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HomeMy WebLinkAbout07-21-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA Estate of Ravenda W IUine File Number ~ ~ - ( ~ ~lQ ~~F also known as Deceased Social Security Number 202-20-0578 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 Co-Executrices named in the last Will of the Decedent dated December 17, 1996 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 (Ijapplicable, enter: c.t.a.; d.b.n.c.t.a; pendente life; durante absentia; durante minoritate) tV Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following~ouse (if any)<nn°~d heirs: (If Administration, c.t.a. or d.b.n.c.t.a., enter date of Wi11 in Section A above and complete list of heirs.) ~0T *~ ,~•; .+.~ ~..J ~..' Name Relationshi Re ~~~ - :; 1 :-')QT ~ S7 (COMPLETE IN ALL CASES:) Attach additional sheds if nec~csary. ~ --~ _ CI"c Decedent was domiciled at death in Oberland County, Pennsylvania with his /her last principal residence at 5225_Wilson Ln.. Mechanicsbure. Pa. (List street address, tow-dctty, townshtp, county, state, ztp code) Decedent, then 95 years of age, died on July 14, 2009 ~ Bethany Village West -Assisted Living Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 38,640.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County ~ Value of real estate in Pennsylvania $ situated as follows: PNC Bank, N.A. Central PA Form RW-02 rev. 10.13.06 Page 1 of 2 Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Leners in the appropriate form to the undersigned: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF Cti-mberland 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 `' ,~/ stg before me the '~ day of c rv c .o Signatwe of Personal Representative `-' C!~ ;F; ~-~ C"7 ('~'~ ~Q-1i . ~ a File Number: ~~ `~~' ~~~ Estate of Ravenda W. Kline ,Deceased C _.. i- tv ~.-:-~ i 3:w tt~ Sociat Security Number: 220-20-0578 Date of Death: July 14, 2009 AND NOW, ~ ~ ~ in consideration of the foregoing Petition, satisfactory proof having been presented fore me, IT DECREED at Lett ~ Yl/L.~ aze hereby granted to 0. 5 ' c° O rl 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 Will (and Codicillsll of 1)ecetienr FEES Letters ............... $ O~ Short Certificate(s) ........ $ 40.00 Renunciation(s) .......... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ".~4A:A9' Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Form RW-01 rev. 70.13.06 Page 2 of 2 _ _ LOCAL REGISTRAR'S CERTIFICATION OF QEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This is to certii-~~ that the information here given is correctly coded from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. Certification Number Local Registrar Date Issued -____ __ --_.__.- ---_-..__ ..-__ -_-_. __._- ---_._. _... n O -`SAS. ~ W -- __ -- - - :` T,~~ c -- _ - -- .-... ~ ..._ 3 .~ - ~7 _ -~' `~ .. REV ttno36 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN K"ENKT CERTIFICATE OF DEATH - _ (See instructions and examples on reverse) RTATF FII F NI IxxPCo ~..~~e u. veceaenr tnrsr, mioore, last. sunixl 2. Sex 3. Social Secunry Number 4. Date of Death (Month, day, year) Ravenda W. Kline f l ema e 202- 20--0578 July14,2OO9 5 A L Bi . ge ( ast mxlay) Undo I year Under t day 6. Date of Birth (Month, day, year) 7. BidhpWp (City and state or forego country) Ba. Place of Death (Check only one) 9 5 "~"' Days Hours kfxnnes Hosplal Other PA Assisted Living Yrs April 2, 1914 Harrisburg , ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ^ Residence Omer ~ Speciy: eb. Counry a Deem 8c. Ciry, Boro, Twp. of Oeath lb. Facifiry Name (If npl insMUtion, give street entl number) 9 . Was Decedent of Hispanic Origin? C] No ^ Yes 10. Race: American Indian, Black, N/nite, etc. Cumberlan Lower Allen Bethany Village -West (lfYes.specfyCuhan, 7(' (l ~fy}~ Mexican, Puerto Rican, etc.) Wh 1rC e 1 t. DecedenYS Usual eon KiM of work tlone du' moll of waki kfe. Do not state retired 12. Was Decedent ever in the 13. Decedent's Education (Speciy Dory hghest grade completed) 14. Marital Status: Manied, Never Marnetl, 16. Survivi n9 Spouse (II wife, give maiden name) Kind of Work KiM of Business I Intluslry U.S. Armed Farces? Wid owed, Divorced Elementary /Secondary (U12) College (1-4 or 6.) (SpepvM nurses aid health care ^ Yea ®Np 12 widowed • 16. Decedent's Mailing Address (Street dty! tam, slate, zip totla) Deceden's 5 2 2 5 W i 1 S o n Ln . Did Decedent ,,~-A,,// Aauai Residence 17a. Slate PA Terry 17c. IJ•Yea Decedent Lived in i.ntuP r A 1 1 P n Mechanicsburg, PA ' , Twp t7b. COUnry Cumberland ~D na ^NO, Decedem uvea wnnm Actual UmiLs pf 16. Fadwr's Name (First, mitl~e, last, suffix) Ciry / Boro Harry Baker 19. Mother's Neme (First, middle, maiden sumama) Katherine Shafner 20a. Informant's Name (Type / Pfirn) Barbara J Shu hart 20b. Informant's Mallirg Atldrass (Street caY /tam, state, zip cetle) . g 100 Westgate Dr. Mt. Holly S s PA , 21 a. Method of Dlsposaron ^ Cremation ^ Doralbn 27D. Date a Disposition (Month, day, year) 21c. Place of Dispostion (Name of cemetery. crematory or other pace) 21tl. Location (Ciry /sown, slate, zip cotle) ® Bunel ^ Rertlovalfrom$rete WSSCremedonorponatbnAulhorized Jul 20 2009 R lli y , o n Green Mem. Park Camp Hill, PA ^ Omer -Specify: Medkel Examiner I Coroner? ^ yes ^ No g r 22a. Siplglure aloe Lgerlsee (or rson -rig as such) 22b Ucense Number 22c. Name aM A ress of Facility M • W p~ t \ 011 ~ usse - J - V 248E man FH&CS Inc. 324 Hummel Ave. Lemoyne, PA Compete Nems 23et pnry when certitying • physidan a rrot available at ame of deem to 23a. To t of my knowled deem occunetl al the time, and place slatetl. (Signetur antl title) 23b. rise Number 23c. Date Signed (Month, day, year) petty puseddeam. ~~~~~~~ / Items 24-26 mull DQ completed by person wTp porwrmces death. 24. Time of Death 25. Date P ed Dead (Mpnln, tlay, ar) ~ `• 3 O ~/ 26. Was Case Rerened to Metlipl Examiner / Coroner f a Reas her than Crematon or Oonanon? , M ^ Yes CAUSE OF DEATH ee inatruetiona an ampl r Approximate interval: Part II: Enter other sionif a t conde~ ~_ ~ t' ~ og t =ath, 28. Did tobacco Use Contribute to Daelh? Item 27. Pan I: Fster the chain of events - tliseases, epodes, or C0Inplipapr45 - Thal tlirr!cNy caused me death. NOT a erminal events such as cardiac anest r Onset to Deem but not resulen n the untleri respealary arrest, or ventricular fbrXlation wilhoa snowing me etiapgy. List only one cause on each line. r 9 i ying pose given in Pan I. ^ Yes ^ Probaay IMMEDUTE CAUSE (Final tlisease or i corldaion resuhkg in death) I N G r~ I ~ ~ ( O ~ r ^ No ^ Unknown a . to v -> 29. If Female: Due to (or as a consequence o(f. SequanAaly int condilbrrs H any b •{ (~ a~ T ~.~..p ~ ~? ~ ^ Npl pregnant within past year - ~~ V ~ ~ r 0 ~ ~ t ( ~ J ! A sal la the pose Nsted on line a. • ' -- R I L ^ Pregnant al time of death Enter UNDERLYING CAUSE Due to (or as a consequence ofJ. (disease or wpury met inilieletl me c ^ Not pregnant, but pregnant within 42 days events rr!sullmg in death) LAST. r of death Due to (a az a consequence o r ^ Not pregnant, but pregnant 43 days l0 1 year d. ~Ntaa 6:.G1NG~ ~~vtG M1=1 SS ; pf pre tleam ^ Unkrwwn if t pregnan within the past year 30a. Was an Autopsy 300. Were Autopsy Findings 31.1. Matmer afleath 32a. Dale of Injury (Month, tlay, year) 32b. Describe flow Injury Occurred Penomted? Availaae Prior Ip Corn lelion / 32 P p c. lace of Injury: Home, Fartn, Street Factory, ,~~L~,'Ig a Cause of Deam7 aNrel ^ Homidtle Odee Building, etc. (Speciy) r~ / ^ Yes Ly~~ ^ Ves ^ No ^ ~~nt ^ Pentling Invastigelbn 32d Trine of Injury 32e. Injury at Work? 32t. II Tranaporletion Injury (SpeptyJ 32g. Loption of Injury (Street, dly I lawn, state) ^ Saade ^ Caad Na be Derenninetl ^ yaz ^ No ^ Ddver /Operator ^ Passenger ^ Petlestnan M. ^omer- spears 33a. Certifier (check poly one) 33b. 5 e and Tde a rtiliar • Cerlityirg physklan (Physkian prtitying cause of loam when anaher physiaan has pronounceo death and competed Item 23) • To the beat of my knowledge, deem oaurred due to the causgc) arM manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - ~ `r J _ _ _ _ _ _ _ _ _ • Pronouncing and cerlllying physlclan (Physiaan bom pronouncirg death and ceditying to puss a death) 33c. Lkens Number To the beat of my knowlege, Death occurred et the time, dale, and place, and due to the cause(s) end manner as ahtetl_ _ _ _ _ _ _ ^ ~ ~ ~ 1 ~ ~ ~ ~ ~~ Dal ~ n (Mont tlay, year) • Medkal Examiner /Coroner - - ~ - - - -"' - 1 5 1 p On the basic a examination and 1 or investigation, in my opinion, death occurretl at the time, date, and place, aM due to the cause(s) and manner as slated_ ^ 34 N a a dtlr ss ofof P1ekrs~pn,W C[o!mpktetl Caus@vol,Dea, Ih (IterO 2) ype / Priryy _ 1 35. Registrar's Signatu Drstrid Numb~iy~ ~ ~ 36. Da Filed ( m year ~ ~ ~ " "~"'v~ ~ L V ~ • r` JC,J~ 1~T1 ~ day ~ ~ ~ / ~ , , ~ I I I • - ~ G I ~ I ~ If !4~ a ~ 3 1~ - ~ ~ C L 12-i N 01k QJ01~ ~~'1~ 1~ ~'L l,l. }~ 1 Disposition Pertnil Nc. V ~ 7 j l.. I_.~s~~~ ~~~;~Il.l..~:~~,~ ~rl,~;~rAl~l~rv-r ol~ Rnvlvl~n w. l:[,1N1? I, IZA~,%I:NllA ~~'. I~:LIN[„ unren~.!?-t~ied widow, of the Lipper Allen Township, C:~umberl~:nd County, Fr~m~svlvani~t, hcin~ cif sound and disposing mind, memory and ,utderstatulin<.;. do rnakc, ~,ublish anal d~cl;u~e this my Last Will and "Ccstanicnt, heret~y revoking and ma~:itig void ~tny and ail ~~rior ti~/iils t;v rr.e at ~zny time heretofore n~adc. 1. 1 direct the payment of a.ll guy jus}-debts aitd funeral expenses as soap after my decease as the sauce can convenie<<tIy be done. All file rest, residue and rctn~~in~lcr of my Iatate, real, personal aizd mixed, whatsoever and ~~.~here.soevc~r situate., I give, devise <<nd bequeath to my beloved daughters, BARBARA J. SII~UEh1.R"i', and LOI ~ ~..{AR~fIESON, in equal shares, per stirpes. 3. I tiontinate., con~titutc and ah~r,~int my daughters, BARBARA .I. SIILJGI-TART and LUIS J. Ir1.~,}1F~ ±(~1'V tr) I',~ t~~.' c"r } ':o'r111C?~''>~. r^.F !hip; ;n ,, 1 ;~~;t~Uill atir} 1~ c!;i!Tt~nt f firth;=r ~T,-Prrrh,tr!i~,~ shall not be rc~Iuire~ ut Gle bond or ether security in the Gftice of the Register of Wills for the hatrE:x~se. of adttunisterirt<~ my I;tit,~te. li'~ ~~~I"hNI:~~~; ~ti-'Ell;~l~:C7F~, [ haa:; hereunto set my hand and seal this _~ 7'~_ day of ~~~.e~--- , A.ll. I9z)fi. _ ..... _ .,M~ ~~~~ ._ ~~~, arm... ~.~- - -~- ~""--`-- (SEAL) R,~VI NllA W. KLINE ,, 'T _ Signc~~l., sr:'z~Ied, ht~l.~lished a~7d declared by the above-Warned RAVEIsI[:)A ~`J. KLINC as and .for her Last ~N~~11 and `I'esta~~t7ent, in the }aresence of us, who at her request and in her presence, and it°i tl~te preseatice of eaelt other, have hereunto subscribed our names as witJ~esses. :,~ rl3 :'.6 ._~ w~ 1~:) G:1 c.~ .~:~, t:a.._ t-.- !~`1 ~i L ~'~ .' t_.y -'J 1......~ Y„f G'~ .. t, C.~=-t ~-- 4.1,: ~t ~'- `~ V ~,,..,. ,, ~ ~ _. .. ~. (,t { .r ei 1.. ~; ~ /t! J r /t"~.~,. c t,~ E f ,C~.r ~~ t' ~ :' lr a' ~ ~.. r ., r I~I III lil IIIII III®I~I ~I VIII I I ~I I I IIIIIII III II I OATH OF NON-SUBSCRIBING WITNESS(ES) REG STER OF WILLS ~~! /1 COUNTY, PENNSYLVANIA Estate of (Si~ature) (Street Address) a ~ and~~~;.s r~ ~~miHds~h , (each) being dul~ualified ac ding to law, depose(s) and say(s) that she / he they was / ere well- acquainted with a V e n aPcZ ~ . ~ ~ i~ !~ ,~ and am/ re familiar with the handwriting and signature of the decedent, and that the signature of ~Q ~P~o (~l. ,Gl/~/.'h ~ / to the foregoing instrument purporting to be the Last Will and Testament/Codicil of d"A U~iCJ~C~- ~ ~!/%'~~ is in his/her own proper handwriting. e . ri / a ~~ (Cit ,State, Zip) Executed in Register's Office Sworn to or affirmed an`d~subscribed befo e me this ~ ~! day of , ~. Deputy for Register of ills (City, Stnte, Zip) Deceased N Q CO . C1 V1D ` y S~ ~ >~ •~ ~ c~ ~ S r-- ~ ;.. ~ .. t~ c_~ ~ ~. ~-r~ ~ ~ , v Farm RW-04 rev. 10.13.06