HomeMy WebLinkAbout07-24-06
Register of Wills of Cumberland County
Estate of J 0 ,oj r<Jv.); '- '- \ .s KE , rY1
I k .,) ~ '~ - IY)
aso nownasB~~~ JC~':) ~
, Deceased.
PETITION FOR PROBATE and GRANT OF LETTERS
No. Q/ - (JU - (fl~5 ~
To:
Social Security No.
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, and the execut.q 1)< named in the last will of the
above decedent, dated A tt c- us 'dS- , 20 () .j
and codicil( s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in t. IA f'Y) <3 E{2.. L. fI tv D
Penns, ylvania, with hLslast family or .P, rincipal residence at " "
'1 Leu..} 6..5 DO (U= W4 '/. c..fl ~ Li .5 Lot.:: V 1\ I '/ (; j 3
( , l
(list street, number and municipality)
0. . . C:..vV"rlI3r.(l..t1 "'-"> C;zc.(.5; ~(, ( k,Z77/L.f;; r::' GIVT
Decedent, then ),,}... years of age, dIed J vL'j 11,0 ,20 L't" , at I I-<.tJ(.;, bC'~C 'vJr"J'f LrM.u.}(<.:'" PH
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after I
execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent:
County,
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 ofreal estate in Pennsylvania
situated as follows:
$ . 30 , 000
$
$
$
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.)
~
thereon.
Signature(s) ofPetitioner(s)
~df;-4~4e~4< ~~
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Residence( s) of Petitioner(s)
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
}
SS:
The petitioner(s) above-named swear(s) or affmn(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 affmned al1?fubscribed. {
Before me this d\ ~ day of
n ~ ' 20 C;J...iJ
~~tvh~~6u~
vp-e~ ~ ~ L~t~:.. .-T7.
I~ No~ -010 >
Ed.., of ~ II L. ~ p; 0 ~~ , n..,...d
DECREE OF ROBATE AND GRANT OF LETTERS
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20<J1.q in consideration of the petition on the reverse side
having been presented before me, IT IS DECREED that the instrument(s), dated
, described therein be admitted to probate filed record as the last will of
; and Letters are hereby granted to ..~ -rY1:.64 ^ J
d~U1r&~ "
Register of fIfs
FEES
Probate, Letters, Etc. ............. $
Will. .. . . . . . . . . . . . . .. . . . . . . . . . . . . .... $
Renunciation....................... $
Short Certificates ( ). . . . . . . . . . . . $
JCP. .. . . ..... . .. . .. .. ..... .. . ..... . .. $
Automation Fee..... .... .......... $
Bond................... .......... .... $
Total $
Filed ~A->- ~ '21 .;;g- 20~
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Attorney (Sup. Ct. LD. No.)
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210C1 H Mt.f:-t .STI
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717 7s1 ~~Or--
Phone
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TYPE/Pfl INT IN
PERMANENT
BLACKlNl<
1 Name ot Oecedont (Firsl. mKldle, last)
John W. Keirn
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
J. Social Secuf~yNurrtler
4 Dale 01 Death (Month. day. 'leaf)
July 16, 2006
5 A(j{I (lClSI birthday)
92
v"
7, Dateo/8irth Month,do
Apdl 10,
8b. CmmlyotOea\\I
Cumbecland
s. Middleton Twp.
11, Decedent's Usual Dce lion Kind of wolk done durin most 01 workin lile; do no! stale retired
Kind oj Worll car~~ 8U~lffgrl:USlry
16 Oocedent's Mading kidress (Stree\, dtyflowfI, s\ale, z~ code)
1 Longsdorf Way
Carlisle PA 17013
13 Deeedent'sEducation 5 eet 0
E~mentallecOndary (0-12)
l7b. County
PA
Cumberland
ST.UE FILE NUMBER
189 09
Sa. Place of Dealh Check on one
Hospital'
o In alieni 0 ERtOu\ tieni C1 DOA Ql N\JI!'. HOlm
g, Wa!; Decedent 01 Hispani: Origin?
XI No 0 Yes (lfyes, specify Cuban,
Mexican. Puerto Rican,elc.)
,
.,
, )
)
"I
c,
o Residence 0 Qher. S
10. Race: American Indi8n. Btack. While, etc.
(Specif)1
White
Did Decedenl
Liveina 17c.IK Yes, Decedent Lived in
TOWliSh~'l
H Mal~a~ S\alus: MaITial, Ne...el married, 15, Surviving Spouse (11 wite, give maiden Mme)
W~joW9d. Divorced (Specify)
Widowed
Twp
h' hesl adeco k3\ed
College (1-4 or 5+)
19. Molher's Name (First, middle, maiden surrlarne)
Martha Groff
17d.IJ No, Decedenl Lived within
AclualLimils of
18 Fa\hefsName(Flrsl,middle.lasl)
Guy R. Keirn
208, Informant's Name (Typalprint)
Mary Lou McGinn
2l:*l. Inlormant'S Mailing Address (Street, cityllown, state, zip code)
13 Bentley Place, Carlisle PA 17013
o
w
U)
::J
U)
..;
::;
..;
July 20, 2006
21c. Place of Disposilion (Name or cemetery, cremalory or other place)
Westminster Mem. Gardens
21d, Location{Cityl1own,state,~code)
Carlisle PA 17013
'sle
21b.DateofDisposilion(Month,day,year)
21a MelhodofDisposilion
JIJ Burial 0 Cremation
o Olher. Specify:
22'.;i,:&::;ts'~Zt"'!7_Ze&: 220 ~~;~"ZL
Co Ie Items 23<l-G only whell certifying 238. To the bast 01 my kr.owledge, death occurred at the lime. date and place stated. (Signature and titte)
physcianis not available at time ofdaa!h 10
cer1ify cause otdaath
o Rall1Ovallrorn Slale
S. Middleton
CilVl8oro
22c. Name and Address of Facility
Hoffman-Roth Funeral Home, 219 N. Hanover St.,
.. 1\ems 24-26 must be oonv1eled by person
.. wnoPfonouflCesdeath
24. TrmeofDeath
25, Date ProoourlCoo Dead (Month, day, year)
8:45 July 16, 2006
CAUSE OF DEATH (See Instf1JCtlons and examples) : Approximale interval'
ttem.27. Part t Er1tefthe~_diseases,~fJlies,Of~Iiof\S-\Im\dif9C\\yca\lSed\hedBath. DONUT eniellerminalevenlssllChascardiacarresl. ~ Qnsettodea\h
respiratory arrest or ventrrular ttwUabon without showmg the etiology DO NOT abbreViate Enter only one cause on a line _.. '
IMMEDIATE CAUSE (F,,,,'d.,,,,,, @; ~. ~ !1 / ,V:
cond~K1n[eStlftlnglndeath) ---> aE 4~~~~-t.-.-:
Duelo(or saconsequenceo~ /... . ,
Sequemla"Y Ust condi\'OO!'. it any Ci "., :
leadlllg 10 Ihe cause IlSledon Linea Due to {orasa conseQuenceoQ ;
.. Enter Ille UNDERLYING CAUSE '
.. ~~~~~~~~~~~~1nl~~~i~~~~ihe Due 10 (or as a oonsequence 00 :
308. Was an Autopsy
Performed'l
Oie5~
d
JOb. Wefe Aulopsy Findings
Available PriOltO COlTlllehon
clCallSeo-lDe2l\h1
DYes ~o
32d. Time of Injury
32a.Dateoflnjury(Monlh,day,year)
31 Ma~.ofDeath
TINalural 0 Homicide
o Accident 0 Pernling Investigation
o SuickJe 0 Could Not Be Determined
l-
Z
W
o
w
u
w
o
u-
o
w
'"
..;
z
35a. Certlfler\c\)ed<,onlyooe)
Certifying physiCian (PhysICian certifying cause of death when aoothe/ physician has pronounced deeth and cOfTllleled Item 23)
To the best of my knowl&doe:, death. occuned. due to the cau~s\ and manner as satl!(! ...
Pronouncing and certifying physician (physician bolh pronOllncing death and certifying 10 cause of dealh)
To tile ~I 01 my knowledge, d~ath occurred at the time, dale, and place, and due to the cause(sl and manner as stated
Medicale.-amlnerkoroner
On the basis of examination andior Investigation, in my opinion, death occurred at the time, date, and place, and due to the cause{s) and manner as slated ... ....0
35
IB-I 11d.1 \ 10 I
23b. UcmlseN\lTItIer
23c. DaleS'lgne<lIMonlh,day,year)
o Yes QI. No
26. Was Case Referred 10 a Medical Examiner/Coroner?
05-';><1)//0,( /)
34 Name and Mdress of Person Who Completed Cause of Death (Item 27) Typ~rinl
I (Jlb~.J ;OJ)
'100 :; '1'(0/ ::;T.
( -:) / .u
Par1Il:Enlerother~ondilionsconlributinctodeath, 28
bul not les\ll\mg in 1M ur.dell'ling cause Qivel\ in Part I.
~,.~~
. . 'C'.......L-""
32b, Describe hoW Illjury Occllrred
.....0
321 ilTransportalionlnjury(Specityj
o DriverlOperatOi 0 Passen1;ter
o Pedestrian 0 Dlher - Specify:
33b. Si at and Hie of Certifier
141 /-~ 4J
.....~
(,
Did Tobacco Use Contribute 10 Dealh?
DYes 0 ?fObably
o No c:r-t:n!Known
29. If Female
o Notpregnantwilhinpaslyear
o 1'I-00000alIlallimecld%a\l\
o Notpregnant.bUlpregnantwilhin42days
of death
o Not pregnant. but pregnant 43 days to 1 year
beloredealh
o Ullkoo'HfI ~ pI'*Jr.am Wl\l\in the paM yeal
32c. Place 01 Injury: Home, Farm, Street, Factory, Office
Building, elc. ($pecif)1
32g. Location (Street. cilyl1own, stale)
/60 5 ,P/C/!
A/J}?U j He- L ;#/1'
/:2.. 'I(
33d. Dale Signed (Month. day, year)
dt
I ) 2. .1
LAST WILL AND TESTAMENT'
OF
JOHN W. KEIM
I, JOHN W. KEIM, of 214 Todd Circle, Carlisle, Cumberland County,;
Pennsylvania, being of sound and disposing mind, memory and understanding, do mak~
pubiish and declare this as and for my Last \/Vill and Testament, hereby revoking and
making void any and all former Wills, Codicils, or writings in the nature thereof, by me at
any time heretofore made.
FIRST:
I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary expenses
and all Inheritance, Estate, Transfer and Succession Taxes, as soon as may be
conveniently done after my death, out of my residuary estate.
SECOND: I give, devise and bequeath all the rest, residue and
remainder of my estate to my wife, HELEN W. KEIM, provided she survives me by a
period of thirty (30) days.
THIRD:
In the event that my wife, HELEN W. KEIM, fails to survive
me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of
my estate as follows:
A. Forty-five (45%) percent of my estate to my daughter, MARY
LOUISE McGINN;
B. Thirty-five (35%) percent of my estate to my son, JOHN W.
KEIM, JR.;
C. Ten (10%) percent of my estate to my grandson, BRETT J.
KEIM; and
D. Ten (10%) percent of my estate to my !:;Irandson, WALTER J.
KEIM, JR.
LASTL Y:
I nominate, constitute and appoint my daughter, MARY
LOUISE McGINN, to be the Executrix of this my Last Will and Testament. In the event
that my said daughter, MARY LOUISE McGINN, shall be unable to serve as Executrix for
any reason, I appoint my granddaughter, KRISTIN L. MAHOONEY, as Executrix. No
Executrix shall be required to file bond in this or any other jurisdiction.
(~) S IV-
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
NM.I' lL,J-'
~
day of
,2004.
, <~j6~rl W~'K~ial, /
.... -' ~,.
vy!
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
""'.
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2
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, James D. Flower I Jr. I Esq. and Dawn L. Flower ,
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
Testator sign and execute the instrument as his Last Will; that he si~Jned willingly and that
he executed it as his free and voluntary act for the purposes therein expressed; that each
of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the
best of our knowledge the Testator was at that time 18 or more years of age, of sound
mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed to before me by James D. Flower, Jr., Esq.
and
Dawn L. Flower
this
25th
day of
August
2004.
'I i li L < 'l)' tf-~{,-( 11 ~
" \ '. Witness I .-
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Witness
1
~L~~LL~
_NotarY UbliC__ J
NOTARIAl SEAL c.
R~NEE L. MURRA'~ Notary Pvt#
CarlIsle Bore, CumOOir1and cOl'!' roi '
My Commission ExpirE~ De'" "":06
4
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, JOHN W. KEIM, Testator, 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
willingly; and that I signed it as my free and voluntary act for the purposes therein
expressed.
Sworn or affirmed to and acknowledged before me, by JOHN W. KEIM, the
Testator, this 25th day of AllgUst , 2004.
, /';' /,
. ,j / "'VI
'! '.
John W. Keim, Testator
J l/l;1 i
Lut{t . jI Lic{~
Public '&
NOTARIAL sw~--"~-"t
R~NEE L MURRAY, f~otary Publ' ;
CarlIsle Bar C . Ie ,
M .~, uml.ierland County, fJA I
y CO~ISSlon E:2i~~_~~~. 13,20051
3