HomeMy WebLinkAbout08-18-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of KAY I KUHNS
also known as
COUNTY, PENNSYLVANIA
File Number 21 -11 ' ~~~~
,Deceased Social security Number 175-34-8183
MARY E. EUTZY and JILL I. KUHNS
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE `A' or `B' BELOW)
QX A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the named in the
last Will of the Decedent dated 03/10/2011 and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
After the execution of the documents offered for probate: Decedent did not mar ;was not divorced; 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); did not have a chlild born or adopted; was not the victim of
a killing; and was never adjudicated an incapacitated person, except as follows:
B. Grant of Letters of Administration
app ica e, en er• c..a.; . .n.c..a.; en a e; uran e a sen -a; uran a minon a e
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 on Section A above and comp/ete.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 1'or divorce had been established as
provided In 23 Pa. C.S.A. § 3323 (g), except as follows:
~ .~
Name Relationshi Residence ~ ~, ;,~;;^
"
-~., ..~.. m ---- ,
.....-~ \ ~ 4 J .i14..M
f ..,y~14w. 1
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at
-~
304 NEALY ROAD, NEWVILLE, PA 17241
(List street address, town/city, township, county, state, zip code)
Decedent, then 69 years of age, died on 07/28/2011 at CARLISLE REGIONAL MEDICAL. CENTER
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 450,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 71,000.00
situated as follows: 304 NEALY ROAD, NORTH NEWTON TOWNSHIP, CUMBERLAND COUNTY, NEWVILLE, PA 17241
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:
Signature Typed or printed name and residence ~
MARY E. EUTZY 151 GOODHART ROAD
~~ ~ ~ SHIPPENSBURG, PA 17257
JILL I. KUHNS 467 OAK FLAT ROAD
NEWVILLE, PA 17241
Form Rl/~-d2 Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2010 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland } ~7 °~:
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct t~fl~est of .
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and~~ ~
_.__. rn
administer the estate according to law. ~ ~' ~
._r ?' ~7
/~ y - `=• C.~^j ~ Chi
.._---- -
Sworn to or affirmed and subscribed
~h
be me this day of
~~ister
Signature
Signature
~ ~
..~, ---a
~. _..,_
JILL I. KUHNS
_~~
-~--,
~, ,
-~
- ~:~
:~ t~`~
~:.~ ~
--r-~
Signature of Personal Representative
File Number: 21 - 11 "' O
Estate of KAY I KUHNS ,Deceased
Social Security Number: 175-34-8183 Date of Death: 07/28/2011
l l , in consideration of the foregoing Petition, satisfactory proof
AND NOW,
having been presented before me, IT IS DECREED that Letters Testamentary
are hereby granted to MARY E. EUTZY and JILL I. KUHNS
in the above estate
and that the instrument(s) dated 03/10/2011 _
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES ~ ~~
Letters ......................./.. .......... $
Short Certificates ! ~. $ ` V V
Ren nciation(s) ............................. $
/' _//~~
Q` r V~
~ ~~ $
TOTAL .................................... $
Regr'ster Cl s
,~
Attorney Signature: ei(~~- ~ ..
Attorney Name: Hamilton C Davis
Supreme Court I.D. No.: 10264
Zullinger Davis, PC
Address: 20 East Burd Street
Suite 6
Shippensl~urg, PA 17257
Telephone: 717/532-5713
Form RW-OY Rev. 10-13-2006 Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
_ _ -- _ _ _
tilo;.nti; kt~~ Invml •
_ .~. ~ -1 f - G ~~~~
LOCAL REGISTRAR'S CERTIFICATION ~JF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 17727~~1
Certification Number
e-.~_~~_ _-- _ ___. __ _ __- . _ _. __ _ _- ._ .____._
___..
_.~ _
_ __ _ __
This is to certify that )he infor;nation hel-e given is
correctly copied from an original Certificate of Death
duly filed with me as Loyal 'ZE gistrar. The original
certificate will be fo(-w.(rde~ to he State Vital
Records Office for per)nallent f ling.
Local '.registrar Date Issued
',.
__,,, ~ a~• ,-~~
~:
n ~~ ~ ~-:
~ r
-
~. J'v..J ~~I ~N ... -i'.,.
1
~
~~ ..
~~
'r.
Ht05.143 REV 11PZ006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE /PRINT IN
PERMANITIT CERTIFICATE OF DEATH
BLACK INK
(See instructions and examples on reverse) C7G7F FII F NI IMRFR
1~
~ ;
0
y
~ ~
_<
~ I
0
w
w
0
Z
1. Name d Decedent (First, middle, last, suffix) 2. Sez 3. Sodel Security Nanber 4. Date of DeaN (Month, dey, year)
Ka Ir Kuhns Female 199 - 34- 7688 Jul 28, 2011
5. Aga (Last Birthday) Under 1 er Under 1 da 8. Date of Birth Month da , ar 7. Birth C end state or f cou Be. Place of Death Check one
MonNS Days liars kenutes Hospital: Other:
69 Yrs. 7 24 1942 Carlisle, PA ^ impatient ER / Outpalknt ^ DOA ^ Nursing Home ^ Residence ^ olha - Slteciry:
8b. County of DeaN tk. City, Boro, Twp. of Death Fadliry Name (I1 not' Ntbn, gWe street and nu r) 9. Was Decedent of Hispanic OAgin? ®No ^ Yes 10. Race: American Indian, Black, Whfle, etc.
• (II yea, specify Cuban, (Spedl}~
Cumberland South Middleton • I Mexican, Puerto Rican, etc.) White
11. Decedents llauel Lion Kind of work done d u ' moat al Isle. Do not state reti 12. Was Decedent ever kt the 13. Decedent's Educatbn (Spedty Doty hlgfteat grade axnp leted) 14. Marital Status: Monied, Never Married, 15. SurvNing Spo use (If wife, give maiden name)
Kind of Work
Kind a Busmeaa/Irduslry U.S. Armed Forces?
Eleme 1 ry I Secondary (0.12)
College (1.4 a 5+) Widowed, ~~ /~h')
W
d
k
Hananaker Her awn bane ^ Yea >~] No o 7We
1C
16. Decedents Mailing Address (Street, city /town, state, zip code) Decedents Did Decedent
Decedent Lived'm North Newton Twp.
PA Live in a 1'rc. ~ Yes
Actual Residence 17a
State
304 Neely Road ,
.
Cimnberland T0W1eh1D? 1'rd. ^ No, Decedent uved wiNin
Newville PA 7241 '7b.c°Dmy ActDalLimitaol ciry/Brrr
18. Fathers Name (First, middle, last, suffix)
Paul Frederick Orner, Sr. 19. Mother's Name (First, middle, maiden surname)
S. Irene Wickard
20a. Informant's Name (Type I Print) 20b. Informant's Mailing Address (Street, dtY /town, state, zip code)
Ma E. Eut 151 Goodhart Rd., SrFippensburg, PA 17257
21 a. McNod of Dispositbn ' ^ Cremetbn ^ Donation 21 b. Date of Dispoei8on (Month, dey, year) 21 c. Place of Dispostibrt (Name of cemetery, crematory a odter place) 21 d. Location (City /town, state, zip code)
Budal ^ Removal from State i Was Cremation a Donation Authorized
8/2/2011
Cumberland Valley MaYlorial Grds.
Carlisle, PA
^ ~,- ' by Medleel Examiner/Cororts7 ^ Yea^ No
22a. Signature of F Licensee (a ~cG ) 22b. License Number 22c. Name and Address of Facility
~ FD 012633 L Ekaing Brothers Funeral Horne, Inc., Carlisle, PA 17013
Cartpbte dams 23a,r only when cer8lyirg 23a. T best of rtowled a urred ,date and place stated. (Signature and tale) 23b. license Number 23c. ate signed (M~or
tN; dey, year)
able at time of death to ~
,
~ ~~ ! GC
~ / ,
L~
lu~~ c~a D 3 t ~' - :- /
~~ 'Z-c l
certlly cause of des ~~
/
S.-
4/e ~
L r
L
Items 24-26 must be completed by persm 24. ime of Death 25. Date Prortotrxxd Dead (Month, day, year) 28. Was Ca::e Referred to Medical Examiner /Coroner for a Reason er Nan Cremetbn or Donatlon?
^ Y
~ "
~^° ~°^°°n°~ daaN. rx. 10:50 AM. July 28 , 2011 e;
°
CAUSE OF DEATH (See Instructions end examples) r Approximate interval:
DO NOT enter terninel events such as cardiac arrest
kcatbns -Nat dredry caused tie death
Onset to I)eaN
f
t
-di
i
ie
or corn
I
27
P
rt I
E
ti
i
h PaA II: Enter other;;icrificant rbrtditions rxtnlrNutlnq to deatit.
in the underryin
iven in PaA I
but not resultin
cause 28. Did Tobacco Use Contribute to Death?
^
Y
^ P
b
bl
, ~
.
even
s
seases,
njur
s,
p
tem
.
a
:
nter
e c
n o
a
ith
h
l
l
Li
t
l
one ca
se o
ch kne
i
t
i
l
fib
Nl
li
t
i
ti .
g
g
g ro
a
y
e~
,~
ow
ng
a
s
on
y
u
n ea
ratory arrest, a ven
r
cu
ar
r
a
on w
ou
s
e e
ogy.
. r
resp (Q No ^ Unknown
IMMEDIATE CAUSE ((Foal disease or '
~ ~1~
~'~~'
I A'~
N ~E
Z /
q~ ~' r O n.
(~ ~
1~ (j: ~('1
29. If Female:
r
f
-
condition resulting m deaN) _~ a. flA.~ d C~'
p
t r
G re
nant wdhin
est
ear
Not
Due to (or as a cansequertce on: .,~ _,p t
$ap~anha~y list condltians, N any, b. ( fr'U~ < 'L C i^~tiL ~ f ~ ~1~ d ~ Y"~1 ~~'' ; '> ~ "~
r* 7 P ~.~- ~..1 {r' t ~2 WI (i~ p
y
p
g
^ Pregnant at time of deaN
^
leading to the cause ksted an kne a. r
NG CAUSE Due to (w as a consequence of): r
UNDERLY
is
ti Not pregnant, but pregnant wfthin 42 days
let
e
I
(draease a kxytsy Nat initiated the r
c' of death
t 43 d
1
t
t
b
t
t
^ N
~
events resul~tg to deeM) LAST.
Due to (or as a wnsequence on: t
d. ~ year
pret~tan
,
u
pregnan
ays
o
o
before deaN
^ Unknown ti pregnant wiNin the past year
30a. Was an Autopsy 30b. Were Autopsy FlrMktgs 31. Manner of DeaN 32a. Date of Injury (Monty, day, year) 326. DescAbe Fbw Injury Occurred 32c. Piece of Injury: Home, Farm, Street, Factory,
PeAOmted?
Avafialtle Prbr to Completbn
of Cause of DeaN? ~~~
'L1 Natures ^ HortlcMa Office Bufldmg, eta (Securty)
^
^
^ ^ Accident ^ Pending Investigatbn 32d. Time of Injury 32e. Injury at Work? 32f. If Transportation Injury (SpecilyJ 32g. Location of injury (Street, city /town, state)
Yes No Yes
No
~ Sulfide ^ Could Not ba Oeternined
^ Yes ^ No
^ Driver /Operator ^ Passenger ^ F'edeatdan
M• ^ ONer - Sperdly:
33e. Certifier (check only one) 33b. Skyteture epftTa
CenMying physician (Physician certifying cause of deaN when another physician has pronounced deaN and completed Item 23)
To fife bast of my knowNdgs, daaN accumd due to the eauss(s) and manna as stated _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ +~'
-
h
N
d
a
i
d
N
• 33c. License Number n
ed
(ManM, dey, year)
33d. Date S
ig
proraundng dea
an
c»rt
y
ng to cause d
ee
)
Pronouncing and tanHying physician (Physiden bd
To tM beat of my larowkdgs, death occurred at the time, date, and place, and due to the auae(a) and manna as statsd_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• IMdical ExamMa/Carats i~t 0 ,~ ~ ~ Y L~ ~(~ ,jam
CJ w
-
s
l
` l'3 ~I (
On the Beals of examination and / or inveatigstion, In my opinion, deeN occurred M the time, daN, and place, and due to the cause(s) end manner ore atatad_ ^ 27) Type I PAnt
d C
ause of Death (~te
m
34. Name and Address of Person W w Complete
e~
zA
y
,,
'+~
~~ ~ ~'
-~
~
S
~~
~ 1 LL 1 r~l '
35. Regstrar ~ta~e and q'
~ I I I ~ I ( I o ~
~
~
~ 36. Date Filed (Monty, dey, year r-e
v
l
+
.
i
c !'~~ 1° F4 ('1 ~9 ~ 3
l C~
2t s P 11-r AJ b -'~
~
i~r
,L
-
.~. k~u. ` l
~
-
~/
Disposition Pemdt Nq.4 f ~ (Olin ~ (o
~+
~ <.