The URL can be used to link to this page

Home My WebLink About03-21-13 Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA Cl> M Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letts = specific—q> peci b W and in support thereof aver(s)the following and respectfully request(s)the grant of Letters in th�lpWo)riat rm:,, 7V Decedent's Information m _.�i � � 2�- r.. r.) tti�r t°�i Name: ROBERT B.KOEHLER File No: )> (n ::a a3da: (AssigdM bey&gis ) a/k/a: C,> C) 72 . . °� a/k/a: Social Security No:* Date of Death: 02/16/2013 Age at death: 94-,° Decedent was domiciled at death in CUMBERLAND County,PENNSYLVANIA (State)with his/her last principal residence at 210 BIG SPRING ROAD,NEWVILLE 17241 WEST PENNSBORO TOWNSHIP CUMBERLAND Street address,Post Office and Zip Code City,Township or Borough County Decedent died at GREENRIDGE VILLAGE NURSING HOME NEWVILLE 17241 W PENNSBORO TWP CUMBERLAND 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 $ 1,000,000.00 If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County $ Value of real estate in Pennsylvania......................................................... $ TOTAL ESTIMATED VALUE. ... $ 1,000,000.00 Real estate in Pennsylvania situated at: (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 and Codicil(s) thereto dated State relevant circumstances(e.g.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. O NO EXCEPTIONS O EXCEPTIONS ® B. Petition for Grant of Letters of Administration (If applicable) c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante minoritate If Administration,c.t.& or d b.n.c.t.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. Q NO EXCEPTIONS ®EXCEPTIONS Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(if any)and heirs(attach additional sheets,if necessary): Name Relationship Address FREDERICK P.KOEHLER SON 66 LITTLE BRIGGINS CIRCLE,FAIRPORT,NY 14450 PETER G.KOEHLER SON 27446 BEACON SQ.FARMINGTON HILLS MI 48336 DAVID R.KOEHLER SON 483 RTE 376,HOPEWELL JCT,NY 12533 Form RW-02 rev.10/11/2011 Page 1 of 2 Clath af Personai Representative o�e��a�use o�,iy COMMONWEALTH dF PENNSYLVANIA } } SS: COUNTY C}F CUMBERLAND } ��.; w %� Petitioner(s)Printed Name Petitioner(s)Printed3'd s � � � C;� � FREDERICK P.KOEHLER 66 LITTLE BRIGGINS CIRCLE FAIRPORT 0 c;,� �� t :r� ° � �' :i7 � � r3 � ""t'� � ",'7 � � ° L""� � ....� r.� The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are true and cor�t to the best�ie kn�i le¢ge and belief of Petitioner(s)and that,as Personal Representative(s)of the Decedent,the Fetitioner(s will weli and truly administer the estate acoord'ng ta w. Sworn to or affir�ned an bsc ibe e�/rJe// _ �-�-^- ��-�� +--� Date ��2 l 13 JTIE t�li ��v O� , .�'-['!I� . Date By: Date For Register DBte BOND Required: Q YES Q NO T'a the Register of Wills: FEES: Please enter my appearance by my signature below: Letters . . . ... . .. . . . . . . . . .. .. . $ 660.OD Attarney Signature: { � )Short Certificate{s). . . . . . �.00 ( 2 }Renunaiation(s}... . .. . . . 10.00 ( )Codicil{s). . . . . . . . . . . . . � �_ �• ( )Affidavit(s}.. . . . . . . . ... Bond.. . . . . . . . . .. . .. . . . . . . . . . Printed Name: ROG . IRWIN,ESQUIRE Commissian. . . . . . . . . .. . . . .. . . Supreme Court Other . . ... . . . ID Number: 62g2 INVENTORY . . . . . . . . 15.00 INH TAX RETURN . . . . . . . . 15.Q0 Firm Name: IRWIN&McKNIGHT,P.C. ... . . . Address: �Q WEST POMFRET STREET ••� • � � • � CART,Ifit.F.,PA1701"i . . .... . Phone: (71?)249-2353 Automation Fee. .. . . . . . . .. .. . . 5.00 Fax: �717)249-6354 7CS Fee. . . . . . . . ... . . . . . . . . . . 23.50 Email: TOTAL. . . . . . . . . . . .. . ... . . . . � 733.50 DECREE OF THE REGISTER Estate of ROBERT B.KOEHLER File No: � °1�"�� aJkla: AND N{)W, �� t„�' ,'��,in consideratian of the foregoing Petitian, satisfactary proof having been present before rne,IT IS DECREED that Letters OF ADMINISTRATION are hereby granted to FREDERICK P.K4EHLER in the abave estate and(if applicable}that the instrument{s)dated described in the Petition be admitted ta probate and fiied of record as the last Will(and Codicil(s))cf Decedent, t�� Register of Wills,,�� '�` ` ` Form RW-02 rev.101t 11201/ Page 2 of 2 H105,805 REV(9/11) X1-1 �� LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. RECORDED OFF,110t- OF Fee for this certificate, $6.00' J'A�': W - This is to certify that the information here given is eJ "It RIEGISTER OF #'i i L L S correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original 2 certificate will be forwarded to the State Vital MR 1 FFJ: 2 26 a Records Office for permanent filing. CLERK OF P 19 2 1` 70 %Rj�ANS COURT 1,4-x r2/9 bw 3 Certification Numb OUMBERLAN D C,O., PA Local egistrar Date Issued Type/Print In COMMONWEALTH OF PENNS'AMANtA•DEPARTMENT OF HEALTH VITAL RECORDS Permanent CERTIFICATE OF DEATH Security State File Number. (Moz-.'>a ack Ink y/Yr)(Spoil MO) 1.Decedent's Legal Name(First,Middle,Last,Suffix) 3.Social Number 4.Data of Death Mal 3-4 287 February 16, 20IL3 1 2-12-1 1 Robert: B. Koehler n%�Ount_v) Sm.Age-Last Birthday Cyrs) 13b.Under Year 15c.Under Da v Is.Data of Sl,th(Ma/Day/year)-(Spoil Month) 7a. -irthplace I State or Forols Glen d!e, Months Days I Hours fAlnu.] April 3_, 3_93_8 n RL New Jerae 94 1 1 17b.Birthplace(County) go.Residence(State or Foreign country) Bb.Residence(Street and Number-Include Apt No.) bid Township? West Pennaboro_- -twp. Femal g7anla WYes,decadent lived In u 210 B:LS Spring Road Scl.Rea (County ;JEE:3 No,decedent lived within limits of city/boro. Cumberland So.Residence(Zip Code) 17241 9.Ever In US Armed Forces? IQ.Marital Status at Time of Death Married Unknown Widowed J 11.surviving Spouse's Name(if wife,give name prior to first marriage) M Yes C3 No [3 Unknown C3 Divorced C3 Never Married known ri 12.Father's Name(First,Middle.Last,Suffix) 13.Mother's Name Prior to First Marriage(First,Middle,Last) Henr R. Koehler Florence G. Beaver y 14m.Informant**Name Relationship to Decadent 24c.Informant's Molting Address(street and Number,City,State,Zip Code) 114b.Relatl 66 Little B-rLigaIns Circle Fairport, NY 3-4450 Frederick Koehler Son I I s.Fria-ce--oTue .......... .............. tf Death Occurred in a Hospital: �inpatient ............. Than a Hospital: -Term Cam Facility E3 Other fSpocify) rgency Roam/Outpatient E3 owed on Arrival Nursin!Hams/Lon d Zip Code 15d.County Emo St.t. n rity of Death 15b.Facility Name(if not Institution,give street and number! 15c.City or Town, Greentiftge Village Nursing Horne Newv:Llle, PA 17243- Cumberland 11 - - Disposition(Name Of Cemetery,crematory,or other place) 168.Method of DISPOSIM7 Burial UM Cremation 16b.Date of 01;POSI on 6�c. in of Removal from State E3 Donation 2-1-1-3 Cremation Services of m !zimu'.2r, M Other ty) consee or Person In Charge of Interment 27b.License Wd.Location of 01(sSpPECItion(City or Town,State,and Zip) 17o.Signs re of Funeral SServicajol Harrisburg, Pennsylvania 17109 <7- FD-013376-L 17c_Name and complete Address of Funeral'Factittv Pennsylvanle 7109 of Penns ylvan a Inc. 43-00 Jonestown d HaVVIStiuv1s, ofii�� I AV a I,,a Check ONE OR M races to indicate what %a.Decedent's EMMatij,'f=TCh!��Ith t best describes the 19.oecediiint of Hispanic Origin-Check 2o.Decadent's Rata- that decadent considered himself or herself to be. P2. highest degree or level of school completed at the time of death. box that best describes whether the decadent IS Spanish/Hisponic/Latino.Chock the"No" White C3 Korean E3 Sth grade or less box if decedent is not Spanish/Hispanic/Latino. E3 Slack or African American C3 Vietnamese E3 Na diploma,9th-12th grade Native C3 other Asian C3 High school graduate or GED completed No,not Spanish/Hispanic/Latino C3 American Indian or Alaska Yes,Mexican,Mexican American.Chicano E3 Asian Indian E3 Native Hawaiian [:3 some college credit,but no degree C3 Ye C3 Guamanian or Chemarro E3 Associate degree(e.g.A^,AS) Q Yes,Puerto Rican C3 Chinese Bachatoes cleSnOw(•.g.SA,AD,SS) C3 Yes,Cuban C3 Filipino C3 Samoan E3 Yes,other Spanish/Hispanic/Latina E3 Japanese C3 other Pacific Islander ,MSA) C3 Master's degree(e.g.MA,MS.MEng,MEd,MSW E3 Other(Specify) E3 Doctorate(e.g.PhD,Edo)or Professional degree (specify) A e. .MO.DDS.DVM LLS,JDI z2g.Decedent's Usual occupation-Indicate type of work self-Designation ON or herself to be. 21.DecoclariVS Single Race s. -Check ONLY E to indicate what the decadent considered himself done during most of working MO-00 NOT USE RETIRED. i 0 White C:]Japanese E3 Samoan 41 E3 Stuck or African American C3 Korean C3 Other Pacific Islander Electrical En lacer C3 Vietnamese E3 Don't Know/Not Sur* E3 American Indian or Alaska Native C3 Refused 22b.Kind of Susi-OW/Inclustry E3 Asian Indian C3 other Asian E3 Native Hawaiian C3 other(Sp•cify) C3 Chinese Electrical/ IBM E3 Filipino C3 Guamanian or Chemorro I I c.Llc*nso Number iTlEms 230-ZSd MUST 69 COMPLETED Data Pronounced Dead I Day/Yr) 23b.signature or-person Pronouncing Death(Only when BY PERSON WHO PRONOUNCES Olt JeN 140:3&4 L_ ry tle_ W.pate Signed(mo/Day/Yr) 24,1 1 9f Death Xa minor or Coroner Contacted? 0 Yes No k_&bf1Ja_ y 1 25.was Medical E CAUSE OF DEATH Approximate Interval; -that directly caused the death. DO NOT enter terminal events such as cardiac arrest,necessary 26.Part 1.Enter the IgIaJnA7J_&y91W-c1lseases,injuries,or complications-that-cations additional lines If no Onset to Death respiratory arrest,or ventricular fibrillation without showing the etiology.DO NOT ABBREVIATE- Enter only one cause on a line.Add IMMEDIATE CAUSE Ell (Final disease or condition Due to(or as a consequence of): resulting In death) b. 3 Duo to(or as a consequence of): Sequentially list conditions, If any,loading to the cause listed on line*.Enter the C.UNDERLYING CAUSE Due to(or as a consequence Of)- (disease or Injury that Initiated the events resulting d. in death)LAST. Due to(or as a consequence Of). pay Performed? 27.was an auto to dew but not resulting in the underlying cause given in Part I Q0 No 26,Part Ha Enter other Ions - C3 Yes sings ovalleDis Wore autopsy to co tare the cause of death? Yes 12NO rofDo I 30.0111 Tobacco use contribute to Death? 31.M a Death 29w It Female: I'n".ral C3 Homicide 3 4 1 C3 Probably -1 Yes E3 Not pregnant within past your E3 Unknown E3 Accident E3 Pending InYeAlgOtlOn 1:3 Pregnant at time of death C3 Suicide E:3 Could not be determined E3 Not pregnant,but pregnant within 42 days of death afore death _�2_.Date of injury(Mo/Day/W7)(Spell Month) 0 C3 Notprognent,but pregnant 43 days to I year b 33:nMe Of Injury C3 Unknown if pregnant within the post your Zip Code) 35.Location of Injury(Street and Number,City,State, f Injury(ft. 34.Place injury S.home;construction site;form;school) 38,Describe How Injury Occurred: injury,specify: So.Injury at Work 37.1 -transportation E3 Driver/Operator E3 Pedestrian C3 Yes C3 Other(Specify) C3 No C3 passenger 39s.Ceajnbr(Chock o ono): go,death occurred due to the couse(s)and manner stated E1,15rtillYing physician-To the best of my knowledge, knowledge,death occurred at the time,dote,and place,and due to the cause(s)and manner Stated nerstated -f3-Pronouncing a Certifying physician-TO the bast of my opinion,death occurred at the time.dot*,and place,and due to the couse(s)and man F Medical Examiner/Coroner-0 basis Of mination,and/or investigation,in my License Number: p c>(0 Title of certifier: 00 Signature of certifier. ge.Date Signed(Mo/r)ay/Yr) 39b.Name,Address and Zip Cod W;r;so-ncom leting-Cmus.of Death(item�6) teat, u -701 PA r Lto rr al 44w I�-tw I fl4r P-AI(II 142:1ke 40.Registrar's District Number -g-ror nature ep? 43.Amendments HIOS-143 REV 0712011 Disposition Permit No >~ co C> <D U NED ^---4' LU RECE A„w rr./ Li�.i C= CO me MAR 0 4 2013 o RENUNCIATION IRWIN&WKNIGHT SAW OFFICES REGISTER OF WILLS CUMBERLAND COUNTY,PENNSYLVANIA Estate of ROBERT B. KOEHLER , Deceased I, DAVID R. KOEHLER , in my capacity/relationship as (Print Name) SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to FREDERICK P. KOEHLER (Date) (Signature) 483 RTE 376 (Street Address) HOPEWELL JCT NY 12533 (City,State,Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of that he or she executed the renunciatior�or the purpo es stated within on this day Deputy for Register of Wills 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.) ROY 13ARTELS STATE OF NEW NOTARY PUBLIC Form RW 06 rev. 10.13.06 MY COMMISSION EXpDUTCHESS CNN IRES 01/22/2015 �1"l3 33� RENUNCIATION �ti °: REGISTER OF WILLS c� � CUMBERLAND COUNTY, PENNSYLVANIA Mw C:> C) :r-- U-1 Estai w?sR RT B.—KOEHLER , Deceased I, PETER G. KOEHLER , in my capacity/relationship as (Print Name) SON of the above Decedent,hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to FREDERICK P. KOEHLER M (Date) (Signatur) 27446 BEACON SQUARE (Street Address) FARMINGTON HILLS MI 48336 (City,State,Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the before me this day party executing this renunciation and certified of ,_ _ that he or she executed the renunciation for the purposes stated within on this day of 1 �,krc ti a o 43 Deputy for Register of Wills tary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) JAN Mares KANd Notay Public-Michigan Form RW-06 rev.10.13.06 Oakland County 14 OWC*Slon Expires March 27,2013