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HomeMy WebLinkAbout10-13-11PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Catherine M. Keefer Eile Number ~ ~ _ I I ~ I C~ also known as Deceased Social Security Number 177247220 Cathv R. Allen Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' OR 'B' BELOW.) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the eXeCUtor named in the last Will of the Decedent dated 4/29/2003 and codicil(s) dated Wanda K. Koontz renounced in favor of Cathv R. Allen; renunciation attached (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 instrument(s) offered for probate, was not the victim of a killing, was never adjudicated incapacitated, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce had been established as provided in 23 PA C.S. section 3323 (g): none B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d. b. n. c.t.a.; pendente life; durante absentia; durante minoritate) 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 SectionA above and complete list of heirs.) C~ r ~ ~.~~ -'?;SC7 --a - (COMPLETE INALL CASES:) Attach additional sheets if necessary. ~~ t. -~ _ --+ Decedent was domiciled at death in Cumberland ~ ='1 ~- -r County, Pennsylvania, with his /her last principal~sidence at i ~, ~.-~ r~ 201 E. Burd Street. Aot. 3066 Shiooensbura PA 17257 Shippensburg Boro Cumberland County '' (Lut street address, townlc:ty, township, county, state, z:p code) Decedent, then 80 years of age, died on 10/1/2011 at Menno Haven Nursing Home. 2075 Scotland Avenue Chambersburg PA 17201 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 2.500.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ none 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 appropriate form to the undersigned: nature Typed or printed name and residence /~ /' ~~ (~ Cathy R. Allen 210 Walnut Dale Road Shi ensbur PA 17257 Page 1 of 2 Form RW-02 rev. 10.13.06 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND 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 lrnowledge 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 the ~ ~~ day of Signature of Cathy R. Allen -17 .~7 October 2011 ~6~ ~~ ~ ' % ~--~~ ~~~ o the Register Signature of Personal Representative ~ ~~~ Signature of Personal Representative ` ~ :~ -'yC.> -r~t ~. _. File Number: ~~~ I ~ ~ 1 ~ ~ y ~ 7 Estate of Catherine M. Keefer ,Deceased ~- r-r-~ c_ __; -- ~, ~:~, ~_. ~ "'~i r •, `~~ ~. ' Social Security Number:177247220 Date of Death: 10/1 /2011 AND NOW, October i ~~~~ , 2011 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Cathv R. Allen in the above estate and that the instrument(s) dated Aoril 29. 2003 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES ~ ~ ~ ~ ~ 't,ch.l~ ~^ Letters ............................. $ 30.00 eguter Wi ~ ~` ~ 1~) ~ - - Short Certificate(s) • • • • • • • • • • • • $ 8.00 Attorney Signature: J ` Renunciation(s) •••••••••••••••• $ 5.00 JCS fee .... $ 23.50 Attorney Name: oel R. Zullin Automation .... $ 5.00 Supreme Court I.D. No .: 17516 Will .... $ 15.00 ..,, $ Address: 14 North Main Street. Suite 200 ~~~~ $ Chambersburg .... $ .... $ PA 17201 .... $ $ Telephone: (717)264-6029 TOTAL ............................. $ 86.50 Form RW-02 rev. 10.13.06 PagO 2 Of 2 .,~< ,,,, _~I_ I/-_1~~77 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photoclraph. Fee for this certificate. $6.O0 P 17~95~95 Certification Number (~11ti I~ ?f) cc" i _?' I1?-Ill tile' Ifll~tl~1?1<i11t •`t tltl-c~ ~'i ;<'ii i:(yrrex'Lit: Ct`~};t ~rLHll dIl t~l"1L'I t. (.. C,UI~~±?C ('1 ~-)~~i clulti~ tilc~l ~~~tl~~ 'ile a~ i t,iai ~L ~>(1,1r .~i1e ,tl-)_.;(1 • ccrtiti<aie~ '.~' , `+~' f t'~~;ueicll li4 (},i 1i,tT~, \'ii Recortic F,)1;~r ;sj. ~lcrln~ui.~ tii;rl~ _ ~_ ~ - ----- -- __- -- _ l~ -,!off ?-~_ `. ~ 9 t'_. ..,.-. ~~ ",~ yam' ~' ~ 1 ~ v ~'~' i l _ ~ ~ ~ - ~ 1 ~~ ~l .t ~!' ~~ r ~~ .-1 ~~ ~ E7 Ht05-143 REV 1110006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS TYPE 1 PRIM IN r D -.:i7 . ,,. '~~• ~ -' r ' PERMANENT CERTIFICATE OF DEATH :J.%L ~ = "--~ BLACK INK (See instructions and examples on reverse) „_,_~ ~„ ~ ~; ~ .._ .-r; ~~ 0 1. Name of Decedent (First, midd~~y I~ 1~, sWlix) " ~ ~ 2. Sex 3. Social Security Number d. Date of Death (Monih~ year) ~ ~e'f/vtQi 3" ~ CJ~'-'i"t-/ Female 177 - 24 - 7220 October Z" 2011 . 5. Age (Lest Birthday) Untler 1 ar Under 1 6. Date of Ginn Manm, da , er 7.8' lace Cit and stale or lor d n count 8 a. Place of Death Check onl one Months Days Hours Minutes Hospital: Other. 8 0 vrs. November 5 , 19 3 0 F a n n e t t s b u r P A ^ Inpallem ^ ER / ompatieM ^ Doa ^x Neramg Home ^ Reaiaer~ce ^ omer sperdy: Bb. County of Deets &. City, Boro, Twp. of Death 8d. FadMy Name (II not instttution, give street and number) 9. Was Decedent of Hispanic Origin? ©No ^ Yes 10. Race'. American Indan, Black, Whlle, etc. (If yes, spedfy Cuban, (Specrl;7 Franklin Chambersbur Merino Haven Mexican,PUenoRican,etc) White 11. Decedent's Usual Oa anon Kind of work tlone tlun most of worki tile. Do not state retired 12. Was Decedent ever in Me 13, DecetleM's Education (Specity only hl}ptest gratle completetl) 14. Mamal SIaWe'. MarrieQ Never Marred, 75. Surviving Spouse (lf wile, give maitlen name) Kintl of Work Kind of Business/Industry ILS. Armed Forces? Elementary /Secondary (0-12) CMlege (1d or 5t) Widowed, Divorced (Spedty) Homemaker Own Home ^Yes ®No g Widowed • t6. Decetlem's Mailing Atldress (Street, city I town, state, zip code) Decetlent's Did Decetlenl State Pennsylvania Live in a 17c Actual Residerwe 17a ^ Y D d nt Li d I 201 E. Surd St. Apt. 3068 . . es, ece e ve n T . Township '"p p S h l ensbur P A 1 7 2 5 7 P P 9 17tl. ®No, Decedent Lived within S it l 17b. county Cumberland p p e n a b U r , Actual omits of q City /eoro 18. Father's Name (First, middle, last, sotto) 19. Mother's Name (First, mitlde, maitlen surname) Geor e Rexroth Mary Rosenberry 20a, Informant's Name (Type /Print) 20b. Informant's Mailing Address (Slreei, city /town, stale, zip code) Cath R. Allen 210 Walnut Dale Rd. Shi ensbur PA 17257 21 a. Mmhod of Disl>osttbn t ^ Cremation ^ Donaton 21 b. Date of DisposNion (Month, tlay, year) 21 c. Place of Disposhion (Name of cemetery, crematory or other place) 21tl. Location (City/town, slate, zip code) w ® Burial ^ Removal from Slate t Wes Cremation or Donation Amhonatl ^ rimer s tbyAktlbelExunlrterlCoroner7 ^vea^NO 10-5-2011 Methodist Cemeter U er Strasbur PA 17265 22a. Signatu un rvice Licari tson acting as such) 22b. License Number 22c. Name and Adtlress o1 FadMy - ___..-,_ ' 014831-L Fo elsan er-Bricker F.H. Inc. 112 W. Kin St. Shi ensbur PR 17257 Cmtplm ems 23ac only when ce ~ 23a. To the best of my knowl ,deem occurred at the lime, ~1ate entl place sutetl. (Signature and t41e) 23b. License Number 23c. Dale Sgned (Month, day, year) physician rs not available at lime of death to ceniry rouse of death. ~ ~~~ ~` ~ ff ~ \ L~i,(~..E/ ~j,/ ,[J ' l 2 /~ N S v~ S v~ Off„ ~~ b Fr ' Z,~ 1 Items 24-26 must be completed by person 24. Time of Death 25. Dale Pronoumad Deatl Month, tlay, year) 26. Wes Case Relerre to Medical Examiner /Coroner for a Reason DIMr than Cremation or Donation? ~ who pronounces death. ~ M. OG 1 ~ e ~- ' ~ Q (! ^ Yes No ~~~ (((((( CAUSE OF DEATH ( Inatructlona and examples) , Alproximate interval: Pan II: Enter other sianilira nt contlitiens coutr but no to tleath 26. Ditl Tobacco Use Comdbule to Death? hem 27. Pen I: Enter me chain of events - tlLSeases, injurles, a complicatiore ~ that directly causetl the tleath. DO NOT enter terminal events such as wrGac artesl, Onset to Death but not resuhmg in the uMenying cause given In Pen I. ^ Yes ^ Probabl respiratory erred, or veMrkuler fibrillation whhout showing the elwlogy. List Doty one cause on each kne. y ~T! ^ Unknow 0 n IMMEDIATE CAUSE !Final disease or , contlilion resulting m death) ', -~ a. S R ~ g t J' ~ ~ c' ~ 4 } ~S. ~ i cif 17 z" t~+~ k 29. II Female. [~ N Due to (or as a consequence oO: 1 ol Pregnant within past year ^ Pr aril a7 time of deem SeouentialN list conditions, it any, b. C)',i x....~. e 1 t ('r T -=1 leadin to the cause listed on line e ~'Y`Yt M F t ~iC •tA ^T • D ^ te , g UNDERLYING CAUBE Due to (or es a consequence o11: ~ E t th ~ Nol pregnant, but pregnant vnthin 42 days n er e (tlisease or injury that Inhialetl tbe c 7~ o. (~ ~ f-e. S ('`(tt 1 i t (~ S T ~ `~L t events resu4irg in tleath) LAST. t of death ^ Due to (or as a consequence oQ: Nm pregnant, bN pregnanl43 tlays to 1 year d. i t before tleath ^ Unknown II pregnant wimin the past year 30a. Was an Autopsy 306. Were Autopsy Findings 31. Mariner of Death 32a. Dale of Injury (Month, tlay, year) 32b. Describe How Injury Ocwned 32c. Place of Injury: Home, Farm, Street, Factory, Pedormetl? Available Prior to Completion ('EL Aural ^ Homicitle Oglce BuilCing, etc (Spedly) M Cause o1 Death? `f ~~tt ^ Ves i No ^ Yes ~No ^ Acddenl ^ Panting Invesligalion 32tl. Tirtce of Injury 32e. Injury al Work? 321. II Transponalbn Inury ISpecMy) 32g. Location of injury (Street, city /town, state) y ^ S icid ^ Coultl N l be D t i d ^ Yes ^ No ^ DrNerl Operelor ^ Passenger ^ Petlestrian u o erm ne e e M. ^ abet - Speaty~ 33a. Cen4ier (check only one) 33b. Sgnature and Tttb of Caniliar , • Ceditying physician (Physician certifying cause of death when another physician has pronounced tleam end completed Item 23) L.x ~,,,, .- ~ ` M ~ Tothebestolmyknowledge, tlerih otturred due to the uueefaj end manner ea steted_________________________________~ . J + - • Pronouncing end anlrying physVClen (Physkien both prorwurcing death and cen9ying to cause al death) 33c. License Number 33d. Date Signetl (Month, day, year) To the best of my knowledge, deem ottumtl M the time, tlNe, ant place, entl due to the cause(s) entl manner as steted_ _ _ _ _ _ _ _ _ _ _ ^ ------- • Medial Examiner! Coroner [~DObs"'Igt~l- 1o~31`zoLl lM the bests of axaminetlon entl / a Investigetbn, In m'y opmlon, death occuretl sl the time, date, end place, and due to the cause(s) entl manner as staled_ ^ 34. Name ant Address of Person Who Complelqd Cause of Death (Item 27) Type /Print Reginrar's Signature tlDisl' Numbe I -•, /' ~ / I ( + 36 to Fd (Month, day, year) ~ M~rz t~. H•,r-cam 'P hySt U o..~ T-r(v<w/ ' 5 1 ' Z-l ~ A )7'l0 X01 __scoll.r-t$ Aw«Y1, c{~•...nv-cA~.c 4 - •/ v Disposition Permit No. U~~@7CJ .e-sue _~_ ; -C"l ~..~ ^ RENUNCIATION - -~~ ~~~~.... -~ ~~ ~-~ _.~ Zs t-_ >-~~ L_- REGISTER OF WILLS .~' ~~ o _,-, - - - CUMBERLAND COUNTY, PENNSYLVANIA ~' ~.,ry c~ ~2/ _ // _ / J~ ~ --r, Estate of Catherine M. Keefer ,Deceased I, Wanda K. Koontz , in my capacity/relationship as (Print Name) Co-Executrix of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Cathy R. Allen 10/6/2011 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , F ~ ~ ~ .~._.,f.~. .... ~~ (Signature) c- 309 N. Fayette Street (Street Address) Shippensburg PA 17257 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciatio for the purposes s ~,dt in on this day of C~ ~/j . Deputy for Register of Wills Form RW-06 rev. 10.13.06 Notary Public " My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTF# :?~ PENBy aYLVARIIA No±aria! :seal !;ar!n L. Walter, P:o4arY Public CI?embe~rsburg Boro, Franklin County nny Commission Expires May 13, 2013 _ _~ ~, _ ~:, -~, _ . '~-r't_7 •-~ LAST WILL AND TESTAMENT '- ~' ~= _-. ,. t:. ~!, ;cam-+~ =. •.. ~~ ~.~> • I, Catherine M. Keefer, presently residing at 201 East Burd Street;y~partment=H- ~•'~ 306, Shippensburg, Cumberland County, Pennsylvania 17257, being of sound mind, memory-and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. 5EC0?~1D. I give, devise. and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved daughters, WANDA K. KOONTZ and CATHY R. ALLEN, in equal shares, on a per stirpes distribution basis, provided that they survive me by a period of sixty (60) days. THIRD. I nominate, constitute and appoint my daughters, WANDA K. KOONTZ, presently residing at 309 North Fayette Street, Shippensburg, Pennsylvania 17257, and CATHY R. ALLEN, presently residing at 495 Mainsville Road, Shippensburg, Pennsylvania 17257, or the survivor thereof, to be the Co-Executrices of this my Last Will and Testament. FOURTH. I direct that my personal representative(s) shall not be required to give bond for the faithful performance of their duties in any jurisdiction. FIFTH. I direct my Co-Executrices to retain the services of JERRY A. WEIGLE, ESQUIRE, with offices located at 126 East King Street, Shippensburg, Pennsylvania 17257, with respect to the settlement of my estate due to his familiarity with my affairs. IN WITNESS WHEREOF, I, Catherine M. Keefer, have hereunto set my hand and seal to this my Last Will and Testament, written on one (1) page, this _ day of _ ,~~. .~C~- , 2003. ~ ~ ~ SEAL) ,~ o WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 This instrument was by the Testatrix, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in the presence of each other, we believing her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. .~ ~., - ~ ,~, (" ~ f,. ~. f b`~" ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS I, Catherine M. Keefer, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Catherine M. Keefer, t Testat ' , ~`~``~~ day of ~~ r, 003. ~; ~ ~ NOTARIAL SEAL Je A. Weigle, Notary Public Shi~ensburg, PA Cumberland Courrty My Commission Ex Tres October 7, 2006 WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-7397 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS ---~, and ,'"., ~' ~~~~ ~.' ~' ~ ~- G-- `.~ ~'~ ~,`~ ,the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Catherine M. Keefer, the Testatrix, sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix, signed the will as witnesses; and that to the best of our knowledge the Testatrix was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. ,~ l,l'd.~~ ~ (UY1'.~ l ~~ ~( a ., - ~ , ~ ~~r` ,, (~- ~..~C~c~c~ ~. ,~ , ,r~ _. Sworn or affirmed to and subscribed before me and ,C~'~~'~j ~.. ;Tc~// r~~.. - w' es s, this Z~,day of ~ , ~b~f 3. C.i . NOTAl~1AL SEAL Jerry A. Weigle, Notary Public Shippensburg, PA Cumberland County MY Commission Expires October 7, 2006 WEIGLE & ASSOCIATES, P.C. -ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397