj oTt)~~(Fbnth, day _ -
Lizetta H. Kimes female 192 - 24 - 6927 ,a~levember' 200$ ;_ --"
5. Age (Last BiNday) l1Mar 1 year Under 1 day 6. Date of Bhm (Month, say, year) 7. Blrmplace (City and slate a kxeyt counhy) Ba. Place of Deam (Check only qta)
MwxM ay, Hw, kliaaea Hospital: OHmr: '. -
Jan. 5, 1921 Concord, PA.
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HOma ^Resitlenca r-spadty:
®bpauem ^ERrot,tpaHam ^DOA ^Nure
Yre
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66. Count' of Death &. City, Boro, Twp. of Death 8d. Fadlity Name Qf not bmituHOn, give streM end number) 9. Was Decadent d HLSpartic Origin? ®No ^ Yes 1 . ~ Amencan kt6an, Black, White, ek.
Franklila Chambersburg (II yes, spedly Cuban, (Spedr}+I
Chambersburg Hospital Mexben,PUenoRken,ek.) white
it. Decedent's l)sual Oa ion Kull d woA done most d Me. Do not swe retired 12. Was Decedent ever in tlta 73. Decedents Educatbn (Specity arty Nghest grade compbled) 14. Marital SbNS: Marled, Never Married, 75. Survivvp Spouse III wde, give maiden name)
Kindel Work Kxtd of Business I Inmmtry U.S. Armed Forces? Elementary /Secondary (612) College (1 d or St) Wxbwed, DNorced (Spedyi
SecrE~tary Hospital ^Yaz flNo 8 widowed
16. Decedent's Maifi~ P~ddreaz (Sheet, city /tam, st N, rip code)
131 Cottage Roa~ Decedents Did Decedent
Ac1ualReaidance i?a.State Pennsylvania Liveina rn.pY::,De~amMlNaak Twp.
PA. 17257
Shippensburg Cumberland T°""~9? t?a.®No,Deaedentl.ivedwimb Shippensburg
tro.coanty
, AauelL;mma c;,y/~„
i6. Father's Name (First, midde, last sulfa) 19. Momei s Name (Rrst. middle, maiden surname)
Madeline Runk
Mar
Daniel A. Hammond y
20a. Informants Name IType r Pdnq 20b. InlomtenCS Maisq Address (SUeet, cav / bwn, stale, zip code) ~
Gary Kimes 23 East Sixth Street, Pottstown, PA. 19464
21a. Metlwd d DLSDosHbn i ®Cremetbn ^ t3omiort 21 b. Date d CisposiHOrt (Momh, day, year) 21c. Plan o1 DLSposiHon (Name M cemetery, crematory a orbs place) 21tl. LI1t811aft (city / bm4 aWa, np cede)
^ Removal ham Slate }
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Nov Thomas L. Geisel Crematorium Chambersburg, PA. 17202
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~ 22a. Signs 0 Se ' ~ (a 226. License Number
FD-014781-L 22c Name and Address d Featiry
Thomas L. Geisel Funeral Home, Falling Spring Rd., Chambersburg,PA
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e llwna 23ec aJy when ceMlyirg 23a To me b,ul of my krowkdge, death eoaxretl at me Nrtm, dale erd place slatetl. (Signature and mlel 23b. Licerme Number 23c. Date Signed (Month, day, year)
physician o ml avetlabk aI corm of deem to - t
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ceriN cease d deem. ,t,L.,,a,..J ~ (e 9 9 L
Harm 24-26 must be cen>Oleled by person 24. Time d DeaN 25 aU Pmaunced Dead (Month, day, year) 26. Waz Casa Role b Medical Examiner 1 Cornier la a Reason Other than Cremation a Donation?
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CAUSE OF DEATH (See instructions a examples) t Approxirtmle interval: Pan 11; Enter aher siartificerd corxfdkrm canldhutino to dean. 28. Did Tobago Use CmWWe b beam?
Hem 27. PM I: Eller mschain d evems - 6sazses, kquries. a colnpfiaaliprm -that tiredty caused Hm deem. DO NOT enter terminal evenm such az cerdat enmL r Oraet b beam but not resukbg b the underlying cause given k Part L ^ Yes ^ Prabebty
respkahsy arrest. or veMdgW fibrltlation without showkg me etiology. List ony am cause on each inc. i b ^ lhsutvwrl
WMEDIATE CAUSE IFuul tisease a ~D ~+~ ~ ~
condition rewllxtg n dh) -~ a
7 29. H Female:
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SequenGaM isl conddioin. H arty, b
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baduq b the cause lishd on ine a.
Due to (a a ansequerxre oQ: r ^ Not OregnaM' 6u1 pregnant mmm 42 days
Enter 6m UXDERLYHIG CAUSE
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(dmease a injury that intiated me ~
,~y n C' ! ~ - ~ t a deem
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evenm cascading m Beam) LASL
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o ^ Na lxegnaM, bet pregnant 43 days to 1 year
as a consequence off:
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r belora deem
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A ^ lMkrpmt H pregnant within me pazl year
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30a. Was an Aukpsy 30b. Were Aubpsy Findings 31. Manner al beam 32a. Date of Injury (MOnm, day, Year) 32b. Describe How Injury Ocourred 32c. Place d ktjury: Lamm. Farm, greet, Factory,
Ogxa BuBdutg, etc. (Spedty)
Padommd? Available Prior b Completion
of Cause of Deem? ~ Mural ^ Ibmkide
^ Acadenl ^ Pending InvesHgaion 32d. Tune of Injury 32e. 4qury al Work? 321. If Transpona9on Injury (SDedyl 32g. Location of Injury (Street, cdY I tovm, slate)
^ Yes ~NO
I ` ^ Yes ^ No
^ SuNdde ^ CaWd NM be Delemtined
^ Yea ^ No ^ Driver / Opemkr ^ Pessartgx ^Pedastdan
M ^Other • Specify.'
33a. Cerifia (Deck anl'I one)
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• Cenitying phlraiGan (Physkian cerHtybtg cause of deem wMn another physican has pronounce
deem occurred due to the cause(s)and manner as stated_______________________ __________
knowbd
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• Pronouncing and ceNfydng phyakhn (Physidan born Drorwuncing tleam and cenitying to cause of tleath)
To the best of my knowledge, tleam accared M the Ume, date, and pWCe, and due Lo the cause(s) all manner as staled,. _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ ^ 33c. License NUr9ber
/( /) O ,- ~ Z { , _ ~ /~ L
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v 33d. Date Slgrmd (Monet, day, year)
! l - ~ 7 ._ 'z p0 /'"
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• Medial Examiner I Coroner
On ill besU of examination and / or InvesUgatlon, m my opinion, death occurred al the Nme, data, and plxe, end due to the causNa) all manner as Makd_ ^ 3t'^N~ama an~d7Addrelss a~P,ers~n YJho Camel tea Cause of Deam Qlem 27) type / Pr'utt
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day
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Date Filed (Monet
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36. Registrar's Signature and Dishict Number ? , I ~ I /~ I ~ I l I 5 I ,
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D'mposition Permit No. !~ . ~ / J ~ J Jn
LAST WILL AND TESTAMEI~
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OF ~~ ~~
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LIZETTA H. KIMES ~~~ - =?
'- 0 ~
I, LIZETTA H. KIMES, of Franklin County, Pennsylvania, being of soun~' and
dis~-osing mind, memory, and understanding, do hereby make, publish and declare this as and
for my last will and testament, hereby revoking all other wills and codicils heretofore made by
me.
~~ FIRST
r,
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\~ `~~ I direct the payment of my debts and expenses of my last illness and funeral from my
`~~
1 ~ estaile as soon after my death as conveniently may be done. It is my wish to be cremated.
.~\
~~~' SECOND
~` ~ I give and bequeath all tangible personal property owned by me at the time of my
~~
n ~\~ deatlh, togetherwith all insurance policies thereon, unto my son, GARY G. KIMES, if he survives
me k-y sixty (60) days.
THIRD
I give, devise and bequeath all the rest, residue and remainder of my estate unto my
son, GARY G. KIMES, if he survives me by sixty (60) days. In the event he fails to survive me
by sixty (60) days, I give, devise and bequeath all the rest, residue and remainder of my estate,
in equal shares, unto my nieces, BARBARA J. CARBAUGH, GLENDA LOWSON, and PATTY
HOCKENBERRY, provided, however, that should any one of the not survive me their share is
to be divided among the survivors thereof.
FOURTH
I direct that any and all Inheritance, Estate and Transfer Taxes imposed upon my
estai:e passing under my will or otherwise, shall be paid out of the principal of my residuary
estai:e.
FIFTH
In addition to the powers conferred by law, I authorize my Executor, in his or her
absolute discretion:
~1
~~ (a) to retain in the form received, and to sell either at public or private sale any real
"~
~ or pE~rsonal property;
'~~ \
' (b) to exercise any option or rights arising from ownership of investments;
'~_,
~~
(c) to compromise claims without court approval, and without the consent of any
~\ ~~?'
benE~ficiary, and to abandon any property which, in my Executor's opinion, is of little or no value;
. ~ ~,
(d) to file any state or federal income tax return for any year for which I have not filed
. ~
%' such return prior to my death.
C
SIXTH
Provided always, and I do hereby declare my will to be, that if any person or persons
to whom any estate or interest is given or limited by this my will shall, in any court of law or
equiity, or otherwise, controvert the same, or dispute or call in question the validity hereof, or of
any of the estates, limitations, powers, provisos, or dispositions hereby limited or given, or
macle, or herein contained, then and in such case the estates, interests, limitations, &c., so
herE~by limited, &c., to or in favor of such person or persons so controverting my said will, shall
cease, determine, and be absolutely void to all intents and purposes whatsoever, as if such
Page 2 of 5
person or persons was or were naturally dead. And then and from thenceforth such estates,
interE~sts, limitations, powers, provisos and dispositions shall go and belong to and be vested
in the person or persons who, by virtue of this my will, shall be next in remainder after the
person or persons so disputing as aforesaid: Provided he, she, or they shall not controvert or
dispute the validity of this my will, or any of the devises, limitations, powers, provisos, or
dispositions herein contained or hereby made.
SEVENTH
~\ ~ Any and all payment or payments of any sum or sums, whether in cash or in kind and
whether for principal or income, payable to the said beneficiaries or any of them, shall be made
~:;.
~~, upon the sole receipt of the respective individual to whom the payment is made, and free from
~` \ anticipation, alienation, assignment, attachment, and pledge, and free from control by the
~'. '~' creditors of any such beneficiary. All shares of principal and income herein given shall be free
~.. ~ ~
from anticipation, assignment, pledge, or obligations of any beneficiary, and shall not be subject
to any execution or attachment.
EIGHTH
I nominate, constitute and appoint my son, GARY G. KIMES, Executor of this my last
will and testament. In the event of the renunciation, death, resignation or inability to act for any
reason whatsoever of my said son, I nominate, constitute and appoint my niece, BARBARA J.
CAR.BAUGH, Executrix of this my last will and testament. I hereby relieve my Executor from the
necE~ssity of posting security in connection with the Executor's duties as such in anyjurisdiction
in which my Executor may be called upon to act insofar as I am able by law to do so.
Page 3 of 5
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last will
and 1testament, consisting of five pages, the first three of which bear my signature in the margin
for the purpose of identification this 29t" day of August, 2007.
Lizett H. Kimes
Signed, sealed, published and declared by the above named Testatrix, LIZETTA H.
KIMIES, as and for her last will and testament, in the presence of us, who, in her sight and
presence, and in the sight presence of each other, have hereunto subscribed our names
as v,ri~t ss ~~ ~~'
16767 Path Valley Road
Spring Run, Pennsylvania 17262-0051
1257 Brechbill Road
Chambersburg, Pennsylvania 17201
23632 Back Road
Concord, Pennsylvania 17217
Page 4 of 5
/'
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Sherry Rosenberry
Lacy-J J h son
ACKNOWLEDGMENT
COMIMONWEALTH OF PENNSYLVANIA
COUNTY OF FRANKLIN
SS.
I, LIZETTA H. KIMES, having been duly qualified according to law, acknowledge that I
signE~d the foregoing instrument as my will, and that I signed it as my free and voluntary act for
the purposes therein expressed.
. %~
Lizet H. Kimes
V'Ve, having been duly qualified according to law, depose and say that we were present and
saw LIZETTA H. KIMES sign the foregoing instrument as her will; that she signed it as her free
and voluntary act for the purposes therein expressed; that each of us in her sight and hearing
and at her request signed the will as witnesses; and that to the best of our knowledge she was
at that time eighteen (18) or more years of age, of so
influence.
Subscribed, sworn to or
affirmed, and acknowledged
before me by the above-
nam~ed testatrix and by the
witnesses whose names ap-
peal~ opposite on the 29tH
day of August, 2007.
and under no constraint or undue
Witnes
~'~~ ~.
Notary Pu Ic
Notarial Seal
Sherry A. Rosenberry, Notary Public
Fannett Twp., Franklin County
My Commission Expires May 5, 2011
Page 5 of 5