HomeMy WebLinkAbout02-0811
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of t.); / / J q fY\ f.f K e. I'm
also known as
No. :LJ- c ~ -g II
To:
Register of Wills for the J _ _ l
County of ~ \.). '\"<\. 'b elr t....l1....Q1n the
Commonwealth of Pennsylvania
Deceas~.
Social Security No. ,;269 . ~8'" 15' If
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl \ r\ a
\
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Q
h \ OS last family or principal residence at
Decendent at death owned property with estimated values as folllows:
(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:
$ )() I 7:2/ ~ L/t:p
$
$
$
Petitioner h()5after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Dr
t1o..{"O
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersi~n~. .
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF ~_<A. VY\. "De-'\- \a. 't,J .
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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 above decedent petitioner(s) will well and
truly administer the estate according to law, ; )
Sworn to or affirmed an. d SUbSCribedf ~ /11. {-(~
before me this 6th day of v Ic /Y) ~ ~
SEPTEMBER ~~2002
~ 'Ol. QJb I u..tt'lor'Ira'f'.1 ~1LYl~~ I
Register l
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No. 21-02-811
Estate of WILLIAM H. KEIM
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW SEPTEMBER 10, ~2002 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that RITA M. KEIM
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to RITA M. KEIM
in the estate of WILLIAM H. KEIM
~ vn.~ 1~~'fOL' (ELl. ~~~ ~
Register f Wills
FEES
Letters of Administration
Short Certificates( 1) . . . . . . . . . .
Renunciation ................
:c~'c......,"'"f"'.>
$ 50. 00
$ 3.00
$
$ 5 . 00
TOTAL _ $ 58.00
FiledS~.~~~~F;~. .1.Q'....... A.D. u 2002
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
MAILED LETTERS AND SHORT TO ADMINISTRIX SEPTEMBER 11, 2002
H105.805 REV 9/86
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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
8386850
No.
:t'-,.-? r,../....-"
0).;,.4(,/ / /," 7' &:2..-{~./F
Local Registrar
AUG 2 U Z002
Date
3 Ae\l. 2187
COMMONWEALTH UF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STAfE J."II.E :-luMBER
~.A"EO~7~E~E:T;~M'~:'~~e im --''--- -------------- :::- -lo~~tCURITYNUM~~ _ ~~ ~4
AGE !ldSl BIfIMay) UNDER 1 YEAR UNDER 1 DAY - [ OATE OF BIRTH BIRTHPLAce:c~I'~:;;; -- ~E or DE~~~~~..-;;~" ;)j.::...._~~ 'Jl"'~' .~t
Monm. Days Hou.. U....... MOfUh Day '8t11'l jtilltJ.)II"Cf~rgfl(OUf.lI'() HOSPITAl.
.. 6 5 y" . 2 / 2 8 / 3 7 ~_t""'l~ ER/Outpa..... LJ 00.. D
COUNTY OF DERH CITY. 9ORO. fwp oFciEAni-- FACk.~NAMEiil no! ,nsNI.,ll(;fl, ,;jl'..e s1r~ oIn,J llUfn08f I
G.l1 {Z,T +IOSPrr/lL
lb. Cumberland
DECEDENT'S USUAL OCCUMION
(~~~otlif~:SO~~:.l~
. Pa State:Police
11.~OrenS1C photographe 11b. .
DECEDENT'S MAfLJNG AOOReSS (St.eet:. C.r,ITown. $tate. bpCoael
6018 Hummingbird Dr.
Mechanicsburg, pa. 17050
...
FATHER'S NAME (Flf5l. Mt4XJle. Last)
II. Harry G. Keim
INFORMANT'S NAME ,11pelPnnt)
2C1a.Rita M. Keim
METHOO OF DiSPOSITION
8uriIf 0 c.emationII Removal f.om SIal. 0
0thtIr (::ipeafyl
..~ast Pennsboro
KINO OF BUSINESS/INDUSTRV
:.7VJ(J[6TJE dOt))
::;,.,,0
RACf . Amenun Indian, aa.c.... WMe. otic
ISpecfl'.,)
'0.
White
DECEDENT'S
ACTUAL
RESIDENCE
(~IOSl'UCIlOl1$
onOlt\er Sldel
17a. State
UAAlTAL STATUS. Manred
Navet ~fle<J. Widowed.
0N0tce<J ISpecdy)
1.. Married ... Rita
"..IID Yoo.__.....'" Hampden
SUFtV'VING SPOUSE
lit ........ ill.... ma.oet\ nama,
M. Kautz
Cumberland
Did
--
liYe..,a
IOW"SlUp?
Iwp.
1 lb. County
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DATE OF DISPOSITION
lMonm.lJav. Year)
D 21bAugust 28,2002
LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER
.~ 22b FDOI2774-L
...Eas t
Harrisburg Crematory 21.. Harrisburg, Pa.
NAME AND AOOAESS OF FACILITY
22c.Richard!l~n F.H.29
LICENSE NUMBER
17109
S. Enola Dr. Enola Pa. 17025
DATE SIGNED
{Month. DillY. 'fearl
2..
27. PART I: Ente, Chw dlhaHS, I"JUlies Of compkcallons which cau
Laaa onty one cause on each ltna
()Q;2
2D. 23c.
WAS CASE REFERRED TO MEO~MINERtCOAONeR1
... Yo.l':T A' G #1 NoD
I ApprQ.JF.imate PART H; OVI8r s.gniftcanl condIIion8 CXM'IIrlbuting co a.ath, bur
: int4tfWt behtr.en not resuftang lilt'" undeftvmQ cauH given In PART I
I OflM( and dI.
,
! 0 l ,,)
Items 24-28 musI be completect by
peifson who pIOOOUflC8fo d.t.lh.
tIIMEOIATE CAUSE (FH\aI
d4sease or Condrllon
reSUl\lngIl"lOMth)--.
._fVl~~ljj~Lc;ouf};o'J e C DV~
Yo. D
No'5{
Yos D
MANNEA OF DEATH
Hat",", 1& Homeide: D
""""nt D Pendmg In....SCi9olUon 0
Suicide D Could I'lOI be d8ltumlned D
,
,
---'----,----~, &---
I
,
,
-- --r-------
I
,
- ----'----
TIME Of INJURY
INJURY AT 'NORK?
DESCRIBE HOW INJURY OCCURRED.
Sequentidy'" condthons
if anv,lUdtng to nnmedlale
cauM. Ene., UHOEALylHQ
CAUSE (OtMase Of IC'\tUI'I
. thallflftiaIede.........
f85Olttng.., 0NIh1 LAST
WAS AN "'UTOPSY
PERFORMeD?
I:
WERE AUTOPSY FtNOINGS
AVAILABLE PAtOA 10
COMPLETION OF CAUSE
OF DEATH?
DUE 10 ,OR AS A CONSEOUENCE on
DUE TO 'OR AS A CONSEOUENCE on
DATE Of INJURY
IMoll1tl Oay. Yearl
Yos D
NoD
2... 21b.
CERTiFIER ICt'edl; any one)
.CERTlFYtHG PHYSlClAH (Phys.c.an cemtVIOg cause at Qealh ""her" .;jl".)ltoer ~lfs>c'an tlclS plonouoced l.htdltl CinlJ <:oml)1eled Ilem 231
To the bait of my knowledge, d.ath occurred due to the c.auM(s~ and mannef a. s.aled.
2..
~. )Qb.
PLACe OF INJUAY~ho~-.' ia,';.-weel. I~ctory, offic.
building, .Ie. ISpecllv)
300.
M. JOc:.
NoD
'..IEDlC...L EX.....INERlCORONER
On the be... of .xaminatlon and/or Investigation, in my opinion, death occurred at the hme, date, and place. and due to Ihe cause(a. and
m.nn......tat~.....,........,... ..,."".,.,..... ..,..,....."."...,.......
31..
REGIST~. 'S SIGNATURE AND NUMBER
33 U4t.,7C/ 7.J? '-~
~/dl( I
301.
s. lG~lU~;YTlmC CERTI
31b. ~...-
liCENSE NUMBER J OATE SKlNE-OIMotlcn. Day. Year)
[] 31L _i'l-\ ~!:?.i_9~L.J_~__ 31..
NAME AND AOOReSS OF PERSON WHO COMPLETED CAUSE C# DEATH
(Ii.'" m rypo Of Print -l(, PQ.O u.. -\ k.... y'\..1, iJ
o ~, 12. Tr-. ~ <:\ \~ ,i(J.
32. c,,,, L-J.. \I ... t" 0 1/
DAlE FllEOiMonlh Od.,. feall
.PRONOUNClNQ AND CERTlfVING PHYSICIAN ,PhySoCldll txJft, ''':If'l)u(!(;.ng \J~dth <l1l!.1 C@flllylOQ tOCdv~~ .1' (wcl.lhl
To the beM 01 my knowledge. dealh occurred at the 11m., dale, ~ place. and ck.ta 10 lhe cause,s. and manner.. slaled..
d
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4.
JRD/June 30, 1992/17858
Estate No.: 21-02-811
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
In Re: Estate of WILLIAM H KEIM
Late of HAMPDEN TOWNSHIP
NO. 21-02-811
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: RITA M KEIM
Counsel for Personal Representative:
Date of Grant of Original Letters: 09-10-2002
Date of Delinquency Notice: 12-20-2002
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5,6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on DECEMBER 20,2002, and that
the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule
5 ,6( e) the Court is hereby notified of such delinquency and the undersigned requests that a Court
conduct a hearing to determine whether sanctions should be imposed upon the delinquent
personal representative or counsel for the delinquent personal representative.
Date: 01-02-2003
~~~~~st~
Distribution: Personal Representative
Counsel for Personal Representative
Estate File
A hearing is scheduled for d2 ~/l/--o 3 at 9',' .3t?.lj.j1In Courtroom No.3. If the
.
Certification of Notice is filed prior to the hearing date, the hearin will automatically be
cancelled.
'0
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
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Name of Decedent: ~ 1 ') \ \ \ \ 6... \"^-
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.
1 \
Date of Death:
1> ~~3--D ?-_
Will No.
Admin. No. ~;2. OO~~ j:j IF 11~)-
!JflFtle-rYo, ~/-O~ -CJ?/I
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on I - I/'}' :7 nc. "3
Name
Address
S U,. Sa X\
. \~ S m\\-\""
/) 0 ~C) L A \J.-~ f'1\ <2. c\.. (t-.\) t'
.
E Cl s. 4: \~ l2.'" \ \ \'\
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\{ e uJ 'f'c") c\.. Y') s i- ('-', k: .'" \ '\ r",,- \ l n I =3
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
j'Vej /} L
Date:
Signature
Name Q ~ \\\. \,--\ -.R I .~
Address (obI p fit( m fYll Y}C'( b, ~d Dv-
~ \ \ \)
\\\ e 0,,\ u_:'\ \ ~.5 0 l\ \---- <1 \-A
, Ylc.So
Telephone (f 17) 7 9 5' - OJ t.f 0 If
Capacity: ~ Personal Representative
_Counsel for personal representative
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/08/2004
KEIM RITA M
6018 HUMMINGBIRD DRIVE
MECHAiqICSBURG, PA 17050
RE: Estate of KEIM WILLIAM H
File Number: 2002-00811
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 8/23/2004
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASBAUGH
REGISTER OF WILL, S
cc: File
Counsel
Judge
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~" \~ \O._,~w'x X(~ X~
Date of Death:- _[Qi. ti__P~, 0~ ~ -~, ~
WillNo.: ~ ~ ~ (X~ Admin. No.:
Pursuant to Rule 6.12 of the Supreme Coua O~hans' Coua Rules, I repoa the
following with respect to completion of the adminis~ation of the above-captioned estate:
1. State whether administration of the estate is complete:
2. If the answer is No, state when the personal representative reasonably believes
that the adminis~ation will be complete:
3. If the answer to No. 1 is Yes, state the following:
a.Did the personal representative file a final account with the CouP?
Yes No
b. The separate OChans' Cou~ No. (if any) for the personal representative's
account is: ~
Did the personal representative state an account info,ally to the paaies
c.
in interest? Yes ~ No
c. Copies of receipts, releases, joinders and approval of focal or
info,al accounts may be filed with the Clerk of the O~hans' Couff
and may be attached to this~o~.
Signature
Name
~ ~ :~ ...... ~ ....
:::..~ ~ :~ Address
Telephone No.
Capaci~: ~ Personal Representative
~ Counsel for personal representative