HomeMy WebLinkAbout01-25-08
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of DOROTHY M. FORTENBAUGH No. j.. / c {).9.; OO~~
Deceased Social Security No. 183-12-1672
RICHARD A. FORTENBAUGH
Petitioner, who is 18 years of age or older, applies for:
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner is the Executrix named in the Last Will of
the Decedent, dated MAY 17, 2007 and codicil(s) dated
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 to victim of a killing and was never adjudicated incompetent:
B. Grant of Letters of Administration p ~
(d.b.n.c.t.a.: pendente lite; durante absentia; durante minori~e) . ?
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survive@tJhe foll<9Wing
spouse (if any) and heirs: _ <-"~ S;:
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Name
Relationshi
Residence
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COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal
residence at Messiah Villaae. 836 Oak Oval. Mechanicsbura. PA
(List street, number and municipality)
Decedent, then.-JHL years of age, died
January 4. 2008 at Holy Spirit Hospital. Camp Hill. PA 17011
(Location)
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 ......................................................................................................................$
1 ,100,000.00
None
T otal...................................................................................................... $
1.100,000.00
Real Estate situated as follows:
Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant
of letters in the appropriate form to the undersigned:
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T ed or rinted name and residence
Richard A. Fortenbaugh
213 Tall Oak Drive
New Cumberland, PA 17070
,
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
:SS.
The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the
Decedent, Petitioner will well and truly administer the estate according to law.
Sworn to and affirmed and subscribed
Before me this :}5rh day of
~t=- ,2008.
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No.
Estate of
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DOROTHY M. FORTENBAUGH
. Deceased.
Social Security No: 183-12-1672
Date of Death:
January 4. 2008
AND NOW, ,215#J ~~ CfjJfLU Ii tLJ- ,2008, in consideration of the Petition on the reverse side
hereon, satisfactory proof h ing been prese~ted before me,
IT IS DECREED that Letters Testamentary are hereby granted to Richard A. Fortenbauqh in the
above estate and that the instrument(s) dated May 17. 2007 described in the Petition be admitted
to probate and filed of record as the last Will of the Decedent.
FEES
Letters........................... $
Short Certific~~~(s) $
Rcnul"lciation.lIY..I...l.l $
Affidavit ().................. $
Extra Pages ()....... $
CodiciL......................... $
JCP Fee....................... $
I nventory.h..........X'... . $
~.&.I..uJ.))QJ10\'\ $
TOT AL......... $
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Register of Wills
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Attorney: Edmund G. Mvers
I.D. No: 20558
Address: Johnson. Duffie. Stewart & Weidner.
301 Market Street. P.O. Box 109, Lemoyne. PA 17043-
Telephone: 717-761-4540
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
U1('.~.O;:f\:" ~~v ((\'/fI'",
Fee for this certificate, $6.00
P 13991976
It.
Certification Number
ITEM #
SHOULD READ AS FOLLOWS:
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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.
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Local Registrar ~:::5 Date Issued
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
88
Vrs.
Middletown, PA
8b. Couoty of Death
Cumberland
Sd. Facility Name (II not inSliMlcn, give street and runber)
Twp. Holy Spirit Hospital
11. Decedent's Usual Occu tion Knd of wOOl done most of life. 00 nol stale retired
KirxlolWOl1< Kind of Business/Industry
Secretar Insurance
16. Decedenrs Mailing Address (Street. city I town, state, zip code)
100 Mt. Allen Drive
Mechanicsburg, PA 17055
18. Father's Name (First, md:Ie. last, sutrix)
Charles Keyser
12. Was Decedent ever In the
U.S. Armed Forces?
o Yes IXINo
Decedenfs
Actual Residence 17a. Slate
3. Social Security Number
183 - 12 - 1672
4. Dale of Death (Month, day, year)
January 4, 2008
Other.
o Nu""ng Home 0 Reside""" OOlher - Sped~:
9. Was Decedent ol Hispanic Origin? ~ No 0 Yes 10. Race: American Indian, Black, While, etc,
I~ yes, specify Cuban, ISpecify)
Mexican, Puerto Rican, elc.) W hit e
13. Decedent's E<iJcalion (Speci~ only highest g..de completed)
Elementary I Secondary (0-12) Co~e (1-4 or 5+)
12 1
Did Decedent
Uveina
Township?
14. Marital Status: Married, Never Married,
Widowed, Divorced 1 Specify)
Widowed
Pennsylvania
Cumberland
17b. County
17c. ~ Yes, Decedenl Uved in
17d. 0 No, Oe<:edent Uved wHtOn
Actual Umits 01
Upper Allen
Twp
City/Born
20a. Informant's Name (Type' Print)
Richard
DDS
19. Mother's Name (Ars!, mkXIe, maiden surname)
(unknown)
2Qb, Infonnant's MaiNng Address (Street, city, town, state, zip code)
213 Tall Oak Drive, New Cumberland, PA 17070
21c. Place of Disposition (Name 01 cemetery, crematory or olher place)
Evans Crematory
21d. location (City I town, slate, zip cOOe)
Schaefferstown, PA 17088
22c. Name and Address of Facility
Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Approximale Interval:
Onselto Death
=~=~~~S~t~)d~~
m klh 1'1.;"/,....... O/';~.... rat /""1' "-
Due" I'" es e ~ce 01), /" ;. /'
bJurqel'') +';r 00'1 ~l1cer-
Due to (or a18. con~uence ef):
~~~~='~~a.
Enl~ UNDERLYING CAUSE
~~~~~ta~Gr~
Due to (or as a consequence of)
d.
308. Was an Autopsy
Performed?
OVes
OVes
o Homicide
o Accident 0 Pending Investigation 32d. Time 01 Injury
o Suicide 0 Coold Not be Determined
M.
33a. Certifier (check. only one)
Certtfylng physician (Physician certifying cause 01 deatl1 when another physician has pronounced death and completed h.&m 23)
10 the best of my knowledge, death occurred due to the ctuu(s) and manner as staWd_ _ _ _ _ _ _ _ _ _... _... _... _ _ _ _.. _.............................
~~=::':,.~ :O~~J::-:C~~= :::~I:e~::;n~;~C:~~=~ot~::~~~~ manner as stlted......... .. ....... ...... .... .. _...... 0
Medial! Examiner' Coroner
On the basis of examInation and I or Investlgallon, In my opinion, death occurred al the time, dale, Ind place, Ind due to the cause(s) and manner as stated.. D
35. RegiS!rar's Signalur a
..
1021 /IO? I / I /1
Disposilion Permit No. (J t') q 3 B :3lt,
23b. License Number
23c. Date Signed (Month, day, year)
26. Was Case Referred to Medical Examiner / eorone,lor a Reason Other than Cremalioo or Donation?
OVes .P/JNo
Part II: Enter other sionlficant COl'KIllonlI oontribulina io deBlh,
but not resulting in the underlying cause gillen in Part l.
28. Did Tobacco Use Contribute to Death?
o Yes OProbebly
o No 0 Unknown
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29. If Female:
D Not pregnant within past year
D Pregnant at time of death
D Not pregnant. but pregnant within 42 days
01 death
o Not pregnant, but pregnanl43 days 10 1 year
belore death
o Unknown il pregnanl wilhin lhe past year
32c. Place of Injuf)': Home, Fann. Street. Factory.
Office Building, etc. (Spedfy)
32g. Location of Injury (Street city / town, state)
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Last Will and Testament
OF
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DOROTHY M. FORTENBAUGH
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I, DOROTHY M. FORTENBAUGH of Mechanicsburg, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make,
publish and declare this as and for my Last Will and Testament, hereby revoking and making
. '. void any and all Wills or Codicils at any time heretofore made by me.
ARTICLE I
DEBTS AND TAXES
I direct the payment of my legally enforceable debts and the expenses of my last illness
from my Estate as soon after my death as conveniently may be done. I direct that all taxes that
may be assessed as a consequence of my death, of whatever nature and by whatever jurisdiction
imposed, shall be paid from my residuary estate as a part of the expense of the administration of
my Estate.
ARTICLE II
SPECIFIC BEQUESTS
A. I give and bequeath the sum of FIVE THOUSAND DOLLARS ($5,000.00) unto
my friends, ROBERT ORMSBEE and LEE ANN ORMSBEE, 4434 Venus Avenue,
Harrisburg, Pennsylvania, provided at least one of them survives me;
B. I give and bequeath the sum of FIVE THOUSAND DOLLARS ($5,000.00) unto
my friends, KENNETH L. SHOAFF and NANCY SHOAFF, 4424 Venus Avenue, Harrisburg,
Pennsylvania, provided at least one of them survives me; and
C. I give and bequeath the sum of FIVE THOUSAND DOLLARS ($5,000.00) unto
GOOD SHEPHERD LUTHERAN CHURCH, 3200 Rutherford Street, Harrisburg,
Pennsylvania.
ARTICLE III
TANGIBLE PERSONAL PROPERTY
I give and bequeath my automobile(s), household and personal effects and other tangible
personalty of like nature (not including cash or securities), together with any existing insurance
thereon, unto my son, RICHARD A. FORTENBAUGH, provided he survives me.
ARTICLE IV
REST, RESIDUE AND REMAINDER
I give, devise and bequeath all the rest, residue and remainder of my Estate, of
whatsoever nature and wheresoever situate, in equal shares, one unto my son, RICHARD A.
FORTENBAUGH, and one unto each one of my grandsons, BRIAN R. FORTENBAUGH,
SCOTT M. FORTENBAUGH and ANDREW R. FORTENBAUGH, subject to the provisions
of Article V.
ARTICLE V
TRUST FOR THE BENEFIT OF BENEFICIARY UNDER THE AGE OF THIRTY.
If, at the time of my death, a beneficiary has not achieved the age of thirty (30), I give
and bequeath the share of such beneficiary unto LeTORT MANAGEMENT & TRUST
COMPANY, in SEPARATE TRUST, to hold, manage, invest and reinvest the share so
received, and to distribute the income at least as often as quarterly unto such beneficiary, and to
use and apply so much of the principal as, in Trustee's discretion, may be necessary or
appropriate for such beneficiary's support and education (including post-graduate and
professional education), taking into account such beneficiary's other readily-available resources,
or to make payment for these purposes without further responsibility to such beneficiary. When
such beneficiary shall achieve the age of thirty (30) years, Trustee shall distribute the balance of
principal unto the beneficiary, at which time the trust as to that beneficiary shall terminate. In
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the event any beneficiary dies before receiving his final distribution hereunder, the Trust as to
that beneficiary shall terminate and the balance of principal shall be paid to or in trust for such
persons or organizations - other than such beneficiary's estate, his creditors, or the creditors of
his estate - as the beneficiary may appoint by will containing a specific reference to this power.
Any principal not effectively appointed by such beneficiary shall be distributed to such
beneficiary's then-living issue, per stirpes, or if there be a failure of same, then unto my
surviving grandsons or their then-living issue, per stirpes, as the case may be.
If any beneficiary to whom Trustee is directed to distribute a share of Trust principal is,
in the sole opinion of my Trustee, incapable of properly managing his own affairs, his share shall
then vest in interest in him indefeasibly, but the Trustee shall continue to hold such beneficiary's
share in further TRUST, with all of the powers granted to it as Trustee herein, and with authority
to use both income and principal for the beneficiary's health, education, maintenance and
support until in the Trustee's sole judgment no further incapacity exists, at which time Trustee
shall distribute such share to the beneficiary absolutely.
ARTICLE VI
SPENDTHRIFT PROVISION
I direct that the interest of the beneficiaries shall not be subject to anticipation or to
voluntary or involuntary alienation.
ARTICLE VII
POWERS OF PERSONAL REPRESENTATIVE AND TRUSTEE
My Personal Representative and Trustee shall have the following powers in addition to
those vested in them by law and by other provisions of my Will applicable to all property,
whether principal or income, including property held for minors, exercisable without court
approval and effective until actual distribution of all property:
A. To make distribution in cash or in kind, or partly in cash and partly in kind, and in
such manner as they may determine.
B. To retain any or all of the assets of my estate, real or personal, without restriction
to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to
any principle of diversification or risk.
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c. To invest in all forms of property without restriction to investments authorized for
Pennsylvania fiduciaries, as they deem proper, without regard to any principle of diversification
or risk.
D. To sell at public or private sale, to exchange, or to lease for any period of time
any real or personal property and to give options for sales, exchanges or leases, for such prices
and upon such terms or conditions as they deem proper.
E. To allocate receipts and expenses to principal or income or partly to each as they
from time to time think proper.
F. To compromise any claim or controversy.
G. To make such elections, decisions, conceSSIOns and settlements in connection
with all income, estate, inheritance, gift, generation skipping or other tax refunds and the
payment of such taxes as my Personal Representative and/or Trustee shall deem appropriate,
without obligation to adjust the distributive share of any person thereby affected.
H. To combine, without prior court approval, any Trust contained in my Will with
any other Trust with substantially similar provisions, although such Trust may have been created
by separate instrument.
I. To resign any time, for any reason whatsoever, without court approval.
ARTICLE VIII
COMPENSATION
Trustee shall be entitled to reasonable compensation for its services in accordance with
its standard schedule of fees as may be adjusted from time to time while the services are
performed hereunder.
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ARTICLE IX
PERSONAL REPRESENTATIVE
I name, constitute and appoint my son, RICHARD A. FORTENBAUGH, Executor of
this my last Will and Testament. Should my son, RICHARD A. FORTENBAUGH, fail to
qualify or cease to so act, I name, constitute and appoint LeTORT MANAGEMENT &
TRUST COMPANY, alternate Executor to complete the administration of my Estate. I direct
that no fiduciary appointed herein shall be required to post bond for the faithful administration of
the duties required in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will
and Testament, this /7.J!1dayof ~ ,2007.
Jj;;.~, Jt;. J~~ (SEAL)
DOROTrw M. FORTENB~UGH
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in the presence
of each other, have hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT
COMMONWEAL TH OF PENNSYL VANIA
: SSe
COUNTY OF CUMBERLAND
We, DOROTHY M. FORTENBAUGH, furvtLlfLCi G tv\ ~ cJ/J--
and (:J U - ' '--- (llJV-.I , the Testatrix and the witnesses,
respectivel , whose names are signed to the attached or 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 purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her
knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under
no constraint or undue influence.
/Jv~ /tJ. .JJ.~f:t/
DORO HY M. FORTEN AUGH
w~~~
Witn~~
Subscribed, sworn to
FORTENBAUGH, Testatrix,
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and acknowledged before me by
and (JJ\ \i Luvl t . ~I {j (-
, witnesses, this IllVldayof K:
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Notary u lie
DOROTHY M.
and
,2007.
My Commission Expires:
:298148v2
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Dana L Wleseman, NotaIy Pltic
L.emoyne Bore. ClJ11ber1and Q)Ulty
My Commission Expires Nov. 15, 2008
Member, Pennsylvania Association Of Notaries
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