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HomeMy WebLinkAbout04-24-13 PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Cumberland County, Pennsylvania Petitioner, named below,who is 18 years of age or older, applies for Letters as specified below, and in support thereof, avers the following and respectfully requests the grant of Letters in the appropriate form:: DECEDENT'S INFORMATION Estate of CAROL O. KIRK File No. � L-1 a/k/a CAROL ANN KIRK Deceased Social Security No. 217-42-7510 Date of Death: April 6, 2013 Age at Death: Decedent was domiciled at death in CUMBERLAND County,Pennsylvania,with her last family or principal residence at 5155 Kylock Road Mechanicsburg, Cumberland County PA 17055 (List street,address,town/city,county,state,zip code Decedent died at 5155 Ky1ock Road, Mechanicsburg 17055 Upper Allen Township Cumberland Co. PA List street,address,Post Office and zip code city,township or Borough County State, Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property.....................................................................$ 300,000-00 (If not domiciled in PA) Personal property in Pennsylvania.....................................$ (If not domiciled in PA) Personal property in County....................................................$ Value of real estate in Pennsylvania......................................................................................................................$ Total.........................................................................................................$ 300,000-00 Real Estate situated as follows: (attache additional sheets if necessary) Street address,Post Office and Zip Code City,Township or Borough County,State A. Petition for Probate and Grant of Letters Testamentary Petitioner avers he is the Executor named in the Last Will of the Decedent, dated December 30 1987 State relevant circumstances,e.g.renunciation,death of Executor,etc. Except as follows, After the execution of the instrument offered for probate, Decedent did not marry,was not divorced, and was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce has been established as defined in 23 Pa.C.S.A. § 3323(g)and did not have a child born or adopted and the Decedent was neither the victim of a killing and was never adjudicated an incapacitated person © NO EXCEPTIONS ❑ EXCEPTIONS (M " El B. Petition for Grant of Letters of Administration (if applicable) rn -ts enter:c.t.a.;d.b,n,c.t.a.;pendent elirr=; F"absej ia;dUrbAlminoritate If Administration, c.ta. or db.n.at.a., m -n Except as follows: Decedent was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce has been established as defined in 23 Pa.C.S.A. § 3323(g)and was neither a victim of a killing and was never adjudicated an incapacitated person ❑ NO EXCEPTIONS ❑ EXCEPTIONS Petitioner, after a proper search, has ascertained that Decedent left no Will and was survived by the following spouse (if any)and heirs(attached additional sheets, if necessary) Name Relationship Residence OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA . Official Use Only COUNTY OF CUMBERLAND Petitioner's Printed Name Petitioner's Printed Address PETER D. KIRK 5155 KYLOCK ROAD MECHANICSBURG, PA 17055 The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Mrn n Sworn to and affirmed and subscribed mss ' PETER D. KIRK M C*> Before me this_ day of ;° r" r" r'+i r- rn —� 2013. U' -c For the Register Cn a BOND Required 0 YES B NO FEES : To The Register of wills Letters........................... $ 31vo Please enter my appearance by my signature below: {t ) Short Certificate(s) $ p'LA.1 Attorney Signature: { } Renunciation..............$ { } Codicil(s) $ { }Affidavit(s).................. $ Bond $ Commission $ nted Name: JERRY R. DUFFIE e $_ — Supreme Court I i $ lMD I.D. No: 09601 Firm Name: Johnson Duffle Stewart& Weidner, WON $ Address: 301 Market Street P.O. Box $ Lemoyne, PA 17043 Automation $ Phone: 717-761-4540 � JCP Fee....................... $ Fax: 717-761-3015_r � TOTAL......... $ Email: JRD(a jdsw.com DECREE TO THE REGISTER Estate of CAROL O. KIRK a/k/a CAROL ANN KIRK , Deceased. File No. o.�'!{J•17 Social Security No: t�2111��7-42-7510 Date of Death: April 6, 2013 AND NOW, Y �� , 2013, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary are hereby granted to PETER D. KIRK in the above estate and that the instrument dated December 30 1987 described in the Petition be admitted to probate and fil d of record as the Last Will of the Dec ent. egister of Wills H105.805 REV(9/11) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 f,,fyl��"' --- This is to certify that the information here given is NTH OF p P == FNyf an original duly filed with me asLocalRstrar.. The oo original - Z certificate will be forwarded to the State Vital Records Office for permanent filing. P 194 5472 '=°q � a�?''� -.IMfNT 0 � Certification Number """"""'"FFffIF Local Registrar Date Issued se/Print In COMMONWEALTH OF PENNSYLVANIA•DEPARTMENT OF HEALTH•VITAL RECORDS " ' CERTIFICATE OF DEATH socck k Ilk' State Fill Number: 1.Decedent's Legal Name IFirst Middle,last,S.M.) Z.Sax 3.Soclal Security Number d.Date of Death IMo/Dav/Yrl(spell Moil Carol Ann Kirk Female 217-42-7510 �{ n I (y X013 Sate age-fast BlrthdaY IYrsI Sb.Under l Year 5c.Under 1 Day 6.Date of Birth(M./Day/Year)(Spell Month) 7a.Birthplace(C"and State or Foreign Country) 69 Months wy Hours Mloutn May 14 1943 C23ambers Penns Mtnia y I 71.Bhthplace(County) Franklin r.�� ..••�yqq 8a.Residence(Slot.or ForNFn Country)dge.8b.Residence(Street and Number-Include Apt No.) Bc.Dld Decedent Live In a Township? C- Ina Penns ly) 5155 K lock Road es,decedent lived In tipper Al len 40 Wp. `j = r" ea.Res de e(DOUmty) Y M Resident.(zip Code) 17055 ❑No.decedent lived within limits of C ty/bom. 9.Ever in US Armed FOrcea7 10.Marka]Sta'us at""of Death �MSrrled ❑Widowed 11.SUMNng Spouse's Name(If wlfe,give name prior tofl r ❑Yes 1p No ❑Unknown ❑Divorced ❑Never Married ❑Unknown Peter Kirk a 12.Father's Name IFirst.Middle,Last,Sumx) 33.MotheYS Name Prior to First Marriage(First Middle.Last) RT1 .,,may Harold E. Ocker Janet L. Hall lea 17110 9��1 14.Informant's Name ldb.Relationship[o Decedent 114t.Informant's Milling Address Side Peter Kirk 5155 R lock Road M C r. 1 5 G ___ ti_ ____ ____ ea g If Death lkcurred In a Nosplbl: �Inpatient IIf Death Occurred SomewhttecOther Than a Hospital t�Hospice Fadlky y,Dec�t's oma 7 ❑Emergency Roum/❑ut setient ❑D.ad cn AMwl 1 ❑NUning Home/Long Term Care Facility ❑Other(Specify) �„r4 15b.Facility Name(H not 01utlon,gale street and numbs) 15c.City Town,State,end Zip Code ISd.County of Death 5155 K lock Road Keellanicsburg, PA 17055 Clunberland C� C�a m16a.Method of Olsposltlon tx Burlal ❑Cremation 16b.Date of Ohposkion 16c.Place of Disposition(Name of cemetery,crematory,or other plat �� "",•, I ❑Removaltrom Stale ❑Donation abet April 12, 20 3 Rolling Green Cemetery �O ❑ Sxdlyl ry 16d.Ittadon of DlnposlHOm(City or Town,State,and Zip) 17a.Slgnrt Funeral Service its or Person In Charge of Interment 17b.Lkeme Number v 7 V Camp Hill, PA 17011 FC?-138630"U G �1 17c.Name arM Compiet!Address of Funeral Facility wkst 00 3R Mal zzi Funeral Hone 8 Market Plaza Way, hanks , PA 17055 .1 1B.Decedent's Education-Check the box that best sesedbes ten 19.Decedent of Hispanic Origin-Check the 20.Decedent's Race�Check ONE OR MORE races to indicate what s= 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 ❑Ith grade or less is Spanish/HispanicAatino Check the"No* Whlre ❑Korean ❑No diploma,9th-12th grade box If decedent is lot Spanish/Hispenk/LatIm. ❑Black or African American ❑Vemnt.e. ❑High school graduate or GED completed X No trot Spanlsh/HlspankA tlno ❑American Indian or Alaska Net" ❑Other Asian ❑Some college creek,but rro degree ❑Yes,Mexican,Marshal American,Chlcam, ❑Asian Indian ❑N.H.Hawaiian ❑As latedesme(e.g.AA,AS) ❑Yes,Puerto Rican ❑Chinese ❑Guamanian or Chamorro IA Bachelor's degree(a S.BA,AB,55) ❑Yes.Cuban ❑Filipino ❑Samoan ❑Mines degree(e.g.MR.MS,MEng,MEd,MSW,MBA) ❑Yes,other Spanish/HlspaniUlatino ❑Hhumaue ❑Other Pacific Islander ❑Doctorate p.g.PhO,FEDI or Pmfeso,al degree (Specify)__ ❑Other(SPaClfy) !..MO DOS DVM LLB ID 21.Decedent's Sidgle Race Sell-Oesignatbn-Check ONLY ONE to IMicate what=Went considered himself or herself to be. 22•.Decedent's Usual Occupation-Indicate type of work Rj White ❑Japan.. ❑Samoan done during most of working life.DO NOT USE RETIRED. ❑Black or African American ❑Korean ❑Other Pacific Islander Homemaker American Indian or Alaska Native ❑Vietnamese 13 Don't Know/Not Sure ❑Anin Indian [I Other Asian ❑Refused 22b.Kind of Buslness/IMustry []Chi_ ❑Native Hawaiian ❑Other(specify) ❑Filipino ❑Guamanian orChamorro Own Hone ITEMS 23a-23d MUST BE COMPLETED 23a.Date Pronounced Dead(MO Day/* 2M Ignecii,of Persen Pronouncing Death IO W when applicable) 23c.Ucense Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH 23d.Data Signed IMo/Day/Yr) 20.Time o Death �u(J F.Ym 25.Was Medical Examiner or Coroner Contacted? ❑ Yes No CAUSE OF DEATH : Approximate 26.Part I.Enter the chain of events--diseases,injuries,or wmplkatbns-that directly caused the death.DO NOT enter terminal events such as cardiac•nest I Interval: respiratory arrest or samrkuin fibrillation wkhoutshowing the etiology.DONOTASBREVIATE.Enter only ongcause an aline.Add additional lines lfnecenery. I Onset to Death t L. I IMMEDIATE CAUSE -..-_.__.-_> a. M64,:.Qd C'I'ic etG VA_a'l r(. CKa.,,,e✓• I (FlMlliss. -peon (er as acanuquence oft: resufteg In death) 1 b. SegsrcnHagy list coMitbm, Due to(or as a consequence on: H a-baling to the cause listed on Nn!a.Enter he c. UNDERLYING CAUSE Due to(or as a consequence of): fi iva.or Injury that Q Initiated the even.resulting d. In death)LAST. Due to(or as a consequence of): 3 26.Part fl.Enter other slenificant coneltlom contrNlutlna ro death but trot resulting In the uroerlying cause given In Pan I. 27.was an autopsy peed? ❑Yes No F 28.Were autopsy findings avallable to compiete the case of death? ❑Yes No 2 29,If F/�^ale: 30.Did Tobacco Use Contrbute to Death? 31. a er of Death E r Naltpregnam with],Past Year ❑Yes Probably Natural ❑H-iol 9 ❑Pregnant at time of death ❑No Unknown ❑Accident ❑Pending Investigation ❑Not pregnant but pregnant within 42 days of death [3 Suicide (3 Could not te determbed [3 Not pregnant but pregnant 03 days to 1 year before death 32.Date of Injury IMo/Day/Yll(Spell Month) ❑Unknown If pregnant within the past year 33.Time of Intory 34.Place of Injury(e.g.home;construction site;farm;school) 35.Location of Injury(Street and Number,City,County,State,Zip Code) 3fi.Injury at WOrk 37.11 Transportation Injury,Specify: 38.Describe How Injury Occurred: ❑Yes ❑Other/Operator ❑Pad.Man ❑No ❑Passenger ❑Otber(Speclfy) 39 Ondfler-physklan,certified nurse pnctkbner,medical essiolmo/coroner(Check only one): Certifying only-To the best of my knowdedge,death occurred due to the cause(,)and manner stated. Prorwunclng B CertHVing-To the bed of my krrowiedge,death mc-ol at Me time,date,and piece,and due to the causes)and manner stated. ❑Medical Welliver/Coroner-On t is of Amination and/w Invnbgatbn,In my opinion,death occurred at the time,date,and place,and due W the causes)and manner stated. Signature of e.rtlRe,: This of c.rtmer: VA h Uce,e Number: Nl)�Ei'ZZ//�f 3% epee,Address and Zlp code of Person completing Cause of Death lltem 26) n 39c. te Syned IM./De,/1') ua /70 2d/3 Q.likirdive,Dind.Nu d1.RH r a ! d� gl j r File�IMo-, rl AL AIN 1+ lfl 43.Amendments nnn-s-nn H105-143 kirk.wl �aot Bill =0 Ovotatumt C> M C-i rn C 7-U of . r" r'0 ;;; r i CAROL O. KIRK - 7 r, ca -7 �3 I, CAROL O. DIRK, of Upper Allen Township, Cumberland Coaty, P&h1sy4,vdffi*a, declare this to be my Last Will and revoke any will previously Made by me. " I. I bequeath my automobiles, household and personal effects and other tangible personalty of a like nature (not including cash or security), together with any existing insurance thereon, to my husbank, PETER D. KIRK, provided he shall survive me by thirty (30) days. Should my husband, PETER D. KIRK predecease me or die on or before the thirtieth (30th) day following my death, I bequeath such tangible personalty and the insurance thereon to my children, LAURI ANN KIRK, WENDY LYNN KIRK and BRADLEY DAVID KIRK, as are living on the (31st) day after my death, to be divided among them by my Executrix with due regard for their personal preferences in as nearly equal shares as practical. 11. I devise and bequeath the residue of my estate of every nature and wherever situate to my husbank, PETER D. KIRK, provided he shall survive me by thirty (30) days. Should my husbank, PETER D. KIRK, predecease me or die on or before the thirtieth (30th) day following my death, I devise and bequeath the residue of my estate and every nature and wherever situate, in equal shares, to my children, LAURI ANN KIRK, WENDY LYNN KIRK and BRADLEY DAVID KIRK. In the event that any of my said children, LAURI ANN KIRK, WENDY LYNN KIRK or BRADLEY DAVID KIRK, should not be then living, then I devise and bequeath his or her share to his or her then living issue, per stirpes, and in default of said issue said share or shares shall be added to the share or shares of my surviving child or children or his, her or their issue, per stirpes, as applicable. kirk.wl III. I appoint COMMONWEALTH NATIONAL BANK, of Harrisburg, Pennsylvania guardian of any property which passes, either under this will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discreation to distribute a share where possible to the minor or to another for the minors benefit. Such guardian shall have the power to use principal as well as income from time to time for the minor's support and education (including trade school and college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payments for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. IV. I direct that all taxes that my be assessed in consequence of my death, by whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expense of the administration of my estate. V. I appoint my husband, PETER D. KIRK, Executrix of this, my last Will. Should my husband, PETER U. KIR1: , fail to qualify or cease to act as Executrix, I appoint my daughter, LAURI ANN KIRK, Executrix of this, my last Will. Vi. I direct that my Executrix, or his successor shall not be required to post bond for faithful performance of their duties in any jurisdiction. - 2 - kirk.wl IN WITNESS WHEREOF, I hereunto set my hand and seal this 3 day of December, 1987. l . (SEAL) Carol O. Dirk Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have hereunto subscribed our names as witnesses. �' C—­_(SEAQ �" SEAL) - 3 - kirk.wl ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND 1, CAROL O. KIRK, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. • Carol O. Dirk Sworn to or affirmed and acknowledged before me, by Carol O. Kirk, the Testator, this 3o+`�Nday of 1981 Notary is Idy commission expires: A"IG, Notary Public My Commission Expires Dec. 21, 1989 Dyne, PA Cumberland County 4