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HomeMy WebLinkAbout09-02-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CIIMBERLAND COUNTY, PENNSYLVANIA Estate of Bertram W. Olley File Number ~ ~-09-~$a~ also known as Deceased Social Security Number 183 12 7612 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 EaeCUtrf% named in the last Will of the Decedent datedJanuary 14,1983 and codicil(s) dated (Slate 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 of Letters of Administration (/f applicable, enter: c.t.a.; d. b.n.c.t.a.; pendente /tte; 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.) Decedent, then 85 years of age, died on August 7, 2009 at Holy Svirit Hospital. Camp Hill . PA Decedent at death owned property with estimated values as follows: ~ Q ~~ ~ (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 $ situated as fol 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: or printed name and residence X ~~~~ ~ C~~~>~ (Joan R. Olley, 470 Brentwater Road, Camp Hill, PA 17011 Form RW-02 rev. 10.13.06 Page 1 of t (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. ~=''~ ~ ~' ~ ~}t Cumberland ~ ~~'~ ~ ~~ Decedent was domiciled at death in County, Pennsylvania with his /her last principal-~st~ence at 470 Brentwater a amp ill, PA 17011 ?' c.rl (List street address, town/city, township, county, state, zip code) _~~ ~ Oath of Personal Representative COMMONWEALTH O SYLVANIA SS COUNTY OF CUMBERI'AND . 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 r,d before me the day of ~,.a:~ For the Register - Signa re of Personal Representative ~ ~ yo ~ ~~ ~ ,_;, Signature of Personal Representative '~ ly j-n ~ ;" ' ' C.~ J ;c N - ,. Signature of Persona! Representative ,r -~ ~~ ~ _' ~ -p !~ 'fi ~ , ~ N File Number: ~~ ~ C~~ - ~ g ~~/ ~~ Estate of Bertram W. Olley ,Deceased Social Security Number: 183 12 7612 Date of Death: August 7, 2009 AND NOW, ,cal ~_C'~1~.. ~ 2~~"~ , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters testamentary are hereby granted to Joan R. Olley in the above estate and that the instrument(s) dated 3anuary 14 , 1983 described in the Petition be admitted to probate and filed of record as the last fi~1 (and Codicil(s)) of Decedent. FEES Letters ............... $ Short Certificate(s) ........ $ Renunciation(s) .......... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ 0.00 Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Register ojWills Form RW-02 rev. 10.13.06 Page 2 of 2 _ - ~ - LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 Certification Number ITEM # / ~ _.__~nTrr~o- nuFAnAS-FQLLQI~~:_ _ ~~ ~~ 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. ~~~, ~ % ,~ u~ ~/ ~ goo Local Registrar Date Issued ~~ c~ ca ~ ~-,~ ~ ~ , ~ -n i ~~ N ~ r.. ' r_ ~ ~ ~' 1... ST ~..~~ ~ ~ - l ~ ~ ~ ` ^ v , _ N Ev 1lnoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS WENTN CORONER'S CERTIFICATE OF DEATH KINK (See instructions and examples on reverse) srgrE FIEF NUNtBER n .~~-v Name of Decedent (Flrsl, midtlle, last, suffix) 2. Sex 3. Soda) Security Numher d. Dale of Death (Hoorn, tlay, year) 1 . Bertram W Olley Male 183 - 12 7612 August 7, 2009 S. Aga (Lest BirtMey) UMar 1 year Under t day 8. Date of Birth (Month, ,year) 7. BMhplaca (C' end sYete or fora country) M. Place of Daeth (Check only one) g5 ""'"'~ °°" "°'""' "~'"" Aug. 18 1923 Hospital: Other a Renshaw, PA ^O S ~ ^ ^ ^ ~ ther - Nursing Home Residence peciy . ER / Oulpelient DOA Vre ^ Inpatient Bb. County of Deelh &. City, Bo T I Death 6d. Facility Name (p rat insdMlon, gNe street and numher) 9. Was Oetedenl of Hispanic Origin? ~] No ^ Yes 10. Race: American Indian, Bteck, White. etc. (If yes, spadfy Cuban, 5ppcdN Cumberland East Pennsboro h 1 Holy Spirit I-Iaspital Mexican, Pueno Rkan, eta) LL ee it. Decedem's Usual lion Kind d work d urw Oudn rtasf of wo ' file. M riot smte refired 12. Wes Decedent ever in me 13. Decedent's Educatbn (Specify only highest grade completed) 14. Marital Sletus: Monied, Never Marded, 15. Surnving Spouse (II wile, give maiden name) Divorced (Speclfyl Widowed KxM of WqN KiM of Business I Industry U.S. Armed Forces? Elementary t Secondary (0.12) College (1-4 or 5+) , Joan R e i t z Yaa ^NO married 18. Decedent's IAeiktg Address (Street, city 1 form, state, rip cotle) Decedenrs D'd Decadent Decedenloredm East Pennsboro Twp PA uraina ,?G[~Yea 470 Brentwgter Rd. . . AdualReaidence 17a.Smte 7awnsNp? 17d. ^ No, Decedent Lived within Cumberland Camp Hill, PA 17011 ,TC.county Aauatumoatf city/Boro 18. FaMer's Name (First, mkldte, last, sullixl Robert Russell Olley 19. Mdher's Neme (First, mddb, maiden sumemel Edna May Barnes 20a. Informant's Name (Type I Pnnq 2pb. InlormanYs Mailing gddress (Street, dry !town, stale. zip code) PA 17011 Camp Hi11 470 Brentwater Rd Joan R. Olley , . 21 a. MemoO of Disquabn ~ ^ Cremation ^ Donetbn 21 h. Date of Dispoattion (Month, day, year) 21 c. Place of Disposition (Name of certratery, crematory a other place) 21d. Laotian (City I town, state, zip code) ® Buda+ ^ RemovanmmSate ' waaCromenonorDOnehonAUmorized Ug. 1 3, 2009 Rolling Green Mem. Park amp Hill, PA ^ Other .Specify; Medlcsl Examiner /Coroner? ^ Vas ^ No 22a. S F M ~ as such) 220. Lkerrse NunrMr 22c. Name eM Address of Fadlhy ! Musselman FH&CS Inc. 324 Hummel Ave. Lemoyne,PA - • 011248E Canpkte Items 23ac Dory whren cedXykg 23a. To the of my krxrwleege, deem oavned at die ame, date and place stated. (Signature and fide) 23b. License Number 23c. Dale Signetl (Month, tlay, year) physitlen u rat evakeble at atria of deem to certify cause of deem. hems 2426 mrttt M wngleted W Person 24. Time of Death 25. Date Pronounced Daad (Month, day, year) 28. Was Case Refenetl to Medkal Examiner I Coroner for a Reason Other than Cremation or Donation? ~ N woo pronounces death 11:34 A M. August 7, 2009 ves ^ o CAUSE OF DEAITi (SSe inatructlone and examples) r Approximate interval: Pan II: Enter Diner gjgn'fcant rorrddons contnbutine to dean, 28. Did Tobacco Use Comnbule to Death? ttem 27. Pan L Enter me chain of events -d'aeases, inryMa, a complications -mat directly caused the death. W NOT enter terminal evens such as cardiac angst, Onset to Deem but not resutting in the urdedying cause given in Pan L ^ Yes ^ Probably respireory anesL a ventricular fibdlletim wimaa showing tM etoogy. List oMY one cause on each line. ^ No ^ Unknown IAIMEdATE CAUSE IFinel disease a r mrrdlbn resuttrng in deem) ~. a Probable Mvocardial Infarction __ ; 29. If Female'. ^Nn nmd . Due to (or as a consequence of): r SeQuetttHfi'/ ~ ~~' p am b n pregnant a pas, yea, ^ Pregnant a1 time of death leadng to me cause Ibted online a. Due to (or as a consequence of): r CAUSE , th UNDERLYNM E ^ Nat pregnant, but pregnant wihin 42 tlays e . nter (daease a sMttY that kwtiafed the d, r of death events resuttirg in deem) LAST, ~ Due to (a as a conseguence oft: ^ Not Dregnant but pregnant d3 days l0 1 year before death r d ^ Unknown if pregnant within the past year . 30a. Was an ANOpsy 30h. Were Autopsy Findings 31. Manner of Deem 32a. Date of trnury (Monet, day, year) 32b. DeacriM How Injury Occurred 32c. Place of Injury. Home, Fann, Street Factory, Ohice euikling, etc. (Speciyl Performed? AvaaaNe Prior to Completbn a Cause of Deem? W Natural ^ Homicide ~~ ~..x 11 ^ q~t ^ Pending Imastigalion 32d, Time of Injury 32e. Injury at Work? 321. II Trenaponedon Inlury (Security) 32g. Laation of Inlury (5lreet, city I town, slate) ^ Vas yxL No /~' ^ Yes ^ No ^ Suidde ^ CouVtl Not M DMertnined ^ Ddver! Operates ^ Passenger ^Pedastnan ^ Ves ^ No M Other ~ Specity: 33a. certifier jchetk Doty one) C le Deputy 33b. signal ~ • Cenhyirg physician jPhysaan certifying cause d deem when another physidan has pronounced deem aria completed ham 231 deaM oaumd due to tM uuae(s) aM manner w eteted_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ To m18 best d my knowledge ~^.C'-""rte ~ ~ , - C O r one r , • Pronouncing end wn„Yle9 phyalelen (Pnysidan boM pronoundng death and ceNtying to cause of tleath) ^ 33c. License Numher 33tl. Date Signed (MOnm, day. year) To the beN or my knowledge, desM occurred et the time, date, and plate, and due to IM eauaNa) end manner ae stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ August 10, 2009 • kledlcalExaminerlCOroner and due to the cause(s) end manner ea afated_ ~ aM place deaM occurred al the time date opinbn d I a tnvesli etion in m n i U l I 7 T l Pri , , , , g , y exem na O en On tM basis v L ype m tem 2 34, Name era Atldress of Peram Who Completed Cause of Deatfi ( Chief De uty Coroner Eckenrode Todd C 35. Registrer's ~r~tum and Dist' ~ I ~ I ~ l ~I / I~ I 36. Date Filed Month, day, year) ~ , . 6375 Basehore Road Suite 111 ~ - fjn~,.. ~/i ilJ > 7050 Mechanicsbur PA Disposhion Permit No. J ~~ 1 ref LAST WILL AND TESTAMENT OF BERTRAM W. OLLEY I, BERTRAM W. OLLEY, of Camp Hill, Cumberland County, Pennsylvania, do declare this to be my last Will hereby revoking all prior wills and codicils hereto by me made. lst. I give, devise and bequeath my entire estate to my wife, Joan R. Olley. 2nd. In the event my said wife shall not survive me or shall die within a period of thirty (30) days after my death, I give, devise and bequeath my estate as follows: (a) One-half (1/2) thereof to Isabel J. Reitz, mother of Joan R. Olley, absolutely. If Isabel J. Reitz predeceases me this portion shall be given to H. Wesley Reitz, brother of Joan R. Olley, or his issue, absolutely. (b) One-eighth (1/8) thereof to my daughter, Bonnie Louise Hostetler, or her issue, absolutely. (c) One-eighth (1/8) thereof to my son, Donald Russell Olley, or his issue, absolutely. (d) One-eighth (1/8> thereof to my daughter, Sandra Arlene Olley, or her issue, absolutely. (e) One-eighth (1/8) thereof to my son, Wayne Leroy Olley, or his issue, absolutely. C~ ~ _..; iii ~ ~ .~ -~_. r- ;. L ~ ^--i '"~~ s .. "~~'J- -~_, ~ _ ~ --~ ~ . . iV 3rd. I constitute and appoint my wife, Joan R. Olley, Executrix of this Will. IN 4dITNESS WHEREOF, I, BERTRAM W. OLLEY, the testator„ hereunto set my hand and seal this J'~ day of ,/~~:z.~,,.c~ ~-~ ~„'~ _ ` ~~ ~ fi'?~`-'~'/`" __( SEAL) Signed, sealed, published and declared by the above named Bertram W. Olley as and for his Last Will and Testament, in the presence of us, the subscribing witnesses, who at his instance and request, and in his presence, and the presence of each other have hereunto set our hands and seals the day and year aforesaid. ~ '~~--' C~ ~;%?~ OATH OF NON-SUBSCRIBING WITNESS(ES) REGISTER OF WILLS CIIMBERLAND COUNTY, PENNSYLVANIA Estate of Bertram W. Olley Deceased William W. Caldwell and ~er6,dY(,~- ~~ ~ ~G~oh i~,~ (each) being duly qualified according to law, depose(s) and say(s) that she / he /they was /were well- acquainted with Bertram W. Olley and am/are familiar with the handwriting and signature of the decedent, and that the signature of Bertram W. Olley to the foregoing instrument purporting to be the Last Will and Testament/Codicil of Bertram W. Olley is in his/her own proper handwriting. v Sign eJ 507 Bridgeview Drive .~ (Street Address) Lemoyne, PA 17043 (City, State, Zipf Executed in Register's Office Sworn to or affirmed and subscribed bef me this ~-~L rcf day of ~ >~eputy for Rel~ister of Wills ~~ ~. (Signature) 5 ~ ~ ~ S prt~ i vii -{I~ r ~~^~ v~ (Street Address) N~tra~is bc~-> ~ P~ ~ ~ ~~~ (City, Stare, Zip) ta) ~,,~ ~:s ca ~- © ..s~ cn c:f -~ =, N ;~ -;; ~ N ~ ' t Form RW-04 rev. 10.13.06