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Home My WebLink About05-09-08 PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND .vfL Estate of D~ores Kelly also known as COUNTY, PENNSYL VANIA File Number JI-08'" 051c; , Deceased Social Security Number 200-24-24] ] Petitioner(s), who is/are ]8 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) Ii) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the Executor last Will of the Decedent dated August 10,2004 and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) named in the 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 (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite: durante absentia; durante minoritate) 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: (If 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 N c;::t C# :;E. ''"'7r11 ~ ~ ':JJ (COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary. >:: (j) '?' ..J n 0 ':P"' County, Pennsylvania with his / her last princi~9'~de~ce at ~ ,-- ':JJ, .. -0 0 "):>' c.n Decedent was domiciled at death in Cumberland ]] 7 North 34th Street. Camp Hill. Pennsvlvania ] 701] (List street address, townleity, township, county, state, zip code) Decedent, then 74 ...p years of age, died on May~ 2008 at Holy Spirit Hospital. Decedent at death owned property with estimated values as follows: (]f 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 $ $ $ $ situated as follows: 117 North 34th Street, Camp Hill, Pennsylvania 17011 -~~:: c"') '(-~ rn r~; ,-) -.. 1. 150,000.00 150,000.00 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: T ed or rinted name and residence Keith A. Kelly, 40] 9 River Ridge Road, Charlotte, NC 28226 Form RW-02 rev. 10./3.06 Page 1 of2 Oath of Personal Representative COMMONWEALTH 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 ofPetitioner(s) and that, as personal representative~() the Decedent, Petitioner(s) will well and truly administer the estate according to law. In! Sworn to or affirmed and subscribed 'II. __ ~ 'l..!:.. \. ~ rIu.J_ SIgnature of ersonal Representative c::::> before me the ~ day of ("") a6 ~AAu ~~ ~ , W { A JI"J Signature of Personal Representative ~J, :.c ("") ~ ~~2~Fn I ~,:~21 \0 --1 i~ Signature of Personal Representative -JCJO r'" -n ,J r- ~ -0 1:> :c- :x (..~ ,':=-:> .-:: I - i-~l - - .. ~ ~~ '-I C-'J :-:1 (, ':", " :) File Number: rQ/- Dr - 05,g o 0''' Estate of Delores Kelly , Deceased Social Security Number: 200-24-2411 Date of Death: Mav 1,2008 qth , Q. DO 8 , in consideration of the foregoing Petition, satisfactory proof that Letters ~ sta rn cn~ and that the instrument( s) dated described in the Petition be admitted to in the above estate FEES Letters ............... $~ Short Certificate(s) . . . . . . . . $~ robate and filed of record as the last Will (and Codicil(s)) of Decedent. fJundL l 'TOJ1/1lJ1J J/M.J, bo Ll~ ~Wj!!t ~7 .. tt)kqr Attorney Signature: ~~ ~mes W. Kollas Attorney Name: Renunciation(s) .......... $ ~' .. . $---15 lJD .. . $ IO,t){) t'Y1a~ .. . $ 5.0/) .. . $ . .. $ .. . $ '" $ ... $ .. . $ TOTAL ............ . . $ Supreme Court J.D. No.: 81959 Address: 1104 Femwood Avenue, Suite 104 Camp Hill, PA 17011 Telephone: 717-731-1600 ~g()&.6(t- Form RW-02 rev. 10.13.06 Page 2 of2 U 1('':; YfI.:; l)t::'\' tn' !,,~ :;. f - C? ~ C 5/g LOCAL REGISTRAR'S CERTIFICATION OF DE,~~THi WARNING: It is illegal to duplicate this copy by photostat or photograp". Fee for this certificate. 56.00 P 14330343 Certification Number REV 1112006 PRINT IN ~ANENT ::K INK This is to certify tl.lt th,~ information here given is correctly copied frem an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded 10 the State Vital ~'~~~~Y27~ Local Registrar Date Issued o CO :/::0 :-:;3 --0 0 ~: -.:: ..- ,! '::!:; If} , ~ .c-:; ::0 "cf)~>' (")0 -.0-" >S(=' ;-. :0 . ::-\ -0 >'" ~ ~ :::t:: ~ , u:> ~ ;1..."') .:;) 'J "c''') :"':1 ':::J .::2 ,'-\-j ~"~~'?1 t.,'":I':=~ - - COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See Instructions and examples on reverse) C) 0" 1. Name of Decedent (Rrsl, middle, last, suffix) Dolores M. 5. Age (Last fMhday) 6. Date 01 Birth (Monlh, day, year) HarriSburg,PA ad. Facility Name (If no! instRution, give streel and IlOOIber) Twp Bethany Village West 12. Was Decedent ever in Ihe U.S. Armed Forees? DYes Il6No Decedent's Actual Residence 178. Stale 17b. County 13. Decedent's Education (Specify only highest grade completed) Elementary I Secondary (0-12) College (1-4 or 5+) 12 pj::llnn~yl 'T~n i;:a Cumberland Juran 19. Mothers Name (Rrsl, middfe, maiden sumame) STATE FILE NUMBER 4. Date of Death (Month. day, year) May 4, 2008 10. Race: American Indian. Black, While, etc. wlf{'t~e 14. Marital Status: Married, Never Married, Widowed, Divorced (SpeciM widowed Did Decedent Live ine Township? 17c. 0 Yes, Decedent Uved in 17d.Jlf. ~~iu=lo~ved within C amp Twp. Hill City/Boro 21b. Dale of Disposition (Month, day, year) 2<tl. Infonnanrs Malling AM'ess (Street. city flown, state, zip code) 2915 Green St., Harrisbur 21c. Place of Disposition (Name of cemelery, crematory or other place) ,PA 17110 21d. Location (City ItOWfi, stale, zIp code) 2.A 16065 Mt.HOlly ~prlflgS Hollinger Crematory 22c. Name and Address of Facility FH&CS,324 Hummel Ave.,Lemo ne,PA17043 23b. Ucense Number 23c. Date Signed (Month, day, year) 5" - L/- J1CiCl8 RNS~II".;? L 26. Was Case Referred !YAed1cal Examiner I Coroner for a Reasoo Other than Cremalion or Donation? DYes ~o Approxi'nate interval: Parl II: Enler other sionfficant condition.<: conlributino 10 death, 28. Did Tobacco Use Conlrihuta 10 Death? Onset to Death bul not resulting In lhe underlying cause given in Part I 0 Yes 0 Probablv o No 0 Unknown th O_,;de o Accidenl 0 Pending Invesligalion 32d. TIme of In;ury 321. If Transportalion Injury (Specify) o Suicide 0 Could Not be Delermined 0 Driver! Operator 0 Passenger OPedeslrian --. ~ OOlher.SpeciIy . ._. ._________.~_______.____._ __. 33a. CeMler (check only one) 33b Signalulll and TIlle of Crtlfl6r _ ~ Certifying phYlllclan (pllYSlClan certifYIng cause of dealh when another phYSICIan has pronoonced death and compleled lIem 23) ~ ~ \ I\. " ~ To lhe basi of my knowledge, death occurred due 10 the causers) and manner as stated_ - - - - - - - - - _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 - VV":' . ______________ Pronouncing and certifYing phYSICIan (PhYSICIan boIl1 pronouncmg death and certifying 10 cause of death) 33c LIC&n!e Number ~3d Dale SIgl1~MndaY year) To the best of my knowledge, death occurred al the lime, dAle, and place and due to the C8USe(S) and manner as stated.. - - - - - - - - - - - - - - - - - 0 _^ ^ A-.....I ~ ~ ~ f VI C> MedIcal Exammer f Coroner '-'lU ~ -, ~ _ _...l. V ~ On ,he bnsm ofexam"""n "d/or In, ~Nii :nr~NWhI COE'ed",cj":' 01 Ic+i{ (I J~AN ~--'- I lo\l/ldl / I II 366''!777;y~rl ~\.b-l T ~d\\~ ~~__L~~~______J CIWLO IO~~.s P I "fLA.:i\)tt<'t 'PtfU<.. 4 !r Due 10 (or as a consequence of): b. b I ft"P.>~ 1{.! YY\ ~ MJ1 \X" Due 10 (or as a consequence on: c. Due to (or as a consequence o~' d. n. Were Autopsy Findings Available Prior 10 Completioo of Cause of Death? DYes DYes ONo DispOSition Permit No. . o / 'I btJ CZ--- Awlt.. Url HI1\> I::>PJrv ttef'rl\ I { 29.lfFemale: o Not pregnanl with;ll pasl year o Pregnanl at lime of death o NoI pregnant, but pregnanl wilhin 42 days 01 dealh o Not pregnant. but pregnant 43 days to 1 year before dealh o Unknown II pregnanl within the pasl year 32c. Place ollnjury: Horne. Farm, Slreet, Factory. Office Building, etc. (Spocify) 32g. location of Injury (Slreel. city Ilown. slale) LAST WILL AND TESTAMENT OF (") Go ~Q ~ (") ~~ ,~(J C'-, (:) :on . '-- <:)':0 --I -0 :,?" DELORES KELLY r-..) <;::) <;;:;) cD :JIl: ~ , \.0 ~ I, DELORES KELLY of 117 North 34th Street, Camp Hill, Cumberland County, Pennsylvania, being of sound mind, disposing memory and full legal age, do hereby make and declare this to be my Last Will and Testament, hereby revoking all prior Wills and Codicils heretofore made by me. All references to my children are to my sons, JAMES M. KELLY and KEITH A. KELL Y. FIRST: I direct that my Executor pay all my debts and funeral expenses as soon after my death as may be practicable. I further direct that all state, inheritance, transfer, legacy, or succession taxes which may be assessed to my estate, or any part of my estate, whether passing under my will, shall be paid out of my residuary estate as an expense of administration and without apportionment. SECOND: I give all the rest and residue of my estate in equal shares to my executor in trust for my grandchildren Carrie Ann Kelly of Willow Grove, Pennsylvania, and Eva Elizabeth Kelly of Charlotte, North Carolina, to hold the principal ofthis trust for the benefit of my grandchildren then living and shall distribute the principal and income in such proportions as trustee shall determine, without being required to maintain equality among them and, after considering all other resources available to them, for the education ofthe respective beneficiaries, until there is no ,/\ l~ 'fJ - - .. C> ~ ~~(~ rOo} ~}2, \.~-,_.' --n , 'C:J ('''''' ,-.-f! ..,'J >:::'- .. l ~ ;. r-:-' r-- . !.-",1") grandchild of mine living who is under the age oftwenty-six (26) years. Such distributions may be made to cover the following associated expenses of primary and secondary schools and college, university, and vocational or technical institutions: tuition, laboratory fees, books and supplies, and room and board. If there is no grandchild of mine under twenty-six (26) years of age, the then- remaining principal and any accumulated and undistributed income shall be distributed equally among my then-living grandchildren. THIRD: I appoint my son, KEITH A. KELLY, of Charlotte, North Carolina, to be the Executor of my Last Will and Testament. FOURTH: In addition to having all the powers conferred by statute or by general rules of law, my Executor and Trustee, with respect to the properties in my estate, subject to any limitations stated elsewhere in this Will, are specifically authorized and empowered: ( a) To invest any funds of my estate in any corporate shares, bonds, notes, or other securities or property, real or personal, including any common or commingled funds maintained by my Executor and Trustee hereunder. This is to reflect my intention to give the broadest investment powers and discretion to my Executor and Trustee; (b) To sell or otherwise dispose of any property, real or personal, at any time forming a part of my estate, for cash or upon credit, in such a way and on such terms as my Executor and Trustee may deem best; (c) To manage, operate, repair, improve, mortgage, and lease for any term any real estate at any time held; 2 j)~ (d) To make distribution in cash or in kind upon any division of my estate; and ( e) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property in his own right, and to do all acts which my Executor and Trustee deems necessary or proper to carry out the purposes of this will. FIFTH: No Executor or Trustee acting hereunder shall be required to post bond or enter surety in this any other jurisdiction. SIXTH: If any person or institution entitled to share in any distribution under the terms ofthis my Last Will and Testament becomes an adverse party in any proceeding to contest the probate of this Last Will and Testament, such person or institution shall forfeit his, her or its entire interest inherited hereunder and all provisions in favor of such person or institution shall be declared void and of no effect. The share of such person or institution so forfeited shall be distributed a part of the residue pursuant to Paragraph Two hereof except that if such person or institution is entitled to share in the said residue, that interest shall be distributed proportionately to the other residuary distributees. r/h- IN WITNESS WHEREOF, I have hereunto set my hand this /D day of ~ ,2004. g~,u 1& /)IJ Ku~ (SEAL) DELO S KELLY '- 3 SIGNED, SEALED, PUBLISHED and DECLARED by the above, DELORES KELLY, 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: Lg~ /; WITNESS of 5f' E 5.SeK f!J ~ 11//12/7011 of IS' G./~"L~A~;T /~ ~ IJ~. fZ /70 I) , RlJ-J /, ~ ~. ~ I-UA ~ WITNESS COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF I, DELORES KELLY, Testatrix, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument of my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn to and acknowledged before me by DELORES KELLY, the Testatrix, this day of ~2004. ~ 4_N IJ ~ljt DELORE'S KELLY j O-tb. ~ U)LL 0 otary Public W~ " A IAl CAROlE A ROSE Notary Public TWSP OF LOWER ALLEN CUMBERLAND COUNTY My Commission Ex ires Oct 21.2007 4 COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF S We, Ll5ft SOUL and_Bptt:-htlL~' -g~rz Dcz:"ffu~ witnesses whose names are signed to the attached instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, DELORES KELLY, sign and execute the instrument of her Last Will and Testament; that she signed it willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight ofthe Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. 0 ') 6 r.1l. Sworn to and subscribed to before me by LiS If I":> oeL and v';}II'~ riM J f.!JO?1{t.tJf ({'7- , witnesses, this (c:fri- day of /J-u~ 2004. ~~k~ itness CfuJJLL Q. fb~ Notary Public j~~c-~ a~duxL Witness NOTARIAL SEAL CAROlE A ROSE Notary PubliC TWSP OF LOWER ALLEN CUMBERLAND COUNTY MY Commission ExPires Oct 21. 2007 5