HomeMy WebLinkAbout11-21-11PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of Jim Williams Holli
also known as
COUNTY, PENNSYLVANIA
File Number 21-11 - ~ ;~~~
,Deceased Social Security Number 189-16-8252
Richard D Hollingworth, Jr.
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE `A' or '8' BELOW.•)
® A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the Executor named in the
last Will of the Decedent, dated 03/18/2011 and codicil(s) dated
State relevant circumstances, e. g., renunciation, death of executor, etc.
After the execution of the documents offered for probate: Decedent did not marry; was not divorced; was not a party to a pending divorce proceeding
wherein grounds for divorce had been estabiished as provided in 23 Pa. C.S.A. § 3323 (g); did not have a child born or adopted; was not the victim of
a killing; and was never adjudicated an incapacitated person, except as follows:
B. Grant of Letters of Administration
(1/applicable, enter: c.t.a.; d.b.n.c.t.a.; pedente liter durante absentia; durance 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. ord.b.n.c.t.a., enter date of Will on Section A above and comp/ete.listofheirs); was not the victim of a killing; was never
adjudicated an incapacitated person; and was not a party to a pending divorce proceedtng wherein grounds for divorce had been established as
provided In 23 Pa. C.S.A. § 3323 (g), except as follows:
Name Relationship Residence
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary. - r=.
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Decedent was domiciled at death in Cumberland y, Penns Ivania with his /her last rinci al rYice at -
101 Green Ridge Lane Newville, Cumberland County, PA 17241 ~ -'~'
(List street address, towNcity, township, county, state, zip code)
Decedent, then ~_ years of age, died on 11/14/2011 at Holy Spirit Hospital, Camp Hill, Pennsylvania
Decedent at death owned property with estimated values as follows:
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylvania
situated as follows:
Ail personal property
Persona! property in Pennsylvania
Personal property in County
g 50,000.00
Total 50,000.00
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
Signature Typed or printed name and residence
Richard D. Hollingworth, Jr. 103 Linden Avenue
Red Lion, PA 17356
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Form RW-OY Rev. 12-26-2010 (interim form, pending action by the Court) Copyright (c) 2006 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS
COUNTY OF Cumberland }
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
before me this ~ I rs ~ day of
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For Register
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File Number: 21-11 -r' ~ ~ ~ ,~»
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Estate of Jim Williams Holli , Der~esed
Socia/l~Security Number: T., 199-16$252 Date of Death: 11/14/2011
AND NOW, '~ ~ ,S f ~~, ~Il.- ~~~J~~1 ~ZC . ~' ~`,~C'
having been presented before me, IT IS DECREED that Letters Testaments
are hereby granted to Richard D. Hollinaworth. Jr.
in the above estate
and that the instrument(s) dated 03/18/2011
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent
FEES ~ z
Letters .......................................... $ - ~;` ; .-,,;
Short Certificate(s) ....................... $ ~ 1 !
Renuffnciation(s) ............................ $
$ ~-~~.C:~'~
$ ~ , ~~ j
TOTAL ..................................
Form RW-02 Re~.fo-~s-2oos
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in consideration of the foregoing Petition, satisfactory proof
York, PA 17401
$ Telephone: 717-854-9506
$ 1
$ ~~~ ~,~(._3
Copyright (c) 2006 form software only The Lackner Group, Inc. Page 2 of 2
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Signature of Personal Representative ;, ~ --- -A ; _ri
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Register of Wil/s
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Attorney Signature: _,,~
Attorney Name: Leo .Gribbin
Supreme Court I.D. No.: 07390
Address: 138 East Market Street
Signature of Personal Representative
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, ~b.00
~ 175~05~1
Certification Number
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--lis is to certif~, that the infol-mation here`gicen i
Trectly copsed ii'um an original Certificate of Deat
Ily tiled with ~ne as Local Ke~~istrar. The origin:
rtificate ~~~ill he forwarded to the State Vita
°cords (~fficc '.or, ecmanent filing.
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__~cal Registrar ~ , ; Date issued
r1105~+63 aEV ,+2006
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS D ~ ~
TYPE PRINT IN 11
Pte" N"NK' CERTIFICATE OF DEATH r
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Dtsposttron Permit No. 06 9 5 4 3 9
LAST WILL AND TESTAMENT
I, jIM WILLIA~MS HOLLI, of the Borough of Newville, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and Testament, hereby
expressly revoking all Wills and Codicils heretofore made by me.
L I direct my personal representative to pay all of my debts, funeral and
administrative expenses as soon as may be done conveniently after my decease.
II. All the rest, residue and remainder of my Estate, both real and personal,
I give, devise and bequeath unto Newville Fire Department Ambulance, Newville,
Pennsylvania.
III. I nominate, constitute and appoint my nephew, Richard D.
Hollingworth, Jr., as Executor of this my Last Will and Testament. In the event that
my aforesaid nephew fails to survive me by thirty (30) days, or is otherwise unable or
unwilling to serve, I then nominate, constitute and appoint the law partner of my
aforesaid nephew, Leo E. Gribbin, Executor in his place and stead.
IV. My aforesaid Executors are to serve without posting of bond or other
security in Pennsylvania or in any other jurisdiction.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~~ ' ~
day of ~1~''~ , 2011.
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t.t,:~_,,,,.-~ l '~ ~ ~-,~ ~ ~ v; [SEAL]
'JAM WILLIAMS HOLLI
Signed, sealed, published and declared by Jim Williams Holli, the above-named
Testator, as and for his Last Will and Testament, in the presence of us, who, at his
request, in his presence and in the presence of each other, have hereunto subscribed
our names as attesting witnesses.
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Witness /Witness ~~
2
ACKNOWLEDGMENT
COMMONWEALTH OF PENN5YLVANIA
COUNTY OF CUMBERLAND
ss
I, JIM WILLIAMS HOLLI, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do herebt~
acknowledge that I signed and executed the instrument as my Last Will; and that I
signed it willingly and as my fxee and voluntary act for the purposes therein
expressed.
Sworn to or affirmed and acknowledged before me by JIM WILLIAMS HOLLI,
the Testator, this ~ ~~ day of /YiQrcr-, , 2011.
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%f~IM WILLIAMS I~OLLI~
Notary Public
My Commission Expires: l - / s- l y
COMMONWt<ALl i~ t~~ PCNNSYLVANiri
0 Notarial Seal
Vcki L. Hopkins, Notary Public
West Pennsboro Twp., Cumberland County
My Commission Fires Jan.15, 2012
Member. par,~xylv~~sa fi+aa~xnintion ~t Notaries
3
A FFTT~ A V TT
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
We, ~.. ~2.^~ .Q_ and I~ 1 C~ll.i~L t._ ~L, (~ e (~ (~c~~ t<-~~ ~ the
v~~itnesses 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 the
Testator sign and execute the instrument as his Last Will; that the Testator signed
~~illingly and executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of the Testator
signed the Will as a witness; and that to the best of our knowledge the Testator was at
that time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn to or affirmed and subscribed to before me by - en1~,~ ~C ~e~~, ~~
and /V~cof(~ .D. "~o1(eJ~c~.~•~~ witnesses, this /~ ~ day of
(1'1a~ct1 , 2011.
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Witness
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Notary Publi
COMMONW~AL7'i-i Y,~r' E'~tVtUSYLVAFfiA
Notariai seai
Vdci L. Hopkins, Natary Public
West Pennsboro Twp., Cumberland County
My Commission Expires Jan.15, 2012
Member; ~~r~~eylva~o~ ~,c~~e~a~l6h ai Ndtk~rta~
My Commission Expires: / - / ~ - / a~
4