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Home My WebLink About11-16-11Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: Kevin L. Cohick File No: ~ ~ ~ 1 ( - ~ ~ ~3 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: 178-50-6352 Date of Death: October 28, 2011 Age at death: 53 Decedent was domiciled at death in Cumberland County, Pennsylvania (Stare) with his/her last principal residence at 239 Bobcat Road, Carlisle, PA 17015, Lower Frankford Township, Cumberland County Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 3400 Block Waeconers Gan Road, North Middleton Township, Cumberland County, Pennsylvania Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 12,000.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 0.O(1 TOTAL ESTIMATED VALUE.... $ 12.000.00 Real estate in Pennsylvania situated at: n/a (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated and Codicil(s) State relevant circumstances (e.g. renunciation, death of executor, etc.) ~ ':.: Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorcedot a partyto~a pend~g,-~, divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and dill have a child born or--; adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~ ~ •-=:: :.~ ~- -_ _ , NO EXCEPTIONS o EXCEPTIONS ` ~,: !;_~ C-y ' 7 - -- ' .-> --, - B. Petition for Grant of Letters of Administration (If applicable) % ~ -~ - c.t.a., d.b.n., d. b. n. c.t.a., pendente life, durante a7ise~lia, duran~e.lninoritat T~ --1 If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete-list of heirs. - `" r Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorc h d been established defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated ca acitated person. ~ ~fto-t 2 C /S ~ e /,~ NO EXCEPTIONS ~ EXCEPTIONS ~~~ ~ Zecj e ~'~t~ r2~tclJgr/ 2S~2 Petitioner(s), after a proper search has/have ascertained that Decedent left no Will ay(d was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationshi Address Juanita E. Cohick wife 239 Bobcat Road, Carlisle, PA 17015 Michelle R. Junkins daughter 7 N Corporation Street, Apt. 1, Newville, PA 17241 Kevin L. Cohick, Jr son 4A Watershed Drive, Duncannon, PA 17020 Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } ot~ 1CU~se Only __ ~~ ~T, - _ n i i -- [~ } SS: COUNTY OF Cumberland } Jf~71 ~, L ~ Ll ~ Y.. - " ' ~_~c ;~ - - .,~ - , Petitioner(s) Printed Name =U - - -- Petitioner(s) Printed Address Juanita E. Cohick ~ .. ;.~. 239 Bobcat Road Carlisle PA 17015 °-~• `n The Petitioner(s) above-named swear(s) or affirm(s) 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 edent, t Petitione (s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date me this ~~ day of -~}OJ-e V~tr1P~ 3U l- Date By: .E1''1 ,Q D.f'~, ~~Q,u,QJ~(.I~l . Date For the Register Date BOND Required: Q YES Q NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ ~~ .OU (~) Short Certificate(s)...... ~` (}• UG ( )Renunciation(s)........ . ( )codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ Attorney Signature: ~~ l Printe ame: Taylor P. Andrews, Esq Supreme Court ID Number: 15641 Automation Fee ............... . (~-(} JCS Fee . .................... ~3 • ~~ TOTAL ..................... $ 0.00 Firm Name Address: Phone: Fax: Email: Andrews & Johnson 717-243-0123 717-243-0061 tnandrewcnpa_net DECREE OF THE REGISTER Estate of Kevin L. Cohick File No: ~ ~ - ~ ~ - l .~ 3~ a/k/a: AND NOW, ~(~~ VY1 gyp,(' ~ L.p. c~ U 1, , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Admnistration are hereby granted to Juanita E. Cohick in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills (~-e r ~~.~~~c~r ~~ Form RW-02 rev. 10/11/201! Page 2 of 2 )yin, sns ur: Irr~;;n, LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 17978416 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Loca] Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~9~;,n.1~~.~ ~~~,~• N0~1 2 2011 Local Registrar Date Issued ~ ~ -... ~ ,. ~ - ., A _ H. ~n ~ - r Tl IOS.1N REY 112008 TYPEIPRM,T IN PERMANENT BLACK INN /, ~'] _. 1 ~ 1 3 3 a COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See Inetructlona and examples on reveres) STATE FILE NUMBER 1. Name d Dacaaed (Flop, nedae. be4 seal 2. Sea 3. Sadel Sacairy Numer a. Dab a Drm (MOdh, dY, YrO Kevin L Cohick Male - - October 28 2011 s. Apo IIaN BimNey) lA1de 1 leader 1 5. Deb a Bits Monts. 7. Blrogeca eM stets a ) N. Plea a Deets ICnrk arm) wan Dave rwse MrwY Hospibl: Otlan Carlisle PA , ^Inpatiant ^ER/oapewnl ^DOA ^NUeirwHarm ^Reeidenw ome•s>aedy: 53 Yn. June 16 1958 Sb. Couny d Death 8c. City, , Twp. DeMh r. Filly None QI not imwtlan, plus weN ed nemep 9. Wr Oawaem d Hbpeea Oagin7 [~ No ^ Ye, 10. R : Anbdwn hdbn, Bock, WMb, ak. ("Ike, epecpy DuWn. (SOea~ Cumberland North Middleton 3400 Block Wa oners Ga Road "1idni'P'""°R~'"'"`~> White 11. Dewtlere'e llrN eon IOM d aaxk tl am mots d Me. Do nil ebb 12. Wee Oewdent ew m ma 13. Dawderp's Eduwtlon (S>~7 only hart 9~ ) 1p. Madbl 9blus: Mamed, Nam MenleQ 15. Survivkg 5pa w (p wile, Abe mNmn name) IOrd d Waa Iona d BwYaa I Yldredy U.S. Amatl Foiwe4 Elerenbry / Secondary (612) CoAep• (1d Of 5i) Wpbwea. Olsorcea (Spadly) sistant General Truck Stop ^rr ®Na Married Juanita Gei er 18. (Streal alY /town. Nab. dp weal 239 Bobcat Road Oacedsd'e DW Deaaled 17c. (y~ Yee, Decaeenl lived In r ~,tGr~C3nkford Twv Anal Rraenca ne. Sba ~} Carlisle, PA 17015 ~? ,ro.cwnry Cumberland na. ~ IoLtluedwlYSn ~,,~ 1B. Feme'e Name (~. neddb, bet soma) 19. MdMr's Name (P1M, mitlde. meitlen wnieme) Marlin Cohick Ruth Lehman 20a. InformenYS Name (Type / PM1) 200. InbmrnYe MNag Atldaes (Sweet, dY I own, ebb, dp cab) Juanita Cohick 239 Bobcat Road, Carlisle, PA 17015 21e. MNnotl d Dbpaabn ~J CamNbn ^ Daremn 27a. Dab d Dlepuwal (Made, say, yrr) 21c. Place d DMpaelmn (Name d aanNey, anxnNay a amer pier) 21d. l.awtlon ICM /tam. able, dp wile) Ba RerovMhanSeb ^ November 4, 2011 Hoffman-Roth Funeral Home & Carlisle PA 17013 ^~ ^ ~ , 22a. ' a FurrN s«v~. ' roman sake r "`") 22b. three Number 22a """° aM Aaaar a FaawrHof fman-Roth Funeral Home & Cremator y - 344 lien. 23ec aey weer cartllyMp 23a. Tame Beat d my knwMtlpe, arm aarmd N M 1bm, aab ed place ebbd. (Sigrhaa ed ab) , d»', Year) plryNtlr b na.venebb N wr a aeon b aMMy wrs d deM. ller 2e-28 muN bs axrolatea M pwew 2A. Tim. d Drtlr 25. DMa Pmiaalwa Ikel IMaM, aaK r«A Z8. 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CerNbr (dock aey aw) 33b. • Gn"Yeq physbbn (PhyNdr wrary'eg wise d aNh wMn enaher phyNCbn Me pmnaxwa deem aril ampbtea nem 2S) To the beetd my bbebape,ardlamrmaaueblM Cmae(s)bM mre.raeme~-------------------------------- ^ - oroner • Pmmisltlnp ana ~Mnp qe~ (PlryNClan can placaaAlp arm em wnilyYS a awr d deNn) m tM wnd b w a m a Nn tl bb l l a ^ 3x. uwnr Hamer 33a. Dare Sgretl ItAam, say, ywoq --- - -- my mw pe, es wcum a me,r , rp sw, end p uebm.awr(.)aM naalerststed__-__----_-- • MeaCNEnmine/COrone On tM bWS d eunaMbn and / or InreNi nlea M m o lMan tlrtll oaaerad n the 1Mb rb mrd soil ale b 1M cwrlel mtl manner r stned ~ bce November 1 2011 . p y p , , _ , p . ')c'TyP./Prva ne; ~"orbn z ~ " n e P~ " ~. RageVate nets 3e Deb FdM lManm, aay,yrr) ~ ~ 6 3 75 Baseh or e - I~ I f La I I- I G I , (• Mechanicsbur Pa. 17050 Diepoenbn Pemn No. ~ fo _S'.-~ U (~ .