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HomeMy WebLinkAbout01-26-12Reset 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: Kenneth L. Orndorff File No• ~ ~ - ~ a - Q(~ ~ a/k/a: • (Assigned by Register) a/k/a: a/k/a: Social Security No: 161-40-1610 Date of Death: January 8, 2012 Age at death: 61 Decedent was domiciled at death in Cumberland County, pennsylvania (stare) with his/her last principal residence at 39 Sandbank Road. Shippensbure Southampton Township Cumberland County Street address, Post Office and Zip Code City, Township or Borough County Decedent died at Chambersbure Hospital, Chambersbure Boroueh Franklin 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 $_ 20,000.00 Ifnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsy!vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 12"i,nnn nn TOTAL ESTIMATED VALUE.... $ 143.000.00 Real estate in Pennsylvania situated at: 39 Sand Bank Road, Shippensburg Southampton Township Cumberland (Attach additional sheets, ijnecessary.) 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 May 5, 2009 and Codicil(s) thereto dated NONE State relevant circumstances (eg. renunciation, death of executor, 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(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS Q EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or db.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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS O EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationshi Address '' ^~ r :~ . . ~ ~O~ ~ - --i ~.~ ~~ Form RW-02 rev. 10/!1/20/1 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } } SS: } Official Use Onl~ ~F~;t.;~~ t:~, ~ ~, r ?~sF. ~f r,14~C f ll ~°~` ~~ J~ Petitioner(s) Printed Name Petitioner(s) Printed Address Christina Youn aka Christinea Youn 44 Sand Bank Road Shi ensbur PA 17257 ~s CRT Ct!MR,_ ~~:_, .~~ ~ , 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 tl~ edent, t e Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed a d subscribed before ~l ~ ~=. ~. (~ ~ Date ~ -a (.,Q -' ~ a me ~ day of JCJ ~ Date Byr. ~~ J Date For the Register Date BOND Required: Q YES ~ NO To the Register of Wilts: FEES• Please enter my appearance by my signature below: Letters ..................... . ( (U )Short Certificate(s)..... . ( ~ )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond .. ...................... Comm ission ................. . Other ~t ~ ........ l ........ $ wren . o0 .~ t5• aU Automation Fee... ~J? . fJ(~ JCS Fee. ........~ .......... 'J . U TOTAL ..................... $ ~ Attorney Signature: ~' `~ r Printed Name: H. Anthony Adams Supreme Court iD Number: 25502 Firm Name: H. Anthony Adams Address: 49 WPS Grange Street SL11tP. ~ Shippensburg, PA. 17257 717-532-3270 717-532-6673 htaclam¢lawnPmharnmail.cnm Phone: Fax: Email: DECREE OF THE REGISTER Estate of Kenneth L. Orndorff File No: ~ `- 1 ~ - CU l I ,~j a/k/a: AND NOW, ~ X1l -R-J~..~~~h , Jy ~ ~- , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to Christina Young aka Christinea Young in the above estate and (if applicable) that the instrument(s) dated May 5, 2009 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. /~ +i' C~t.IJ Register of Wills ,~ ~, ~Q~V~r~ ~ Form RW-02 rev. 10//1/10/1 Page 2 of 2 H 105.805 REV 19111) LOCA~~i~~R'S CERTIFICATION OF DEATH WARN ~it~i~ iileg ~ .duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ?~~2 ~}~~{ ~~ ~~ 3~ 30 Chis is to certify that the information here given is con~ectly copied from an original Certificate of Death ~~~ ~~ duly filed withi me as i,ocal Registrar. Tl~~e original certificate will b? forwarded to the .`•irite Vital ~y p~~})~ ~~~T Records ffice for ~ tie ant filing. ~' 1815 G ~ ~ ~? ___ _ -~~-___-_ ~~_1~~ L~o1 L Certification Number .o al Registrar Dat(° Issued Typc/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Parma^`nt CERTIFICATE OF DEATH ~~ 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Kenneth L. Orndortf Male 181-40-16'IO January 8, 2012 Sa. Ag<-Last Birthday (Yrs) Sb. Under 1 Year Sc. Under 1 Da 6. Date of Birth (MO(Oay(Ytar) (Spell Month) 7a. Birthplace (City and State or Foreign Country) Months oars Hours Minutes Shippensbu 81 November 8, 1950 7b. Birthplace (cggnty) Cumberland ga. Residence (State pr Foreign Country) 8b. Residence (S[rett and Number -Include ApY No.) 8c. Did Decedent Live in a Township? PA 39 Sandbank Road ~[ves, d«ed<n<uYed In Southampton t,,,,p. ad. Resmenc< (county) Cumberland Be. Residence (Zip Code) 172$7 ONO, decedent lived within limits of clYy/boro. 9. Ever In VS Armed Forces? 30. Marital Status aY Tfine of Death Married Widowed 11. Surviving Spouse's Name (if wife, gWe name pHOr to first marriage) Q Yes ~[ No Q Unkno ~[ DlvOrced Q Never Married Q Unkno w 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First. Middle, Last) Roy R. grntlorfl, Sr. Roselle P. Kelley 14a. Informant's Name 14b. Relationship M Decedent 14c. Informant's Mailing Address (Street and Number, City, State, 21p Code) e< Christinea L. Young daughter 44 Sandbank Road Sh)ppensburg PA 17257 ...... ..... _ x . . N Death Occurred In a Hospital: ~ Inpatient ..............................wwtt ......................---........... ..-.....................---......-- xlf Death Occurred Somewhere Other Than a Hospital: tJ ~HOSpice Facility ~ Decedent's Home y Emergency Room/OUtpatieM Desd on Arrival Nursin Hom</LOn -Term Car< Facility Other (Specify) • a 15 b. Facility Name (If not Institution, give street antl number; lSC. City or Town, State, and Zlp Code SSd. County of Death Ghamberoburg Hospital Cfiamberoburg, FA 17201 Franklin 16a Meth Otl of DlsposlHOn Burial Cremation 16b Date W Dls osltlon 16c Place of Dis oaltion (N f c m t t th i . )~ Removal from 6[ate ~ Donation . p . p ery, crema ame o e e ory, or o er p ece) 2012 Cleveroburg Cemetery u J 13 other (Specify) an ary , S 16d. Location of DlsposlHOn (City or Town, State, and Zip) I7a. Signature of F~''<aal~Sa-vlce Lic ee or Person In Charge oT Interment 17b. Licenae Number Shippensburg, PA 17257 - i~/q_. (/-)p/\~~Q~.- FD-012984E 1?c. Name and Complete AddfE55 of FunEral Facility 3 Fogelsanger-Bricker Funeral Home 112 W King St. PO Box 336, Shippensburg, PA 17257 ~ 16. Decedent's Education -Check the box that best describes Che 19. Decedent Of Hispanic Origin -Check the 20. Decedent's Race -Check ONE OR MORE races to Indicate whaC highest degree or level of school completed at [h<[ime of death. box that beat describes whether the decedent the decedent considered himself or herself to be. ]~ 8th grade or less Is Spanish/Hispanic/Latino. Chock the "NO" ~[ White 0 Korean Q No diploma, 9th - 12th grade box if decedent Is not Spanish/Hlspanic/Latlno: ~ Black Or African American Q Vle[nameae Q High school gratluate or GED cOmpletetl ~$( No, not Spanish/Hlapanicflatlno Q P)merican Indian or Alaska Native 0 Other Asian Q Some college credit, but no degree Q Yes, Mexican, M<xicsn American, Chlcsnp ~ Asian indlan [] Native Hawallan 0 Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese [] Guamanian or Chamorro Q Bachtlor's tlegree (e.g. BA, AB, BS) Q Yes, Cuban t7 FIIlpino ~ Samoan Q Master's degree (e. g. MA, MS, MEng, MEd, MS W, MBA) Q Yes, other Spanish/Hispanic/Latino Q Japanese ~ Other Pacific Islander Q DoROrate (e.g. PhD, Etlp) or Professional degree (SpetNy) Q Other (Specify) MO DDS DVM LLB JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what [he decedent considered himself or herself to be. 22s. Decedent's Usual Occupation -Indicate type of work White Q Japanese Q Samoan done during most of working life. DO NOT VSE RETIRED. Q Black or African American 0 Korean Q Other Pacific Islander Shipping/RaCBiving ~ American Indian or Alaska Native 0 Vittnamese ~ Don't Know/Not Sure Q Asian Intllan -- - = - Q Other Asian Q Refused 22b. Kind of Business Industry Q Chinese ~ Native Hawallan 0 Other (Specify) B@Is21e COT 8n FIIlpino Q Guamanian or Chamorro p Y EM523a - 2 U aE CO L D 23a. Dots Pronounced Dea Mo Day r 23 .Signature of Person renouncing Death (Only when appllca le 23c. License Num e r BY PERSON WNO PRONOUNCES OR January 8, 2012 CERTIFIES DEATH 23d. Date Signed (MO/Day/Yr) 24. Time of Death 3:14 AM 25. Was Medlcsl Examiner or Coroner Contacted? IQ Y<s ~ NO CAUSE OF DEATH ~ ApproKlmaYe 26. Part 1. Enter the chain of events--diseases, inju rtes, or tomplicatlons-that directly caused the death, p0 NOT enter terminal events such as cardiac arrest, ; lnterysl: respiratory arrest, or ventricular fibrillation without showing the Etiology. DO NOT ABBREVIATE. Enter only one cause on a line. Atld additional lines If necessary 2 Onset to Death IMMEDIATE CAUSE ------------r a SEVERE HYPOXEMIA ~ O.5 HOURS (Final disease Or condition Du<to (o as s consequence of): r resulting in death) ' b PULSLESS ELECTRICAL ACTIVITY E 0.5 HOURS Sequentially Ilst contllHOns. Due to (or as a consequence pf): if any, I<ading [o the cause MASSIVE PULMONARY EMBOLISM ~ Iistatl on line a. Enter the c g 2 DAYS UNDERLYING CAUSE Due to (or as a consequence f o) W (disease or Injury that initiated me events resplnng d. NON S -T ELEVATION MYOCARDIAL INFARCTION ~ 18 DAYS .aF.4 a In dear!. WST. as s con , ) DvE to (or sequence oT): [ y f~ 26. P<K II. Enter Other i niff n i i n ribu In th but not resulting In the underlying Cause given in P<rt 1 27. Was an autopsy performed? ~ Parenchyma pulmonary disease; Anemia, acute and chronic; End Stage renal disease; H vea No ypertensiOn 9 2B. Werc autopsy findings available to complete the cause of death? Yes No a 29. If Female: 30. Did Tobacco Use Contribute to Death? 31. Manner of Death E Q Not pregnant wltHin past year 0 Yes Q Probably ~ Natural 0 Homicide ° [] Pregnant at time of tleath No Unknown ~ Q O Accident 0 Pending Investigation e; Q No[ pregnant, but Pregnant within 42 days of death [] Suicide d Could not be determinetl 0 Not prepnant, but pre t 43 days to 1 gnen year before death 32. Date of Injury (MO/Day/Yn (Spell Month) [~ Unknown if pregnant within the Dast year 33. Time of Injury 34. Place of Injury (e.g. home; construction s1te: farm; school) 35. LocatlOn of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 36. Describe How Infgry Occurred: 0 Yes Q privet/Operator ~ Petlestrian [] No l7 Passenger Q Other (Specify) 39a. Certifier (Check only one): O Certifying physician - To the beat of my know)etlge. tleath occurred due t0 the cause(s) antl m tatetl Pronouncing 6 Certifying Physician -TO [he best of my knowlEdge, death occurred at the time, dace Santl plate, and tlue to the cause(s) and manner stet<tl Medical Examiner/Coroner - On the basis of exam i n aHOn, and/or Investigation, in my opinion, tleath occurred at the time, dote, and place, and due to the cause(s) and manner stated //)) s s l Signature of certifier: ~ ~ 3 _%.~ i//„~ Title Of certifier: M~D~ License Number: MD064990L 39b. Name, Address and Zip Code of Person CpmpieHng Causc of poach (Item 26) 39c. Date Signed (MO/Day/Yr) iwona J Janicka, M. D. 501 East Main Street, Wayneabor 17268 Janue 8, 2012 4 . Registrar s D strict Number 41. Regl is 51 re 4 giatrar FI < DatE ( o DeY r ~/- ~ jS . o B ZO/Z 43. Amentlments Dlsposltlon Permit No. 0713440 H305-143 - REV O"l/2011 f... Y' ~C t~ 't,;l! i r11~2 J~~d 26 F~"~ 3~ JU CLERK ~F ORPHA,~!'S COURT RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of KENNETH L. ORNDORFF Deceased I, H. Anthony Adams , in my capacity/relationship as (Print Name) Executor of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Christina Young aka Christinea Young (Date) - _ __ -- (Signature) 49 West Orange Street (Street Address) Shippensburg, PA 17257 (City, state, zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~` of ~ ~y_ ,- v ~~ t ~ ~ ~ r ;) , eputy for Register of Wills Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of 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.) Form RW-06 rev. 10.13.06 ~~f1r'!'~~'ry '.r~r','1 r i~~~ , =' ~,n~ ~ c LAST WILL AND TESTAMENT OF KENNETH L. ORNDORFF :;=F2..~~~ 26 i=( 3~ aQ CLERK QF (~RPH~N'S CCUR CL{I~P~F~LAt~~0 ~C., PA KNOW ALL MEN BY THESE PRESENTS, that I, KENNETH L. ORNDORFF, of Cumberland County, Pennsylvania being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament hereby revoking all prior wills and codicils by me at any time heretofore made. FIRST: I direct the payment by my Executor of all my legal debts, burial expenses including my grave marker and my federal estate and state inheritance taxes together with the cost of administration of my estate as soon as may be conveniently done following my death leaving all specific bequests free of tax to the legatee. SECOND: I give and bequeath my 760 Remington 30.06 rifle and my Springfield 30.06 rifle to Christina Young. THIRD: The rest and residue of my estate, be it real, mixed or personal, of whatever nature or kind, I give, devise and bequeath to my children, Jeffrey Orndorff, David Orndorff, Richard OrndorfF and Christina Young, in equal shares, share and share alike, per capita. FOURTH: I name H. Anthony Adams to be my Executor of this my Last Will and Testament. Should he fail or cease to act, I name Christina Young to be my Executrix of this my Last Will and Testament. If administration of my estate should be necessary in any jurisdiction where my Executor is unable to qualify or if my Executor deems it necessary for any other reason, I give to my Executor the power to designate any individual or corporation with trust powers to serve with my Executor or in my Executor's stead. I request that no security be required of any Executor, including an Executor named pursuant to the preceding sentence. References in my will to my "Executor" are to the one or ones acting at the time, except where otherwise specifically provided. I grant my Executor the powers set forth in 20 Pa. C.S. §§ 3311-3332 and 20 Pa. C.S. § 780.6 respectively. My Executor may distribute tangible personal property passing to a minor to any adult person with whom the minor resides, and that person's receipt shall be a sufficient voucher in the accounts of my Executor. in WITNESS WHEREOF, I, KENNETH L. ORNDORFF, to this my Last Will and Testament set my hand and ofFcial seal, this ~~ day of 2009. (SEAL) ENNETH L. ORNDORFF Sworn to and subscribed, declared and Published by KENNETH L. ORNDORFF, as His Last Will and Testament, and so Done in the presence of we the Witnesses, who sign at his request, And in his presence and in the presence Of each other. COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND I, KENNETH L. ORNDORFF, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed it willingly; and that I signed it as my free and voluntary act for the purpose therein expressed. KENNETH L. OR DORFF Sworn to and acknowledged, before me, By KENNETH L. ORNDORFF, the Testator, This ~~ day of _ 2009. 1 Notary Public COMMONWEALTH O]~ FEF]NSYLVANLA Notarial Seal H. Anthony Adams, Notary Public Shippensburg Bora, Cumberland County My Commission Expires May 3i , 2010 COMMONWEALTH OF PENNSYLVANIA: :SS COUNTY OF CUMBERLAND WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we saw the Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses, and that to the best of our knowledge and belief the Testator was at the time at least eighteen (18) or more years of age and of sound mind and under no constraint or' undue influence. w Sworn to an~~ subscribed before me by, Darlene M. Bigler and Sharon Coleman Adams, The witnesses, this ~ day of ~ 2009. Notary Public COMMONWEALTf3 Or P_EN_[YSYLVANIA Notarial Seat H. Anthony Adams, Notary Public Shippensburg Boro, Cumberland County My Commission Expires May 31, 2010