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HomeMy WebLinkAbout08-27-12Reset 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: THOMAS E. KECK ~ _ I :~ _ C~~ ~ / a/k/a: ' File No: a/k/a: (Assigned by Register) a/k/a: Date of Death: 06/22/2012 Social Security No Age at death: 95 Decedent was domiciled at death in CUMBERLAND County pA i pr ncipal residence at 2100 BENT REEK ROAD SILVER SPRING MECHANICSBUR (Stare) with his/her last G PA 170 0 Street address, Post Office and Zip Code City, Township or Borough Decedent died t 2100 BENT CREEK ROAD SILVER SPRING MECHAMCSBURG PA 17050 S Coanty treet address, Post Office snd Zip Code City, Township or Borough Estimate of value of decedent's property at death: County State If domiciled in Pennsylvania .................. Ail personal property not domiciled in Pennsylvania .......... $ 15 000 00 ........................ Personal property in Pennsylvania $ If not domiciled in Pennsylvania -- , . ........................ Personal property in County $ Value ojrea! estate in Pennsylvania ... ............................. TOTAL ESTIMATED VALUE.... $ Real estate in Pennsylvania situated at: ---- I5.000 00 (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough A. Petition for Probate and Grant of Letters Testamenta Petitioner(s) aver(s) h / h / h ,, (county ~ e s e t ey is/are the Executor(s) named in the last Will of the Decedent dated thereto dated ~'" ~tCl <~~ ~ m .~ , State relevant circumstances (eg renunctatton, death afexecutor, etc.) - a L~ ~ ~ ~ ~ t`r ` Except as follows: after the execution of the instrument(s) offered for probate Decedent did not mar ~ ~ ~ Tai r f divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S N'a3323divorced,Qt apartytb~d' pendi adopted; and Deced and t ( ) en g ' was neither the victim of a killing nor ever adjudicated an incapacitated person "Dt5 have a cilit>r born~+~ t'T1 . NO EXCEPTIONS Q EXCEPTIONS U't `'~ N B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d.b.n.c.t.a., pendente lice, durance absentia, durante minoritate If Administration, c.ira. 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 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS Q EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (il'any) and heirs (attach additional sheets, ifnecessaty): Name Relationshi -'-' THOMAS E. KECK II SON Addresa 3723 MONTOUR ST, HARRISBURG, PA 17111 .. ~ so ~ ~ n- ~~ ~s t ~- ~~o ~ LtJ ~~ ~_ , .r1- ~ 1. Form RW-02 rev. 1(3/11/2011 ~I~o~ Page 1 of 2 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 xnow~eage anu ~~„~. of Petitioner(s) and that, as Personal Representative(s) of the Decede a Petitioner(s) wrll w and truly administer the estate according to law. Date ~~ 2=~ Sworn to or affirmed a d subscribed before 1 Date met ' ~~ day of ~ ~~~' Date By: ~ Date For the Register BOND Required: ~ YES FEES: (~NO To the Register of Wills: ..,....~,, e..«or ..,~ aonesrance by my si¢nature below: $ Q • ~1 Letters ..................... . ( .3 )Short Certificate(s)..... . fr~ • ~)~) ( ~ )Renunciation(s)....... • • ~ • Qd ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ....................... . ------------ Commission ................. . _---------- Other ••••••• • ---- Automation Fee ............. ..-- ~~CJ JCS Fee . .................. .. $ l ilk TOTAL ................... .. Attorney Signature: Printed Name: W1L1-IAM A. ADDAMS Supreme Court ID Number: 6265 Firm Name: Address: ~~ ~t~ enrrmu S'1' ~euT 1cT F PA 17013 Phone: 717-243-7638 Fax: 717-243-8955 Email: -- --r,..,._.r.r.,r, nPt DECREE OF THE REGISTER File No: ~ ~ ' ~ %~ `L' ~ ~~ Estate of THOMAS E. KECK a/k/a: AND NOW, ~ U ~ ~- , in consideration of the foregoing Petition, satisfactory proof having en presented before me, IT IS DECREEI ~ at Letters ~ ~~ ~ ~'~ are hereby granted to Tf1(I Cr C ~_ D C ~ ~~ ~`~~ `~ ~ ~' ~ ~ ~~ ~~ - in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. Register of Wills ~~. ,~ ~ y~~tC~,~~ ~;~ Page 2 of 2 Form RW-01 rev. 10/1!/1011 Oath of Personal Representative ~r ~t~: ~~ir ~ _. 1 , c U[ "I COMMONWEALTH OF PENNSYLVANIA } } SS: j't+ COUNTY OF CUMBERLAND } t'[~1~ AVU Z1 ~~ ~~ ~~ H 105.805 REV (9/I1) LOC~~~gR'S CERTIFICATION OF DEATH WA~~? tt ~~: i~f~~ to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ?~ ~ 2 ~~~ z 7 AM ~: 5 This is to certify that the information here given is correctly copied from an original Certificate of Death `~~ t~=`~I,' duly filed with me as Local Registrar. The original U~~l~ i;Q(,~}~I certificate will be forwarded to the State Vital ~B~~Q ~.r ~ Records Office for permanent filing. P 18~~~268 ~~y ( Certification Number ?~2.r.,'ee.«C~~aS'~/~ Local R istrar llate Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS Permanent Black ink CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, SuMx) State Flle Number: Thomas E . Ka elc 2~ s•" 3. Seci.l seeurRy Number 6. Date d Death (MO/Day/yrI (Spell Me) - male 71709-0150 ,7 - U d s i ~' rg 9 $ Months Days n ^NOU er 1 Da rs Minutes 6. Dab of Birth (MO/Oay/Year) (Spell Month) 7a. Birth lace G t1n@ 22 , 201 Z P F ty and State Ba. ReaWenca (State or FOra lgn Cou t or orelfn Country) Har November 13. 1916 Ti n ry) Panne lvania Bb. Residence (StrNt and N umber - Include Apt No.) ,_ Binhplaee (county) Dau hin 8e. Dld DauderK LNe In a TownshipT ad.RLii~gJDm..a„~d d~ ZZ``JJ::88 2100 Bent Creek Road mY.:, d.c.e.m lWedb Silver .Shrine s. Ewr In US Armed Fortis) 30. Marl M. Rbktenee (Zip Code) bl stat Ti ewP. Q No, decadent (Wed whhln limits W Y•s Q No Q Unknown Q DN L2 F ' us at Orcad me of Death Married WI Q Never Married Q Unk cl[y/boro 11. SurvWing Spouse's Name (H wih, Bhro name prior to fl rt . ather s Name (First, Middle, last, SuMx) now r n marriage) Charles E. Kec1C 13. MotMr's Name Prior to First Marrb6! (Pint, Middle Last) 14a. InfPnnagn=yNQ L. El 1 14b , A B W s . K6c1C . R•IeStleOnn Ip to Decetlem 14e. Infermant s Maury Address (Street end Number ei ty s:eca zI c d ................................................ ....... 1 Death Occurred i ...................... n a Hospital: ~( i l .................. ..............:...~£! , , , o a) P est Cmdar St -, Palmyra, PA 17078 !< n nwe em Ems Roem/O nt Deed on Arriwl 15b FaNI ....~T..~~. , ~, ,Th ~ ....~ ..~ .i..............Pa If Deaen occurred a ....................~ ..............~, r• r an a sP e : NosPlu Facli ••••••••••••• •••• l Nursi H D d ' m ~-~-~~-~•~ . Name (If net Inetitutlen, Bri~$as at Bant NBwye rtr«tand numb er; ece ent s Ho e oma/LOn -Term Gre Fu11Ry Ocher 5 15c. Glty or 2own Staq dZ Craelc .6•. Method f Dl , ,~n iP Code @C aniCiOUrg lsd.countyo Desch PA 1705 o sposlHOn Burial Cremation Q Rem l f , 0 b a land 16b Date of Dl ova rom State p Donaaen och.rs . spoaRlon 16e. Plsca of Dk+POSRiOn Name of camebry, ererry tern, er een.r place) June 25 201 H Bd. Leutbn of Disposklon (CRy or Town, SLte, end ZIP( , oover Funeral Home6 Crematory Harrisburg , PA 1 711 2 1 a. 3 lgnat here ~ n Perron In CherBe a<IntermenY ~~_ _ _ iTb. UcanN Number Te. yp1aa a and Cpmppktte Ad+ras ofvuneral FKllity 1YOOVar P ttt~ s~ ___ _ - FD 0119 21 L -• •• - .........vn - a.neu the box that bast deserlWS the 18Mrt deBref or Jowl of school completed h 19. Decedem of Hls v + s.. '~~'~~~_ at t e time of death. Q 8th Brad! or less box that best describes whether the d•udent Q No dlplome, 9th - 12th grade Is Spanish/Hlspanl4LaUno. CM<k the "Ne" Nigh school graduab or GED wmpleted Some college credit, but no degree box H tl~eedent Is not Spanish/Hlroanl4laHno. of Spanish/Hispanic/Latino Q Associate decree (e.g. AA, AS) Yes, Mexlun, Mexlun American, Chicano Q BacMlor•a degree (e.g. BA, AB, BS) Q Master's degree (e.g. MA, MS, MEnL MEd MSW MBA O Yes, Puerto Rlun fl Yes, CuWn , , Q Doctorate (e.g. PhD, EOD ) or Prpfesslonal degree Q Yes, other Spanlah/Hispanic/Latino !. . MD DDS DVM LLB lD (Specify) . Oacadent's Single Race Self-DeslBnatlon -Check ONLY ON! to Indlcab what the decadent consbered hlmseM or hire Q laPane w Black or Ahican American Q Korean Q SamoM Q AmMUn Intlhn or AlaNCa Natlye Q VlKnamese Q Asian Indian Q other Paeifle Islander Q Don't Know/Not Sure Q Other Asian Q Chinese Q NKIw Nawal4 Q Refused n ( pecNy) Q FIIIPIno Q Guaman4n or Chemorro Q Other S cheek ONE 6R MORE raps to Indicate whet decedem eonaldered himself h or e .rW~hRe bl k rseM to be. Q Korean ac or African American American Indian or Alaska Native Q Vletnamesa Q Other ASlan Aslen Indian Q Nature Hawallen Chinese Q Guamanian or Chamorro Filipino Q Samoan Japanese Q ether Paclfle Islander Other (SpecHy) during moat of working Ilfe. DO NOT USE RETIRED, Truck Driver a. n D.ath ~~ a 7 -~ ~ _ ...Y..r ~ ~I~NSo`1697L I ' ' - - ~ ~O'~ ~~t 25 W s Madk:e E t ~ CAUSE OF DEATH 6J Y a No 26 P K 1 E t th h 1 of [s Iseases, InJurles, or complications--that dire t qpT prox~mata respiratory arrest, or ventricular ,brlllatlen without showing the etlol `LIY caused the death. DO NOT a ter terminal events such as cardiac arrest. ~ Interwl: `~)={JA ogy. OO NOT ABBREVIATE. Enter on1Y QD• cause on a Ilna. Add additional Ilnea If neussa IMMEDIATE CAUSE - ~ ~,J\-r ry { Onset to Death f Finei dla.aa. or condrcior, ~ r~'"~ Y ~' ~ ~ ~ ~.~~~ ~ s ~'~_ resultlng in death) D u nu or/r Sequentially Ilst conditions, Due to (or ~ ~ ~ Q-117 H anY, leading to the cause as a censegwnee of): -- i Ilrted on Iin• a. Enter Me j UNDBRLYING GUSg (disease or Injury that ow to (or as a consegwnca of): -- Inltlated the events rewiring d, In death) LAST. Due to (or as a consequence off: i Q Not pregnant within past year 30. Dltl Tobeeeo Uae ContrlbuH Q PregMnt at time of death Q Y•s Q Probably Q Not Pregnan4 but Pregnant within 42 days of deatF e Q Unknown Q Net Pregnant, but Pregnant 43 days to 1 war before deatt Q Unknown If Dregnent within eM Peat war 32. Date of Inlury (Me/DaY/Yr) (! to complete the uuY of death? ~ Yes ~ N Q Homicide Q Pending Inwrtlgatlon Q Could not W determined Q Y•s Q Driver/Operator Q pedestrian I38. Describe H I J ry paurred. Q No Q Passenger 0 ether (Specify) rtlfl (Check :^ ) rtifying Phwlcl - To the best of my knowNdq, duth occurred dw to the cause(s) end m Pronouncing B GRHying PhYSlelan - TO the best of mY knowled either sLted ~ Medical Exeminer/Coroner - On the basis pf exert,lnetipn d g•• deeM occurred at the time, tlab, and piKe, and tlue to the cause(s) and manner stated _/Y7h-r-f_. -, en /or InvestlNHOn, in my opinion, death occurred et the time, date, end lace, end due to the uuae a Signature of uRmer: ' ~ sA-i..~ j•'irV. L1' P ( )and manner stated a. Name, Address and ZIP Code of Person ComPletin Ouse of Death (Item 26) Title of urtHler. Uunse Number.~~ a - 1 ~ J ~( ~ 2^~ Q~i ~LTohnathon B. TOOC1ca Sac. wt. sign a (MO Dey r) Reglrtrar s rt R um ~+'~ _ ~ / 41. R•glatrar s gnature ' Amendments 42. Re6 ,s ~ ap aY C Y ne 7 C~_ l ~ J ""l Dlaposltlon Permit No._ 0~(., 7 7 2 3 H105-143 REV OT/2012 +~~.CO~;~;~r ;;Fr;'~F OF t ~ ._~. t~F" ~ _, r ~ ,,r~l~ ~ ~ ~aJ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~Esf2 AUG 27 AM 9~ 52 ~~~~ ~Jf.~t~I Estate of THOMAS E. KECK Deceased I, TIMOTHY J. KECK (Print Name) , in my capacity/relationship as SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to THOMAS E. KECK, II 08/13/12 ~ (Date) ~ e /~~ (SrgnatureJ 20~ ~E/ ~/ L I/L. QL l~ (Street Address- ) ~r (Crty, State, ZtpJ ~ Executed in Register's Office S~;torn to er a±~rmed and s,.ibscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 Executed out of Register's Office Lefare rhP'»^dersioP.ed personally appesred the party executing this renunciation and certified that he or she executed the renunciation for the pure ses stated within on this ~~ day of ~ ~.~ ~ ~ Notary Public .t,,t. ©~~ ~~ ~'3 My Commission Expires: ~ a~. ~~ ~ '3 (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~pTA,~~ O~FFICIA~L S~E1AL ruBLicAndrea Walker Ruedy IN AND FOR STATE OF Cleveland County ~ca--~'