HomeMy WebLinkAbout07-23-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of ARLENE B. HENRY
also known as
COUNTY, PENNSYLVANIA
File Number Z ~ ' ~ ~' ~ ~ 1
Deceased Social Security Number
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 EXECUTOR
last Will of the Decedent dated 04/13!2005 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 instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant oiLetters of Administration
(lfapplicable, enter: e.t.a.; d.b.n.c.t.¢; pendente liter durante absentia; durante minoritate)
.., _, ,
(COMPLETE INALL CASES.) Attach additional sheets if necessary. ~ ~'7 ~ -
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his !her last princti~:`~residence'~~ tL' , ~P N„s fn r, l ~ Tw P,
19 E MAIN ST PLAINFIELD PA 17081 z- c -~
(List street address, towrr~city, township, county, state, zip code) ~
Decedent, then 81 years of age, died on JUNE 30 ~ WEST PENNSBORO TOWNSHIP
Decedent at death owned property with estimated values as follows: 10 , 000.00
(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 $ 75,000.00
situated as follows:
Form RW-02 rev. 10. ]3.06 Page 1 of 2
Petitioner(s) after a proper search has I 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.)
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters priate form to
the undersigned:
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 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 affsrmed and subscribed
before me tlye Z~d day of
~~.•1 ,
.(,r~r~~ ~:r~~
For the Register
~~
Signature of
~a:
Representative
Signature of Persona) Representative
Signature of Personal Representative
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File Number: Z ~ ' O ~' ~ ~~ - `~ -~
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Estate of ARLENE B. HENRY , D~ased W
.c"
Social Security Number: 201-18-0237 Date of Death:JUNE 30, 2008
AND NOW, ,_~,~._~,~u 2 ~ Z~ . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters TESTAMENTARY
aze hereby granted to STEPHEN C. HENRY
in the above estate
and that the instrument(s) dated 04f13f2005
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
FEES
Letters ............... $ Z1'~ • c~
Short Certificate(s) ........ $ ~ 2 • ~
Renunciation(s) .......... $
~.. ... $ 4~•~
... $ ~.~
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ ~-9~d-
Attorney Signature:
Attorney Name: SUSAN J. HARTI~v AN
Supreme Court I.D. No.: 65184
Address: 1 IRVINE ROW
CARLISLE, PA 17013
Telephone: 717-249-7780
Form RW-02 rev. /0.13.06 Page 2 of 2
tos x(h aev Inutcl
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ Fee for this certificate, $6.00
P 1.464903
Certification„~lumber
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TYPE/PRINT IN
PERMANENT
BUCK INK
This is to certify that the information here given is
co~7-ectly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate wit] be forwarded try the State Vital
Records Office for permanent filing.
A • ~es„ic~~~~,~U~ 2~ 2008
Local Registrar Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on rnvnrsnl ~ r .-. h -~.~ ~
1. Name of Decedent (First, midtlle, lest, suglz) .,...._,._"...,....,, .vU / ~ 1
2. Sex 3, Social Socuriry Number 4. Date of Deam (Mmih, tlay, year)
Arlene B Henry emale 201 - 18- 0237 June 30, 2008
5. Age (Last Rinnday) Under 1 year Untler 1 day 6. Date of SiM {Month, tlay, year) i. Binhpiace (City and state or loregn country) ea. Place d Death (CnecN only one)
81 aim pays iwrs Mx,Nas 3 / 2 6 / 19 2 7 O dell I L HOSpirel oma~.
Vrs' ^ Inpatient ^ ER /Outpatient ^ DOA ^ Nursing Home ®Rasidenm ^Omer - Speciy:
9D. County of Death &. City, Bore, Twp. of Death Bd. Facility Name (II not iwtiluton, g ive street and number) 9. Wes Decedent of Hlspank Origin? ~ No ^Ves 10. Race: American Intlian, BWCk. White, etc.
Cumberland West Pennsboro 19 E. Main St. plainfield olyea,apecilyc"ba", (y«,;~
Mexican, Pueno Rican, etc.)
11. Detadenl's Usual Oau ton Kind of work tlaw dun most of wok life. Do not M818 retire 12. Wes Decedent ever in the 13. DBCatleni'b Education (Spedry only highest gretle mmpletedj 14. Marital Slates: Merced, Never Married, 16. Surviving Spouse (II wile, give maiden name)
K I W m Kirk of Tress /Indus U.S. Armed Faces?
Post P~pdas£er U.S
~aosta~' Elementary /Secondary (0.72) College (1-0 or 5+) Widowed, DNorced (Spenl~
.
^Yea t%rp 12 Widowed
16. DecetlenYS Maikrlg Adtlress (Street, oily I town, stele, zq catlel Decedent's
°
°
a
~
d0o1
P . 0 . BOX 4 3 Actual ReSiaerKe na. seta PA
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n
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®Yes, Decetlenl Lived in W P R ~' P n n c h o r o Twp
• Plainfield PA 17081 nb.cpanlr Taxnshlp?
iedwNFup
Cumberland tid'^
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t
~m~at
18. Father's Name (First, mitldl8, last, suffix)
Wilbur Bolen A
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pal
n
cityyepre
19. M01her's Name (FirM, midtlle, maiden surname}
Edna Smith
zoo. mmmlad'S Name Rype / PnmJ Stephen C . Henry 200. Imormant'S Mailing Atltlress (Street, uty! town, slate, zq cotle)
289 Smith Rd Shippensburg, PA 17257
21 a. Metnod d Dispwdion ®Crsmation ^ Done08n
^ Banal ^ Removaliromsate ~ wa
cre
ta
D
u
h b. D to of Dia Non (
~u~-Y ~, ear}
~~~~ 2 PI D'ISPwilion Named mry, creme ry «om« place)
~ol~ing~r ~rema~or omtio I 19,
~'~. "~PS~'S'j~ ~~~in
s PA
e
m.
n«
one
cnAut
odxed
^ Other ~ Speci/y by Medical Examiner f Cerorler7 }'Yea ^ No y g
17 0 6 5
22s. signawyA % Sernca ~ ee ( Person acting as such) L'
~~°~I5 L 2;g' ~~ E~~r~t WIR~r a Ome n C
" ~ Newville PA 17241
Canplele earns 23ec Dory when cardlyln
pryaidan a mx avereble el lima a deem
ceNy ca
% d d
em . To me bas y knowledge, deem occurred m me IMie, date and place smtetl. (SignaNre aM mle)
~ ~~ 23b. Llca Number 23c. Data S etl Monm, da year
>9n I r )
~ .15f
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e
. ~ ~ / ~~ 7 L
~/ ~ ` 40rJ
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Items 24-26 must tre canpleletl by person
• woo plmdnces tleam 4 Tine of eth 26. Dale raw Dead (Monm, day,
~ ' year) 26. Was Case Refertetl to Medical Examiner / Coroner fo
r
a eeson lher than C
remation or Donation?
. ~M. ~ ^Ves ^No
CAUSE OF DEATH (See Inattuctiom and a amples)
Item 27. Pan is Enter the chats d events -dkaeases, inrynea, a complka9ow - Ihel dredty mused the death. W NOT emer lenninel evems 1 Approximate interval:
such es caNiec erred Pen II: Enter other.donificant condtions c0nlnbut'Rg to deem, 29. Did Tobacco Use Conldbule Ip Death?
respiratory arrest, a ventricular fi0nllelion wahoul showing the etorogy List only one muse on each line. , Onset to Deem but rid resugirg in the untlerkr4ng cause given in Pan {. ^ Yes ProLrebry
IMMEDIATE CAUSE (Final Disease or
r ^ No Unknown
cmdNion resuNirg In eaih) ~ n"~••~a51t.1'l y LET y( ~A- (~
a
V
l ~ V t~ `~ 29. Il Female:
Due tp (pr as a mnsequenm pf):
• ^ Npt pregnam whhin past year
SeWa,laadY list rdldxions, if any, 0.
lead to the muse listed m Ilne a. Due to
s
for
f
t ^ Pregnant al lime d loam
q )
a mnse uertca o
a
ErAer IM UNDEgLYHJG CAUSE
adsease pf injury met Inuialed 1118 ^ Not pregnant, out pregnant wflho 42 tlays
v m resulting in death} LAST.
C of death
Due Ip (pr as a mnsequenm ol):
^ Nol pragnani, but pregnant 43 days to 1 year
d r
r befog Daam
^ Unknown it pregnam wdhin 91a pest year
30e. Was an Autopsy 30b. Ware Aulapry Findings 31. Mamrer d Desih 32e. Date of Injury (Momh, tl0 ,year) 326. Describe Hex In ury Oceurtetl
Pedomwtl? Availade Prior to Canpletion y )
32c. Plain d m'ryry: Hone, Fartn, Street, Factory,
d Caws d Dmmv ~Netutal ^ Noontide Ofrica Bdldrg, etc. /SpecNy)
^ Yes ~ No ^ Yes ^ No ^ Acadenl ^ Pending Inve5ligallOn 32tl. lime of Injury 32e. Injury ai Work7 321. II TmnsponflNen Nluty (Specify) 32g, lDpatlen of Injury (Street, dty l town, stale)
^ Suidde ^ Could Not be Determined ^Ves ^ No ^ Driver I Opemta ^ Pasaringer ^Pedeslnen
M char . spedly:
33a. cannier (check Doty one)
• CeNilying phyaicmn (Physidan mrtilying cause d Beam when another physidan has pronounced dealn antl completed Item 23) 33b. Sgnature TNe of Canifrer
7p IM beet of my NnowNkge, tleaM occurred due la lha cause(e} ark manner a etele~ ~ ~ ~y.
A.
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Pronouncing and cenityin
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b _ _ ~ _ _ _ _ _ _ _ _ _ _ _ _ ~ .
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pronouncing death and cemfying to mesa of tleath]
To the heel of my knowledge, death occurred at the time, date, and place, ark due tome cause(s) end manner as stated_ _
• IAedicnl ExammeN C«
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. Cleanse Number
Ida O t (, •2 4 ( ~, 33tl. Date Sgned (Monm, day, year)
~ ~b V
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e
0 the heals of examin tlon BnD 1 or invesligalion, in my opinlan, tleath occurred at the time, data, and place, and due to the cause(s) and manner as atated
^ ~
_ 34. Name antl AtldreSS of Person Who Coin letl Cause of Death (ite m 27) Type I Print
35. Regi ignature arq Distract
Dale Filed (Month, tlay, year) ~e6 O (~ l p . 2n ty ~ (M J ~
- V
I ~I ( I ~ I 1 I , f S S~ w •tn.nvZ 30
(~ Crr+,cla Pe
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Diapwnia,ParmNN". ~~-~f~~
LAST WILL n
TESTAlIlENT OF ; ~, ~___ r-
= rv
=1 cs --
I, ARLENE B. HENRY, of 19 E. Main Street, P.O. Box 43, Plainfield, P~ ~7(~81,
Cumberland County, being of sound and disposing mind, memory and understai~,~g, do h€~by
make, publish and declare this as and for my Last Will and Testament, hereby revoking an~,nd
all other wills and codicils heretofore made by me.
FIRST. I direct that all my just debts and funeral expenses be paid from my estate as
soon after my death as practically and conveniently may be done.
SECOND. I direct that my remains be cremated and my ashes disposed of in accord with
my expressed wishes.
THIRD. I authorize my personal representative to expend funds from my estate, in such
amounts as my personal representative shall consider necessary and desirable for the purchase,
erection and inscription of a suitable marker for my grave.
FOURTH. I give, devise and bequeath my 1.2 carat diamond ring unto my daughter,
CAROL D. WILLIAMS.
FIFTH. I give, devise and bequeath all the rest, residue and remainder of my estate unto
my sons, MICHAEL P. HENRY, ROBERT L. HENRY and STEPHEN C. HENRY, in equal
shares, per stirpes.
SIXTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my residuary
estate.
SEVENTH. I hereby nominate, constitute and appoint my son, STEPHEN C. HENRY
as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation
or inability to act for any reason whatsoever of STEPHEN C. HENRY, I nominate, constitute and
appoint my son, MICHAEL P. HENRY as Executor of this my Last Will and Testament. I
hereby relieve my Executor from the necessity of posting security in connection with his duties,
as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to
do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute
discretion, to retain in the form received, and to sell either at public or private sale any real or
personal property owned by me at the time of my death.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Last Will and Testament, consisting of two typewritten pages this 13
day of ,~ j~j~lL
2005.
~c~~~~
ARLENE B. HENRY
Signed, sealed, published and declared by the above named Testatrix ARLENE B. HENRY as
and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and
presence and in the sight and presence of each other, have hereunto subscribed our names as
witnesses.
~. ~
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COMMONWEALTH OF PENNSYL VANIA
. SS.
COUNTY OF CUMBERLAND
I, ARLENE B. HENRY ,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 instrument as my Last Will; that I signed it willingly; and that I signed it as my
free and voluntary act for the purposes therein expressed. (~
~1~L9~(J j~*~-G~
ARLENE B. HENRY
Sworn or affirmed to and
acknowledged before me, by
ARLENE B. HENRY this ~ 3I'~` day
of ~ ~ , 2005.
r=_ -~
~~~
otary Pu is
NOTARIAL SEAL
Kathy L. Mummert, Nogry Public
Barough of Carlisle, Cumberland Co., PA
My Commission Expires Aug. 11, 2007
COMMONWEALTH OF PENNSYL i~ANIA
COUNTY OF CUMBERLAND
SS.
We, 5~`~n j t-~tCtyy~4n and aout~ ~ Pr~C~~S the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to law, do depose
and say that we were present and saw ARLENE B. HENRY sign and execute the instrument as
her Last Will; that she signed willingly and that she executed 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 that time eighteen
(18) or more years of age, of sound mind and under no constraint or undue influence.
~,
Sworn or affirmed to and
subscribed before me by
SvS~ri :.~ ~~.C~'~ci~n and
~~~ ~ his ,witnesses,
this j3 day of ~~ l , 2005.
Notary Public
(~ NOTARIAL SEAL
i F;~thy L, Mummert, Notary Public
~$orough of Carlisle, Cumberland Co., PA
My Commission Expires Aug. 11, 2001