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HomeMy WebLinkAbout06-18-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C (.!/J1,,tgE~L~4/1/D 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: W/LC/~4/r1 KONL~7? a/k/a: ~JILUif/fl h: KoHl.F717~~~ a/k/a: a/k/a: Date of Death• Decedent was domiciled at death in Cltrri +5E+ ~~ County, principal residence at 3 tf N. Sf . T has ~r ~ ~7/~ /iii/~ Decedent died at Street address, Post Office and Zip Code ~Eanon V~ /h~t~l.l C'cn fer Street address, Post Office and Zip Code or Borough County County Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ -si 0~' ~ ~ If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ I not domiciled in Penns lvania. Personal property in County $ -• f y ....................... Value of real estate in Pennsylvania ...................... ............................. $ '- TOTAL ESTIMATED VALUE.... $ O O • ~ ° Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) nioNG` 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)~w/she/tbe3t isYere the Executor( named in the last Will of the Decedent, dated ~GCGf7-'~U'3~i Z~Id and.Ceclicil(s~- thereto dated 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 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 lite, durance absentia, durance minoritate 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 left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): ~ a .-•. ~~ Name Relationshi Addres ~ ~- ~~ C r- ..r _ _ C~, __ C-~ ~ - ~ C~ ' ~ -t \':. ~ G7 File No• ~~- ~'Z' ~~~ li 1 (Assigned by Register) Social Security No: /b.s :?G-,$~6/D Age at death: p'o (State) with his/her last C'c~~1a~t/ Borough Form RW-02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF C um~3E-e.~~-nrD } Official Use Only ~~ c `'r Petitioner(s) Printed Name Petitioner(s) Printed Address ' 117LUCEN7" T. ST,i4~E ~'~, r~- t ~~-'r 3~ N, ST J~ii-~s ,~Po~GZ ~1P H/[[, P/t ,~~ CUMBERLAND CO., PA The Petitioner(s) above-natned 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 Decedent, the Petitioner(s) will we~l and truly administer the estate according to law. Sworn: to affirmed attd subscribed before X ~ ,~ ~ ~ ` ~ Date ~~~ me this ~ day. of ~ , ! ~ a , • ~ Date ~~~~, ~, 1 Date By: ~-~. rC- ~ ~ - E" ~ Date For the Register BOND Required: O YES ~ NO FEES: ~~~ $ 7 ~ Letters ................... ... . • (~ )Short Certificate(s)... ... ~~, . (~~(~, ( )Renunciation(s)...... .. . ( )Codicil(s) . ......... .. . ( )Affidavit(s)......... .. . Bond ..................... ... Commission ............... .. . Other ....• ••• I1~~~ ... ~\~ ... ~~ , `.l i Automation Fee ............ ... ~ .L JCS Fee . ................. ~ `~~! ~'" ` .. ~~- TOTAL .................. ~ ~ ~ ... $ 1,~,'> •~xi Estate of W !LL/~4/ai a/k/a: !~//Ll/~M /l r/ 111 -~~, ~ ;~ in consideration of the foregoing Petition, AND NOW, ~~;~L(~0 satisfactory proof having been presented before me, IT IS DECREED that Letters ~,~s15a~~ta~y are hereby granted to /I1 ~%/~ Gei1 t .T eS~2 ~ in the above estate and (if applicable) that the instrument(s) dated "~tca.+.bar' .~i Za~O described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills Form RW-01 rev. ioil~noii ~ge 2 of 2 To the Register of Wi11s: Please enter my appearance by my signature below: Attorney Signature: L~~~a~ l~G!/f C • fc%~~~N Printed Name: G~,t/'~ES '~ s~iiG~G?/S Supreme Court TD Number: 3~S/3 Firm Name: Address: f'o ~.' otlStJ' /yl ech2~;cs ba r~ P~ /moo sS Phone: 7/7- ~Glo - O,~o9 Fax: 7/7- 79 - 7 Email: L'eS iP~dS 3~ CLYl1LtQ.S •/~ DECREE OF THE REGISTER File No: Z/-/.Z - C.1,~ ~j WA~RNINi~~~ IS,IC, ~~ u li~.ata this; ^c3c?y ~'; .~igr( 3~czr;lr r,3 ;~>)_,~ ,;~ :~-~; ~~ _~.~ ~ :~~12 JUN 18 AM !0~ 4U ,' .I ,, „ ,~ . I Fee t~~r this certifictue. ~f).~u? ~ Ii ~+~?~~i"" J~ f'e'~~ I r.. ` < tt1iC (11 .1 ~) Lt!) , ;, _ .. _ t _. o~~~;i ~ ~ l Ij.. _~.1 . i .., 5 u(1U~ir 1 .. ~, r ,i ,, -~ ~ .ti: ,. ; CU~uIBERI.AND CO.f PA ~ _ , ~~ ~: ._L P 18 5 ~ ~,~ ~. 7 ~ ~' f ~' _- ~ ",~r _ ~~~' ~~~GL ALL s (p~' ~ _ L~' ~. Certit)~atiOn '`J.)s)jf)c ~ ;.;'s( ?,,1);°,? Typ</Print In COMMONWEALTH OF PENNSV LVANIA • DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH State File Number: 'r. •F la D William H. Kohler Jr. M 161-Lb-JOIN '•° "" ---- ell Month) 7a. Birth rate PeP ar) (S /Y t n C t e-Last Birthday (Vrs) Sb. Untler 1 Vear A 6 Sc. Under 1 Da p e 6. Date of Birth (MO/Day ia lvaO nna abuY Side n g a. Months Daya Hours Minutes January 8, 1932 ]b. Birthplace (county) 80 R Sb esidence (Street and Number -Include Apt No.) Bc. Did Decedent Live in a Township] tw P. . Sa. Residence (State or Foreign Country) 34 North St. Johns Drive yes, decetlent nvetl In Hamvden ~ Penns lvania city/bore Htl. Residence (GOUnCV) d ) 17011 QNO, decedent lived within limits of e Cumber land Se. Residence (tip Co th ~ Married Q Wido f I to first marriage) wed il. Surviving Spouse's Name (If wife, give name pr or Dea 9. Ever in US Armed Forces] 10~tMarl[al Status at Time o M letl QU^k^ow^ dyes Q No Q Unknown ast Divorced Q Never arr Middle, Last) ther's Name Prior to First Marriage (First, M 3 12. Father's Name (First, Middle, Last, Suffix) o 1 . Helen Clelan William M. Kohler Sr to Decedent hi 14c. Informant's Mailing Address (Street antl Number, Clty, Stat Zip Code, 17011 14b. Rela 14a. Informant's Name p tions 34 North St. Johns Dr ive ,Camp Hill, PA Sister Mrs M111 icent J . Stare ~ -------------~~---- _ ... _ ace o Deat -ec On Y one - --- --- - ------- -- act - ~~-~•-~~~ ecedent s Home D ltai: - ---~ Hospice F Ilty -- a Hos Th ~i s -------- """' -""-'- -"------"- I h Occurretl In a Hospital: tall In Patient an P if Death Occu rretl Somewhere Other other (Specify) II1 If Deat Q Emergency Room/OUtpatlent ~ Dead on Arrival ' tY rain Homes/Long-Term Cara Fac Nu H 16d. County of Death and Zip Cade State Town Ci a~ 15b. Facility Names (If not inatRUtion, g\Ye street and number; , , ty or 1St. PA 17042 Lebanon L VA Med cal Center Lebanon pos ( ry, or of Place of Dis Itlon Name of cemetery, <rem ato her place) 16c r 16a. Method of Disposition Q Burial Cremation 16b. Dace of Disposition . Q Removal from State Q Donation T~ e 1 2012 Cremation Soc iet o£ Penns lvania $' Other (specify) I . 1]a Slg cure of Funeral Ice Licens~Ey~r Person In Charge of Interment 1]b. License Numb<r ~ 16tl. Location oT Disposition (City or Town, State, and Z p) 6j~/n j f)/ Harrisburg, Pennsylvania 17109 ~' E 1]c. Name and Complete Address of Funeral FacilltY ` lg. Decedent's Education -Check the box that best describes The 19. Decedent of Hispanic Origin - Check the ~- highest degree or level of school com plefed at the time of tleath. box chef best tlescrlbes whether the decedent f h/His ante/Latino Check the "NO" F s E 0 8th gratle or less Is Spans p box if decedent Is not Spanish/Hispanic/Latino. Q No diploma, 9th - 12th grade l d ~ No, not Spanish/Hispanic/Latino et Q High school graduate or GED comp e Q Yes, Mexican, Mexican American, Chicano Some college credit, but no degree Q Yes, Puerto Rican Q Associate degree (e.g. AA, AS) Q Yes, Cuban Q Bachelor's degree (e.g. BA, AB, BS) MEn M5 ' MBA) M6W MEd Q Yes, other Spanish/Hispanic/Latino g, , s degree (e.g. MA, Q Master Q Doctorate (e.g. PhD, Ed D) or Professi , , onal degree (Specify) . MD DDS OVM LLB JD Self-Designation -Check ONLY ONE to in R ( ' dicate what the decedent considered himself o ace s 61ng e 21. Decedent ese Q J p Q White rican A rea o Q K ^ Othe rPacific Izlantler Q me Black or African i Q Vietnamese Don't Know/Not Sure Q ve Q American Indian or Alaska Nat Other Asian Q Refused Q Asian Intlian Q Hawaiian ti Q Other (Specify) Q Chinese ve Q Na h Q Filipino amorro Q Guamanian or C ITEMS 23a - 2gd MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r) 23b. Signature of Person P BY PERSON WHO PRONOUNCES OR ~ ~ , ^~ ~ ' I'_ Decedent's Race -Check ONE OR MORE ra es to inoicate wnat decetlent consltleretl himself or herself to be. White Q Korean Black or African American Q Vietnamese American Indian or Alaska Native Q Other Asian Asian Indian Q Native Hawaiian Chinese ~ Guamanian or Chamorro Filipino Q Samoan Japanese Q Other Pacific Islander Other (Specify) f to be. 22a. Decedent's Usual Occupation -Indicate type of won done during most of working life. DO NOT USE RETIRED. din Link Fence Installer 22 b. Klntl of Business/Industry Self- Employed i. Date Signed (MO/Des /Yr) 24. Time of Death ~ Yes ~ No - 25. Was Medical Examiner or Coroner Contacted? Q CAUSE OF DEATH Approximate in I y cause Interval: 26. Part 1. Enter the cha'n of a ents--diseases, jur es, or complications--that direct) d the death. DO NOT enter terming I nee Atld adtlitlonal,lanesrilenecessary Onset to Death Y Hier onl cause on respiratory arrest, or ventricular fibrlll n without s!h'opwing the etiology. DO N~yOT ABBREVIATE. E Y one IMMEDIATE CAUSE a. ~ ` C ~~ ~ ~` ~~~ t (Final disease or condition Due to (or as a consequence of). - resulting in death) - b. Due to (o as a consequence of): Sequentially list conditions, if any, leading to the cause _-- - listed on line a. Enter the Due to (or as a consequence of)' UNDERLYING CAUSE (tlisease or injury that ---- - nitiated the events resulting d. Due to (or as a consequence of): in death)LAST. ' _. ~._.___ ___._, ~...~..e .,. ,Math but not resulting In the untlerlYing cause Blven in Part I 27. Was an V-to PSY PSrf9r Qed7 28. Were autopsy nnomgs avn~~a.,,~ to complete the c of death? Q Yes No 30. Did Tobacco Use Contribute to Death] 31 Manner of Death Homicide l ~ ' Female: Q Not pregnant within past year Q Ves Q Probably Q Unknown N Natura Accident Q Pending Investigation d Q Pregnant at time of death o Q Q Suicide Q Could not be determine Q Not pregnant, but pregnant within 42 days of death ear before death 1 S tl y R Month 32. Date of Injury IMo/Des /Yr) (6pe ) y ays o Q Not pregnant, but pregnant 43 0 Unknown if pregnant within [he past year 33. Time of Injury 36. Injury at WOfK r. it grans .ia.,.,,, ,-r - . Q Yes Q Driver/Operator O Petlesirlan Q No Q Passenger Q Other (6pecify) ~. 39a. CertiRer (Check only one): ccur t anner statetl anner std G~'t Certifying physician - To the best of my knowledge, death o red due o the cause(s) and m ted _ ~Pronouncing & Certifying physician - To the best of my kno lfetlgge, deg h o'courred at the time, date, and place, antl due to the cause(s) antl m oQ Metlical Examiner/Coroner ba f exa_pJl) ~~~r i~niy/es n, in my opinion, death occu /I/fd a(((j~>he time, date, antl place, and due [o the ~ ~~(/J "~'~l i/if J e `~ /~a Tltl f iii / / L.f / License Number: 6lgnatu re of certifier: 39 D S Sig 40. Registrar's District Numbe 43. Amendments r~ ~ ` O$a 2 sition Permit No. O ` ~21 Dispo FD- 138753 ~ 1 ~ H 105-143 REV 0]/2011 LAST WILL AND TESTAMENT OF WILLIAM KOHLER I, WILLIAM KOHLER, currently of 1924 Fisher Road, Mechanicsburg, 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 and making void any and all prior Wills and Codicils by me at any time heretofore made. 1. ~,;, I direct the payment of all my just debts and funeral expenses as soon after my de as tl~e x.4 rn '~~. ;`= same can conveniently be done. ~, c ~:;;, .; -. v~ ~ _~- 2. ©~- r-. All the rest, residue and remainder of m Estate real c~cF ~' J - -~~-z y ,personal and mixed, whats~~r and ~ ~_ wheresoever situate, I give, devise, and bequeath to be divided and distributed as follow~,'to wit: .~- ~'~ ~ A) Fifty (50%) percent to my ex-wife, BEVERLY ZIMMERMAN, currently of 5510 Moreland Court, Mechanicsburg, Pennsylvania. B) Fifty (50%) percent to my sister, MILLICENT J. STARE, currently of 34 St. Johns Drive, Camp Hill, Pennsylvania. In the event my said ex-wife predeceases me, then her share shall go to my said sister. In the event my said sister predeceases me, then her share shall go to my said ex-wife. 3. FOR PURPOSES OF CLARIFICATION: I have several children. Their omission herefrom has been by design and not by accident or oversight. Additionally, my children are absolutely not to serve as Executor or Administrator of my Last Will and Testament under any circumstances, by representation or otherwise. 4. In the event that any of my said children shall undertake to contest this, my Last Will and Testament, in any way, form, or manner whatsoever, I direct that any share to which they may be arguably entitled shall be forfeited and shall be divided and distributed among the other beneficiaries in the proportions as set forth above. I further direct that, insofar as I am legally authorized to do so, my said Executrix and her counsel are to seek the payment of any attorney's fees and court costs incurred in a defense of this, my Last Will and Testament, from such contest or similar proceeding. 5. It is my intention that beneficiaries named before or after the date of this Will on my life insurance, annuities, individual retirement accounts (IRAs), in Trust for or joint bank accounts and any other assets for which I may designate beneficiaries will receive such investments and that my Will provisions shall not control such investments. 6. I nominate, constitute and appoint my sister, MILLICENT J. STARE, to be the Executrix of this my Last Will and Testament. In the event that she is unable or unwilling to act as Executrix, I appoint my ex-wife, BEVERLY ZIMMERMAN, to be Executrix in her place and stead. I Page 1 %"Y~4~~~ ~~Zt~'v„'~' further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~/y~ day of 0 , A.D. 2010. ~ r ~ ,I (SEAL) WILLIAM KOHLER Signed, sealed, published and declared by the above-named WILLIAM KOHLER, as and for his Last Will and Testament, in the presence of us, who at his request and in his presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~~~, Page 2 ~~~/,/ ' ~~ V` . .-_L~J :~ ~! 2 JUG i 8 ~~ 10~ 4 u OATH OF SUBSCRIBING WITNESS(ES) O~Pr:u.~~`~ L~vr~r CUME~FRIAND CO.. PA REGISTER OF WILLS Gt U,m/3~~Ysl~ COUNTY, PENNSYLVANIA '~~ ~ Estate of W/~~~ ~~/~L~ ~ ~~~~~ ~ ~~L~Z~, `~• ,Deceased L/Yi~~~ ~. ~i~/~~~ ~ ,-~~ subscribing witness to (Print Narne/sf the ~ Will 9-~•~isi-1{~) presented herewith, {}being duly qualified according to lain, depose(s) and say(s) that sloe / hem was /-~ve~s_ present and saw the above Testato~ ' Tex sign the same and that s~ / he /~ signed the same and that --she-/ he-~e}~ signed as a witness at the request of the Testator '' 'r'-f--=.~~- in -l~ei~~ his presence and in the presence of each other. (Signature) ~ft4~~ ~' S'`j/BIRDS ~LL (o G~/ousei- Gt~c~ (Street Address) (Ciq~, Stare, Zip) Executed in Register's Office Swam to or affirmed and subscribed before me this ~~ day Deputy for Register of Wills (Signature) (Street Address) (City, Statc, Zip) Executed out of Register's Office Sworn to or affirmed and subscribed before me this day of Notary Public My Commission Expu•es: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Vleasc have present the original or copy of instrument(s) at time of notarization. corm Rhf-03 rev. 10.13.0( r't.r7,tr_ ^y `~u f Z JUN 18 AM 10~ 40 OAT~EI OF SUBSCR~BIl`~G ~~VITl~TESS(IJS) oRPN;r~~ ~ ~~>>~~~ REGISTER of WILLS CI~tIBFRI.Af~iD CO., PA C GLhjggZLAy/.~ COUNTI', PENNSYLVANIA __~~ I _ , ~ - ~~-c~~ ~ ~ Estate of WIL.L,I~4~?7 KoHLE~ ~ frJlGL/~F/H K. fCoHGt~,JR_ ,Deceased ~~L-~y~E- f ~'k,p.~~ , (cnelr} a subscribing witness to (Print Name/s) the ~ Willrs) presented herewith, {~aek) being duly qualified according to law, depose(s) and say(s) that she ~ was-t~e~e- present and saw the above Testator sign the same and that sheer-~e~ signed the same and that sha~~ signed as a witness at the request of the Testator ' in phis (Sigrtatwe) (Street Address) (Cite, State, Zip) presence and in the presence of each other. _ X (Signature) ~/L1~/ /L(iQ/~-~([ (Street Address) /ylecLia~z,c.s b~, P~4 l 7 Uss E.~ecuted its Register's Office Swon~ to or affirmed and subscribed before me this day of Deputy for Register of V+'ills (City, Stare, Zip) S ~ ~ .fir ~ ~N ' O (~ ~ s Office ~ E.~ecuted otct of Register A ~~ Sworn to or affirmed and subscribed ~ ~~ before me this ~~'~ _ day ~ • ~ ~' W ~ ~ ~ ~ ~L '~ _~ Notary Public My Conunission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) (VOTE: To be taken by Oi6cer a~d+orized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. FornrR61'-03 rev. /0.!3.06