HomeMy WebLinkAbout08-27-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the
following and respectfully requests the grant of Letters in the appropriate form:
Donald A. Fry
Decedent's Information (~ 2~
Name: Ralma C. Fry File No: 21-12 -`"I J`1
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 204-40-2973
Date of Death: 06/29/2012 Age at Death: 62
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at 49 West King Street, Shippensburg 17257 Shippensburg Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Harrisburg Hospital, 205 S. Front St., Harrisburg, PA 17101 Harrisburg Dauphin PA
Street address, Post Office and Zip Code City, Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ...................... All personal property $ 412,500.00
If not domiciled in Pennsylvania ................ Personal property in Pennsylvania $
/f not domiciled in Pennsylvania ................ Personal property in County $
Value of real estate in Pennsylvania ................................................................... $ 335,400.00
TOTAL ESTIMATED VALUE $ 747,900.00
Real estate in Pennsylvania situated al 49 West King Street, Shippensburg 17257 Shippensburg Cumberland
(Attach additional sheets, if necessary.)
^ A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated
thereto dated
Street address, Post Office and Zip Code
City, Township or Borough
County
and Codicil(s)
State relevant circumstances (e. g., renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not mar was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. ~~3323(g), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
^ NO EXCEPTIONS ^ EXCEPTIONS
^X B. Pe+ition for Grant of Letters of Administration (If applicable)
c.t.a., d. b. n., d. b. n. c. t. a., pedente lite, durante absentia. durante minoritate
If Administration, c.ta ord.b.n.c.t.a., Pn+pr date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to.pending divorce proceedin wherein the grounds for divorce had been established as defined
in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS ^ EXCEPTIONS C7
L r a~~ i~
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following (if any) heir~7(ditaCt
additional sheets, if necessary): rn ~ f G~ ~',J
7~0~~r- ~ ; ~ i~'j
Name Relationship Address U'
~. - \ J
See attached schedule ~ Gt1 -
Form RW-OT rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
PETITION FOR GRANT OF LETTERS
(Continued)
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Decedent: Ralma C Fry File No: 21-12 -Q~~
a/k/a: Social Security Number: 204-40-2973
Date of Death: 6/29/2012
Age at Death: 62
~~ Relationshio Address
Abigail Y. Hanson Daughter 5303 N. 7th Street
Phoenix, AZ 85014
Katherine Y. Fry Daughter 121 W. King Street
Shippensburg, PA 17257
Timothy D. Fry Son 24 Silver Maple Drive
Boiling Springs, PA 17007
Colby A.R. Fry Son 405 Westover Road
Shippensburg, PA 17257
Donald C. Fry Husband 49 West King Street
Shippensburg, PA 17257
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA } SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name
Donald A. Fry
iJ
Petitioner(s) Printed Address C ~
'"`' ~~-~-
_
49 W. King St. ~ C
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Shippensburg, PA 17257 ~
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The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing PetitiSn~ II well and truly administebthe estatekaccordigg to a
belief of Petitioner(s) and that, as Personal Representative(s) oft a P~~ ~) Date ~7~
Sworn to or-7affirmed and subscribed efore Date _
Date
me t ~ / •-day f C ,~)/~
By: - '~ Date
For the Register
BOND Required? ^ YES C
FEES:
Letters ..........................................
( 2 )Short Certificate(s).........
( )Renunciation(s) ..............
( )Codicil(s) ........................
( )Affidavit(s) ......................
Bond .............................................
Commission ..................................
Other JCP
Automation Fee
To the Register of Wills:
NO
Please enter
nawre oeww.
$ 560.00
8.00
23.50
5.00
Attorpey Signature
~fil
Printed Name: George F Douglas, III Esq.
Supreme Court 61886
ID Number:
Firm Name: Salzmann Hughes P.C.
Address: 354 Alexander Spring Road, Suite 1
Carlisle, PA 17015
Automation Fee ............................
JCS Fee .......................................
596.50
TOTAL ......................................... $
Phone: 717-249-6333
Fax:
E-mail: gdouglas@salzmannhughes.com
DECREE OF THE REGISTER Date of Death: 06/2912012
Social Security No: 204-40-2973
File No: 21-12 -~3'l
Estate of Ralma C. F
a/k/a: +, ~ ~~ , in consideration of the foregoing Petition,
AND NOW,
satisfactory proof having been presented bef r me, IT IS DECREED that Letters of Administration
are hereby granted to Donald A. Fry
in the above estate and (if applicable) that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as tMepa~t Wi~(~ d CodicilO) of ~ ~ ~dent(~r n ~~ ~ / ~~
egister of Wills t' ~~,~~,~;~~ IZ~ ~~ge z or z
Copyright (c) 2D11 form software only The Lackn Group, 1 ~ ~
7.15.801 RED' ii)'Il~
LOCA~~i~~"I~~~~'S CERTIFICATION OF DE,~TIi
WARNII>1~;.,4~•r#s-'llf~g~i;~~Q~dupiicate this copy by photostat or photograpr~
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ree for this certificate, X6.00
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CUMBERLAND CO„ PA
This is to 'erNty -hat the 7~~fl~s'tna')n7: here ~~iti~en is
correctly- co~)ed t~~o77 an ori~Yin:~1 C ~.titicate of Death
duly filed ~ti°ith jt7e ~(~ t~ocz~l Regist~a)~. The !)s'iginal
certitica[e w)1, )c ru uaE_1 to tl,e Stag ~'itai
Records Otto i'(~,r- _,cr ~~~ t7iinv.
L.or e~istrar ~ ~ ate 15ued
Certification Number
Type/PNnt In
Permanent
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COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH .VITAL RECORDS
CERTIFICATE OF DEATH staeFU<Namb<r: __
ick ink
1 - 2. Sez 3. >ooal >ecunry rvamo~• •- ~ -• --•~ ~ ~- ~ -
.Decedent's Legal Nam<(Flrs; Middle. Last, SUfflx) beyp~Q• 204-40-2973 6-29-2012
D
TLa,Qma. C . Pn•y
G~;nuh to or Forclgn Country)
IJthplase (
Date of Berth (MO/Day/year) (Spell Month) 7a.
6
S e
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.
a. Age-Last Birthday (Yrs) Sb. Vntler 1 Year 6<. Untler 1 Da
YY11QQ1i7777DD LDS
62 Mentha Daya Hears Mlnatea .pe.Cembeh 16 1949
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, 7b. Birthplace (county)
untry) 8b. Residence (St t and Numb Include Apt No.) 8c. Oid Decedent Llve in a Townshlpi tw
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a. Residence ( fate or Fore
cc 49 W¢.bz K.i.ng S~iLe-ems Qvea,a!<laeninyetlln
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limits of Sh-Lppe.rw bwcg city/boro.
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rior To first marriage)
name
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widowed 11 rviyin (I
i SAOyse
Marital Status at Tlme of Death ®Married Q DSO
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9 .
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. Ever In US Armed Forces
wn Q Divorced Q Never Merrled Q Unknown 7l LLC.C
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Q Yes ®No Q Vn
Suffix 1 Mother's Name PNOr to FLrs Marriage (Firrt, Middle, Last)
Last
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12,AF`t+l~_s N•ame (First Mi
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14b. Relationship to Decedent 14c. Informant's Melling Atldress (Strce and Number, Iry, State, 21 Code)
17257
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14a. Informant's Name
66a.nd 49 Weak K.i.ng Ste. S
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Other Than s Hospital: ~J Hospice Facility ~ Decedent's Home
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.
--•••-^•••••"""""""•""•""~•• in tient ;
th Occurred in a Hospital: ~ Pa
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If Death Occurred S
Other (Specify)
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S ea
Dead on Arrlvai
Q Emergency Room/OUtpatlent Q
Na (If net Instltutlo7, 'tr! reef and number;
Facllit
iSb ry
Nursln Home/LO g-Term Care Fac
1 County ~Of Death
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~ Q Burial ® Cremation ry,
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of Olspositlon (Name o
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16 b. Dlte Of Disposition 16c. P
~, 16a. Method Of DlsposlHpn
[e p Donation
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7-2-2012 Ha•C.t.t•ng eh- Cn•emGL'tolL(.WT
.
Q nemeyal tram
' Other (Specify)
and Zip)
State
wn
T or Person in Charge Of Interment 17b. License Number
17a. SI furs of Fu rat 1 LI
'
,
,
o
16d. Location of Disposition (City or
MZ. Ho-2.ey Sp~.nge, Pa._ 17065 _
~
D 0 1 4 3 51 - L
,<. Nam dCOmplete tldreaa pfF„n<rgt Faallry Home. 112 We.d~ K.fng Ste. Shi.ppe.nbbw(.g, Pcc. 77257
C2PJL Yecne~(.ae
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k the box that best describes the 19. Decedent of Hispanic ONgin -Check the 20. Oeeedent's Race -Check ONE OR MORE races to Indicate w
lf
r hlrse~
d hi
CM
'
~ C
mse
o
s Education -
I8. Decedent
tl at the time of death. box that best deacNbes whether the decedent the decedent considere
rean
i
t
K
l
~ comp
e
e
o
highest degree or level of schoo
Is Spanish/Hispanic/latino. Check the "NO" ®White Q
Vietnamese
Q 8th grcde or less
box 14 decltlent is not Spanlah/Hispanic/lJtino. Q Black or African American Q
Q No diploma, 9th - 12th grade
d ®No, not Spa nizh/Hlspanic/Latlno Q AmeNCan Indian or Alasb Native Q Other Aslsn
ii
H
awa
an
Q Hlgh school graduate or GED complete
Q Ves, Mexican, Mexican American, Chicano Q Asian Intllen Q Nativ!
Chamorro
i
an or
Q Some college credit but no degree
Q Vea, Puerto Rican Q Chinese Q Guaman
`
Associate degree (e-i~ AA• ~
) Q Yes, Cuban Q Filipino Q Samoan
Q
nder
I
l
P
ifi
a
ac
c
s
Q Other
~ Bachelor's tlegrce (e.g. BA, AB, BS)
MEng, MEd, MSW, MBA) Q Yes, other Spa nlsh/Hispanic/Latino
MS
MA
r
e (e
'
d
,
,
.g.
eg
e
Q Master
s
Q Other (Specify)
Q Doctorate (e.g. PhD, EdD) or Prohsslonal degree (Specfy)
~ . MD DDS OVM LLB JO type o
what the decedent considered himself or herself to b!.
al O
di
t
I
M
^
n
ca
e
n
VSE RETIRED.
DO NO
king life
21. Decedent's Singe! Rs<e Self-DesignaTlon -Check ONLY ONE to
most of
or
during
done
an
S
I
-
amo
Qj White
Se Q Other Pacific Islander C ILQ
m~(.b~Ly T2CLCheJ(.
-
Q Black or AfNOn Amerlun Q Ke ean
Q Vistnamese Q Don't Know/Not Sure
tiv
N
rt
k
d
e
ry
a
a
u
Q American Indian or Alas
Q Other Asian Q Refused 22b. Kintl of Business/In
n
Q Asian Intllen
Q Native Hawaiian Q Other (Specify) (~taf~(~,eQ SCH.O a~. 1)~L-b ~~LC-C~
Q Chinese
Q Filipino Q Guamanian or Chamorro r
n Pronourtting Death (Only when applicable 23c. License Num e
r
P
e
so
ITEMS 23a - 29d MUST BE COMPLETED 23a. Cate Pronounced Dead (MO D!Y Vr) 23b. Signature o
••
+
r~ .
~ -
BY PERSON WMO PRONOUNCES OR
`
.
/
~ ~
CERTIFIES DEATH
23d. Dah Signctl (MO/Day/Vr) 24.~ ~ of D<ath
•~ 25. Was Mediol Examiner or Coroner Contacted? Vas Q No
CAUSE OF DEATH Approximate
In ies, or <ompllcltiOns-that directly caused the death. DO NOT enter terminal events such as cardiac arrest, Interval:
26. PaK 1. Enter the rheln of events--diseases, Jur y one cause on a Tine. Add additional Ilnez If netessary/7iys.Onset t th
Ing the etiology. DO NOT ABBRE TE. Enter one ~0 9~ 5
respiratory arrest, or ventricular flbriliatlon tyJtli
~~
-'"fF
~
_
4 L
(/ ,O ~~~ 40 ~
IMMEDIATE CAUSE >
Du o ( nsequen f).
co
(Final disease or condition
re:siting In aeacn) _ .
b Oue to (or as a consequence'of):
Segvlnt1e11V lest condltlens,
1f any, wading to the cause
1lstetl on Ilne e. ErlCer the Due to (or as a tonaequence Of):
<
V NDERLYING CAUSE
(tllsease or injurythe[ ]1
~ InHiated the events rlSiflting d. Due to (or as a consequence of):
~ '
c
'~ In death) LAST.
er y g cause g 27. Was a autopsy performedi
t d th but not resulting In the and 1 In Ivan in Part i
Yes No
26. Part II. Enter other I Ifl t dire t Ib tl
S
t~.+ 28. Wer¢ autopsy findings available
to complete the cause f death?
Q Yes Np
.~ 29. if F ale: 30. Did Tobacco Use COntrlbuTe to Deeth7 31aa. ~~Manner of Death
Q Q Probably ~ Natural Q Homicide
NM pragnsnt within past year ~ Q Unknown Accident Q Pending Inves[Igatlon
Could not be determined
ld
th
l
f d
S
m e Q
ea
c
u
Q Pregnant at time o
Q
Q Not pregnant, but pregnant within 42 days of deett
before dean 32:'Date Of InJury (MO/Day/Vr) (Spell Month)
Q Not pregnant, but Pregnant 43 days to 1 year
33. Tlm¢ of Injury
Q Unknown if pregnant within the past yea,
school) 35. Location of Injury (Street and Number, city, State, Zip Code)
f
arm;
34. Place of Injury (e.g. home; construction site;
36. InJury st Work 37. If Transportailon InJury, Specify:- 3B. Describe How Injury Occurred:
Q y~,s Q Driver/Operator Q Pedeatrlan
Q NO Q Passenger Q Other (Specify)
3 fler (Check only one): e, death occurre to the caus¢(s) and manner scared
Certifying phy Tclan - To the m knowledg date
end due to the cease(s) and m fated
and place
t the time
d
r
_
,
,
a
, J s
Pronouncing & Certi physician - o the bas[ of kno Ie a[h occurre
t
aminer/ tuner - On t sly of nta nation, a 1 atlon, In my opinion, death occurred the time, date, end place, and tlue
t O /
O yt~~ r r-
dl
l E
Y
e
x
Q Me
ce
p
--
Ttle of certifier: ~ License Nu
Slgnatvre of certifle - g^< (
39c. 1 d Mo/Day/Yr)
Address and Zip CO a oT Person Completing Cause o1 Death (Item 26)
39b Name, - O 3 b Z
4 egistr r Flle Date Mo/Day/Yr)
District Number 41. R<gl ar's Sig tare
40. Regisirer's
.-~ ®2 X19 i -z
_
.
g
d ~ -' ~J
43. Amendments
H 105-143