HomeMy WebLinkAbout10-08-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Marilyn A. Kangas
also known as
COUNTY, PENNSYLVANIA
File Number ~ t- bq - D 9 5 2
,Deceased Social Security Number 191-40-9428
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Petitioner(s), who is/are 18 years of age or older, apply(ies) for: `; ~ ~'-'
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0 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the _-~
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last Will of the Decedent dated and codicil(s) dated _
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(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
(If applicable, enter. c. t. a.; d.b.n.c.t.a.; pendente liter durante absentia; durante 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: (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 ~
Helen H. Kangas ~ Mother ~ 1 Beaver Road, Camp Hill, PA 17011
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
1776 Weatherburn Drive, New Cumberland, Lower Allen Township, Cumberland County, Pennsylvania 17070
(List street address, town/city, township, county, state, zip code)
Decedent, then 61 years of age, died on June 29,2009 at 1776 Weatherburn Drive, New Cumberland, Lower Allen
Township, Cumberland County, Pennsylvania 17070
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
5,000.00
$ 115,000.00
situated as follows: 1776 Weatherburn Drive, Lower Allen Township
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:
or printed name and residence
- - - ~ ~~I Helen H. Kangas, 1 Beaver Road, Camp Hill, PA 17011
Form RW-02 rev. 10.13.06 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 representatives} of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
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Signature of Personal Representative
Signature of Personal Representative ~-j ~
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Estate of Marilyn A. Kansas ,Deceased
Social Security Number: 191-40-9428 Date of Death: June 29, 2009
AND NOW, ~~~~~.. ~ oZ (~U , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Helen H. Kansas
in the above estate
and that the instrument(s) dated NONE
described in the Petition be admitted to probate and filed of
FEES
Letters ............... $ Z.I,~tJ • l7~
Short Certificate(s) .. ~.... $ ~ 2 - Ulf
Renunciation(s) .......... $
... $ 5. ~1~._
... $
... $
... $
$
...
$
...
$
...
... $
TOTAL .............. $ L ~ ~ - 0 ~ ear
Form RW-02 rev. 10.13.06
the lasx WJ~11(and Codicil(s)) of Decedent.
Register
Attorney Signature: ~
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Attorne Name:
Y Elyse E. R ers
Supreme Court I.D. No.: 41274
Address: Keefer Wood Allen & Rahal, LLP
635 North 12th Street, Suite 400
Lemoyne, PA 17043
Telephone: 717-612-5801
Page 2 of 2
Sworn to or affirmed and subscribed
before me the ~ day of
H1~~.Rt?5 ngV rat/~7i
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
This is to certify that the information here given is
correctly copied 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.
P 15~7~7~2
Certification Number
JUL 0 2 2 09
Local Registrar Date Issued
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REV 1112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
AANENTN CERTfFiCATE OF DEATH
CK INK See Instructions and exam lee on reverse
P STATE FILE NUMBER
1. Name of Decedent (First, middle, lest, sufax) 2. Sex 3. Soceat Security Number t 4. Data of Death (Month, day, year)
Marilyn A. Kangas female 191 - 40 - 9428 June 29, 2009
5. Age (Last Binltdey) Under 1 ear Urxfer i da 6. Date of Birth (Monts, de ,year) 7. Birthplace (' and state or fo count) 8a. PWce of Death (Check Doty one)
Hospital: Other:
Mo.w~ t>~ twvn t
61
July 4 , 1947 Knoxville , TN ^ trtpatient ^ ER / Oulpatlent ^ DOA ^ Nursing Home ®Residence ^Other - Sperafy:
Yrs.
' 8b. Camry of Death 6c. Ciry, Boro, Twp. of Death 6d. Faddty Name (If not instllu6bn, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^ Ves 10. Race: American Indian, Black, While, etc.
• Cumberland Lower Allen Tw
p . 1776 Weatherburn Drive (if Yes,apecitycuben, (specny)
Mexican, Puerto Rican, etc.) whit e
11, lkcedents Usual ibn Kind of work d one du mast of 9fe. Do not slate retired 12. Was Decedent ever in the 13. Decedent's Educatbn (Spertily Doty highest grade completed) 14. Marital Status: Married, Never Married, 16. Surirving Spouse (If wife, give maiden name)
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Kind of Work Kind d Br>einess / Irtdtrstry U.S. Anted Forces? Elements /Secondary (0.12)
2
~ Cola (1-4 or 5+)
6 '
er Married
N
Teacher Education ^Yea ®No . ev
16. Decedents Maidrtg Address (Street, city i town, state, zip code) Decedent's Did Decedent
State Pennsylvania Live in a 17c. ®Yee, Decedent Lived in Lower Allen Twp
Aduel Residence 17a
17 7 6 Weatherburn Drive .
Township? 17d
Decedent Liven within
^ No
• New Cumberland, PA 17070 ,
.
17b.County Cumberland AdualLimitsof city/Born
• 16. Father's Name (First, midde, lest, sullix) 19. Mother's Name (Rrst, middle, mttidart wrrtame)
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Onni E. Kangas e
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20a. Infarttant's Name (Type I Prinq ZOb. Informant's MallNtg Address (Street, city / tarn, state, zip code)
Helen H. Kangas 1 Beaver Road, Camp Hill, PA 17011
- 2ta. Method of Disposition ®Cremalbn ^ Donatiion 21b. Date of Disposition (Month, day, Year) 2tc. PWce of Disposilbn (Name of cemetery, crematory or other place) 21d. Locaton (City /town, state, zip code)
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^ Burial ^ RerttovalfromState ! W
n„n,ar~ad
July 1, 2009 Evans Crematory Schaefferstown, PA 17088
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^ Doter - spary: by
~ 22e. signature d F (or person actktg as stx;h) 2~. ucensa Number 22c. Name and Address of Fadfiry Pa r t hem0 r e FH & C S , Inc .
O. Box 431, New Cumberland, PA 17070
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Contpble Nana 23a~c arty 23e. To the best d my kno•'l•rl9•, death otxxrrted et the time, and place stated. (Signature and title) 23b. License Number 23c. Date Signed (Month, day, year)
physician W not available at death to
- cattily cause d death.
' Items 24-26 must be oorttpletad by Parson
24. nme or Deem
26. Date Pronounced Dead (Month, day, year)
26. Was Case Refened to Medical Examiner i Coroner for a Reason Other than Cremation or Donation?
• who pronotatcea death. M. U e ^ Yes [/~No
CAUSE OF DEATH (See Instruetlons and examples) r Approximate mtervai:
t
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Pan I
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lti 26. Did Tobacco Use Contribute to Death?
[] Yes ^ Probabty
as car
ac arres
events suc
, t Onset to Death
Item 27. Pert t. Enter the Mein devents -diseases, injuries, a contplicatiats -1ha1 directly caused the death. DO NOT enter termina
respiratory arrest, or ventrialar 6bridation without showing Mte etiology. List Dory one cause on each lute. ~
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but not resu r No ^ Unknown
pJMEDIATE CAUSE (Paul disease or r
Cortdflion resukatg in lh)
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a 29. If Female:
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to (or a consequence o . t
Yst cortdtions, d ant, b
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pregnan
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^ Pregnant at time of death
.
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a Oue to (or a conseq off: r
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o ^ Not pregnant, but pregnant within 42 days
NIG CAl1SE
U1~E
Enter 9u
' (daease a irtNtry that initlated the r
r
o of death
events result n death) LA T,
'
r ^ Nd pregnant, but pregnant 43 days to 1 year
• Due to (or as a consequence of):
t
• d. r before death
^ Unknown if pregnant within the past year
~. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of DeeCt 32a. Date of Injury (Monts, day, year) 32b. Describe How Injury Occuned 32c. PWce of Injury: Horne, Farm, Street, Factory,
Olfwe Building, etc. (Specify)
Perforated? AvaiWble Prior to Completbn
of cause of Death? ~Naturel ^ Homicide
~ ^ Aatidern ^ Pendng investigation 32d. Time of Irtryry 32e. Injury at Work? 32f. H TrenspoAadon Injury (Specfly) 32g. Location of Injury (Street, city !town, sate)
^ Yes ~NO ^ Yes ^ No
^ Sukide ^ Could Na be Detemdned ^ ~
^ Yes ^ Driver! Operator ^ Passenger []Pedestrian
M Otlter may.
33a. Certifier (check oNy one) 33b. S' re and W of iffier
• C•rtNYM9 phyabWn (Physician certifying cause of death when another physicWn has prortourtced death and completed Item 23)
_ _ _ _ _ _ _ _ _ _ ^ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
death scarred due to dre cause(s) end mertrter as atatad
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• Prortoundtp and carlMying physkWn (Physician both pronouncing death and certifying to cause of death)
^ 33c. L' se Num r / 33d. Date Sgned (Month, day, year)
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To the best of my knowedge, death occurred at the time, date, and place, and due to the cautpe(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ _ _ h'1 ~ "' ~ '1 L 3' 7 L l (J '' ~'
2. L1;- ,
• Medcal Examiner /Coroner
On the baste of examinetfon and I a Investlgetion, In my opinion, death occurred et the time, date, end place, and due to the cause(s) and manner as atated_ ^ n Who Completed Cause of Death (Item 27) Type I Pd t
Ot Pers
me and Address
34. Na
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