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HomeMy WebLinkAbout11-17-11PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ~~~ ~ f I Cl` (~ ~I 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: .~i ea~1 ~Ct~'~ a/k/a: a/k/a: a/k/a: Date of Death: l 1 ~O 11 Decedent was domiciled at death in Cu vv~~ ~ / ~a v~ principal residence at ~a~ Mani; ~a- a n ~ Street address, PoAAst Ofticeiiand Zip Code Decedent died at ~ ~r1 .~GyWcl. L-GI) ~ Street address, Post Om and Zip Code Estimate of value of decedent's property at death County, Lam. File No: ~ - ~ ~ -) "2 (..~~ (Assigned by Register) Social Security No: I5 ~ - i (~ -- ~ c7 ~ Age at death• ~'S ~f4 (scare) with his/her last 5o Htl( Cuylnber~4~ ity, Township or Borough County 11 CU vN b~~ ~4 nc~ PA, hip or Borough County State If domiciled in Pennsylvania ............................ All personal property $ ~, '~ O 0 If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ -- -•-- Ifnot domiciled in Pennsylvania ........................ Personal property in County $ ---_ [value of real estate in Pennsylvania ......................................................... $ -- - TOTAL ESTIMATED VALUE.... $ ~ l~C) U Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Of[ice 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 ~/ ~ ~/~Ot' 7 and Codicil(s) thereto dated State relevant circumstances (eg. renunciation, death ojexecutor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~NO EXCEPTIONS ^ EXCEPTIONS ^ 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 absentia, durante rninoritate 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. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ^NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent lefr no W it l and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): C7 - Name Relationshi Address ~_ - - T 1 -~ ..' r, ~__ . -_ _`\~ -ti - .~ ~ - __._.. i ~ - ,. _ i Y `'~ 7 Fornt RW-02 rev. !0/!l/1011 Page 1 of 2 C7 -~ _ ,_. ,. ,. ., Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF } } SS: } Petitioner(s) Printed Name Petitioner(s) Printed Address ~arbarc~ .~.. f~ejso~ ~o`c1 ~lah~ ~ane~ Carn (-l,I( A ~10(I T1;e 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 Pe~ition~r(s) and that, as Personal Representative(s) of the Dec ent, the Petitioner(s) will well and ntly administer the estate according to law. Sworn to or affirmed and subscribed before Date ~~~/ 7~~ ~ ~ t2ie t: is ~, day: of ~~~~;,- c~01) Date ~y~~~~ ~i.~ C{, ~/ / rC~l..i~ Date For the Register Date BOND Required: Q YES ~NO To the Register of Wiils: FEES: Please enter my appearance by my signature below: Letters .................... .. $ o[V ~ U~ ( 'S )Short Certificate(s).... .. ~O • UG ( )Renunciation(s)....... . . ( )Codicil(s) ........... . . ( )Affidavit(s).......... . . BOlld ........ ............ .. . . Commission ................ . . Other ... . Automation Fee .............. . JCS Fee ..................... J TOTAL ..................... $ Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of ol~c~.r ~ ~Q~,-~-~ File No: ~ ~ ' + ~ - (2 ~-{ a/kla: AND NOW, ~ i C\ 1~Q,1'V1 ~'~ ~ 7 ;~O I ~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~e,~ } G ~fLt ~, r1-~ Cj 1~~/ are hereby granted to ~ Y ~t i ~a ~ (j ,~ ~~jl'1 the instrument(s) dated ~~ ~ / ~ l / ~ CJO 7 in the above estate and (if applicable) that described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. r Register of Wills ~ '( ~1 0~, ~~ L~,~S Offigial t7s¢ ~ my - - , __. -, , -.... .. ,- ,~ - .. `' f. Tl --ri Fonn RW-0? rev. 10111/2011 Page 2 of 2 Hl(15.805 REV IntJpT 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 17926502 Certification Number a REV n(2ooa /PRIM 8J RMANENT ACK INK 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 be forwarded to the State Vital Records OYfice for permanent filing. ~ y~ aj`' ~pv o ~ Zo~~ ~, Local Registrar Date [sued c'~ ~~7 ti~ _ ~? ,. _ - ~ _ / -~ - I ~ ~.) \-_.~ \ - ~ `\ 1~~ -~~ ~.. I~~l 1.1 ~ _''! -__. _. ~ TI .. ~' `~ ~ "T'1 COMMONWEALTH OF PENNSYLVANUI • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See Instructlona and examples on reverse) ~~,.< <„~ 1. Nana d Decedwa (FM, nedrlle, mR sumx) 2. Sss 3. Sodd Seasry Nunpr !. Dem d Dedh (Monts, my, year) ~_ 5. Ape (leaf BWsmy) Under 1 Under 1 8. Defy d ant 7. S' and dsm a !m. Pmp d DaeN Check one Iona Data Flour Manes HoepNel: Other: 85 vrs. November 19 1925 New York New York ^ Inpdiant ^ ER l o•gapnl ^ DOA ^ NuraYg Hare ~ Residence ^ Other - SpacNy. Bb. CauMy d Deelh &. CNy, Boro, Twp, d Daelh Bd. Fetlay Name IN not iretlhNp, give abed and numMr) 8. W» Decadent d HiaPank Orpln? Q.No ^ Yea 1 D. Race: AmMpn IMan, sack, Wt1im, eN. IN Y•& ePadlY Cuban, li (Sped7» Q~mberland en Meaicen, Puerto Rlpn, em.> • 11.Oacetled'a UaW KNd dwork dare mod d IMe. Oo notdam 12. W» OeaedaM mw m the 73. Decsdaa'a EducaBan (Spedy ady hlpvd Breda mnpldad) 11. MarIW Smha: Marded, Navar McMed. 15. SurvNing Spou» (II wile, gha maiden name) IOnd d Wark Igrd d Budrwe/Indatry U.S. Armed fom»7 Emmentery / Sepldery (p12) C,Wege (1d or 5f) WMOwed, DNaad (SpedyJ l ^ Y» ~ 78. Decederlya Me1NnB Addre» (Sb»t, dry/tam. state, zp codel Depderd'e DM Decedent 829 Mandy Lane AdWd N»Idarice 17a. State PR Live m e 17c. ®Y», Deadem Llvotl m HamtldC~i1 Twp. T~ 7 [ii 11 P 17011 17d. ^ No. Decedent LNad wNNn q 17b. County ~. 1mb2rlflilr~ a AaNd IinNm a cly/ Born 78. Fetlmfe Nana (Fhal, midde, led, eu8bc) N/A 1B. ModnYa Name (FNeL nadfe, maiden cunanr) Amanda Kitchen 20e. IntdrrienYa Noma (Type / PrIM) 20b. Idommnya McINiB Addmp ISbsd, dtY 1 fawn, Asm, zip coral 21a. Metlmd d DYpogtlon t ~] Cremsgon ^ DorWmn 21b. Dda d Dlepwllbn (lloreh, dry, yaarf 21c. Plop d DYpodBon d cenrMy, oarn•mry a other pare) 21d. Lopaon (CNylmwn, arse, zp coda) ^ &aw ^ d ban Smm ~ Wr IAeeeldlall a oorodon Autlmrh» ^ by lledkd Elarrdllr(CalatKt ~ Y»^ No November 4 2 1 Slpeksa epYg r •uch) 22b. Lkare Number 22e. Name ant Adhw d FadNy - 011654-L Canpmle 23aa a1y wean 23a. TO Ne beeldmy hgwledBe, tleeN aocurred llna,dda and pmp (SfBirLxe andtlm) 29h. lkan»NumDx 23c. Dam Signed (Mean, py, year) ytryafden b nd evWble tl Ere d daeN m pMyppe ddedN ~~ `~ R./~+ Va - )..^- II - ©I - I~ Nanr 24.28 mud be oonglamd by Parson 24. Tare d Deets 255. Dale PnxlaaieW Deed (MmN, day, yed) 28. W» C»a Rdarrad m M•okal Examiner /Coroner mr a Beeson ONer Nan Cremetlan a Omalan? • ~~ ~2c, PM. l~av. Ise- o?GL( ^Y» ~~ CAVSE OF DEA'yH (SN Inatructlona YId ~x»npN») ~ Appoxlnieh hdsrvd: Pan II: ENar o8ix 28. DN idrecp U» Conlrihuh m D»M? Item 27. Pan I: Emer Ne ~A1apl9- dh»sea, Fqun», a cmglkatlare ~ Nat dtedly qu»dtle tledh. DO NOT er»r Esmlinel e~ems auch» ceNec artest, i Oned m D»m but rpt ra•uINnB In Iha MabdymB pose given In Pert L ^ Y» ^ Probeoy reeplmmry art»I, a vanmaAV NbiNetlon wahaA dpwing aie e8obgy. one pw p each Nna. r No ^ Unloawn nIMEDIATE CAUSE ((fMd disease a prrdl8on resdmp n dedh) _~ a. r 29. N m: Duem(a»a ~ i pregnant vdhm pest year L ~Yd corldmom, N any, b, ~ m ~ a Preplenl al tlme d d»N ^ ~ Oue m (a ea a oQ: i EMd UNDE LYW CAUSE Nd papnent but McBnent wiNm d2 days (olawe a ~Y tlW YYtltled Ne c r made resehp in daaN) LAST. i d daeN ^ ~ m la » a ~~ ~: Nd pregnant. bd preglent 13 tleys m 1 year d r i r betas d»N ^ Unlnoan it pregnant witlan ba pad year 30a. Wee an Autopsy 30b. Were Adopay FYMIgs 31. d D»N 92a. Dam d Ir~ury (Madh, day, year) 32E. Deeerbe Flow Injay Opunad 32c Plop d In)ury'. Home, Fartn, S1reaL Faaory, Permmled7 Available Prior m Conpklbn Nabnel ^ HomMda Orca &iilanB, alc. ISpedyl d Ceuee d DeeN? 1c~ ^ Yee Ia1 No ^ Ya ^ No ^ Aa:pan ^ PerWnA kr~gdmn 32d Tina d In)ury 32e. Iryury at WarKl 321. M TrerepoMtlar In)uN (SDecBY) alp. Loce3on d injury (Street, cNY / Mrn, atom) ^ Suicitle ^ Cauld Not be Dalennhiad ^ ~ ^ Ve6 ^ prNerlOperela ^ Paeaanper ^ PedaaUlen M Otlw ~ Spedry: fie. CeNher Idrd aMy op) 33b. Slpamro d t*Ya~ (PhMMden oartXying ceuee d path wMn anther pnyalden n» proraakad tl»8i eM mnplamd Imm 231 • Totn.bwdmy mnmadps, daeN Opumddus to the plrs(q and man»raat»ad_________________________________ • ProrrourrdnB and ••nMN•g phyekmn IPIAaICron mm Prawwrarg deeN end pNlyYg m pu» d d»N) io1M h»laa mtowmd a dadh oanr ddN lm M m d a a mu ^ 33c. Lkxree 3:1d. Dam signed I ,day, rear) , ry g m e lq e, an p,» ue r ppya)and mrew»amad------------------ P • aaapl EarnhwyCaarwr ~ 03Sj ~'L I (~ 3''1 ~ On tlra beam d axan3rrtlon srM / a NvaallBdbrl, In my opNmn, dadh secured dtM Ums,dab, snd plea, and due ro tla puaalp and nWlrw» •mlarl. ^ 31. Name mM~ddroy,d Par Vioryi ti _ d Deelh (Nam 27) Type I Pnnt l l C ~ ~~ p t' 35. Reglasafa S end Dmtrld ` ~ ~ ~a I ~ a ~ ~ ~ ~ - 38, Dam Fled ( dry, year) 3~°""' T l~ ~y ( ~ f 'T `~ ayrQ 'T 1 ` , r - - : as-~ avii ~rr . ~ DiaPOdNOn Pennl No. 4J ~O s ~ 9.5~ LAST WILL AND TESTAMENT OF JEAN A. KEITH KNOW ALL PERSONS BY THESE PRESENTS, that I, JEAN A. KEITH, presently of 3 Ashton Drive, Etters, York County, Pennsylvania, being in good health and of sound and disposing mind and memory, do hereby make, declare and publish this as my Last Will and Testament hereby revoking all Wills and Codicils previously made by me. I declare that I am a divorced woman and that I have four children whose names and dates of birth are as follows: JOANNE F. GOGLIA Born January 4,1946 BARBARA J. NELSON Born November 24, 1949 RALPH E. NELSON Born May 7,1952 PAMELA J. KUTCHMAN Born July 10, 1953 All references in my will to my children refer only to those children identified above. 1 ARTICLE I FUNERAL EXPENSES I direct that all just expenses of my last illness and funeral be paid by my Executrix from my estate as soon after my death as conveniently maybe done. ARTICLE II REAL PROPERTY I give, devise and bequeath my interest in my real property located at 3 Ashton Drive, Etters, Pennsylvania, including any and all insurance thereon, to my daughter PAMELA J. KUTCHMAN, presently of Etters, Pennsylvania, provided she survives me by thirty (30) days. Should my daughter predecease me or fail to survive me by thirty (30) days, I direct that my Ashton Drive property be sold and the proceeds added to the residue of my estate. ARTICLE III PERSONALTY A. I give and bequeath all of the items of my household furnishings and tangible personal property identified in the most recently dated separate writing in existence at my death, which is signed by me and describes the items given with reasonable certainty, to the persons specified in that writing. It is to be conclusively 2 presumed that I have left no separate writing if one has not been found by or delivered to my Executrix within thirty (30) days after my death. B. I direct that my Executrix shall have sole discretion and authority to gift my household furnishings and tangible personal property not effectively disposed of by any separate writing referred to above nor elsewhere in this Will (whether by omission or because I have left no valid separate writing), to my children andfor grandchildren as she deems appropriate. Any and all property not gifted to my children and/or grandchildren by my Executrix shall be sold and the proceeds added to the residue of my estate. ARTICLE IV AUTOMOBILES I direct that any and all automobiles that I own at the time of my death, including any and all insurance thereon, be sold and the proceeds added to the residue of my estate. ARTICLE V RESIDUE I give and bequeath the rest, residue and remainder of my estate as follows: A. In the event I am no longer a titled owner of my Ashton Drive property, this Section A of Article V of my Last Will and Testament shall be void and the residue of my estate shall be divided in accordance with Section B below. In the event that I do still own my Ashton Drive property at the time of my death and my interest in the 3 property passes to my daughter PAMELA J. KUTCHMAN, as outlined in Article II above, then I give the rest, residue and remainder of my estate as follows: i. ONE-THIRD (1/3), to my daughter JOANNE F. GOGLIA, presently of Oceanside, California, provided she survives me by thirty (30) days; ii. ONE-THIRD (1/3), to my daughter BARBARA J. NELSON, presently of Camp Hill, Pennsylvania, provided she survives me by thirty (30) days; iii. ONE-THIRD (1/3), to my son, RALPH E. NELSON, presently of Bella Vista, Arkansas, provided he survives me by thirty (30) days; Should any of my children identified in this Article V, Section A, Subsections i through iii predecease me or fail to survive me by thirty (30) days, that child's share of my estate shall pass to his or her surviving issue and if he or she should have no surviving issue, then that child's share of my estate shall be divided equally among and between my surviving children identified in this Article V, Section A, Subsections i through iii. B. In the event that I am no longer a titled owner of the real property located at 3 Ashton Drive, Etters, Pennsylvania, I give, devise and bequeath the rest, residue and remainder of my estate, in equal shares, to my children who survive me by thirty (30) days. Should any of my children predecease me or fail to survive me by thirty (30) days, that child's share of my estate shall pass to his or her surviving issue and if he or she should have no surviving issues, then that child's share of my estate shall be divided equally among and between my children who survive me. 4 ARTICLE VI EXECUTRIX A. I appoint my daughter BARBARA J. NELSON, as the Executrix of this Will. In the event of her death, resignation, renunciation or inability to act in that capacity, then I appoint my son, RALPH E. NELSON, as Executor, with all of the same rights, powers, duties and obligations as if he were originally appointed my Executor. B. No bond or other security shall be required of any Executrix or Executor appointed in this Will. C. I specifically authorize, empower, and direct my Executrix or Executor to sell and convey, by good and sufficient deed, in fee simple estate, any and all of my personal property and real estate, at public or private sale, for such price or prices, upon such terms and conditions, as in her or his judgment are best for my estate, provided doing so is not contrary to my specific wishes outlined herein. ARTICLE VII SURVIVAL If any provision of this Will or of any codicil thereto is held to be inoperative, invalid or illegal, it is my intention that all of the remaining provisions thereof shall continue to be fully operative and effective so far as it is possible and reasonable. 5 ARTICLE VIII PAYMENT OF TAXES All estate taxes, inheritance taxes, transfer taxes and other taxes of a similar nature, together with any interest and penalties thereon, payable by reason of my death and imposed with respect to any property, whether or not disposed of by this Will, shall be paid as soon as practicable out of the residue of my estate. (The remainder of this page is intentionally left blank.) 6 IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this, my Last Will and Testament, consisting of nine (9) typewritten pages, including this attestation clause and notary pages, to be executed, declared and published this 1 ~ tL day of ~.,..4 ~.~.s ~-- , 2007. J A. Reith WITNESSES: Residing at 1~~~~~~LG ~/~ ~7!(Z Residing at ~"~ lei ~ s t3 c_.vZL, Q E1 ~ `~- i i L 7 COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN SS. I, JEAN A. KEITH, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrtument as my Last Will and Testament; that I signed willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. J A. Keith Sworn or affirmed to and acknowledged before me, by JEAN A. KEITH, Testatrix, this / (~`~ day of ~ ~ „~. 6 -~-~ , 2007. ~ ~~ ~ .~- - Notary Public My Commission Expires: coMw~w~A~rH of ~wisr~.vAiw~- NOtARfAL SEAL MINOY S. GOQ~MAN, Notary Public City of Harrisburg, Dauphin County M Commission Expres May 21, 2009 8 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF DAUPHIN . We ~ L ~oT~fS<=1f1 ~~ and ~a- ~ ~ 2E ~ Nom. ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw JEAN A. KEITH sign and execute the instrument as her Last Will and Testament; that she signed willingly; that she executed it as her free and voluntary act for the purposes therein expressed; and that each of us in 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, of sound mind and under. n~nstr~int or undue influence. Sworn or affirmed to and acknowledged before me, by~.A c~ ~~-tsL~l y> and L~a ~ ~ ¢~ , ,~~~ ,this / (.a`~ day of ~ ~c~ ~ s }- , 2007. Notary Public My Commission Expires: COMMONVVEAi.TFf OF PENNSYIVAPgA NOTARIAL SEAL M1NDY S. GOODMAN, Notary Public City of H~risburg, Dauphin County My Commission Expires Ma 21, 200.9 9