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HomeMy WebLinkAbout02-22-13Reset 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 ~ ~ _ (~ ~ 21 n Name• JULIE A KOUGH File No: `1 a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 12/18/12 Age at death: 68 Decedent was domiciled at death in CUMBERLAND County, PF.NNSYT.VANTA (state) with his/her last principal residence at 34 PEACH ORCHARD ROAD NEWVILLE PA 17241. PENN TOWNSHIP CUMBERLAND COUNTY Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 111 S FRONT STREET HARRISBURG PA 17101 CITY OF HARRISBURG, DAUPHIN COUNTY, PA Street address, Post Office and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 6,300.00 If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not domiciled in Pennsylvania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 57,500.00 TOTAL ESTIMATED VALUE.... $ 63.800.00 Real estate in Pennsylvania situated at: 34 PEACH ORCHARD ROAD NEWVILLE, PA, PENN TWP, CUMBERLAND COUNTY (Attach additional sheets, if necessary.) 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 thereto dated State relevant circumstances (eg. 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 life, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.~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 followi~ spouse (ifanji~~ d heirs (~ich additional sheets, if necessary): ~ © c` ~ i m -~., Name Relationshi Addr®~ r'*'1 '" ROBERT W. KOUGH, JR SPOUSE 34 PEACH ORCHARD ROAD ~ b. c" - N "'i a ~ fri NEWVILLE PA 17241 r ~ m N- T. GREGORY THORSON SON 507 N BEDFORD ST ~= - ~c C p VAN THORSON SON 251 PARKER ST '~'~ ~ ;'„ir ~ CARLISLE PA 17013 ~ N SEE ATTACHED FOR ADDITIONAL ~ Q ~ Ca Form RW-02 rev. 10//1/201 and Codicil(s) ~, Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } ss: COUNTY OF CUMBERLAND } Petitioner(s) Printed Name ROBERT W. KOUGH, JR ORCHARD The Petitioner(s) above-Warned swears} or affirm(s) the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) ax~ri that, as Personal RepresQntative(s) of the Dec a Petitione ) wi w 1 and truly administer the estate according to law. Sworn to or a2Tirtned subscribed before ~ Date 2 12' ~ 3 ~l~ Date me this ay o ,~'V Date _ Date r the Register BOND Required: Q YES Q NO FEES: Letters ...................... $ (~ )Short Certificate(s)..... . (tom )Renunciation(s)......... ~ ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ••••••• ...... ~~ ....... J Automation Fee . ............. . JCS Fee . .................... 'J' - TOTAL ..................... ~-A6' To the Register of Wills: Please enter my appearance by my signature below: Attorney Signature: Printed Name: LISA M. GRAYS SQUIRE Supreme Court ID Number: 78269 Firm Name: LISA M. GRAYSON, ESQUIRE Address: t t cuFR AT(~N DRIVE - rART TCT F PA 17013 Phone: Fax: Email: Use RECORDED OFF#CE OF REG#STER OF #LLS loner(s) Printed Address NEWVILLE PA 172 ~ E ~ ~ O ~ ANS' COURT ., 717-580-1254 717-249-5032 T M~TAC'rn,{'*MATT C'nM DECREE OF THE REGISTER Estate of JULIE A KOUGH File No: ~' -~ ~ ` Z. ~q a/k/a: 1 Q AND NOW, c~ , ~iJ , in consideration of the foregoing Petition, satisfactory proof having been pres nted before me, IT IS DECREED that Letters ~' are hereby granted to ROBERT W. KOUGH JR in the above estate end (if applicable) that the instrument(s) dated described in the Petition be Form RW-02 rev. 10/11/2011 to probate and filed of record as the last Will (and Codicil(s)--) of Decedent. .~~~iJ~i.~~. . Register of Wi is ~-,, n~r ~~~~Ul-~,~ ~ ~1' `~'~- Pag 2 of JULIE A. KOUGH, 206-34-8352 ADDITIONAL BENEFICIARIES: RICHARD THORSON SON 90 PARKER ROAD NEWVILLE PA 17241 ROBERT THORSON SON 133 E. LOUTHER ST CARLISLE, PA 17013 STEPHEN KOUGH SON 725 W. SIDDONSBURG RD DILLSBURG, PA 17019 o ~~ rn ~-~~, rn ~o rn = ~, cv ~,~, ~ ~'~~ N ~~ ~~~` ~ OGti `TT O C ~ ~ ,,,,~ ~ ---a f.._ ,. C a !'"" to D - t~ Cn 4 ~ '~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OFFICE OF Fee for this certificate, $6.00 RE6iSTER OF ~y1LLS This is to certify that the information here given is correctly copied from an original Certificate of Death 7013 FEB 22 duly filed with me as Local Registrar. The original i I~ ~ j Q~`j' certificate will be forwarded to the State Vital Records Office for permanent filing. P ~~~~.~~ IpRPCIERK OF ~, HANS' COURT L ~. ~- D 1 9 2012 Certification Number GM.BERLA N ~ C Q, ~ PA Local_ Registrar Date Issued ~~`O Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF.HEALTH • VITAL RECORDS Permanent BI cklnk CERTIFICATE OF DEATH 1. Decedent's Legal Name (First, Middle, Last, Suffix) State Flle Number: 2. Sex 3. Social Security Number 4. Date of Death (Mo/Day/Yr) (Spell Mo) Julie A_ Kough F ~~_ _ _--_ t _ Months ~ Days ~ Hours Minutes ~e 2, 1944 PA - - - --- ~ ---•-_..- -. «• any ,..amver - mcluae APt No.l 3d. Residence (county) 34 Pe=ach Orchard Rd. G~~-berland ga. Residence (Zip Code) 1 7241 i. Ever In US Armed Forces? SO. MaHtal Status at Time of Death MaMed 0 W Q Yes ®No Q Unknown ~ Divorced Q Never Marcled ~ Vnknown l2. Father's Name (First, Middle, last, Suffix) 1 Jarrl~es Grou Loa. Informanc's Name 14b. Relationship to Decedent 1 Robert W . Kou h , Jr . Husband f Oeath Occurred in a Hospital: Ir.r,an~..e -•--• :-------••--- ...,o vewaent cave In a Township? yes, decedent lived In Pen No, decedent lived within limits of ~11. Surviving Spouse's Name (If Robert W _ Kc name pnor to Jr_ Hazel M. Highlands Informant s Maiiing Address (Street and Number, City, Slate, Zip Code) 4 Pe,:_ach Orchard Rd_ Newville, PA 1 7241 ec on y one . ............................................... .......... 'e Other Than a Hospital: ........... .............. ........................ Hospice Facility ~ Decedent's Mome - -Term Care Faciilty t--t rHw~. rc..__,a.. twp. or u~sposrclon 16c. Place of Disposition (Name of cemecery, crematory, or other place) Q Removal from State ~ Donation Other (Speetfy) 12/22/201 2 Westminster M•c~LOria1 Gardens ~. Location of Disposition (City or Town, State, and Zip) 17a. Signature of Fu eral Service Licens rso arse of interment 17b. Ucense Number Carlisle PA 17013 17c_ Name and Complete Address of Funeral Facility FD O 1 2633 L g7win Brothers Funeral Hccne, 2ne_, 630 S_ Hanover St_ 18 D d ' Carlisle PA . ece ent s Education -Cheek ehe box that bast describes the ~ highest degree or level of school com l t d h , 19. Decedent of Hispanic Origin -Check the , 17013 20. Decedent's Race -Check ONE p e e at t e time of death. ~ 8th grade or less box that best describes whether the decedent OR MORE races to Indicate what the decedent considered himself or herself t b ~ No diploma, 9th - 12th grade is Spanish/Hlspanic/Latino. Check the "NO" box If d o e. $'White ~ Korean $~ High school graduate or GED completed ecadent is not Spanish/Hispanic/Latino. No, not Spanish/Hispanic/Latin ~ Black or African American ~ Vletnamese~ ~ Some college credit, but no degree A o Q Yes, Mexican, Mexican AmeNCan Chic n Q American Indian or Alaska Native ~ Other Asian ssociate degree (e.g. AA, AS) ' , a o ~ Yes, Puerto Rican ~ Asian Indian Q Native Hawaiian Q Bachelor s degree (e.g. BA, AB, BS) ' Q Yes, Cuban ~ Chinese a Guamanian or Chamorro Master s degree (e.g. MA, MS, MEng, MEd, MSW, MBA O Yes, o[her Spanish/Hispanic/Latino ~ Filipino ~ Samoan 0 Doctorate (e.g. PhD, EdD) or Professional degree (S f 0 Japanese ~ Other Pacific Islander e. MD DDS DVM LLB JD peci y) ~ Other (Specify) 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indlwta what the decedent considered himself or herself to be 8511/hite 22s Decede t' U ~ Japanese ~ Black or African American ~ Korean Q Samoan Other P ifi I l . . n s sual Occupation -Indicate type of wort done during most of working life. DO NOT USE RETIRED Q American Indian or Alaska Nature ~ Vietnamese ~ Asian Indian ac c s ander Q Don't Know/Not Sure - Ba)Cery 4~r-]{eZ- ~ Other Allan Chinese ~ Native Hawaiian ~ Refused ~ Other (Specify) 22b. Kind of Business/Industry Q Filipino Q Guamanian or Chamorro ITEMS 3a - MUST BE CO P D BY PERSON WHO PRONOUNCES OR 3a. Date Pronounce Dea Mo Day r 23 ~ Bnature o Person Pronouncing Dea Grocery Stor th Only when a c e CERTIFIES DEATH._ _ ._ _ - ~ Z - ~ ~ - ZO/ ~_ pp a a 3c. License Num er '°- -- - - - - - was Meolcal examiner or Coroner Contacted? ~ Yes No CAUSE OF DEATH 26. Part 1. Enter the chain of eve re i t n -diseases, Injuries, or complications-that directly caused the death 'Cpproximate DO NOT t sp ra ory arrest, or ventric . en er terminal events such as cardiac arrest ular fibrillation without showing the etiology. DO NOT ABBREVIATE Enter onl IM . y one cause on a line. Add additional Tines if necessary Onset to Death ~ MEDIATE CAUSE ------------> a. ~/ ~ [J L h (Final disease or condition resulting In death) ~ Due to (or as a copse uence o - r q f) Sequentially list conditions, b. -~ _ ~ ~ if any, leading to the cause Due to (o as a consequence of): listed on line a. Enter the c, UNDERLYING CAUSE (disease or Injury that s Due to (or as a consequence of): Initiated the events resulting d. in death) LAST. Due to (or as a consequence of): 26. Part 11. Enter other slaniflesn t conditions c ntrlbu Ina to de h but not resulting in the underlying cause given in Part I .°5. g m a`S' 27. Was an autopsy part ed7 Yes Q No 28. Were autopsy findings available ` F em ale: to complete the cause death? ,. .~ C ep .Vot pregnant within past year 30. Did Tobacco Use Contribute to Death? ~ Yes No 31. M per of Death ~ Pregnant at time of death Not ~ Yes ~ Probably Q No (Unkn Natural ~ Homicide re Want, but g Y ~ P B pre Want within 42 da s of death Q N own ~ pending Investigation O i t ot pregnant, but pregnant 43 days to 1 year before death ~ Unknown if pregnant within the past year 32. Date of Injury (MO/Da Y/Yr) (Spell Month) Suic de ~ ~ Could not be determined O •--~•~•-• •.,~ r.a.,w ,n)ury a.s000rred: Yes ~ Driver/Operator ~ Pedestrian p No 0 Passenger p Other (Specify) a Certifier (Chock only one) ~~Certifying physician - To the best of my knowledge, death occurred due to the cause(s) and manner stated ^ Pronouncing 8a Certifying physician - To the best of my knowledge, death occurred at the Hme, date, and place, and due to the cause(s) and manner stated ^ Medical Examiner/Coroner - On the basis of examl tlon, and/or investigation, In my opinion, death occurred at the cime, date, and piece, and due To the cause(s) and manner stated Signature of certifier: Title of certifier: - v~ w•_~~ Ucense Number.~_~ 'IS Z t S 2 ( b. Name, ddress and Zip Code of Person Completing Cause of Death (Item 26) S e~ Z- 1 Z t I Z 39c Dete Signed (Mo/Day/Yr) . Reg{atrer s Istrict Num er ~+ T ~ - _ ~ Z 41. Registrar sture ~~ 2. Registrar FI a ate Mo Day r a ~-a~ o . Amendments ~ -~~ ` ~,p~~ Disposition Permit No.~~~ ~ ~ ~ H705-143 REV 07/2011 RECORDED OFFICE OF REGISTER OF MILLS ~~~ i3 FEB 22 9~ 1 i ~~ Estate of Deceased I, I ~ ~ I -~(,~`~ in my capacity/relationship as (P ' Name) . _ S O h of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Ro~ert ~W. I~ou g ~- . J r. (Dam) (Signature) (Street Address) . (City, State. Zip) Executed in Register's Office Sworn to or affirmed a d subscribed befor a day ~~~1~• puts fo~'Re>;ister of Wills RENUNCIATION CLERK OF ORPHANS' C0t1RT REGISTER OF WILLS CUMBERLAND CO., PA .S a w- ~ ~a~ COUNTY, PENNSYLVANIA Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 RECORDED OFFICE QF REGISTER OF ~~ILLS 013 FEB 22 q~ ll 0? RENUNCIATION CLERK OF ORPHANS' COURT CUMBER~ANp CO,, PA REGISTER OF WILLS C a rh b~ ~4~ COUNTY, PENNSYLVANIA - .~~ - ~ - o~~ "I Estate of J u ~ i I, _~ d ~5a/~ Deceased in my capacity/relationship as ' (Print Nante) S O h of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to o~ert W. ~`ou Jr. ~ ~~ (Date) ~ _ / ~ ~ /~ Executed in Register's Office Sworn to or affirmed a d subscribed before me this ,%~t~ day ' ~~. uty for Register of Wills (Signature) (Street Address) (City, State. Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 RECORDED OFFICE OF REGISTER OF 1~11LLS ~:'~ti3 FEB 22 ~f~ lI 0? RENIJNCIATIO~T CLERK OF REGISTER OF WILLS ORPHANS' COURT S u~.~ ~ COUNTY, PENNSYLVAI~~ M B E R L~ N D C (~., P~ Estate of I, ai-13 -a~G i ~ . .~ 0 Deceased in my capacity/relationship as (Print Name) _ S O h of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to 1~Co~ert W. ~`ou 4 ~- . ~ r. a~~~ (Date) 99 ~~~e~ Rel. (Street Address) l/ 1 e~vv~ (~~ Q c~z~ l (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this 1 `~ ~ day of ~~ r' , . Deputy for Register of Wills Form RW-06 rev. 10.13.06 Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the pu oses stated within on this ~cLB~ day of ~ 3 N a Publ c ~ ,. omrnission Expires: (;~,t,~ ~ 1 c~01 ~p cial qu ified to admi~. ~~ date of expiratio of Notary's Commission.) JOpY ~ (pT ~WIAL,LE ~WiO. GM~µ~q ~p~Ty . My G~Mp~ E~ Aw.O. ~t~ RECORDED OFFICE OF REGISTER OF SILLS 1013 FEB 22 q~l lI 0? CLERK OF ORPHANS'COURT RENUNCIATIO~1c~MBERl.ANa eQ., P~ Estate of REGISTER OF WILLS C u iw- e/~ ~a~ COUNTY, PENNSYLVANIA Deceased • I, ~~ ~ e~'t ~. T h d r S o n , in my capacity/relationship as (Print Name) _ S O h of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~ ~ert W. ~~ou ~ ~• a~ ~6. ~3 ~~~ ~~ (S+S~+ature) l33 ~s~ ~~~~~ (Street Address) (City, State. Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Executed out of Register's Offrce Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of tart' Public y Commission Expires: ~~ (~ ~ 0201 (Signature and Seal of Notary or other official qualified to admini ~ _ fission.) vOTARIAL SEAL MORGs~N CEMARK, Notary Public Carlisle C~arough, Cumberland County My Commission Expires September 6, 2015 Form RW-06 rev. 10.13.06 RECORDED OFFICE OF REGISTER OF ~'ii_~.S X013 FEB 22 q~l ~. ~ 0? RENUNCIATION CLERIC OF ORPHANS' COEIRT REGISTER OF WILLS BERIAND CO., PA S, uw- er ~a~ COUNTY, PENNSYLVANIA ~I-13-a~G Estate of I, uqA Deceased in my capacity/relationship as (Print Name) S 011 of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~O~er~ W. ~`OU ~-~1-~3 (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~ day of __ Deputy for Register of Wills Form RW-06 rev. 10.13.06 (SiB~~) ~.~ ~ s~~ (Street Address) ~1~~ ~ ~ ~f (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this _~ sy day of ~t°6~~-~ a ~~ 3 Notary Public My Commission Expires: ~~l~~y (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) coMMONw~un~ of Notarial seal Mark O'Shea, Notary Pubik Lower Allen Twp., Ctunberfand CottMy Comm~slon Expkes Feb. i, 2014 MEMBER VANIA ASSOCtATlON aF