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HomeMy WebLinkAbout09-15-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Terry M. Kemper File Number 21 - (~' - o~5~ also known as ,Deceased Social Security Number 162-48-1276 Julie M. Kemper 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 named in the last Will of the Decedent dated and codicil(s) dated lo~e~e reievanr c~rcumsrances, e.g., renunaanon, aearn or executor, etc.) ; ~.-~ _ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of~tl~+ for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ;=_, C~ ~~. ~ It~,) offertad ~~-~ _... ~J ~ ~5 _ -; _, ,, m - - __- ^X B. Grant of Letters of Administration ?' C,J ~ {.:".} app Ica e, en er: c..a.; ..n.c..a.; pe en e ~ e; uran e a sen ra; uran a m~non 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) and 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.) Name Relationship Residence Kellie Kemper daughter (minor) 46 Argali Lane Mechancisburg, PA 17055 Jessica Kemper daughter (minor) 46 Argali Lane Mechanicsbur PA 17055 Julie M. Kemper spouse 46 Argali Lane Mechanicsbur PA 17055 (coMPLETE IIV ALL CASES:) Anach aadirional sneers if necessary. See continuation schedule attached Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 46 Argali Lane, Lower Allen Township, Mechanicsburg, PA 17055 (List street address, town/city, township, county, state, zip code) Decedent, then 52 years of age, died on 02/05/2008 at Holy Spirit Hospital, Camp Hill, PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ (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: 0.00 Estate opened for possible litigation. 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 t ,.5~~~~'W" `/ V ` ~~~~~~-. ( Julie M. Kemper 46 Argali Lane i Mechanicsburg, PA 17055 Fwm KW-0L Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Ina Page 1 of 2 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 affirmeyd~and subscribed before me this ~ J~ day of For the ister Signature of Personal File Number: 21.-~ Estate of Terry M. Kemper ~ r ~ SJ ~ C/) :t', t ? __~ ~ ~ rrt -- ~ rTi! f1 ~.__J L~ ~ - ,... ~ ~. - ~ , Deceased Social Security Number: 162-48-1276 Date of Death: 02/05/2008 AND NOW, ~ ~ Q~- , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT S DECREED that Letters of Administration are hereby granted to Julie M. Kemper __ 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 Codicil(s)) of Decedent FEES Letters ........................................... $ Short Certificate(s) ........................ $ ~ r Renunciation(s) ............................ $ ~ $ + O• U $ $ $ $ TOTAL .......................... $ $ $ Supreme Court I.D. No.: 29922 Kerwin 8~ Kerwin Address: 27 North Front Street Harrisburg, PA 17101 Telephone: 717/238-4765 Form RW-O2 Rev. f0-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2 Attorney Signature: ~~~!2~,,P,t~~ `~~t-G~l (/'~l/1~ Attorney Name: Terrence J. Kerwin 105.ft05 REV fUl/07) /~~~ r/'~~~,i/~ 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 ~~ ~A~ ;N INK X131-ZOR This is to certify that the information here given i correctly copied from an original Certificate of Dea duly filed with me as Local Registrar. The origins certificate will be forwarded to the State Vita Records Office for permanent filing~~R ~ ~ 200e ~~~ ~ d~' / /__ Local Registrar Date Issued Irv V/~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS `,,~ ©~ ' = ~ -~ '~9 ~ ` ~ CORONER S CERTIFICATE OF DEATH ~,~a ~ (See Instructions and examples on revefSe) STaTF FII F NI YarrG pp ? y ! . 1. Nona d Decedrl (FNd, nedde, red. rRa) 2. Sex 3. Soda) Security Number 4. Date d Deem (MaMh, Terry M Kemper Male 162 - 48 -1276 February 5; 2008 s. Age (Lad SkNtlay) leMr 1 laelr 1 e. Dated &M (Month, 7, & ( rla stare a ) Ba Place d Deem ((mock one) 52 yro. "°"" °rys "°"~ """~ Sep. 29,1955 Harrisburg, PA "°'P"d' ~~tla,a ^ERIOulpmrent ^DDA °tl"° ^NUraingrmn,e ^Reaidence ^omer.spedy: !m. Caunry d Dean, ec. Clry, Twp Deam ed. FadNy None (lf nd kletlAltloll, gue shed end nuroar) 9. Wee Dxedent d wevadc Oligln7 ~J No ^ yr 10. Nan: Atnericen kldlen, Sleds, wNre, etc. Cumberland East Pennsboro Holy Spirit Hospital (11Man~cerl,P~uarmW~cen,dc.) Whe 11. Dendra'a l1rW Kpld d wok dons mrt d tie. Do MN dr 12. Wr Dendrlt ever in me 13. Decedenya Eduntlal (Spedly oMy NgMM gads conpkte0) 14. MBMd Sredx: Monied, Never Herded, 75. SurvNklg Spolr (N wife, give melden name) Kill d Sninee I y~„y N:d d wads Re U.S. Armed Folcr? Erememary I seaondery (012) Cdlege (1J or Si) waowed, DKoraed (Spedly . De t of f ^yr ~ 1 Married Julie M. Whitmore 18. Deceder8e Mating Addrose (Bred, coy I Gown, state, tq aerie) 46 Argali Lane DendeM~e °id DaCetlBM Lower A 11 en acmd Residrlce 17a. slate PA Live in a 17t.~[ Yr, Decedent lived in rwy. rawnshl ? Mech nic bur PA 17055 p 1n.counry Cumberland ,Td.^ a dwaMn a s clry / r3oro 10. Fatlrera Nmne (Feat, nNdtle, led, rdfix) 19. Homer's Name (Flrel nddde, maiden sumrn) Marlin Kem er Faye Lee 20a. IMammll's Nrle (Type /Print) 206. mbrmenCe MdFq Addror (Sand, all' / mvm, arese, zIP rode) Julie M. Kem er 46 Argali Lane, Mechanicsburg, PA 17055 21a Memod d Oiapodlion I [~ Crrrtlon ^ Daramm 21b. Doh d Diepodnn (Month, day, yrlj 210. Plea d D'epninon (Name d nnbtrY, aemetay or omr plan) 21d. Lrodkrr (dry /town, sate, zp code) ^ ~, Flemord~msate I ~Mw,e,.~l°~"c« "oaerr° es^Na Feb. 7, 2008 BFH Crematory Grantville, PA 17028 22e. d funeral tiroree (or ad'nq r elxm) 22b. tloaree Number 22c. Name and Address d Fedh'ly FO 012342-L Stone & Murray F.H. 408 3rd. St. ,New Cumberland,PA17070 Nerr 23et gray wllr adNyilq 23a. To Imadedpa. death arolpled d me Nme, dare and plan stared. (SipneNro arvl tltle) 23b. lkenr Nwnber 23c. Dare Sgned (Halm, day, yrr) ! nsl avaNede r tare d drm Po ceray uuee d death. nrr 242e mrN ba mryMW by person 2~. rxns a Deem 25. Dde Pralolnced Drd (MOMII, day, year) 2fi. was Cre Referted m Medical Eraminer /Coroner for a Reran Otlrer mr Cremetlon ar Dortbn? wnatxanaaardedn• 3:34 P. H. February 5, 2008 ~(rr ^rm CAUSE OF DFATN (gee Insaauotlone end elrsmplse) r Apprexkrere kNelvd: Pan Ib Forer amer ' 23. Did Tabaao llr CantMxae re Daem7 Nam 27. Pr 1: Eller the meaAtlre~- dherr, M)uMa, or rongtlutwle -mat directly rolaed me drtll. DO NDT sorer temerld evenre suds r nrdiac enesy I Ord m Deem bd nd rruro^9 n me undrykg cane given n Pen I. ^ Tr ^ Plabeby reeprrery errod, a veMdedar Imdlrenall waled ehowing me etldogy. lid ody ar err on each IY1e. r ~ ^ No ^ llnknaam ~Flrl ~rorAdgMdeem) ~ Adverse Drug Effects ; zs.nFemele: a Dn m (ar r a romeplrn d): i ^ Nd lxepneM wkhin pad year SeplertadN Nd andtlms, N mY, b. ~ b d t M ^ Pro4rl et Mn d drm e nd o I ~~~ ~~ a Due to (a as a consequence of): ~ En mr 9l e ^ Nd progreM, Ma preprent within 42 days l re e~ ~~ a i bvrts ddrm Dn to (a r e consequence d): I ^ Nd prsgreM, but pregleM 43 days to 1 year d. i Oelae dedh ^ llnkllaavl N progrM wakn me pest yrr 30e. Wr r Aulapey 306. wero AurepP/ F,Idmge 31. Meaty d Deem 32a. Dde d Irglay (Month, day, year) 32b. Deaame How lyury Oroumed Adverse effects O f 32a. Pka d lnjley: Her, Farm, Bred. Factory, PedamadT AvWde Prbr re Carplelial ^~m~ ^ Feb.2 2008 prescribed medications Ofin BliyNlg, etc. (Specify) Home acrraDeem? , ^ ~vr Na ^ ~vr Na ~ AacdeM ^ PeMkq Imasegean 32d TNne d Ir(ury 1TNKNOWN 32e. Irl)ury d work? 321. N Tronaparetlon reNY /sPec'flyl 32g. lantlan d Iryuly (seed. sty / mwn. dare) ^~, ^CaINdNdbaDdennkrd ^Yr ^~ ^Ddver/Operat« ^ ^P~en Argali Lane, Mechanicsburg, PA M. Omer. ~Y 33e. Ceralr (dbdl ody ar) 33b. Slglerro one roe • Cdtllypq phyeMr (Ptryeidr artlgMq nw d deetlt when amtllr phyddrl tr pralsulcad deem and mtplebd peen 23) Corona T TelM brtdmylolorWge, drahoalarM 4Mmnr WeNa)end eaaarrereaed--------------------------------- ^ • Fronraldng erld ordfykq t~~ (PhY~n botll PO detll and anNyklg m our d dwnl h d tl k d W Y Mm mtl d M d ^ 33c. ~ 33a. Dare SPwd (Mmm, day, yeeH lenrNgrl ------------------ ocaurro d Mt r, eee,er p a,e re merwre S T~twwt M drl April 2, 2008 . l I or Nwtlpolon, In my apMeon, drm aaurad rt ms Nra. rite, rd pMn, rd dw m tM arye) rd msmar r ahYd_ 1~ On 1M Caere d rem6latlon rM 31.~i~~e} d~rton ~I~enpN~C~rs(~ Type I Print rd ~ ~~ ~l ~ / ~ ~~ r ~ ~l~G~ % ss.od.FN.a dares) 6375 Basehore Road Suite /fl Mechanicsburg, PA 7050 , lV v Dieprtlbn Pemd No. '~ ® 7 3 ~" C~ JY'