HomeMy WebLinkAbout03-31-06
Register of Wills of Cumberland County
DONALD T. KLEE
Estate of
also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
J./- O~- o~q A
No.
To:
, Deceased.
Social Security No. /,.; - ;)..{c - C S q'J ,,-
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with h~ last family or principal
residence at 211 0 Page St., Camp Hill, PA 17011
(list street, number and municipality)
Decedent, then 70 years of age, died December 12 , 20 05 , at
Holy Spirit Hospital, 21st Street, Camp Hill, Cumberland County, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$ 43,000
$
$
$
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
N R I' h' 'd
ame e atlOns lID Res) ence
Natalie A. Klee spouse 2110 Page St., Camp Hill, PA 17011
Pamela K. Gracey daughter 3950 Brookridge Dr., Mechanicsburg, PA 17050
Patrice K. Fehl daughter 24 Stone Run Dr., Mechanicsburg, PA 17050
Kateri K. Martin daughter 3914 Ridgeland Blvd., Mechanicsburg, PA 17050
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
Signature( s) of Petitioner( s)
4CirJ,;~
n. -k-.t~
\
Residence( s) of Petitioner( s)
2110 Page St., Camp Hill, PA 17011
Register of Wills of Cumberland County
RENUNCIATION
Estate of DONALD T. KLEE
No.
jl-Ovl- O~ql,
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned PAMELA K. GRACEY, PATRICE K. FEHL, KATERI K. MARTIN daughters
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters OF ADMINISTRATION
be issued to NATALIE A. KLEE
., {1i'- M h
Witness my/our hand(s) this rJ. day of arc
,20~,
PAMELA K. GRAC'
3950 BROOKRIDGE DR., MECHANICSBURG, PA
(Address)
Or
:',. ,;~1{'t-i (L )). ~~ILL
. (Signature)
PATRICE K. FEHL
24 STONE RUN DR., MECHANICSBURG, PA
(Address)
Affirmed and subscribed before me this
_ day of
I.. /
i1\Cl.V:
"
i )f)Z ~/*
,
(Signature)
Register of Wills
KATERI K. MARTIN
3914 RIDGELAND BLVD., MECHANICSBURG, PA
(Address)
Deputy
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Sara J. Ensinger, Notary Public
Carlisle Bora, Cumberland County
My Commission Expires Oct. 17, 2009
Member, Pennsylvania Association of Notaries
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CERTIFICATE OF DEATH
COMMONWEALTH OF PENNSYLVANiA. >>EPARTMENT OF HEALTH" VITAL RECORDS
NAME OF DECEDENT (~irst, Middle, Last)
1, Donald T. Klee
AGE (Last Birthday)
SEX
2, ~1al",
5. 70
COUNTY OF DEATH
7, Scranton P<,::
UNCER 1 DAY
Hours I Minute$
_~_ 6
CITY, BORa, TWP OF DEAl'H
DATE OF BIRTH
(Month, Dav. Year)
BIRTHPLA.CE (City and
State Of Foreigr, CO'Jntry)
PLACE 0.E.DEATH (Check onlv one - see instructions on other side
HOEiPITAL: i OTfiEq,:
Il"1patlent cgJ ERIOutp811ent 0 nOA 0 NUISi'lg
l3~.~__ Home
~t~:~ifi) 0
RACE - Ameflcan Indian, Black, While. et
(Specify)
I MOTHER'S NAME (First, Middle, Maiden Surname)
19, Mar 1 Donahue
INFORMANTS MAILING ADDRESS (Street, CltylTown, State, Zip Code)
20b, 2110 Pa e Street Cam Hill Pa 17011
PLACE OF DISPOSITION- Name of Cemetery. Crematory LOCAT!ON - CityfTown, State, Zip Code
or Other Place
21c Hollinger Crematory
NA~E AND ADDRESS OF FACILITY
22c.~1 ers-Harner Funeral Home
Yrs.
Sb, D~~~~'~ ~~~~OCClIPA TleN 8cE~~N~ o;:~~~~s~~~~~~STRY I~~,~J:~~~; D~R~N "Ie; f~\~~~~~N~ s EuUCATIO~
(GivekindOf.WOrl<:donedUring~most u.s. ARMED FORCf:.G? E~g"e~~
of wo;''"9 IIf" do 001 '" "ficed: :jQi N 0 '''"0"",,15''''d,,, '0''''9'
11a, Computer Security llbCarlisle Ivctr Coil =fj"ees 0 '3 10.121 1'-'0"'1
DECEDENT'S MAILING ADDRESS (Street. CityiTown. State. Zip Code) DECEDENT'S 17 <:' t DE--
ACTUAL a. '- fa e L .... Did
RESIDENCE ~~~~~~nt
~~e~t~~~t~y~~)ns l1b. County Cumber land mwnship?
2110 Page Street
Camp Hill, Pa 17011
16,
FATHER'S NAME (First, Middle, ~ast)
1S, Edward ((lee
INFORMANTS NAME (Type/Print)
20a, Natalie Klee
METHOD OF DISPOSITION
Burial fX] crematio~emoval from State 0
ther (Specify)
o
To the best of my knowledge. death occurred at the tiine, date and p!ace stateo.
(Signature and Titre;
23:1.
Items 24-26 must be completed by TIME OF DEATH OAT!:: PRO~IOUNCED DEAD (Month, Di'lY, Year)
peroon who pronounces doath 24, 5, :15 PM 75 D CC(li JI Ll\i' (" I ~ I ~J,[;Q.~C) "
27. PART I: Enter thl; dl~9ases, injurlea or complications wh:ch caused the dea!h. 0.:. not enter the mode of dying, such as cardill.c cr rellpirtltory ..rralll, shock (I hltart failure.
list only one (./!'use on each line.
IMMEDIATE CAUSE (Floal
disease or condition
resulting in death)---'
Q".e..::;.\-
"'\"~~~~\~O < $\~\
~\l\W'\ \ k,<<>~~ .
Sequentially list conditions
if any, leading 10 immediate
:ause. Enter UNDERLYING
CAUSE (Disease or injury
that initiated events
resulting on oeatli ) LAST
E
DUE TO {OR AS A CONSE'QUEN(;E ofi~-----
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
I OA~~ ~~,.~EA~Hi (Month. Oa:., Yea~) ~I
___l~~J~Ll}lQ~.C . .,'.' [/1:.,
3. 175 -
26
- 0597
p.esidenreO
10,
t.Jhi te
MARITAL STATUS - Married,
Never Mc.rried, Widowed,
Divorced (Specify)
14,Married
SURVIVING SPOUSE
(Ifwife,givemaide'lname)
tb talie Jenninps
17e. 0 'yes. dec'=ldent lived in
__ twp.
17d. [J" ~ijhi~e~~~~?~j~i~~ of
Camp Hi 11
city/boro.
LICENSE NUMBER
23b. 23c.
WA,S CASE REFERRED TO A MEDICAL EXAMINER ICORONER?
26, R-1'"f .~ FV . No 0
: Approximate PART II: Other significant conditions contributing to death, out
. interval between not resulting in the underlying cause given in PART I.
: onset and deatt:
Natural
o
o
o
Pending Investipation
Could not be determined
~~ OF INJUHY
o I (Moo,", C"y, Y"'I
D
30a, 30b, M
o PLACE OF INJURY - At home. farm, street. factory, office
building, etc. (Specify)
30e.
Yes 0 No 0
30e. 30d.
LOCATION (Street, CityiTown, State)
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
Homicide
Accident
Yes 0 No QQ
Yes 0
NoD
Suicide
28a. 2ab.
CERTIFIER (Check only one)
.~~~~:F~~tGor~;~I;~~eWghl.S~c~~rh C~~~i~r%aaduj: t~ ~e:~a';j~:~(~r~~3rJ~X~i.;~a~s h:t~r:~~?~~~~.~ .~~~~~. ~~~ .~?~~~:~~.~ .i~~~: .:~).
29.
"PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certifying to cause of death)
To the best of my knowledge, death occurred at the time, date, and place, and due to the causes(s) and mannar as stated....
"MEDICAL EXAMINER/CORONER
~~~~:rb::':t:tfe~~~.~I.~atjon andlor In~~~~~~~~~~.~: .l.~,~~ .O~I,~~~.~: ,~~~.t~ .~ccurred at th~. ti.~~.'. ~.~~~.'.~.~~.~.l~.~~,. ~~.~.~,~~.~~ ,t.~~..~~~~US(S) and. 0
31a.
REGnR'S SIGN~ ~,.N~MBER
t...VJ'vn.. / / / '/ ?'j-r1",U/P"'?':Z ~I ~I /Jd
33. "" - (1'" ~
TIME OF INJURY
INJURY AT '''laRK? DESCP.IBE HOW INJURY OCCURRED
ff'\
/.5'", ';OO.r-
.,
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA
}
SS:
COUNTY OF CUMBERLAND
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 ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affimled and subscribed
Before me this.~ day of
N\('\ R.t ti- -,20 nlp
LI' --- \. \! .
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Estate of Donald T. Klee
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, Deceased
GRANT OF L~TTERS OF ADMINISTRA nON
~ APRIL
AND NOW this 3 day of t R I L. 20~, in consideration of the petition on the reverse
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Natalie A. Klee
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Natalie A. Klee
in the estate of Donald T. Klee
$
$
$
$
$
Automation Fee................... $
Bond............. ......... ...... ..... $
Filed -1 .'!!1al- 20ClD $
~1trh'uU.lJt:ll \4ili~Cl C\
'\ ' ( Register ofWi~ ) 'tlL :n, ,~ltl..(t'~f~1
Sio .00 83993 7t'-4\/V\-- 1~{1-~-----,:- if-
Attorney (Sup. Ct. l.D. No.)
Thomas E. Flower
2109 Market St., Camp Hill, PA 17011
Address
,-Pj.CO
~ . DC
~.DC
\.OC
I \K.OC
717-737-3405
FEES
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