HomeMy WebLinkAbout09-16-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF t /�,�,yN, 6,�n,�st„� COUNTY,PENNSYLVANIA I
-
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 request(s) the grant of Letters in the appropriate form: '
Decedent's Information ��
Name: 0 �� P J� � File No: �� �� �}� �C� �
a/k/a: _�o !/u E l i aa lce'�-� i v► �e v (Assigned by Register)
a/k/a:
a/k/a: Social Security No: mQ (e .tl„0• 7'b L a
Date of Death: /� � �Z.Z • ;Z,� L iZ. Age at death: �0
Decedent was domiciled at death in � o� County, � (Srure)with his/her last'
principal residence at ' ��
Street address,Post Office nd Zip Code City,Township or Borough County
Decedent died at • S �r • �.� 02� S�'• � �� � 'n p�
Street address,Post Office d Zip Co City,Township or Borough County State
Estimate of value of decedenYs property at death: n J
Ifdoniiciled in Pennsylvania............................ All personal property $ 7f �� 0 •
If not domiciled in Pennsy[vania. ....................... Personal property in Pennsylvania $
Ijnot domiciled in Pennsyh�ania. .....:................. Personal property in County $
Va[ue of rea!estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE. ... $ �
Real estate in Pennsylvania situated at: � •
(Attnch ndditionnl sheets,i�nemssary.) Street address,Post Office and Zip Code City,Township or Borough County
� A. Petition for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)}�e/she/they is/are the Executor(s)named in die last Will of the Decedent,dated��vr► ��, Z.Q� (p and Codicil(s)
thereto dated /��t �--
State relevant circmnstances(e.g.renuncirttian,death ojexecuror ete.) ; ''
��4 - C:"? ._ .
Except as follows: after tl�e execution ofthe instrument(s)offered for probate Decedent did not marry vvas►sotd�vorced'�as not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C S�3�'a3(�),:and�id not h�ve a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated persen; �,; ' ' .. ,
�NOEXCEPTIONS ❑EXCEPTIONS - - -'
;. � . ��.�
❑ B. Petition for Grant of Letters of Administration (If applicable) " �
c.t.u.,d.b.n., d.b.,z.c.r.u.,pendeKtE lite,durunte ub,�ntiu,`c7urante minoritute
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent 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 was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑NO�XCEPTIONS �EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by tlie following spouse(if any)and heirs(uttuch
udditionul sheets,iJ'necessury):
Name Relationshi Address
Fo,�,�,aw-nz rev.10/1//201I Page 1 of 2
Oath of Personal Representative ofs�sa�u5�o�iy '
�
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF ����,L�l`�I�C� } SS. '
Petitioner(s)Printed Name Petitioner(s)Printed Address
�-�v►c�a l.. � �n k e I a i v �' 1 s ' �e Rd . w �� A
i'7o 70 '
The Petitioner(s)above-named swear(s)or affirm(s)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 Deced the Petitioner(s)will Il and tru admi ster e estate according to law.
Sworn to or ffirmed a d subscribed before �--�a�c`. C���� ` `'�--./C� Date / -�� -% �--
me this • ��day o �� � � �✓,�� Date
By:� � .1G�' Date
For the Re�ister Date
BOND Required:�YES �'O To the Register of Wi[[s: � `, �
FEES: Please enter my appearance by rtt��sigt�ature beTo'w: ' '
Letters . . . . . . . . . . . .. . . . . . . . . . $ ��� Attorney Signature: �' �
,
( /JJ ) Short Certificate(s). . .. . . �.(7 U �
_�-� .
� '..
Renunciation s ---
� ) � ).. . . . . .. . ,
� )Codicil(s). . . . . . . . . . .. . `. ` �:' , -
� )Affidavit(s).. . . . . . . . . . . ., ,_ '
. ., , .
Bond.. . . . .. . . . . . . . . . . . . . . .. . Printed Name: "
Commission. . . . . . . . . . . . .. . .. . Supreme Court T.-„ ` "
Other . . . . . ID Number: _% � ---,
�X1hfX� C�' (��. .�f':�L�YfI 15• `? ;-=' - .
v `1� . . . . .. . . �'7. Firm Name:
`��,�1 �.I . . . . . . . . ( S. �� Address:
. . . .. . . . Phoue:
Automation Fee. . . . . . . . . .. . .. . j.�� Fax:
JCS Fee. . . . . . . . . . . . . . . . .. . . . � �� Email:
TOTAL. . .. . . . . . . . . . . . . . . .. . $�
DECREE OF THE REGISTER
Estate of�\i � �'���,� � `����T�j TCe�-F�1 �YII�File No: _ �(�/ �j� ����
a/k/a: �
AND NOW, ��y�'� �%� 5������_, Z'�1� , in considerat'on of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DEC ED that Lett s
are hereby granted to � r'1
in the above estate and(if applicarle) that
the instrument(s) dated � f,i.trl l.11`��'l.1 tf�, . ,(o
described in the Petition be admitted to pr ate and filed of record as the last Will (and Codicil s))cf Becedent.
`� h. h. 9�
Register of Will� � �� N � mn �
'U'�.L�' I �
Fo,�»�irw-na ,��v. loiiiizn�� Pa 2 of 2
_ ,a �� .�,��.,�,�....�.� . �
HIOS.8Q5 REV(9/11)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.0(? ' ' " ,,,,����"' � This is to certify that the information here given is
. .� . _ . . . � 1�,��'�sE,P�T���PF�%;:_ correctly copied from an original Certificate of Death
��' `�` `fG\ duly filed with me as Local Registrar. The original
� � ' _� ' ;=�"� ) (;� ?�__ ����' s; certificate will be��forwarded to the State Vitai
� "`� '° � Records Office for permanent filing.
i v ,;�` a:
`* � �' : ' *���
P 188 � 161 � ` - .� �. . , ��`��°q9 .. �,a��'�� �� � o �2 s
a�. .� v �. � .: � -.jMfNT UE�;,,
, 0�2
Certification Number ^ r,i �, , �,,� "'������""'"� Local Registrar Date Issued
V�i'��GF�1�r,t.� . . . � .
Type/Print In COMMONWEALTH OF PENNSYlVAN1A�DEPARTMENT OF HEALTH�VITAI.RECORDS
� °efTan`"` CERTIFICATE OF DEATH
Black 1nk State File Number:
1.Oecadeni's Legal Nama(First,Mitldle,Last,SufFlx) 2.Sex 3.Social Sec�rity Number 4. atc of Death(MO/Day/Yr)(Sp�ll Mo)
Dol1 E. Perr Fema e
Sa.Age-LasS Birthday(Yrs) Sb.Untle�1 Vear Sc.Und�r 1 Da 6.pate of Birth(MO/Day/Year)(Spell Month) la.Birthplace(City and State or Foreign Co�ntry)
Mo'rths . oays No.,.: nno-,�c�s � �� Dover-Foxcroft y .ME � �
�^ 80� . A ri1 ].6 I;932, � 7b.Birthplac��co��c�.) �piscata uis
8a.Rcs(dence(State or Forelgn CoUnYry) 8b.Residance(Streat and Num6er�-Include Apt No:) 8<�.Did Decedent Ltva in a Township7 � . .
8d.laesidence.CounYy) � S 1 O H311side �Road � � AYeS•d«ede.,c n..ea i., � � � t,,,,P.
umberland �se.aesme��e(zip code> 1 ��� ��NO,tlecedent Iived wicnio m„�cs os New Gumb esi�and�-'�'oi�/bo�o.
9.Ever in US Armad Forces? 1D.Marital Stafus at Time of Death 0 Married (�Widawetl 11.Surviving Spouse's Name(If wife,give name prfor to flrst marriage)
�Ves �No �Unknown �Dlwrced �Never Marrled �Unknow
12.Father's Name(Firsc,Middle,Last,Sufffx) 13.Mother's Name Prior to First Marriage(First,Middle,Last)
Jamea Harve Finle Mildred Abbie Gra
14a.Informanf's Name 14b.Relationship to Decedent 14c.Informanf's Mailing Address(Street and Nvmber,Gity,Staie,Zip CodaJ
0
Linda Henkel Dau hter O illside Road New Cumherland PA I7 7
r, . � �� � � . isa:...a<e o oe e �e� � y one � � ��
................................."""""�,.��"""""'......................"""""""""' ....... .. ......,_
s If Death Occurred in a HosPital� V{InPaNent ;IT Death O c rred 5omew ....•...•."""........ ........"""""""�"' '�..•'"W. � -'... .`�...."�""
e Other Than�a�Flospital. ��HOSpice Facilt(y �u Decedent's Home �
� 0 Emergenry Room/OUtpaHeni � � Dead on Arrival Q Nur51n� HO @/LOn rTefm�CaYe Factlity Other(Spectfy) � - �� � �
eg 15b.Facility Name(If not InstituLO�,give street and number� 'i5c Gty or T�own;Staie,.and Zip Cotle���� � � i5tl.Couniy of�eath -� �
� Harrisbur Hos ital Harrisbur PA 17T 1 Dau tiin
�� 16a.MaSF�od of Dieposltion 0 Bu�lal � Cr�matlon 16b.Date of Dispositlon 16<.Place of Dispositlon(Name of cemetery,crematory,o o.the�place)
�R�movel£rom StaYe �Donatlon � ZO 1 L�. �� �
� ocne��sPe«r�q October 23y Evans Crematory
? 16d:�Locatlon of Disposition(Qty o�Town,Sfa[e,and Zip) 17a.Sig Yu�4 0�Fu�neral Ice Licens e Person tr1 Gharge af Interment I7ti�.Licens¢N�mber �
� Scheaf£eratown PA 17088 FD 013 340 L
17c.Name and.Complate Address of Funeral Pacllity � � � �� .. -
�§ Partt►emore FH&CS Inc. PO Box 431 New Cumberland PA 17070-0431
� 18.Dec�dent's Etlucatlon-Check the bot that b�st describes th< 19.Decaden(of Hlspanic Origin-Check the 20.De<etlenT's Race-Check ONE OR MORE ra es So i�dicate what
� hlghest dogree or laval of school completed at the[ime of death. box that best tlescrlbas wheiher ihe decedent the decedant considered himself or herself to ba.
0 Sth grada or Iess is Spanish/Hispanic/Latino. Check the"NO" WhiCe Q Korean
0 No dlploma,9ih-12th grade box if decedenc is not Spanish/Hispanic/Latino. �Black or Afrlcan American �Vieinamese
'�High school graduate or GED completed �No,noT Spanish/Hispanlc/Latlno 0 Amerlcan Indlan or Alaska Native � Other Asian
0 Some college credli,but no degree �Ves,Mexican,Mexican American,Chlcano �Aslan Indlan � NaCive Hawatlan
0 AssoGate degrce(a.g.AA,AS) �Yes,Puerto Hican 0 Chinese � Guamanian or Chamor�o
0 Bachelor's degree(e.g.6A,AB,BS) �Ves,Cuban �Fiifpino � Samoan
� Master's degree(e.g.MA,M5,MEng,MEd,MSW,MBA) �Ves,oiher Spanlsh/Hispanlc/Latino �Japanese 0 Other PaciFlc Island�r
� Doctorate(e.g.PhD,EdD)or Professional degree (Spacify) �Othar(Sp�cl
fY)
.M� DDS DVM LLB J�
21.Deceden['s Single Race Self-Designatlon-Check ONLV ONE to indicate what the tlecedent considered hlmself or hersalf to be. 22a.Decedent's Vsual Occupation-Indicate type of work
Q�White 0 Japanese �Samoan tlone during most of working life. DO NOT USE RETIRED.
�Black or AfNCan American Q Korean �O[her Paciflc Islande�
p Q Amwrlcan Intlian or Alaska Netive 0 Vle[namese 0 Don't Know/NOt Sure
� �Asian Indlan 0 Other Aslen �Hefused 22b.Kintl of Business/Ind�stry
� p en�ne:e p Neiwe Hewanan O Othar(Spedfy)
o Fmvi�o p��a�,a„ia.,o�cr,aR,o��o
ITEMS 23a-73d MUST BE COMPLETEU 23a ate Pronounced Dead Mo Day Yr) �. Z3b.Signature of Person Pronouncing Death(Only when�aRAlicable).�� Z3.c.UcenEe Nun1 gr. �
BY PERSON WHO PRONOUN�ES�R .. . . . � � � �
CERTIFIES DEAYH.� � � \ �� � � � . �
23d.DaYO Signad(MO)DayjY�) - . � 24.Time of Deaih � ��� �� �� � �
(� � 25.Was Medical Exa�miner or Coroner Gontacted� � Vas f.in �
� ��_ � CAUSE OF UEATH����� � � -�� � =� nPP.o.i.,�ace
26.P�rt L Enter Hie Ghaln of e ents--disaases,InJuries,o complications--that direcfly caus�d the death. DO NOT enter terml�al e ents such a ardiac arrest Interval:
respiratory arrest,o�ventricular fibrillatio liho�at shoWing She etionlogy�. DO NOT ABBREVIATE. Enter only one cause on a Itne. Add addlfional Ilnes if necessary Onse[to Death
IMMEDIATE CAUSE ------------> a. �V�Q�C-�. �( ,� � '
(c�nai d�:�ese o.conai:ion o.,a co for as a consequen�e ofl:
resulting in death) . . . .
� b. . � . . . . .
Saquenilally Ilst contlltlons, . Due to(or as a consequence of): � � � �� �� �
If any,Isading.to thw ca�se . � - � �. .
Ilsted on Ilne a. Ente�the � �c. � � � �
UNUERLVINp GUSE Due to(or Os a consequence of): �� � �
(disease or InJury thaY � . �� �� . .
� Initiat�d th�evenes resulting tl. as a con � �
� M.Ceath)LAST. � Dua to(or . sequence of): . . .. .. .
. � 26.Part 11. Entar other si nl nt c nditi n ontrib H�but nof resulting in the untlerlying cause gWen i�Part 1 � � . 27.Was ait'autopsy perto ed�
8
� � � � �.���YCS�. No
� � � �� �� � � �� � � � 28.Wefe aufopsy flndings available
pm � . � . � � � . io mplete the cause af death�
3 er co���Ves 0 No
29.If Fynale: 30.Did Tobacro Use Contrfb�te to Death7 31.M n of Death
E .[�Not pregnant withln pasc year 0 Ves � P bably �Natural � Homicide
S 0 Pragnant a[tlme of death 0 No [�nknown � Accideni � Pending InvestigaUOn
� 0 No[pregnan[,but pregnant wlthln 42 days of deatF� 0 Suidde 0 Could not be tletermined
� 0 Not pregnant,bui pregnant 43 days co 1 year before Death 32.Date of InJury(MO/Day/Vr)(Spell Month)
0 Unknown If pregnani wlthin the past year 33.Time of Injury
34.Place of InJury(e.g.homa;construction site;farm;school) 35.location of InJury(Street and Number,City,Siafe,Zip Coda)
` 36.InJury ai Work 37.If TranspoKatlon InJury,Speclfy: 38.Dascribe How InJury Occurred:
y 0 Yas �Driver/Operetor � Pedestrian
�( Q No 0 Passenge� 0 Other(Specify)
/ 1
1 39a.�C Klfier(Check only one):
��Cer[ifying physielan-To the best of my knowledga,death occurred due to the se(s)and manner stated
Q Pronouncing 8a Cer'[ifying ph slcia Ta b�sf of my knowledQe,death o etl at che(Ime,date,and place,and due to the c
se(s)and mannar s2ated
��� � Medical Examiner/COroner- f examinaHOn,and/or InvasNgaqonr In my opinion,death oc u red at the Hme,daSe,and plac�,and due to the cau e(s)and mann�r statetl
��^'
//V''''�� Signature of ertlfier.. .. TItIG of certifler: ��r �ICense Number�`(����-7Q13E
/� 3 b Name�Atltl'ess antl�21p�COCe of Verson ComplaHng Cause of Deat (liem 26J . � 99.Uate Slghed(MO/Day/Vi)
� � 1 U� . �amo �A I-7o4�
�i 40.ReglSSrar's.Dlstt ct Num e � � � . . 41.Registrar's Sign � 4 . egistre�Fqe Date(MO Day- r)
� / -ai� i6/�L o�z
� 43.Amendments
�
Dlsposltion Pe�m,�No. O'15�9 I 9 M305-143
REV 07/2011
LAST WILL AND TESTAMENT
of
DOLLY ELIZABETH FINLEY PERRY
I, Dolly Perry presently residing at 5406 Ridgewood Heights Drive,
Wilmington, NC, 28403, being of full age and sound and disposing mind
and memory, hereby make, publish and declare this to be my Last�V�ll and�� : � ;
_6
Testament. �, �-�� �'
���, �
FIRST: I hereby revoke any and all Wills and Codicils by��-, ;� _:;
anytime heretofore made. �- �,; ' ' _-
SECOND: I direct that all of my just debts and funeral exp����s be _ �� `
��.,
paid out of my Estate as soon as practicable after my death. � � ���
. .. ;�,_,
THIRD: a. I am presently not married. � .
-� � ;
b. I am the parent of the following child/childreri ' .• �
1. Linda Lou Perry Henkel 2. William Thomas Perry, III
3. Timothy Wayne Perry 4. Gregory Lane Perry
FOURTH: I hereby give, devise and bequeath all of my Estate, real,
personal and mixed, of every kind and nature whatsoever and wheresoever
situated, to my beloved children, per stripes (at no less than 21 years of age)
in the following manner.
l. $44,000.00 to Linda Lou Perry Henkel, or if she should predecease
me, to her estate or to her daughter, Heather Anne Henkel Ceja for
loans made to me and for payoff of the mortgage on my home.
2. The balance to be divided equally (by 4) and distributed to my
beloved children, per stripes (at no less than 21 years of age).
FIFTH: I nominate and appoint Linda Lou Perry Henkel as Executrix
of this will. In the event she shall predecease me or fails to serve as such
Executrix, then in such event, I nominate and appoint William Thomas
Perry, III, executor of this my Last Will and Testament. I further direct that
no appointee hereunder shall be required to give any bond for the faithful
performance of his or her duties.
SIXTH: I give to my Executor/Executrix, authority to exercise all the
powers, duties, rights and immunities conferred upon fiduciaries by law with
full power to sell, to mortgage and to lease, and to invest and re-invest all or
any part of my Estate on such terms as he/she deems best.
THIS IS PAGE ONE OF TWO I1�IITIALED BY ALL CHILDREN
PAGE TWO CONTAINS FULL WITNESS SIGNATURES
_ < .�., �..�.�.�.�.„M.���, w_ � ��-� �.,� �.�. � .,�.�.. �� �,,�,�_s� ,. , . � _
WTTNESS WF-3CFREt�F, I hereunto set my hand this ����day
af .vu :u , 20G��a �
%`,t� ,�% ��:�' ,
{Dall Eliza eth Finley Perry) ��
�,,,,�,����,�„,,,
f �,.`' R- bV �'�'•
t �� � ti'� `���q�`�4ff•
fi '-.,
' �' :
(Witness Sign Here) �Qr �O�AA y �`��
My commission expires C�'�1 -,,�1� 4 '�' �
:;� ClgL4�'�.z�^�
Signed sealed, published and declared by the above named testatrix, as ai� c,a.. �
� •. MOVER
for her Last Wi�l and Test��ment, in the presence af us, who at her request, iri`"`j,«"t��"'"'
her presence, and in the presence of one another have hereunto subscribed
our names as attestin witnesses, the day and year last written above.
� Residing at Ic�YJ �.�r`; q�� c:«�.0 c.,,,.��
c'"l. .So� r4'•,.sra-�, �� ,�YSr�--
, � � Residing at Sy�&' R:�� e d._��o��
�� � :J� �� v. `����`/.�
Residing at i� �;:�..� �.CO
--� w�,�,.�-.-.,��c. z�-�"4-z.�
� _ -� .�.� �. � Residing� at �lr r,�-z��- 1�-
•S fv r..��, CA 9S'�-�o
�
THIS IS PAGE TWC} OF TWO.
PAGE QT1E CONTAINS TEXT (�F LAST WILL AND TESTA�UIENT.
c� -
c��� �� -^- _ ;
/
.,
- .. �:-, .
(��TH OF SLBSCI�iBI�G jti'II��ES�(,ESjJ .- � ,
�: �
�1 ( REGI/STER OF ��'ILLS ° `'`' � "
I��CVYI kl-?.�L.��rc-�( COU�ITY, PE�ISYLVANL� c.a `'' :;�
Estate of �—_'�� � ` . �z°
� , Deceased
I ��o� �. P� �d� � � �� 1�
, (each)a subscnbing witness to
(Print Name/sJ
the O Will Codicil(s)presented herewith, (each)being duly qualified according to law, depose(s) and
say(s) that she/he/they was/were present and saw the above Testator/Testatrix sign the same
and that she/he/they signed the same and that she/he/they signed as a witness at the request of
the Testator/Testatrix in her/his presence and in the presence of each other.
�� k�
(Signalure) (Signah�re)
� 1 0 � l S � Ct 1°_�c� . '`�l g�t d c,�.�croc� ?`�7� � c u-e
(Street AddressJ (Streer Address)
-2.t,t� �l.0 Vl/1 �� �,.� ��"t � yj . �, �-�� �
(City,S�a1e,Zip) (City,S1ate,Zip) i
1 � o � t�
Execc�ted in Register's Office Executed otct of Register's Offtce
Sworn to or affirmed and subscribed Swom to or affirmed and subscribed
before me this P�4� day before r,�e this day
of� �,� , ��/� . of ,
���� , f� �P�,��-
Deputy for Reg:ster o` i:is '�o:���� Pubiic
?�1} C;or�:r.issior. E�pi.e�:
(Signatu;e aad Sea'.oCP�o:ary or o:her e;:,ci•�:;uaii�ec to
administe:oaths. Sho«date o:`e�pi;a;ion c:No:a:;'s Commissio�.)
tiOTE: To be tal<en by Officer authorized to administer oaths. Please have present the original or copy of insVwnent(s)at time o:`notarization.
Form RW-03 rev. 10.I3.06