HomeMy WebLinkAbout09-03-08PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~umgE,eLg,v~i
COUNTY, PENNSYLVANIA
Estate of ~sA L ~ N L. ~O L Tie y File Number d~ 1 ~~ ~~"lv
also known as p p
,Deceased Social Security Number ~~~ -~a ~ ~ 7 ~d
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(~C.,O/MPLETE 'A' or 'B' BELOW:) / ~
lkJ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the L-/q~~ ~- /70 LTR y named in the
last Will of the Decedent dated F~1~, .:tDOct and codicil(s) dated
(State relevant circmnstances, 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 [he victim of a killing and was never adjudicated an incapacitated person:
^ B. Grant of Letters of Administration
(lfapplicnble, enter.• c.t.a.; d. b. n. c. t. a.: pendenre fire; durance absen[ia; durmue nrinoritate)
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and~rs: (!f _, ~
-.
Administration, c. t. a. ord. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.) coo .pi • -'
Name Relationshi Residen -~ C: ~=`';
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(COrY1PLETE IN ALL CASES:) Attach additional sheets if necessary. -"'4 -"~' ~''
Decedent was domiciled at death in CU/YIBE2LaM D County, Pennsylvania with his /her last principal residence at ~"
(List scree[ address, town/cli~ty, township, county, stnte, aip code) ' `
Decedent, then 7 ~ years of age, died on ~ a 7 0 [~ at ~' 7' S~
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(lf 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:
$ /7~ DOO
Wherefore, Petitioner(s) respectfully request(s) the probate of the last W ill and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Signature Typed or printed name and residence 1
~~,e,~y ~ f {oLre~°. ~/o ~k'E..v roil ~'T CSt~,ppE~.s~~~ {fA ~ ~~~7
Farm Rlv-o? ,e~-. 10.13.06 Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
SS
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 ' °
Signnture ojPe n l Representntive ~ ~ i=r ~ > :'
bef re me the ~..-._ day f n ~ ~°r ,."~
~~/fQ1~~ ~rt 1 t~ : ` r'i
'~/ , _ i;~~wCJ Signature ojPersonnl Representative ~ GJ =~i tr.3
n ~---;~.-'.'
For the Register Signnture of Personal Representative ~ ~ N r'--`- =+-
.~ ~ ~ Y' _;
File Number: (J~` Q D b~" ~ ~
Estate of I /'t) ,Deceased
Social Security Number: I ~~ I o? ~ Date of Death: 0~7
AND NOW, ~~~~ L~ , in consi eration of th foregoing Petition, satisfactory proof
having been presented before ~me^, IT IS DECREE hat L tters
are hereby granted to L_L~~_~~ L
and that the instrument(s) dated ~7` ~'lf t
described in the Petition be admitted to probate and
FEES
Letters ... 11 S,~r~'~.~-.~... $ a~08
Short Certificate(s) ..~ ~. .. $ ~
Renwiciation(s) ........ .. $
(.c' r i' . .. $ 15
'~ . .. $ S
. .. $
in the above estate
record as the last Will (and Cspdicil(s)) of Dec
Register of Wills
Attorney Signature:
Attonney Name:
Supreme Court I.D. No.:
Address:
... $
... $
... $
• • • $ Telephone:
... $
TOTAL .............. $ ~(~.
For»i RW-0_' rev. l0.l3.or Page 2 of 2
urxo> tte~ ~nuu-,
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
hee for this certificate, `6.00
P ~4481~88
Certification Number
' This i~ to certify that the information here given is
con-ectly copied from an original Certificate of Death
duly filed with me as Local Re gistrar. The original
x certificate gill be forwarded to the State Vital
Records Office for Wane t fi ling.
a
egistra o DaI~,?Issued
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H706143 REV 11/2006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~` r •
TYPE /PRINT IN
PERMANENT CERTIFICATE OF DEATH ~y /~,
BLACK INK (See instructions and examples on reverse) ~r.r~ ~„ ~ .,, ,...,~.. ~ 1 ~ ~ 7C "' 1
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1. Name d Decedent (Fast, midtlle, last, sulfx) 2. Sex 3 Soda) Secumy Number 4. Dde o1 Death (Month, day, year)
Galen Leroy Holtry a 184 _ 12 _ 4988 August 27, 2008
5, Age (Last Birthday) Umler 1 year Under 1 tlay 6. Date of Bidh (Month, day, year) 7. Binhpgce (Chy eM state a fordgn country) Ba. Place d Death (Check Doty one)
91 Minas I>sYs Hws MYwtes Haphal: gher.
' Yrs. $el 27, 1916 -4nTrrnnc}~mr~ PA
^ Inpatient ^ ER /Outpatient ^ DOA ®Nursing Home ^ Redtlenre ^Olher -$pecity:
Bb. County of Death 8c. City, Boo, Twp. al Death ed. Factiny Name Qf rid irNilulbn, give sued and number) 9. Was Drcedent oI Hispanic Orvjn? ®No ^ Vea 10. Race: American Indian, Black, Whae, etc.
Franklin QTambersbuzg PA (N yes, spedly Cuban, (Sp¢oryy)
ME71I10 Havat NL~1Tlg H®e
_ Mexican, Puerto Rican. dc.) 4tLite
11. Decetlem's Usual lion Kmtl d want done duri most d Poe. Do rot slate retired 12. Was Decetlenl ever in the 13. Decedent's Education (Spechy only highest gretle carplded) 14. Marital Slalus: Marred, Never Married, 16. Surviving Spouse (If wile, give mdtlen name)
~V~ h Kintl d Wplk ~ K4M d Business / InMMry
+
Y7
X T
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' U.S. Amred Forces? Witlowed, Divorced (Spacily)
Elementary /Secondary (0-12) College (1 d or 5a)
7+
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e p]i3T(ufdCt71L
2r ®Yes ^NO 8~ ~
ls. Decedent's Mdlkg Address (Street, dry /lam. stile, zip cotle) Decetlant's lNtl Decedent
PA
610 ffientat Street 4bj~„o„cr,mg Pa. 17257 Aduel Residence 17a. State
Live in a 17c. ^Yes. Deretlent LNedm
TwP
Township?
17d. ®No, Decedent LNed whhm.Gt'Ll
17b. County Q~erlaT)d
""°"""
Actual Limhs d 1 i
y Cily / Boro
18. F~
tleme (Frm
Mde lad 18. Mother's Name (Full, mitlwe, meitlen sumeme)
y
~
~ltry Josephine M. D.aff
20a. Imomrem's Narrre (Type / Pdnl) ~ 206. Inlomram's Mafing Address (Street city /town, slate, zip code)
iarry L. Holtry 610 ffi~Tton Street Shippt~lst~y Pa 17257
21 a. Mdlatl d D'sposilgn ^ Cremation ^ Donaton 21 b. Dale d Disposition (Momh, my, Year) 21c. Place d DisDOSnion (Name d cerrrdery, crematory a Diner plarel 2Itl. Locatgn (City /lam, slate, z'p cotle)
® Burial ^ Removal from Slate j W Cemation a Donation Authorized
^ gher - 'ty: i I Examiner I Coroner? ^Yes ^ No
2 r 2~g
^~ ~~ .~,~.,~1.,,,..,.,
~ir2^-••°.^.~y Pa • 17257
22a. S 1 Funerel5 a such) 22b. Licerue Number 22c. Name and Address of Facility
014351-L -Bricker ESmeral Ht~e 112 West Kv1g St. Shippatsburg Pa. 17257
Complde hems 23a-c Doty when cediyrng 23a. To tlw bent of my krxxr , deem occured d are tune, date and place datetl. (Sigroture antl thk) 23b. License Number 23c. Date Sigrretl IMomh, day, Year)
physidan n rot avatiable al time d deem to
certity cause d death. ~ [~`k~r~ ~~, n n n t~/l
(/ ` / u(J U v t 12N 59 Co 3 31- ~ugus~- a 7 , a o0 8
Items 24-26 mull be completed by person
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d 24. Time of Death 25. Date Prenourxetl DeadL(MOnth, day,-y7ear) ~7 ~~('~ Q
"'
~ 26. Was Case Rekned to Medical Ezamirer / Corarer br a Reason gher then Cremation a Donation?
o pronounces
ee
.
w 1 p~ 1 / L `~`-~ C.D
45 P t"1~ ~ U 9 (,,,~ S
3 ^Yes [1~No
CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Pan II. Enter dher @gnhiranl axxfil' coran6dkm to ath, 28. DM Tobeaa Use Conlribde to Dealh7
Item 27. Pan C Emer the chain of events - 6seases, kljuries, or axrWlicalions -that direclty ceased the tleah. DO NOT emer terminal events such as cardiac arrest Ousel to Death
i but rid resdlm m the urde n cause
9 rtyi g even in Pan I.
^Yes ^ Prebably
respiratory anent, a vemricvlar libntialkm whhod showkg the eddopy,USl Doty ale cause on each line.
r
IMMEDIATE CAUSE Fi
l di
r ^ No ,.® Unknown
-~
na
sease or -
candilbn relating at ~alh) ,~ a. Nan-EFoA~kct-ts LycvnTmg 4.~--Q Ivzi~t~.xS~2S~f r ~<r-n„nl--t rw 29. II Femek:
' Due to (a as a con uerrce oQ: ^ Nol pregnam whNn past year
SequenlialN 1i51 mrrtlitgns, X any, b, r
r
IeaNng to Ik cause tilled an ine a (•~ -
_ ~+~c C~~z51C~ci • of 1~1 tnv++..n. ^ Pregnam al tine of death
.
Enter the UNDERLYING CAUBE Due to (or as a consequence d): r D ~ 0 ~ J ;'-'- ^ Na pregnant but pregnant within 42 days
(disease ar injury Ihal vrilialetl the c
evens resWlkg m tleath) LAST. r d tleath
Due to (or as a consequence d): r ^ Nol re am, but
p gn pregnan143 tlays to 1 year
d. helore tleath
^ Unknown it gegnanl wmm~ Itre past year
30a. Was an Autopsy 30b. Were Amopsy Findngs 31, Manner d Death 32a. Dale d Injury (Mash, day, year) 32b. Describe How Irqury Occurred 32c. Mace of Injury: Home, farm, Slreel, Factory,
Pedormetl? Available Mbr to CaryAelbn ^ Hanmide
~alural ONice Building, do (Spedly/
d Cause of Death?
^ Yes ~ No ^Yes ~ No ^ Aadenl ^ Pending mvestigafion 32tl. Tine d Iryay 32e. Injury al Work? 321. II Trarsponatbn Inryry (SpecMy) 32g. Location of Injury (Sired, oily /sown, state)
^ Suicitle ^ Could Nol be Detennkxd ^Yes ^ No ^ Diner / Operdw ^ Passenger ^Pedeslrian
M gher - spaeay:
33a. Centlrer (check oily one)
• CertNying physkian (Physician cenitying cause d tleath when andha physidan has ponounced tleath antl carpleled Item 23) 33b. Sigrelure and Thle of Cenilier
(~
7o tM best d my knowledge, dedh otturred due to the cause(s) and menrrer as stded_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ I~' / '
- ~"~ (.J ryvy ~,• (Y(1 ,:
• Pronoundng end rerlirying physlebn (Physidan both prorwuncing death antl cetlilying to cause of tleath)
To th
be
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t the ll
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th
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^ 33c. License Number 33d. Dale Signed (Momh, tlay, year)
row
occurr
e, an
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my
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ea
a
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a
. p
ace, an
ue
o
e cause(s) an
manner as staletl_ .y_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Medical EzemlrKr /Coroner n'1 ~ ~ ~ S" ~ °~ L ~' '~
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i
On the basis of examindion a r investige n, In my Ibh, o ed d the time, dde, end place, end'tlue to the cause(s) and manner es staled_ ^ ,
~
34 Name and Address of Whp Completed Cause of Death glem 77) Type / Prml
e
6
35. Registrar's Signature a Di ml ;, , f ~
36: FNetl (MO ,day, year) . a.
,_,.,,t u, ~ICnC-levy ~ MSS
rYl lt` n , ~ e.-. 'fT~ ~ f 1 ~ »., ~ T v v s-~il
- I~ I I ZI I I (`12~- -p``;(~SAt ;, ch~ml~,rrb~~ 'P A 1`l ~o
r ~ Dispositon Permit No. [~/ ~ / /C.1 /
JRZ - 5.1 holtry.l January 28, 2002
LAST WILL AND TESTAMENT
I, Galen L. Holtry, of 302 North Fayette Street, Shippensburg,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby declare this to be my will, hereby
revoking any and all former wills and codicils thereto by me
heretofore made.
I.
I direct that all my just debts and funeral expenses,
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
,~ ,,..,,
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I give, devise and bequeath the residue of my estat~~ ev ~ ~~ r~4,j
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.-
nature and wherever situate to my wife, Esther M. Holtry, providing
she shall survive me by thirty days.
III.
Should my wife predecease me or die on or before the thirtieth
day following my death I give, devise and bequeath the residue of
my estate of every nature and wherever situate to my son, Larry L.
Holtry. In the event my son, Larry L. Holtry, predeceases me or
dies on or before the thirtieth day following my death, the residue
of my estate shall be distributed to his issue, per stirpes, living
on the thirty-first day following my death, and in default of any
such then-living issue, to his wife, Carol L. Holtry.
IV.
Any fiduciary under this will 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 retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
fiduciaries as they deem proper, without regard to any
principle of diversification of risk.
C. 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
Page 2
as they deem proper.
D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
I direct that all taxes that may be assessed in 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.
VI.
I appoint my son, Larry L. Holtry, as executor of this my
will. Should my son predecease me, fail to qualify or cease to
act, I appoint my daughter-in-law, Carol L. Holtry, as executrix of
this my will. Should my daughter-in-law predecease me, fail to
qualify or cease to act, I appoint Eileen Gaylor, on Boonsboro,
Maryland, as executrix of this my will.
Page 3
vII.
No bond shall be required of any fiduciary hereunder in any
jurisdiction.
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first four of which bear my signature in the margin for the purpose
of identification this / S~day of ~.~ 2 D~~.~
(SEAL)
Signed, sealed, published and declared by the above-named
testator as and for his last will and testament in our presence,
who in his presence, at his request and in the presence of each
to set our hands as attesting witnesses.
_ h'y/ ,~
We, Galen L. Holtry, ~_ .~~r/~~~~j and
_ ~
~Jy the testator and the witnesses respectively,
whose names are signed to the attached or foregoing instrument,
being first duly sworn, do hereby declare to the undersigned
authority that the testator signed and executed the instrument as
his last will and testament and that he executed it as his free and
voluntary act for the purposes therein expressed and that each of
Page 4
other have he
the witnesses, in the presence and hearing of the said testator
signed the will as witnesses and to the best of their knowledge
said signer was at that time eighteen years of age or older, of
sound mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
above-nam ~ witnesses t is ~ day of
~ 2 _~.--
Not Public
Notarial Seal
Carin L. Walter, Notary Public
Chambersburg Boro, Franklin County
IM Commission Ex fires Ma is, 2005
Page 5
Testator ~-