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HomeMy WebLinkAbout01-10-13PETITION 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: KATHRYN__F• GARDNER ________ a/k/a: KATHRYN _FLOYD_GARD_N_ER_- -_ a/k/a: a/k/a: _ _ ---- - Date of Death: 12/20/2.012 __ -____ File No: -~-/__ %_~ _ ; 1~ i, ~ `~' (Assigned by Register) Social Security No: 185222612 __ Age at death: 84 Decedent was domiciled at death inC_UMBERLAN__D_ ___ County, PENNSYLVANIA (State) with his/her last principal residence at 79 HUM_MEL_AVEN.IJE_ ____ _17043_ _ _LEM_OYNE BOROUGH- __ __ CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County Decedent died at HARRISBURG_ HOSPITAL ___ .1.7.1.01___ CITY___0_F HARRISBURG DAUPHIN PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: /jdomicileditrPennsylvania .............................. ..All personal property $ ___9iJ,~UO•~0 /jnot domiciled in Pennsylvania ........................... ..Personal property in Pennsylvania $ .__ -_ _ /jna domiciled in Pennsylvania ........................... ..Personal property in County $ Value of ren(estnte in Pennsylvania ........................ ...................................... $ 12 5 , 0 00.0 0 TOTAL ESTIMATED VALUE.... $ _215 , 000 • 00 Realestatcinl'cnnsylvaniasituatedat: 79_HUMMEL AVENUE_ ___17043____-.LEMOYNE_BOROUG H CUMBERLAND (Anoch oddiriaiol .h,a-is, fnecessarbtJ 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) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 8 / 7 / 2 ~ 0 ~ _ and Codicil(s) thereto dated Smte relevant circumstances (e.g. renrarcintion, deaf/r ojezeeutor, eta) Except as follows after the execution of the instrument(s) offered fur probate Decedent did no[ marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as delined in 23 Pa. C.S. § 3323(g), and did not have a child bom 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 pf applicable) __ ..___ - __- _.. ___.__- ___. _ _. - cCa., d. b. n., d. b. n. c. t. a., pendente life, durante absents, durante minoritate ~cc~~ ,~~ If Administration, e.t.a. or fl b.n.c.t.a., enter date of Will in Section A above and comDleteiist of heir~~ Except as tbllows': Decedent was not a parry to a pending divorce proceeding wherein the grounds for divorce had 00t:rC~tablished~-defin~j ~7 in 23 I'a. CS. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ ~ n -~1 ~ ~ ^ NO EXCEPTIONS ^ EXCEPTIONS -- _-___ ,-_ _- _- _-- __ ___~_Z fT I`'` ; ~ ~ ~- Petitioner(s)- a(ier a pruper search has/have ascertained that Decedent IeR no Will and was survived by the follovt~g ~ous~if any) and his (attach addi(ionalsheets, rjnecessary): ,~ ~~ r--~ T! ~,,, ~p ;. _- .. ~ ~. r ., -1 Name Relationship ~ A~dce~s `% ~. ~ .-, ~. r"~r; ~^r - - - _ - _ __ -_ - _ v~ _ _ -- _-- ''"t -_ -___ - - Form RW-0:' rrr l U l i 20l l Page 1 of 2~~s.; f ;: ..:: ~r° 3 ~ +. u .,, ?~13 vtll ~0 r. i ~ ~~~ , P ~~~~49~~? CLERK C': ~~~ DE;C 2 11`2012 i .l I OR~HA~S' CUi` - Types/Pant In CU M B E RLA ~d MMONWEALTHYDF P[NNSV LVANIA DEPARTMENT OF HEALTH VITAL RE[OR D$ Pesrmanenf CERTIFICATE OF DEATH State FRe Number, Z° Y ~~Se l.. 1 v ~S ~f C 1ack In k Decrdant'a L¢gal Nam¢ (FITS[, Mltltlll, List, SuHI=) 2. 52x 3- Social $ertrrlty Number 4. Date of Death (MO/Day/Yf) ISPaII Mo) 1 . Kathryn Floyd Gardner emale '185-22-2612 Sa. Age-La St BlrtM1day (Vrz) 3b. Vnder'1 V¢ar Sc. UnEer 1 Da 6. Date of Hirtl[ (MO/Day/Year) (Spell Mon[M1/ >a. Blrt M1plac¢ (City and State or Foreign Country) 84 Mnnma Davs HoprS MIn~[ea July l S, l 928 Jb. 6irtM1place Dqunm antes er Ha. Reslden (State Or ForelHn Country) 8t>7Rgzldepu Street d bet-Include Ap[ No.) sJJ'' LL1l Inme~ ~vr? _ h 82. Dld Decrdnnt Live in a Township? t enna _ qa. aaaldesn<e (cppnty) Lemoyne , PA wo. []YeS. tl¢C¢d¢n[ IIV¢d In Lemoyne i r n /b Cumberland aa. Reamenca (zIp coda) ry . n Nn, dareaent RVaa w¢mn emit:Of _ -_ r 9. Ever In 5 Armed FOrcas2 1D. Marital Status at Tlma of Death Q Marrl¢tl Wltlowetl 11. Surviving Spouse's Name (If wife, Blvc name odor t0 first marriages) ~ Vas ~NO O Vnknown [] DiVO ed ~ Ne r Marrletl D Unkn n w 12. FatM1er's Names (Firs[, Middles, Las[, Softies) 13 Mnther'z Name Prior to First Marrlag¢ (First. Midtlle, Last) Hoover Mar George Floyd y 14a. Informant's Names 14b Rela[lo h to Decadent ~ ~ 1 Mailln Atltlr 5]Irn t,and.JLLUOmbe~ry[y~SLaiq, 2lgCOdal~ `kf~~'f2 ~'an~roc9n {~~ L W O > l.1L C:1 l=r l Jan Jennings des ug 15 a. P ace O Deat C ec on y One __ ice Facility ~ Decetl¢nt's Home ital: e] Hos H TM1 M1 "s1 If Death Occu rrad Ina Hospital: Inpatient : p er an a osp If Death Oc<urretl Somew M1ere Ot °, ~ Emergency Room/Outpatient 0 Dead on Arrival r Q NursinH Hom¢/Long-Term Care Faclllty O[M1er (Sprrify) f [M1 2a' ] Sb. Faclllty Name (If no[ Ins[ItUtlon, Hlvi street end numbers Oea ]SC. City ar Town Stale, d ZI Cotla 1 tl. Coon l~A 17101 ~auptyl-iin g b Harrisburg Hospital ur , Harri s M¢thod of Dispnzltlon 0 g lal ~ Cremation 16a lfib. Daft OF Disposi[IOn 16c. Place of Disposition (Name of cemetery, ~ ar story, nr other places) m . ORemovil Prom S[a[e ~mnabn^ 2012 ece 21 Humanity Gi£ts Registry ~ , Z 16tl. Location o1 Olzposl[lon (Glty ur Tewn, States, antl Zip/ f Forrestal Scr vice I.irnn• r P r n CM1arge of Interment Sl~,a t u r e o / 1Y6. License Number FD-013163-L ~ Philadelpl-lia, PA 19105 ~ / ` L fl g 12c. Name antl Com pieta Add r¢ss of Funeral Faclllty Musselman FH&CS, 324 Hummel Ave.,Lemoyn~, PA 17043 °•6 Decetlant'z Education -Check the box the[ best descd bas tM1e 19. Decedent of Hispanic Origin - CM1eck the 2D. Oe<etlent's Race -CM1eck ONE OR MORE races to Indicate what SB . highest tlagraa r level of school completed a[ tM1e time u(tleafh- box [M1at best tles Cd bes whether the tlecedem M1 de[edan[ conziderrd himself nr M1arsalf [o be. 0 g[M1 grade or lass is Spanls M1/Hispanic/Latino. Check rhr "NO" Whl[e [] Korean ~ Nn diploma, 9[M1 - 12th Hratle bn= If dacatlent H not SpanisM1/Hispanic/Latino. 0 Black or African American Q Viatna mdse ~ High sch OOl gratluata or GED completed O No, not Spanlzh/Hispanic/Latino 0 Amedcan Intllan or Alaska Native Q Otlter Asian Q 5 coll¢ga .radii, but no tlegrec Q Yes, Mexican, Mexican American, Chicano Q Asian Intllan Q Native Ha nailan mono q Associate degree Ie.H. AA, AS) O Y¢s, Puerto Rican ~ fhlnesn (_] Guamania or CM1a acM1alor's degree (c.g. 9A, AB, B$) (] Yes, Cuban Q Filipino ~ Samoan Q Master 5 tlagr¢e (a.g. MA. M5, MEng, MEtl, MSW, MgA) Q Yas, OtM1Cr SpB nISh/HlSpa nit/Latino 0 Japanese ~ Other Pacific Islander ~ Doctorates (a.g. PM1D, EtlO) or Profasslonal degree (Speci(y) ~ O[har (Specify) _- - -- -_- _ - MD DOS DVM, LLB JD 2 D tlent'S Singla Race Self-Daslgna(lon -Check ONLY ONE fn Intlica[a whet <M1e decedent consitleretl himself or M1e rself to be. 22a. Deiedenr's t[sual Occupation - Intllca<e type of work ~WM1lte 0 la pHnese 0 Samoan tlOne tluring TOSt of working Ilfe. 00 NOT VSE RFTIREO- Q 81ack Or African American O Korean ~ OfM1ar Pa[ifl< Islander nurse ane S tt12 t 1 5 t AmerlCan Intllan or Alaska Native 0 Vlr[namasa Q Don'[ KnOW/NO[ Sores p A,Ian Indian o DtM1ar ASIan Q q±fused 226. Kind of Business/Industry [~ CM1lnasa Q Native Hawaiian 0 O[har ($p¢clfy) I'lO S p1 t a 1 ~ Nllpino 0 Guamanian or CM1amorro ITEMS 23a - 23A MUST BE COMPLETED 23a. Date Pronouncetl Daatl (MO/Day Yr) 236. Signa[u re Of Parson Pronouncina Dea[F. Only whin applicablal 2JC. License Number BY PERSON WNO PflONOUNCES OR CERTIFIES DEATH 23tl. Date Signed (MO/Day/Yr) 24. Tlm¢ Of D¢a[M1 j'. - 23. Waz Medical Examiner or Coroner ConTact<tl+ 0 Ves No CAVSE OF DEATH Apnre=imam c rc0 v sc r Part I. Enter the chain of events--tliseas s, injuries, o mpllcatlons--that directly caused the deatM1. Do NoT enter terminal a cots sucM1 a and lac a rest Interval: 26 . goe causes on a Ilne. Atld atldltional Ilnes If necessary Onset to D¢a[M1 BBREVIATE- Enter only sM1Owing tM1e etiology. DO NOT A [l on wItM1OUt respiratory arrest, or ventrlrular fl6dlla J )) I / em L_C~1l Cpl fO ~~ 5 LY-GCZ'~~ rt"C''L LC ~~ ° i 1 IMMEDIATE CAUSE ____________ a- (Final disease or condiflnn Du¢ t (or as a consaq ueroe nf): resul[Ing In tlea[M1) /'. /~ ( ~. ~ vI ~~ Q C C ~ C ~ /U J N p ~ LL. ~ " V b. ( ~~ L $aquan[lally Ilst c ntlltlons, Oua t0 (or as a consequence of): If any, leatling to tM1e taus ~~ ( p~K. l ~-Ef `Yl_ ~Z n1~~ l T -- -. ' listed on line a- Enter rhea c. I l UNDERLYING CAUSE Due to (or as a consequence of): (tl lseaze or injury [het W ___ Iniriatad the events resulting d. ---- s In tl¢atM1) LAST. Due to (Or as a [o nzequenca of): ~ d tribut'n¢ fo drath but not resulting In TM1e underlying cause Riven In Part I Enter o[M1er s~plfl< Part II 26 a 2T. Was autnpzy pa~fnrm~d7 [ - . . . _ o Yes ld"N ~ 28- Were a topsy Flndings ailable to mplata that y~tlea[ItJ co a o Ye QNo 8 29. If Female: 3U. VId Tobac<O Vse Contribute to O¢a[M1'T 31. Manner n ath o .-Not pregnant wltM1in past Y¢ar O Y¢z ~ Probably O HOmicltle [~ Frognan[ a[ time of tleaCh U NO ©-mown ~ Accident ~ Pending Invesiigafinn $' but pregnant wl[M1ln 42 daVS of tleatM1 ~ No[ pregnant 0 Sulcitle ['] Coultl not be tletermin¢d , s to 1 year befor¢ tlaatF nant 43 da n but re N t 32. Date oT Injury (MO/Day/Vr) (Spell MontM1) y p g ~ pregna a t ~ Unknown If pregnant wltM1in tM1e pest year J3. Time or Injury 34. Place of Injury (e.g. M1emr; rOnstruc[lon site; farm; scno0l) 35- Luc-atlon of injury (Street and Number, Ci[y, State, Zip COtle) 36. In)ury at Work 3T. It Transportation Injury, Specify' 38. Describe How Injury Occurred: ~ Ves Q Orlvar/Operator 0 Prdretrlan ENO Q Passeng¢r O Other (SPaciry) 39a. Ce¢ ar (CM1eck only 1: rtifylnR pM1yslclan th¢ b < of rrry knnwlndg d tlue to [M1e <ausefsl antl manner stated 0 Pronormcing 8. Cartl I~ pM1ys Ian I o the b V k 1 d atM1 occurred at rM1r Limn, date, antl place ntl due [o tM1e cause(sl antl manner stated and place, and due to fhr r n (s) a tl t a tl n pr 5 tlea[M1 occurred a~[M1e time date ~ft In my Oplnlon f [lon"• u~tlgatlon 1 ` , , , , 5 o O M¢tll<al Examin¢r/Cprortar- D [h¢ ))x5 ~/a T / / ~ ~ ~ L II ~ J r_ [ J ` / 1 y 1 irpnce Number: TI[12 Of C¢r[Ifl¢r: ` F $ignaillfa Of C¢rtlfl¢r: J / [ 39 .Name, AtldfBSS tl Zlp Code of Per Cnmpl rig Cause Of D¢ith (I[fm 26) ~ sllrr~ t~48~~f~j ~au~cff ~+ ' r s 34r Oarr Signetl (MO/Day/Yr) la , o i n o~ncwz "z. e,r s ~iswar~ ~~. 1~- ~~- 40. Reg15[rar's Olztrlc[ Number 41. R¢HIS[ra I'S SIR n~s q 42. Registrar File Oa[a IMO OHy r1 /-07 /~ / / _ ~ _ `iniL ~ /a ~°7 i~a7 0 / L 6 43. AmCntlm¢nt5 plspozl[lon Permh No. ~ ~ ~/ y ~ ~ r REV p//2011 /~ -- ~y' LAST W/LL AND TESTAMENT OF n .,; ~~:, u', ~ m c o ~~ ~,~ m ~ ~o KATHRYN F. GARDNER rn ~ ~ ~._ cn ~ y„ r- ~..~ ;,~ r~~ r ~ rn ~ ~ ~ ~-" <~. ' ~ ~a ~, ,-.., ---r _ ~ :,~ r ~ " ~:a I, KATHRYN F . GARDNER, of 79 Hummel Avue , B~48"OUc~l `-" pf ~J ~ Lemoyne, Cumberland County, Pennsylvania, do make, publi sh and declare this as and for my Last will and Testament, hereby expressly revoking all wills and codicils made by me heretofore, and dispose of my estate as follows: ITEM 1: I direct the payment of my just debts and funeral expenses to be paid as soon as can be conveniently done following my demise. I direct that my mortal remains be cremated and my ashes scattered in the Atlantic Ocean. ITEM 2: I direct all State and Federal Transfer T_rheritarce Tax, Estate Ta.,:, Succession Tax or ar~y other tax, including any interest, assessments or penalties thereon, that may become due and payable by virtue of my death, or by virtue of the passing of any property either under my Last Will and Testament, or in any other manner, shall be paid by my estate, just as if such taxes were my debts, and no beneficiary shall be required to pay or refund any part thereof. This shall not, however, include G taxes for assets to be administered in any foreign country. Taxes on future interest may be prepaid. ITEM 3: All of my belongings, which include all the rest and residue of my tangible personal and real property of whatever nature and wherever situate, I give, devise and bequeath unto my daughter, JAN JENNINGS, of 1828 Crown Point Wood Ci, Ocoee, Florida 34761. ITEM 4: Should my daughter, JAN JENNINGS, fail to survive me by thirty (30) days, then I give and bequeath all my estate unto my son, Jere G. Gardner, of 27 Hornsilver Place, The Woodlands, Texas 77381. I specifically leave nothing to my other children. ITEM 5: I nominate, constitute and appoint my daughter, JAN JENNINGS, to be the sole Executrix of this my Last Will and Testament. Should JAN JENNINGS be unable or unwilling to act or continue to serve, then I nominate, constitute and appoint JERE G. GARDNER, my son, to be sole Executor of this my Last Will and Testament. ITEM 6: I direct that no fiduciary appointed in my Last will and Testament shall be required to give or enter into any bond or security in any jurisdiction, regardless of the state of their residency. 2 IN WITN$SS WHEREOF, 2 have hereunto set my hand and seal to this my Last Will and Testament consisting of three (3) typewritten pages, this ~( day of F~ y ~.s ~- 2003 . ~4 ~r ~ ~ can d~-~ ( Ste) KATHR F. G NER We, the undersigned, hereby certify that the foregoing Last Will and Testament was signed, sealed, published and declared by the above-named Testatrix, KATHRYN F. GARDNER, as and for her Last will and Testament, in the presence of us, who at her request and in his presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testatrix was of sound and disposing mind and memory. ,~~j~-~,f~r residing at residing at 7~ 7 ©A K l~r+o 1~ ~V eW Guv~~eryl A.,d P~ ~ ~o7O ~(c5~ c.ow~~ ~~~ hC&-W C.c.1ri4.$Y~2tA'-~t~ pCr tZ0?d p~C, 3 COb4iONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS.: We, the Testatrix, KATHRYN F. GARDNER, and ~O I~~-1-V. Co 12,r~ a r~ and ~Avl. ~. ~(C~c~.(L the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the 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, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. KATHR F. G NER Subscribed, sworn to and acknowledged before me by the Testatrix, hP~THR F. GARDNER, and s bscri ed and sworn to before m~~ by ~;(, and Ztn witnesses, this day of 03. ~~ Notary Public (SEAT, l My Commission Expires: ~, .,,a NOTARW. SEAL i 4 N M Baro,Ctarand Co. -=~ ~, Cortxn~aion Expba Dom. s~, zoos