HomeMy WebLinkAbout02-16-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C.uM0ERLAN.h
COUNTY, PENNSYLVANIA
Estate of V ELM A ,~. r- E. 1<.1 eN P>Au 61-1
also known as
File Number
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. Deceased
Social Security Number /~ :2 . .J :2 - 0 i 7 q
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
~ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the allUA-~] J I- -e1'S
last Will of the Decedent dated 'h/~ .3:__ :"J andcodicil(s) dated ~ -16"-o~ -
II / I~ /~C)Oo
,
named in the
(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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
o B. Grant of Letters of Administration
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Petitioner(s) after a proper search has I have ascertained that Decedent left no Will and was survived by the following sp~e:1jf anyjj!id heirs: (II'.
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) fU'
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(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; duf-al.iu{1J;inoritate) ~
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Name
Relationship
Residejlc.e"~
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(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
Decedent, then
XL
years of age, died on J //() /;;00'7 at
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frz.s ide-nCR-
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
1>-{.5l:J.
$
$
$
$
~
J80i~
situated as follows:
Where tore, 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 appropriate form to
the undersigned:
T ed or rinted name and residence
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTYOF tv..r'VlAERLAN ~
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
) f.t; day of
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Sworn to or affirmed and subscribed
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File Number:
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Estate of ~ E.L-M A J F ~ R. -r t. N ~ Au.. G-rf
1&:1 - 7.:2 - ~/ 7 t/
, Deceased
.2 -IIJ - ~ 00 7
and that the instrument( s) dated
described in the Petition be admitted to pro
FEES
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$~l9(J .
1~.00
Attomey Signature:
Letters
Short Certificate( s) . . . . . . . . $
Renunciation(s) .......... $
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. .. $
.. . $
.. . $
$
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... $
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... $
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.............. $~
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{'S; ,Oc.>
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$.0
Attomey Name:
Supreme Court I.D. No.:
Address:
Telephone:
TOTAL
Form RW-02 rev, 10,13.06
Page 2 of2
H !O).W) REV I/O)
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~->n"%<. 'J('Jw ~
Local Registrar
Fee for this certificate, $6.00
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13377979
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.. Date
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Hl05-143 REV 1112006
TYPE i PRINT IN
PERMANENT
8lACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse)
STATE FilE NUMBER
-
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82
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4. Date 01 Dealh (Month, day, year)
February 10, 2007
1, Name of Decedent (First, middle, last, suffix)
Velma
5 Age (lasl Birthday)
Cumberland
esidtince DOlhef. Specify
10. Race: American Indian, Black, While, ale
IS".",,,,
Bb. Counlyof Death
11, Decedent's Usual Decu hoo Kind of wOOi done dIN
KindofWOf'k.
Homemaker
Oy" ~No
Decedent's
ActualResidence 17a. SCale
14 Marilal Stalus: Married, Never Married,
Widowed, Divorced (Specify)
Widowed
- 16. Decedent's Mailing Address (Street, dry I town, stale, zip code)
63 Honeysuckle Drive
Mechanicsburg PA 17050
17b. County
PA
Cumberland
Did Decedent
liYeina
Township?
17c 1iII. Yas, Decedent lived in
17d. 0 No, Decedeollived within
AclualUmils01
Silver Spring
Top
18. Falher's Nama (First. middle, last. sulfix)
Daniel P.
Cily/BofO
lOa lnlormanfs Name (Type I Prinl)
DarIa K.
Ritter
Harlacher
19. MoIher's Nama (Firs!. middle, maiden surname)
Mary S. Martin
2Ob. Inlormanrs Mailing Address (Strael, city I town, slate, zip code)
55 Manada Creek Circle Carlisle PA 17013
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21c. Placo of Disposition (Name 01 cemetery, cramat~ Of other place)
21d. location (City I town, sLate, zip code)
Letort Church Cemetery
Carlisle PA 17013
HOME E MAIN ST MECHANICSBURG PA 17055
230. License Number
23c Date Signed (Month. day, year)
IIams 24.26 mU5t be compltlled by person
. wtlo plOOOUnces death
24. Time 01 Dealh
f"/5SIt'M
25 Date PrOOOtJrlced Dead (Moolh, day, year)
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26. Was Case Referred 10 Medical Ellaminer ! Coroner lor a Reason Other Ulan Cremation or Donation?
DYes IKINo
=t~~~~~S: ~~~~ dISC::'
CAUSE OF DEATH (See instructions and examples)
Iltlffi 27 Part I Enterltie ~t!i!n Ql~ - diseases, inlUries, Of complicalions . that directly caused the death. DO NOT enter termInal events such as cardiClC arrest,
respiratory arrest, Of venll1cular librillatioo without showing the etIology. list only ooe cause 00 each line
/A' //
Due 10 (or as a cooseque~ 01)
b ( )L't"'y-~~ ....-~ /"." /;.,
Due 10 (or as a consequence 01).: / / '/ /. ciW
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Due 10 (or as a cOl'ISequence o!): /' ~
(If ~-#.p't:V",~
Approximate interval
Onsel to Death
Par1l1: Enter other sionilicant condilions~~, 28 Did Tobacco Use Coolnbule to Oealh?
but not resulting in the UIlder1)'ing cause given in Pan I. 0 Yes D Probably
~ 0 Unknown
29. II Femate:
(]]...H6iplegnantwrthmpaslY&ar
o Pregnanlallimeofdealh
o Not pregnant, but pregnant Wlthm 42 days
01 death
o Not preglldnl, but pregnant 43 liavs 10 1 year
before death
o Unknown if pregnant within the past year
32t. Place of Injury: Home, Farm, SMel, Faclory,
OIflCe BuiIdir1g, elt. (SpecIfy)
u'~., ./f'-4'A"~
SeQuentially IlsI conOllioos, if any,
~~~o ~NOER~I~~rU~E a
Idlseaseorll'lJurylhaliniliatedltle
events resunrng HI 0e0l1ti) LAST.
o SuicIde
o Could Nol be Delermined
32d. Time of Injury
--
30a Was an Autopsy
Per1ormed?
0'" ~No
JOb. Were Autopsy Findings
Avail.lble Prior 10Compleliorl
of Cause ot Oealti?
/
o Yo; [!] No
31. Manoer01 Dealh
~Natural
D HormClde
o ACl.:ident DPendinglnvestlgaliOO
M
321. II Transportation Injury (Specify)
o Driver / Operalor TI Passenger DPedestrian
Otner. Specify.
33b. Signature and r~ 01 trti1ier
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33c license Number
32g location ollrlfUry (Slresl, city I town, state)
33a Certifier (check only ooe)
~::~9si~:~i:::;=,n~~~Iy=~:;: ~~:I~h:t~::(~~:n~h~~:rh: ~;=-oc~~ d~a~h::d~~n~l~e~ ~e~ ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
~~o;~~C~;l:t~: ~:~~=:,h::a~~~:;:: :~~~~~~~:n;n~;:;c:~~~:n~Z:l~ol~hc:~:~~:~ manner as staled- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0
~~a~:~sm~;':~~;~~:I~:~ and / or investigation, in my opinion, dealh occurred ;lllhe lime, dale, and place, and due to the causels) and manner ;lS staled_ [J
Disposition Permit No. (j
33d Dale Sl (Mon, day, year)
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34.NameandAdOs:~~.~Con~ca~0~~127~1~1
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35 Regl
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(;, Signdlure and DIstrict Number
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LAST WILL AND TESTAMENT
I, VELMA J. FERTENBAUGH, of 63 Honeysuckle Drive, Mechanicsburg,
Cumberland County, Pennsylvania, do hereby make, publish and declare this to be my
last will and testament, hereby revoking all wills heretofore made by me.
1 . I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as convenient after my decease. I direct that all
inheritance taxes imposed or payable by reason of my death and interestand penalties
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thereon with respect to all property, whether or not such property passes ul'lQer thi~;YVill,
shall be paid by my personal representative out of my estate. ) ;::_1
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2. I authorize and empower my personal representative to sellar}y realty,;
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and/or personalty owned by me at my death and not specifically devised or beque~ed
herein, at public or private sale or sales and to give good and sufficient deeds and/or
bills of sale therefore, in fee simple, as I could do if living. My representative is
authorized and empowered to engage in any business in which I may be engaged at my
death, for such period of time after my death as seems expedient to said representative.
3. I give, devise and bequeath all of my estate of whatever nature and
wherever situate as follows:
A. My diamond ring to my granddaughter, Karen Harlacher;
B. My mother's ring to my daughter, Daria Harlacher;
C. My birthstone ring to my daughter, Jane Geiling; and all the
D. Rest, residue and remainder to my spouse, John W. Fertenbaugh.
4. If my spouse does not survive me by a period of sixty (60) days, then my
residuary estate I give devise and bequeath to my children, share and share alike, the
child or children of any deceased child taking the share their parent would have taken if
living.
5. I nominate and appoint my spouse to be the personal representative of my
estate, to serve without bond. If my spouse cannot or does not serve, then I appoint
Daria K. Harlacher, Jane L. Geiling and Carol A. Convery to be the substitute co-
personal representatives, also without bond.
6. I suggest that my personal representative retain the services of Harold S.
Irwin, III, Carlisle, Pennsylvania in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 16th day of
November, 2000.
.~
i/d"",eC ; ~h~/
VELMA JfFERTENBAU
(SEAL)
Signed, sealed, published and declared by the above-named person as and for a
last will and testament, in our presence, who at said person's request, in said person's
presence and in the presence of each other have hereunto set our names as
subscribing witnesses.
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ACKNOWLEDGMENT AND AFFIDA VIT
WE, VELMA J. FERTENBAUGH, RHONDA S. VON KLlTZING and HEATHER
A. BARBOUR, the testatrix and 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
purpose herein expressed, and that each of the witnesses, in the presence and hearing
of the testatrix, signed the will as a witness and that to the best of their knowledge the
testatrix was, at that time, eighteen years of age or older, of sound mind and under no
constraint or undue influence.
~,~~i~~
VELMA J ERTENBAUG
~dJ~ W~tM<
HEATHER A. BARBOUR
COMMONWEALTH OF PENNSYLVANIA
:55:
C;OUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by VELMA J.
FERTENBAUGH, the testatrix herein, and subscribed and sworn to before me b~
RHONDA S. VON KLlTZING and HEATHERA. RBOUR, witnesses, this 16T day
of November, 2000.
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ADDENDUM TO LAST WILL AND TESTAMENT OF
VELMAJ.FERTENBAUGH
I, VELMA J. FERTENBAUGH, of 63 Honeysuckle Drive, Mechanicsburg, Cumberland County,
Pennsylvania, do hereby declare this to be an addendum to my last Will and Testament dated
November 16,2000.
1. I wish to leave to each of my seven grandchildren: James R. Harlacher, Jr., Karen L.
Harlacher, Daniel R. Harlacher, Richard M. Geiling III, John W. Geiling, Timothy D. Geiling,
and Brian L. Fertenbaugh, the amount of $3,000.00 each upon my death. These funds shall
be distributed prior to any funds being distributed to my three daughters.
1 ~ A~~ ~ :6#:1,,, '?JA
Velma J. Fert baugh
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Date
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Date
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Date
Subscribed, sworn to and acknowledged before me by VELMA J. FERTENBAUGH, the testatrix
herein, and subscribed and sworn to before me by the witnesses this 15th day of August, 2002.
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Date
Notary Public N~arja; 2'-Ba!
Mart!n Pipson. N,,):;,,,! Pubik~
Lo~r Ai:en T:.l.lp.! Cu!the;;aTlc! CDuntv
i r.,'I'y' Comm;SSll)[1 Exp,rm; Ju!y 27, 2(Xl4
MemS8iJ5enMYlvi:iia'Assooa:talO! Notanes
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