The URL can be used to link to this page

Home My WebLink About01-30-12PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Cumberland County, Pennsylvania Petitioner, named below, who is 18 years of age or older, applies for Letters as specified below, and in support thereof, avers the following and respectfully requests the grant of Letters in the appropriate form:: DECEDENT'S INFORMATION i ~ -, Estate of LEE E. FORTNEY SR. File No. ~~ ~ !,-~. "~ --~~ - --- a/k/a LEE E. FORTNEY Deceased Social Security No. 195-16-4980 Date of Death: JANUARY 23 2012 Age at Death: 88 Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his last family or principal residence at 10 B Richland Lane A t. 106 Cam Hill East Pennsboro Tw .Cumberland Count Penns Ivania 17011 (List street, address, town/city, county; state, zip code) Decedent died at Hol S irit Hos ital Cam Hill PA 17011 East Pennsboro Tw Cumberlan~dnCounstatPA List street, address, Post Office and zip code city, township or Borough Y Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ............................:........................................$ 20 000.00 (If not domiciled in PA) Personal property in Pennsylvarna .....................................$ (If not domiciled in PA) Personal property in County ....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ Total ......................................................................................................... $ 20 000.00 Real Estate situated as follows: (attache additional sheets ifnecessaryJ Street address, Post Office and Zip Code City, Township or Borough County, State U A. Petition for Probate and Grant of Letters Testamentary Petitioner avers she is the Executrix named in the Last Will of the Decedent, dated September 17 2010 Slate relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, After the execution of the instrument offered for probate, Decedent did not marry, was not divorced, and was not a party to a pending divorce proceeding at~the time of death wherein grounds for divorce ~ been eslished ~r defined in 23 Pa.C.S.A. § 3323(8) and did not have a child born or adopted and the Decedent was~~ter the ~iictim ,~°; killing and was never adjudicated an incapacitated person ~!_ ~ ~ ~ ~,~ , ~m~ w r ,; t-,'.' . .- Q ~ ,-- 3 D NO EXCEPTIONS ^ EXCEPTIONS - -rr .:~: ^ B. Petition for Grant of Letters of Administration (if applicable) ~~ ~ 6a ~~ "~ enter: c.t.a.; d.b.n.c.t.a.; pendent elite; durante abs~tia; durante `~ ritat~n c '7 ~-,: =fit If Administration, c. t. a. or d. b. n. c.t.a., Except as follows: Decedent was not a party to a pending divorce proceeding at the time of death wherein grounds for divorce has been established as defined in 23 Pa.C.S.A. § 3323(8) and was neither a victim of a killing and was never adjudicated an incapacitated person ^ NO EXCEPTIONS ^ EXCEPTIONS Petitioner, after a proper search, has ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attached additional sheets, if necessary) Name Relationshi Residence OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Printed Name JANE FORTNEY The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. _ ,~~~ Sworn to and affirmed and subscribed Before me this day of i ~ 1.. C , 2012. ,:~ For the Re ister 0 BOND Required ^ YES ~ NO FEES: Letters ........................... $ { ~~ Short Certificate(s) $ / ~~ .~~~ { }Renunciation .............. $ { )Codicil(s) $ { )Affidavit(s) .................. $ Bond $ Commission $ Other $ ,v $ ~ z Automation $ JCP Fee ....................... $ ._ , TOTAL......... $ I ~~ tiL.i ~; ~~ ~ ;-r, ~~ ~ - L~ ' a ~~ ~ C ~ ~ z~ ~ ;~~ ~ ~ ,, T. ~,~7,C7 ~ .,,-~ J ~ ~:~a: C°': --t W `''~ To The Register of Wills ``~ Please enter my appearance by my signature below: Official Use Only Printed Address MARY JANE FORTNEY 1502 Timber Chase Drive Mechanicsburg, PA 17050 Attorney Signature: ~~ i?v?,lvGyL~~ Printed Name: EDMUND G. MYERS Supreme Court I.D. No: 20558 Firm Name: Johnson Duffie Stewart & Weidner. Address: 301 Market Street P.O. Box Lemoyne PA 17043 Phone: 717-761-4540 Fax: 717-761-3015 Email EGM(a~idsw com DECREE TO THE REGISTER Deceased. File Nose / ^I ~~~ ~ ~ ~ Estate of LEE E. FORTNEY SR. a/k/a Lee E. FORTNEY Social Security No: 195-16-4980 Date of Death: Januar~r 23 2012 '~ I•« ' ` L " ~l, ^~ . ~,. , 2012, in consideration of the foregoing Petition, satisfactory proof AND NOW, ~' having been presented befor tne, IS DECR D that Letters Testamentary are hereby granted to MARY JANE FORTNEY in the above estate and that the instrument dated September 17 2010 described in the Petition be admitted to probate and filed of record as the Last Will of 'y J-~ V U7 7 t.1_! ^; i~ 1 ~ ~ ~~lf~~; It is i{I~~~g try ~t~~slic. ~)[~ ~t ~~ :,•t g~t~~t(;a~ta~t ~ ;:. ,. ~. :: 1 O [-~ i ~. - C~ ~ CSC ~ ~~`~'"~ ? . I . .._. ~ g¢ ~)Y s .. (I 1 COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORDS Type/Print In Permanent CERTIFICATE OF SEAT State File N^mrbe_: ^f ne~th 1 _. __ __ Mr./Dav/yr) [Spell Mo) Sa. Age-Last Birthday (Vrs) Sb. Under 1 Year Months Days Sc. Under 1 Da 6. Date of Birth (MO/Day/Year) (Spell Month) Hours Minutes July 23 , 1923 7a.H rthplace (Cl~ty andPsenn r F° l V n18 1 7b. Birthplace (County) r Foreign Country) Sb. Residence (Street and Number -Include Apt No.) Bc. Did Decedent Live in a Township? F Pennsbot-o twP- B. t e o Residence (Sta • lOABtRi h~~nd Lane . ,. ~J Ye:, decedent eyed in /boro it 1 y ONO, decedent Ilyed within limits of c 8d. Residence (County) 7 ~ Cumber land Se. Raaldence (Zip Cods1 I am i to first marriage) ried $] Widowed 11. Su rviving Spouse's Name (If wHe, g ve n e pr or M !~ ar 9. Ever in US Armed Forces? 10. Marl[al SCatus at Time of Death ~ d ~ Never Married ~ Unknown Q Ves ® No ~ Unknown 0 Divorce 13. MoCher's Name Prior [o First Marriage (First, Middle, Last) Last, Suffix) 12. Father's Neme (First, Middle, Mary Ann ginner tionship co Decedent 34c. Informant's Mailing Address (Street and Number, C(ty, State, ZI Code) PA 170 R l b bpur h i e a 14 . g , an cs hter 1502 Timber Ctlase Dr _ Mec 14a. Informant's Name D u g a Mary Jane Fortney --°- ~ Ise. a°e Deat c-~~ or:•y qne --• ---• ... . ........ .. - - -.•- --°-.... .- .. here Other Than a Hospital: ~ Hospice Facility ~] Decedent's Home S omew --•----•••----'•"""--'-'---"----•-----~•- - ••- In bent ;If Death Occurred If Death Occurred in a Hospital: ~ Pa Home/Long-Term Care Facility Other (Specify) rsin N S g u Dead on Arrival ~ 0 Emergency Room/Outpatient ~ lSd. County of Death Gity or Town, State, and Zip Code • 16c . 16b. Facility Name (If not institution, give stroet and number; Z - - matory, or other place) Date of Disposition 16c. Place of Disposition (Name of cemetery, cre 16b . 16a. Method of Disposition Burial Q Cremation ltromstate O Dgnati°^ 1/27/2012 E. Harrisburg Cemtery p Rem ya °Other (Specify) f F ral Se ice Licensee or Person in Gharge of Interment 376. License Number /~ s~ \~ 36d. Location of Dlsposltion (City or Town, State, and Zip) 17a. Signature o 2 ~ PA Harrisburg, E 17c. Name and Complete Address of Funeral Facility ~ 38. Decedent's Education -Check the box that best describes the h 19. Decedent of Hispanic Origin -Check She x [hat bast describes whether the decedent b ~- . highest degree or IevN of school completed at She time of deat o is Spanish/Hispanic/Latino. Check She "NO" ~ Bth grade or less box If decedent is not Spanish/Hispanic/Latino. No diploma, 9th - 122h grade d ® No, not Spanish/Hispanic/Latino ~ High school graduate or GED complete O Yes, Mexican, Mexican American, Chicano ~ Some college credit, but no degree Q Yes, Puerto Rican ~ Associate degree (e.g. AA, AS) ~ Yes, Cuban 0 Bachelor's degree (e.g. BA, AB, 66) g. MA, MS, MEng, MEd, MSW, MBA) ree (e de ' Q Yes, other Spanish/Hispanic/Latino . g ~ Master s Q OoROrate (e.g- PhD, Ed D) or Professional degree (Specify) . MD DDS DVM LLB JD k O NLY ONE to le Race Self-Designation Sin t' d ecedent considered himself or indicate w h h g en s 21. Dece O lapa Se O oan Sam White Korean American ~ f Q Other Pacific Islander rican Q Black or A dian or Alaska Natiye ~ Vietnamese I Don't Know/Not Sure O n 0 American Q Other Asian Refused ~ Q Asian Indian Q Natiye Hawaiian Other (Specify) ~ ~ Chinese Q Guamanian or Chamorro ~ Filipino EMS 23a - 23d MUST BE COMPLETED MO Day r 23a. Data Pronounced Dead ( 23b. Signature of Person Pr IT BY PERSON WHO PRONOUNCES OR O / ~ 2~ ^^ ~ ~ ` ~~~~ /YlA 4-y6 )r_S~ SZI No Q ~ ~ ~ /J -' - - CAUSE OF DEATH - A imate pprox l I t urles, or complications--that diroc4y caused the death. DO NOT enter terminal f events--diseases, InJ se on a I h I events such as card Add additional lne : n erva iac arrest. lines if necessary Onset to Death n o y one cau 26. Part 1. Enter the ~ illaYlon without showing the etiology. DO NOT ABBREVIATE. Enter onl flb . r respiratory arrest, or venCricular IMMEDIATE CAUSE -----------~ a. uence of). nse q a Due to (o a (Final disease or condition h ' ~ ~ ^^ ---- G S-few-~ ~•S7-S- t - resulting in deat ) G OA b ~l~ ~L12 Due io (or as a consequence of). Sequentially list conditions, if any, leading t° the cause listed on Ilne a. Enter the Due So (or as a consequence of): UNDERLYING CAUSE - x that (disease or InJu - ryl Inltiated the eve is esulting d~ Oue [o (or as a consequence of): aFe v, in death) LAST. rt I i P _ 27. Wa autopsy performed? s s n a tr u i t d h but not resulting In the underlying cause given 26. Part 11. Enter other i nific S c i ~ 0 Yes ~ No bl il n _ _ _ / G . _ 7 Gtn G ~i C r a e Were autopsy Endings ava 2g. th? f d m ~ / - IJ , ` ~ o ea t co plate the cause o O Ves ~ No ~// CQ.t Gt%'LD J"'>'~PY I~R~ 30. Did Tobacco Use Contribute to Death? 31. Manner of Deat ral N t h ~ Homicide ~ 29. If Female: ear t Q Yes Q Y a a u ~ Accident O Pentling Investigation E y ~ Not pregnant within pas f death own O No ~ Unkn 0 Suicide Q Could not be determined ag ~ ~ Pregnant at time o 0 Not pregnant, but pregnant within 42 days of death h Data of Injury (MO/Oay/Yr) (Spell Month) 32 ~ but pregnant 43 days to 1 year before deat ~ Not pregnant, . 33. Time of Injury [within the past year ~ Unknownif pregnan _ .. ._ _. __~__~. 35. Location of Injury (Street and Number , City, State, Zip Cod e) 0 yes lO Driver/Operator Q Pedestrian I O N Q p g ~ Oth (SPecify) 3a. Certifier. (Check only one): au annex stated Q Certifying physician - To the best of my knowledge, death occurred due to tch u' se(s) and m and I ce and due to the c se(s) and manner stated Pronouncing 8a Certifying physician - To She best of my knowledge, death o c red. at the time, date, ccuP a nd lace, and due to the ca (s) and m fated Q Medical Examiner/Coroner - On the basis of exa instion, d/ r investlgatlon, in my opinion, death o rre/d~at She time, data, a p N}u~ ~ ' `a ^ !~{ /~ Title of certifier: ~~ ,/ License Number: !!JJ 1.~~ S-•]~ Signature of certifier: ~ rt+ 39c. Oate Signed (Mq/Day/Yr) 9b. Name, Address anc~Zip bode of Person Com~ting Causa~f De~; h~ itegl 2c ~~~~ ~ ^ 1// ~Q / ~~ /~ O ~ _ ~ 3 ~ /r~- s p~ict NurL~l/ O ^ ~~Q~ H105-143 Dlsposltion Permit NO. I/c•'~`J/ REV 07/2011 FD-014404-L 20. Decedent's Race -Check ONE OR MORE races to Inolcate wnat the decedent considered himself or h erself to be. ® White ~ Korean Q Black or African American ~ Vietnamese 0 American Indian or Alaska Native ~ Other Asian Q Asian Indian Q Native Hawaiian ~ Chinese ~ Guamanian or Chamorro 0 Flli Pino Q Samoan Q Japanese Q Other Pacific Islander O Other (Specify) self to be. 22a. Oecede nt's Usual Occupation -Indicate type of wort done during most of working life. DO NOT USE RETIRED. Foreman US General Service P- r ~ te . 9 ~ ~ r - -_ ~ ( 3 \ ! , ~ Last Will and Testament ~ ~ ~ ~ tT, <~ ~'-'~`~ , -, . ~_. --rrte~ , -'Ur~\ - OF =-~ ~ =~ - - '°' c-,n --~ `n ~ LEE E. FORTNEY _ , I, LEE E. FORTNEY, of East Pennsboro Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as ar_~ for may L?.st `JJill and Testament. hereby ;evoking a:,d ~r~~ng v:,id u:~,~ and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. ARTICLE II TANGIBLE PERSONAL PROPERTY I give and bequeath my household and personal effects and other tangible personalty of like nature (not including cash or securities), together with any existing insurance thereon, unto those of ..,:~ chit?re^, '.VI~-,~i2Y JANE Ff~I?TNEY ~ :~~? LEF F. F(?~RTNEY, .'Jl?., u~ho s~~^,>ive me; *.o bP divided between them in as nearly equal shares as is practicable. I direct that should there be disagreement as to the disposition of any item or items in this Article, I direct that the same shall be disposed of under Article IV hereof. ARTICLE III CHARITABLE BEQUEST I give and bequeath the sum of Two Hundred ($200.00) Dollars unto the TRINITY UNITED CHURCH OF CHRIST, 117 Verbeke Street, Marysville, Pennsylvania. ARTICLE IV REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, as follows: A. One-quarter (1 /4) thereof unto my son, LEE E. FORTNEY, JR., provided that should he predecease me, I give, devise and bequeath his share unto my daughter, MARY JANE FORTNEY; B. Three-quarters (3/4) thereof unto my daughter, MARY JANE FORTNEY, provided that should she predecease me, I give, devise and bequeath her share unto my son, LEE E. FORTNEY, JR.; C. Should both my son, LEE E. FORTNEY, JR. and my daughter, MARY JANE FORTNEY, predecease me, I give, devise and bequeath the residue of my estate in equal shares unto my nieces, MARY ANN iiZIDWELL and FLORA MAE PHILLIPS. 2 ARTICLE V PERSONAL REPRESENTATIVE I name, constitute and appoint my daughter, MARY JANE FORTNEY, Executrix of this my Last Will and Testament. Should my daughter, MARY JANE FORTNEY, fail to qualify or cease to so act, I name, constitute and appoint my nephew, ROBERT P. MATSKO, SR., alternate Executor to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS VV'HEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this r?'Lh day of ~ ~~`-•~-r.~ 2010. ~~ (SEAL) LEE E. FORTNEY Signed, sealed, published and declared by 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 witnesses. H ~J~F ~+a,n,, f 3 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND We, LEE E. FORTNEY, _ -~~~'~~',~ F~ ~ - ~~Of ~/TI ~ . ss. and the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and that he had signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as witness and that to the best of his/her knowledge the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. EE FORTNEY Wit ss QJ~'{"~ Witness Subscribed. sworn to and acknowledged before me by LEE E. FORTNEY, Testator. and J ~l~l ~L! ~~ /~ ~ ~'G:1 ~- x and ,.~ /-~w"'. /~ /f ~ !-~ c:' ~~ i7IF3 ~~ , witnesses, this ~ /~ day of , » ~ ~ _ r~%Z-, 2010. Edmund G. Mye Attorney I.D.#20558 4 COMMONWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND . On this, the ~ day of ~_ ~ ~ L~~~.t'. ~ , 2010, before me, the undersigned officer, personally appeared EDMUND G. MYERS, Attorney I.D. #20558, known to me (or satisfactorily proven) to be a member of the bar of the highest court of Pennsylvania and certified that he was personally present when the foregoing acknowledgement and affidavit were signed by the Testator and the witnesses. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~~~C ~"~'- `~.!~.~ ,,s' ~,,cL (SEAL) Notary Publi ~ ,/ IHUFPENN~`~'VANIA CONIMON~'~". , NOTARIA No ~ ~blic Margaret E. Ruff, Boyne Boro, Cumberland3 oZOty M cpmnnission ex ices May :413470 5