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Home My WebLink About05-03-12PETITION 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 requests the grant of Letters in the appropriate form: Michael J. Horan Decedent's Information Name: Kevin L Sheriff a/k/a: a/k/a: a/k/a: Date of Death: oa/1s/2o12 File No: 21 -12 -~ ~},~/ (Assigned by Register) Social Security No: 186-54-1347 Age at Death: 45 Decedent was domiciled atdeath in Cumberland County, PA (State) with his/herlast principalresidenceat 200 Valley Road West Fairview Cumberland Street address, Post Office and Zip Code City, Township or Borough County Decedentdiedat 200 Valley Road West Fairview Cumberland PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate ofvalue ofdecedent's property atdeath: IfdomiciledinPennsylvania ........................ Allpersonalproperty $ IfnotdomiciledinPennsylvania .................. PersonalpropertyinPennsylvania $ IfnotdomiciledinPennsylvania .................. PersonalpropertyinCounty $ Value ofreal estafe in Pennsylvania........... $ 5,000.00 TOTAL ESTIMATED VALUE$ 5,000.00 Real estate in Pennsylvania situated at (Attach additional sheets, if necessary.) Street address. Post Office and Zip Code City, Township or Borough A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated thereto dated County 01/07/2011 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 mar ,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. ^X 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.; pedente lice; durante absentia; durante minoritate If Administration, c.t.a ord.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 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 pe O NO EXCEPTIONS ^ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the fo~~._ ping spouse (if any) and heirs (attach additional sheets, if necessary): C7 .. Name Relationship Address ~, :,-0: t:`~_':' z~- , '..j ~ ~ -~C ~_C -y.zrn - - . - ~> r~ ~ c.~ _..., - :"~C 7=n car .~.. , • ` ~ Gtr _ ;=r, ._..._. ~'' J (~ _.,r.t Form RW 02 rev 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2 :~, ~` Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Official Use Only ~ - -:, ~ ,~~, =:~ l ~ rte- ""G -. Petitioner(s)PrintedName Petitioner(s)PrintedAddress ?~:'.~~ ~,, - ~, - ' V Michael J. Horan 200 Valley Road "C , , -~ Summerdale, PA 17093~~ C~ `~ r ` "' - _ ....J 1...._ -_. I f ___ D ..•. `-f~ ~~ f~ -Y~ The Petitioner(s) above-named swear(s) or affirm(s) the statements th ore oing Petition re rue and correctto the best of the knowledge and belief of Petitioner(s) and that, as Personal Representative(s) ofthe °c ent, tition (s) II ell and truly administerthe estate according o law. yy ~'- Date A ^' ~ ~) Sworn to or ffttir~~mmed and s scnbed before meth ~dayyof ' ~ ' , ~4~iZ.- Date By. L Date r t e Register Date BOND Required? ~ Yes ~X No FEES Letters ............................................ $ 30.00 ( 2 ) ShortCertificate(s)........... 8.00 ( )Renunciation(s) ............... ( )Codicil(s) ......................... ( )Affidavit(s) ....................... Bond ............................................... Commission ................................... Other Will 15.00 AutomationFee .............................. 23.50 JCS Fee ......................................... 5.00 TOTAL ........................................... $ 81.50 Estate of Kevin L Sheriff a/k/a: AND NOW, ~ ~, satisfactoryproofhavingbe presented before me, IT IS DECREED that Letters areherebygrantedto Michael J. Horan LU~L ,inconsideration oftheforegoing Petition, Testamentary in the above estate and (if applicable) thatthe instrument(s) dated described in the Petition be admitted to probate and filed of record as th 01 /07/2011 Copyright (c) 2011 form software only The Lackner Group, Inc. To the RegisterofWills: Please enter rp~appearance by my signature below: Attorney ture : P nted ame: Nora F Blair Supreme Court ID Number: 45513 Firm Name: Address: 5440 Jonestown Road PO Box 6216 Harrisburg, PA 171120216 Phone: 717/541-1428 Fax: 717/ E-mail: NFBLAW@comcast.net DECREE OF THE REGISTER Date of Death: 04/15/2012 Social Security No: 186-54-1347 File No: 21 -12 °- /,~S / 7 ~g 'r--I(;E r{~ .a~ ,'~ i ~ ,~ P 18329695 ~, .~' Type/Print In Permanent O ~z O 2 CLERK ~~ ORPFfq~(~IS COURT C~ocilcvc, ~~~e~•c-~,~~j(e.~a~c' APR 1 9 2012 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH _ VITAL RECORDS !`COT~C~~`ATC n~ n - - - -- State File Number: 1. Decetle nt's Legal Name (Fl rsi Middle Last Suffix) , , , 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo) ' Male 186''-54-1347 A ri1 15, 2012 6a. Age-Last Birthday (Yrs) 56. Under 1 Year Sc. Under 1 Da 6. Date of 61rth (M°/Day/Year) (Spell Month) 7a. Birth place (City and State or Foreign Count ) j ry 45 'y'°^tns Days Hp„r~ MI"°tes Feb_ 1, 1967 Carlisle, PA - fib. Birthplace (county) Ha. Reside ce (State or Foreign Country) 8b. Residence (Street and Number -Include Apt No.) Sc. Dtd Decedent Live i a Township? " PA 200 Valley Rd _ ®Yes decedent lived in WPVY F l , a Y P 8d. Residence (County) twP. Cumberland Se. Residence (Zip Code) Q No, decedent lived within limits of city/boro. 9. Ever in US Armed Forces? 10. Marital Status at Time of Death ~ Married Q Widowed 11. Surviving 5 0 's Name (If wife give name rior to first mar i , p r age) Q Ves ~ No Q Unknown Q Divorced Q Never Married Q Unknow Mi criae~ James Horan 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to Firs[ Marriage (First, Middle Last) , John H_ Srieri££ Doris F_ Kin 14a. Informant's Name 146 Relation hi < D d ' . s p o ece ent i 14c. Informant s Mailing Address (Street and Number, Gity, State, Zip Godej o C M chael Horan riusband 200 Va11e Rd_ Summerdale PA 17093 s ..................................................................Pa........_............. __.......... ~._....,. ISa_ Place o Deat Check only one ............. ..... . ...._..... _. .................. ...... ............. .. If Death Occurred in a Hos to l i Q I a _ _ P Y ......... ..... ....... ...... ..... : p n tient ;If Death Occurred Somewhere Other Than Hospital: ~] Hos ice Facilit ~ Decedent's Home Q E mergency Room/Outpatient Q Dead on Arrival Q Nursing Home/Long-Term Care Facility Q Other (Specify) . 15 b. Facility Name (If not institution, give street and number; 16 c. City or Town, State, and Zip Code 16d. County of Death 200 Valley Rd S d _ ummer ale, PA 17093 Cumberland 16a. Method of Disposition Q Burial ~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory or other place) .c , p Removal frpm state p Dpnannn ~ 9~ ~~ 2 Ho££man-Rotri Funeral Home & Crematory Q Other (Specify) 2 16d. location of Disposition (City or Town, State, and Zip) 17 ignatu re of Funeral 6ervi a Licensee or Person In Charge of Interment 176. License Number Carlisle, PA 17013 013144E 0 1?c. Name and Complete Address of Funeral Facility Ho££man-Ro h Funeral Home & Cremato 219 North Hanover Street Carlisle PA 17013 ' m 18. Decedent s Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decede ni's Race -Check ONE Oft MORE r es to Indicate what h ~- ighest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be . Q 8th grade or less Is Spanish/Hispanic/Latino. Check the "N O" White Q Korean Q No diploma, 9th - 12th grade box if decedent is not Spanish/Hispanic/Latino. Black or African American Q Vieina mese Q Htgh school graduate or GED completed ~ No, not Spanish/Hispanic/Latino Q American Indian or Alaska Native Q Other Asian Q Some college cred(t, but no degree Q Ves, Mexican, Mexican American, Chicano Q Asian Indian Q Native Hawaiian Associate degree (e.g. AA, AS) Q Yes, Puerto Rican Q Chinese Q Guamanian or Chamorro Bachelor's de ( BA AB gree e.g. , , BS) Q Ves, Cuban O Filipino Q Samoan ' Q Master s degree (e.g. MA, M5, MEng, MEd, MSW, MBA) Q Yes, other 5 panish/Hispanic/Latino Q Japanese Q Other Pacific Islander Q Doctorate (e.g. PhD, Ed D) or Professional degree (S ecif ) Q p y Other (Specify) . MD, DDS, DVM, LLB, JO 21. Decedent's Single Race Self-Designation -Check ONLY ONE to intlicate what the decedent considered himself or herself to be. 22a. Decedent's Usual Occu a[IOn -Indi t t f p ca e ype o work O White Q Japanese Q Samoan done during most of working life. DO NOT USE RETIRED. Black or African American Q Korean Q Other Pacific Islander Q American Indian or Alaska Native Q Vietnamese Q Don'i Know/Not Sure Application Developer Q Asian Indian Q Other Asian ~ Refused 22b. Kind of Business/Industry Q Chinese Q Native Hawaiian Q Other (Specify) Q Filipino Q Guamanian or Chamorro =nsurance Co _ ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Oead (MO/Day/V r) 236. Signature of Person Pronouncing Death (Only when ap pitta blej 23c. License Number BV PERSON WHO PRONOUNCES OR CERTIFIES DEATH /~~ 1 / S t ~ sc s L s 8 ~ ° ` °' -ma D t c ~~_ ~...i ~... 23d. Date Signe (MO/Day/Yr) 24. Time of Death ~ a ~N7 y f ~ ~ a ~ ~ - 25. Was Medical Examiner or Coroner Co n[a cted? Q Yes Q No CAUSE OF DEATH Approximate 26. Part 1. Enter the chain of events--diseases, injuries, or complications--that directly caused the death. DO NOT enter terminal events such as cardiac arrest Interval: respiratory arrest, or ventricular fibrilla n w i tho ut showing the etiology. DO NOT ABBREVIATE. En t/i ~o er only one cause on a line. Add additional lines it necessary Onset to Death t ~ ^ \ - / IMMEDIATE CAUSE - > a. l.'C' TTCI ~ Q ~ ~~ ~~1'Y~ (~.,~ rrJ~ (Final disease or contlltion Due to (°r as a consequence of resulting in death) ~ ~ b. Sequentially Ilst conditions, Due to (or as a consequence of): if any, leading to the cause listed on line a. Enter the c UN DERLVING CAUSE Due to (or as a consequence of): (disease or Injury that in itlated the events resulting d. - in death) LAST. Due to (or as a consequence of): S 26. PaK 11. Enter other significant cond't'o ontributin¢ t d h but not resulting in the underlying cause given in Part 1 27. Was an autopsy pertorm 7 o Yet o-.~ _ 28. Were autopsy findings available to c mplete the c of deaths a ° v ^+ Q No O Yes 29. If Female: 30 Did T o . obacco Vse Contribute to Death? 31. Ma er of Death Q Not pregnant within past year ~^ Q Yes Q Probably IV t l H a ura Q Homicide Q Pregnant at time of death Q No known Q Accident Q Pendin Investi ati n ~ g g o Q Not pregnant, but pregnant within 42 days of death Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of In Q Suicide Q Could not be determined jury (MO/Day/Yr) (Spell Month) Q Unknown If pregnant within the past year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occurred: Q Ves Q Driver/Operator Q Pedestrian Q No Q Passenger Q Other (Specify) 39a. ~r~ fier (Check only one): Certifying physician -To the best of my knowledge, death occurred due to the cause(s) and manner stated Q Pronouncing ffi Certifying physician -TO the best of mY knowledge, death occurred at the time, date, and place, and due to the cause(s) and manner stated Q Medical Examiner/CO her - On the b Sts examination, and/or Investigation, in my opinion, d~th o tarred at the time, date, and place, and due to the ca e(s) d an r stated c ~ y Signature of certifier: Title of ce rtifler: 1 _l~ License Number: (~~ O /y~~~~~ 396. Na me Ad d ress and p Cod e of Per ompleting Cause of Death (Item 26) n 39c to S ned (MO/Da /V n ~ f ~v~ l C" lr ~. 1 -1- ~ ~ S ~C7 ~tl ~~ _. . y r) 40. Registrar's District Number 41. Registrar's S ~T~ ure ^ 42. ft gist a File Date (MO/Day Yr) ~, ~ ~ ~ - "1R C A ~~\ t~ ao la 43. Amendments Disposition Permit No. V ~ i c~~~~ I REV 07/2011 n -_ ,~-, d ~ r: :. ~ ~ -~ r~ .. ~:7 LAST WILL AND TESTAMENT "'~-"? w;: _ _ i. r:: KE V 1N L. SHERIFF I, KT~JVIN L. SHERIFF. a resident of and domiciled in the Township of Winslow, County of Camden and State of New Jersey, being of sound mind, memory and understanding do hereby make, publish and declare this to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils at any time heretofore made by me. ARTICLI~; FIRST' I direct that all my just debts and my fiuieral expenses, expenses of my last illness and the costs of administering ary estate be paid as soon as practicable after my death. ARTICLE SECOND I direct that there shall be paid out of my residuary estate all estate, inheritance, succession or other taxes, assessed by reason of my death, imposed by the government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect of all property required to be included in my gross estate for estate or like tax purposes by any of such govenullents, whether the property passes under this Will or otherwise, including property over which I have a power of appointment, without contribution by any recipient of any such property- ARTICLE TIlIRD I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nah~re and wheresoever the same maybe situate, of which I may die seized ar possessed or have any r•l ;,~~ iC .^.: Interest '..: L1r4~.~ ~~r lueliZ..a~rl rlra~~ ~+:. ,. ,-tI ~:?", ~"IIC~I:~EL J. TJr'RR~^ N, :~ °a mil ir-~~P ., ~:.... .. n~~ .~.. ~~_,:,~ r~~r n z. _ 1:r provided he shall survive me for a period of thirty days. ARTICLE FOURTH In the event that my beloved domestic partner- MICIIAEL J. HORAN, should predecease me or not survive me for a period of thirty days, or in case we meet our death in a common disaster and under the circumstances that there is no presumption of s~~rvivorship in law. then in either of said events, I give, devise and bequeath all the rest, residue, and remainder of my estate to my beloved parents, JOHN H. SHERIFF, JR. and DORIS F. SHERIFF, in equal shares, share and share alike. In the event that my beloved domestic. partner, MICIIAEL J. HORAN and my beloved parents, JOLL'v H. SHERIFF, JR. and DORIS F. SHERIFF have predeceased me, then I give, devise and bequeath all the rest, residue and remainder of my estate to my beloved cousin, JULIE KELLEY, in fee simple ARTICLE FIFTH In the event my beloved domestic partner, MICHAEL J. HORAN and I should become deceased at the same time and it cannot be determined who died first, then in that event, I hereby give, devise and bequeath my estate as follows: 50 ~o to beloved parents, JOHN H. SHERIFF, JR. and DORIS F. SHERIFF, in equal shares, share and share alike. In the event my beloved parents should both predecease me, then I give and devise their share to my beloved cousin, JULIE KELLEY; and 2. 50% to SCOTT T. IIOR~N and hELLY T. H(~RAN. in equal shares, share and share alike. KLS ARTICLE SIXTH I hereby nominate, constitute and appoint my beloved domestic partner, MICHAEL J. HORAN, to serve as my Funeral and Disposition Representative. In the event MICIIAEL J. HORAN should predecease nle or for some other reason not qualify as my Funeral and Disposition Representative, then I nominate, constitute and appoint my beloved mother, DORIS F. SHERIFF, as my Funeral and Disposition Representative. My Representative shall have the authority and power to control the arrangements for my fiuleral and the disposition of my remains. ARTICLE SEVENTH I hereby nominate, constitute and appoint my beloved domestic partner, MICHAEL J. HORAN, Executor of this my Last Will and Testament hl the event, however, of the death of my said beloved domestic partner, MICHAEL J. HORAN, before me or should he not qualify for any reason as Executor or if he is unable or unwilling to act at any time prior to or subsequent to qualifying as Executor, or dies after he is qualified but before he completes administration of my estate, then I hereby nominate, constitute and appoint my trusted friend, SCOTT T. HORAN, to be the Executor of this my Last Will and Testament. ARTICLE EIGHTH I authorize and empower my Executor, to sell, lease, mortgage, partition or exchange any and all real and personal property of which I might die seized or possessed, at such price or prices as to said Executor may deem best, at public or private sale, upon such terms as to cash or credit as may be deemed for the best interest of my estate and to execute, acknowledge and deliver all proper writings, deeds of conveyance and transfers therefore. ARTICLE NINTH I direct that any fiduciary under this my Last Will and Testament shall not be required to fi~rnish bond or other sec~~rity in any jurisdiction whatsoever for the faithful performance of his duties hereunder. I, KEVIN ~ L. SHERIFF, the Testator, sig11 my name to this instrument this i day of ~',~~,,' ,,~ ~ , 201 1, alld beil~g first duly sworn, do hereby declare to the undersigned authority th t I sign and execute this instrument as my Last Will and Testament and that I sign it willingly, that I execute it as my free and voluntary act for the purposes therein expressed, and that I am 18 years of age or older, of sotuld mind, and under no constraint or undue influence. ,~ ,.-~~ ~ "" ~ KEVIN L. SHERIFF ' ~ ~"1 ;'J~ ~~ ~~;±G , ~y' ` -J ~, ~L + l+ ~ .~' - L')~t ~/~ f_ ~f ~'c ~~1 t`~t'1 C3G> ~CirSf the w1t11eSS0S, being first duly sworn, do hereby declare to this undersigned authority that the Testator signs and executes this instrument as his Last Will and Testament and that he signs it willingly, and that each of us states that in the presence and hearing of the Testator, they hereby sign this Will as wihlesses to the Testator's signing, and that to the best of their knowledge the Testator is 18 years of age or older, in~iiu, and :illder 110 ::oiiSllaint Cr UllQLie 1C1S1Llefli;C. ~f ~~ . _ ,7 ,~.- `~~z ~-~ residing at ~`~ ~',~,.-~~'tx t "~, ~~ ~-u ~;~; '~' ~' ~' ~~ ~~ ~ ^ r. residin at ~ ~~x,-~:~t.cz,r_~s ~~ ~Y~f~~ ~~,r?~+~ g t-,rfz,~k~ I„-? ~~f (~ ,N,~ STATE OF NEW JERSEY SS COUNTY OF GLOUCESTER Subscribed, sworn to and acknowledged before e by KEVIN L. SHERIFF, the Te Bator, and s lbscribe and sworn to before me by /~ ,,. ~ %: ~ % ~ ..,~ . ~' ~ `d ~~~_ _-and l- '~F ~~ f ~~~ `'`, /~~': t ~ , ~ ~ ~ f, the witnesses, this ~~ay of _.>:,,rs~ aL_~` - --= 2011. r~ .-. ~.....--------~-......,.~,. ,,..~ MIC ~-- ~, ___~- r` `. -- --- -~. __. My u Expkes 8J17 __._