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HomeMy WebLinkAbout02-27-13 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF 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 U /4 f2 f L' lTA c / c=am c L[ L-2 File No ~~L1 -1 ~ --Dr2 7' a/k/a: 177 A A / t3 /?A C, l't~ L Z 17W (Assigned by Register) a/k/a: a/k/a: Social Security No: a? - C) Date of Death: /><Nyt /~/ZY /7; oZ d / 3 Age at death: a (I Decedent was domiciled at death in (u M &--XL-,4W County, Pt wA)S f e ✓,4A)11f (State) with his/her last principal residence at _ / d~Rtvd 1J lbau L=N 0 [-R Ccc Y14 J3 ~QLJr-A,) D Street address, Post Office and Zip Code City, Township or Borough County Decedent died at 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 $ ~~Ol ~OO , Ifnot domiciled in Pennsylvania Personal property in Pennsylvania $ If not domiciled in Pennsylvania Personal property in County $ Value of real estate in Pennsylvania $ -W-6-5 TOTAL ESTIMATE//DD/ VALUE.... $ a 6, 6 Real estate in Pennsylvania situated at: g#j2-/Z Urgze2UP 1Tt¢L /4RdZ158 i 124, On 14 Ply/V (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 ,SEp7`t 9t / QF Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated 4 and Codicil(s) thereto dated State relevant circmnstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced, was not a party to apending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS ❑ EXCEPTIONS B. Petition for Grant of Letters of Administration (If applicable) e.t.a., d.b.n., d.b.n.c.t.a., pendente lite, durante absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list, f heirs. Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds Gediorce had be n esta1fi1she s defined in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitatedMsX. tom. tt s~3 ❑ NO EXCEPTIONS F]EXCEPTIONS M n cm --q C~ Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by ti;fo in spo M v u3'0fan ltd tyl its (attach additional sheets, if necessary): ;~K O C-3 C7 C-y -Tt 71 Name Relationship esa _ C~AlUress F--a Cn L> Form aw 02 rev. 10/11/2011 Page 1 of 2 Oath of Personal Representative om.:aics.o�y CO�INONWCACCIIOFPES]A'}yLV9NIA j F SS: WC�TY OF } PeGt[one�(s)Pnnted Name Poti[ioner(s)Pnnmd Address /r o� �� r-��� R. ���� �R� U�Y orro ��7lGrsTop+w�J Pa. /'7396 .�o �Nnl � /� aoo g r�ocD o�+J LNo�R ) DaJ ihe Peiiioncr(s)aboco-namrd sweaKs)or affmn(sJ ihe sta�amcnts In ihc[o�cgoing Pe�iiion um truc avd coaec��o the bes�of�he knoalcd�c end belief of PaiiOoncqs)a�d ihut,ns Peaonel Repmsenm�ive(s)of ihe Decedant,�hc P.liiione�(s)will wcll a ly adminis4x�heesm�e acc rtlive m low_ Swom io oc affi�med and subseribed befoa d Da�c� o� 2 �/3 me t� ' w'day�� ,0�/3 Da�c �( a' 7 v' B �J Du�e Fm�he RcA�ner Detc ➢OND Required: O Y�'S O NO To the ReF�ster of{Vllls: FEES: Pleasc cn�cr m�appearancc by my siynvture bclow: Leuers . - S ��(nO.D� N�omeySignamra�. ( -rj )ShortCcrtificute(s)_ . �-- 2S� ( )Renuvciation(s).. ..___. . ( )Codicil(s). . . .. ... . . . . . o ( )Aflidavil(s). . .. _._ . ... . n c.a � f�l .-_. Bond.. . . . . . . . . . . . . . . . . . . . . . . Prin[ed Name: C O m n Cnmmiss'mn. . . . . . . . . . . . . . . . . . Supreme Cour[ m � r^ — � Ot er ID Number: �� n v_�� �i . . .�;'G� � r' z r^ � z o - I�U . � Firm Namc: Z N A �. .. �flV(I(�n� (A , , , , , Addresr. O :� T 'T� � CJ <� '.� :E — . . . . . . �Z_� r m _ . . � r . . . . . . -a i—.. !n o Phone: D m � n��o�»,no�r��. . . . . . . . . . . .� . . �3� ra.: 1CS Fcc. . . . . . . . . . . . . . . . . . . . . � Email'. 1 O'1'AL. . . . . . . . . 5 DF,CREE OF Tfl& REGISTER Estate of ��l 1�1 P I I � ����� �� ��� File No: �.� � � ����� � a/k/a: AND NOW, �(�� (`�, �� ��A�U , ���- , �n co side a[ion of the fo�eg�ng Petitioq satisCactory pr of heving been eseated before m � I IS DECR�jED that I.�ett}�es �� aee hereby granted to �i�n�(7 K 1�( � (7�11 ' in Ihe above estate and(if applicable) [hal the instmment(s)dated described(�the Pefitlon be admillm to m ate and filed of recurd as the las[Will (and Codicil�s))of DecedenG 1 �Q ° ; ' � �l � , _ Regialarof �s . ���� ���� , _ '�� � ro„�arv-oz .�._miu;zou Page 2 0 1(105.805 REV (91II) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 RECORDED ONCE This is to certify that the information here given is 01" REGISTER ~STER OF ILLS ~y~A!! 0FpFy~ correctly copied from an original Certificate of Death `rl~ % duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital 13 FEB 271 Records Office for permanent filing. CLERK G F i13, 2 J. 4 6 6' 3 Certification Number ORPHANS' COURT g9jMENTpF„2Q`~ CUMBERLAND CO., PA Local Registrar Date Issued Type/Print In COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH State File Number: Black Ink 1. Decedent's Legal Name (First, Middle, Last, Suffix) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Vr) (Spell Mo Marietta McKee Keller Female 219-20-2654 D So. Age-Last Birthday (Y-) 56. Under 1 Year Sc. Under 1 Da 6. Date of Birth (Mo/Day/Vear) (Spell month) 7a. BI place (Ciille Stet .1 Foreign try) Months Drys Hours Minutes Bray 86 January 3, 1927 7b. Birthplace (County) Frederick 8a. Residence (State or Foreign Country) 8b. Residence (Street and Number - Include Apt No.) 8c. Did Decedent Llve In a Townshl p? Penns lean is ®Yes, decetlent lied In East Pennsboro tip. 81 Arnold Road Sd. Residence (County) GUmberland Se. Restd ente (Zip Code) 1702$ 0 No, decedent Ilved within limits of city/born. 9. Ever In US Armed Forces. 10. Marital Status at Time of Death 0 Marrietl Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) 0 Yes M No 0 Unknown ®Dlvorrod 0 Never Married 0 Unknown 12. Father's Name (First, Middle, Last, Suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Last) John Calvin MCI— La-ems, May Deter 14a. Informant's Name 14b. ReSlatlonshlp to Decedent 14c. Informant's Mailing Address (Street and Number, Clty,iState, ZIP Code) Harold Keller, Jr. on 81 Arnold Road, Enola, Pennsylvana 17025 5a. Plac If Death Occurred In a Hospital: LY InPatlent 51f Death Occurred somewhere Other Than a Hospital: Hospice Facility Decedent's Homa a 0 Emergency Room/Outpatient 0 Dead on Arrival • O Nursing Home/Long-Term Caro Facility Other (Specify) S6b. Facility Name (If not institution, glue street and number; - City or Town, State, and Zip Cod• lSd. County of Death PHS Harrisburg Hospital Harrisburg, Pennsylvania 17101 Dau fiin m 16a. Method of Disposition 0 Burlal ® Cremation 16b. Date of Dlsposltlon 16c. Place of Disposition (Name of cemetery, crematory, or other place) 0 Removal from State O Donation j Cremation Society of Pennsylvania other (Specl-1 16d. Location of D{sposlUOn (City or Town, state, and Zip) 17a. Signature ofServLicensee or Person in Charge of Interment 17b. License Number FD-013376-L Harrisburg, Pennsylvania 17109 17c. Name and Complete Address of Funeral Fadlity Auer Cremation Services o£ Penns lvania Inc. 4100 Jonestown Road Harvl_!denV Penns lvania 17109 a~ 18. Decedent's Education - Check the box that best describes the 19. Decedent of Hlspanlc Origin - Check the 20. Decet's Race -Check ONE OR MORE races to Indicate what highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. 8th gra d e or less is Spanish/Hlspanlc/Latino. Check the "No" ®Whlte 0 Korean 0 No tl,, a a, 9th - 12th grade box If decedent Is not Spanish/Hlspanlc/Latino. 0 Black or African American 0 Vietnamese 0 High school graduate or GED completed ® No, not Spanish/Hispanic/Latino 0 American Indian or Alaska Native 0 Other Asian 0 Some college credit, but no degree 0 Yes, Mexican, Mexican American, Chicano 0 Asian Indian 0 Native Hawaiian 0 Yes, Puerto Rican 0 Chinese 0 Guamanian or Chamorro 0 Associate degre e (e.g. AA, AS) Bachelor's degree (e.g. BA, AS, BS) Yes, Cuban Filipino 0 Samoan 0 Master's degree (e.g. MA, MS, MEng, MEd, MSW, MBA) 0 Ves, other Spanish/Hlspanlc/Latino Japanese Other Pacific Islander 0 Doctorate (e.g. PhD, Ed D) or Professional degree (Specify) 0 Other (Specify) . MD DDS DVM LLB JD 21. Decedent's Single Race Self-Designation -Check ONLY ONE to Indicate what the decedent considered himself or herself to be. 22a. done dDeucetlg ^mos Usual Occupation -Indicate type of work Samoan rin most of working life. DO NOT USE RETIRED. [M White 0 Black or African American 0 KoreanSG 0 Other Pacific Islander Homemaker in Own Home Amerlwn Indian or Alaska Native 0 Vietnamese 0 Don't Know/Not Sure 0 Asian Indian 0 Other Asian 0 Refused 22b. Kind of Business/Industry 0 Chinese 0 Native Hawaiian 0 Other (Specify) Domestic. 0 Filipino 0 Guamanian or Chamorro ITEMS 23a - 23d MUST BE COMPLETED 23a. Dafe Pronounced Dead (MO Day r) 23b. Signature of Person Pronouncing Death Only when applicable] 23c. License Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d. Date Signed (Mo/Day/Yr) 24. Time of Death No y 25. Was Medical Examiner or Coroner Contacted? 0 Yes CAUSE OF DEATH Approximate ceal: iac arrest. 26. Part 1. Enter the chain of events--diseases, Injuries, or complications--that directly caused the death. DO NOT enter terminal events such as card n respiratory arrest, or ventricular fibrillation without showing the etiology. DO NOT ABBREVIATE. Enter only one cause on a Iine. Add additional Ilnes if necessary Onset to Death S IMMEDIATE CAUSE a. (Final disease or condition Due to (or onsequente of): -.1 Ing In death b. Sequent) ally list conditions, Due to (or as a consequence of): if any, leading to the ,use listed on line a. Enter the UNDERLYING CAUSE Due to (or as a consequence of): (disease or injury that M- Initiated the events resulting d. I Due to (or as a consequence of): M- In death) LAST. i s 26. Part 11. Enter other -si-Ificant conditions ontrlbuting to death but not resulting In the underlying cause given in Part I 27. Was an Yaes utopsy perf med? No 28. Were autopsy findings avaliable to complete the taus f death? 0 Yes No 3+ f Fe ale: 30. Did Tobacco Use Contribute to Death? 31. M ner of Death 29.1 Homicide Not pregnant within past year 0 Ves O ' ably Natural 0 Pregnant at time hI death 0 No [Unknown 0 Accident O Pending Investigation 0 Suicide Not pregnant, but pregnant within 42 days of death e 0 Could not be determined 0 Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Day/Yr) (Spell Month) 33. Time of Injury 0 Unknown if pregnant within the past year 34. Place of Injury (e.ghome; construction site; farm; school) 35. Location of Injury (Street and Number, City, State, Zip Code) . 36. Injury at Work ~TransPO-tirfn Injury, Specify: 38. Describe How Injury occurred: 0 yes 0 Pedestrian 0 No 0 other (Speclfy) 39a. Ce er (Check only one): _ ertlfying physlclan - To the best of my knowledge. death occurred due to the cause(s) and manner staled 0 Pronouncing ,,physician physician - T. the best of my knowledge, death occurred at the time, data, and place, and due to the cause(s) and manner stated 0 Medical Examiner/Coroner - the basis mI Dn, and/or Investigation, in my opinion, death octurrod at the time, data, and place, and due to the cause(s) and mann r stated Signature of certlfler: xa Title of certlfler: ~ - License Number: L7 Z l e Z_\ y/Vr) 39 Address and Zip Code of Person Completing Cau of Death (Item 26) Date Signed (Mo/Daa _ 39b. N me, ~e z- se 1-l v\J Mo Day r 40. Registrar's District Number 41. Registrar's Signature 42. Registrar FIIe a. a~-a o ~3 43. Amendments H205-143 Disposition Permit No. Sr~^. 2 REV 07/2011 BEFORE THE REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF MARIETTA C. KELLER, DECEASED NO 21-13-0241 DECREE OF THE REGISTER OF WILLS AND NOW, this 28th day of February, 2013, upon consideration of the Petition for Grant of Letters filed by Harold K. Keller, Jr and JoAnn K Moody, for the above decedent and the instrument offered for probate as the Last Will and Testament, which is dated September 9, 1998, and containing an obliteration, the Register of Wills having given consideration thereto, has made an official determination and renders the following decision: IT IS DECREED that the instrument, dated September 9, 1998, be admitted to probate as the Last Will and Testament of Marietta C. Keller including the obliteration which removes Section IV in its entirety. IT IS FURTHER DECREED that Letters Testamentary are hereby issued to Harold K. Keller, Jr and JoAnn K Moody who shall have all the rights and duties of fiduciaries under the laws of Pennsylvania and shall proceed with the administration of this estate according to law. u. co o cn N < _wa j C h- n- r~ ~ (Z> CL- ° Of W Glenda Farrier Strasbaugh, Register of is lLl Lit W Z J °a_ C" -j Fr M co c.> W o U.J m Uj ~ ° n w _ o M C') -4 r N m m r x M -J ;v 1=7 LAST WILL AND TESTAMENT cry c o v C, o =7D n BE IT REMEMBERED THAT c~ © ` = C'> I, MARIETTA C. KELLER, a resident of Cumbtr-Vand ~ uxytA Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and codicils previously made by me. z I declare that I am not married, and that I have four (4) children, HAROLD K. KELLER, JR., JOANN K. MOODY, PATRICIA L. CARSON, and JAN M. COONS. II I direct that all my just debts and funeral expenses shall be paid from my residuary estate as soon as practicable after my decease. III I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. IV I 1 bequeath ONE THOUSAND "DOLLARS---- ($1, 000. ----tom -per- ..cappita. V I give and bequeath my dining room table to my son, HAROLD, per stirpes. VI I give and bequeath my Boonsboro coverlet to my daughter, JOANN, per stirpes. VII I give and bequeath my Dovetail cedar chest to my daughter, PATRICIA, per stirpes. VIII I give and bequeath my antique jelly cupboard to my daughter, JAN, per stirpes. IX I borrowed $Y;"500.-00 from my daughter, PATRICIA, and $1,500.00 from my daughter; JAN, which funds I invested in my house. I direct that the principal of each loan, together with an amount proportionate to the appreciation of the value of my real estate, be returned to each of my daughters. X I direct that my jewelry be divided among my four children, with the distribution being made by a drawing. XI All the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment and my First United Corp. stock, I give, devise, and bequeath to my children, HAROLD, JOANN, PATRICIA, and JAN, in equal shares, per stirpes. XII I nominate, constitute and appoint my son, HAROLD K. KELLER, JR., and my daughter, JOANN K. MOODY, as Co-Executors of this LAST WILL, to serve without bond. If either is unable or unwilling to act in that capacity, then the other may act alone as Executor of this LAST WILL, to serve without bond. IN WITNESS WHEREOF, I, MARIETTA C. KELLER, have set my hand to this LAST WILL this day of ~J 1998. MAkIETTA C. KELLER Signed, sealed, published and declared by the above-named MARIETTA C. KELLER, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto Subscribed o names as witnesses. i ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND I, MARIETTA C. KELLER, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my LAST WILL; that I signed it as my free and voluntary act for the purposes therein expressed. MARIETTA C. KELLER Sworn or affirmed to and acknowledged b fore me by MARIETTA C. KELLER, Testatrix, this 9V,4, day of 1998. Notary Public Notarial Seal Diane M. Smith, Notary Public Mechanicsburg Boro, Cumberland County AFFIDAVIT My Commission Expires June 22, 2000 t COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND 7 We,/) "kt.17' and the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw Testatrix sign and execute the instrument as her LAST WILL; that MARIETTA C. KELLER signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 1 years of age or more, of sound mind and u der no c nstrai r undue influence. ' -r f Sworn or affirmed to and acknowledged before me this qV~_ day of 1~?k yi~~ , 1998. s s Notary Public Notarial Seal Diane M. Smith, Notary Public Mechanicsburg BOro, Cumberland County My Commission Expires June 22, 2000