HomeMy WebLinkAbout01-29-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Estate of INEZ J. KOONTZ File Number 21-0~= - Q~~
also known as
,Deceased Social Security Number 174-34-9451
Gene C. KOONTZ
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or `8' BELOW.)
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor named in the
last Will of the Decedent, dated 06/04/2001 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:
B. Grant of Letters of Administration
app ica e, en er: c..a.; .n.c..a.; pe en e i e; uran e a sen ia; uran a mmon a e
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) a~+~d 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.) ~ c~
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Name Relationship Residence = ; .i ~7 ~ '
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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 principal residence at
5225 Wilson Lane, Mechanicsburg, Cumberland, PA 17055
(List street address, town/city, township, county, state, zip code)
Decedent, then 92 years of age, died on 01/04/2009 at Holy Spirit Hospital, Camp Hill, Pennsylvania 17011
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) g 275,000.00
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows:
All personal property
Personal property in Pennsylvania
Personal property in County
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:
Signature Typed or printed name and residence
Gene C. KOONTZ 813 Michigan Avenue
C/1 l o ~ ,,lr`G~~ Lemoyne, PA 17043
Rev. f0-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. rage i or ~
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
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 this a(~~____ day of
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KOONTZ
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Signature of Personal Representative ~ c~
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File Number: 21-~' O1~1`S
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Deceased
Socia~llcS.~ecurity`Number: 174-34-9451 Date of Death: 01/04/2009
AND NOW, ~l ~~h O^O-a ' o '~ J0.vw~-~=~-t a~~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to Gene C. KOONTZ
in the above estate
and that the instrument(s) dated 06/04/2001
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ..............s~7~f.(?~:`.~l?.....
.....$
J~ )~r~~,
Short Certificate(s)........~.R•••••~~
~••• $ 00
a~
Renunciation(s) ......................... .... $
l.>~ t 11 $ ~ ~~cs
$
(~ 1- J
$
$
$
$
$
$
TOTAL ............................... ..... $ 3V~1~c0
Estate of INEZ J. KOONTZ
Supreme Court I.D. No.: 20558
JOHNSON DUFFIE
Address: 301 MARKET STREET
PO BOX 109
LEMOYNE, PA 17043
Telephone: (717) 761-4540
Form RW-U2 Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
Attorney Signature: ~~~(.
Attorney Name: EDMUND G. MYERS _ __
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee t~~r this certi(icar:. ~~6.(1(?
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Certification Ni.mlber -
This L~ to certify the! the infor)n~tti<m he(-e ~*i~~e^ is
c~l~-ectly co},ie~i t~-1?m an (~ri~inal ('ertificatc ~/f D~uh
duly iileci ~~iUi r~r° as L1~cal Rel~lstrar. The c>rir_inal
certificate wili he furw~lyded tl> the State Vital
Records Office ii~r ~~ermanent fili)s,r
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Htos-143 REV nnoas COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE /PRINT IN
PERMANENT CERTIFICATE OF DEATH - _,
BIACN INK (See instructions end examples on reverse) „_,_~ ,. ~ \ (~ Cq (~ Y'~
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1. Nana d DecWed (Brat, mMde. lass, wltix) 2. Sex 3. Sxbl Seadry Numbu a. Date d Dean (Monty, day, yap
Inez J. Koontz emale 174 -34 -9451 Jan. 4 2009
5. Aga (last BiNMay) Untler 1 year Under 1 M 6. Dale of BiM Monty, My, ar) 7. BidhpMta C and eats or forego country) G. Plau d Death (Check only one)
Norms Om Noun kc elm Hospital: Otlar.
9 2 Yrs. Feb . 2 9 1916 Beaver F a 11 s PA ®Inpalbnt ^ Efl / Ou~atienl ^ DOA ^ Naming Hana ^ Reskbna ^OIGr Specify:
Bo. Coumy d Death &. City, Boro. Twy. of Death 9d. Faegiry Name (n na kalaufion, give street antl meNar) 9. Was DeaMnl d Hbpank Origin? ~ No ^ Yes 10. Rue' Ararkm IMien, Black, Whib, etc.
Cumberland amp Hill UI yea, sDecnY Cuban, 13P/t'iM
Holy Spirit Hospital Mexicen,PUeMRkan,ek.) White
11. DeceMnts Usal Inn Kkd d work dma most d work' Ids. Do trot sbb retired 12. Was Decedent aver'n the 13. DecedenYa Education (Spedy any highest grade completed) td. Manly Status: MemeQ Never Marred, 15. Surviving Spouse QI wile. gNe maitlan name)
NkN of Work Itintl d Buwass / Irqustry U.S. AmnM Forces? Elementary /Secondary (0.12) College (1.4 or 5+) WMOwed• Divorced ISpec/M
School Teacher Public Educati n ^va g]Na 4 Widowed
1s. Decedenra Mailng aadreaa ISred, dtv / awn, cute, rip totlel Oeatlenf
a aD
eaMm
5225 Wilson Lane b
s dance tTa. sob P a n n c y 1 va n i a
3 , 7c. ^ Yea, Deatlem Livetl n Twp.
Township?
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19. Febu's Name (Fast, middle, lad, sulnxl 19. Molhefs Name (Rrd, mMme, meMm wmunel
Clara E. Wahl
20a. INOmenl's Nanw (Type / PdnQ
Mr. Gene C. Koontz 20b. InlomaM's Maifuq Addtgas (Street, city / bvm, sate.Yq )
813 Michigan Ave.,~emoyne,PA., 17043
21a. Method d DLapoaition i ^ Cremation ^ DgWbn
^ BNdal ^ R
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b 21 b. Dab d Diapoeitim (Month. My, yar)
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2009 21t. Plan d Dispos~m (Name d cemetery, aemabry or oMer peal
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d 21d. Location ICiry / bwui, sate, i mda)
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Cemetery Bedford, P
. 15
Other -Speedy: Medial Examiror /Coroner? ^ Yes ^ No
22a Sigralure d Funeral Se la person acting as suM) 22b. lkense NuMer 22c. Name and Adtlreas d Fad4'ry
14947 Dais Geisel Funeral Home 330 E. Pitt St
Complete ItmM Zdac aNy when arraying To the bed d my knowedge, MeN attuned d tla 9me. Mb and pbadeled. (SigaNre and INIe) 23b, licence Number 23c. Date Signed (MOntlk My, year)
plryekian a rat avaaWb at nma d MeN to
arMy tease d tleaN.
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norm land road G tonVbted by persm 24. rune os
~eath 2s. Dde Deatl IMOf+tn, day, year) 6. Was Case RefenM b McBcal EaeMner / Cororar tar a Reason ONer than amdnn or Donatbn4
wtp praraaroes dorm. nn
. V. . M. - e D ^Yes .~°
CAUSE OF DEATN ( Inatruetlona antl examples r Approximate Wervat
Item 27. Pan I: Erder tla dean d wems - tliseases, kgaba, a mnrylce9orN -IhM dredy eased tlro rbath. DO NOT solar bmdral erede wch a ardac erred, r Onset b DeaN Pad 11: Emer other
bd not rmuMng n tM urderybg reuse given in Pad L 2B. Did Tabxa Use CanbOub b Deets?
~ ^ Yes ^ Pmbeby
rasp4alay erred, a vMlrb4r nbdaMn rritlwut showiy the eeobgy. fiat any errs ream an each 6ne.
IMMEWITE CAUSE 11FnM dseaee or
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^ No ^ Ihtlatown
a I j R ~ ~ 1 L I S Sfs~
cadition resdOng n deaMl -~ R 01 E. ~ 5 m f 5 1 S ~ 29. II Female:
Due to (or ac a ansWuence en: ~ ®Nd pregianl wkhn pad you
e. ~~I fJ /~(.>,y ~(zA G~ j~EL Ci I(~N ;
Sbea~dulpro ~'ms''a
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r aUNDEIILYRIG CAUSE Due to (a as a consequence off: ~
EN B:e ^ Not pregxnl, but pnpunl witlin 42 days
(d a~ ~ ~'mN'A)'bIUWSTtlte r
t
r dtlNln
Due b (or as a wnsequence op: Nd
^ pregant, bid pregnun 43 days to 1 year
d. bdors OeaN
^ UNmawn N prrpnaN within the past year
30a. Was m Autopsy
Performed? 30b. Were Autopsy Fin6rgc
Available Pr'ror to Compdimr 3t. Mama d Death
~ 32a. Date d Irptty IMmm, day, Year) 32h. Deacdba Now Injury Occurred 32c. Plata d Inj ry: fbme, Farm, Sdeet, Factory,
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^ Yes ~ No ^ Yes ^ No ^ AuitleN ^ Pendng Mveatigakon 32tl. Tana d Iryury 32e. Injury et Wak7 32f. If Trereponadm Inryry (Spaciy) 329. L.oatnn d Injury ISlreu, cily /fawn, stale)
^ Sunide ^ CouM Nat G Oetsmdned ^ Yes ^ No ^ DrNer / Operekr ^ Pusengar ^PeMS(den
M Other-Speey
33a. CeNfier (check aMy one) 33b. Sigrahue aM idle d CarNier
• Certllying phYaklen (Physkien anir/ng ease of Metll when aroear physician has pmmunad death alts rmplded Item 23)
To the beat of my knowledge. Mats accumed due to the auae(al and manner as abted_________________________ ________ o•Lp„ ~.~.~ ~'~,-q,' ~M t~
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^ 33c. lxense Number 33d. Daa Signed (Momh, day, year)
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• MsdicM Examiner I Cooney ~`
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On iG Gain of examinetlan and / or inveaagsibn, in my opinion, deem oeeunsd at tlrs tlme, dab, and plea, arts due b iG ausela) end manner u aubtl_ ^ 34 Name aM Atltlra d Person Wlw Campleled Cause d Deuh (Item 27) Type 1 Print
Registrer's SignaNre an0 District Number
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j-(/ : Dispaition Permit No. 7 7 ~ ~ 5
Last Will and Testament
I, Inez J. Koontz, of the Township of Bedford, Bedford County, Pennsylvania, herebti~
declare the following to be my Last Will and Testament, hereby revoking all other wills and
codicils heretofore made by me.
ARTICLE I: I direct that my debts, the expenses of my last illness anc~uneral, aid
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the costs of administration of my estate be paid from the principal. of my resid.~ estatt~-as
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soon as may be reasonably practicable after my death. ~ r.~n ~"
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417Tjr'T F jT: j give and bequeath ~>>ch it?rns of my tangible perso .'~xrohert~ as
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are set forth and described in a written Memorandum signed by me and to ~ found with
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my valuable papers to the persons named as the recipients thereof in such Memorandum.
ARTICLE III: I give, devise and bequeath the rest, residue and remainder of my
estate, of whatsoever nature and wheresoever situate, in three equal shares, share and share
alike ,as follows:
A. An undivided one-third. (1/3) share to the children of my deceased son,
Joseph C. Koontz, who are Susannah Koontz and Howard J. Koontz, in equal shares
between them, share and share;
B. An undivided one-third (1/3) share to my daughter, Clara Ann Bratton; and
C. An undivided one-third (1/3) share to my son, Gene C. Koontz.
ARTICLE IV: In the event any of said residuary beneficiaries should predecease me
leaving issue to survive him or her, then the share of such beneficiary shall pass to his or her
issue per strpes and in the event any of said beneficiaries should predecease me without
leaving issue to survive him or her, then such share shall lapse and shall pass to the other
residuary beneficiaries hereunder in proportion to their respective shares or interests in the
residue.
ARTICLE V: No interest in income or principal shall be assignable by a beneficiary
or available to anyone having a claim against a beneficiary before actual payment or
distribution to the beneficiary.
ARTICLE VI: I appoint my son, Gene C. Koontz, executor under this Will. In the
event of his death, adjudication of legal incapacity or unwillingness to so serve for any
reason whatsoever, I appoint my daughter, Clara Ann Bratton, executrix under this Will.
No fiduciary acting hereunder shall be required to give bond or other security for the
faithful performance of his or her duties. Any fiduciary under this Will shall have the
following discretionary powers in addition to those given by law:
A. To accept, retain and invest in real or personal property, without restriction
to legal investments.
B. To sell, exchange, partition or lease for any period of time any real or personal
property and to give options therefor for cash or credit, with or without security.
C. To borrow money and to mortgage or pledge any real or personal property.
D. To compromise, arbitrate or abandon claims.
E. To make distribution in cash or in kind or partly in each.
F. To make such elections, decisions, concessions and settlements in connection
with all income, estate, inheritance, gift or other tax returns and the payment of such taxes,
without obligation to adjust the distributive share of income or principal of any person
thereby affected.
ARTICLE VIII: All estate taxes, inheritance taxes, transfer taxes and other taxes of a
similar nature payable by reason of my death to any government or subdivision thereof
upon or with respect to any property subject to any such tax shall be paid by my executor
out of the principal of my residuary estate and all interest with respect to any such taxes
shall be paid by my executor out of the income or principal or partly out of the income and
partly out of the principal of such portion of my estate, in the absolute discretion of my
-2-
executor, without reimbursement from or apportionment among the beneficiaries, recipients
or owners of such property for any such taxes or interest.
IN WITNESS WHEREOF, I, Inez J. Koontz, have hereunto set my hand and seal this
~ ~
' day of June, 2001.
(SEAL)
I . Ko ntz
The foregoing instrument, consisting of this page and two others, was on the date and
day thereof, SIGNED, SEALED, PUBLISHED anal DECLARED by Inez J. Koontz, the
Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request
and in her presence and in the presence of each other, have hereunto subscribed our names
as witnesses.
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AFFIDAVIT
Commonwealth of Pennsylvania
SS:
County of Bedford
W e. Inez J. Koontz, the Testatrix in,
and ~/ ~ ~ yc(e ~ ~~
and ,~Gl,_h~, ,J1-~f.~~,~ ,the witnesses to, the attached or foregoing instrument,
who have signed the same, having been duly qualified according to law, do depose and say:
(a) that I, the Testatrix, do hereby acknowledge that I signed and executed the
instrument as my last Will, that I signed it willingly and as my free and voluntary act for the
purposes therein expressed; and
(b) that we, the witnesses, were present and saw the Testatrix sign and execute the
instrument as her last Will, that he signed it willingly and executed it 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 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.
Witness
ez J. oontz
Wi Hess
Sworn to or affirmed and acknowledged. before me by Inez J. Koontz, the Testatrix, and
sworn to or affirmed and subscribed to by C~~i`f ~ ycQc r ~ and
~r J L_ ~ )~~ . ~1~ 1.1 S~~ ,witnesses, this ~ ~ day of June, 2001.
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-- _ NOTARIAL SEAL N tart' Public
TAMMY L. LASURE, NOTARY PUBLIC
~?ECFORD BOROUGH, PEUPOAC~ CO'' PA
I~p;~, CC"~~4di1SSI0N EXPII~~S AUCa,1~, 2~9~ - , -