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HomeMy WebLinkAbout05-11-12Reset 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: Glenda L. Kutz ,~ ~ ~' File No: _~~ ~ ~ ~~ ~~ . ~ ~: ~ ` r a/k/a. (Assigned by Register) a/k/a: ~~a' Social Security No: Date of Death: 04/21/2012 Age at death: 71 Decedent was domiciled at death in Cumberland County pA principal residence at 108 S. 15th St. Cam Hill Borou h Cam Hill Cumberland Co. PA 17011 (Stare) with his/her last Stre<~t address, Post Office and Zip Code City, Township or Borough Coun ty Decedent died at 120 S. Filbert St. Mechanicsbur Cumberland Co. PA 17055 Street address, Post Office and Zip Code City, Township or Borou h g County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ r -~ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ "D 0 ~ f" Of If not domiciled in Pennsy[vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $_ ) to 00 Real estate in Pennsylvania situated at: 108 S. 15th St. Cam Hill Cumberland Co. PA 17011 (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough Coun ty A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/sheithey is/are the Executor(s) named in the last Will of the Decedent, dated ~~I lr(79 thereto dated and Codicil(s) State relevant circumstances (eg. renunciation, death of executor, eta) 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. 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 life, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com lete 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 ~) EXCEPTIONS 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 (attach additional sheets, :f necessary): -z~ ,:~ ;-,-; G . Form RW-02 rev. 10/11/20/! Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF _~ ~, ~~ \ ~~ ~~ < < 1C-~I~_ SS: a~rOffieial,iDseOnl~~,',~ O~ 1,, ~iC !:~f? hi~Y I I F~°` 2~ 2 Petitioner(s) Printed Name Petitioner(s) Printed Address ' ' Marie Fetrow 208 Senate Ave. A t. 108 Cam Hill PA 17011 ~N~" "'' ~ ~' `"""-' Edwina A. Jackson 108 S. 15th St., Cam Hill, PA 17011-5501 The Petitior~r(s) shove-named swear(s) or affirm(s) the statements in the r mg Pe ' ' are true and correct to the best of the knowledge and belief of Petitioner(s) and thzt, as Personal Representative(s) of the Dece ent he eti 'o r(s) will~vell and truly administer the estate according to Iay~. Sworn ro or afftrtned and subscribed before a,~c.~= - ~ , ~ -, Date ~ // ~/~ me t;ais, ~ day of '~~~~~ ~ ~, ~" ~ n~?~ Date ! -T Date " } I For the Register Date BOND Required: ~ YES ~ NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters ...................... $ "~ ~C ( ~~ )Short Certificate(s)...... ~ (1~ ~ _i ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other Automation Fee ............... JC °o - ~~ T ' - S Fee . .................... TOTAL . , J~ ~ ~ `~ ..................... $ --0:90' Attorney Signature: ~' r ~ ~ '~ Printed Name: Ha M. Baturin, Es uire Supreme Court ID Number: 83006 Firm Name: Baturin & Baturin Address: 2604 N. SPrond S r ~1a_rri_sh~g- PA 171 10 Phone: (717)234-2427 Fax: (7171234-7544 Email: ~dhandh(n~anl cnm DECREE OF THE REGISTER Estate of Glenda L. Kutz File No: ~ ~ - ~ ~~' ~ ~. ~ f ~~, a/k/a: AND NOW, '~ ~ ~Lt_ ~ ~~` C 1-~ in consideration of the foregoing Petition, satisfactory proof having ~ n presented before me, IT IS DECREED that Letters - ~_`. ' -1 r_ ; - are hereby granted to ~\C~ ~ , ~ k~ ~tYC~'u ' ~c 1~~~ \~~~1C, i ~ ~ ; ~, ~ ~C~ to the above estate and (if applicable) that the instrtunent(s) dated _7 C ( ~ C>["j described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Form RW-Ol rev. 10/I //20!! Regtster of Wills J . Wage 2 oi'2 Nlilc unc u ~ ,,, ~. ~ac~~.~~;~~Gr1-$i~AR'S ~~~R7"~FI~,~,`1"~C~h~ ~-~~ (~~"` Waf~tif51G 1~ is;ill~~~~fio duplicate this. ~~,a~~,j ~"IV y~~ha~~t?~stai ear pfd c~~a~~,p~~~~r+ Fee for this Certificate. bh t)7 ~'E ~ ~~~~ ~ ~ ~; I 2' e~.CS I,, , I~~~~(~{ rl~~r ~~ lit ~ ii i( 1 (Il ill II?(111 fu IC !'IA(..S 1, v l i' ''1 _ .llt.ij (. L "1!llt LC l)9 11Cat~7 ., ~ r _. 1 p~°i Jf H I,, ' i. ~~ ~,'~ ~ rv' _~ .~ ~t~j~C-3T I IlC i)JI (1137 ^~i'11 ~,, i r i= (,~tit'I Vll'~ u v~.Ji,~l 1' ;mow' ~ m ,z~,j Ili <„ ll ii'I~ LI) r!h .`lull(` `t~tia~ CIIM~ERIANi;: C0 , PA ~ ~ "~ ~_ i ~ ~, . 't;~ ~. I 11; 11tIn(7. <- ,~ , • ,,>~: P 1~3~~~~~ ~e ~~': - © ~~~~ --- - - -- '*~: ~~~,, APR/2 ~ X12 _ _ _ '~+~ r~r 1, Ct,CIItICaU0i1 ,~LI1Tl~_?i ~ _ - - -- ----~ ------ ---- Type/Print In COMMONWEALTH OF PENNSV LVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Permanent ~~ .~ ~[J Jf ~ ~ yr vCA 11-1 1. Decedent's Legal Name (First, Middle, Last, Suffix) State File Number: 2. Sex 3. So<lal $ecu rlfY Number 4. pate of Death (MO/Day/Vr) (Spell Mo) Glenda L. Kutz Female 198 - 30 - 1703 6a. Age-Last Birthday (Yrs) 56. Under 1 Year Sc Under 1 D . a 6. Daie of Birth (Mo/Day/Near) (Spell Month) 7a. Birthplace (City and State o Forei Months Days Hours Minut n C g ountry) es 71 S Edinbur h cotton eptember 11, 1940 8a. Residence (State o 76 Birth F la i C . p r ore ce ( gn Couni ounty) ry) 8b. Residence (Street and Number -Include Apt No.) 8c Did Deced t Li . en ve in a Township? Bd.Resleen<e(co~nty> 108 S. Fifteenth Street pYes,de<edentlovedln __ _ twp. Cumb E`r1Hnd 8e. Residence (Zip Code) 1701 ] ~NO d d . , ece ent lived within limits of Camp Hi11 _ 9. Ever in US Armed Forces? 1.0. Marital Status at Time of Death ~ Married city/boro. Wid Q V Q owed 11. Su rviyin 5 es ~NO ~ Unknown ~( Divorced Q Never Married ~ g Pouse's Name (If wife, give name. prior to first i marr age) Unknown 12. Father's Name (First, Middle, Last, Suffix) ROnald Lloyd Roberts 13. Mother's Name Prior to First Marriage (First, Middle, Last) 14a. Informant's Name 01 ive Dixon o 14 b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number Marie K. Fei=row Ci G , S r 208 Senate Av • e . , A t 1 Ca 08 m Hi11 t c - a 1s P , PA 17011 IF Death Occurred in a Hospfta l: ~~~ WW.. ~ ~~~~~~- "'-""'-""""""--~~~~~--~-~~~ a. ace o Deat C eck on y one ~J In ~~ ............ ... ... . ..... Patient ~ ..................... If ____ _ ... Deat Occurred Somewhere Other Than a Hospital: ~~ Yi~ ~ Emergency Room/Out ~ LI~H OSpice Facility ~~ ~~~ ~~~~~(~ ~ - ~~--~ patient 0 Dead on Arrival ~ D ' ecedent s Home ursing Home/Long-Term Care Facility Other 5 156. Facility Name (If not institution, give street and number; ( Pecify) .16c ic T . y or own, State, and Zip Code t ~~ ~1` } i5d. Coun ty of Death 16a. Method of Disposition ~ Burial Cremation 166 Date of Dis o t [t i . p s on 16c- Place [] Removal from State 0 ponation ositlon (Name of cemetery, crematory or other l , p ace) other (sPe^Ify) April 24 2011 E v , vans Crematory 16tl. Location of Disposition (City or Town, State, and Zip) 17 i a. S gna f F rat rvice Licensee or Person In Char Schae£ferstawn, PA 17088 Be of Interment 176. License Number E IZC. Name and Complete Address of Feu Herat Facility FD O1 2 848 L Parthemore FH & CS Inc. P.O Box 431 m . New Cumberland PA 17070 1B. Decedent's Education -Check the box that best describes the 19 D d I- . ece ent of Hispanic Origin -Check the highest degree or level of school completed of the time of death box that b C O . [o Indicate what (] Bth grade or less I est describes whether the decedent the decedent considered h m Self O h S ers s eif to be. panish/Hispanic/Latino. Check the "N O" ~ White [] N° diploma, 9th - 12{h grade b ox If tlecetlent Is not Spanish/HIS Q Korean g] High school graduate or GED completed Panic/Latino. ~ Black or African American ~ Vietnamese Some toile ~. No, not Spanls h/Hispanic/Latino ~ American Indian or Alaska N ~ 0 ge credit, but no tlegree (] yes a Ye Oth M t , er Asian exlca n, Mexican American, Chicano (] Asian Intlian [] Associate degree (e.g. AA, AS) [] Yes Puerto Ri ~ Native Ha ii , can wa an (] Bachelor's tlegree (e.g. BA, AB, B:i) Q Y 0 Chinese es, Cuban 0 Guamanian or Cha mono Q Master's degree (e.g. MA, MS, MEng, MEd, MSW (] FIIlplno MBA) ~ Y S h , ~ es, ot er 5 amoan ~ Doctorate panish/Hispanic/Latino ~ Japanese O (e.g. PhD, EdD) or Professional de ree g Other Pacific Islander (Specify) MD DDS DV ~ . , M, LLB, JD Other (Specify) __ 21. Decedent's $Ingle Race Self-Designation -Check ONLY ONE to indicate what the tlecetlent conside [] Whit d hi re mself or herself to be. 22 a. Deceden s Usual Occu e [] Japanese ~ Samoan t~ poison - Indicate ty e of Q Bl k k p wor ac or African American [] Korean 0 Other Pacific Islande done during most of working Ilfe- DO NOT USE RETIRE (] A i r mer D. can Indian or Alaska Native 0 Vietnamese [] Don't Know/Not Sure Q Asian Indian 0 Other ASian BOOZCZCE spar 0 Refused ~ Chinese ~ NatiYe Hawaiian (] Other (Specs 22b. Kind of Business/Industry [] FIII i° NJ p ° [] Guamanian or Cha mono Communications ITE MS 23a - 23d MUST BE COMPLETED 23 a. D to Pronou c d Dead (MO Day/V r) 23b. Signature of P BV PERSON WHO PRONOUNCES OR ~ \ ~~ erson Pronouncing Death (Only when applicable; 23c. License Number CERTIFIES DEATH 23d. Date Sign^ed (M /Day/Vr) 24. Time of Deat _ ~w \ ` \ ~~ ~~ CC ~ ~\!`l Medical Ex n cted? Ye~y NO CAUSE O F DEATH 26. Part I. Enter the chain of events--diseases, injuries, or complications--that tllrectlY caused the tleath _ APProxima<e respiratory arrest p0 NOT i . , or ventr enter terminal e cular fibri lla[lon without showin the etlolo vents such as cardiac arrest i t I B gy. DO NOT ABBREVIATE ^ erva Ent l - er on y one cause on a line. Add additional lines if ne<essa - ry Onset to Death IMMEDIATE CAUSE -----.._- ___- _~ a ~ --R _ (Final disease or con dltion ~ -_ D ue o (or as a consequence of7: -~- ~ '~ tA_a~ L 1 resulting in death) t - ~/~ b. Ci`>!a-nL~f7---t1 f->32.~P~YhO ~]v Sequent) ally Iis[ condltio ns, ~'~~d1- `// if an leadin Djue co (or as a consequence of): --- ~- ----- Z/C7 Ls_, Y. g to the cause ~~ listed on line a. Enter the c. ~k~J 7~t' ~ ~~~6,-~'Z`f~tl y /~ -)~ - UND Ff~ - f-•-N-) L ERLYINGCAUSE Due to (or a a conse (di ease o I ue f --- ~ /~ t q r nce o n ): Jur nth at - W i toted the e e is resulting d. In death) LAST. ` -' __ Due to (or as a consequence of): ---- - -- - a~ 26. Part 11. Enter other si¢nif"can[ condlfions contributin [ d th but not resulting In the underlying cause ive P ~ g n in art I 27- Was an autopsy performed? m (] Yes ~~No ~ 28. Were autopsy findings a aila ble ^_' 29. 1I f to complete the cause of death? Fe male: of .~ / 30. _Ditl Tobacco Use Contribute To Death? ~ Yes Q No ~J Not pre gn nt within past year 31 M l . of Death ~ Pragna ^ai time of death ~ Yes ~ Proba bey rat o ~ No preg ant, but pregnant within 42 tlays of tleath 0 NO ~ Vnkno n Q Accident O t 'd ~ Pe Ha s n Investigation Not ~ g [] pregnant, but pregnant 03 days to 1 year before death (] Suicide o 32. Date of In ~ Could t be tletermined 0 Unknown If pregnant within the past year jury (MO/Day/V r) (Spell Month) 33. Time of Injury 34. Place of Injury (e.g. home, constru coon site; farm sch l ; oo ) :35. Location of Injury (Street and Number, City, Sta<.~, Zip Code) 36. Injury at Work 37. If Transportation Injury, Specify: J8. Describe How Injury Occurred: [] Yes Q Driver/Operator 0 Petles[rlan No [] Passenger ~ Other (Specify) 3 9a. Certifier (Check only one): '~~Certifying physician -TO the best of my knowledge, death occurred due to the cause(s) and Q Pronounci 8 ng m nne fed Ce rtifyi g physician - To the best of my knowledge, death occurred a the time Q Medical Examiner/ date land l t , p ace, and due [o the Her - On the basis of exa minatlon and/or InvesTigaflon, In cause(s) and manner stated my opinion death o ccur d , e at the time, da nd plat ,and due to the ( )and m Signature of certifie c=. ~. - ~tti r / e, a e taus anner stated t 3 Title of ce rtifie r:_r~/f"~~'.ky~~> ZA 96. Name, Addre and ~~` License Num ber: Zip COde of Person C ~~~_~C3 i _ om p ecing Cause f Dea h (Item 26J ~ p ~~ ~ 4 CiLC<J ~ C/!(-(~-e ~ /~ A . , ~p ( 39c. o to Signed (Mo/oaY/yr) 0. Reglstr District Number ' ( ~?~~ ` ~/ 41. Registrar nature ~ - Z 02 ~ - ~ ~~ 42- Registrar File Da[e Mo/Day/Vr) 4 3. Amendments i/`q73 "-~ 7 ~ Q / 2• Disposition Permit N°. n'7 ~-! ~ ~ -J Cj H105-143 _- _.- -. _- _ __ _. - - - ___ -. __.. REV 07/2011 LAST WILL AND TESTAMENT OF n __ GLENDA L. KUTZ ~ ~-? '~" '-~ ;~ ---x: _, ---~r I, GLENDA L. KUTZ, of 108 South 15`" Street, Camp Hill, Cumberland ~ unt f Y, h, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this instrument to be my Last Will and Testament, hereby revoking any and all Wills or Codicils by me at any time heretofore made. FIRST: I direct my hereinafter named Co-Executrices to pay all of my just debts, funeral expenses, administration expenses and inheritance, estate, succession or excise taxes, which I owe or may become due on account of my death, as soon as maybe convenient after my decease. SECOND: I give, devise and bequeath to my beloved sister, Marie Fetrow, any and all of my cash, barik accounts, jewelry, and the motor vehicle in my possession at the time of my death. j (SEAL) GLENDA L. KUTZ, Tes atrix ,z, -: ,k Page 1 of 4 THIRD: All the rest, residue and remainder of my estate, consisting of both real and personal, of whatever nature and wherever situate which I may own or have the right to dispose of at the time of my decease, I give, devise and bequeath, in equal shares, share and share alike, to my beloved sister, Marie Fetrow and my beloved friend, Edwina A. Jackson. FOURTH: I hereby waive any requirement which may have otherwise been imposed upon the Executrix in this, my estate, to post bond, or enter surety in connection with the administration of said estate, in this or any other jurisdiction, where permitted by law. FIFTH: I hereby make nominate, constitute and appoint my beloved sister, MARIE FETROW and beloved friend, EDWINA A. JACKSON, as Co-Executrices of this my Last Will and Testament. I hereby give unto my Co-Executrices the fullest power, in their sole discretion to do any and all things necessary for the complete and proper administration of my estate with full power to sell at public or private sales or sales without Order of Court, any real or personal property belonging to my estate, and to compound, compromise or otherwise settle or adjust any and all claims, charges, debts and demands whatsoever against or in favor of my estate, as fully as I could if living. In the event that one of my Co-Executrices predeceases me or fails to act, or continue to Page 2 of 4 ~~ (SEAL) GLENDA L. KUTZ, Testatrix act, or qualify, or is not able or willing to serve in said capacity, then my remaining C'o-Executrix shall continue with all powers and authority in place. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my seal this ~~~ day of `~__, 2009. (SEAL) G N A L. TZ, es~tatri SIGNED, SEALED, PUBLISHED AND DECLARED BY THE ABOVE TESTATOR, AS AND FOR HIS LAST WILL AND TESTAMENT, IN THE PRESENCE OF US, WHO HEREUNTO AT HIS REQUEST SUBSCRIBED OUR NAMES IN HIS PRESENCE AND IN THE PRESENCE OF EACH OTHER AS WITNESSES HERETO. it's-~!~ ~ ~- Address ~ ~' ~`l ~ ~,.~~ ~(-- ~~~~ f ~. 1 ~,' F 1, ~~l ~ ~. ~'~~-.2.,~ Address ~~ ~' ~`° ~'. ~-'c' j ~ . ~------~ .J Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF PERRY ~ WE, i~ ~~,,,~a., ~,,.r.,L 1~f~r /''~ ~ja~(-rt:~ and ~L r m; ~ ~ ~ ~-' ~ ~ ,the Testatrix and the witnesses respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed this instrument as her Last Will and Testament and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, in that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witnesses and to the best of their knowledge, the Testatrix was at the time eighteen years of age or older, of sound mind and under no constraint or undue influence. _(SEAL) GLENDA L. UTZ, Testatrix ~fn"riY ','` ~~ (SEAL) 4 -z- ~~;~ ~ `~~ .(SEAL) Sworn to and Subscribed before me this ~~_ day of_ a,y ~ ~ , 2009. l ~, Notary Public ,DAVID A p,>~ MME-~1~i4 Cigr of Hrriip~~q~ ~ Y Caiur+i~! Is~m~a .~. t: ~. Page 4 of 4 _.. ~ f . «,::.~,.,~...s.......~..