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HomeMy WebLinkAbout08-12-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Cumberland Estate of James K. Harvey also known as . Deceased COUNTY, PENNSYLVANIA `,~ ~~ File Number ~~ ~ ~ ~ ~ ~ Social Security Number 192-09-7818 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 Tests~mentxry and aver that Petitioner(s) is /are the last Will of the Decedent dated Nov 11, 1985 and codicil(s) dated (State relevant circumstances, e.g., renunciation, dearh 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 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 (Ifapplieable, eater: e.t.a.; db.n.e.t.a.; pendente liter durante absentia; durance minoritate) r~.a Pedtioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spo (if any) and~its: (If < a ,_ Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ ~ ~,,, w ,- Name Relationshi Residence' :-r} r-" ~ ` --~~ . _: ~ .- --~-, ~ ; _._ ± ~.. ~ r,,,, ,.,=5 ~=1 (COMPLETE INALL CASES:) Attach additional sheets if necessary. '~' O ` '~' `-^' .~" Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at 707 S 21st St Camp Hill PA 17011 (List street address, tow-dcity, township, county, state, zip code) Decedent, then 92 years of age, died on July 6, 2010 ~ 707 S. 21st St., Camp Hill, PA 17011 Decedent at 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 situated as follows: Wherefore, Petitioners} 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: name and residence Lyla J. Harvey, 707 S. 21st St, Camp Hill, PA. 17011 $ 22,429.27 S named in the Form RW-02 rev. 10.73.06 Pale 1 of 2 GAI~ REGISTRAR'S +GEI~TII~•:,iA-'°I~IGI~ G1= "~R ~'V~t~NING: It i~ illegal to duplicate: ~hi~ ~'t~:;~ ht~+ J~ht:3#+r.~S~at ~t~ ~hot~+~r~:~~~: l~t~t~ r~rlr this ~.~ertlE~it~~f1~,• `',(l (~5{ ~,;, ~~ ~ { , ~+ 1, 1 , }r,i 111 i[tlr ~1 ~) ll c,, _g )ti; ,,.' ~~ ' ~" { I ~ ~~ ,~d~~-~ ~~ ~, t411'> i '.tit ~ a _. t ~i ~ t° ~} ,'+`I'~3 ~ i ?~ ~ ~ dttli .t~ ;._ ~i°~©. ~~~.~ ~lr~"-.~ `v^ I t ~' _ ) ~J! ~`) li.: ~_ ~ )4l' i' t 1jl~li ~~ v . irr ~ k ~ `~ , ': tF~< ,: ~_ __ _A _____ ,,. --- ~-~ r...-, - C ._.~ ~ T! ~' = . ~~~ - '~~ ~ ... ~ ~ c- ~ 3 ,,,~ ._ ~ T ~, _.... ~ 43 REV 11/2006 'E /PRINT IN =RMANENT !LACK INK COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH a VITAL RECORDS CERTIFICATE OF DEATH (See instructlons and examples on reverse) CTATF FII F NI IMRFR 1. Name of i>eoedent (Flrst, mktde, lest, suffix) 2. Sex 3. Social Security Number 4. Date of Death (Month, day, year) James K. Harve Male 192 - 09,- 7818 Jul 6, 201.0 5. Age (Last BiMtday) Under 1 ar Under 1 da 6. Date of Birth Month 7. BI end state or for e corxt 6a. Place of Death Check on one 91 Momhs Deys Hotxs Minulea July 21, 1918 Clarion, PA Hoapnel: ^ ^ ^ Omer: ^ ^ ® Yrs DOA Inpatlent ER / Outpatlent Residence Other - Specfy: Nursing !tome 6b. County of Death fk. Cfty, Bao, Twp. of Death 8d. Fadlity Name (If not ktstlttlAon, give street and number) 9. Was Decedent of Hispert~ Origin? ®~ ^Yes 10. Race: American Indian, Black, White, etc. . (It Yes, epecny Cllban, (Spectly) Cumberland Lower Allen Twp. 707 South 21st Street Mexican, Puerto Rican, etc.) white 11. Decedents Usual tlon Kkrd of work d ata dart most of fie. Do not state retl 12. Was Decedent ever in the 13. Decedents Edlxstbn (Speclly Doty highest grade completed) 14. Madtal Status: Married, Never Married, 15 SurvhAng Spouse (If woe, give maiden name) Kind of Work Kind ol8usinees/Industry U.S. Armed Forces? Elementary I Secondary (0.12) College (1-4 Or 5+) Wklowed, Divorced (Seedy) Assistant Director State Government ®Yes ^r~ 12 4 Married L la J. Foulk - is. Decedent's Mailing Address (Street, city /town, state, zip coda) Decedents old Decedent Lower A11 e ri stela Pennsylvania Live in a 17c. ®Yes. Decedent Lived in Twp. Actual Residence 17a 707 South 21st Street . Township? Cumberland 17d' ^ ~ ~ nt f ~~~n m Camp Hill, PA 17011 17b.camty A city/Bao ual Li fts o 18. Fathers Nartre (Flrst, middle, last, stdbx) 19. Mother's Name (Flrsl, middle, maiden sumeme) William H. Harvey Mary Amanda Myers 20a. Informants Neme (Type /Print) 20b. Intorment's Mailing Address (Street, aA' I town, state, zIp code) Lyle J. Harvey 707 South 21st Street, Cam Hill, PA 17011 21 e. Method of Disposition r ®Cremation ^ Donation 21 b. Date of DlsposNion (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21d. Location (City /town, state, zip ends) • ^ Buda! ^ RemovalhanState i Wea~t~~oi~ md~ 2010 Jul 8 Evans Crematory Schaefferstown, PA 17088 / Y~^~ ^ 07ter • ' by y , _ 22a. rvice L (a person actlrlg as such) 22b. License Number 22c. Name and Address of Fertility . ~ FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070 Complete when certifying 23a. To the best of my knowledge, death occurred at the time, date and place stated. (Signature and tltle) 236. License Number 23c. Date Signed (Month, day, year) physklen Is rat avabeble at time of death to certlfy cause of death. • Items 24.26 must be completed by person 24. Time of Death ' 25. Date Pronolxtced Dead (Mrxttlt, day, year) ~^ 26. Was Case Referred to Medal Examiner /Coroner fa a Reason Other then Cremation or Donation? Q ^ ~ who praaurtcea death. ~ , ~ 5 tPM. -~1 l.l_1 l~ [~ r 2(~ ~ ~ No Yes CAUSE OF DEATH (See instructlons and examples) I Approximate Interval: di i h t O t t th DO NOT l t D Part II: Enter other eionibcant condiliats contributlnc to death. iven in Part { the underl in cause b t t res ltin i 28. Did Tobacco Use C 'bate to Death? ^ l ac arres ne even s suc as car , i nse o ea enter tertn item 27. Part I: Enter the chain of events - dseases, injuries, or canplications -that directly caused dte death. respiratory arrest, or ventricular fibriNation without showing the etiology. List Doty ate cause on each line. t y g g . u no g n u Yes robab y ^ No ^ Unknown l1AMEDIATE CAUSE (Final dsease a ~ 1 ~ C°ttditlon resulting in atlt) ~ a /~ ~ ~ ~ ~ ,(~~, ( ~ ~~ ~,~_ t 29. I1 Female: nant within ast ^ Not re ear Due to (a es a consequence ot): t I y g p p ^ Pregnant at time of death ~uentielty list cortditiorta, n any, b ~ ^ '°°"'rq t° the reuse Need °n bite a' Due to or as a uer>ce o ~ Emer Ste UNDERLYING CAUSE ( conseq ~~ Not pregnant, but pregnant wilhln 42 days of death - (deease a cowry oral initiated rite ' ° t t 43 d t 1 e ^ N t b t - ' ~ events resulting In death) LAST. Due to (a as a consequence ot): t ~ d o pregnan , pregnan ays o y ar u before death ^ Unknown b pregnant within the past year • . 30e. Wes an Autopsy 30b. Were Autopsy Fmdngs 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Describe Hove Injury Occured 32c. Place of Injury: Hans, Farm, Street, Factory, Office Building, etc. (Spedly) Perfomted? Available Prbr to Compbtion of Cause of Death? ^ Natural ^ Haniade ,,,( ^ Yes l~l Nc ^Yes ^ No ^ Accident ^ Pending Inveatlgetion 32d. Tkne of Injury 32e. Inury at Work? 32f. n Trartsportatbn Injury (SpecByJ ^ Pedestrian erator ^ Passenger ^ Driver/O 32g. Location of Injury (Street, city I town, state) ^ Could Not be Determined ^ Suicide M, ^Yes ^ No p ^ Other • Specify: 33a. Certlber (check only ate) th leted Item 23) h h d d d h i i h h Signature and Title of I;ertffler ~ ys an as prortounce ea an comp w en anot er p c CertHying phyalcian (Physician certitying cause of deat death occurred due to the cease(s) and manner as stated _ _ • To the bMt of my Imowladge _ ^ - - - - - - - - - - - - - - - - - - - - - - - - - / 2 ~~~ _ _ - - - , 33c. Lksnae Number 33d. Dat e ned ( onth, day, Year) • pronouncing and Ixrtnying phyaklan (Physican both praaurx*tg death and cerillylrg to cause of death) ^ er a ststad t h d d d l d d 1 ~ S mann . _ _ ,. _ _ _ _ _ _ _ .. _ _ _ _ _ _ _ ue a cause(s) an ata, an p ace, an o i To tM beat of mY knowNdgs, tistlh occurred et the time, ~ r / ~ ~ ~ V (v l.' • bladial Examiner/Cororlsr On the bob of exeminetlon arnt t or investlgatlon, In my opinion, death occunsd M the Urns, date, and place, and due to the alae(a) end manner a stated_ ^ 34. Name lord Address Parser Who Completed Cause of Death (Item 27) Tye / ri ~ ~ ' 35. Registrar a and ~ / ~ r 36. De Fl (Month, day, year) 1 !/Y( l/l2 p~ ~ /LLJ l n r ~ ~ ~ ~ / ~ i { 1 0 I 1 l v ~ rn~ J .t i~ 7P~ ~~ >~ Dispostion Permit No. ~~ R' F^ l t.~.~..~ ~f ~~~ LAST WILL AND TESTAMENT ~-~' ~'~'~ ~ " , ,_ ,_. - ,:. _._ l _. _... ~ `, J O F -~, .. :; ~,•, . . ; : , ;; ,...~~ .y, . JAMES K. HARVEY I, JAMES K. HARVEY, of Lower Allen Townsh~_p, Cumberland County, Pennsylvania, declare this to be my last will and testament, and revoke any wills previously ` made by me. m ~ ~ r ~ x ~ • I. ~+ 1, ~ ~ '~ ~ I direct that all of my just debts and last r' expen~e~, including all expenses of my last illness and r `'~ z. disposal of my remains, shall be paid from my residuary estate as soon as practicable after my decease, as part of the expense of administration of my estate. II. I devise and bequeath the rest, residue and remainder of my estate, of every nature and wheresoever .- situate to my wife, Lyla J. Harvey, providing she shall survive me by sixty (60) days. IIIF ~' ~` Should my wife, Lyla J. Harvey, predecease me or die on or before the sixtieth day fallowing my death, I devise and bequeath all of the rest, residue and remainder of my estate, of every nature and wheresoever situate, to my children, Paula L. Snyder, Kim A. Ray, Janet L. Harvey and Mary Ann Harvey, share and share alike. IV. I appoint my wife, Lyla J. Harvey, executrix of this, my last will and testament. Should she be unwilling or unable to act as execurix I appoint Paula L. Snyder and Kim A. Ray to be co-executrices of this, my last will and testament. V. I direct that my executrix or co-executrices, or -2- their successors shall not be required to give bond for the faithful performance of her duties in any jurisc~iction. IN WITNESS WHRE4F, I have hereunto set my hand and seal this I~~ day of ~~-~ 1985. ,~/ames K. Harvey The preceding instrument, consisting of tYiis and two other typewritten pages, identified by the signature of the testator, JAMES KR HARVEY, who on the day and date there- of, signed, published and declared by JAME5 K. HARVEY, the testatar therein named, as and for his Last Will anc~ Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto: r~ :_ °~w c- Residin at ~ ~ Residing a t 7 d `~ - S~,,,,,,~,~ ~~~ ~Jtir, ~-a ~.I~ ~k.-. __ l Z o L ~ C~`,~ ~.~ OATH OF SUBSCRIBING WITNESS(ES) ~_-~ ~} _ : , REGISTER OF WILLS `_` ~?r 4--r-, -~- ~ ~~~' ~i~--~' m ~~ ~ ~ ~~ ~s1 ~ COUNTY, PENNSYLVANIA ~ :; ~~ cv (.~ ` . , __., .{ __ -- _ , f ~ ~. Estate of --~~? ~? Q' S ~ ~ , ~ Deceased /~ , ~~ w' (each) a subscribing witness to (Print Nance/s) the Will ^ Codicil(s) presented herewith, (each) being duly qualified according to law, depose(s) and __~ say(s) that ~h~e-/ he /they ~vas,~/ were present and saw the above C Testato~% Testatrix sign the same _.___ and that she ~[~ /they signed the same and that ~e J he /they signed as a witness at the request of the C. Testator /Testatrix in her /his presence and in the presence of each other. (~S'e) (Street Address) (city, state, Zip) (Signature) G (Street Address) i (City, State, Zip) Execiuted in Register's Office Sworn to or affirmed and subscribed before me this day of ,~ Deputy for Register of Wills Executed out of Register's Office Sworn to or affirmed and subscribed before me this ,~ day ,7' , ~~~--- Notary Pu 1~ My Commission Expires: ~ ~~d "~~~ C~---~ (Signature and Seal of Notary or other official qualifed to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev. 10.13.06 COMMONWEHLI'H_ Q~ P'~NN9YlVANIA NOTARIAL SEAL CHERYL R. GARN4AN, Notary Public Camp Hill Boro, Cumberland County My Commission Expires May 20, 2012 ._...M....~..~,_~,~ ~.... t.......~~.... OATH OF NON-SUBSCRIBING WITNESS(ES) GISTER OF WILLS f Cum ~ G. COUNTY, PENNSYLVANIA Estate of ~~ ~Yl ~ G ~' Decreased ...~~n Yl ~ ~~. ~ L ~^, ~ ~ and (each) being duly qualified according to law, depose(s) and say(s) that acquainted with she / he I they was /were well- and amiare familiar - - V with the handwriting and signature of the decedent, and that the signature of -~~ S 1~ ~. r to the foregoing instrument purporting to be the Last Will and Testament/Codicil of ~C~,n-e 5 ~~ ~G~r•v-t-~ 1 (S~,, at is in his/her own proper handwriting. v ~~ ~{o TG n tLt r (Street Address) D~ ~ ~ ~ ~1 (City, State, Zip) Executed i~z Register's Office Sworn to or affirme1d and subscribed before me this 1 +~ day of ~_ ~ `~ - , .~~~- ;, l Deputy for Register of Wily (Signature) (Street Address) (City, Stale, Zip) i°..~, ~~ c. :,; . _x~ , ~ ., :~ ._~ ,y~ E - -- ;~a :.. r.... ._ . ~~-j .. . ~~ r Form RW-04 rev. 10.13.06