HomeMy WebLinkAbout06-15-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
Estate of Charlotte C Koser
COUNTY, PENNSYLVANIA
File Number ~' - ~ U ~ ~ l..P 0
also known as
,Deceased Social Security Number 161-34-1~'7 ~~
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Petitioner(s), who is/are 18 years of age or older, apply(ies) for: y~~ ~ ~ ~ '
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(CO.tIfPLETE 'A' or 'B' BELOW:) ;F. ~ ~ ^~. _---.1
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A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the reed in the r
last Will of the Decedent dated and codicil(s) dated ' ~ """" -~_~ r`r~3
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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 xeiauonsm ncsiucuvc
Tina Toombs daughter 854 Lindsey Road, Carlisle, PA 17015
Jerry Kennedy c/o Tina Toombs son 854 Lindsey Road, Carlisle, PA 17015
James Koser son 553 Robin Circle, Apt. 3A, Wasilla, AK 99654
Paul Weigle son 90 Gordon Drive, Carlisle, PA 1701
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Tara Jones , daughter , 1 16 E 1 m S t r e e t
Carlisle, PA 17013
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
116 Elm Street Carlisle Carlisle Borough Cumberland County Pennsylvania 17013
(List street address, town/city, township, county, state, zip code)
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Decedent, then 67 years of age, died on June 6, 2010 at Harrisburg Hospital, Harrisburg, Dauphin County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 1 ~ , ~o`~' a
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ ~~% •'~'~ "j
situated as follows: ~ ~ ~, ~ f /~'~ S "t/'a*L l~ ~~-" ~ J) ~'Z- )~~{ ~ -7 ~ 1 .3
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:
Si nature T ed or rinted name and residence
.~G~"^-- -_. Tina Toombs, 854 Lindsey Road, Carlisle, PA 17015
Form RW-02 rev. 10.13.06
Page 1 of 2
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fee for this certificate, $6.00
P 16534681
Certification Number
I H105.143 REV 11!2008
TYPE /PRINT IN
PERMANENT
BLACK INK
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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.
t~ ~ ~%~~-C/ ` ...TUN 8 010
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t_ocal Registrar Date Issued.
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examoles on reverse) __-__ _.. _ _.... ____
t. Name a Decedent (First, middle, last. sunlx)
Charlotte Koser 2. Sex
Femal 3. Social Security Nurllbar ate a aalh (Mon day, )
e. 6 - 34 - 1177 d~~
5. Age (Last Bkdtday) Untla 1 Under 1 9. ale a BiAlt Madtt, der , 7. and sb4 a ' 8a. Place a DeaM Check ate
67 1lorter Days Fioas Milaees
Mar . 12 , 1943
Cumberland Co .
PA Hoapit Other:
Yre , ~ ^ ~! Outpatient ^ ooA ^ Nureing Hans ^ Reaidatce ^ oti,er speciM.
Bb. Cotrtty d ash Bc. City, Boro, Tit. a Deadt 8d Fadtity Name (If not irtsttilrtiort, give street and rllmtber) 9. Woe Decedent a Hlapank Odgn7 ®No ^ Yes 10. Race: Artterkan ktdart, &eck, Wilde, etc.
Dauphin
I'
Harrisburg
Harrisburg Hospital
(, PuarbcR~kan', ek.)
(~~ White
• 11. Dscadsre's Utaral lion a work d ata most a Ye. Do not state 12. Was Decedent ever n the 13. Dendent'a Education (Spetdly ady Fwplxwst grade conp kled) 14
Marital Status: Married
Never Mertied
15
Survivin
S
o use (If wile
ive melden name)
KlndaWork KlndaBtainesa/ktdeky U.S. Armed Forara7 Ehmenhry / , (0,12) Cabge (1.4 to 5+) .
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Widowed, Dtvand (Specify) .
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Executive Secretor State Goverment ^Yes(~Na 12 Divorced
11i. Dendanre Meiling Address (Street, ciy /loam, slate, zqt soda) Decedenys Did Decedent
116 Elm S t . Aaual Residence 17a. stale
17c. ^ Yes, Decedent lived In Twp.
Carlisle
PA 17013 ~?
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wedwiUtin Carlisle
,ro.cotatty Cumberland nd. [~
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AcWaILmsla
18. father's Name (first, rttirkfe, lest, sulfur) 19. Motltera Name (Fret, mkkee, maiden sumante)
Paul Myers M rtle Baum
20a. InformenYs Narre (Type !Print)
Paul Weigle 20b. Inbrrttant's Meiktg Addreae (Street, ttily /town, state, zIp code)
90 Gordon Dr. Carlisle PA 17013
21a. MNltod d DisposiUort ~ ®Gerltetbn ^ Datation
~ ^ Budd ^ Removal tram st
t 21 D. Dale d Dlspottidm (Month. day, year) 21 tton (garn~ t n cremabry qr o pin)
~oa I Iman-K Lo °11 "nerSl Rome & 21d. l.ocetlon (Ciyl bvm, slate, z~ code)
a
e r Wss Crematkn a DoltsBon A
^ other- l by ExamYter/Cororrx?Yea^ No June 8, 2010 Crematory Carlisle, PA
22e. a Funeral atdkg as such) 226. Llnnee Number 22c. Ntm end Adt*ese a Fedlity
Hoffman-Roth Funeral Home & Crematory
Inc
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138504 ,
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219 N. Hanover St., Carlisle, PA 17013
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pftysidan bl not av set tlme d death b 23a. To the best d my knowledge, death axsred at the dme, date ant place slated. (Signatree and 11tle) 23b. Licenea Number 23c. ate
Signed mod'' day, Y~~
certlly rarxia a deah.
game 24-28 mtW 6e completed by person
~ who pronounces deatit 24. Tme a Death 25. ah Oead (Month, de year) 28. Wes Case Referred to I~iadkal Examiner /Caster far a Hasson Other tlten Cremelbn a Donetion9
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CAUSE OF DEATH (Sea IasVuctlona a xamples) l Approxkneh interval:
Item 27. Part I: Enter the ritekt a events -diseases, iry'sies, a calpkcatials • tlml directly caused the des NOT enter hmtktel events such as cardiac arrest, r Onset b aallt
i
t Pert II: ter other '
but not m the ands
resatilg dYn9 cause given in Part I. 28. Did Toftacco Uae CaNrbtlte to Deadt9
^ Yes ^ Probably
resp
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ory arrest, a ventdadar BbliMetion witltout showktg Ste etiobgy. Ust sty ate Catree kne. r
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IINIEDUITE CAUSE fFvt~ disease a
r ^ No ^ Unknown
i
cortdlYon restAlirtg m b) _~ a ~ ~ ~` t Lr.+~.t' ~ t /.s.--' \ ~ ~ ~ V 5 i 4c1 '
29. I{I-Fyem~~p_.
Due b (or a ~ a): i
f-m--WI kst axldtlons, g arty, b. r V~ ~ ~ Z ~ ~ t ~~ ~ rtn ~,~ i
(~W OIB CBUSa IISOBd al Mlle 8.
~~ m ^O1 t•t P~ Y~r
^ Pregnant at time a death
^
erg 10 a ae 8
Enter UNDERLYMIG CAUSE ( a): ~ Not pregnant, but pregnant wi8tilt 42 days
(disease a itj<try that ktitiated the
r of death
c
evenly resulting n death) usT. l
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Due b (a as a consequence oq: r Not pregnant, but pregnant 43 days b 1 year
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l bebre death
^ UnknOwn N preglwd witlen the past year
30a. Was an Aubpsy
Pedamedl 3tlb. Were AWapsy firtdhtgs
Available Prior b Corlpletial 31. Manner of Death 32a. Dale of Irtjlay (Month, day, year) 320. Descrbe How ~Y Oaared 32c. Plxe a Injury: Home, Farm, SbeeL Faclay,
a cauaa a Daetn~
~' ^ Hanktide Odice Buiktrlg, ek. (Specify)
^ Yes No ^ Yes ^ No ^ Accident ^ Pertdirtg Mvesligatiat 32d. Time a Injtxy 32e. Injtxy at Wak? 321.9 Transportation Injury (SpepTy) 32g. Lotatiolt a kNury (Street. city /town, state)
^ Suicide ^ Cadd Not be atemwted ^ Yes ^ No ^ Driver/Operela ^ Passenger ^ Pedestrian
M Other • Sped/y
33a. Certifier (Glatt! ally ate) 33b. Signature and Tito a Cert9ier,.
• ~tfYln9 PhY~~ (P6Y ~gYk9 cause a decal when arto8ter physiGart ltas pratourxxd deatlt and completed Item 23)
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rote.6e.LamYknowrdge.dsaMoeuwredduatotheauaNa-andmanneraaatatW--------------------------------- ^ r .--;
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• Prarauncfrtg and aAilykq phyNcisn (Physiden both prortotxtcng death and atrt8ykg b cause a death)
To the bat a my krtowlsdge, detlh oct'uned n the tttrr, doh, rid plan, and due to dh ceuee(e) and manner a ahbd_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
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ale Signed ( ,~, Year! /~
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On the bss{e a stremlmUon and / a Invastlgetbn, In my oplnlon, d.ant osclxnd st the Ums, dab, and plan, and due b Ute cause(s) and manner ee etalad_ ^ 34. Na
mye~end Address a/ 1e
~ C rtes a Death T Print
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R ; 66rs ~Sgrettxe and DTs ' N r
~~ ~/ ~~/ ~ y ~ 38. Da Fried (Mmtlt, day year)
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Disposition Permit No.
RENUNCIATION ~ ~ --~
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REGISTER OF WILLS ~ ~ ~
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Cumberland COUNTY, PENNSYLVANIA ,
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Estate of Charlotte C. Koser ,Deceased
I, Jerry Kennedy , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Tina Toombs
~ i~~
(Date) ignature)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
'.~:%
(Street ddress)
~~ ~ a ~
(City, State, Zi )
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciat' n for the
purpos tated within on this day
of fl ~
N
ssion Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
pE{W~ISYLV
....__..------°-~ Public
~~@ @~~ @.~irM vNo , 29, 2011
~44,~Ctf :~~~~F+ia Astaean of otarie~
RENUNCIATION r~~ ~.. ~ ~f-
REGISTER OF WILLS ~` ~~'' ~ ~ -~ _
C"~ C..~ -,-r s~
Cumberland COUNTY, PENNSYLVANIA ~~~`~ c '
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Estate of Charlotte C. Koser ,Deceased
I, Tara Jones , in my capacity/relationship as
(Print Name)
daughter of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Tina Toombs
l1 ~u~n ~ ~Oln
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature)
//I~.~t-~yS~
(Street Address)
~rrlr~/~~ 114 /7GY,~
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunc}a~~,on for the
u os state within on this ~l ~`1 da
p rp a~~ Y
of _ ,
No ry Pu li U
M omm>ss>.on Ex Tres:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
CiOMMCNiNEA-L~H ~~ pENN~~LVANIA
Ncl!ta-~aii ~epd
,lenrilf~' ° ~~ Llrxisay, Notary R'ut~lic
CarltsWe ~, ~~ ~~
My Ccxnmissicxt E~ires Nov. 29, 2011
Member, F'ennsyl~ania Association of ' otaries
RENUNCIATION
REGISTER OF WILLS ~ ~ `'
Cumberland COUNTY, PENNSYLVANIA ' ~ ~'c-~ _J^~' ~ __i
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Estate of Charlotte C. Koser ,deceased
I, Paul Weigle , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Tina Toombs
(Date)
.-~-~
Signature)
c/ d ~'ot ~o~ ~r'
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
(Street Address)
~ r /~ ~ (~ /~~' /701 ~j
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciat}on for the
purposes ated within on this ~ °~ day
of 1
Nota~/Public U ~ ( ~
My C emission Expire
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Form RW-06 rev. 10.13.06
Notarial Seal
Jenrwfer ~', undsay, Notary Public
Carlisle Boro, Cumberland County
My Commission Expires Nov. 29, 2011
Msmbsr, Pennsylvania Association of (~otarles
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RENUNCIATION ~ ~ ~ J
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REGISTER OF WILLS ~~~ ~„ {~~~~'~ "r
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Cumberland COUNTY, PENNSYLVANIA ~~ `~' =~~~~ ~~ -`
`j 'xY u't ~ '~ ~,~
Estate of Charlotte C. Koser ,Deceased
I, James Koser , in my capacity/relationship as
(Print Name)
son of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Tina Toombs
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of ,
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
1/
(Si ature)
,5~~~'3 ~v~•h C,~ 3~
(Street Address)
(city stare, zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciatip~n for the
purposes ed within on this ~"~'1 day
of ~
No~:~~ Pu is ~ 1J
M ((~~ ommission xpires:
(Signature and Seal of Notary or other officia4 qua{ified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH ®F PENNSYLVANfA
Notarial Seal
Jennifer ~ ~ .Lindsay, Notary Public
Carlisle Boron Cumberland County
My Commission Expires Nov. 29.2011
Member, Pennsylvania Association of Notaries