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Home My WebLink About01-17-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cmnberland COUNTY, PENNSYLVANIA Estate of Kennit L. Shultz also known as File Number fR {- 00 - 00& 0 , Deceased Social Security Number 187242285 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE ~' OR 'B' BELOW:) 00 A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the Executrix last Will of the Decedent dated 7/21/99 and codicil(s) dated 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 instrumtmt(s) oftereJ for probate, was not the victim ofa killing and was never adjudicated an incapacitated person: o B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante mino'1t~e) r.'~ -"" C') , " Petitioner( s) after a proper search has / have ascertained that Decedent left no Will and was survived by the followi~~~use (if a~Y1 and heirs: (.([ Administration. c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) -' . '.: Name Relationshi --1 "P" .~ (.n (COMPLETE IN ALL ("ASES:) Attach additional sheets ifnecessary. Decedent was domiciled at death in Cumberland Carlisle BorG Carlisle (List street address, town/city,' township, county, state, zip code) County, Pennsylvania, with his / her last principal residence at 1 West Penn PA 17013 Decedent, ,hen 77 years of age, died on 12/20/07 at Forest Park Nursing Home PA 17013 Carlisle Dece.den~ at del!thcwned 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 $ $ $ $ 2.500.00 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 appropriate form to the undersigned: Typed or printed name and residence Connie S. Shultz 308 Kralltown Road Wellsville P A 17365 Page 1 of2 Form RW-02 rev. 10.13.06 Oath of Personal Representative COMMONWEAL TH OF PENNSYLVANIA 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 of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed 'x o. -+1.........- before me th\~ .-L '\ day of lan'lary , 2008 Signature of Personal Representative 'r\.\!;;~~ ~ n,,-, ',--,) \ ~ For the Registe;'~ Signature of Personal Representative File Number: ~ \ -D~- C"J:i 00 Estate of Kermit L. Shultz , Deceased Social Security Number: 187242285 Date of Death: 12/20/07 AND NOW, having been prese are hereby granted to , 2008 , in consideration of the foregoing Petition, satisfactory proof before me, IS DECREED that Letters Testamentarv Connie S. Shultz in the above estate and that the instrument(s) dated Julv 21. 1999 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. TOTAL ............................. $ 30, <::Y0 $ ~. 0') $ 5. 0.) $ 15.co $ \().6b $ -S. 00 $ $ $ $ $ $ $ -'3. o..."J Attorney Signature: FEES Letters ............................. Short Certificate(s) ............ Renunciation(s) ................ Lu... ~ ~(lP ~.~~>r---' Attorney Name: Supreme Court J.D. No.: 52662 Address: P.O. Box 204 York Springs PA 17372 Telephone: (717) 528-8900 Form R W-02 rev. 10.13. 06 Page 2 of2 H105.905MS REV. 6106 This is to certifY that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records In accordance with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953. WARNING: It is illegal to duplicate this copy by photostat or photograph. /7 J, ~ ~d c--o ---:J (J-~ ffRM>(oL Hl05-143 REV 11/2006 TYPE I PRINT IN PERMANENT BLACK INK No. Frank Yeropoli State Registrar Calvin B. Johnson, M.D., M.P.H. Secretary of Health 1300020 nEe 2 7 2007 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) Date 77 9/28/1930 Jnaville, PE. STATE FILE NUMBER Kem' 5. Age (laslBirthdayl -24 4. Dale 0' Death (Month, day, year) Decp-nbC',:70 2007 1. Name ot Decedent (FilS!, milt!le, last. suffix) j..\ 6. Dale of Birth (Month. day.yearl 1 \lest Penn - Carlisle, Pa. 170]3 18. Father's Name (First. middle, last, suffix) arIe" C. Shultz 12. Was Decedent ever in lhe U.S. Armed Forces? @Ves DNo D9<;t3denl's Ac1ual Residence 17a. State 13. Decedent's Education (Specify only highest grade completed) Elementary I Secondary (0-12) College (1-4 or 5+) 12 Ba. Place 01 Dealh (Check only one) Hosprtal o Inpatienl 0 ER IOutpatienl DDOA 'U-Nufsing Home 0 ReSidence OOthe!. Specify: 9. Was Dececlenl 01 Hispanic Origin? &a No 0 Yes 10. Race: Amencan Indian, Black, While, elc. (If yes. specllyCuban. (Specify! Mexican, Puel10 Rican, etc.) ,vhi te Bb, County of Death ad. Facility Name {It nol instituHon, give street and number! c; 1TI~;~ lanel Foref't Par'e Nursing Home Pa Did Decedent live in a Township? 17C.O Yes, DecedenlLilledin 17d. ex No, Decederlt lived within Aduallrmilsol Twp 14. MaMtaf Status: Married. Never Married. Wido....ed. DillOrced (Speciljl) vic10ved 17b. County (:llmhpr 1 ::Inn Carlisle City/Bora lOa, Inlonnanfs Name (Type I Print) Freeleric'e L. ShnItz 19, Mother's Name (Firsl, middle, maiden sllrname) Joanna Laura Heller 2Ob. Informanfs Mailing Address (Street city l town. slate. zip code) 08 KraIltown Rd. Wellsville,Pa; 17365 21a. Method 01 Disposition 21c Place 01 Disposihon (Name of cemelery. cremalory or olher place) 21 d, location (City I town, state. zip code) o ~ ~ Inniantovm Gap National Cemetery AnnviIle, Pa. 17003 Funeral Home DNo c;52.CJ ~ '7 Appro~imate interval: Onselto Dealh Part 11: Enter othersionilicant condilion~ contributinnto death, but not re5l.iltingin Ihs lI00erlyi1g cause given in Part I. ~~~~Je~&t~n~~~ d~~I) dise:;. f't..."".:J...~~ Due ~ (,/'1:: ;:~uence 01): _ _ I. _ ~;?~ Due to Ar.:~::n.' c DlIetO(O~eqUenCeOf) ;J~ 28. Did Tobacco Use Contribute to Death? DYes o Probably D No ~wn z o u o is ,V,/,O,/ ,011 29. If Female: o Nol pregnanl within past year o Pregnant at lime of death o Nolpregnanl.blltpregnantwithin42days 01 death o Not pregnant. butpregnanl 43 days to 1 year belore dealh o Unkr;own il pregnant within the past year J2c. Plape of Injury: Home. Far.m. Street. Factory OffICe BUlldmg. etc. (Speofy) Sequenliallylistcondibons. if any. ~~t:~~o J~DW~~I~~~X~~~ a. (diseaseor~lurylhaliniliatedthe events rewllmg In death) LAST. 308. Was an Aulopsy Performed? DYes~ 3Ob, WeleAlltopsyFindings Available Prior to Complelion 01 Gause cl Death? DY"~ 31 ManrlElrO(Death .0N~lllral 0 Hcmidde o Accident 0 Pendinglnvesligalion 32d. Time ollnlUry o Suicide 0 ColJld Not be Determined 32g.locatiOl1ollnjury(Streat,cityllown.state) M. 338. Certilier (check onty one) Certifying physician (Physician certifying cause 01 death when another physiciarl has pronounced death and completed Ilem 23) To the bell ot my knowledge. death occurred due 10 the caUlle(l) and manner al sta1ecL _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ~~~U:~~t;: :~::~:~~a~c~uh:~~~ 1:~j~~~:;:~n~:i=~~~~r1~:~~~~a~:~~~~~~ manner ISltllted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 MedIca! ElIaminer I Coroner On the basis of examination and I or investigation, In my opinion, death occurred althe dme. d.., and place, and due 10 Ihe cause(s) and manner as stated_ 0 34. Nlj a~~r~s ~.son W~ooieted Cause 0: Death (Ilem 27) Type I Punl (CD ~ -'" ie k /V[.ui//t--t.-L ~ 2. L/ ( -~l ,~ -..J ):~I :J (..11 <J1 ~ ~ ~ LAST WILL AND TESTAMENT OF KERMIT L. SHULTZ I, KERMIT L. SHULTZ, of Tampa, Florida, being of sound and disposing mind, memory, and understanding, do hereby publish and declare the following as and for my Last Will and Testament, hereby revoking any and all Wills by me at any time heretofore made. ITEM I I direct that all of my legal debts, the expenses of my last illness, and my funeral expenses be paid from my residuary estate, as soon as practicable after my decease, as part of the expenses of the administration of my estate. C) ITEM II .-., i ~..,' -1- 1--: "':;,j< ~ "..,... --.l ~ ~ '..... All of the rest, residue, and remainder of my estate, real, personal or mfxed, of === -_.~ .. 01 whatsoever kind and nature and wheresoever situate at the time of my decease, I givEf,-'l devise, and bequeath to my three children in equal shares. My children are as follows: Frederick L. Shultz, Debarah M. Thrush, and Jeffrey L. Shultz. In the event that any of my children should predecease me, then the share to which that child would have been entitled I hereby give, devise, and bequeath to that child's children, per stirpes. In default of issue of any child of mine, then the share to which that child would have been entitled I hereby give, devise, and bequeath to my then living children in equal shares. Any of such effects distributed to a minor may be delivered to the person with whom the minor resides, or such other person as may have custody and control of the person of the minor, without the intervention of a guardian, and the receipt of any such person shall be a full acquittance of my Executor as to such distribution. ITEM III I nominate, constitute and appoint my appoint my son, Frederick L. Shultz Executor of this my Last Will and Testament. In the event my son should predecease me, resign, renounce or be incapable of acting as the Executor of this my Last Will and Testament, then I nominate, constitute and appoint my daughter-in-law, Connie S. Shultz, Executrix of this my Last Will and Testament. ITEM IV I direct that no bond shall be required of any fiduciary, trustee, executor or guardian, hereunder in any jurisdiction. IN WITNESS WHEREOF, I, KERMIT l. SHULTZ, named herein, have '" hereunto set my hand and seal to this my Last Will and Testament, consisting (Sf' two (2) typewritten-pages, on this the ex. \ day of ~,,:::,~ ~4f~ kERMIT l. SHULTZ ,1999. (SEAL) Signed, sealed, published, and declared by the above-named Testator as and for his Last Will and Testament, and we, in his presence and in the presence of each other, and at his request, have subscribed our names as witnesses hereto. ~)~- j{ ~L ~r-k ~~7L) · ~ / Addres / ~~~ g 2)'t'~ rl\~.",.~ Address ............. 2 ;;2/- 0 8 - CX-,)lJ;; 0 RENUNCIA TION o -..! REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ?:::' (J1 u-: Estate of KERMIT L. SHULTZ , Deceased I, Frederick L. Shultz (Print Name) , in my capacity/relationship as Executor of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to Connie S. Shultz 1/14/08 (Date) ~LJkt~ (ttgnature) 308 Kralltown Road (Street Address) Wellsville. PA (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this 14th day of January , 2008 Deputy for Register of Wills (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. /0.13.06 COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL JOHN C. ZEPP, III, Notary Public Huntington Twp., .Adams ~ounty My Commission Expires Apn116, 2010 I