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HomeMy WebLinkAbout06-11-09 REGISTER OF WILLS OF C U 13'J ~~~~ COUNTY, PENNSYLVANIA Estate of ,/O~Ii! IQ• K~r~/N File Number ~l" ~9' ~~ lJ also Known as ,Deceased Social Security Number .~~{" ~6 "B~S~ Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) _ - L A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is!-are the Lear named in the last Will of the Decedent dated ,Tu-1G '.Z7, ~Q89 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 (/jmpp(icable, emter.• c.t.n.; d.b.n.c.t.a.; pendemte lire; durnnte absentia; durance mimoritate) N Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followin~ouse (if an~nd heirs: (If., Adrrrinisn•ation, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~~ v° =i __ Name Relationship _ R,~ ` r- ~ ~ r-' (COMPLETE IN ALL CASES:) Attach additiotral sheets if necessary. Decedent was domiciled at death in Cwm~"~a _;~~7 S~ ~St , Enblu , E (Lis[ street address, sown/cit)~, township, count), state, zip code) County, Pennsylvania with his /<her last principal residence at .... -r t .. • .; ..~ is? Decedent, then ~r'o years of age, died on B~ at ~'4f~s~e (~e~1'on4~ ~~~~~ Ctti~r Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ SaOo• C~ (lf not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania situated as foil Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with [his Petition and the grant of Letters in the appropriate form [o the i.mdersigned: Si~nauue Typed or printed name and residence x f ~ ~--r' O~FR~Y T: K~euni ,r~u~,~~ ~ /S8S W • L~'sdur~r ail., Mee~ta+~ %csbar~, f ~ /7os s'' Faun R6P-0? re~~. lO.l1.0G pabe 1 Of ~ Oath of Personal Represel~tative COIvIMONWEALTH OF PENNSYLVANIA SS COUNTY OF CL(IYI(~~i ~A~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect to the best of the l.nowledge 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 affirnred and subscribed ~ ~/L"- Signnture ojPersonal bef~me the ~_ day of a/4-R1Ly T. , Signature ojPersaial Representative N 0 ~ .~ `° _. - `', For the Register Signature ojPersatnl Representative ,~ C ~"` c,'~ i ~ ~ ~ .' ' _~.1 "~ _~ f '- t.ri ~~ _ .~~ ai_o 9 _ bs~ `° File Number: Estate of ,Totin ~• /l ChM ,Deceased Social S urity Number: oZDy- ~6- ~/SS Date of Death: ~~ '~~~ 2BD9 AND NOW, l 2~~ , in consideration of the foregoing Petition, satisfactory proof having been presented be re me, IT IS DECREED that Letters TS~dIX~/1d~t ~N are: hereby granted to ~e ~n ~ 7.' kr~n in the above estate and that the instrument(s) dated ,Ti(,n! aZ7i ~Qd described in the Petition be admitted to probate and filed of record FEES Letters ..... ~.t.~ ~ (~.. $~_ Short Certificate(s) .. ~.... $ ~--d Renunciation s) .......... $ _ ... $ 15 _ ... $ ~U ... $ 5 ... $ ...$ ... $ ... $ ... $ ... $ TOTAL .............. $~- Attorney Signature: Supreme Court I.D. No.: 3p~~.3 Address: 6 Clouser '~d' /1'le~u~n~csbury, P~ l7oss• Telephone: ~ ~7- Tit w ` QaOy Form RN%0? re,-. 10.13.06 Page 2 of 2 Attorney Name: ~-+lar~ ~ S~~I ~~s IUS.NU? REV 1(11/071 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Certification Number This is to certify that the information here given correctly copied from an original Certificate of Deg duly filed with me as Local Registrar. The origir certificate will he forwarded to the State Vi Records Office for permanent filing. ~-' JUN 4 2 9 ocal egis -ar Date Issued tea 0 © ,, `° :x , a n ~ x < yt ~ ~. ~ ~~ r ~ 7 ` ~"'~ 1 ^ ~ •• K . « ; PRINT IN TEV t1/2oofi COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS (ANENT ;KINK CERTIFICATE OF DEATH (See instructions and examples on reverse) r1 , (1 ~ip 0 G~ 1. Name of Decedent (Rrsl, m6idk, last sumz( STATE FILE NUMBER (/~ V 2. Sex 3. Social Secunly Number 4. Dale of Death (Month, day, year) t 5. Age (Las1 BinhdaYl Under 1 veer Ilnrlwr t n•. .._ _. o... ,..__.. .. ma 1 P 7 n A -7 G -o ~ r r . _ _ _ 7 6 Manttn Day, Itoura ~nmea J Yrs. eb. County or Deatn 8c. Chy, Boro, w i beam Cumberland S Middleton y 14,1932 ~Harrisburg,PA Kind of Work I Kintl of Business / Indushy clerk _ Food Fair 16. DecedenYS Mailing Address (Street, cdy /lows, state, zip coda) 1585 Wt=_st Lisburn Rd. Mechan:i_csburg, PA ,18. Father's Name (First, midtlle, last, sutlix) John D.. Kerlin zoa. mlprmanre Name (type / PnnU Barry R. Kerlin 21a. Memotl of Dspositfon ^ CramaGon ^ Doretbn Burial ^ Removal from Stag ! Wu Crertutbn or Doretlon Authorized ^ Other - Specity.' ; IryllQdicel Examiner I Coroner? 22a. Signature d rnxlerel Service sea e~,(or as such) Other: Inpatient U ER / Outpatient ^ ppA ^ Nursin Home Bd. Fadlity Name (If not insthulkn, give street aM number) 9 ^ Residence ^Other - Specify: 9. Was Decadent of Hispank Origin? ~ No Yes Carlisle Regional Me d . C t r , P1 Yes, speedy Cuban, ~i`3i ^ 10 RarR Amarkan Indian, black. wore, etc. Mexican, Puerto Rkan, etc.) (SpecyM 12. Was Decedent ever in the 13. Decedent's Education hit e U.S. Armed Forces? (Speunh' ~Y highest grade completed) 14. Marital Status: Marred, Never Marred, 75. Surviving Spouse (II wile, give maiden name) Elementary /Secondary (0.12) College (1-4 or 5.) W~'^'ed Divorced (SpeolN ~7Yes ^"° 9 never married Decedent's Did Decedent Acual Residence 17a. State ~ A Live in a T nship? 170' ~ Yes, Decedent Lived in Midd 1 e s e x ,7h. cppnty Cumberland T"ro~ 17d. ^ No, Decedent LNetl within Actual LimhS of 19 Homer's Name (First. midde, maiden surname) City / Boro Caroline Webb 20b. Infortnanrs Mailing Adtlress (Street, cHY /town. state, zip code) 1585 W. Lisburn Rd. Mechanicsburg, PA 216. Data of Disposiion (Month, day, Year) 21c. Place of Disposition (Name of cemetery, cremat or other lace June 8 2 0 0 9 "'' p ) 27 d. Location (City /town. state, zip code) .5^Np r oiling Green Memorial Park Camp Hill, PA Lcense Number 22c. Name and Address of Facility ~ ~~~'"'"'- '~~ 0 01 248E ussel an FH&CS INC. 324 Hummel Ave. Lemoyne, PA Complete hems 23a-c ony when cenitying 23a. To tM t my kraMadge, Beam occured at t date aM place statetl. (Signaure and title) physican a rim avaBable at bete ld deem k 236. License Number cerMy cause of death. - ' ~ (,': -.= ., t 3c. Dale S~ red (Month day, year) 2 1 hems 24-26 must be canWeted b 24. Time of Deam ~ ' - ~ •~ r 1r ~..~ d~t~.' ~ 7 ~ (_ {-: ~ _ , -.. J..'~ ~ j:..-~.~. y person 25. Date ronouncetl Dea (Monet. day, ' 1 who pronounces deem. 2fi. Was Case Referted to Medcal Examiner / Coroner br a Reason Other than Cremation or CA E OF DEATH (See Instructions and examples)' Item 27. Pan I: Enter hre g~jg.pfgyggy¢ _ d~y~y injuries, or complications - (hat directly caused V1e deem DO NOT enter te i l r Approximate interval: Pan II: Enter other significa nt mndiao canto a~ . rm na events such as cardiac anesL respiratory artest or venincular fibnllatipn w'Maul showing the etiology List poly one cause on each line. ~ Onset to Deam ng to deem, but not resulting in the undenying cause given in Pan I 28. Did Tobamo Use Conidbule to Death? ^ Yes ^ Prob bl IMMEDIATE CAUSE ((Foal disease or ~ _ ( contlilion resulting indealh) ~ ~-~.xV4l,~. ~ 1 1 -~ a. ~tiLw c a~:~ ~- ~"r'G ~ . a y ^ Na ^ Unknown Due to (or a consequence oQ:/ , 29. If Female: Sequentially list mMnions, H any, b. ~~-.5.;~.,~t ,__L_...~,~~~y{, , y,~ J.i_.r' leading to Ste rouse fated m line a. 1 t I E D r ^ Not pregnant within past year ^ nter the UNDERLYING CAUSE ue to (or as a consequence op. (dsease or injury mat initiated the evems restatin LASE c. In d th ~ Pregnant al time of death ^ Not re nant b g ea ) Due to (or as a consequence oq: r p g , ut pregnant wdhin 42 days of death d~ r ^ Not pregnant, but pregnant 43 days l0 1 year 30a. Was an ANOpsy Penormed? 3°h. Were Autopsy Findings A 31. Harmer of Death 32a. Date of I u Monet tla ear) M ry ( r 32b D before death ^ Unknown it pregnant within ire pest year vailable Prior to Completion of Cause of Death? ^ ^ Homwrde Natural , y. y . escn6e H ow Injury Occurted 32c. Place of Injury. Home, Farm Stree6 Facto , ry, OB~ce Buildhg, etc. (Spent') ^ Yes ^ No ^ Yes ^ No ^ Accident ^ Pending Investgation 32tl. Time of Injury 32e. Injury at Work? 321. Ii Transportation Injury (Specityl 32 ^ Suicide ^ Could Nol be Determined ^ y~ ^ ~ ^ Dover /Operator ^ Passenger ^Petlest' g. Location of Injury (Brest dry /town, state) M ran 33a. Certifier (check 0nry one) ^ Other - Speclty: • Certifying phyaklan (Physician certhying cause of loam when another physician has prawunced death era completetl Item 23) 33h. Signature of Certifier To the best of my knowk:dge, death occurred tlue to me cause(s) and manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ' • Pronouncing arW certllylrg phyakian (Physician born pronounckg death and certtying to cause of death) To the heat of my knowkxlge, death occured at me time, date, and place, and due to the ceusefs) and manner as statetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Number _ 33d. Date Syned (Monet, day, years • Medical Examiner /Coroner + 1, 1~ ~` i11 On the basis of ezamina1ion and / or Investigation, in my opinion, tleath occurred at the time, date, and place, and due to the cause(s) and manner as statetl_ ^ V s'\ ~ ~ ~L ( `~ ` ~'' ~ ~~1' 34. Name and Address of Person Who Completed Cause of Death (Item 27( Type /Print 35. Registre' ignature antl I ~ ~ ~ ~ 36./Data Rled (Month, Aey, year) ~ -"(~tiV ~r~ L..- ~C C•' qt' '~/ / ~"I\~~1~ .J ~~~I ~.~` livx~~~ Di3oositign Permit Nn IJ ~ ~ ~ I ~ ~ I D LAST WILL AND TESTAMENT OF JOHN R. KERLIN KNOW ALL MEN BY THESE PRESENTS, That I, JOHN R, KERLIN, of the Borough of West Fairview, County of Cumberland and State 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 Executor or Executrix hereof to pay all Amy just debts, funeral expenses and costs of administration as :soon as conveniently may be done after my death. I further direct the Executor or Executrix 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, real and personal, to my brother and sister-in-law, BARRY T. KERLIN and BRENDA J. KERLIN, or their siurvivor, and if both fail to survive me, to their issue per ~? n ~ .~ '~ t c7 ` ^ ~. 4 V3~ .~ ~~;YI t r. •~... 1 "'~ ~- s~ 'T ~~ t __ ~.. C.'a ~... stirpes. THIRD - I appoint my said brother, BARRY T. KERLIN, to be the Executor of this my Last Will and Testament. In the event of the death, resignation, renunciation or inability to act of my said brother, BARRY T. KERLIN, then I appoint my said sister-in- law, BRENDA J. KERLIN, to be the Executrix hereof. In the event of the death, resignation, renunciation or inability to act of my said brother, BARRY T. KERLIN and my said sister-in-law, BRENDA .J. KERLIN, then I appoint all the children of my said brother and sister-in-law, BARRY T. KERLIN and BRENDA J. KERLIN, to be the F~xecutors hereof. I do hereby give to the Executor or Executrix hereof full power, discretion and authroiby 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 deliver any and all deeds, mortgages, contracts, ~~~~ leases, bills of sale or other instruments necessary or desirable therefor. 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 three (3) typewritten pages on the margin of which (except this page) I have affixed my initials this :Z T~F day of,/L~.~, 1~ A.D. 1989. o~ . ~'~~~,~,.~ ( SEAL ) Signed, sealed, published and declared by JOHN R. KERLIN, the above named Testator, as and for his Last Will and Testament, in the presence of us and each of us, who at his request, and in his presence and in the presence of each other, have hereunto subscribed our names as attesting witnesses. /.,~C.I~ ~~~:~ ~ ~~~ rl~y ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA :SS COUNTY OF ~F~~$I CUMBERLAND I, JOHN R, KERLIN, testator 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 signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by JOHN R. KERLIN, the testator, this 27th day of June - 19 89 . 0. ~C.trr,n,~._.._ „1 ~ 1 ti ,C ( SEAL ) Notarial Seal V. 4omayne Fcrienbaugh, No'~ary Public rie~;anics,~.urg E3oro, Cumberland County My Commission ExpirE-s April 5, 1993 ~1,em,q~ryPennsytvania AssoGaticn of No?aries AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ;ss COUNTY OF CUMBERLAND We, _ Nancy G. Diehl and Pauline F Banks , 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 testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the Will as witnesses; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or under influence. Sworn or affirmed to and subscribed to before me by, Nancy G. Diehl and Pauline E. Banks , Witnesses, this 27th day of June 19 89 Notarial Seal V. Roma ne Fertenbau h, Notary Public tdev-l;anicstu;g Boro, Cumber an oun ~dy Commissian Expires April 5, 1393 tdember. Fennsyl~fania Pssodafic~r o; Notaries