HomeMy WebLinkAbout07-28-06
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Dorothy V. Pentz
also known as
No.
21-2006-
t 1~'
:) \:J\~V'
, Deceased
Social Security No. 181-09-9945
Robert J Kohler Jr
Petitioner(s), who is/are 18 years of age or older, app/(ies) for:
(COMPLETE 'A' or 'B' BELOW)
IKI A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the
the Decedent, dated 02/23/2006 and codicils dated
Executor
named in the last Will of
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
o B. Grant of Letters of Administration
(c.t.a; d.b.n.c.t.a; pedente lite; durante absentia; durante mlnoritate)
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:
I Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family
or principal residence at 103 South George Street, Borough of Mechanicsburg ,Cumberland County, PA
(list street, number, and municipality)
Decedent, then
89
years of age, died
06/17/2006
at Hospice of Central PA, Linglestown Road, Harrisburg, PA
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
47,000.00
$
$
$
$
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant
of letters in the appropnate form to the undersigned:
Signature Typed or printed name and residence
Robert J Kohler Jr 2205 East Coventry Lane
Enola, PA 17025
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group. Inc
Form RW.1 (1991)
Oath of Personal Representative
Commonwealth of Pennsylvania
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 of Petitioner(s) and that, as personal representative(s) of the Dececlent, Petitioner(s) will
well and truly administer the estate according to law.
~if~~<j I L~ /~_
Robert J Kohler Jr
Sworn to or affirmed and subscribed
before me this
'19,
,j',.--
day of
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Forthe e9if1.eJ\.v'xL(
No. 21-2006- (~',.c.\ Q'-.J/
Estate of Dorothy V. Pentz , Deceased
also known as
Social Security No: 181-09-9945
06/17/2006
Date of Death:
AND NOW,
, in consideration
of the Petition on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters 00 Testamentary 0 of Administration
(c.I.a., d.bn.c.l.a, pendente lite; durante absentia; durante minoritate)
are hereby granted to Robert J Kohler Jr, Executor
in the above estate and that the instrument(s) dated
2/23/2006
described in the Petition be admitted to probate and filled of record as the last Will of Decedent.
Letters.....................~~~.~..........$ Lit) - (ICl t/0iLII~l!fU..)tl ~<L~VhDl.Lh: :)~/\ (C /,;
~. '. Register ~ Will
)0 . 0(1 fiA.I
Short Certificate(s).. ................... $ '~.. ~:
Renunciation................. ........... $ :;- 00 Attorney: EDMUND G. YERS
. Affid'aVIts (
i'ill
).............. ............$
I ~ -. (' ()
j
1.0. No:
20558
Johnson Duffie Stewal1 & Weidner
301 MARKET STREET
Extra Pages (
...........$
Address:
Codicil............................. ............. $
, 'j r
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JCP Fee. ........,............................$
LEMOYNE, PA 17043
I<:';.(}(J
Telephone: (717) 761-4540
Inventory
.................$
E-Mail:
Other.......
............$
TOTAL...........................$
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Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc.
Form RW-1 (1991)
Register of Wills of
Cumberland
County:, Pennsylvania
RENUNCIATION
Estate of
Dorothy V. Pentz
No. 21-2006- tJ lcAcl {
also known as
, Deceased
The undersigned,
Norman E. Snyder '
Friend of Decedent Named Co-Executor
(Relationship) (Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to
of
Robert J. Kohler, Jr.
WITNESS my/our hand(s) this
121>
~
(Signature)
day of ~
4-
? .. Y1
, )-00 6 .
12 Slate Hill Road Camp Hill. PA 17011
(Address)
(Signature)
(Address)
(Signature)
Sworn to or affirmed and subscribed
before me this I j I tL
Of~, jG~~
~Q tl)l1AQl\Ll, Il )
otary Public
(Address)
day
My Commission Expires:
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission.)
Prepared by the Pennsylvania Bar Association
Copyright (c) 2004 form software only The Lackner Group, Ine
COMMONWEALTH OF PENNSVlVANfA
Notarial Seal
Dana L Wleseman, Notary Public
l.em0')11e Boro, CLmber1and Col.nty
My Canmlsslon Expires Nov. 15. 2008
Member. Pennsy!vanla AssociatIon Of Notaries
NOTE: Renunciations executed outside the Office of Register of Wills
in some counties are required to be notarized.
Form #RW-4 (1991)
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trns UiPY' by photostat or
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JUN 2 1 20u6
0212006
'TIN
ONT
IK
1. Name of Dece<ient (First, middle, last, suffix)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
5. IvJe (last 8rlhday)
, '"
7. Birth ace Ci
.181 - 09
STATE FilE NUMBER
4. Dale of Death (Month, day, yeCl")
b- \ "J -)-oC;{:;;
89
,Bb. County of Death
Yrs
7, 1917 York, FA
ad. Faciity Name (If not insIilution, give street and number)
8a. Ploce of Death Check Ol'l one
HospilaJ:
o Inpatienl 0 ER I Oulpatienl 0 DOA 0 Nursing Home
g. W..DecedentoIHispanicOrign? Iia No DYes
(II yea, specify ClJban,
Hos ice of Central FA MexIcan,PuertoRk:afl,elc.)
13. Decedent's Edu~ (Specify on~ h~heslgrade 0Jm~eted) 14. M..tlal S1lIIus: MllIrled, Never M..ned,
EOm"'tary I Setondary (0-12) College (1-1 Of 5+) Widowed, Divon:ed (Spedfy)
8 Widowed
Hospice
OResidencs f}o~er. Specify:
10. Race: American Indian, Black, White. etc
(Specify)
White
Decedent's
Actual Resklence 17a. Slate
FA
Dauphin
19. Molher's Nane (FifSl, middle, maiden surname)
Lidia Ann Warren
Did Decedent
Uveina
Township?
17b Goo~
t7c. m Yes,DecedentUvedIn Susquehanna Twp.
17d. 0 ~~~~~vedwithin
Too.
City/Born
1 B. Fathe(s Name (First middle, last, suffix)
Harr McCauslin
2Oa. Informanfs Name (Type I Print)
er Jr.
2Qb. Irrfoonll'lrs Mailing Address (Street, city I town, slale, zip code)
2205 East Coventry Lane, Enola, FA 17025
210. PlaceollJisposition(N"""oIcemeIeIy,aomatcryor_~ece} 21d. localion(Citylrown,_,zjpoode}
Harrisburg, FA 17109
23c. Date Signed (Month, day, yew)
24. r"", 01 De~ :2.0 25. Date Pronounced Deed (Mon~, dey, yeer)
6~ 1\ ,M G- 17-;;..(:.0(.;
CAUSE OF DEATH IS.. instructlone and examples)
1tem'lJ. PART tEnter 1tle ~- diseases, njuries, or compIicalio!'1s - thai directly caused the death. DO NOT enter lermlnalevents such as cardiac arrest.
respiratory arrest or venlricula'fibrinaticn wilhclItshowing the etiology. List only one cause on each fine
Items 24-26 must be compleled by peISCfl
who pronounC88 death.
26. Was Case Referred 10 Medlcal Examiner I Coroner for a Reason Other than Cremation or lJof'lation?
o Yes 0 No
"""""'male i1le1v~'
Onset 10 Dealh
Part II: Enlerolher~ionsrnnlriblflinakldealh
but not resulting il the undertying cause given in Pat I.
28. Did T obac:co Use Contribute 10 Dea1:h?
o Yes 0 Probably
o Na 0 U'koow,
29. IfFernele:
o Not pregnant within past year
o Pregnant at lime of death
o Not pregnant but pregnMI within 42 days
of death
o Not pregnant but pregnant 43 days to 1 year
ofdea1l1
o Unknown ~ pregnant within the past year
32c. Place of InjUlY Home, Farm, Street, Factol"1,
Office Building, etc. (Specify)
=~~~~~= dmease-+
l!1i:T/!"..'I/t17 '-- !tDG"'YVO<:A-I.C.<: I (1J~iV>1j
Due to (or as a consequence of)'
c 0.- O,y'
~uentially ist conditions, ~ any,
En~n: ~oeah.~~\~~1;E
(cflSease or injury that initialed the
events resulting In death) LAST.
b.
Due to (or at; a C:OI'lSe(!Llence of)'
DLle to (or as 8 conseqLlence of)'
d.
DYes ONo
31 M8fVlefofDeath
o Natural 0 Homdde
o AccIdent 0 Pondlng Investigation
o Suicide 0 Goold Not be Determined
328_ Date of Injul"1 (Month, day, year) 32b. Describe How Injury Occurred:
308 Was an Autopsy
Performed?
3Ob. Were Autopsy Rndings
Avalable Prior 10 Com~_
of Cause of Death?
DYes DNa
32d. TJmeoflr1ury
321. IITI1ll1.portation kjury(SpecifyJ
o Driver I Operator 0 Passenger 0 Pedes~an
OOlher.Spocify:
33b~~ ~--) /1 ,0.110
~,.~ -V~ '-'-,. '~.J.A-.
33c. Ucense Number 33d. 0'1"' S~ned (Month, day, year)
;1-1D('))()C;07E: 6- 2/- 200f
34. NJI!!! md Address of Person Who~pIeted Cause of Dealh (Item 27) Type I Print
17,iHO"VlIJ'S I /PI1.LJ.-v.\, ,0110
--:; '7 /'Z." riG I ~" "~ 1'4/'1'0
c.~1" 1-1/,,-,- I"./-t'" 171 -"
(See instructions and examples on reverse)
32g. location 01 Injury (s...t, city lrown, stEm)
M
33a. Certifier (check only ooe)
Certifying physician (Physician certifying cause of death whell another physician has pronounced death and compleled Item 23)
To the bost of my knowledge. death occurred due to the C8USe(S) and manner as 11ahl,ii____ _.. _ ___ _ _ _ _ __ _ __ _ _ _ _ __ _..... _ ____...D
~::u:st~a: ::r~~=a~=:~t::~~n~~a~ :=:Uo~~:r:~d manner H statt<L.. _ _ _ _ _ _ _ _ _.. .. _ _ _ _ _-D
~::="::'~;f=~ and I or Invettfgatlon. in my opinion, death occurred al the time, date, and place, and due 10 the cause,s) and manner as sIatfd_ _ ...D
: eg~nd~
1 011 / 10(1/ 1 / 1
LAST WILL AND TESTAMENT
OF
DOROTHY JI: PENTZ
I, DOROTHY V. PENTZ, of the Borough of Mechanics burg, County of Cumberland
and State of Pennsylvania, being of sound and disposing mind, memory and understanding,
do make, publish and declare this my Last Will and Testament, hereby revoking and making
void any and all former Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can be conveniently done.
2.
I give and bequeath the sum of Two Thousand ($2,000.00) Dollars to my good friend,
ROBERT WOOD- HOSLER, absolutely and unconditionally and direct that the inheritance
tax on this bequest be paid out of my residuary estate.
3.
I give and bequeath fifty (50%) percent of my estate then remaining, to my
granddaughter, DESIREE M. MILLER, absolutely and unconditionally.
4.
I give and bequeath the remaining fifty (50%) percent of my estate, to my grandson,
URIAH C. PENTZ, absolutely and unconditionally.
- 1 -
5.
In the event that I should die within one (1) year of the date that I transfer title to my
home at 103 South George Street, Mechanicsburg, Pennsylvania, to my grandson, URIAH
c. PENTZ, making it a transfer in contemplation of death and thus subject to Inheritance
Tax, I hereby authorize and direct my Executors, hereinafter named, to pay the inheritance
tax due on such transfer, out of my residuary estate.
LASTLY, I nominate, constitute and appoint my good friends, NORMAN E.
SNYDER and ROBERT J. KOHLER, JR., Co- Executors of this my Last Will and
Testament and direct that they be excused from posting bond or other security for the
faithful performance of their duties, in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this t."3 day of
February, A. D. 2006.
(, # n / ;1) -f
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Doroth~, Pentz
(SEAL)
- 2 -
COMMONWEAL TH OF PENNSYL VANIA)
: SS
COUNTY OF CUMBERLAND)
I, DOROTHY V. PENTZ, the testatrix, 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 same instrument as my Last Will and Tt::stament; that I signed
it willingly, and that I signed it as my free and voluntary act and deed, for the purposes
therein expressed.
li~;:7~z-:7;~/' { :'v!<~? 11- r~-" (SEAL)
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DorothY v. Pentz
Sworn and subscribed to before
me this-,j,::...,;/ day of February, 2006.
NOTARIAL SEAl
HEIDI M. NElSON, Notary Put~ic
Mechanicsburg Born, Cumberland Co.
My Commission Expires June 27, 2007
; I
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Notary Public
COMMONWEAL TH OF PENNSYL VANIA)
: SS
COUNTY OF CUMBERLAND )
We, the undersigned, J. ROBERT STAUFFER and JOHN ]\'1. EAKIN, the
witnesses whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the testatrix,
DOROTHY V. PENTZ, sign and execute the instrument as her Last Will and Testament;
that the said testatrix executed it as her free and voluntary act for the purposes therein
expressed; that each of us, in the hearing and sight of the testatrix, signed the Will as
witnesses; and that, to the best of our knowledge, the testatrix, was, at the time, eighteen
(18) or more years of age, of sound mind, -:andlfnder no constraint, duress or undue
influence. ~ %./ur:j);uj~,"",-
r '
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. j~i hi/'iL
Sworn and. su?scribed to before
me this y:r day of February, 2006.
~L4uL{ ,--/1;1. -f1l~/1c,1
Notary Public
HElDI M ~~ SEAL I
Mechanicsbu ~, ~ PublJc
I My Comml~ ~, Cumberland Co.
W\fllres June 27,2007
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