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HomeMy WebLinkAbout02-23-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS , t Estate of Sys V ~ ~ 1'-'le Kos 4, ,Deceased ESTATE NO: 21- ~ ~ ` ~ ~ Y a/k/a: a/k/a: a1k/a: SS NO: I81- 3~-ZSSS~ Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or `B' AND "C" as applicable: ^ A. Probate and Grant of Letters Testamentary or ^Admilistration c.t.a., or d.b.n.c.t.a. (complete Part also) ~ = under, and aver that Petitioner(s) is/are entitled to the aforementioned Letters ~ and codicils dated - ~ -+~ m the last Will of the above-named Decedent, dated O ~,-~ r~ -.~., ~:~~' w `~-''--~ a ~~ ', _,: (State relevant circumstances, e.g. renunciation, death of executor, etc.) ~ C'~ s~ ," ~' ' '~~ ' ti cr~the ;~ -„ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted aft cu on ~ j instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated persct~and wa$Qiot a t- ~' party to a pending divorce proceeding at the time of death wherein grounds for divorce had been esb~lished as definedin ~i~i 23 Pa. C.S.A. § 3323(g): ~. Grant of Letters of Administration (If applicable, enter d.b.n., pendent life, durante absentia, durante minoritate) C. 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 and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except as follows:- Name ~ ~ C ~O :LL USE ADDITIONAL SHEETS IF NECESSARY THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) LaGs~- ylll~r. , A~ Decedent, then ~_ years of age, died l~ ~ S - ~D/b at C' rnD ~~ ~~ P~ 'b- (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA All personal property $ /d4 Do0 , o0 If not domiciled in PA Personal property in Pennsylvania $ If not domiciled in PA Personal property in County $ Value of Real Estate in Pennsylvania $ - Total,Est-i'manted Value $ 0.00 Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~~~"1 ri ~7Gn ~-~-~T ~ ~ ~ l 7th ~ Signature(s) -..~ >~ ~~ Form RW-02 revised 1 Name(s) & Mailing Address(es) by Cumberland County pending action by the Court X36 ~ (ls,' d~. p ~ N C . ,4 > >~ ?o ~~r 1 d 53~.>7r'~n.ac. ~ ~,C {~i{-17o; Page 1 of 2 ", ~y~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS n COUNTY OF l ~~ ~ ~~ ~-~ '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 Decedent, Petitioner(s) will well and truly administer the estate according to law. r. ca _ °70 -~-i G~7 ~ ~ s :r' Sworn to or affirmed and subscribed _ Signature ojPersona Representative ~ C '~ ~ ~ . ;~ ~ ~ ~ before me the ~ ~ ~1 day of l ~,J ~..~ ~ ~, ~_ - Signature of Personal Representative <J~ ~ -F~ ~ ~ F r t Register Signature of Personal Representative L- i File Number: Social Estate of AND NOW, having been presented before me, IT IS are hereby granted to Date of _, , in consideration of a foregoing Petition, satisfactory proof that Letters and that the instrument(s) dated described. in the Petition be admitted to probate and filed of FEES Letters ............... $ Short Certificate(s) ........ $ Renunciation(s) .......... $ ... $ ... $ ... $ ... $ ... $ .$ ... $ ... $ TOTAL .. ........... $ in the above estate Will (and Codicil(s)) of Decedent. Register of Wills Attorney Signature\ Attorney Name: Supreme Court I.D. No.: Address: Telephone: / ~e ~, V I 1 1~ ~' ~~ " ~"~~_~ Page 2 of 2 Form R6ROZ rev. !0.13.06 OATH OF PERSONAL REPRESENTATIVE Commonwealth of Pennsylvania ~ SS County of Cumberland The Petitioners} herein named swear or affirm 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 Decedent, Petitioner(s) will well and truly administer the estate according to law. ~. ; Sworn to or affirmed and subscribed ~ ~~ -~~ ~ 1-- c_:• a ~l r~ da of ~ ~--~rn rv _k.~~. before me this Y ,,..~ ~ ~ -p. `.. ~ S1 m "- C'7 ~n c.~ For the Register DECREE OF PROBATE AND GRANT OF LETTERS Estate of SV ~ \~ I at N ` ~ ®~ f I ,Deceased File Number: 21-___~~____-~~02 AND NOW, this ~~ay of ' ~ , in consideration of the Petition on the reverse side hereon satisfactory proof having be resented before me, IT IS DECREED that Letters Testamentary / of Administration are hereby granted to: (If applicable, enter c.t.s., d.b.n., d.b.n.c.t.a., etc.) .~ rl t _ in the a ve to an that instrlunents(s) ated described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. lenda Farner Strasbau °~ Register of Wills FEES: Letters ....................$ Will ........................ Codicil(s) ................. (lp) Short Certificates o2~~ 0© ( )Renunciations....... Bond ............................ Other ............................ .............................. Automation FEE......... 5.00 JCS FEE ................... 23.50 a~ a s~ TOTAL ................$ -~~ Signature of Counsel Required to Enter Appearance Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2 105.805 RFV 101/07) ~~ - ~~~~~~'~ 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 he forwarded to the State Vital Re~~ f~ for pgrmanent filing. ~~"~ aN ~ s z ~~ Local Registrar Date Issued n r~~~ o ~~ ~ ;~'1 QJ ~ n t'Tl '~ ~ ~Zr - ~ c.r ~~ ~ ~ I..; ., t.+.i vi ~ ~ W 'z t~ 7 ~~C7 (..._.1,wi i'9 "r~ '4'~ +~ ~I-i T _~ ~ t~ 4~ 4 RLV 112006 ~lN~., COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS a~riE r" CORONER'S CERTIFICATE OF DEATH ACK INK (See Instructions and examples on reverse) STATE FILE NUMBER (r~z-syi 2. Sea 3. Sodel Seaxay Number 4. Dale of Deem (Room, ay, yrr) 1. Name d Decoded (Fag, midde, Wes, Suss( h M k Female 181 - 32 ~-7554 December 5 2010 e os S lvia ) Untler 1 Ikds 1 B. Dee d BNIh Madh, 7. Bkppka erldwe a 5 A ~ 13~ 1 B a. Plea d Deem Chedr aro . ge ( Y uoar tnYe Howe MMa„ Hoepitel: Omer March 26 1941 Ashland, PA ^Irpatled ^ER/OlapatleM ^DOA ^NUrakgelaa Rrlance ^omm-sP.dlr 69 YA . • Bb. Cady d Oeam &. Clry, Tvrp. Deem aa. Feday Name (N not kwNutlon, gNS eueN aq a4lt~•d 9. Was Dacerrnt d tWpsrb Origin? ®No ^ Yr 10. Rea: Anrrbr.lndien, Slack Wage, etc. In rr, epedM CWen. lsPedM Cumberland Lower All n 1295 Letchworth Road "a"'it°".ParbRro.n'ero.) white • 11. Deadrfs IMrrel 10rd d Mork done mat d IM. Do M emro 12. Wr Deaden! evMr in the 13. Deaded'e E4ratbn (Spady ah' t>I~ ) 14. Medal Saba: Merrkd, Nevin Monied, 15. SuMMrg Spouse (II wile, gM maiden name) WidowMd, ONaced (SPMM Ked d Wok IOM d Brmkar I adaoy U.S. Ambd Faces? Elementary I Secondary (0.12) Cdbge (1 ~ a 5+) 12 Divorced Clerk Law Enforcement ^rr ®Nd . w 16. DaaanYe MaMg Aadrer (Boat, dh /roan. arob, lip Adel DecWenYe ~ tchworth Road ArbWReaaena 17e.Sero Pennsylvania Dwi°~lnc? t t7~,®vr.Deaaenurvwin Lower Allen_ ____ Twp. 1295 L e Uved withb De~t Cumberland na.^No d ~d Cayl Boo Camp Hill, PA 17011 ,7b. coast 16. Fams'e Nra (Fast. mode, Irt wlAx) 19. Homer's Name (Prat. midde, mekkn auoiemel Helen Kadingo John Mekosh 20a. Idamled'c sass (type / Prlnn 20b. InlanwnYe kmuk,g Addrer (saga. dry I taMlr, afire. ap t«bl New Cumberland, PA 17070 236 Hillside Drive Susan M. Britt , z1a. Memad a olapallidr l ^ Crematon ^ Daupon zm. Doe d Ohpalpori IMaah, day, yrr) z1a Plea d Depoanlan twine a orator, cmrrrory a Omer deal z1a. Locaeon (cln r sown. ewa.:ip coal Assumption of the Blessed ~ Centralia, PA 17927 ® Bala ^ RamovalromSlate rrrcrmwbn«oau0onAUmbrliM December 10,2010 Vir in Mar Cemeter ~ ^N ? ^y c e, d eyal.abaE,rarrl «erw ^ op.r ~h, ~ 22a. SlpWee d InsW la Pin ~p r such) 22b. IJarlr Number 22c. Name end Addrer d Fadny FD 013 340 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 ~ ~ Campwe peme 23ec say when staying 23a. To pM boa a my knowledge, dam auared a Ab aa, dam ens dace sated. (5'gawm and tltle) 23b. lkense Number 23c. Date signed (MOnm, ay, yes) dryades a nd eYeMbN a tlme d deem b arwy see. a gem. Time d Deem 25. Dae Praaaa.'ed Deed (Mordh, day. yrr) 26. Wr Car Referred ro Medal Ezaminar I Caarx la a Reason Omer men Cremation a Donation? 24 w . tins 2426 mat a comdeled b/ Wma^ .' dbpalaartrarp,. A rx. 10:00 P;A. December 6, 2010 ~Yr ^"° CAUSE OF DEATH (SSe MsMactbne arW MlfedlRlee) r Appmxiate Nasvd: a - tlw drxgy arced pie deem. DO NOT errr Isniiw events such r ardac eneaL r Orksa ro Deem brea injaba d • Part II: Edx opts but nd rruNp b me urldenykq twee gNan m Pan I. 26. Did Tdlexo Use Caanbde ro Deets? ^ res ~ ProOedy , , e Mm 2/. PM I: Edx pie f - rrpsabry arras, a vsMrblMr paNepon wWad ahoxYq nle etldogy. Ua only oro our an each pne. ~ ^ No ^ Udcmeri A~ r )~B°a a r A I To Chest And Abdomen ~ bbi St 29. n FamW: ser ^ Na wawltlwr rl e ly n iaw n a ...~. a. _ Due ro la r a coreWsbe eA~ , y p g g ^ PregwN a mne d deem 9euraWW IY mappap, n vM~ b. ~ , ^ Nd preganL but Pregad wntan 42 M'a ~ gbpr our MNd on ens e. p~ro(a asamraeWena afl: r bas me IMIDERLWNG CAUSE r G tlk m ddeem c. r ue IAerr a, yn ~ 8vsaa Sf ^ Nd pregwm, out pregwm 43 days b 1 year Due oo (a r s muaprrce oft: ~ r llaae drm ^ udrw,n a pra~eM wmr;, me Wes yrr d • 30s. Wes 8n Autopsy 30b. Woe Adopey Faidrgi 31. klaarr d Deem 32a. Dale d Inlay (Monm, day, y.al 32b. Deeabe Hots InWry Occurred 32t. Plan d klpny: Home, Farm. Burt. Fsdory, 010ce ~. ~. d PedonaC! Aveaehk Pna b Calpron m? ao ^"a"y ^ Dec. 5 2010 Intentional Self Inflicted Stabbin ome dcaur r " ^ Acddrl ^ PerMbg lnvealgaan 3zd. TNa d lr(ury rx A ork+ 3zf. n Tmnavaurn kwn (s~rl Sze. lMury e w ~l tn d ^P 32e. Logan a Inlay (areeL «r r rows. swat ^ rr ~ w ^ ~ ^ 0 D k d p . en ff acc ~~ e r ^ Yes ty w ^ pNar I Operaror ^ Pasrrga Hill PA aenn M Sukkk ^ Cab Nd be 10:00 P. H. -` omer•speary: Latch th R ad Cam 33.. Certlar (abdr say oat • pbn~ (PMT «rannp oar a arm wrwn anotlts ptrysidsl hr vraaanad arm end ampwed aem z31 ^ _________________ M meurxrawed t tl 33e. ~ ne r ____ ___________ w aare(a(a o ToIM DMdmy lawwMdps,draroa«nd dr m Lcrr Nurrlber ~ 33d. De" SgMd (Main, day, Yea) 33c ) Prataetchq erq aruPMg phreldn ( Ootlr Pm^an«rA dam end tedlyYlp b tape d ca ^ . Te tlw bees dory k,bwNdge, Beam axuMa0r tlme,deb, and des. erd dw to me aur(sl end msursrewM__________________ January 11, 2011 • Hedkd Eeantkrer I Csons ~ On the beets d eaemYrNbn aMl a Mwetlpslbrt, k+ my opmlar, deem oxlared a Me tlme, deq, end pMa, and des to Ors eewe(e) eM mslrrs r steted_ ~ ~ p~• p ojpr 31. d Who Cow m lam 27) Type I Prim o C enrO e, OTOneY 3sReg~lmraslye w~a ,ry I ~ l I ~ l I ~ I ~ 36.DmeF ,Qeavesl / /dr Z~JI / 6375 Basehore Rd., Suite 4l1 170 0 r Pa b M h i ~ a , . u an cs ec ~''~ DL,palpon Permit No. ~~ 4 Z2 C9 7