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HomeMy WebLinkAbout12-08-08PETITION FOR PROBATE AND GRANT OF LETTER REGISTER OF ~~"ILLS OF Estate of ~ ~.y7 E'.y L-1 ~~5~ ~ ~~;~ also known as Dec. ased COL~`~TY, PE~~SYLV~~;IA File Number D` ~ ~~ ~ ~~ - Social Security Number °~~ Petitioner(s), who is/are 1 S years of age or older, apply(ies) for: (CO:YIPLEI'E 'A' or 'B' BELOIY:) ^ A. Probate and Grant of Letters Testamentar and aver that Petitioner(s) i}C(are the L° X~CL~1'yP ~ named in the last Will of the Decedent dated T ~ ~ and codicil(s) dated ~7 N C~ (Stare re(evmit circumstances, e.g., renunciatio+r, deadr ojeeecutor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the insnument(sl offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ^ B. Grant of Letters of Administration r"`~ (Ijapplicable, enter.' c. t.a.,~ d. b. n.c.ta.; pendente lire; durance nbsentin; dnrarr,~e~rissn~~oritntej ~~.~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was sur-tived by the fallowing spousc~if any) an~~~irs: ~"If ~.t _. .t,;,.,;,,;~r~-„r;,,~, ~ r „ ,,,- ~ h „ ~ r ,, onror Ante of Will in .Section A above and cornDlete list oTheirs.) ~ `' ~ 't ' ' (COMPLETE I:V'ALL CASES:) Attach additlona(s/reefs if necessary. dent was domiciled at death in County, tfisylvania with his /her last principal residence at ~ Z S_ l~h r.~ (List street tddress, town/city, ownsAip, corurh~, state, zip code] ~ Decedent, then ~_ years of age, died on 2- at Cf (,D~ J?1"1 ) IGw~ F "'S t 1(~ ~ DC~K~~ Decedent at death owned property with estimated values as follows: pf (If domiciled in PA) All personal property $ ~~ Q ©U ' (1f not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real~ersta~te in Pennsylvania $ ~ ~d Q ~ ~ C situated as follows: ~ZS Ip~'~I+"~n "L`~Cx/ ~~LC ~ ~k'S~ ~~HS ~~~ `~^~"~~" Form R6V-0? rev. !0.!3.06 Page l of 2 Wherefore, Petitioner(s) respectfully request(s) t e of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to the undersigned: Oath of Personal Representative COtiI~1ON~VF,ALTH OF PENNSYLVANIA COUNTY' OF SS 'The Petitioners} above-named swear(sj or affirm(s) that the statements iu the foregoing Petition are h1~e and correct to the best of the kno~.v~ledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(sj will well and truly administer the estate accordinb to law. Swop. tc or affirmed and subscribed bctore me the _~_ day of ~~ ~ rg ~. _, j -- ! For the Register ~-Srgnttzt~e ojPersonul Representative ~~JJ Signntur-e ojPersonal Representative rya C7 ~ rr~ U =~ ;. ,, ;: Signature ajPersonnl Representative °L7 ~ -' r File Number: ~~ ~~ \~~~ j ~:-~ r.~ h yam' ~ ~~~~ t ~ Estate of C~ ~ 1~~ ~ ~~ ,Deceased ~ -r~ Social Security Number: ~ I ~ o~-U ~J ~"~~~ Date of Death: ~ ~ 6`~ ~~ ~ _ `~_. ~' AND NOW, ~ ~~ Ut ~~~'~V`~-~ ~ ~~~'~ , iu consideration of th foregoing Petition, satisfactory proof having been presented before me IT IS DECREED th~at~"Letters f'E ~ ~ L are hereby gra~~ted to ~~ Z. ~ rl %'~ ~ ~ in the above estate aitd that the instrument(s) dated _ ,~~/ ,~__-_~C~~ - -~-------_ - _-- ___--- described in the Petition be admitted to probate and filed of record ~s the last Wild (and Codicils)) of Decedent 1. ,~ <° 'iJ r~ ~.. FEES ~nyiC..tC.J 17UC..lltt~/~- Y L~' ' ' v--% _ ~~ (I ~~ll ,~~y~ C!'!~..... Letters Jv 2 1'l $ J 1lJ Register ojW" ~ .~ . ~ ~ Y ~ Short Certificate(s) .~ ... . $~ Attorney Signature: - Renunci tion(s) ......... . $ ~ Attorney Name: ~ ~ 1 - ~~~ ~~ ~ . . $ /~ _ .. . $ 1~T_ Supreme Court I.D. i~TO.: '`~ 2 .~~d~ / Address: ~ ~~ i a V`fC 1/~! 'E'-~tn.l ~ .. . . $ . $ r/'r .Sh ~ ~_ ~ Il . .$ . .. $ .. $ Telephone: ~ ~ 7 ~ ~ 3 ~3` •~' Q . .. $ ~- ToTAI, ............ .. ~ 3`t8 .~ Furnt RbV-0' rev 10.13.0( pO~E: 2 Of 2 LOCAL REGISTRAR'S GERTIFICATIC~N OF DEATH WARNING: It is illegal to duplicate this copy by photostat or !photograph. 1~~ee for this certificate, SE~.f~(~ _____ P_~.4_~..~~! ~_7_~_- Certificataon Number ~- -~~ Th7~ li ll+ +rtlt~~' l~.I. lht Vltf)illl t,lal] hr.Ct •?I\ii ;h l~r ~p~FH OfP~~,~ collc,u~y ~typ.L'Li Irc+I an flit ur<+'. C c•lif~l"fIC lyl~ Iharli ;`° ~~ x`o~~ ~`,rf ,,, duly iil~~:; ~~ith n e I ~ L<xal :,c I~t.rar she c~l-I- .na ~~~~_ ~` z ~ ce~tilicatE `,~•i~I '~c ort~ tided kr the tit,ite ~~ir(1 ~~v' ,ys a~~ k-~k~rds (~Iti~e ~ ~ T~rl1't.n~~t?f tihl~ C7 c~ - C- ~ ~ ,_,~ ~ ~_ ~ y r {.s 1 r_ ~ J ~:'` J ~.~} ~; _ N ,, N REV nrzgofi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~nNEN1N CERTIFICATE OF DEATH ,cK INK See instructions and exam les on reverse P ~ STATE FILE NUMBER 1. Name of Decedent (First, middle, last, suffix) 2. Sex 3. Social Secudty Number 4. Date W Death (Month. day, year) (; ~, ~~~~.~ ~, ~L~.c ~n~- emale 297 -28 `-5677 December 2 2008 5. Age (Last Birthday) Under ,year Under 1 day 6, Date of Binh (Month. day, year) 7. Bidhplace (City and state or foreign country) ea. Place of Death (Check only one) uonrns oaya noers rninures 2 2 4 / 31 Hospital. Other. / Cherry Tree, PA yrs ^ Inpatient ^ ER /Outpatient ^ DOA [~ Nursing Home ^ Residence ^Omer ~ Specify. 6h. County of Death Bc. City, Boro, Twp. of Death 84, FadlAy Name (If not Institution, give street and number) 9. Was Decedent of Hispanic Origin? ~ No ^ Yes 10. Race: American Indian, Black. White, etc. PA hin Harrisburg Dau (II yes, specify Cuhan, (Specityl Carolyn Croxton Slane Resid. White , p Mexkan,PuenoRmar.ak) n. Decedent's Usual Occu tkn Kmtl of work done dunn moss of workin life. Da riot slate retired 12. Was Decedent ever in the 13. Decedent's Education (Specity only highest grade completed) 14, Marital Slalus. Married, Never Married, 15. Surviving SDouse pl wile, give maiden namel Kind of Work Kind of Business I Industry U.S. Armed Forces? Elementary I Secondary (042) College (h4 or 5+) Widowed Divorced (Specify) Homemaker Homemaker []Yea ~Nq U NK Widowed ,6. Decedent's Mailing Address (Street, city !town, state, ziP code) Decedent's Did Decedent East P e nn s bo r o P e nn s y 1 va n i a Llve in a , 7c ®Ves Deced nt Lived n T i St R 125 Henry Rd. . , i e wp. Actual es dence , 7a. ate Tqwnanip? ,Tb cpunry Cumberland 10 Q AM °iumesoi1Vetlwi`bi° Enola, PA 1 7025 ciNranrq ,B Famar'a Name (FiraL middle, teat, aunix) Alden W . Bee k S r • s Mother'a Name (First, middle, maiden aamame) Alberta M . Yingling 20a. Informant's Name (Type /Print) Knight William E 20b Informant's Mailing Address (Street city l lawn, state, ziD code) . 144 Lakeside Dr. Lewisberry, PA 17339 2, a. McNotl of Disposition ^ Cremation ^ Donation ~ 216. Dale of Disposition (Month, day, year) 21c. Place d Dispositon (Name of cemetery, cremalary or other place) 21 d, Location (Clry !lawn, slate. zip code) ~Bmra! ^Removal from Stale i Was Cremation or Donation Authorized • 12/9/08 Indiantown Gap Nat. Cemeter Lebanon, PA ^ Other - Speci/y i by Medical Examiner 1 Coroner? ^ Yes ^ No 22a. Signature W Funeral Service C rises person a 'n ~~~- 22h. License Number 22c. Name and Address of Facility S u 11 i va n F une r a 1 Home • ~ ,- f~tizx~ FD014993 51 N. Enola Dr. Enola PA 17025 Gomplele Items ~c mly when cenitying 23q To the best of my knowledge, death occurred al Me tune, date aM place stated. (Signature and tAle) h. License Number 23 23c Date Signed (Month, day, year) physician is not available at time of death to I ~1,1 / _? /~ ~ ~~( ' n J `~f~ ~ J ,2,~ 7 / ' / ~ //j / '1 /:' ~'[ ~~., TL ~ 11 cenly cause of deaN. ~~ I // f / ~i/ "`" ;y, . 77v .;. +.-~~ (. items 24-26 must be completed by person .Time of Death ~ ~v 25. Dale Pmrwuncetl Dead (Month, day, year) ~ 26. Was Case Refened to Medical Examiner I Coroner for a Reason Olner than C emation or Donation? who pronounces death. y7 / p M. 1/ m N ~ 2(JnL)ri ^Yas ~No CAUSE OF DEATN (See instructions and examples) r Approximate interval: Part II'. Enter other sidnif~canl corMitions contnht Tina to death. 28. Did Tobacco Use Contribute to Death? Item 27. Pad I: Enter the chain of events -diseases, inlunes, or complications -That directly caused the death. DO NOT enter terminal events such as cardiac arrest r Onset tq Death but not resullirg in Me underlying reuse given in Pad I. ^ Yes ^ Prohahly respiratory arrest, or ventricular fibdllalien without showing the etiology List only one cause on each line. ~ ~ No ^ Unknown IMMEDIATE CAUSE (Final disease or r G ' r 0 n,o~~lW coMilbn resWtingm Bath) _' a. ~~•hC.a-~ L C~~CC ` r 2S. II Female. ~] _ _ Due to r as a consequence ot): Nol pregnant wnnin pass year I ^ Pregnant al lime of death Sequentlaay Fst crnMitrorxs, it any, p. leadirp to the cause listed on line a. Due to (or as a consequence of) ^ Nol pregnant, but pregnant w4hin a2 days Enter he UNDERLYING CAUSE (disease or inryry that indicted the q of death events resuNing In death) LAST t [~ Nat pregnant, but pegnam a3 days l0 t year ): Due to (or as a consequence o hetore death d. ~ ^ Unknown If pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Odle of Injury (MOnN, day, year) 32b. Descdbe How Injury Occured 32c. Place of Injury. Home, Farm, Street. Factory, Performed? Available Prior to Completion of Cause of Death? ppII yy NaWral ^ Homkide OKce BuiMing. etc. (Specityl ^ Accident ^ Pending Investigation 32d. TxrteW Injury 32e. Injury at Work? 32f. If 7ransponation Injury (Specify) 32g. Location of Injury (Street, city I lows, stale) ^ Ves ~ No ^Ves ^ No ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Driver /Operator [] Passenger ^Pedestrian M ^ Other ~ SDecilyr 33a. Cenilier (check only one) ''` ~'~ -•. 33b. Signature and Title of CartAier C ~~ \/ ~~ - - • Certirying physician (Physician cenilying cause el death when aramer physician has Dronounced death and completed Item 23) To the best of my knowledge, death occurred due to the cause(s) end manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ _ ~ . I~ ~-V ~~•~y_ ) \ ~ `~ C ~ ~\S ~.b~ ® ~ S ~ 1 • Proneuncing arid cenifying physician (Physician bosh pronouncing death and certifying Ib cause of death) ^ 33c. License Number 33d. Dale Signed (Month, day, ye To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. _ ~ ~ ©1 1 ~ t' ~ I ~ (Z _ ~ 3 _ ' ~ L l~ 't T O • Medkal Examiner/Coroner On the basis of examination and 1 or Investigation, in my opinion, death occurred et the time, date, and place, and due to the cause(s) and manner as stated_ ^ 34 Name and Address of Person Wno Completed C se of Deam hlem 27) type ! Prinr ~ L . Sc 4V.. ~_~ ~S JJ.~ i ~ 35- RegisU Ignature and ~ i ~` I ~ I °~ I ~ I I 36, Date Filed (Month day, year) ~ 'Cr r7 /~ ~~~ , ~ w~ \ ~~ ~ z 5 i '-t~-t= ~t t~.l\~e:~''~ J ~ L ~ , y _ V n,enneainn Permit No. ~ •./ ~ UI ~ ~ rte, LAST WILL AND TESTAMENT OF ELIZABETH ROSE KNIGHT KNOW ALL MEN BY THESE PRESENTS, That I, ELIZABETH ROSE KNIGHT, of the Township of East Pennsboro, County of Cumberland and Commonwealth of Pennsylvania, do make, publish and declare this instrument to be my Last Will and Testament, hereby revoking and making void any and all former Wills by me at any time heretofore made. FIRST - I direct the Executors hereof to pay all my just debts, funeral expenses and costs of administration as soon as conveniently may be done after my death. I further direct the Executors hereof to pay all inheritance, estate, transfer and succession taxes which may be levied or assessed upon any property which is included as part of my gross estate for the purpose of any such tax. SECOND - I give, devise and bequeath all the rest, residue and remainder of my Estate, both real and personal, as follows: (a) Fifty (50%) percent thereof to my son, WILLIAM EUGENE KNIGHT, or if he fails to survive me, to ~-; ~ - his issue per stirpes or, if he leaves no issue, to his spouse; ' <--> ~a _ (b) Twenty-five (25°/0) percent thereof to my daughter, BARBARA ANN SHADLE, or if she fails to __ - . survive me, to her issue per stirpes; =:~: ., ,~~> _ n ^. (c) Twelve and one-half (12 ''/z%) percent thereof to my ' `~ granddaughter, BROOKE ELIZABETH SHADLE; and (d) Twelve and one half (12 Y~%) percent thereof to my grandson, ANDREW W. SHADLE. THIRD - I appoint my said son, WILLIAM EUGENE KNIGHT and my said daughter, ~c ~ ~~ Page 1 ERK W-1 W-2 BARBARA ANN SHADLE, or their survivor, to be the Executors of this, my Last Will and Testament. I do hereby give to the Executors hereof full power, discretion and authority at any time or times to sell, at private or public sale, mortgage, lease, pledge, exchange or otherwise deal with or dispose of the property comprising my estate upon such terms as deemed best, to settle and compound any and all claims in favor of or against my estate as deemed best and, for any of the foregoing purposes, to make, execute and delivery any and all deeds, mortgages, contracts, leases, bills of sale or other instruments necessary or desirable therefore. LASTLY - I direct that no fiduciary appointed by this, my Last Will and Testament, shall be required to give Bond and that if, notwithstanding this direction, any Bond is required by any law, statute or rule of court, no Surety shall be required thereon. IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and Testament, consisting of two (2) pages on the margin of which (except this page) I have affixed my initials this ~~ day of ~ ~ ~ , A.D. 2008. t~ ~ ~ft.~'~ ~~-~-T ~~ ;~/ (SEAL) Signed, sealed, published and declared by ELIZABETH ROSE KNIGHT, the above named Testatrix, as and for her Last Will and Testament, in the presence of us and each of us, who at her request, and in her presence, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. .,~~~7 "'~` i ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN ss I, Elizabeth Rose Knight, 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; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Elizabeth Rose Knight, the testatrix, this day of .~~ ti,~ r, 2008. ., Eliz eth Rose Knight, Testatrix ~ r ~ : , -~ f ~ ~~ ~,~ .[ ~. ~ , ~.,,~,•~.~sau No ry Public GC~i1~Ci~3~T~=;~€:b ~ ~,t~= i'i=~Jt~~~'~ k~vE~-~ NANCY L.. NNI~~r~St~~, Notary Public Suvatara Tv~~., Dauphin County try Commission Expiras Jan. 28, 20II AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN :ss We, Gregory R. Reed and Susan F. Reed, 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 the testatrix sign and execute the instrument as her Last Will; that the testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testatrix signed the will as a witness; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by Gregory R. Reed and Susan F. Reed, witnesses, this~_ day of ~ hw,~~~' , 2008. >~~ /i--~,, // Witness Witness Notary ublic Gt'~11iM(~tVV~~ALT'~ ~i" ~''=Cvi~iSYi_isfi~6~ ~y(~TA3~~At. SEAL NAPICY ~. ANQ~.PSORi, Notary Pudic Svaatas~a ~~,~~., ~A~uph~sa County ~y Gor~miss~cr~~ ~x;~~~r?~s J~ar~. 28, 2011