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Home My WebLink About02-14-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of Gayle Harlin Kluz a/k/a: a/k/a: a/k/a: Deceased ESTATE NO: 21- . ~~, a.~- '~ ~ :> ~ _ SS NO: 167-34-4068 Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: D A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) is/are entitled to the aforementioned Letters Testamentary _ _!_ under the last Will of the above-named Decedent, dated 8/1 ~/2010 and codicil(s) dated (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 instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceediing at the time of death wherein grounds for divorce had been established :~s defined in 23 Pa. C.S.:~. § 3323(8): _- ^ B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent lite, durante absentia, durante minoritate) C. Petitioner(s), after a propet• search, has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs {[f'rlcln~it~istr~ttic~n c.t.a. car d.b.n.c.t.a.. Lt~t+vr ilatL t~l't~'ifl in Sectitln :1 ;~ncl t:t~~~ipl4te ii~t s~f` hcirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce 12roceeding ~~~1~er•ein grounds for divorce had been established as provided in 23 I'a. C.S.A. § 3323(8}, except. as follows: Name Address Relationshi to L~eedent . R ~ .__..... ~' ., ,- - ,.;~- _; - _ _ R.,r., --z - ~ ~"~"'t =~, _ f fT _....~ _ , ~_ t'til°; 11)1)CE"10:11: ~111•:F,"1'S 11~' N1('1;SS-11t1' _. ~-~._~ __.__ `--t THIS SECTION MUST BE COMPLETED: ~=~1 ~~~~~ ' ~ ~~ Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family 3~r principal r~ idence ~~ At 71 Partridge Circle, Carlisle, Cumberland County, PA 17013 _ (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 63 years of age, died 1/28/2011 at (Month, Day, Year of death) Estimated value of decedent's property at death: Carlisle, PA (City and State where death occurred) If domiciled in PA All personal property $ 15,000.00 If not domiciled in PA Personal property in Pennsylvania $ ____ If not domiciled in PA Personal property in County $ __ Value of Real Estate in Pennsylvania $ 150,000.00 Total Estimated Value $ 165,000.00 Location of Real F,state in Pennsylvania: (Provide full address if possible.) 71 Partridge Circle, Carlisle, PA 17013 _-_ Sil;natttre(sl \atne(s) c~: Mailing .'#ddress{esp ' _~ ~~ t i ;'~_ Christopher ]. Speece __ ' 847 Lindsay Drive Carlisle, PA 17015 Interim Form R~4'-02 revised 12.26.10 by Cumberland County pending action by the Court Page 1 of 2 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland ~ ~: .~ _~~~ - ~ fir-, The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petitiort_~~;t->~e arm iy ~- correct to the best of the knowledge and belief of Petitioner(s) and that, as personal repres~tt~~i~a(s) o~-the -, Decedent, Petitioner(s) will well and truly administer the estate according to law. _ , ~ ~,;,~~~ __t~, ~ ~ ' . y ._ . , _:~..~ ~ _ .~ F ,, - - Sworn to or affirmed and subscribed ~ ~' ~ ;, ~~~~~ _-~=~ ~..x--~ ~_-~~ be~fg~e e this ~ -tS'~ day of . ~ U -~ ,,, -- ,. _ .. ., ~_ ~.. ~~ , . L 1 1 t.~,C .~ .. ,~ For the Re~i~fer DECREE OF PROBATE AND GRANT OF LETTERS Estate of (~~ - ~.=a ~ j.~~ (~ g,n ~ i ~; ~ ,Deceased File Number: 21- ,'~ c'' l ~ - (~ ~ C' 1 1 - -- AND NOW, this t t-{ day of ~ ~~-1_~ rc`C~ ~ ~~ , in consideration of t:he Petition on the reverse side hereon, satisfactory proof having bee presented before me, IT IS DECREED that Letters Testamentary of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) the above estate and that instruments(s) dated ~' - ~ 1- :>C c ~~~ described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. • ~ i ~ ~ ~ ~ _ `~ -(^ tic ~~~, ~~ ,=- < <~-- Glenda Farner trasbaugh, ,~-c ~ ~_'~~~'~(~i.-c,E.~~~c f i ~~~t c Register of Wills FEES: Letters ....................$ -) (C C` ~ Cj C; Will ....................... (~`~ . ~~r> Codicil(s) .............. . ( `~) Short Certificates • ~-' ~cf- ( )Renunciations....... Bond ............................ Other ............................. ................................._ Automation FEE......... 5.00 JCS FEE .................. 23.50 TOTAL ................ $ ----~ Signature of Counsel Required to Enter appearance .~ ~ ~ r-- ~ ,~l Atty's Signature ~ ~~(//.,. ~~',,~~ `~ , -~ ~. ~' i A~f~~~f ` r PRINTED Name: Melissa P. Tanguay __ ~~,; Supreme Court ID No.: 307155 Address: Abom & Kutulakis, LLP 2 West High Street, Carlisle, PA 17013 Phone: (717) 249-0900 Fax: (717) 249-3344 Interim Form RW-02 revised 1226.1(1 by Cumberland County pending, action b_y the Court Page 2 of OCAL REGISTRAR'S CERTIFICATION OF DEA~"~-I ~11I~~NING: It is illegal to duplicate this copy by photostat or photogra~;f~l.. ~'cc' `^'. 1T lfllti Ca,:(~llllClil~.' `fit`? (}E __ __ _-_P __17 _~ 14 916 ('el-tii~EC,(titlj~ 'ti;)I111~~ H105-143 REV 11/2006 TYPE /PRINT IN PERMANENT BLACK INK Lh1S 1;ti (CI Cel-(11~ ~ .. '':t :_,filt)C'lll:i(Il)Il I)el'f' ~'I~'Ci) l~ cr~rrec.tly ct)pie/I °I~ ~ 1 tri~tin,.tl t ~rtiti~ate of 1.71.~ath duly filed ~~ith ((tl~ I'- ~ t~tr~~ol IZ+`~*I~,tl-~(~-. "I~he t~ri~inal certificate ~~~ill 1s_ If+ , ~ci~~,it.~d jl3 the State Vital! Y3Ea>rds 0ltihe ~ : ~,.~~ ,~ ,r (~)t t~ilir~~t. '~ . t~e~ac~i~ryr.vr' J_~I__3 -~2 O 1 ~ Llfcal ~ZetYis~r (i ~~:(It:~ issued fT~ _ - ~'~Y ~ ~ rr.. ~..~ __..i • T.. ,,,. ~~ ~~ 0 w w w 0 0 w 6 Z ~~`"~~~H O_F p "'~ ,~' ~ ,r ~~ ~ ~ ~~~~ _ ,9 o. ~ z ~, ,i ~- !a ~~99jMENt 4F~`~`P,;r COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) ~r.r~ ~„ ~ ,,,,,,,,~„ 1. Name of Decedent (First, middle, last, suffix) le Harlin Kluz Ga 2. Sez F l 3. Social Secudy Number 4. Date of Death (Month, da , ar) ~~ y ema e 167 -34 - 4068 January , 2011 5. Age (Last Birthday) Under 1 ar Under 1 da 6. Date of Birth Manfh, da , ar 7. BiM ace Ci and state or tor si count Ba. Place of Death Check on are 63 Months Days Hours ~^°~ March 29, 1947 Valley Stream, NY Hospital: Other: Yrs. • ^ Inpatient ^ ER /Outpatient ^ DOA rr~q~ ^ Nursing Home lJ Residence ^ Other -Speedy: fib. County of Death Bc. City, Boro, Twp. of Death fid. FadlRy Name (If not institution, give street and number) 9. Was Decedent of Hispank Origin? ~ ~ ^ •yeS ~ 10. Race: American Indian, Blade, White, etc. Cumberland N. Middleton Twp. 71 Partridge Circle, Carlisle ('f Yea, SP~~r aban, (specify Mexican, Puerto Rican, etc.) White • 11. Decedent's Usual lion Kind of work atone d u most of wo Ilfe. Do not state retir 12. Was Decedent ever in the 1 3. Decedent's Education (Specify only highest grade comp leted) 14 Madtal Status: Married Never Married I5 Survivin S o use (If wife iv id Kind of Work Kind of Business/ Industry U.S. Armed Forces? Elements / Seconds P12 ry ry ( ) Coll age (1-4 or 5+) . , , Widowed, Divorced (SperJlyJ . g p , g e ma en name) Business Anal st State to ee ^ Yea S7 No 12 Widowed 16. Decedenys Mailing Address (Sheet, city /town, state, zip code) __ Decedents Did Decedent 71 Partridge Circle Actual Residence 17a. State p]~ Live in a 17c. ®Yes, Decedent Lived in _ N _ M i [x[91 Pt An TwP, Carlisle PA 17013 17b. County ('1 ~n1F~c~r1 anr7 Township? 17d. ^ No, Decedent Lived within , Actual Limits of c;ty/pro 18. Father's Name (First, middle, last, suffix) James Harlin 19. Mother's Name (First, middle, maiden surname) Lois Borman 20a. Informant's Name (Type /Print) Chris J. Speece 20b. Infonnent's Mailing Address (Street, city I town, state, zip code) 847 Lindsey Road, Carlisle, PA 17015 21 a. Method of Disposition ~ Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21 c. ce ition ( f cremato o the ace ~o~~l~°ian-`~o~~i`~`~n ~ ~ ~ ry & 21 d. Lexxlion C' /town, state, zi code ^ Budal ^ Removal from State ~ was cremation or zed ^ , ^ Jan . 31, 2011 er a or e ~rl i sle, PA 17013 br i~ea ~ Yes ~ Other - S No Cremato 22a. signature Ing as such) 22b. license Number 22c. Name and Address of Fadlily Hof fman-Roth Funeral Home & Crematory - 138504 Rams ~ only when certifying physiden is not available at time of death to 23a. T best of my knowledge, death occurred at th ~~ da te an d place stated. (Signaure and title) ti License Number " 23c Date Signed (Month, d~ y, y ear) ceniry cause o1 efeath. ,' t V'-' ~-C~~~ ~ y ~ _ 1 ~ J / 3~ ~ l.i ~ L.__ ~ ( ~ i7uZJ ~ ~ Items 24-26 must be corn feted b ~ p y person wha pronounces death 24. Time o ath ~ % 25. Date Prortoemced Dead Month, de , ear ( Y Y ) ~ 26. Was Case Referred Medical Examiner !Coroner for a Reason Other than Cremation or Donaton? . ~ ~ ~ M. C...J ~ ~ ~.~ ~ J ~4! ^Yes CAUSE OF DEATH (Sae Instructions nd examples) , Approximate interval: Item 27. Part I: Enter the ch8N1 of events -diseases, injuries, or complicatbns -that directly caused the death. DO NOT solar terminal events such as pNiac anesl i Onset Io Death Part II: Enter other sigpifk=nt conditons conMlwtine to dea07, but rat resulting in the underlying cause given in Pan L 28. rDiad~Tobacco Use Contribute to Death? U Yes ^ Prob bl respiratory arrest, or ventricular fibrillation without shtnvmg the etiobgy. List Doty one cause on each line. ~ r IMMEDIATE CAUSE (Final disease or a y ^ No ^ Unknown , /~ condition resulting in death) ~` (j , , w . f F 29. I e m ale: _~ a L ti. C e ~ c.a.~ ` ~) • w~..,.• r r l ~ , ~I Due to (or as a consequence oQ: r Sequentially list conditions, it any, b ~ b to the puss listed on line a. ~ - ~ Not re nant within st ear P 9 Pa Y ^ Pregnant al time of death Enter UNDERLYING CAUSE Due to (or as a rxxtsequence ot): ~ - ^ Not pregnant, but pregnant wkhin 42 days (disease or injury that initiated Rte r events resulting in death) LAST. c. ~ of death ^ Due to (or as a consequence oQ: r Not r ant, but nant 43 da to 1 ear P ~^ Pre9 YS Y ~ d. i r - before death ^ Unknown d pregnant wthin the past year 30a. Was an Autopsy Pedomted? 30b. Were Autopsy Fmr6ngs Available Pdor to Completion 31. Manner of Death ~~ 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Occurred 32c. Place of Injury: Home, Fann, Sheet, Factory, of Cause of Death? LJ Naturel ^ Homicide OfFke Buildi etc. n9~ (~HJ ,~/ ^ Yes U No ^Yas ^ No ^ Accident ^ Pending Investigatbn 32d. Time of Injury 32e. Injury al Work? 32f. Ii Transportation Injury (SpecYfyJ 32g. Location of injury (Street, dry ! tcnvn, state) ^ Suicide ^ Cwld Not be Determined ^Yes ^ No ^ DrNer/0 eretor P ^ Passenger ^ Pedesidan _ M ^ Other -Specify: 33a. Certifier (check Doty one) 33b. Signature and Title of Cedifer • CertKying physicisn (Physician certitying puss of death when another physician has pronounced death and corttpteted Item 23) To the ltsat of my knowledge, death occurred due to the cause(s) end manner as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ K9 • Pronouncing end artHying physicisn (Physican lath pronourtdrg death end certifying to puss of deaM) 33c. License 33d. bate Signed (Month, day, year) To tM best of my knowedge, death occurred a<the time, date, and place, and due to the cause(s) and manner n stated_ _ _ _ _ _ _ _ _ _ - - - ^ • 6Aedkal Examiner/Coroner - - - - - d,S -Od S ` - L ~) ~ K 3l .Z~ On the bash of ezaminetbn and I or Investigatbn, in my opinion, death occurred al the time, date, and place, and due to the cause(s) and manner as statetL ^ 34. Name and Address of Py~n WM Completed Cause of Death (Item 27) Type / Pdnt wJ ~~. '. ~ t' - 35. Registrer lure and Distdct ~~ ~ 36. ate Filed (Month, day, year) . r . i.i . s0 /~f . /1~• aft - I ; , I 1 I <~., l 1 I C> I r c; , '-~I r~~ 1 G~ ~ ..t, c ~~- ! ~ ~ Disposdion Permit No. ~~ ~ z ~,7 r l ~- \ n f ~°ast ill and ~estainent :; C~ ~~~~, C~~ ~- ~. le ~°~-rlin ' l:. ~ 1-'- -~ =~ !'T"I ~... i'f I, GAYLE HARLIN KLUZ, of 71 PARTRIDGE CIRCL~,~ ;;~ARLIS.E, ; _~ _~, ~ ,,~ CUMBERLAND COUNTY, COMMONWEALTH OF PENNSYLVANIA, declare this to b~°my ~" Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ~ `~ I direct that the expenses of my last illness and funeral be paid from my estate as soon as practicable after my death. ~~~BCdy1G~ I give, devise and bequeath all the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, to my son, CHRISTOPHER JAMES SPEECE, born August 2, 1970, of Carlisle, Pennsylvania, if he survives me by thirty (30) days. Z°hll'd If my son, CHRISTOPHER JAMES SPEECE, should predecease me or fail to survive me by thirty (30) days, I give the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, to my daughter-in-law, JODI LYN SPEECE, born February 23, 1973, of Carlisle, Pennsylvania. If my daughter-in-law, JODI LYN SPEECE, should predecease me or fail to survive me by thirty (30) days, I give the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, to my grandson, WYATT SCOTT SPEECE, born August 10, 2004, of Carlisle, Pennsylvania. ~117~ All federal, state, and other death taxes payable because of my death on the property forming my gross estate for tax purposes, whether or not it passes under this Will, shall be paid out of the principal of my general estate just as if they were my debts, and none of these taxes shall be charged against any beneficiary. ~1~1.• I appoint my son, CHRISTOPHER JAMES SPEECE, of Carlisle, Pennsylvania to be the Executor of this Will. If my son, for any reason whatsoever, is unable or unwilling to serve as Executor., I appoint my sister, DEBORAH DAVIS, of Carlisle. Pennsyyvania, the Executrix of this Will. I direct that the Executor be permitted to serve without bond and without any intervention of any Court, except as required by law. I authorize my Executor to sell, encumber, mortgage, invest, distribute in kind, or retain any item of property of my estate including real property in such manner as she shall deem proper, limited only by his own discretion. IN WITNESS WHEREOF, I have, at Carlisle, Pennsylvania, this 11th day of August, 2010, set my hand and seal to this my Last Will and Testament. ! R~ Cz.,...~ ~.~..,~...~~--- ~~~-~. ~ SEAL -~ ) GAYLE HARLIN KLUZ Signed, Seal, 7'ublished and Declared by rhP ah~ve-named Testatrix, GAYLF: HARLIN KI.UZ, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. ___. t ~_ Residence ~ 1 ~, -~ Residence ~,~~~: i~ ~'"l ~,~~ ;--~~ ~.., ~ `.~>~ 1. ~ G~ ~ ~~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss: ...-- GAYLE HARLIN KLUZ (the testatrix), ~ l ~S ~~ ' , W { ~` i' ~ ' i. i. ~., and .m. ~''~Y1~~ L . ~j'h.~-~ ~ (the witnesses), whose names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament in the presence of the witnesses and that she had signed willingly, and that she executed it as her free and. voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. .; ,; ~.~ ~~. ,. ~~ GAYLE HARLIN KLUZ .._ . " ITNESS `` ~~ I ESS Subscribed, sworn to and acknowledged before me by GAYLE IN KLUZ, the cribed and sworn to before me b ~- ~ ~ ~ ~~~ (~-~ ~ (~ vzl<i~ and Testatrix, and ~, subs y r > > -~~ -~i rift ~- ,,~~~"1;~l~ l ,the witnesses, this 11th day of August, 2010. -~ 0, ~OTARY PUBLIC COMMONWEALTH OF PENNSYLVANIA Notarial Seai Shannon L. Freeman, Notary Public Carlisle Boro, Cumberland County My Commission Expires April 7, 2013 Member, Pennsylvania Association of Notaries