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HomeMy WebLinkAbout08-16-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA 1 ~ 1 "` Estate of WII.LIAM A. MCHILLIP ESTATE NO: - (C - ~~ u also known as ecease SS NO: 174-OS-2522 Petitioner(s) who is/are 18 years of age or older, apply(ies) for: [ ] A. Probate and Grant of Letters Testamentary or -Administration c.t.a., d.b.n.c.t.a. (complete Part C also) and aver that Petitioner(s) islare entitled to the aforementioned Letters under the last Will of the above-named Decedent dated: co ci to state re evenat circumstances, e.g. renunciation, ea o 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, was never adjudicated an incapacitated person, and was not a party to a pending divorce proceeding: at the time of death wherein grounds for divorce had been established as defined in 23 Pa.C.S.A. §3323(8): [X ] B. Grant of letters of Administration (If applicab a enter: .n.; pen ente ite; urante sentia; urante minoritate C. Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: If Administration, c.t.a. or db.n.c.tn., enter date of Will in Section A above 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(8), excpect as follows: ame PATRICK McKILLIP JOAN KAUFFMAN RANDALL McKILLIP USE ADDITIONAL SHEETS IF NECESSARY THIS SECTION MUST BE COMPLETED: Decedent was domiciled at i Cumberland Counnty, Pe yl a with ' 7/no cvt W Ito w~R ~n,1c,,`~.1~~o~~ov.~ tst street ress, tow ccry, towns tp, county, state, zip co e Decedent then 98 years of age died Estimated value of decedent's property at death: (If domiciled in Pa.) (If not domiciled in Pa.) (If not domiciled in Pa.) Value of real estate in Pennsylvania 8,700.00 situated as follows: 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 a ro riate form to the undersi ned: .Q.,~,t.~.,P vne or nnnt name an res~ ence ~.y,„ ~ r~~~.~ o ~~-~, 724 Longs Gap Road, Carlisle, PA 17013 r~ T r-~ '. ~, ~T - r y ~ -- -- - -, .'~ - l` ~ - - . -, ~ j -J ^ j 5 .. ~ C~ _.r.~ Page 1 of 2 a -;~ Grandson Granddau Grandson last princip resin at ~~ '~5~ iJA(~ ~~ 7/ 10/ 11 at Thornwald Home OATH OF PERSONAL REPRESENTATIVE COMMONWEATLH OF PENNSYLVANIA courrTY of CUMBERLAND The petitioner(s) above-named swear(s) or affirm(s) that the statement in the foregoing peition are true and cord 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 . ~. ~ before me this ~ ~ ~ ~~;' a`~ ~ ~ o-.~f; i f r i ,~ ~ ~ '~ ~ Gam? ~ , /~~/~'in~C~c-~~'-~`'" . J AN E. KAMOWSKI r < <, ~-(,l t~ .~ ~~~r ,(~_~k f ~~ For the Register ; ~ -- ,~ f ; i`rt 1 -~~,-j I.- C7 ~ - ?. - ~" _ File Number: '~ -~ ~' -, ,~~,--; Estate Of WILLIAM A. MCKILLIP ,Deceased -' `~, -; , , Social Security Number: 174-05-2522 Date of Death July 10, 2011 AND NOW ~~~~~ ~- ~ ~ , 20 11 in consideration of the Petition, satisfactory proof having been presented~before me, IT IS DECREED that Letters of Administration are hereby granted to JOAN E. KAMOWSKI in the above estate and that the instrument(s) dated described in thte Petition to be admitted to probate and filed of record as the las Will (and Codicil(s) of Decedent) ,_ Register of Wills ~ ~ X E~~ ~ E'~ ~-~ ~ C~~, -. FEES j`~ Signature ~~ Attorney Name Robert G. Frey Letters ~,`~-C,`~ Short Certificates y (}~ Sup. Ct. I.D. No 46397 Renunciation ~~ ~,=~. ; j~> Address: 5 South Hanover Street ~:! ~~,~~~~y~ ,.~ . ~~; Carlisle, Pennsylvania 17013 Telephone: (717) 243-5838 TOTAL... "~ j , ~~ G Page 2 of 2 his is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. 602 t~6~ No. ~YV `1~v~a~.~ ©' t'~ `~w~ Marina O'Reilly Matthew Acting State Registrar AUG Q ~~ 2a11 _- .~ Ste' t ~ _;~'l7 ~'--C'> l G7 '. _7 .ta ~._, ~ r - .y -_~. I 1 i L__) -Tl -) L. - ^, 7 ^-. HtD6-143 REV n/zoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS "' • _... TYPE /PRINT IN ~ ~~~-~ r „-~ r~Tl PERMANENT CERTIFICATE OF DEATH `~ BucK INK (See Instructions and examples on reverse) ~ -- STATE FILE NUMBER 1. Name of Decedent (First mitltlle, last, suMlzj 2. Sex 3. Soclal 6ecunly Number 4. Date o' Death (Monts, tlay. year) .. William A. McKillip Male 174 - 05 - 2522 Jul 10, 2011 6. Age (Last Binhtlay) Under 1 year Under I tlay 6 Dale o! Binh (Month, tlay, year) ]. BirMplace icily antl slate or lore n munlry Ba. Place of Death (Check any one) Monau pays ~a~w mare December 3 1912 Noapltal: ulna, 98 Yra Carlisle PA ^Inpabenl ^ER /OUtpatleN ^DOA fc7 Nara~nq Roma ^Rea~danLw ^otMr-specify: 6b. County of Geath ec. Ciy, Boro, Twp. of Death 8d. Facility Name (If not inslilmion, give street arA nunMr) 9. Was Decedem of Hispanic Origin? ~ No ^Ves 10. Race: American Intlian. Black. White, dc. i Cumberland Carlisle Tharnwald Home ur yea, apepiry aban, (spacM Mexkan. Pueno Rlwn, ale.) White 11. Decedem's Usual Occu lien Kmd d wont done dum most of world life. Da nd stele retired 12. Was Decetlenl ever In the 13. Decedent's Education (Speafy only highest grade compleletl) 14. Martlal Bolus: Marred Never Marriec. I6. Surviving Spouse (II wife. give maiden name) Kits m Wark Kind of Business i Intlustry V.S. Armetl Forces? Elementary / SecorMary (0-12) College (1-4 or 5+) widowed, Dieorgea (spediM pvea ^Na 16. Decatlenl s Meilnq Address (Street city I town, state, zip catle) Decetlanl's pA Dkl Decedent 442 Walnut Bottom Road Amusl Reakerce na stale uve in a t?c. ^ vas. Decedent Lived in Twp. Townships 17d No, Decedent LNetl wdhin Carlisle PA 17013 ,Tb. caanq Cumberland ~ AdNal Limbs of Carlisle city; sore 1B. Father's Name (First mitldb, last suffix) 13. Mother's Name (Flrsi, m~tltlle, maiden surname! 20e. Inlorrtunl'a Name (Type l Pnm7 20b Infortnanl's MaIIMg Atltlress (Brest. ally I town, state, zip code) Joan Kamowski 724 Longs Gaq Road, Carlisle PA 17013 21 a. Method al Disposbion ^ Gremalwn ^ Donation 21 b. Dale of Dispositbn (Month, tlay, year( 21c. PMCe of Disposi-on (Name of cemdery, crematory or other place) 21tl. Location (City I town, stale, zip cotle) [~ Burial ^ Removal irorn Slate ;Was Cramalbn or Danetlon AUUlalretl J l 15 2011 Cumberland Valley Mem. Gardens Carlisle PA ^ Omer - Speciy: by Nsdlcal Exsmlmr / CoronerT ^Ves ^ No u y ~ _ zza. e d Funeral service Lican e ( person d a,dr) 2zb. Liwnae Number 22a Noma antl Atltlre aa of Facility Hof fman-Roth E~neral Home and Crematory - - (~ 1 013144E - P-r u .y m ~ ~• ~y~r~y phyacan is rql avaNeble a1 lime of OeaM to wnay paaae of deaM a. v avya v.v wa,v w ar u e . • ua n n u P a¢,: awwv to y rarvre ar u. tie v. ucensa rvurroer ~ 5s sro 3(F c. uate ~ gneo IMOnm, oay, year) ~ I) o ~ wn Items 24-26 must M completed by person 24. Ti of Death C 25. Dale ourrce1tl Dead{Monm, tlay, year) ~ , 26. Was Case Referretl to Metlical Examiner! Gnroner for a Reason Other than Cramanon or Donalbn? who pronounces tlealh. © O RM. ~ (Q 12_0 l ~ ^Yes ~,t4o CAU3E OF DEATH (See Inatruetlona end examples) r Approx male interval: Pan II: Enter purer sianifiranl cmdlions cmidbul ng to deat h, 26. Die Tobaaro Use Contribute m Deam? hem 21. Part I. Enter ttre cha n of events- dseases, inryrres, or carlpticef s -Met tliremly caused tics deem. W NOT solar terminal events such as cardac arrest Onsal to DeaM but not resultinq m the uMenyirg cause given in Pa n I, ^ Vas ^ ProMbly respiratory arrest, or ventricular fibrillation witlwW showing Me etlabgy. List only ore cause on each line. ^ No Unknown IMMEDIATE CAUSE IFnal dseasa w C ~ ^ condnion resumng in amt _~ ~ J y a i U fl ~L(.W 29. I' Female: ^ pus to ;a as a consequence of): Not gegnanl wiMln pass year Saquerroallyy Ilsl ointlbims, Il any. b drr t B lin b U l d ^ Pregnant at time of death gg a o ro a e on e a. pus to ter as a consequence oQ: Enbr iha UNDERLYING CAUSE ^ Not pregnant, but pr m wbhb 42 tla s ~ Y (tl BBe56 or injury Mel InbiateOlM ev ms resulting in Mats) LAST. d death Due Iv a as a consequence of)'. ^ Net pregnant, but pregnant 43 mys to 1 year d Mbre seam ^ unknown rc pregnam wimm IM peal year 30a. Was en Autopsy 300. Were Autopsy Findngs 31. Manner of DeaM 32a. Date of Injury (March, tlay, year) 32b. Describe How Injury Occurred 32c. Place of Inlury: Hans. Farm. Brcet Factory, Pedomwtl4 AvaibNe Rbr to Completun Nalurol ^ Homk:ide DiACe Building, etc lSizecily) of Cause o1 DeaM? ~, . ^ Yes ~IJO ^Yes ^ No ^ Accdent ^ Pending Invesligalion 32d. Tme m Iryury 32e. Injury at WaM? 321. IF Transportation Injury (SimcMJ 32g. Location of Injury (Brest. city! town, slate) ^ Suicide ^ Cadd Nd be Datamtinetl ^Ves ^ No ^ Dtlver / Opamlor ^ Passenger ^PedesVan M ^Dger - spears 33a. Cenil'er (check only me) CMI 'n h skian Ph scion cent • >N g P Y ( Y Fying cause of tleaM when another pn sdan haz ronouncetl tleam orb com le tl It m 23 33b Si na ~ 9 and idle of Cenrfier n y p p e e ) To Me Mat al my Mnowbtlge, tlssth occurted due to Um esusalsl and manner as sttletL______________________________ __ I~ - ~,' V (~` • Pronoundng end caddying phyaleian (Physiian both gorounang death and renirying to cause m deem) T~ 33c. License Number 33d. D ale Signed (Monts day year) t u~ Tq the Mal of my krrowbdge, drM occurretl et Me Ilme. date, and pbce, aM due to the cause(s) aM manner ea abtetl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ ~w T ~ ~ .y ~ I ~ , lL V i , . ` I ~'t Metlleal Examiner/Coroner . ~ u ~ ( ( W On the MBis d examinatlon and / or Investigation, in my opinion, death aeeurretl al tM time, date, and place, and due to tM cause(s) and manner as atalecL ^ 34. Na me a~M Adtlress of Person ~Wyno Canplel~ d Cause o! Death (teem 27) T )qe I Print 0 35. Registrar' a and DI c~6e~ ale Filed (Month 36 tlay year) r j V C ~ ~ ` P v ~~ ^ V G~ ~ J ^ ~~ ~I ~ is i c i o i - ~ . , . ~ _ P ~~ Ncuar, ~r~~ c , cz~~.~al,.~. P ~~o ~ /~ `+ Disposition Pemil No. ~/ ~() 1.'O 1 ~O-n