HomeMy WebLinkAbout08-29-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ~ lDe.. L/ ~ tom/
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
COUNTY, PENNSYLVANIA
File Number ~` ~~ 6 V" 1~
Social Security Number l ~ y~ - ~ `-1 - tG' S y 9
A. Probate and Grant of Letter Testamentary and aver that Petitioner(s) is /are the CPl.a~~c(<rk, / (-du k ,`fir named in the
last Will of the Decedent dated 6~ a~lJ l~r~,~ _ and codicil(s) dated
(State relevnrtt ci,-cumslances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the insttumen~(s~ offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
TC ~ _ .
r_ _ t~--
B. Grant of Letters of Administration ~ -~ `- ~ `'
(Ifnpplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante mirrdrlfate)
- --t
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse;(i~:5n~) and"hairs: (!f
Adntirtistration, c. t. a. or d.b.tt.c.t.a., enter date of Will itt Section A above and complete list of heirs.) - - -° •
- - ) t,`y -
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in (,•~,~t, /~Pt !R d7Q County, Pennsylvania with his / h last princi
Llt/l~~p_ ~~1~ ~~r~ ~c_ra~ri ~.4 ~v'' L6/ C~oEfv~lc~ 45 ~ai~17 L
(List su-eet address, towrt/ciry, townskip, coung,, state, zip cod
Decedent, then l6 ~ years of age, died on Q at w ~ //'1
Decedent a[ 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
at
v
$ /, 57~ Ut /~9 ~
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:
~ Sienature Tvued or printed name and residence ~
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~l~-7 ~7 ~L
Form R6V-0? re~~. 10.13.oe Page 1 of 2
Oath of Personal Representative
CON(v10NWEALTH OF PENNSYLVANIA
COUNTY OF
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are ti~te and con•ect 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 %o or affirmed and subscribed
Signature of Persons! Representative
before me th C:~ ~d~a,(y~~of ~ ~ _=
C Signature of Personal Representative -. -} __
N
l.~
Fcr the Register Signatw•e of Personal Representative
-- -'~j <<
~ ~ ~,~ pc~o~~ a-~
File Number:
Estate of ,Deceased
i~a 3
Social Security Number: Date of Death: I~l,t_~ ~?' a ~ ~~
AND NOW, ' 1 , O~~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before e, IT IS DECREED that Letters
are hereby granted to
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters . ~tJ~.. { Uv~ . $ 1 ~U
Short Certificate(s) .. `-~~ ... $ a
Renwlciati(on(s) .......... $
(: •~l/l
.JC .
. $ ~~
. $ ! c7
. $ `v
.$
... $
... $
... $
... $
... $
TOTAL .............. $ ~,(DDoo
•ecord a the last Will (a Codicil(s)) o
Register of Wills
Attorney Signature:
i
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
in the above estate
Por„~ RW-o' rev. l0.l3.oh Page 2 of 2
105.80.5 REV (01/07)
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 14543255
Certification Number
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.
AUG 2 1008
G~ vn. ~ l
Local Registrar Date Issued
t -.~
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3EV lvzoo6 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PRINT IN
ANENT CERTIFICATE OF DEATH ,,//~'~ ~/'•^'~,
.K INK (See instructions and examples on reverse) ~ ~ n 1") n Y'1Q l !
STATE FILE NUMBER
1. Name of Decedem (First mitldle, last, sucix) 2. Sex 3. Serial Secwity Number 4. Date of Death (Month, day, year)
Chloe 0. F Female 192 - 3/+ 16549 ~ TUC.
5. Age (Lass Birthday) Under 1 year Under t day 6. Dale of Birth (Month, day, year) 7. Birthplace (City and state or foreign country) Ba. Place of Deatn (Check Doty one)
105 monirts Devs Hours N+mtes
January 21
1903
Newville
PA Hospital: Olner:
~~//
Yrs , , ^ Inpatlent ^ ER / Outpatient ^ DOA L2S.Nursing Home ^ Residence ^Other -Specify:
8b. County of Death &. City, Boro, 7wp. of Death fid. Facilty Name (If Trot inslitulbn, ve street and number) g. Was Decedent of Hapanic Origin? No ^ Yes 10. Race: American Indian
Black
White
etc
.n _
Cunberland Upper Allen 1 tap.
~~~~~ ,
,
,
.
^ ~~~~ ~ Mezecan, Puerto Ricann, etc.) (~~)
White
11. Decedent's Usual Oct tan Kind of work done tlur most d ~ Itla. llo not slate relined 12. Was Decedent ever in Me 13. Decedent's Education (Spedly only highest grade completed) 14. Mental Status: Married, Never Marled, 15. Surviving Spouse (If wife, give maiden name)
KIM of Work KiM of Business /Industry U.S. Armed Forces? Elementary / SecoMary (0-12) College (1.4 or 5+) Widowed, Dhrorced (Sped7N
Medical Doctor Hospital ^Yea ~l0 5+ Never Married
16. Decedent's Mating Address (Street city /town, state, zip code) Decedent's pA Did Decedent Silver $ rl
Slate Liver in a 17
Actual Reatlence 17a
®
P nK ~P •
101 Coffman Point Dr . . 0
Yas, Decadent LNed in
Twp.
T
M
?
Mechanicsbur
PA 17050 awns
p
1 m. County 17d. ^ No, Decedent Lived within
1d,11UCr1d11C1
g, Actual Limits of
City I Rom
16. Father's Name (FIrsL middle, last. suXix) 19. MoNer's Name lFlrsl, made, maiden surname)
U. Grant Fry Buela E. Grosh
20a. Infomant's Name (Type /Print) 20b. Informant's Mailag Address (Street, city I town, state, zip cotlel
Geraldine Reward 101 Coffman Point Dr., Mechanicsburg, PA 17050
21a. Method d Disposition Cremation ^ Donaton 21b. Date of Dis{osition (Month, day
, year) 21c. gl Disposkion ( me of cemet crematory a other are)
~~
~'
ery
'~ 21 d. Location lCiry /town, state, zip code)
^ Buna ^ Removal from State ;Was Cremation or oonatlon Autfwrized
^ other - spedry: i by Medical Exarnlner / ~1 Tea ^ No M
A t 29 2008
~S ~ HO
inger
tmera
l Home &
CTPFm8t0 Mt . Holly Springs , PA
22a. S' d Funeral Serdce aensee (or rson s such) 22b. License Number 22c. Name all Address of Facility ens- er Unera Ome
~ - 014819 L 1903 Market St. Hill PA 17011
Carplae Items 23ec onN when certitying 23a. To the best of my knowledge, death occurred at the time, date and place staletl. (SlgnaMe all title) 23b. License Number 23c. Date Signed (Month, tlay, year]
physaan is rid avaiWble at lime of death to
cerlily cause d death.
Hems 24-26 must be completed by person 24. Tim
e of Death 25. Date Pronounced Dead (Month, day, year) 26. Was Case Relerted to Medical Examiner / Cooner for a Reason Other than Cremadon or Donation?
who pronounces death. /
~v ~~ A M, '~ ~GO ^Ves g]No
CAUSE OF DEATH (See instzuctlons and ampler) ~ Approximate interval: Pan IC Eller oMer;(gnificant coMkions ca^L~blsino to tleaLn, 26. Da Tobago Use Contnbule to Death?
Item 27. Pan I: Enter the main of eyenLa -diseases, Injuries, or complications -that duectly caused gre deaN. DO NOT enter termin al evads such as caNiac artest t Ousel Ie Death but not reselling in the uMenying cause given in Pan I. ^Ves ^ Prohady
respiratory artest, or ventnctaar fibrillation wkhota showing Me etidogy. Usl Doty one cause on each lime. r
t
r
~'rvo ^ Unknown
IMMEDIATE CAUSE IFinal disease or /n1
rendrtbn restating In N) AJ YZP~~ Y yu'~ ~2LC~
a.
~ C~iLL
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f~i,Ivyz~iXC cncl s~r~~~
29. M F N:
~
Due Io (r as a cmnsequence d): r
t ,f^
Vb~ LL'Z1
~' ~
~ t Pregrent wahin past year
^ P
Sequentiaty list oorvlkans, N any,
b.
Irst
tl
n Ime a
k
tllr
t
th r
4y regnant at time of death
e
o
e cause
e
o
g
. Due to or as a copse
Enter the UNDERLYING CAUSE ( quanta oft: t ^ Not pregnant, but pregnant wither 42 days
(disease or kgury that initiated the c
events resulting m death) LAST. t
t
t
IC15 ~S L9'C~ ~
/
of death
Due to (or as a consequence d): r ^ Nd pregnant, but pregnant 43 days to 1 year
d, before death
^ Unknown 8 pregnant within the past year
30a. Was an Auopsy 30b. Were Autopsy Fillings 31. Manpar of DeaM 32a. Dale d Inju ry (MOnm, tlay, year) 32b. Desrxibe How Injury Occurred 32c. PWce of Injury: Home, Farm, Street, Factory,
Performed? Available Prior to Complatan
NaWrel ^ Homaide Otlice Buiaing, etc. (Specify)
d Cause of Death?
^ Yes ~o ^Ves ~JO ^ Aatitlent ^ Pending Investgatan 32d. Time of Inju ry 32e. Injury at Work? 32f. II Transportatan Inryry (SP~NI 32g. Location of Injury (Street, city /town. stale)
^ Suaide ^ Coultl Nd be Determined ^Ves ^ No ^ Odver I Operstor ^ Passenger ^Petleanan
M ^Other - Spedly:
33a. Certifier (check anty one)
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23 330. Signature and Title of Canlfier
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To the beat of my knowledge, death oecurted due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ !
• Pronoundng all certifying physician (Physaian both prorwunong death all certitying to cause of death)
death occurred at the cline
all due to the cause(s) and manner as s
T
th
b
t of m
knowled
e
date
and
lace ~~qq
tated 33c. License Number - 33d. Date Signed (MOnln, day, yeaq
es
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,
,
,
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• Medical Examiner /Coroner _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ yy 1 „.
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On the basis of examinatlon and / or investigation, in my opinion, death occurred at the lime, date, end place, all due to the cause(s) and manner as slated_ ^ ,
.
.y
34. Name all Adgress of Person Who Completetl Cau d Death Qtem 27) Type I Print
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R stray's Signature M Dist - ben I ~ / I ~ / I / I 36. D FiIM ( nth, tlay, year) S4~.e a ,v~
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Disposition Permit No. 022 V V'fV
LAST WILL AND TESTAMENT r> - .
_,
OF
'~
CHLOE O. FRY _ ,
_, i --i . .
I, CHLOE O. FRY, of Lower Allen Township, Cumberland County, Pbnnsylvar~ia,
being of sound and disposing mind and memory, do make, publisi ~ and declare this to
"~A r;y Last ~~~lill anu Tes't~trne~~t, hereby revoking all `~Ils and Codicils by me at any time
made.
ITEM I: TAXES. I direct that all inheritance and estate taxes becoming due
by reason of my death, whether such taxes may be payable to my Estate or by any
recipient of any property shat{ be paid by my Executor out of the property passing under
this Will, which is not specifically bequeathed or devised, as an expense and cost of
administration of my Estate.
I"fEM II: POWER OF APPOINTMENT. I hereby exercise all powers of
appointment which I may have at the time of my death in favor of my Executor and all
i:~roperty Subject to all such powers of appointment shall be included in my Estate.
ITEM III:. FUfJERAL INSTRUCTIONS, After notifying Dr. Loucas C. Tzanis, it
iti, my desire that my body be taken to the Myers-Hall Funeral Home in Camp Hill,
I/c;nr~syivania, to be cremated. I direct that there shall be no autopsy or embalming of
rrty body. There shall be no viewing and no memorial service. The ashes shall be
1
buried beside the bodies of my parents in The Rolling Green Memorial Park (from which
an individual marker has been purchased). A Transfar Agreement, Q3702A-Z, showing
transfer of grave Number One, Lot 779A, Block G, from the estate of my brother, Gordon
E. Fry, was issued to me September 3, 1974, and also an adult cremation vault was
purchased from The Rolling Green Company.
ITEM IV: SPECIFIC BEQUESTS. I hereby make the following specific
bequests:
A. Twenty-Five Thousand ($25,000.00) Dollars and my black Chinese
breakfront which currently stands in my dining room to my friend and helper,
MARGARET HOPE, if she survives me.
B. My bureau in my bedroom to my niece, GERI HOWARD, if she
survives me, and if she does not survive me, by bureau shall be given to her elder
daughter, CINDY ORRIS, of New Cumberland, Pennsylvania.
C. Five Thousand ($5,000.00) Dollars to my cousin, LEETA FICKES, of
tiey~~,•ilic, Route ~, Pennsylvania, if she survives nee.
D. Twenty-Five Thousand ($25,000:00) Dollars to GERALDINE WOLF,
225 North Nineteenth Street, Camp Hill, Pennsylvania, if she survives me.
E. Five Thousand ($5,000.00) Dollars to my cousin, MARY FRY
MENGES, of Newville, Pennsylvania, if she survives me.
2
F. Two Thousand Five Hundred ($2,500.00) Dollars to JANE BROWN,
8 Frances Drive, Harrisburg, Pennsylvania, if she survives me.
G. Two Thousand Five Hundred ($2,500.00) Dollars to CLAIR LEWIS,
416 Berryhill Road, Harrisburg, Pennsylvania, if she survives me.
H. Two Thousand Five Hundred ($2,500.00) Dollars to DORSEY FRY,
1938 Cooper Circle, Camp Hill, Pennsylvania, if she survives me.
I. Five Thousand ($5,000.00) Dollars to GORDON FRY, 212 madders
Drive, Mechanicsburg, Pennsylvania, if he survives me.
J. One Thousand ($1,000.00) Dollars to HAROLD FRY, JR., 1816R
Graham Street, Windber, Pennsylvania, if he survives me.
K. Five Thousand ($5,000.00) Dollars to MURRELL BENNETT, 601
Whitefield Road, Mechanicsburg, Pennsylvania, if she survives me.
L. Five Thousand ($5,000.00) Dollars to EMERY BENNETT, III, of
Mechanicsburg, Pennsylvania, if he survives me.
M. Fifteer~ Thousand ($15,000.00) Dollars to D^R!S DO~!!ASK,
4327 Greenwich Circle, Sacramento, California, if she survives me.
N. Five Thousand ($5,000.00) Dollars to ROBERT WACHTMAN,
810 Chambers Hill Road, Harrisburg, Pennsylvania, if he survives me.
O. Five Thousand ($5,000.00) Dollars to CINDY ORRIS, of New
Cumberland, Pennsylvania, if she survives me.
3
P. Five Thousand ($5,000.00) Dollars to JENNIFER HENSLEY
HOWARD, of 101 Mi[Ifording Road, Mechanicsburg, Pennsylvania, if she survives me.
Q. Ten Thousand ($10,000.00) Dollars to UNITY CHURCH, 4695 Charles
Road, Mechanicsburg, Pennsylvania, or whatever its corporate name may be.
R. Five Thousand ($5,000.00) Dollars to MILLIE BURNETTE, if she
survives me.
S. My diamond stud earrings, my S shaped diamond tennis bracelet,
my amethyst sail boat pendant on box chain, and my Omega Symbols Classic 18K gold
watch with .44 ct. diamonds to GERI HOWARD.
T. My tennis bracelet 8.46 ct. diamonds with my tennis bracelet 4 ct.
diamonds with my amethyst tennis bracelet, all which have been made into one bracelet
and my cushion shaped green tourmaline pendant with chain to VALERIE PEREA.
U. My emerald cut amethyst pendant to NANCY WAGNER.
V. My pear shaped garnet pendant with .4 ct diamonds to JENNIFER
W. My emerald cut kunzite pendant .26 ct. diamond with chain to
MARGARET HOPE.
X. My sapphire ring with three diamonds to CINDY ORRIS.
4
Y. My stories, as I have written them during my lifetime, whether
complete or incomplete, and all of the rights to publish these stories, to my friend,
VALERIE PEREA.
Z. My collection of books that I have at the time of my death to my
friend, VALERIE PEREA.
ITEM V: RESIDUARY ESTATE. I give, devise and bequeath all of the rest,
residue and remainder of my Estate in the following manner:
A. I give two-thirds (2/3) of the residue to my niece, GERI HOWARD,
101 Milfording Road, Mechanicsburg, Pennsylvania. If GERI HOWARD predeceases me,
I give her two-third (2/3) share to VALERIE PEREA.
B. I give the remaining one-third (1 J3) of the residue to VALERIE
PEREA. If VALERIE PEREA should predecease me, I give her one-third (1/3) share to
my niece, GERI HOWARD.
ITEM VI: EXECUTOR'S POWERS. In the settlement of my Estate, my Executor
sha!I possess, among others, the following:
A. To sell privately and upon such terms and conditions as my Executor
may deem advantageous to my Estate, any or all personal estate or interest therein,
whether owned by me separately or in conjunction with other persons or acquired after
my death.
5
B. To pay all costs, taxes, expenses and charges in connection with the
administration of my Estate.
C. To distribute my Estate in kind or in money. In the event assets are
distributed in kind, such assets shall be distributed at their value(s) on the respective
dates} of their distribution.
D. To do all other acts in the judgment of my Executor necessary or
desirable for the proper and advantageous management and distribution of my Estate.
ITEM VII: EXECUTOR. I hereby nominate, constitute and appoint GERI
HOWARD, of Mechanicsburg, Pennsylvania, as Executrix under this, my Last III. GERI
HOWARD shall serve as Executrix without commission or any type of compensation for
her services. In the event of the death, disqualification, resignation, refusal or inability
of GERI HOWARD to serve as my Executrix, I nominate, constitute and appoint my
firiend, VALERIE PEREA, as my Executrix.
ITEM VIII: PROTECTIVE PROVISIONS. To the extent permissible by law,
nc~ interest in income or principal hereunder shall be subject or liable to anticipation,
sale, assignment, pledge, debts, contracts, engagements, orders or liabilities, nor be
subject or liable to levy attachment, execution, sequestration, or seizure under any legal,
equitable or other process.
6
ITEM IX: PROVISIONS CONCERNING FIDUCIARIES. No Executor qualified
hereunder shall be required to give bond or security for the faithful performance of duties
in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this
my Last Will and Testament, consisting of ~ typewritten pages, including this
attestation clause and the following Acknowledgment and Affidavit, to be executed,
declared and published this •~ ~ day of ~ ~-~~-~--~-~ , 1995, at ~~-~-22~~,.-~ti~
Pennsylvania.
Chloe O. Fry
7
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
. SS.
COUNTY OF ' __ ~~'{~'~- "~.. )
I, CHLOE O. FRY, the 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.
Chloe O. Fry
Sworn or affirmed to and acknowledged before me by CHLOE O. FRY, the
Testatrix, this ' -C~ ~~ } day of `~, ~ ~~~ ~'~ .
1995.
f
~~
L
Notary Public:
(SEAL)
My Commission Expires:
Notarial Seal
$ Linda A. DeAngelo, Notary Public
Harrisburg, Dauphin County
My Commission Expires Sept. 17, 1998
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF~'tt.?~~`y~ ) i
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,- ,the witn s s, whose name are signed to the ached orb ~ regoing
`--i strume eing duly ~alified according to law, do depose and say that we were
present and saw CHLOE O. FRY sign and execute the instrument 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 Weil as witnesses; and that to the best of our knowledge, the
Testatrix was at the timetwenty-one (21) or more years of age, of sound mind and under
no~straint or undue influer~e.
~.-~
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~'~ '~ Residing
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i i ed t nd,a knowled~ed ,befor ~ e by
n ~_ ~ ~- .,,~ .r---and
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~~_ , 1995. ~ .
C_. ~ ' ~ l~ ~~ '_ l;
~.~~~
Notary Public:
(SEAL)
My Commission Expires:
(~otaria! Sea(
g Linda A. DeArnJJeio, Notary Public
Harrisburg, Clauphin County
Poly Carnmission expires Sept. 17, 1998
Residing at -~ l~~"5~'' /~~-~`~•c- Ti>.~~,
Residing at
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