HomeMy WebLinkAbout09-22-09PETITION FOR PROBATE AND GIANT OF LETTERS
REGISTER OF WILLS OF ~~+~~''~~°~ COUNTY, PENNSYLVANIA
Estate of ~E/Ir:iVP3 ~• ~~~L File Number ~I ~ ~~ ~- 0~~~
also known as ~ E/y~V/.s /~E~-L
___ ,Deceased Social Security Number ~G~" .3 ~ ~ 3 ~~~
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(~'jis / ~ the ~i1'E'C k fJe/ X named in the
last Will of the Decedent dated /~/~1~tCBf /3 , 200j-and codicil(s) dated ~Ii~
(State relevant circwnstances, e.g., renunciation, death ojexecutor, 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: NorvE
^ B. Grant o[ Letters of Administration
(Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durant~absentia; durnnre minoritate)
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: (!f
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~,,,~ r~-a
r_=+
Name Relationshi Resit#eag6l7 ~ ~ ~"
Ems:.
, . ~ .,_t N
_ _ __
.~ _..
~ r
(COMPLETE IN ALL CASES:) Attae% additionLal-s/:eels if necessary.
Decedent was domiciled at death in ~IM~/'/~~ ~ Cc
(List street address, towrt/ciry, township, county, state, zip code)
Decedent, then ` ` years of age, died on '~~ ~ Z~/at
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 Counry
Value of real estate in Pennsylvania
S
$ N ov ~
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the giant of Letters in the appropriate form to
the undersigned:
,.r Si azure T ed or tinted name and residence
X ~ ,~L/.ji~~V~ ~ /«L-LE~-
2Z c~oC w oaD 7`G~~f-~.E
For»i RW-0? rev. l0.(3.oa Page 1 of 2
-r
7
1
~!
~ '-rt
'7
,Pennsylvania with his /her last principal~esidence at ~{Ol'~'+-° :: "~,
~ ,~` ~~
Oath of Personal Representative
CO~~I~IONbVEALTH OF PENLSYLVANIA
/~ ,( SS
COUNTY OF C.~l/JrJY~/~j/ f
'The Petitioner(s) above-named swear(s) or affirn~(s) that the statements in the foregoing Petition are trtie and con~ect to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will we!1 and tnily
administer the estate according to law. ~~
Sworn to or affirmed ands bscribed
nc~
l~,efore me the ~ day of
Si;naau-e ojPersonal nepresentntive N. /~~ L L,~2
~~~/N~ '`
~~?m~~-~ ,a~~C;oI
Si~nnture oJPersona! Represzntntive
~
~
~ ~
~ l.~ .ll • 1 Ue - ~
For the ReglSter Si,,onnture oJPersona) Representative _ i _a <7 "'C7 i
- ,..
,
• - N _
_.,
,
;~
~
~
~
~
- - ~
File Number: ~ ~ -~~
--i r~ ' ,
..
~
~. . .
Estate of ~~°NN~t D
~ • /YLc~'L.. ,Deceased ~~
-'
Social ecurity Number:. /~ ~ " ~ '~ 3 ~~' Date of Death: y tv0. /9i ~'G~ l
AND NOW, , ;~ex~t , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters 7`ES1`!a~'Y1~~1/T'~/Z~/
are hereby granted to ~~-~~~~ ~. /~~~-L~ ~
and that the instrument(s) dated ~~~IC~~'j! ~ 3 ~®4~8
described in the Petition be admitted to probate and filed of record as the last W,~11 (and Codicil(s)) of Decedent.
FEES
Letters ............... $ ~ .O
Short Certificate(s) ........ $ r~~-4 • exj
Renunciation(s) .......... $_
~,,.1~ ~ ~ . ... $ 15 . ~J
`MCP ...$IL.~
... $
... $
... $
... $
... $
... $
TOTAL .............. $-I ~(~
w~.~~,
Attorney Signature:
in the above estate
Attorney Name: !~/i ~/ ~~ `~~ ~'T~~L~~"s
Supreme Court LD. No.: // ~,[(_,
Address: ~~ ~r/Lc~~"' /"/'jam ~'
S7"~ . ~OS~
Telephone: ~~ "~ S`3 - -3 ~ 3~
Pale 2 of 2
OCAL REOISTRAR'S CERTIFICATION IOF DEATH
WARNING: It i:s illegal to duplicate this copy by photostat or photograph.
Fee fin' this certificate. `6.00
P 15730044
Certification Number
This is tie certify that the infornuition here e,i~ren is
currecil~~ copied from ~~.n uri~~inal Certificate I~f Death
duly filed Keith me a, Local Re<~istrar. "I'he original
certificate ~t~ill he forwarded to the State Vital
Records Oflicc Par permanent filin~~.
L~~ ~~ ~~c~~~ae~X' SE ~ 2 1~ 2009
Local Ret~isU-ar Date ls~~ued
C
} -.s
_
L
~ ~n
'
=
;i
`:
~~
' --
r="i ,
~
:.
.
~ r.7
~ ~- .. : 1.
i7 i.
- - '"Ti i`v
_~~-i ~_
~
L, ~1(Ul
l..-, -
• +7
- -t i
G~ ~ .
~
k
H105-143 REV 112006
TYPE/PRINT IN
PERMANENT
BLACK INK
.~
a
0
U
0
N
0
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) ~r,T«„ ~,,,,,,o~o
I. Name of Decedent (Rrst mkdle, last sutlix) 2. Sex 3. Social Security Number d. Dale of Death (Month, tlay, year)
1 - - 6 Se tember 19 2009
5. Age (last Birthday) UMer 1 year Under 1 day 6. Data d Birm (Month, day, year) 7. Itirthpaw (City entl state w foreign country) Be. Place d Death (Check Doty one)
MoaVU Days Han nun+es Hospital: Omar:
6 6 Yrs. Au 2 5 1 9 4 3 Car 1 i s i ~ P a . ^ Inpatlem ^ ER / Outpelknt ^ DOA ®Nursing Home ^ Residence ^Omer - Spedty:
eb. County of Death Bc. City, Bo Twp. Death Bd. Fadlky Name (If not irelilelion, give street erl0 number) 9. Wee DBwOanl of Hispank Origin? ~No ^ Yes 10. Race: Arrelican Indian, Black, White, ek:.
Cumberland U er Allen Tw -'' (q yes,spedtycaben. (spenM
mss S = A ~ ~~ ~ (,,~,, Mexican, Puerto Rican, etc.) White
11. DewtlenYS Usual lion Knd d wodt done dun most d walk' Me. Do ml skle reb 12 Was Decedent ever al th 13. Oecetlenfs Education (Speciry only highest gentle wmpktetl) /4. Mental SIGNS: Mertiad, Never Marred, 15. Surviving Spouse Qf wee, give rtHklen name)
ry,
Nkd d Wark KirA d &uiness I Indust U.S. Amred Forces? ry ry ( ) age (7-0 w Sr) Wdowed, Divorced iSpeciry)
Elamenb / Secantla 012 Coll
Electrical En in er/ Boein ^Yea j{~o 12 rs. 6 + Sin le
16. Decedent's Mailing Address (Street city! town, stele, ziD code)
1 0 0 M t . Allen Drive Decedent's Ditl Decedent UApe r A 11 en Tw
gdrel Residence na. Sale _ P a _ r
sm nc. ~ vea, Decedent Lived in P . ,
~
Mechanicsbur
Pa
17055 o
wn
p ~ 17d. ^ No, Decadent Lrvetl wAhin
,7b.county Cumberland
g,
. AdualUmilsar ciry/Bwo
18. Famels Name (First, mktlle, lest, wHrt) 19. Momei s Name (Frst mkJe, mai0en surname)
Jbhn R '1 Paxton
20a. Intamenl's Name (Type / Pnd) 2W. InlwmanYs Mailing AtlMess (Shea( coy / bvm, Stele, zip cede)
Elain 722 Do wood Terrace Boiling Springs, Pa. 17007
21 e. Method d Disposkion i ^ Cremaam ^ Donation
~
Burial ^ Rertwval hoot Srek i W
C 21 b. Dale of Disposakn (Month, day, year) 21 c. Plew of Dlslrosaion (Name of cemetery, trerlMlory w paler pieta) 210. Lowkon (City / tenet, s1a19, Zip code)
^
r
q
mnatkn or DoM1bn ANhorized
soarsy: iDyMNb.lExamineryDeromr? ^Yea^No
Sept. 23, 200
Good ear Cemetery
Gardners, Pa. 17324
22 tore of Funeral Service Lic pe n such)
~ 22b. Uterine Nurrber
^ 22c. Name ell Address d Facility
501 N. Baltimore Ave.
- D-011932-L Hollin er FH/Crematro Inc. Mt Holl S Tin s Pa. 17065
to Hems 23ac any when cerotyirg 23a. Tome my knowledge, deem attuned at the 8me, date all pace slated (SgnaNre all tkk) 23b, license Number 23c. Date Signed (Monet
day
year)
physkian a rid aveilede at kme d deem to ,
,
wetly wane d deem.
aema 24-28 must ce wmpetetl M person
h
tl
n 24. Time o/ Death )
~ 25. D k Prorwunwtl Dead (Momh, tlay, year) ~
C 26. Wes Case Flefenetl Io Medical Examiner I Coroner fro a Reason Other then Cremation or Donatlon7
w
o pronounces
eat M.
~p r J O (~
1 lT-'~x'O
/~'}~~ ~~ 1
t ^ Ves ^ No
CAUSE OF DEATH (See Inatructlbna enk a mpka)
I gpproximale interval:
Item 27. Pan I: Eller mechain d eyellls -diseases, injures, or campliceturls - mat drectly roused hie deem. DO NOT enter temxrel aveds such es car6ec anent. Onset to Death Part II: Enter dhw gjyDirywnl contlakns contMudno to deem
bN not resUli in the untle '
ri
T
n
e
i
i
P
n I 28. Ditl Tobacco Use CanMdlle to Deam?
^ Ves Probed
resprerory anent w vernrcdar fibMaewi wilhpa showing me etiobgy. Liq linty one rouse on each Imo. g
yi
g rous
g
ven
n
a
. y
IMMEDUTE CAUSE IFinal dsease w ^ Unlmown
wnditbn rewmng In Death)
~/
(~} I
a
J
T I ~
(
~l
C
y 29. q Female:
-~
~
.
\
1
.
Q
I
r
5
Due to for as a consequeree of): ^ Not pregnant organ pest year
sewe^baAy rst cmrtliona, ti any p. D YSPH-A G t A ~ ~.(/QQ~(5
leednp to the wow listed on lire a. ^ Pregnant al &r,e of death
Dw to (or as a
Enter Be IMIDERLYING CAUSE consequence of): I
^ Nol pregrent ba Pregnant wimin 42 days
(disease w inryry that initialed me ~/} ~ K) nrSo N % 5 m .
Q
a of deem
~
~
wRMS resulting in dean) LAST.
, S
Due m (or a wnsequence of):
~
a
l•Wl pmgnant 43 days totyear
^ ~~
p
d. I
QOBRS[-L~ LEWY [30Dx/ DeM~~ 1 ~W ^'f4 euJS ~m
w
e
^ Unkrwwn d pegnant wAtkn the past year
33a. Was an Aulopry
Pedormetl? 3W. Were qukgsy Filk6gs
Availede Prior to Completion 37 Ma of Death 32a. Date of Injury (Monet, tlay, year) 32b. Describe How Injury Occuned 32c. Place al Ir{ury: Home, Farm, greet Factory,
of Cause d Deelh?!
Nelural ^ Iswnkkk ~ Olfice Bdkirg, etc. (Spenlyf
^ ye5. ~ ^ y~ U N0
u ^ Acddent ^ Pamkrg Investigation 32tl. Time of Injury 32e. Injury al Work? 321. If Transponadon Injury (Specity/ 32g. Location of Injury (Street city /town, slate)
^ Suidde ^ Cook Not be Delemunetl ^ Ves ^ No ^ Deter I Ope2tar ^ Passenger ^Pedestnan
M ^Omer -Spent'
33e. Certifier (check only one) 33b. Sigmlure end Tilk of Canilier
• CMitying physiebn (Physkien wrtaying cause of deem when arwttwr pnysidan has pmnaunced death ark wmpletetl Item 23)
~•
%'~
To the bests my krwwkdge, tleslh occurred due totM UUee(e)end manner ae shted______________________~___---____
• P -
~
~Y/[X~`~~~(j/e'v"""~
roriouncing end certayirg phyaklan (Physician born pronouncing deem end wnilying to cause d death)
To the beet of my knawlegg.
deem oxumdat the llme
dMe
and pew
and d
l
,h
d
^ 33c. Liwrlse Number 33d. Date '
Sgnetl (Month, day, year)
,
,
,
,
ue
o
a wua6,eierl
manner ae atalad------------------
• Medkal Examiner /Coroner 'L
~D~dS`~ 75 ..Y
09-a~ -
09
?1
On the basis of examWhon entl I w investigation, in my opiMOn, death occurred at the Bme, dale, and pMCe, all due to the cause(s) and manner es stated_ ^ ,
1
34 Name and Address of Person Who Canpkletl Cause of Deam (Ite m 27) Type / Prim
35
Regist tore entl Dot •S~f~I/ NOORL° /9KSH M/>
.
~ic- ,~
- ~ ~e~,c" der- I ~: I ( I r~ I f I ~t I ,Oa Filed (Monet, day, year) too m T ~9LAEn/ ORS ve
PA i7oS
Dispositron Permit No. ` 1f ~1,•. ~~I
i
LAST WILL AND TESTAMENT
OF
DENNIS NELL
I, Dennis Nell, of Huntington Beach, California, revoke my former Wills and Codicils and declare
this to be my Last Will and Testament.
ARTICLE I
PAYMENT OF DEBTS AND EXPENSES
I direct that my just debts, funeral expenses and expenses of last illness be first paid from my
estate.
ARTICLE II
DISPOSITION OF PROPERTY
A. Residuary Estate. I direct that my residuary estate be distributed to Elaine N. Keller, 722
Dogwood Terrace, Boiling Springs, Pennsylvania 17007. If such beneficiary does not survive
me, my residuary estate shall be distributed to the following beneficiaries in the percentages as
shown:
100.00% to James Keller, 722 Dogwood Terrace, Boiling Springs, Pennsylvania. If this
person or organization does not survive me or is not in existence, this share shall be
distributed in equal shares to the other distributee(s) listed under this provision.
ARTICLE III
NOMINATION OF EXECUTOR
I nominate Elaine Keller, of Boiling Springs, Pennsylvania, as the Executor, without bond. If
such person or entity does not serve for any reason, I nominate James Keller, of Boiling,S~rings,
Pennsylvania, to be the Executor, without bond. ~~
>~ ~ ~:
r~
r--
} , 7
Pv i
'' ~~ _~
~
-, ,-~;
~ ,
,
-
N
°.'~,;
ARTICLE IV
EXECUTOR POWERS
My Executor, in addition to other powers and authority granted by law or necessary or
appropriate for proper administration, shall have the right and power to lease, sell, mortgage, or
otherwise encumber any real or personal property that may be included in my estate, without
order of court and without notice to anyone.
ARTICLE V
MISCELLANEOUS PROVISIONS
A. Paragraph Titles and Gender. The titles given to the paragraphs of this Will are inserted
for reference purposes only and are not to be considered as forming a part of this Will in
interpreting its provisions. All words used in this Will in any gender shall extend to and include
all genders and in numbers when the context or facts so require, and any pronouns shall be taken
to refer to the person or persons intended regardless of gender or number.
B. Spouse. I am not currently married to anyone.
C. Children. I do not have any children at the time of the signing of this Will.
IN WITNESS WHEREOF, I have subscribed my name below, this _~3 day of
PROOF OF WILL
On the date written below, Dennis Nell declared to us, the undersigned, that this instrument,
consisting of r 3 pages, including the page signed by us as witnesses, was his/her Will
and requested us to act as witnesses to it. He/She thereupon signed this Will in our presence, all
of us being present at the same time. We now, at his/her request, and in his/her presence and in
the presence of each other, subscribe our names as witnesses.
We are acquainted with Dennis Nell. At this time he/she is over the age of 18 years, and to the
best of our knowledge, he/she is of sound mind and is not acting under duress, menace, fraud,
Page2of3
misrepresentation, or undue influence.
Each of us is now more than 18 years of age and a competent witness and resides at the address
set forth after this name.
We declare under penalty of perjury, under the laws of the State of California, that the foregoing
is true and correct.
~Gri8
Executed on /v~ ~~iiu'si , ~ at c~9ri.Lt ~~t , /~.e „~, ~~,~,yN~ ~
~'v ~ ~c-~
Witness Signature: ~~
Witness Name: !~/i ~/~ :~-, S, ~~~IG-GS'
Witness Address: /Q yp fl7~srs~~s.~ti ~.~
/ 3 Zy ~-
Witness S
Witness N
Witness Address:
Page3of3
OATH: OF NON-SUBSCRIBING WITN=ESS(ES)
REGISTER OF WILLS
( ~~ //r.~J COUNTY, PENNSYLVANIA
Estate of
~~~
~, ,~~LL.L'2_
and
Deceased
(each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well-
acquainted with , ~~~-.~~ s' /`~~ w~6~ and am/are familiar
with the handwriting and signature of the decedent, and that the signature of ,e~wir ~ '~-~=~~
to the foregoing instrument purporting to be the Last Will and Testament/Gedi•etl of ~~°~-~~/ /~ ~1"~
is in his/13er own proper handwriting.
(.S,,nnrw e)
(SU~eet Address)
(City, Stnte, Zip)
Executed in Register's Office
Sworn to or affirmed and~ubscribed
/Y
bef me this ~~ day
of ~ '' , ' (Xr1
C u.;- C~- 0,~
puty or R ~ inter of Wills
Form RW-04 rev. 10.13.0(
gn ure ~~"~'G.L,L~"~'L
/9 ~.~c_s' Y~ .
(Street Address)
(City, Stnte, Zip)
n N
~
C 0 ~
Ll v7
~ ~.. ~
~
- R7 )
~ _ r
,- m Yv
;
,
_,c.
- ~ ~s
`
w
~,
N
2G~9 SEP 2'L ~~ 3~ 22
OATH OF SUBSCRIBING WITNESS(ES~ ~!-~;~;~ ~., ~
v.,~'i';
REGI/STER OF WILLS
~t~/~~/>~" ~` COUNTY, PENNSYLVANIA
Estate of ~,J~~N~1/IS ~' /~~°'L-L-
Deceased
~^'~~~/~"''' ~ ~~ w~~G'S' , {each) a subscribing witness to
(Print Name/s)
the, Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, deposes} and
say(s) that ~e / he / ~y was / w~ present and saw the above Testator / Te~ix sign. the same
and that s~ / he / th~y signed the same and that ~te / he / tl~y signed as a witness at the request of
the Testator / Te~s~dfrix in l~/his presence and in the presence of each other.
(Signature)
(Street Address)
(City, Slate, Zip)
Executed in Register's Office
Sworn to or affirmed an subscribed
befor,~ me this day
of ^ 7 ) )
eptyfy for register of Wills
(Stgnature ~I~/~~~!'~ `~. ~~~ ~`~
(Street Address)
G'.y2,~ •~~.:.t', ~~ ~ "~- 32-7
(City, State, Zip)
Executed ottt of Reegister's Office
Sworn to or affirmed and subscribed
before me this _ day
of ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified [o
administer oaths. Show date: of expiration of Notary's Commission.)
NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrume:nt(s) at time of notarization.
Fornt RW-03 rev. 10.13.06