HomeMy WebLinkAbout12-05-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
Estate of Richard Leroy Kichman, III
also (mown as
Deceased
Petitioner(s), who is/are 18 years 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
last Will of the Decedent dated and codicil(s) dated
(Slate relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not many, 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
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante minoritateJ
Petitioner(s) after a proper seazch has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) anN alts: (If
Administration, c.r.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) t~
See Attached...
Name
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(COMPLETE INALL CASES:) Attach additional sheets if necessary. ~ ~ - ~p - ~_ ~ =~-~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal res~tence at ~_ '''' ~
821 Wentzville Rd Enola, PA 17025
(List street address, town/city, township, county, state, zip code)
Decedent, then 24 years of age, died on 9/28/2004 at Hershey Medical Center Hershey, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 60,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 0.00
situated as follows: money in an account from mother's litigated will
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:
Si a e T d or tinted name and residence
/ Richard Kichman - 1102 Knightbridge Ct. Graham, NC 27253
NOTE: Assets witl remain in care and custody of Darlene Hombaker
• , . ~ ~ Darlene Mombaker - 909 Wertzville Rd. Enola, PA 17025
Form RW-O2 rev. !0.13.06
named in the
COUNTY, PENNSYLVANIA
File Number ds ~ ~ U ~~~~
Social Security Nutnber
Page 1 of 2
~~
Oath of Personal Representative
COMDrIONWEALTH OF PENNSYLVANIA
COUI\(TY 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 C day of
~~cer~c~~~ T , ~ CD~
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or the Register
Signature
of Personal
Signature of Personal Representative
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File Number: o~ 1 ~ ~ \ 'a1~~.9 .. i- ~1
Estate of Richard Leroy Kichman, III ,Deceased
Social Security Number:{ 1~76-68-9805 Date of Death:9/28/2004
AND NOW, ~ lAl`~ t;t ~JQ ~ ~\~1~Y ,~ ~i~ , in onsiderafon of the foregoing Petition, satisfactory proof
having been presented bef e me, IT IS DECREED that etters ~ '' `v
are hereby granted to ~ C ~-~ fT/ ~ G rYl
~~~ l ~ o C ~r in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last
FEES ~~1~u.1 l~..llt -~~-
Letters C4C~~C`~t~~ $ `3S
Short Certificate(s) .. 1 ~. .. $ `f ~ Attorney Signature:
Renunciation(s) .. ~~ ... .. $ 1 J
~~ C ~ , , , $ I ~ Attorney Name:
I~- -~~ • • • $ ~ Supreme Court I.D. T
. .. $
$ Address:
. .. $
. .. $
. .. $
• • • $ Telephone:
. .. $
TOTAL ............ .. $ 0.00
(and Codicil(s)} of Decedent.
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F•orn niv-oz re<~.10.13.06 Page 2 of 2
Register of Wi11s I ~'"~ ~._~`' '
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Attachment for Form RW-02 rev. 10.13.06 -Petition for Probate and Grant of Letters
List if heirs for Estate of Richard Leroy Kichman, III
Christo her R. Kichman
Half Brother .•
303 Salt Rd. Enola, PA 17025
Darlene C. HornBaker Half Sister 909 Wertzville Rd. Enola, PA 17025
Linda Lee p ~ Half Sister 3859 N. Sixth St. Harrisbur 17110
Anna Hurrell Half Sister 32 Cessna Dr. Halifax, PA 17032-9762
Richard L Kichman, Jr Half Brother 1102 Kni htbrid e Ct. Graham, NC 27253
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner) e..r«„~...,..e« ~ ~ ~ ~ ~1 ~,~~%
NAME OF DECEDENT (Fvst. Middle, Last) __
SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Munlh, Dey, Ymll
Richard L
Kichman 1 1 1 M a l e
1 7 6- 6 8- 9 8 0 5
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28
2004
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AGE (Lest BiMday) UNDER 1 YEAR UNDER t DAV DATE OF BIRTH BIRTHPLACE (City and PLACE OF DEATH (Check only one - see insauctions on other side) - - -
Montha Days Hours Minutes (MOnM. Day. Year) Slate or Foreign Caunvy) HOSPITAL: OTHER:
2 4 9 / 2 6 / 19 8 0 Harrisburg PA
`lrs. +npatient ® ERlOutpalienl ^ DOA ^ IN{°«^e ^ Residence ^ (Speelry) ^
- 8, a. 7. 8a.
COUNTY OF DEATH CITY, BORO, TWP OF DEATH FACILITY NAME (II nd inuitulion. giw street antl number) WAS
CEDENT OF HISPANIC ORX31N? RAC-Amerian Indian, &eck, White. etc
~
Nc Yes ^ It yes. apedN C°Dan, (SDeahl
Dauphin Derry Hershey Medical Center Meaican,Pn.rtnRaan,«~. White
sb. ec. etl. s. to.
DECEDENT'S USUAL OCCUPATION KIND OF BUSINESSfINOUSTRY WAS DECEDENT EVER IN DECEDENT'S EDUGffIdI MARRAL STATUS ~Marned SURVIVING SPOUSE
(Give kind of work done during rtasl U.S. ARMED FOR7A,Cs~~ES7 5 i oN n hest r de com «ed Navar ManNd, Widowed, (It wile. give maiden name)
C`J EkmentaryfSeamdary Cosege Divorced (gRec ry)
of wrk' kte' do rat use retired.) Central P e n R D T y W a l
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DECEDENT'S MAILING ADDRESS (Street CnyRown. Slate, Zip Code) DECEDENT'S ~~}a '
East Pennsboro
PA Did ,7c
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821 Wertzville Rd. ele
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Enola, PA 17025 ea+
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(see in~r°cu°~ Iwe ins
°n °"'« gds) Cumber 1 a n d `ownnhip? "°• d.cedent lived
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16. 77b. Count 17d.
whAln equalGmea of _. -._~'mOf
FATHER'S NAME (First Middle. Lau) MOT R'S NAME (Fvst M e Surname)
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~~ Richard L. Kichman Sr. arie
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INFORMANT'S NAME(TyperPrint) INFORMANT'S MAILING ADDRESS (Street, CiryR n, State, Zip Cal - _-- ---- -
x'7025
PA
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Chri>topher L. Kichman .
a,
z 303 Salt Rd. Eno
METHOD OF DISPOSITION
DATE OF DISPOSITION
PLACE OF DISPOSITION - Nams of Cemetery, Crematory _ - - -
LOCATfON - Ciry/TOwn, Stale, Zip Code
Burial ® Cwemalan ^ Remavd hom State ^ (MOndr, Day, Year) or Other Plxa
Danrdp,^ otn.r(specay+ ^ October 2, 2004 Perry Heights Cemetery Marysville, PA 17053
2 stb z,o z,e.
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' SIGNATURE OF FI/NERAL RVI LICEN~EE OR PERSON ACTING AS SUCH
~~• LICENSE NUMBER
FD012774-L NAME AND ADDRESS OF FACILITY
Richardson F.H. 29 S. Enola Dr. Enola,PA 17025
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Cornplala dams 23a<oNy wMn certifying b the y kraMrdge, dearh axurred et me tirrre, date and Dlace stated. LICENSE NUMBER DATE SIGNED
physicianu rat awileDN M time of dwell a (Signs ra Tate) (Maas U y. Year)
Artily cause of death.
23a. z3b.
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TOnOUnCe DATE PRONOUNCED DEAD (Mash, Day, Year) NNS CASE REFERRED TO MEDICAL EXAMINERlCORONERI
' hems 2428 mu& Ire cortlpNKed M TIME OF DEATH
September 28
2004
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°ar'"iritiopioriounCBB°~a'"
1:55 PM
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z7. PART l: Enter lM dlceasae, iniuriea or wmponalbrs which caused the deem. Ib not Doter Ne mode d Dying, wM ea cardiac a respiratory anrut, shock or hears failure. ~Approxknete PART II: Other signihcaM candalone contributing to deaN, out
iinlnrvai between not resuain
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List uray one cause on each line.
onset end deem
IYYEDIATEa;AUSE (FrW
diaeaee«aX>diNa.
Complications Of Head Trauma ~
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resWlktg in deem)---
DUE TO (OR AS A CONSEQUENCE OF): r
MVA
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Serarende3y list mndeime o.
Many, leafing a knnterliate DUE TO (CXi AS A CONSEQUENCE OF): t
cauta. Enter UNDERLYING ~
CAUSE(Disease a-mWrY c. -. ----_. __.
mat kNiatetl swots OUE TO (OR AS A CONSEQUENCE OFJ: t
reaecrg n tleam) LAST 1
d
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WAS AN AlJ10PSY WFT7E AUTOPSY FINDINGS MANNER OF DEATH DATE OF INJURY TIME OFINJURV INJURY AT WORK? DESCRIBE MOW INJURY OCCURRED.
PERFOFiMED7 AvAIUBLE PRIOR TO (MOnm, Day. Year) Approximately. AN vs. Tree
COMPLEf10N OF CAUSE JUI 4, 2Q04
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Yes
No
OF DEATH7 Natural ^ Hamiude
8:21 PM
rr
Accident N~ Pending l~veelipalfon ^ Sob. _ M. 30c. --_. __
YBa ^ N°~~ Yaa ^ No ^X PLACE OF INJURY-Al home, farm, street. lauory, office LOCATION(S7ruN, CirylTOwn, Stale.
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'CERTIFYING PHYSICIAN (Physician certaya+g cause M death when enomer physiaerl has pronourked deem anA competed Item 23)
7a the beat of m krpadedga, dwth occurred dw to [Mau s) and manner ea eUtrd .................. ................ ............ ^
'PRONOUNCING AND CERTIFYING PHYSICIAN (Physic~n boTh praauncing deem and certlry,ng a cause or Aeam)
Ta Yra beet W mY IuwwNdea, dMd1 aCCUrted al dN time, tlate, and pap, ind dw a dre cause(s) antl rtwmrr r staled .......................... ^
'MEDICAL EXAMINER/CORONFJi
On Ute baale or esartdnetbn and/or Inveatlyatlon, In my opinion, death occurred et Ne time, date, and plea, and dw to the cauea(a) and
manner o atac.d ................................................................................................. .
3/a.
REGIS "S SKiNATUR tSJ}AUEfj _ _ ~ ~~~ -~
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ISE NUR,~T.. V"~ - DATI SN
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AND ADDRESS OF PERSON WHO COMPLETED CAU
?7)rype or Prim patty J. Garber
1271 South 28th Street
/ or /J G
Chief Deputy
(Month, Dar. rm~7.
Member 29, 2004
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RENUl'~CIATION
REGISTER OF WILLS
Cumberland
COUNTY, PENNSYLVANIA
Estate of Richard L. Kichman, III
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I, Linda Wade
(Print Name)
Half Sister
Deceased
in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Richard L. Kichman Jr., Co-Administrator Darlene Hornbaker
~, ~ - ~'
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
.~
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(Sigtxfture)
3859 North Sixth Street
(Street Address)
Harrisburg, PA 17110
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this .~'~~~ day
s
,i-~ ~( Ceti Z C t /> ~ ~K- ;~`r~ _ ~~,
Notary Public
My Commission Expires: Y ~ ~ ~ ~ `~ } ` ''
(Signature and Seal of Notary or other ofticial qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONYVEALTH OF pENNSYIVANW
ca _ _>
Form RiV-06 rev. 10.13.06
Notarial Sea!
Tina h1. Rcbrxtson, NGary PubiiC
East Perr>r.,boro Twp., Ciunbertand GaxRy
My (:arrrrriission E~ires Nov. 15, 2011
YernOer, Pennsylvania Aasociafion of flotarles
RENUNCIATION
REGISTER OF WILLS
Cumberland
COUNTY, PENNSYLVANIA~~
`~ `_~y.
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Estate of Richard L. Kichman, III
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Deceased
I, Christopher Kichman , in my capacity/relationship as
(Print Name)
Half Brother
of the above Decedent, hereby renounce the nght to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Richard L. Kichman Jr., Co-Administrator Darlene Hornbaker
i ~, 3 t;. ~~
(Date)
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(Signature)
303 Salt Road
(Street Address)
Enola, PA 17025
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation far the
purposes stated within on this ? ` `` day
_ ~~~ ~ ,~
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Deputy for Register of Wills
Notary Public
My Commission Expires: r ~ ~' ~ '~ - ~ ` ~
(Signature and Seal of Notary or other ot~icial qualitied to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEAITM OF PENNSYLVANfA
Form RW-06 rer. IO.I3.06
Notarial Seal
'Tina M. Rotx~ttson, Notary Ptbic
East Perxtsbao Twp., GirttberiaM C,atrAy
My Commission Expires Nov.15, 2x11
IiAember, Pennsylvania Assoc4ation of MOtsrfes
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~umbc.rland
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Pstat~' of P.ichard L. I~e.hmaz~. III
i, ~a Hcirrell
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Half ~i=;ter
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[deceased
in m~- caac~tti°~relatie~nsili~ as
of the aba~~e Decedent, her+ebE' renaunce the right to
administer the Estate a~"t1~e Dcc~dent and res~ectfuii}- request that Letters be issued to
Richard. L. I~..ichn-~a Jr.; Ca f~drr~inistratc~r Dari~ne Hc~rnbaiier
{1?uYt:l
.~~e~: rrt`~ct in Red ist~r ss +~f~c~
~r~~c~rr~ to ar atf~rrned anci st-bscribed
befar~: rr}~: this day.'
of
Depute far e~ister of ~~=~itls
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Befare the unciersi~ned persa~~a[ti~ a~~peare€i the
party e~ec~ztinu this renunciatian anti. certif~d
that. he ar she e~ecutGCi the ren~~r~ciatiar~ far the:
purpt~ s state ~~~ithi an this _.~i~ ~._ da~~
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