Loading...
HomeMy WebLinkAbout09-08-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Louise Romaine Kimmel also known as File Number 21 - 09 ~O ~1 ,Deceased Social Security Number 198-22-8538 Brian K. Peters 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 named in the last W ill of the Decedent dated 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: r~s ^X B. Grant of Letters of Administration ~'w app ica e, en er: c.t.a.; .n. c.t.a.; pe en a de; urante a senha; uran a moron a e Petitioner(s) after a proper search has /have ascertained that Decedent left no W ill and was survived by the following sp iy) ar1~ia,/' sears jfif ~r Administratron, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) `- , Name Relationship Residence ~a. =;=, tD .. ~ , (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 1069 Allendale Road, Apt. F, Mechanicsburg, PA 17055 (List street address, town/city, township, county, state, zip code) Decedent, then 1 q years of age, died on 06/15/2009 at Hershey Medical Center, Hershey, PA 17033 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (!f 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: 2,000.00 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 Brian K. Peters 2568 Valley Road ' '/~ y~r~~ Marysville, PA 17053 ..yt /y\~ Form KW-U2 Rev. 10-13-2006 Copyright (cj 2006 form software only The Lackner Group, Inc. Page 1 of 2 PA Rev-346 ESTATE INFORMATION SHEET Heirs (other than spouse) Estate of Louise Romaine Kimmel Soc Sec #: 198-22-8538 Name Relationship 1 Peters, Brian K. son 2 Peters, Vanessa A. daughter 3 Peters, Chris A. son 4 Peters, Tina L. daughter 5 Peters, Mark S. son 6 Peters, Stewart son Deceased t7 a ~ - ~~ r; ~ ti -~ L~ ~ ~ , ; ' 4 R ' i-! V ~~ -.. . i ~ ., 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 ^' C~~~ before me this ~ day of ~~ ~.~ L~ _ ~' For the Register N _ Signature of Personal Representative Q 7 , 3 .1 _. ~ yr ~ t"''t -, t- t ~` G --t i., Signature of Personal Representative ~ - ~ ;. - -; CA ~ ;. _ CJ~ f ~ ~ ~ ,,- - .~r ~, t0 ~ "ri -,. File Number: 21 - 09 - U'7 ~ .~ ~ W Estate of Louise Romaine Kimmel ~. Brian K. Peters ,Deceased Social Security Number: 198-22-8538 Date of Death: 06/15/2009 AND NOW, having been presented before me, IT IS DECREED that Letters are hereby granted to Brian K. Peters in consideration of the foregoing Petition, satisfactory proof of Administration and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............................................ $ Short Certificate(s} ........................ $ Renunciation(s) ............................. $ $ $ $ $ $ $ $ $ Lemoyne, PA 17043 Telephone: 717/761-5361 $ TOTAL .................................... $ Form RW-02 Rev. ro-~s-zoos Copyright (c) 2006 form software only The Lackner Group, Inc. in the above estate Regisler of Wills Attorney Signature: Attorney Name: Sa el L. Andes Supreme Court I.D. No.: 17225 Address: 525 North 12th Street Page 2 of 2 IO ROS RED' rliiiU'I ~i-Q~~ ~~~i3 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, X6.O0 Certification Nutnbe.r This is to certrf~ khat the intitnnati~~n hire <~iven is correctly copied ti-om an ori~~inal Certir?~ate i~f I3e<<th duly filed with me as local Re~~istrar. 'Che original certificate will he forwarded to the State Viral .Records Office ;<3r penn~ineut filin~~. d`~ JU~I _6/1009 oca eggs 'ac y Dnte issued ) REV 1lnoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS a4nNIrNrTir" CERTIFICATE OF DEATH acK INK (See Instructions and exam les on reverse P CTATF FII F NIIMRFR tea N ~ v ' ~ - i rr t r '; t j , _ A.' 1 ~ ~~ ~ .. . ~ ~ ~ ` Y~ G3~•-- W 1. Name of Decedent (First, middle, last, suBix) 2. Sex 3. Social Security Number 4. Date of Oeeth (MOnm, day, year) ,. Louise R. Kimmel female 198 -22 - 8538 use 15,2009 Age Itast Birthday) Under 1 ear Under 1 da 6. Date of Birth Month, da , ar 5 7. BiM lace C' arid state a for ei count 6a. Place of Death Check onl one . 7 9 Mnnths Day, Hoars Minutea ay 1 8, 1 9 3 0 Eno 1 a , PA Hr~papital: ^ ^ ' other. ^ ^ ^ - Yrs. ER /Outpatient DOA J lnpatlenl L Other ~ s Nursing Home Residence pecily. Sb. County of Death 6c. City, Boro, Twp. of Death ed. Facility Name (Il not institution, gNe street and number) 9. Was Decedent of ttispanic Origin? [~ No ^Ves 10. Race: American Indian, Black. White, etc. pf yes, specify cubes, . iSper,M Mexican, Puerto Rican, etc.) W it l L e 71. Decedent's Usual Occu ation Kind of work d one Burin most of workin Ida. Do not state reli 12. Was Decedent ever in the 13. Decedent's Education (Spedty only hghesl grade completed) I4. Marital Status: Married, Never Married, t6. Surviving Spouse Ilf wife, give maiden name) eci ) Wldo eQ Di o ced S K of Work ~ Kind of Businessl Industry U.S. Armed Forces? Elementary I Secondary (0-12) College (1.4 or 6~) ty w v r ( p orer la O • computer ~ H~ ^ Yes liy No 7 widowed 16. Decedent's Mailing Address (Street, city /town, state, zip code) Decedent's Ditl Decedent T,~, pA Live in a 17c Decedent Llvetl In T ~~ ? Y A 1 1 P n Twp ~ Yes id l R S 1 0 6 9 A 11 e ride 1 e Rd . Actua es ence 17a. ta . . , te Y Cumberland Tpwnahip? ivetl within t t7d ^ Mechanicsbur PA oj 17b. County CirylBoro Actua Lem ts 18. Father's Name (First middle, last, suffix) Fred G. Heckert 19. Motl~ers Name (First, middle, maiden surname) enrietta Lambert 20a. Informant's Name (Type /Print) 20b. Informant's Mailing Address (Street, city I town, stale, zip code) Brian K. Peters 568 Valley Rd. Marysville, PA 17053 21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year( 21 c. Place of Disposition (Name of cemetery, crematory or other place) 21 tl. Lwation (City/ sown, slate, zip code) ® Burial ^ Renwval from State i Was Cremation or Donation Authorized • June 1 8 , 2 0 0 9 oiling Green M em . Park Camp Hill , P A ^ Other- S Medical Examined Coroner? ^ Ves^ No 22a. Sign re of F neral Sernce L (or p rson ling as wch) 22b. License Number 22c Name and Atld ass of Facility Lemoyne PA 324 Hummel Ave Musselman FH&CS Inc . ~ (~~-- 011248E , . . Complete items 23a-c only when ceNying 23e. To a bast of my knowledge, death occurred al me time, date arM place stated. (SignaNre end title) 236. License Number 23c. Date Signed (Month. day, year) physician is not available at time of death to cediry cause of tleaM. Items 24-Z6 must be completed by person 24. Tlrtre of Death 26. Date Pronounced Dead (Month, day, year) / ~ 26. W~asl,Case R¢lerred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? ^ who pronounces death. 'A M. { ; `fit. Q ) ~~ ~1t- ~. t.j No LJ Yes CAUSE OF DEATH (See instructions and examples) r Approximate IntervaC Part II: Emer other siene~cant condo ons conMbudne to deaN 26. Did Tobacco Use CoNribule to Deatn? Part I: Enter the chain of events -diseases, injuries, or complications -that directly caused the death. W NOT enter terminal events such as card'uc arrest, Onset to Death Item 27 but not resulting in the underying cause given in Pan I. ^ yes ^ Probably . respiratory arrest, or ventricular fibrillation without showing the eaobgy. List only one cause on each line. ~ No ^ Unknown IMMEDIATE CAUSE Rnal disease or h` - {, y/\~O, ~?OI)~ a'x: m'~~ .Yy corMition resulting In ~eem) r 29. 11 Female. nant within ear ^ Nat re ast 1 _ ~ a. Due to as a consequence of): ~ p p g y ^Pregnam al time of death F4 ~f+~ . ~ if any Ilst conditions uentiall Se ~ / 7 , ^ , b , yy q leading to the cause listed on lure a. - I Not pregnant, out pregnant within 42 days . Este the UNDERLYING CAUSE Due to (or a consequence ory of death (disease a injury that Initiated me re nant 43 da s to 1 ^ Not re nant b t ea c events resulting in death) LAST. Due to (or as a consequence oQ: y p g , u p g y r before death ^ Unknown if Pregnam wdhin the Oast year d 30e. Was an 0.mopsy 30b. Were Autopsy Findings 31 Manner of Death 32a. Data of Injury (Month, day, year) 32b. Describe How Injury Occurted 32c. Place of Injury: Home, Farm, Street Factory, Office Building etc. (Speciy) Pedormetl7 Available Prior to Completion may`, u rvatural ^ Homicide , of Cause of Death? lnvestgaaon ident ^ Pestlin ^ A 32d. Time of Injury 32e. Injury at Work? 321 If Transponatlon Injury (SpecilyJ 32g. Location of Injury (Street, city I town, stale) ^ Ves ~ No ^Ves ^ No g cc ^Ves ^ No ^ Driver/Operator ^ Passenger ^ Petleslrian ^ Suicide ^ Could Not 6e Determined M ^ OMer - Speciyy: 33a. Gasifier (check only one) 3 36. Signature and Title of enifier ~-~y J~ • Gasifying physician (Physician cenilying cause of death when anomer physcian has ponouxed Beam and completed Mte auae(a)antl manner ae stated t h dd d Item 23) _______________ ^ ~ 't l 41 ____________ occurre w o eat To the best of my knowledge, ______ 3 3c. License Num 33tl. Date Signed (Month, day, year) • Pronouncing and certitying phydclan (Physician bath pronouncing deaN and cenirying to cause of death) d t t d ~ \ ~ 9 ~ ~~- ~,~ . S ~-^' manner as To the beat of my knowledge, death occumed at the hme, dale, and place, and due to Me eeuaefa) en _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ a a e - n a ; • Medical Esamina/Coroner On the heals of examination end / ar Investigation, In my opinion, death occurtad at the time, date, and place, and due to the cause(s) and manner as stated_ ^ 3 4. Name end Address of Person Who Completed Cause of Death (item 27) Type I Print ~ ~ ' ag,D Filed (Mon ,day, ye G ~. j ~5 ~S Hershey Medical Ctr M S nature and Di 35. Registmfs ~ / I ~ I / ~ I I ~ I ~ /6 a'C~ i . . . ~ ~ v Disposition Pertnh No. ~ '~ ~ ~ ~ ~ ~~-~~ ~ ~~7-3 RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Louise Romaine Kimmel ,Deceased Stewart Peters , in my (Prior Name son of the above Decedent, hereby administer the Estate of the Decedent and respectfully request that Letters be issued to Brian K. Peters ~ ~. ~ D© r ~ 7 t~ ° ~ ; ~ cn ~; ~,. l 1 -li 11~. •• { e I \ S ri e right ~ ' '= ~~ ~j'J'. t... ) ~ _ / " 4 ~ti ~~ Stewart Peters SM /o $'3U tl13 Market Street (sneer adtlreaa/ Duncannon, PA 17020 ter, sere, z;o~ Executed fn Register's Office Sworn to or affirmed and subscribed before me this- day of_ Deputy for Register of Wills Executed out of Re®lster's Office Before the undersigned personally appeared the pparty executing this renunciation and certified that a or she executed the renunciation for the purposes stated within on this day of - ? ~g Notary Publ' ~~" ~ "" My Commission Expires: ~ l~ Zad~ (Si~raturo and seal of Notary or other oRidal qualHied to admkdefer oaths. Sfww dale of eocpirotion of Nofm~/a commiasim.) r-orm RW-06 Rev. tons-zoos Copyright (c) ~8 form aoftwaro only The Lackner Group, Inc. COMMONWEALTH OF PENNSyLVAN1A NOYARIAL SEAL PuYlic CHARLES E. WELFLEY JR., ~ County City of Duncann(res Marc 18,2013 My Cpmmissi~n Exp' i -C%~ - C~j 7~ ~ RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Louise Romaine Kimmel ,Deceased rv 0 w cr,- ='~; C'7 ~y ~-'r' - - ~~ Mark S. Peters , in my capacity/relation rn ~ ~ . -.<+ r~+;,,, ~ `:~ `,:: 4J (Print Name, n ~ ~. . . -. _,f__, son of the above Decedent, hereby ren ~ the rigt~o T_ , .,, ~ .; _ administer the Estate of the Decedent and respectfully request that Letters be issued to . ; , Brian K. Peters --, Jr~w~_.~~7r ~~~'> (~e~ .~ / /~~ ~^ r ( rure~ Mark S. Peters !~ ,h (Sfraer Address) Etters, PA ~' r~F-~-I (cay, were, zvl Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ ~! day of , Deputy for Register of Wills Executed out of Register's Office Before the undersigned personaNy appeared the party executing this renunciation and certified that he or she executed the ren~ c~_i~tion for the purposes stated within on this -..day of ~-L 2~~ , ~~4 ~~ ~- Notary Public My Commission Expires: ~ - 2 2 - 2 ~-/ L (signature and seal of Notary or other oTfidal qualified to adnrinister oaths. Show dale of explraNon of Notaryrs commission. ) Form RW-06 Rev. tpf9~2QD8 CopydgM (c) 2006 form software ony The Lackner Group, Inc. Witljam FN SEq[, Newixrry 7kp ~No~!' Public My commission ez ' ~O1°ty Pees March 22, 2D12 COMMONWEALTH OF PENNSYLVANIA couNTYOF Cumberland Oath of Personal Representative } SS The Petltloner(s) above-named aw~r(s) or afflnn(s) that the statements In the foregoing Pettion are true and corned to the best of admkniater thge estate aocom ng to law s) and that, as personal representatlva(s) of the De~ent Patltioner(s) will well and truly Sworn to or aiflrtned and subscribed Before me this ~ day of unt . 20I~ For the Register Brian K. Peters Slpnaruro o/Personal Representarlva N .v 1~ ',;,.,. ~ Ft~L~ t~7 U3 :C c>,..,a A 'O Cis i' ~. File Number: 21 - 09 -Q'~~ Estate of Louise Romaine Kimmel , Deceased 3'~?~ z.. +r~ P x Soaal Seadty lumb r. 198-22-8538 Date of Death: O6H 5/2009 AND NOW, ~~~ ~~ , in consideration of the foregoing Petition, satisfacto having been present afore me, IT IS DECREED that Letters ry proof of Admi l t i are hereby granted to n s rat on and that the InsfromeM(s) dated described in the Petition be admitted to probate and filed of record as the last W fli (and CodiGl(s)) of Decedent FEES /y~ ` Letters ............................................ $ ,/I P short cerlFficate(s> ........................ $ --~4(-- '1 _ O~ Renunaation(s) ............................. ~- $~~O f~~~ C (-`1 ~Q~ Attorney Signature: Attorney Name: $am[r~el L. in Me above Supreme Court I.D. No.: 17225 $ Adtlress: 525 North 12th Street $ $ _~_ Lemoyne, PA 17043 $ ~_ Telephone: 717!761-5361 $ $ TOTAL .................................... $ Form RW-0Y Rev. 161}yppg CoPY~ght (c) 2008 farm eolhvare onN Tha WcMner Group. Inc. Page 2 of 2