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HomeMy WebLinkAbout11-24-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA t i~t~~tc oi~ Dorothv Henri File Number ~~ ~ "~ O ~ ~~ tiL;<~ I:n~iwn as U<~rothy 1,. Henry Deceased Social Security Number575-18-9704 Pctitiimcr(s). ~~ho is/arc 1 h years of age or older, apply(ies) for: (COMP!_F. TE ;~9 ' nr 'B' BELOW:) A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ~'-xecutor named in the last Fill of the Decedent dated October 17, 1979 and codicil(s) dated _ era ~ - ...,. O `~ (State relevnnt circumstances, e. g.. renunciation, death gfexecutor. etc.) ~~':'L7 ~ I.zrcpl as Cullows. Decedent did not marry, was not divorced, and did not have a child born or adopted alter excculior+'~tl~3strurp+~A1(s) a4T~;red_~~• -° ,~- f~~r probate. ~~as not the victim of a killing and was never adjudicated an incapacitated person: ~ ~n -~ ..~_._-. C7 ~l: --~ -~-~~ ~ © E3. Grant of Letters o1' Administration JC (/f applicable, enter: c.ta.; d. h. n. c. t. a.; pendenle life; cturante absentia; dr~rle~~inorUatej` I'ctitiuncr(s) utter a proper search has /have ascertained that Decedent left no Will and was survived by the 1<~Ilowing spouse (if any~nd heirs: rl; (rlntrni.cn•atiun. e.t.a or d. h. n.c.l.u., enter date of Will in Sec[ion A above and complete list of heirs.) ~ 1~amc Relationshi P Residence (C'il;Y1PLETE !.N ALL CA,SES:) Attach ndditiona! sheets if necessary. Dcccdcn: was domiciled at death in C~umbcrland County, Pennsylvania with his /her last principal residence at ~cssiuh Viila~,y~l f~hL,Allcn_llrivc_ Mechanicsbure Upper Allen Township Cumberland County PA ]7055 N.i.d sn-~-w n2lrht~a~s. rrnrn city. nnrnsbrp, county, state, yip code) hccd4~nt. Then y=; _ years of age, died on November 18, 2008 at Messiah Village, 100 ML Allen Drive, Mechanicsburg, PA f )cccdcnt at death osvnul properly with estimated values as follows: (lfdomiciled in Pn) All personal property (Ifnot domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) Personal property in County Value of real estate in Pennsylvania ~i[uutcd as li~llows: $ 25,00.00 S \~ hrrclt~rc. Pctilioner(sl 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 lu the undersigned: -- ~i~naturc 'I' ed or rimed name and residence '/'!(! ~`/~ James ft. Henry, 601 South Market Street, Mechanicsburg, PA ] 7055 l~nrnr RR'-02 ri~~'. 10.11.0( Pa~C ~ OI 2 Oath of Personal Representative ('OMMONWEALTH OF PENNSYLVANIA C'OUN~1'y OF CUMBt;RLAND SS "I'he Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best ol~ 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. S~~~orn to or af'lirmedya~nd subscribed beiorc me the ''l day of ~~ ~~_~y„ :'or e Register Representative Signature q~Personalllepresenlalive SiKnanrre of Personal Idepresenlalrve CV C ~ _ c~ tia T~ _ ~ ;. ; ~, r- _ _,.,-;- N File Number: ~.' -~' ~--; . _ Estate of Dorothy Henry , aka Dorothy L . Henry , [~sed ~' ~ ~ --~ Social Security Number:575-18-9704 Date of Death:Novcmbcr 18, 20(~ Q co AND NUW, ~ ~th ~Q,~Q~ ~U\l~l'Y1 ~}P( ,~~+, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters 'I'cstamentary __ __ arc hereby granted to .lames E. Hcnry ___, and that the instrument(s) dated October 17, 1979 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. FEES Letters ............... $ ~.~ Short Ccrtiiicate(s) ........ $ ~10~ Renunciation(s) .......... $ I,U+II ...~ I~~ _ ...~ ID. ... $ J- ... $ ... $ ... $ ... ~ ... $ ... $ ~rO~rni ............... $ in the above estate Supreme Court I.D. No.: 62469 Address: 127 South Market Street P.O. Box 95 Mechanicsburg, PA 170» Telephone: 717-697-7050 h i~rn~ /211'-OZ rc~r. 10.13.0(1 hags ? O ~ Attorney Name: Andreev C. Shccly, Esyuirc i nn ens KEV nnmT' LOCAL REGISTRAR'S CERTIFICATION (JF DPI=A"~iH 1NARNING: It is illegal to duplicate this copy by photostat or photoltraph. ~ Fee for this certificate. $6.00 P 148098:1 Certification Number I REV 1112006 PRINT IN AANENT CK INK "Phis is to certify that the information here gi4en i~. correctl~~ copied rrnn _.n original Certificate of Death duly filed ~tirith me. as Local Red*istrar. The original certificate rill be f~lrwarded to the State Vital Records Office i1>r ~e~manent filing. ~, I'~t~ist't~'~~~~ "~ Date Issued r,.~ C7 ~ C ~ ccx ~. ~. ~-, . r.-I ~ rV _ - '--'c %~_f ~ -a .~ ~ ~ - -i -~ , , N p t~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) 5 rgTE FILE NUMBER t. Name of Decetlenl (Flrsl, mitltlle, lass. suXix) 2. Sex 3. Social Security Number 4. Date of Death (Month, tlay, year) 5 - ~ q ~n ~1 ~I c :, c~.h, ha~ ~ I Q z.v o ~ . 5. Aqe (Last Bidhday) U er 1 year Under 1 day 6. Dale o Binh (Month, day, year( 7. Birthplace (CAy antl stale or foreign c«ntry) Ba. Place of Death (Check only one) Months Days Mars MlnNes Hospital. Other. C Yra Nov. 20, 1913 Elgin, Oregon ^In aU«l p ^ ER I Outpatient []DOA Nursing Home ^ Residence ^Other ~ Specify. 6b. County of Death 6c. C4y, Boro, Twp. of Death 6d. Facility Name (If not institution, give street and number) _ 9. Was D«etlenl of Mlspenic Origin? ®No ^Ves 10. Race. American Intlian, Black, While. etc. (II yes, specify Cuban (Specify) IIpper Allen 14xTp. Messiah Village Nursing Home MexipanPoertoRicanela) White 11. Decedent's Usual Occu lion Kind of work d one du' moll a work' tile. Do «t stale retiretl 12. Was Decedent ever In fhe 13. Decetlenl's Education (Specity only highest grade comp leletl) 14, Marital Slalus'. Married, Never Marnen 16. Surviving Spo use III wile give maiden name) Klntl of Work Kind of Business I Industry U.S. Armed Forces? Elementary / S«ondary (0-12) College (1-0 or 6.( W'dowed, Divorced (Specify) , Homemaker Her Own Home ^rea ®No 12 Widowed 16. Oecedenl's Mailing Address (Street, city /town, stale, Eip code) Decedent's Did Decedent 601 South Market Street Adual Resitlance nor Slate ___l'ennsylvania row s ? 17c.^ Yes, Decedent Lived in trop i h p 17tl ®No D«etlenl Livetl within ' Mechanicsbur , PA 17055 . , 17b. County (, ~}Aer]-mod Adual umna of MechanicsburY city; Boro 16 Formers Narre (First, middle, lass, audiq 1s. Momera Name (Flrsl, maeie, maden aumamej Carl E. Waters Olive Ma Wortman 20a. Infomant's Name (Type! Print) 20b. Informant's Mailing Address (Street, city /town, slate, zip cafe) Mr. James Edgar Henry 601 South Market Street, Mechanicsbur PA 17055 21 a. Method of Disposition ^ Cremation ^ Donation 21 b. Dale of Dispositon (Month, day, year) 21c. Place of Disposition (Name pl cemetery, crematory or other place) 21 tl. Location ICiry I town, stale, zip code) ® Burial ^ RemovallromSmle WasCrematbnorDOnationAuthodzed ^No ^ Other ~ Specify: j by Medlcel Examiner f Coroner? ^ Yas Nov. 21, 2008 Indiantown Gap National Cemetery AIInville PA 17003 ~ 22a. Sgnatura d Funeral Se ice (or rson a h) ~ 22b. License Numher 22c. Name aM Address of Facixry Zimmerman-Auer Funeral Hone, Inc. - FD-013413-L ur P LO Complete Items 23ac onty when cemrying 23a. To the hest of my knowledge, death occuned al rile lime, date and place slated. (Signature and title) 23b. License Numdn 23c. Dale Signetl (Monm, day, year) physican is not available al time of death to ceniry cause a deem. f~ t ~ 1 ~ S hems 24-26 must be completetl by person 24. Time of De 26. Date Prono cad Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? wTC pron«nces tleath. C+ M. • l v e ~r ` ^Ves ^ No CAUSE OF DEATH (See Inatructlona end examples) / r Approximate interval. Part II' Enter dher 5jpp3(jDdN catdilidts wnidbutirw to deem, 26. Did Tobacco Use Contribute to Death? Item 27. Pan C Enter pte chain of events -diseases, Injuries, or complk:ehons -That directly caused the death. DO NOT enter terminal events such as caNiac anesL r Onset to Death hN not resulting in the undertying cause given in Pad 1. ^ Yes ^ Prohahty respiratory arrest, or ventricular fibnlletbn whhout showing the etxAOgy. List only one cause on each line. t r IMMEDIATE CA E fR ~NO ^ Unknown nal disease or ~ US cadifion rasullirtg m alb) ~ ,~/ i -~ a. YIp!/.2LlJ.': L(2- I ~ (' ~ ~/~CL: L7 f7 C~'/ zJ fU 29 II Fe le: r-~/R~A ~ Due to (or as a consequence of): ~ {/~ Nol Pmgnanl wilhln pall year Sequa tialty list conditions, it any, b ~ Ig6np to the rouse listed on line a cZLa~ ~;, ~/~~_(m~ ~ j ^ Pregnant al time of death . Enter me UNDERIYWG CAUSE Due to (or as a consequence off'. t ^ Nol pregnant hul pregnant within d2 days (dsease a injury that infiatetl me a events resuMng m deem) LAST. of tleam Due to (or as a consequa«a off: ^ Nol pregnant. but pregnan143 days to 1 year d ~ before death ^ Unknown if pregnant within the past year 30a. Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe How Injury Oaurretl 32c. Place of Injury: Horne, Fann, Street, Factory, Pedomred? Availeda Prior to Completion r,--,/ LJ walural ^ Hanicide Office Buildln ,etc g ' (arty) of Cause of Deam? ^ Yes ^aIQO ^Ves [~NO ^ Agent ^ Pending Investigation 32d. Tme of Injury 32e. Injury a1 Work7 32t If Tramportatan Injury (Specrry) 32g, Location of Injury (Street city I town, stale) ^ Sukitle ^ Could Not be Determinetl ^ Yes ^ No ^ Driver / Operelpr ^ Passenger ^Petlastrian M ^Omer- Spedty 33a. Certifier (cneck any are) .Signature and Title of Certifier • Cent n h siclen Ph siuan ceni D Y P P ) rl}d g p y ( y ying cause of deem when another h siaan has ronou«ed tleam and com feted Item 23 .f~~ / /)i'7 i~j~ ~~t/~~/ r ~ , ' ' To the best of my knowledge, death «curred due to the cause(s) and manner as staled_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ - ~G.i-V •. /~r • Pro«u«Ing and cedilying physiclen (Physician bah prarou«ing deem and cedih/ing to cause of death) 33c. License Number 33d. Dale Signed (Monm year( day To the best at my knowledge, death occurcetl m the time, dale, end place, and due to the cause(s) end manner as etated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ • Medical Examiner/Coroner , , / ~t ,n - %'17[/ ~~ S y'" 7 ~ - -'~~'f On the heals of easmimtion and ! or investigation, in my opinion, death «curred at the time, tlate, and place, and due to the cause(s) and manrer as smted_ ^ y1 Name and Atltlrass of Parsm y~o Completed Cause of Death h 27) TyP~ r Print R tier's Signatur umber I ~ I [~ [/ ~ [ / 36. Dale 'led (Mon ,day, year) ' ~f~ ~ T ~ ~ G ~ ~ % ~`) 1 F c 711 a S Disposition Pencil No. 0309035 LAST WILL AND TESTAMENT OF DOROTHY HENRY I, DOROTHY HENRY, a domiciliary of the State of :Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this instrument to be my LAST WILL ANA TESTAMENT. I hereby revoke any and all wills and codicils by me heretofore made. I IDENTIFICATIONS AND DEFINITIONS I am married to GIRT ON H, HENRY ("my Husband"). We have three children, GIRTON E. HENRY, JAMES E. HENRY, and ROBIN L, LEONHARA. References in this Will to "my Children" include these three children and any other lawful children born to or adopted by me. The following definitions obtain in any use of the terms in this Will: 1, "Descendants" means the immediate and remote lawful, lineal descendants of the person referred to., and it means those descendants in being at the time they must be ascertained in order to give effect to the reference to them, whether they are born before or after my death or of any other person. The persons who take under this Will as Descendants shall take by right of representation, in accordance with the rule of per stirpes distribution and not in accordance with the rule of per capita distribution. Persons legally adopted when under the age of fourteen years shall not be differentiated from blood descendants for any purpose. 2, "Survive me" is to be construed to mean that the person referred to must survive me by thirty days. If the person referred to dies within thirty days of my death, the reference to him shall be construed as if he had failed to survive me, (Page 1 of 4 Pages) ~ I r~ j"_ / /// O /~,/ 4J _ ._ ~ ~- --- 7 .~ . ~ _ ~-~ ~J . ~ ~.. ~ /J (/~/ ~~ .' JJ ~ +.. _~ ` ~ Z7 t ~•- ~C 'L7 --t 1V . , ~ Ott II PAYMENT OF DEBTS AND TAXES L direct my executor to pay the following before any division or distribution under the following articles: 1, All of the expenses of my last illness, funeral and of the administration of my estate. 2, All inheritance, transfer, estate and similar taxes (including interest and penalties) assessed or payable by reason of my death, on any property or interest in my estate for the purpose of computing taxes. My executor shall not require any beneficiary under this will to reimb urse my estate for taxes paid on property passing under the terms of this will. III RESIDUARY ESTATE A, I define "my Residuary Estate" as all of my property after the payment of debts and taxes under Article II above, including real and personal property, whenever acquired by me, property as to which effective disposition is not otherwise made in this will, and property as to which I have an option to purchase or a reversionary interest, but excluding property as to which I have no interest other than a power of appointment, B. I give my Residuary Estate to my Husband if he survives me. C. If my Husband does not survive me, I direct my executor to divide my Residuary Estate into equal shares and to distribute those shares as follows: r 1, one share to each of my Children then living; 2, one share to the then living Descendants of each of my Children who is not then living, IV APPOINTMENT OF EXECUTOR I appoint my Husband, GIRTON H, HENRY, as Executor of this Will, If GIRTON H. HENRY is unable or unwilling to serve in this capacity, I appoint my san, JAMES E. HENRY, to serve instead, I request that my executor not be required to furnish bond or securities, (gage 2 of 4 Pages) /~ ~~~ c,~ c~~~~- IN WITNESS WHEREOF, I have at Carlisle Barracks, Pennsylvania, this /7%~day of ~'~ , 1979, set my hand and seal to this my LAST 'WILL AND TESTAMENT consisting of four (4) typewritten pages, this included, the preceding pages hereof bearing my signature. / _ - r d _ _ (SEAL) DOROTHY HENRY / Signed, sealed, published and declared by the above-named Testatrix, as her LAST WILL AND TESTAMENT, in the presence of all of us at one time, and at the same time, we, at her request and in. her presence and i.n the presence of each other, have hereunto subscribed our names as attesting witnesses, and we do hereby attest to th.e sound and disposing mind and memory of said testatrix at the date hereof, and to the performance of the aforesaid acts of execution at Carlisle Barracks, Pennsylvania, this / ~~C-,day o f ~c''.~ ~, 19 79 . ADDRESS 7 ~~ .. ~'l (Page 3 of 4 Pages) COMMONWEALTH OF PENNSYLVANIA) ss: COUNTS' OF CUMBERLAND ) Before me, the undersigned authority, on this da~r personally appeared - DOROTHY HENRY, Rsoa A. Ortiz , Steve DiDomenico , and Dixie Lee Stoner , known to me to be the testatrix and the witnesses, respectively, whose names are subscribed to the annexed oz foregoing instrument in their respective capacities, and all of said persoazs being by the duly sworn the said DOROTHY HENRY, testatrix, declared to me and to the said witnesses, in my presence that said instrument is her LAST WILL AND TESTAMENT, and that she had willingly made and executed it as her free act and deed for the purposes therein expressed; and the said witnesses, each on his oath, stated to me, in the presence and hearing of the said testatrix that the said testatrix had declared to them that said instrument is her LAST WILL AND TESTAMENT, and that she executed same as such and wanted each of them to sign it as a witness; and upon their oaths each witness stated further that they did sign the same as witnesses in the presence of the said testatrix and at her request; that she was at that time eighteen years of age or over or being under such age, was or had been lawfully married, or was then a member of the armed forces of the United States or of an auxiliary thereof or of the Maritime Service and was of sound mind; and that each, of said witnesses was then at least fourteen years of age. ~~~ _~yy~ DORQ~HY HEN , Testatrix ~~ ~~ I HESS WI ESS [~ ~ ~~. WITNESS Subscribed and acknowledged before me by the said DOROTHY HENRY, testatrix, and subscribed and sworn to before me by the said Rosa A. Ortiz ~ Steve DiDomenico , and Di:~ie Lee Stoner , witnesses, this 17t day of Octo er , 1979. .~ ~%~ ~~ ~~~a~~~ NO RY PUBLIC ` My Commission Expires f~C:»~r ,~. i~akn;er, P~~tary ;-~,~bhc (Page 4 of 4 Pages) >kir!3~ ANm Ytirr~., Ct:~nk~:rf:~rEr; Ca~;nty ~'IPr~k~, r~~nf~,~a~°f~~~r~ ~_- ~t,~ ai -'rtar;e~