HomeMy WebLinkAbout02-28-06
Register of Wills of Cumberland
County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Larry E. Fultz
No. ?-.OO/.r; - 0) g2.
also known as
, Deceased
Social Security No. 184-38-2195
Petitioner(s), who is/are 18 years of age or older apply{ies) for:
COMPLETE "A" OR "B" BELOW:)
D A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the
Decedent, dated and codicil(s) dated
State relevant circumstances, e.g., renunciation, death of executor, etc.
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents
offered for probate; was not the victim of a killing and was never adjudicated incompetent:
r8J B. Grant of Letters of Administration
(c.La., d.b.n.c.t.a.: pendente lite; durante absentia; durante 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:
I Name Relationship Residence 1
Florence E. Fultz Wife 502 Magaro Road, Enola P A 17025
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Dauphin County, Pennsylvania, with his/her last family or principal residence
at 502 MaQaro Road. Enola. PA 17025
(list street, number and municipaliiy)
Decedent, then 59 years of age, died AUQust 20.2005, at Holy Spirit Hospital. Camp Hill. PA, Cumberland Co.
(Location)
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property ................................................................................ $ 40.000.00
(If not domiciled in PA) Personal property in Pennsylvania ............................................ $
(If not domiciled in PA) Personal property in County ...................................................... $
Value of real estate in Pennsylvania ...... ............... ........ .................... ... ...... ............... .................... ...... $
Total................................................................ .............................. ....................................... $40,000 00
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and
the rant of letters in the a ro riate form to the undersi ned:
Signature Typed or printed name and residence
Flor F:LrZ-
0-' oil)) G 0 L79 . 1/lt"c2...5-'
96037
Form RW-1 Page 1 of 2 (Dauphin County - Rev. 9/92)
Oath of Personal Representative
Commonwealth of Pennsylvania
County of Cumberland
The Petitioner(s) above-named swear(s) and 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 admini~~hT estate accordi~ la~/ .'}
Sworn to and affirmed and subscribed t1./:"~ C. y //-{~.
~
before me this
-7 <? f h
/..-0 day of
FcbvcAtLr~ ' 20~.
~id tC -1ai)1JA-~~7YJ~
{JJA ~~ ~ ..-0
DECREE OF REGISTER
Estate of Larry E. Fultz, Deceased
also known as
Social Security No.: 184-38-2195
No. 2-00tJJ - OJ l2-
Date of Death
August20,2005
AND NOW, ehr-uar':L~ fh ,20 D0 , in
consideration of the Petition on the rever e side hereon, satisfactory proof having been presented before me, _
IT IS DECREED that Letters 0 Testamentary ~ of Administration
(c,l.a,; d,b.n.c.l.; pendente lite; durante absentia; durante minoritate)
are hereby granted to f:=IDYCnCe 6.. FUl'r7-
in the above estate and that the instrument( s), if any, dated
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ................................. $
Short Certificate(s) ..;3.......... $
Renunciation ....................... $
Affidavit ( )........................ $
Extra Pages ( ) ................. $
Codicil...................... ........... $
JCP Fee .............................. $
Inventory & Tax Forms........ $
Other .C\UtP......................... $
qo,oo
12.00
./</hAdtt '-itlJ./ul, -AU~W~
---1;)JJA ~~OfWiIIS ,
I < I defud:!
5.00
Attorney:
1.0. No.:
Address:
~::!\
37422
3631 North Front Street
Harrisburg, PA 17110
717-232-7661
~"'~8;oll
/0.00
TOTAL ...... ............. $
11'1,00
Telephone:
DATE FILED:
I l ~, ~
\ :
Form RW-1 Page 2 of 2 (Dauphin County - Rev. 9/92)
~J 11" is lo certify that the information here given is correctly copied from an original certificate of death duly filed with me as
LULll Ri~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
p
11 6' OS' Q4'11 r~
6 1" . Cd) , <",,:."~
No.
~.f?~?~
Local Registrar
AUG 2 3 Z005
Date
C"~
Rev, 2/87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
NAME OF DECEDENT (First, Middle, Last)
1.
AGE (Last Birthday)
SEX
Jo1ale
E. Fultz
59
Yrs,
5.
COUNTY OF DEATH
Cumberland
E.
8c.
8b.
DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS 1 INDUSTRY
(~iv~o":ki~~;::'~~O d~~teu~~?i:;gt Nor f 0 1 k
11a. Conductor 11b. Southern
DECEDENT'S MAILING ADDRESS (Street, Cltyrrown, State, lip Code) DECEDENT'S
ACTUAL
RESIDENCE
(See instructions
on other side)
17b. County
Cumberland
Did
decedent
live in a
township?
502 Magaro Rd..
Enola PA 17025
George M.
SOCIAL SECURITY NUMBER
3. 1 8 4 - 38 - 21 9 5
Residence 0 ~~:~ily) 0
RACE - American Indian. Black. White. et ,
(Specify)
10.
White
MARITAL STATUS - Married,
Never Married, Widowed,
Divorced (SpecifV
14. Marr ied
SURVIVING SPOUSE
(\l wile, give maiden name)
17c. [j Yes, decedent lived in
1sflorence Phi lljPS
East Pennsboro
twp,
17d. 0 ~~h~e;~~~~\i~~~ of
citylboro.
Florence E.
Fultz
MOTHER'S NAME (First. Middle, Maiden Surname)
19.
INFORMANT'S MAILING ADDRESS (Street, City/Town, State, lip Code)
~~ 502 Magaro Rd. Enola PA 17025
PLACE OF DISPOSITION- Name of Cemetery, Crematory LOCATION - Cltyrrown, Stale, lip Code
or Other Place
Fultz
21c.
LICENSE NUMBER
22b. F D 0 1 4 99 3
Items 24-26 must be completed by
person who pronounces death,
24.
27. PART I: Ellter the dl.euee,lnjurle. or complication. which caused the death. 00 notenterthe mode of dying, .
Llet only one cause on each line.
{)
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)-"
a,
'\ vvJA..J.,.,tV-.-r::.rl/,.A/'Jt
DUE TO (OR AS A CONSEQUENCE OF)'
Sequentially list conditions
if any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or Injury
lhat initiated events
resulting on death) LAST
{ ::
d.
DUE TO (OR AS A CONSEQUENCE OF):
OUE TO (OR AS A CONSEQUENCE OF):
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DATE OF INJURY
(Month, Day, Vear)
MANNER OF DEATH
~
o
o
Natural
Homicide
o
o
o
30a. 30b. M.
PLACE OF INJURY - At home, farm. street, factory, office
building. ele, (Specify)
30e.
Yes 0 No 0
30e.
Pending Investigation
Could not be determined
Accident
Yes 0 No ~
Yes 0
NoD
Suicide
2&a. 28b,
CERTIFIER (Check only one)
29,
.PfoOt~~:~I~fG~~~;;I:J~e~'~e~~~~~~~~~ ~~:i~:~e~~~I~~~~du~I~~~,d:~: da~: l~ell,~i~iut~e~~)~~~ ~:~~er as slated...................... 0
'MEDICAL EXAMINER/CORONER
~:~~:rb::I:::e~~~~I.~~~I~~ .~~.~~~~ .I~~~~~~~~~~~.~: .l~, ~~ .~:.i.~~~~: .~~~~ .~~~.~~~~~. ~.t. ~~. ~i.~~:. ~.~~~:. ~.~~ .~~~.~~'. ~~~ .~.~~. ~~ .t.~~. .~~.~~.~~.(.~~ .~~~.. 0
31a.
33. REGISTRAR'S SIGNATURE AND NUMBER ~;t:p ~':'i~a~:/~~ ~_ I ~ / I '1r / III 34.
. I
Gladys P.
Goss
Enola Cemetery
NAME AND ADDRESS OF FACILITY
22cSullivan FH 51
LICENSE NUMBER
Enola,
PA
21d.
Enola Dr. Enola
DATE SIGNED
(Month, Day, Year)
23b. 23c.
WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONE~
26. Yes 0 No I!::::f
: Approximate PART II: Other significant conditions contributing to dealh, but
: ~~:~a~~de::~ not resulting in the underlying cause given in PART I.
N.
PA
i2 ,--'
'"
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED,