HomeMy WebLinkAbout01-27-06
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PETITION FOR .PROBATE and GRANT OF LETTERS
Estate of [. T {-\ (\- l. \< E LiE '1 No. ~ '\- 'J ~ - <:J \:1 ~ \..\
also known as To:
, De~eas~d. ~~~~~r ~:~i~~~t~ in the
Social Security No. / 'g(/.) - )~ - "\ <::4--l.f- Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older an the execut r l y:
in the last will of the above decedent, dated .:r ~ ~ ..1. \ q g X'
and codicil(s) dated
named
, 19_
(state relevant circnmstances. e.g. renunciation. death of executor, etc.)
Decendent was domiciled at death in La \Af'SL^ t= ~ ~u r ~ T ufCounty, Pennsylvania, with
h: tL. r last family or principal residence at IS \ 1 V\<- ~ So c,"'i' Ad.
_ _' .......1.,'-<-.- '? ~ \'-'"10\3-
(list street, number and muncipality)
Decendent, then llo years of age, di~d . --y ~ {\. \ 'K 2-- 0 0 ~ , 19
at " -- "1 c vJ-r..s;2.A 6:> R ~cl~ t.,,(-'2... PA .
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domicile~ ~n P~.) All personal pf.Ppe~y . $ 3 O. t}7J7')
(If not domICIled In Pa.) Personal property In Pennsylvama $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $.
situated as follows:
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters
(testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
theron.
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OATH OF'PERSONAL REPRESENTATIVE
TH OF PE~SYLY ANIA } ~s
COMMONW
COUNTY OF
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and SUb. scribed { 'f p;,,;u~ k (!/&~~ ~
before me this ').. "\ \-'<'\ day of =:::z== G Y::i
~:.. _ ~~h . a
~ .~~~~ ~
~ <Q. .\Z~ \ ~...,<;)~) Re"ifster ~
-
No. ~\ ~ ~~ .. ~~ ~\..,
Estate of i:+h., ( L \L-d le 1 . Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW -.s ~~~"( ~ ~'l ~~, in consideration of the petition on
the reverse side hereof, satisfactory proof having be<ln presented before me,
IT IS DECREED that the instrument(s) date~ ~) I q B~
described therein be admitted to probate and filed of record as the last will of t +Y1 '2-{ I
k:!ley
and Letters T "- "> ~'" ~ +a. k '\
are hereby granted to <7 II _
Q~Ch(~
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FEES
Probate, Letters, Etc. ......... S ~ ~
Short Certificates('3) . . . . . . . . .. S ~~ r
Reeuasiation .~~~~......... $ \ S
-~~ ~ ~~ ~'"''\~ ~""~ $ \S
TOTAL _ $ \~\) .~~:J
Filed ............\:.);:-..; ~.~. ...... .. . .....
w.ll, ~'- ~ 60v l (~S
ATTORNEY (Sup. Ct. I.D. No.) "3 (1~..j"",
2, W. H \"\h ~r-
ADD~S
Qd--l'l(~le PI\- i/(Jl~
PHONE "/ I -, ). '-t ""J I '1 'q 0
HI fl5.R()<;; RFV 1/'15
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This is to certify that the information here given is correctly copied from an original certificate of death duly filed with
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
No.
l1'~~. ~~H~~
Local Registrar
p
12269345
JAN 2 0 :;'006
Date
H105.143 Rev. 01106
TVPEIPA/NT IN
PERMANENT
BLACK INK
1 Name orOeeedenl {FirsL middle. Iasl)
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
I .
Ethel L. Kelley
5. Age (LaslbirthdllY)
76 v"
Bb. COllntyolDeath
3. Social seellrity NUfTDer
28
4 Date 01 Oaath (Monlh,day, yea,)
January 18, 2006
7. Dale of Birth Month,da , ear
1929
Cumberland Lower Frankford Twp.
13. Decedanl's EdllC8liofl S eei
EJement<!rylSeeOndary(l).-12)
A!
White
1517 McClure's Gap Rd.
Carlisle, Pa 17013
178. Stale
PlI
hi esl de co leted 14. Marital Status: Married, Ne'ier married, 15. Surviving Spouse (If wile, gwa maiden nama)
Collegll (104 or 5+) Widowed, OMltced (Spscj.)j
Never Married
Did Decedenl
Lr,.e in a He. ~ Yes, Decedent Lived in T.r'\tJQr Fr--.::lln lrFf"\'t""O Twp.
Townsh~?
17b, County
Cumberland
17d.D No,Dececlenll.ivadwfthin
Pdual limits of
C~l8oro
1& Falher's Name (First, middle,last)
Roy M. Kelley
19. Molher's Name {First, middle, maiden Sllrn~18l
Romaine Yeingst
208. Informanl's Name (Typelprinl)
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21b. Dale 01 Dispos~ion (Month, day, Yllar)
200. lnlofmaol's MiMing Addr8S& (Street, cilyl1own, stall. zip cod,)
1517 McClures Gap Rd.
Carlisle, PA 17013
Evelyn K. Craig
21c. Place 01 Disposition (Name olcemelary.crllm&toryorolherplacej
Westminster Cemetery Carlisle, Pa 17013
220. .."" ",Ad,.... ,IF.o;'.,. Hoffman-Roth Funeral Home
219 N. Hanover St., Carlisle Pa 17013
23b. license Nulrber 23c. Dahl Signed (MoI1th,day, year)
21d. location (Cityltown, stale, zip Code)
. Ilems24.2tirnustbtlcOrJ1lleledbyperson
wIIo pronounces d8ll1h
24 Time or Dealh
25. Data Pronollnced Dead (Month,day,year)
4:47
A".
January 18, 2006
26. Was Casll Referred to a Medical ExaminerfCoroner?
CAUSE OF DEATH (See instructions 100 examples)
ham 27. Part I: Enter lhe ~ -diseases, injuties,orcorrplications -that direclly caused thedealh. DO NOT enler terminal e'ianls soch as cardiac arrest,
rllspiralory arrest, or 'illntncular Ibrillalion without showng the etio~. DO NOT abbreviale. Enter only one cause on a ~ne. ......r;
'..EDIATE CAUSE (R","..."", A ('-'1'[ /" 1~ Clt/lr1i I(Z, /.v rit/it f (.::?-v
conclMlOnresultiogindeatll) ~ a.
D"",("'.m'J'Z!.....o~' "'^, "7 1'7'1 /?//t~)1~......
SequenliaRylistconditions,iflny, ~ .V~"-_/r /...._ 1/._"
. =~~o ~~D~~~~:~c~ur:e a. Dllll kI (or as a consequance ory'
. (diseaseorinjurylhatinitialedthe
evllnls resulting In death) LAST.
DYesQ[No
Awroximatein!llrval:
onsaltodaath
Part II: EnlerOlhersionificantcondiionscootributinalode.ath,
but nOlresuninginthaundilrlyingC8usegivenin Part I.
28. Did -:-obacco Use Contritlllle to Death?
DYes 0 Probabty
,... No 0 Unknown
29. UFemale'
~ Not pregnant within past year
o Pregnant allime 01 death
o Not Pfegnant, but pregnant within 42 days
oldealh
o Notprllgnant, 001 prllgnant 43 days to 1 year
beloredealh
o Unknown if pregnant within the past year
32c. Place 01 Injury: Home, Farm, St,ee!, Facloly, Office
Building, etc. (SpeciM
Due 10 (or as a conseqUllnce o~.
DYes .,. No
,
3Ob. Were Autopsy Findings
A\I3ilable Prill/lo Co~lion
of Causa 01 Death?
o Yas 0 No
31. Manner or Dealh
)8;,Nalllral 0 Homicide
'0 Accident 0 Pending In'iestigalion
o Suicide 0 Could Not Be Delerrrined
32a. Daleollnjury(Month,daY,Yllsr)
32b. Dascrbe how Injury Occurred
308. Was an Autopsy
Performed?
32d. Timaoflnjury
'2 / 33d.OaleSigned( h,da!,,.r) /
L- Of ~ ytt~ <> 6
Nsms and Address of Person Who Coff1)IeI,- GaUSIl 01 Death (illlm 27) TypelPrflt
f?t,: (/ ;4/"f' 4-?;-..(/ -t:f'. u. 'L ~ 1r
2---"2/& Ir',' { :? r7'-V > r- . (/r"/C. C-,) c (." I ?~." ;J
32e. Iniuryal Work?
o Yas 0 No
321.
32g. Location (Streal. cityllown, slala)
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338. Certifier (check only one)
Certifying physkl.an (Physician cllrtifying C8lJ.5e of death wt1en another physician has prooounc:ed death and cotllIlet~ Ram 23)
To the best 01 my knowledge, dtyrh occurred due to the cause{S) and manr.er as stated _....h....._....._.....
Pronouncing and certifying physician (Physician boIh pronouncing death and r.ertifying \0 causa 01 death)
To the best of my knowlsdge, death occurred at the lime, date, and pla<:e, I'M! due to the cause(s) and manner as stat8d.......~._...
Medical examlnerlcoroner
On the blsls of eXllmlNlllon and/or In\'e5tlglllon. In my opinion, de,;th occurred al the time, dlte. and place, and due to the cause{s) and manner as stated
35 ., !,~~'"'~~~~&.~
l,,;'tll 1~IIIOI
(See instructions and examples on reverse)
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LAST WILL AND TESTAMENT Ot'
ETHEL L. KELLEY
I, Ethel L. Kelley, of Lower Frankford Township, Cumberland
County, Pennsylvania, declare this to be my Last Will and
Testament and revoke all Wills and Codicils previously made by me.
ITEM I: I direc~ ~hat all my legally enforceable debts and
funeral expenses, including all expenses of my last illness, shall
be paid from my residuary estate as soon as practicable after my
decease as a part of the expense of the administration of my
estate.
ITEM II: I devise and bequeath all of my estate of every
nature and wherever situate in equal shares to my brothers, Leroy
R. Kelley, Harvey O. Kelley and Marlin F. Kelley, and my sister,
Evelyn K. Craig. Should any of the above named persons predecease
me, I devise and bequeath his or her share of my estate to his or
her issue, per stirpes, surviving me, and in default of any such
issue, his or her share of my estate shall be added to the shares
for the other named persons, or their issue.
ITEM III: I appoint my said sister, Evelyn K. Craig
executrix of this my last Will. Should my said sister fail to
qualify or cease to act as executrix, I appoint my brother, Leroy
R. Kelley executor of this my last Will.
ITEM IV: I direct that all fiduciaries acting under this
Will, whether or not named herein, shall not be required to give
bond for the faithful performance of their duties in any
jurisdiction.
ITEM V: I grant unto my personal representative the power to
sell, pledge, mortgage, lease or exchange, or to grant an option
for a purchase, lease or exchange of any real estate which I own
fA1-~
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at the time of my death.
IN WITNESS WHEREOF, I have hereunto set my hand and seal,
this ::3 day of February, 1988.
D ?7J~. n
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[SEAL]
The preceding instrument, consisting of thjs and one other
typewritten page, each identified by the signature of the
Testatrix, was on the date thereof, signed, published and declared
by Ethel L. Kelley, the Testatrix therein named, as and for her
last Will, in the presence of us, who, at her request, in her
presence and in the presence of each other, have subscribed our
names as witnesses hereto.
7~K~~~
./
iJ?i fit 06<<~)
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
We, Ethel L. Kelley, William A. Addams and Evelyn K. Craig,
the Testatrix and 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 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 a~Je or
older, of sound mind and under no constraint or undue influence.
C;~..J: ~ J~
- Testatrix
<~~~- -
> Wltness
1J, LA) 1~, (Lli-~
, Witness
\
Subscribed, sworn to and acknowledged before me by Ethel L.
Kelley, the Testatrix, and subscribed and sworn to before me by
William A. Addams and Mary M. Price, witnesses, this '1 day of
_/
February, 1988.
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Notary Public
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