HomeMy WebLinkAbout06-16-10PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ ~i 1 ~j hq (> ~~j~ COUNTY, PENNSYLVANIA
Estate ~f ~~ ~~~ File Number
also known as ~ ~~~ ~ (~ .,_.... ~~
Deceased Social Security Number
Petitioner(s), who is/are 13 years of age or older, apply(ies) for:
(COiYIPLETE 'A' or 'B' BELOW:) ~"~,.~ ~ ® ~-~j _~
LJ A. Probate and Grant of Let ers Testamentary and aver that Petitioner(s) is /are the _ t a 1t~ C1~~~+1 . ~~...~,~~,I~~ed in the
last Will of the Decedent dat and codicil(s) dated `""""
r,-.~
(State relevant circurnstances, 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 o£;~nstrumen~s offer~c~- ,.
' L.~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: _ ~ ~' f ~ ~. ~. :;
~'
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^ B. Grant of Letters of Administration ~ ~ ~`'' - ~ '~
(If applicable, enter: c.t.a.; d. b.n.c.t.a.; pendente lice; durance absentia; durahtzkfu~t~ritate) .__. ~-
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following sp~tse (if any) at d~ieirs: 'flf' 'r
Adrrtirtistratiotz, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~
Name Relationship __ Residence 1
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
was domici
(Lis[ street address, totiwt/city.
death in
county, state, zip code)
Counjty, Pennsylvania with
~" t
last principal residg,~ee at~~ ~ t
Decedent, then y~3 years of age, died on;d~~l~T,?at ~.XJ~ ~ ~~ ! ~~'.C1~J"~~_C'y.~.]-~~5 ~,~~ 1
Decedent at death owned property with estimated values as follows:
(If domiciled iri PA) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(lf not domiciled in PA} Personal property in County
Value of real estate in Pennsylvania
situated as follows:
~1~ . ~~~
$-
-~' ~~
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:
Signature _ _ Typed or printed name and residence
~~1~5
Forst R6V-0? rep-. lo.l3.a6 Page 1 of 2
i /'~
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Oath of Personal Representative ~~~~ ~~ ~,~ ~~ ~~ ~ ~']
COMMONWEALTH OF PENNSYLVANIA
SS ~!_~.~`ii~. L.jr
a r~ ;,n ~ ~` '~
COUNTY OF ~, ~~~~_"',_=;~~ ` t.~~~t~.~f'°T
F~'~ (~ ~ ~' ' a ' ~'; ~ ~~'' ~~.
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition ar~''ht`u~e and conect to the best of
the knowledge and belief of Petitioner(s) and that, as personal representatives} of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ___~_~~ day of
~~ ~ ~ ~~
o e g~ ter
Signature of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
_ (/
File N ber:
Estate of ,Deceased
Social Security Number: Date of Death:
AND NOW, ~~ 1~~-~-~- ~ ~.P ~G~ C"~, in onsiderati n of the foregoing Petition, satisfactory proof
having been presented before me, IT IS D ED Letters'~~
are hereby granted to - '~
n _ in the above estate
and that the instrument(s) dated 1~ ~(ttCi._
described in the Petition be admitted to probate and filed
FEES
ll.~ C~
Letters ............... $
Short Certificate(s) ........ $ L
Renunciation(s) .......... $~,
... $ ~ ~~
... $
... $
... $
... $
... $
... $
TOTAL .............. $ 1 ~.~
as the last bill (and~Codicil(s}) of I~ec~dent. / 4 ~%
Register of,Gyiflls ~ `~ " ~~ ~" _~~-
~~
Attorney Signature: ~.-
Attonney Name:
Supreme Court I.D. No.:
Address:
Telephone:
F~,-,,, Rw-rya rev. lu.l3.u<, Page 2 of 2
(~~_ ~((
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1 Fee t•+~r this i:ertificate, `~6 O(
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Ht06.1a3 REV 11!2006
TYPE /PRINT IN
PERMANENT
BLACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) CTCTF FII F NI IMRFR
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1. Name of Decedent (Frst middle, last, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year)
Paul G. Shultz Male 166 - 20 - 5661 Feh. 13, 201
5. Age (last Birthday) Under 1 year Under 1 day 6. Date of Binh (Month, day, year) 7. Birthplace (City and state or for .ign country) 8a. Place d C>BaM (Check only one)
hbntlu Days Hours AMnuta Fbspital. Other:
83 Yrs
Dec • 23, 1926
Shamokin, PA
^ Inpatient ^ ER /Outpatient ^ DOA rv
^ Nursing fiorne [Residence ^Other ~ Speciy:
County of Death
Bb Bc. City, Boro, Twp. of Death 8d. Fac9Gry Name Ili not institutbn, give street and number) 9. Was Decedent of Hispanic ORgin? ®No ^ Yes 10. Race: American Indian. Black, White, etc.
. (If yes, specify Cuban. (SpecilyJ
Cumberland Mechanicsburg 504 F:. Keller Street Mexican, Puerto Rican, etc.) White
11. Decedents Usual Occ tan Kind of work d one duR rttosl of world life. Do not state retired 12. Was Decedent ever in the 13. Decedent's Educatbn (Specify onty highest grade completed) 14. Marital Status: Married, Never Married, 15. Surviving Spouse (If wife, give maiden name)
Divorced (Specify)
Widowed
Kind of Work Kind of Business I Irdustry U. S. Armed Forces? Elementary /Secondary (0-12) Cdlege (1-4 or S+) ,
Velinski
Theresa P
n~t1; A~~arre Federal Gov't ~YeS ^No 12 raarr;_d? .
• 16. pecedenYs Mailing Address (Street, city /town, state, zip code) Decedents Did Decedent
Achtal Residence 17a. State Pi'1Tl ~ ~ VaTI l ~ Live n a 17c. ^ Yes, Decedent Lased in _ Twp.
504 E . Keller Street T°"""~''~? 17d. ^ No, Decedent Lived witnin Mechanicsb
urg
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J
?
Mechanicsbur PA 17055 city/Boro
er
.arir
Aduallimitsd
'm ~°Dnry Cum
16. Father's Name (Frst middle, last, suffix) 19. MdheYs Name (First midde, maiden surname)
A es ~~cG~ll
20a. Informants Name (Type /Print) 20b. InforrnanYs Mailing Address (Street city f OoaKL state, zip code)
Theresa P. Shultz 4 >; CC S
21a. Method d Dispositon ^ Cremation ^ Donation 21 b. Date of Disposition (Month, day. year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 d. Uxatiat (City /town, state, zip code)
• ® faunal ^ Removal from State
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ka
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b Gate Of Heaven Cemeter PA
Mechanicsburg
or
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r
/
^ Yes ^ No
b
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d
l
^ other - speciy: ,
e
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• 22a. Sigrtettue f Sere ce Licensee ( rson acting as such) 22b. liprtse Number 22c. Name and Address of Facility 8 Market Plaza Way
- ~ u Mechanicsbu PA 1755
Congle ms 23ac ony when t of my , death oxurt at the time re e stated. lure and title) 23b. ~ erase Number 23c. Date S' (Mont day, Year)
' is not avaiWble at tirtte to ,/, -?
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caroly cause of dealt. t
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• Items 24-26 must be cattpleted by person 24. Ti of Death 26. Date P Dead ( ,year) 26. Was Case Referred to Medical Examiner! Coroner fora anon r than Cremation or Donation?
who prortourtces death. ,.,7'lr~s" D~ ~~ .1 ~
- ^ Yes
r Approximate imerval:
CAUSE OF DEATH (See instruetlons a exempt )
h as prdlaC arrest
l
t
t O
OT
t
ti
th
O
D Part 11: Emer other sianificartt conditions cordriMaktq to deatdl,
iven in Part I
i
the underl
in
cause
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b 26. Did Tobacco Use Contnbute to Death?
^ Yes ^ Prottaby
,
even
s suc
artier
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nset to
ea
N
Item 27. Part I: Enter the main Wevents -diseases, injuries, or complications -that direrily caused the death. D
respiratory artest or ventricular f~brelatbn wRhoN showing the etiology. List oNy one cause an each line. ~ .
y
g
g
rto
resu
ng
n
u
'~No ^ Unknown
r
IMMEDIATE CAUSE (Easel disease or ~ / ~ 7 ~ `~ ` ( (~ r p ( r
condAion resuMktg ut death) a. 6', \ ~JI V~ `~+ ~~n Ll 1 ~ ~ ~ ~C J r
~
29. ti Female:
ear
N
r
rtaM witltin
ast
t
t
to (oMr as a uence of): r
Sequen6'aNy kst cortdrttorts, d arty, b. f V S ~u (1 ~ r
-
p
y
o
p
eg
^ Pregnant at tune of death
leading to file pose listed on line a. r
Ether Bte UNDERLYING CAUSE b (or as consequence.oQ: r ^ Not pregnant, but Dregnant within 42 days
of death
(disease or injury that initiated the c. _ ~f r
~ C. ~ ~ -
events resuttk5 to death) LAST.
~
• Due to (a as a consequence of): ^ Not pregnant, but pregnant 43 days to 1 year
before death
r
• d. r ^ Unknown if pregnant withut the past year
30a. Was an Autopsy ?Ob. Were Autopsy Fxdirtgs 31. Ma of Death 32a. Date d Injury (Month, day, Yom) 32.b. Describe Fbw Injury Occurted
~ 32c. Place d Injury: Horne, Farm, Street Factory,
Office Buil6ng, etc. (Specify)
Performed? Available Prior to Corrtpletion
of Cause of Death? ~~ Q ~~
^ Accident ^ Pending Irweslgatbn 32d. Time of Injury 32e. Injury at Work? 321. tf Trensportatbn Injury (Specify) 32g. Loption of Injury (Streit, city /town, state)
^ Yes No ^ Ves ^ No
^ Suicide ^ Could Na be Delertnined
^ Yes ^ No
^ Driver /Operator ^ Passenger ^ Pedesidan
'
M OMar-S
33a. Certifier (check ortty one) lure d T
r
• Certifying physician (Physkaan certityirg pose of death when another physician has pronounced death and corrtpleted hem 23)
death rxcuned due to the pose(s) and mariner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To the best of my knowbdge
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,
• Pronouncing and certifying physician (Physician both prorwtxtcing death and rxRifying to pose of death)
To the best of my knowledge, death occurred at the time, date, and plap, and due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ 33c. License Nurrtber
(~ n /~ ~ i, ~ ~ v{ /~ _ 33d. Date igned ( ,day, Year)
G
• Medical Examiner I Coroner 1 V t Y (~ 11 L
On the basis of examination and / or investigation, in my opinion, death oceurred at the time, date, and plap, and due to the cause(s) and martrter as stated_ ^ ,\34~ Name and Address of Pe Who Completed Cause f D (Item 7) /Print
35. ~ t ignat and Dis ~ Nu r
l ~* I ~ I ~ I .l I ~ I
~ `~ Date Filed (Month, day, ear)
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Disposition PermR No. n 4 2 5~? 3
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LAST WILL AND TESTAl`'IENT ~ ~ ~Y ~ = ;-7.-.;
cx~ m`
BE IT REMEMBERED THAT
I, PAUL G. SHULTZ, a resident of Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and
understanding, do make, publish and declare this to be my
LAST WILL and TESTAMENT, hereby revoking any and all Wi:11s
and Codicils previously made by me.
I
I declare that I am married to THERESA P. SHULTZ,
and that I have three (3) children, AGNES P. WILSON, CYNTHIA
C. CRESTA, and THERESA J. BULLERS.
II
I direct that my debts and funeral expenses be paid as
soon after my death as is practicable by my Executrix out of my
residuary estate, but not from any assets, .funds, death benefits
or insurance proceeds which are otherwise excludable or exempt
from my gross estate for federal estate valuation or tax: pur-
poses.
III
I direct that all estate, succession, legacy, inheritance
or other transfer taxes, however designated that shall become pay-
able by reason of my death in respect of all property comprising
my gross estate for death tax purposes, whether or not such pro-
perty passes under this LAST WILL, shall be paid by my Executrix
out of my residuary estate, but not from any assets, funds, death
benefits or insurance proceeds which are otherwise excludable or
exempt from my gross estate for federal estate valuation or tax
purposes.
IV
I give, devise and bequeath all my property, whether real
or personal, wherever situate, including any property over which I
may have a power of appointment to my wife, THERESA P. ST3ULTZ,
provided that she survive me by thirty (30) days.
Z1
If my wife shall predecease or fail to survive me by
thirty (30) days, I give, devise and bequeath all of my property
whether real or personal, wherever situate, including any property
over which I may have a power of_ appointment, to my children, AGNES,
CYNTHIA and THERESA, in equal shares, per stirpes, pursuant to the
terms of the hereinafter included Trust.
VI
TRUST
If my wife shall fail to survive me by thirty (30) days
and if my daughter, AGNES, or my daughter, THERESA, should also fail
to survive me by thirty (30) days, but have children of their own
who are under the age of eighteen (18) years, I establish this Trust
to administer the funds for the benefit of such grandchildren. If
my wife shall fail to survive me by thirty (30) days and. if my
daughter, CYNTHIA, should also fail to survive me by thirty (30) days,
but have any children who survive her and are under the age of twenty-
one (21) years, I establish this Trust to administer the funds for
the benefit of such grandchildren. I appoint my son-in-law, HENRY
JAMES tiJILSON, as Trustee of the property that I have given to my
grandchildren.
A. The assets that are transferred to the Trust for the
children of AGNES and THERESA shall be held until
reach the age of eighteen (18) years. The assets
to the Trust for the children of CYNTHIA shall be
children reach the age of twenty-one (21) years.
B. During the administration of the Tru
shall apply all net income and principal in trust
such children
that are transferred
held until such
st, the Trustee
as follows
1. The net income of the Trust shall be paid to or
applied for the benefit of my grandchildren at
such times and in such amounts as the Trustee
shall in his discretion deem necessary for their
support, welfare, maintenance and education.
Education shall be def fined broadly to include
not only that available in college, but also
trade school and other similar training. In the
event that the income shall be insuf_fic:ient to
provide my grandchildren with adequate mainten-
ance, support, welfare or education, the Trustee
may invade the principal of this Trust for this
purpose.
-2-
2. The Trustee in exercising his discretionary
authority with respect to the payment of in-
come or principal of the Trust Estate to my
beneficiaries, shall take into consideration
any income or other resources available to
my grandchildren from sources outside of
this Trust that may be known to the Trustee.
The determination of the Trustee with respect
to the necessity of making payments out= of
income or principal to my beneficiaries shall
be conclusive on all persons howsoever
interested in the Trust.
3. The Trustee shall accumulate and add to the
principal any net income of the Trust not
paid out in accordance with the discretion
hereinabove conferred on the Trustee.
4. In the event my grandchildren predecease me
or die prior to the termination of thi~~ Trust,
the interest of my grandchildren in thE~ Trust
shall cease, except that, if_ he or she are
survived by any children, then the Tru:~tee
shall pay net income of the Trust to or apply
the same for the benefit of such children of
my deceased grandchildren, in such amount or
amounts as the Trustee in his sole disc:rection
may determine for support, welfare and main-
tenance.
C. When the children of AGNES or THERESA reach the age of
eighteen (18) years, or the children of CYNTHIA reach t:he age of
twenty-one (21) years, a calculation of the property remaining in
the Trust shall be made and a total thereof shall be distributed
to him or to her.
D. Each child, as a beneficiary of this Trust, shall not
have right to alienate, encumber or hypothecate his or her interest
in the principal or income of the Trust in any manner, nor shall any
interest be subject to claim of his or her creditors or liable to
attachment, execution or other process of law.
E. In order to carry out the purposes of this Trust estab-
lished by this Will, the Trustee, in addition to all other powers
granted by this Will, or by law, shall have the following powers over
the Trust Estate, subject to any limitation specified elsewhere in
this Will:
1. To retain any property received by the 'Trust Estate
.for as long as the Trustee considers it advisable.
2. To spend funds for the maintenance and repair of
real property.
-3-
3. To sell at public or private sale, exchange or
lease for a period of time, any real o~- personal
property and~give options for sale of t:he lease.
4, To execute and deliver any deeds, leasE~s, assign-
ments or other instruments as may be necessary to
carry out the provisions of this Trust.
5. To borrow money and to mortgage or pledge any real
or personal property.
6. The Trustee shall maintain accurate records and
accounts and shall render statements to my bene-
ficiaries hereunder showing receipts and disburse-
ments of principal and income no less frequently
than annually. The Trustee shall serve: without
bond and shall receive fair and reasonable compen-
sation for administration of this Trust., not to
exceed five (5%) percent of annual inco~rne,
7. To distribute property in kind,
8. To do all other acts that are in his judgment
necessary or desirable for the proper management,
investment and distribution of the Trust Estate
VII
I nominate, constitute and appoint my wife, THERESA P.
SHULTZ, as Executrix of this LAST WILL, to serve without bond. If
my wife is unable or unwilling to act in that capacity, then I
nominate, constitute and appoint my son-in-law, HENRY JAMES WILSON,
as Executor of this LA5T WILL, to serve without bond.
IN WITNESS WHEREOF, I, PAUL G. SHULTZ, have set my hand
to this LAST WILL, this ~ ~ day of ~=-~-~~~-~~::-~,~ ~~,. , 1987.
--~
PAUL G .~SHULT Z <
-4-
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA :
COUNTY OF CUMBERLAND
s
I, PAUL G. SHULTZ, Testator, whose name is signed to the
attached or foregoing instrument, having been duly qua:ified accord-
ing 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.
~...~.~.
PAUL G. SHULTZ +_
Sworn or affirmed to and acknowledged before me by PAUL G. SHULTZ,
Testator, this ! 2-- day of /=L=~2~`~ ~t 7 .987 . '"
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otary ~Publ is
;J11'~:.~•- ~• WAtT~RS, I(t, Nofary PubiiC
~,=~;,;,~,,,csburg, Cumberland Co., Pa.
~,y , .,;;omission Cxpires November 21, 1988
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
We , ~~/?~ ra ~ , ~ L~ . U ,~~-~~ r ~ and <; 9r~ ~ ~ ~ /~~~c~ir'~ .ti~.5r~,~,~~-`
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 Testator sign and execute the in-
strument as his LAST WILL; that PAUL G. SHULTZ signed willingly and
that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the
Testator signed the Will as witnesses; and that to the best of our
knowledge, the Testator was at the time 18 years of age or more, of_
sound mind and under no constraint or undue influence.
i.f ~.
,~" 0" ~ _
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Sworn or affirmed to and acknowledged before
me this l 2 day o f_ f= t'=~°'~1 ~~ ~r .d°'1 J°' 19 8 7 .
i
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Notary ~''ublic
PJ~UC;,~,. R. WALTf!RS, ill, Notary Public
w;ec.~:y~,icsburg, Currxberland Co., Pa.
,,~Y Commission Expires November 21. 1988