HomeMy WebLinkAbout10-25-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF C u1'1t,8~'72Lp-IUD COUNTY,
Petitioner(s) named below, who is: are 18 years of age or older, apply(ies) for Leiters as sp
support thereof aver(s) the follow ins and respectfitlly regt:est(s) the grant of ,Letters in the appropri
.Decedent's Information
Name: ~ igia L.. /YBCt File No: 2/-/a -
a/k/a: ~ ~ i e (Assigned by Re
a/k/a: Aiy
a/k/a:
Social Security No: ,Zp
Date of Death• Age at death: ~_
Decedent was domiciled at death in Cknt ~~ County, ~G1pll.
principal residence at /DD
Street address, Post Office and Zip Code City, wnshi Borough
Decedent died at ~ S ,ta ~ ~ /yJt t~//Cp v/~;
Street address, Post O ice and Zip Code y, Towns or Borough ~
Estimate of value of decedent's property at death:
Ijdomiciled in Pennsylvania ............... All personal property $ ~ C
......
If not domiciled in Pennsylvania ........................Personal roe -'•"L
If not domici/ed in Pennsyh~ania ........................ Personal property to Pennsylvania $
p p ry in County $
Value of real estate in Pennsylvania ............. .
TOTAL ESTIMATED VALUE.... $~
Real estate in Pennsylvania situated at: (r ~//~ TrRC
(Attach additional sheets, ifnecessary.) Street address, Post Office and Zip Code Ci
ty, nsh' Borough
[~ A. Petition for Probate and Grant of Letters Testamenta
Petitioner(s) aver(s) he/slieJsbay is6ara the Executor(~ej named in the last Will of the Decedent, dated
thcsate-dated
State relevant circumstances (eg. renunciation, death of executor, etc.)
Except as follows: afrer the execution of the instrument(s) offered for probate Decedent did not many, was not divorced,
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and c
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 lire, durunte a.
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com late 1:
Except as follows: Decedent was not a parry to a pending divorce proceeding wherein the grounds for divorce had t
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), afrer a proper search has/have ascertained that Decedent left no Will and was survived by the following spou
additional sheets, i/necessary):
I 'dame ~ Relationship
Address
7tia, durante minoritate
of heirs.
~ established as defined
(if any) and heirs (attach
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ANIA
tied below, and in
form:
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pare with Sher last
Lt.-M+6G~/Q.11Of
County
*.,~~ Pit
ounty State
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00• ea
Ck.,.b.u./~
County
aftd~od~erelFel
~s not a party to a pending
not have a child born or
Page 1 of 2
Oath of Personal Representative
COMMONWEAnLTH OF PENNSYLVANIA }
COliNTY OF ~G.riJbU-~pAd } SS:
}
Petitioners} Plrinted Name
~t/~~~/Rwr /~ • !f CSI 9 v n.
! -
.. ., ~ k~~
?_I#12 QCT 25 PM I ~ 30
Petitioner(sjPrinted. ddes~ '!
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true attd correct to the best o the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Deced tt, the~.XXr-- er~will ell a truly administer the state according to law.
Sworn to or affirmed a s bscribed before aC
met ' ~ da of ate '1 l7 2 l'Z
$y• ate
ate
For the Register
ate
BOND Required: AYES ~NO
FEES:
Letters .................. 6'O
.... $~
(~ )Short Certificate(s).. .... ~~ U
( ~ )Renunciation(s)..... ~
.... ~
,
( )Codicil(s) ......... _
.... ~
( )Affidavit(s)........ ... .
Bond .................... ....
Commission .............. ... .
Other
~-fl ..
.... 1~-
....
Automation Fee.
..........
JCS Fee ................. ....
-'~-
....
.... 6
TOTAL ................. .... $
To the Register of Wills: ,
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: C.<<!~"~GS
Supreme Court
ID Number: 38s/-3
Firm Name:
Address: ~,~~j.~
- -~
Phone: 7/ 7 7~~ -D
Fax: 7- _
Email: no.c :. i~~ z
DECREE OF THE REGISTER
Estate of iYl/` %AiQ L. ~CCZ File No: ~-/,7
a/k/a: i OKi ~6 ,' ~
AND NOVV,
,~_, in consideration of
satisfactory proof having been presente before me, IT IS DECREED that Letters
are hereby granted to k/~%/i Q/~ ~
K /YCC
the instrument(s) dated
described in the Petition be
Fo,•,»nw-na rev. roi~tizni!
Petition,
in the above estate and if applicable) that
/D
to probate and filed of record as the last 1?~Jill
~'~~E~) of ecedent. /l
Wills - -~`~
r ~C~t~.P~.~
2 of 2
HlO5.R05 REV (9/I I1
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
Wp-Q~f~~~~,~1(~ duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
duly filed with n
certificate will 1
~" ~ - Records Office f(
P 1888224~MB~R ~v~co~~ ~~((~~~~ ~
~_~Vl=
Certification Number
Type/Print In
Permanent
Blaek Ink
1. Decedent's Legal Name (First, Middle, 1
Virginia L_ Keet
`_ Sa. Age-Last Birthday (Yrs) Sb. Under 1 \
~' 1 8 2 Months
Ba. Residence (State or Foreign Country)
\Z 8d. Residence (County)
\VJ Cumbc:rl nd
9. Ever in US Armed Forces? 30. k
Q Yes ~ No Q Unknown Q
~•~
Local Registrar
COMMONWEALTH OF PENNSYLVANIA . OEPARTM ENT OF HEALTH ~ VITAL RECORDS
CERTIFICATE OF DEATH
,affix) 2. Sax 3. social Security Num ber5tate Flle
emale 200-24-2485
Sc. Under 1 Da 6. Date of Birth (MO/Day/Yea r) (Spell Month) 7a. Birthplace (City and
% Hours Minutes
September 2, '1930
b. Residence (Street and Number -Include Apt No.) Bc. Did pecetlent Llvebin8a Towlnsh p7 unfy)
1 O O Mt _ A l 1 en Dr . d1Yea, decedent eyed In _ Unger ~
e. Reamenpe (np cpde) ~ No, decedent lived within Iim(ts of
it Status at _ r.__.~ _ -
Divorced ~ Never Married Q Unknown
0
C u. ne.a nip to Decedent
s
.....................................................
If Death O
a
a
~~--- '"""------"--
- 14c. Informant's Mailing Address (Street and I
7 91 4 Sand
H
1 R
S
y
2 ccurred in a Hos Plta l:
""'--'•"'•••••-•••--•••
inPaclent
C7
~ Emergency Room/Outpatient ~ Dead on Arrival o tit -. ~c on y one
-
a--•••-...,
; If Oeatn oc .<e-....- ...--. -....
currod Somewhere Other Than a Hospital: ~~~ -~~~- a P•
Hos 1
N
i
~
-
0 15b. Facility Nama (If not Institution, gly¢ street and number;
Messiah Vi 11 a urs
ng Home/Long-Term Care Facility Other
5
15c. CI ( Peclfy
ty or Town, State, and 2Ip Code
e'
16a. Method of Disposition 0 Burial Cremation
Q Removal from State 0 Donation
o
h 166, Date of Disposition 16c. lace of Disposition (Name of cemeter
~ t
er (specify)
16d. Location of Disposition (City or To
S 9/1 2/20'1 2 Hollinger Funeral
~ wn,
cate, and 2Ip)
Mt. Holl S tin 17a. Signature of Funeral Servlc License nr Person In Char
,,.,s S gePflntern
17c, Name and Complete Address of Fun s I FaaPtyAH ,p ~ O 6 5
n Ki
e Fu e 1
tat the information here given is
m an original Certificate of Death
as Local Registrar. The original
forwarded to the State Vital
permanent filing.
SEJP 1 1/2012
Date Issued
1 7
erland
r other place)
& Crematory
.ense Number
- 1 388'1 2
FICr~l .~ r Hom~A&'1
~~~atorY. =
.>S' 18. Decedent's Edu
r 1 n $
ti o
ca
7
on -Check the box that best a vibes the 19. Decedent of His
~- highest degree or Icyel of school
l
O
i _
completed at the time of death. box that best descrlbes
er the decedent 20. Decedent's Race -Check
1~ 8th grade pr less
wh
eth e E OR MORE races to indicate what
the decedent considered him
~ No diploma, 9th - 12th grade Is Spanish/Hispanic/Latino. Check the "NO" ~ White If or herseH to be.
~ High school b x if decedent Is not Spanish/Hlspa tilt/Latino. 0 Black or African A
graduate or GE
D completed O
Korean
°
merican
®No
~ Some college credit, but n degree
, not Spanish/Hispanic/Latino ~ gmerlcan Indian
Al
~ ~ Vietnamese
s
or
(
aska
Ye ,Mexican, Mexican American, Chicano
Q Associate tlegree (e
g. AA, qs) ~
Q Asian Indian Natlye
Q Other Asian
c
Yes, Puerto Rican
~ Bachelor's degree
( .g, gq, qg, BS)
Q Chinese Q Native Hawaiian
e
(] Yes, Cuban
Q Master's degree ( .g. MA, MS, MEng, MEd, MSW, MBA) 0 Y
Q FIIlpino ~ Guamanian or Chamorro
es, other Spanish/HI
Doctorate (e.g. PhD, Ed D) or Professional degree sPanic/Latino ~ Japanese ~ Samoan
. MD ODS DVM iL6 lD (Specfy) ~ Other (Specify)
' Q Other Paclflc Islander
21. Decedent
s Single Race Self-Designation -Check ONLY ONE to Indicate what the d
Whl
d
ece
ent considered himself or herself to be. 22s. Decedent's U
teo ~ Japanese ~ Samoan
Black r African American u I
a Occupation -Indicate type of w
t
0 Korean Q Other Pacinc Islander done during most
QAmerlcan lndlan or Alaska Native or
1 working Ilfe. DO NOT USE RETIRED
~Vletnamese QDon•t Know/Not SUre water
~ Asian Indian .
aPat
2n
t
Q Other ASlan Q Refused
~ Chinese y
s
ruC tC
(] Native Hawaiian ~ Other (Specfy)
~ FIIlpino 22b. Kind of Busln ss/Industry
Q Guamanian or Chamorro
ITEM 2 ~ . ~a u. r . ~_ __. __ _ Recrea ion
- -- - -~ / Time pf ~ ,~
CAUSE
26 ~~ rL
25. Was Medical Examiner toner Contacted? Q
OF DEATH ~ t~J a8 3 a 33 ~
yes
No
. Part 1- Enter the chain of t --diseases, Inlurles, or compllcatlons-that directly caused the death. DO NOT enter t
respiratory arrest, or ventricular fibrillation
i
ith
l Approximate
erm
w
na
events such as ca
out showing the etlolo
gY- 00 NOT ABBREVIATE
Enter onl disc arrest
Interval:
.
y one cause on a line. Add addition
IMMEDIATE CAVSE _______________> a
~K
i 1 Tines If necessary Onset to Death
,
~} Q K t Q
~ wt Q ~ ~ ~~L~ P
(Final disease or condition
\ t
Due to (o
resulting in death) as a consequence of):
b
Sequentially Ilst conditions,
If any, leading fo the cause Due to (or as a consequenm of):
listed on line a. Enter the
UNDERLYING CAUSE
(disease or InJu
that Oue to (o as a consequence of):
~ ry'
Initiated the eve is esulting d-
~ in death) WST.
Due t° (or as a con
c
e of):
S 26. Part 11. Enter other sia^IPic t diti t Ib
~ l
but not resulting in the unde 1
h~.{A E/E" ~FMSt'oN r y ng cause given In Part 1
~
, 27. Was an autops
Y Pe ormed7
Yes 5 p
28
Were autopsy flnding available
29. If Female: t
piece the cause of death?
° co
~ ®~NOt pre 30. Dld Tobacco Vse Contribute to Death? 31
gnant within past year
M O Yes No
~ .
anner of Deat
Q Pregnant at time of death 0 Yes ~ Probably
$ Natural
0 Not pregnant, but pregnant within 42 days of death ~ NO ~ Unknown
0 Homicide
t- Accident
~ Not pregnant, but pregnant 43 days to 1 year before d
th
S
l O
l
ea
u
cltle
32. Date of In ~
Q Unknown If pregnant within the past year Jury (MO/Day/Yr) (Spell Month) Cou d not be deg er
0
mined
yes 8. Describe How InJury Occurred:
0 ~ Driver/Operatpr ~ Pedestrian
ENO ~ Passenger Q Other (Specify)
39a. Certifler (Check only one):
-_ ~Certifying physlclan - To the best of my knowledge, death occur ed due t° the c se(s) and m
Q Pronouncing Sa Certifying physlclan - To the bast of my know) dr a%' anner staalted
Q Medical Examiner/Coroner - On the ba Is of axamination, and/or Inyesth occurred at the time, date, d I ce a stated
gation, In P a nd due [o the cause(s) and m
- A As r l1 n `~~- my opinion, death occurred at the time, date, and place, and d co the cause(s) and mann
Signature of certiner:- V ` lh ~ ~7f ~/t t a ~ stated
39b. Nama, Address and Zip Cotle of Person Completing Cause of Death (Item 26) Title of ceRifler: F] License Nu ber:Q~_Q O~ O~y L
r~a O ~ n ~~~+ FC 39c. D to Signatl (Mo/Day/Yr)
40. Registr\ar s District Num a 41. Registrar's Lure GSb HM ~ 1'~-O S`~ S •#8N'J i%K 207 2 -
~`~~~ ~1 42. Re Istrar FI a Data Mo Day
43. Amendments ~ ~ t ( ao~-a
Disposition Permit No._ t~r1Q~1t a\t1-. H305-143
-- - - - - - _ _.- -. REV 07/2011
This is to certify
~~~ ~ ~~~ ZJr P~ f t 3~ correctly copied t
~ ~ 'icy ~
RENUNCIATION
In Re Estate of y~I''iF'Ii4 L, ktG~ a'~'+ vi ~~%,~•;~ LOIIiSC
To the Register of Wills of ~u-M6G1'~M1A~
Vi~y;ni ~ /CCGf
deceased.
County, Pe nsylvania.
The undersigned T rr~, /flat Ha~{/n~~ G,,,,[ K,,,~,, keel' Ski/es~,~
the above decedent, hereby renounce( the right to administer the estate and respectfully
~esftt/rle~ fare
be issued to ~/~~i am ~, /YL G
WITNESS Dttr handsthis ~ ~~~ day of
On this ~~~day of C~~"Dw x ~ ~ZP~ ~.
Tt''~'~y K~ (Signature) .
200 personally appeared before me,
/08 S, George St=
a Notary Public in and for the Commonwealth /Y1CC~i~~eSd.~-~, /?
7rrr ~~ ~ (Address)
of Pennsylvania, _ ~y /Y~~~Ci~l~at
are
(who ~s personally known to me or ~ G
provided sufficient .identification t0 me) stgnacure)
IkA~TN~
~i[/r / 4i 5~ Scr hd f/i %/
and sworn to and subscribed _ _- nam~S ,/~
herein. /yerS~ty~ /~f>: / 70
--T (Address)
Notary Public
SEAL ~ONIMONW~-~'~ OF PEMNSYLYMIIA
Notarial Seal
~~p,~r ~. $hield5 IIt, N..~ary Putdk
Monroe Twin`~~ lone 20016
roa~+eert. PEt+hmv""w noN of ra~r~s
(Signature)
of
that Letters
~ZD/2
/?d S5'
e/GE~
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D ~
I, VIRGINIA B. KEET, of the Cooke Township, Cumberland County,
being of sound and disposing mind, memory and understanding, do make, publi
my Last Will and Testament, hereby revoking and making void any and all prior
any time heretofore made.
1.
Z+..y
K~"'
O 11
~ Q
C~
~ i C~
t7p
~ _: ' ~
U' { ~'~
D ~ - ~ :`+ -~ri
Vim; t~~
in~tlvania, w `" ~
0
and declare this
by me at
I direct the payment of all my just debts and funeral expenses as soon after y decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, hatscever and
wheresoever situate, I give, devise and bequeath to my beloved husband, RI S. KEET, to
his own use and benefit absolutely.
3.
In the event my said husband, RI(~iARD S. KEET, should predecease
the same time I do, such as in an accident or disaster common to both of us, I
rest, residue and remainder of my Estate to be divided and distributed among my
as follows, to wit: WILLIAM K. KEET, TERRY KEET HOB, KATHY
and JAMES F. KEET, in equal shares, per stirpes.
4.
I nominate, constitute and appoint my husband, RICHARD S. KEET, to t
of this my Last Will and Testament. In the event that he should predecease me or
or die at about
y direct all the
>ur (4) children,
EET SKILES,
;the Executor
or any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint m son, WILLIAM
K. KEET, my daughter, TERRY KEET HOFFMAN, and my daughter, KATHY KEET SKILES,
to be Co-Executors in his place and stead. It is my intention that if my said c ' n serve as Co-
__ i
.~ r .~
Executors that they shall split the executor's fee in three (3) equal shares. I further
Executor or Co-Executors, as the case may be, shall not be required to file bond or
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
A.D. 1999. ~
/. ; r ~~ ~ 1~~ J.J. ~ >~
VIItGYNIA B. KEET
. '
that my
security
day of
Signed, sealed, published and declared by the above-named VIRGIlVIA B. I~ET as and
for her Last Will and Testament, in the presence of us, who at her request and in h presence, and
in the presence of each other, have hereunto subscribed our names as witnesses.
- - - ~ .
~-.,~-;~
-2-
~.~
OATH OF SUBSCRIBING WITNESS(ES) m •' ~
~
~,~~
r-- _.. ' .
a.
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REGISTER OF WILLS ~~- _ t~-, ~' ;
Cuiy, ~t~h-,,ol COLJNTI', PENNSYLVANIA Q~_
-~ ' ~
- _-_.~ :~M
-= ~
~~ ~ a -~~~~ ~ ~ ~ ~~o
-~
a
Estate of yi/'4i~li~ L• /SJEE1 ~/r'9i~l~p Loir~St ~sof ¢ !~i%gi~io
J
(i/lRY~LS ~ Sl~G/~f ~ ~ a subsc
(Print Nante/sJ
the' Will ~~~;e{~) presented herewith, (~eackj-being duly qualified according to law, d
say(s) that she-~he..,~13ef was L~,+•e~e~ present and saw the above ~'~ Testatri
and that sl}e-E he /-tl~e~+• signed the same and that .ck~,Lhe~ signed as a witness
the Ito;-T Testatrix in her,~•;`s- presence and in the presence of each other.
~~~~~ ~L
(Sig/nature) (1IrP'h~B$ ~ sgIC~Q/f ~'
p C106lSe~/' ~ossr
(Su•eel Address)
~l'l~i~ii cs~krg, P~ ~7oss
(Cite, State, Zip)
Executed in Register's Office
Swon~ to or affirmed and subscribed
before me this ~ ~ /day
of , C-~-~'~-.
for Register of Wills
(Signature)
(Street Address)
Deceased
witness to
;pose(s) and-
s sign the same
at the request of
(City, State, Zip)
Executed oast of Register's Off e
Sworn to or affirmed and subscr bed
before me this day
of ,
Notary Public
My Connnission Expires:
(Signature and Seal of Notary or other official q alified to
administer oaths. Show date of expiration of No ary's Commission.)
NOTE: To be taken Uy Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of
Form Rtl'•03 rer~. /17.13.06
OATI~ OF NON-SUBSCRIBING WITNESS(ES)
REGISTER OF WILLS °
( L[~~6s~aa~ COUNTY, PENNSYLVANIA _
a--~~ - t1~13
Estate of ~/'~i/JiI L.
iK~'/.,~''iA GOII/SC ~~ rt~'I `/i/',finii ~ /~t~7
r~
~_
~ T C"7
c~ ^~ c~
-~ is
~ r.±., ,-~-i
-~ -, ~ --
_.., . - ,
-v -; :=~,
~ '.. --~,
~= r~,-~
L~ ~`~
0
Deceased
Wi~~/4/~l /~ rJ~CC and ,
{easl~y being duly qualified according to law, depose(s) and say(s) that chi he-L-t~e}~ was well-
acquainted with ~.•~iili4 L ~~G~ and a are familiar
with the handwriting and signature of the decedent, and that the signature of ~/i' ii~~it k~c~'
to the foregoing instrument .purporting to be the Last Will and Testament/.Cod~s}1 of v •
~~ ~ is irr~s/her own proper handwriting.
Y~ ,~t
(ignature) ~/~~iQAY /~(~ /yCCL
a 9 D~~t'<vooq/ /~e•
(Street Address)
(City, State, Zip)
Ea:ecacted in Register's Office
Sworn to or affirmed and subscribed
befo e me this (day
of ,~f~
eputy for Regi~of Wills
r
Fornr RN'-04 rev. 10.13.06