HomeMy WebLinkAbout03-12-07
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of LOREANE M. ENSMINGER,
Deceased
of 5650 Charlton Way
Mechanicsburg, (Hampden Twp.,
Cumberland County, Pennsylvania)
No. J \ Ol o..~LD3
To:
The Register of Wills of Cumberland
County, Pennsylvania in the Commonwealth
of Pennsylvania
The Petition of the undersigned respectfully represents that:
Your petitioner, who is 18 years of age or older, applies for Letters of Administration
on the estate of the above
(d.b.n.; pendent elite; durante absentia; durante minoritate)
decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her
last family or principal residence at 5650 Charlton Way, Mechanicsburg (Hampden
Township, Cumberland County), Pennsylvania.
Decedent, then _80_ years of age, died January _13_, 2007 at _
Golden Care Living Center (fill in of place of death).
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Decedent at Death owned property with estimated values as follows:
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All Personal Property. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ..$4,500
Value of Real Estate in Pennsylvania................................... ...$0.00
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Petitioner, after a proper search, has ascertained that the decedent left no will and was ~
survived by the following heirs:
1. Thomas R. Ensminger, Son, 5650 Charlton Way, Mechanicsburg (Hampden
Township, Cumberland County), Pennsylvania 17050.
2. Lloyd H. Ensminger, Son,
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3. Patricia L. Goddard, Daughter,
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Therefore, petitioner respectfully requests the grant of letters of administration in the
appropriate form to the undersigned.
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omas R. Ensmmger
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (] Q rn b.f rand
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 beliefofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
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administer the estate according to law.
Sworn to or affirmed and subscribed
Q~~/
. ture of Personal Representative
before me the
day of
Signature of Personal Representative
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Signature of Personal Representative
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Estate of LD (.eo...n e m ,f n<:::"Y'(j r n9~ r ,Deceased u:
Social Security Number: ori () f / fS (0;), 7q Date of Death: JGJJL-Ul (( f )3 07
AND NOW, ~ r (I i /3 , ,;;a; 7 ' i:J. ,,,,,,idomtion oft'h' nyegoing p,titi~n, "ti,{aoto'Y proof
havmg been presented before me, IT IS DECREED,-that Letters fjd..Jy-J (() l"s trcc17r;lv
are hereby granted to -mamas. g - EnSrn....tJ1qer
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File Number:
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofrec~ri 7f the last Will (
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Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
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Page 2 of2
Form RW-02 revo /0./3.06
H105.805 REV 1/05
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. 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.
1310494~
No.
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Fee for this certificate, $6.00
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JAN 1 6 2007
Date
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REV 1112006
I PRINT IN
~ANENT
,CKINK
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
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STATE FILE NUMBER
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1. Name of Decedent (first, rni<de, last, suffix) 12.S.'F 13. Soc:ial SOCIIriIy Number 14. Oa.. of Oaalh (lAonlh, day, yaar)
Loreane M. Ensminger 201 _18 ...h279 1-13-2007
5.1qJ (Last Blllhday) Undarl..., Undar 1 day I 6. Oata 01 Birth (lAonlh, dav, ""ar) 7.Bir1hplaceCityandstata"''''''''''''oounlly) 68. Place of Oaalh (Check only ona)
\-1 ~I Hw1 I_I ~arrisburg. I ~"I I Olhec
. 80 VIS. 10-19-1926 PA o inpatient 0 ER I OUlpationl 0 DCA [] Nu,.;ng Home 0 R..illance DOllIe, . SpeciIy'
61>. County 01 Oaalh Be. City, Bora! Twp. 01 DeBth Bel. FadIty Name (If nof _, give _ and nu~ 9.W..0acedan101HlspanlcOrigin? KJ No o Vas r ~-;::':"'" Whfte, are
. Cumberland Camp Hill Golden Living Center (If YO', spaciIy Cuban,
Mexl<an, Puer10 RIcan, 81<:.)
11.0ecadant'.UI\l8lOcx:uolltlon(J(i1d0l__~""_0I"""'Nfe,Donol__ 12. Was Decedent ever in the 13. lle<:edant's EOOcatlon (SpeciIy only higIest grade compIated) 114, Martial SIatus, Married, Nave, Mented, r' SuI'lMng Spousa (If "*" give maiden name)
Kixlol_ I ~of~11ndusl1y U.S. Annad Fon:as? I ElemaolarygSocondary(ll-12)I College (1-4 or 5+) I Widowod,IlIvomed (SpocIf)j ,
Care Assistant Me ica Ov.. KINo Widowed
. 16.__' MaiingAdcllasl(Sllasl, cfIy/_, -,zlp-) 1lac8donf. Pennsylvania Old Oacodont
AcfuaIResidllnce 17a. Stale u..lna 17e. [] Vas, _ UvecI" Hampden Twp.
5650 Charlton wal Township?
. Mechanicsburg. ennsylvania 17050 17b. County Cumberland 17d. 0 No, Decedant UvecI withil
!-.. Ac:1uaIUlritsol City/Iloro
18. F_. Name(F1l1l, _,last, auIfix) 19. Mother's Name (First, middle, maiden 5l.InlIm8)
Thomas H. Schoppert Edna M. Drabenstaudt
208.1_. Nama (Type / Print) ~.lnIormant'sMaMng_(SlrasI,cfIy/_,_,zlp_)
Mr. Thomas Ensminger 5650 Charlton Way.. Mechanicsburg. Pennsylvania 17050
21a._0I0isp0siti0n I It] ~ 0 00nalI0n 21b. Data 01 Il'-"ion (Month, day, yaar) 21e. PIaca 01 Oispoaition (Nama 01 cematary, _ or olhar placal 121d.locatlon(City/_,sIata,zip_)
. o Burial 0 RomovaIlIOln S1a.. . '\ .'
o 0IhaI. Specify, i~==~~V"ONo 1-16-2007 Cremation Soc~.ety of PA Harrisburg. PA 17109
~ ~ \. '~-lr_/tiI(~ 1;;'738453 1~.NamaandAcldnllSoIFociityAuer Memoriat Home & Cremation Services. Inc.
. 4100 Jonestown Road. Harrisburg. Pennsylvania 17109
I~~~~::=o 230. TOlhabaslolmy~;rBllhaUma,dal&andplaca- (S9laI1Jr9andtitle) 23b. Uc:enlleNuri'lber 23c. 08.. S<oned (lAonlh, day, yaar)
C8!IiIy cause 01_. I> j/? " _. L/ /t--J IlIJ 2&7cJJ~ L 1/13/ &007
. IIems 24-26 _ bo~ed by parson 24. l1me 01 Oaalh (p J S- If M 125. i ;i37~O:~7' day, yaar) 26. We Case Referred to MecIcaI examiner' Coroner for a Reason Ottler than Cremalion or Donation?
..... pronooncas daa~, o V.. ~
CAUSE OF DEATH (See I_..nd .xampleo) I Approximate intervel: Part II: Enter other sionificant cordIIons contributiM 10 dMth 26. [l;d Tobal:cc Use ContrIbu.. 10 Oaalh?
ltam 27. Part I, Enlarlha~-_Injurias.",compIIcatIons-lhaIcIrocIIyC8Ulladlha_. 00 NOT ent"tarminal ev9I1ls such as call1acanaBl. Onset 10 Death but no! resulting in the undet1yingcause gtvenin Part!. o Vas o Probably
raspi1IOryanasl. .._ar_tionwllhoulstlowlnglhaallology.l.is1onty 0118 cause on aach 11oo. [3-No o UnIcnown
~~~=)~ /~..,J~,,- ~~-+- ... 29. II Femata,
a. @-1qOIprognantwilhinpas!yaar
Due to (or as a consequence 01): o P_B1Umaoldaslh
~illeoncItionI,~any, b.
:1: awsell8tedonlil'l8a. OUaIo("'asa~ot), o No! pregnanl, but pregnant within 42 days
Ental UNIlERL'/INGCAUSE
=-.:;~~~~~ e. oIdaslh
. Due 10 (Of as a consequence 01): o No! pregnanl, but pregnant 43 days 10 1 yoar
boIor9_
. d, o UnIcnown If pregnanl withillha pas! yoar
308. Was an Autopsy :n.. Wars AuIopIy FondngI 31,MamerolOaalh 328. Oal& 01 l~ul1 (Month, day, yaar) \320. _ How Injury Occuoad 32c. Place of := Home, Farm, Streel. Factoly,
Per1onnad'1 A,_PriorIoComlil_ ,llf"r..turat OH_ IJfticellui "e. (SpecIfy)
01 Cause 01 Death?
o Vas rjNo o V.. ~NO o ACCdent 0 P8lxIng lnuasligatlon 32d. Tme oIln;ny .l32e. In~ry al WOlk'1 ~ If Transportation Injury (SpeciIy) .1321. location 011"'11 (Sllasl, city / town, lIa'a)
D- O C<x;d No! bo OaIarmIned .- Ovas ONo 01Jriuer/0par0I", OPassenge< OP_rian
M. Qlher.SpecI(y:
330. c..tifior (chick onty 0118) 33b. SIgnature and Title of Certifier .A-1\Ly<-
. =::.~=-~ca"::'~lIIo~'"':"Illd,,,,=,:~~_a~~~le~:~mm__m__m_ CJ ~ lb
. PTonouncIng Illd cortItylng p/lyIlclon (1'tryslciat1 both prnnouncIng daslh and C8l1iIylng .. calJS8 of death) . [!3' f33c. license _j33d. Data S<gned (Monlh, day, yaarl
To the belt of my knoWIMtgI, death occurred at the ttme, date, and piece, and due to the cause(l) and manner II statecL ... - ... ...... ... ... ... ...... ... ... ... ... ... ...... 0.5 00 S'"9 i4--1..... ( ,- i S;-07
. ::: ==::= and I or InvestigItIon, In my opinion. deIth occurred at the lime, date, and p68ce, and due to the cauM(s) and manner II stated.. 0 34.NamaandAddr"'oIP"""_~~A.R. D.o.
35 R~~~"" ..2t /...<j 136 Oa~ (Month) yaar) 'fS"1 '" (l--t> (o...c..
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RENUNCIATION
IN THE ESTATE OF LOREANE M. ENSMINGER, deceased, of 56 50 Charlton Way,
Mechanicsburg (Hampden Township, Cumberland County), Pennsylvania.
To the Register of Wills of Cumberland County, Pennsylvania:
I, Patricia L. Goddard, the undersigned daughter of the above named decedent,
hereby renounce the right to administer the estate of the decedent and respectfully ask
that Letters of Administration be issued to my brother Thomas R. Ensminger of 5650
Charlton Way, Mechanicsburg (Hampden Township, Cumberland County), Pennsylvania
17050
cia L. Goddard
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Street Add ss. ~
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City, State, Zip Code
SWM sub~el)cf9i.i me- tb,fs_
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COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Sandra J. GulzweiIer, Notary Public
Fairview Twp., YorI< County
My Commission Expires Feb. 18, 2011
Member, Pennsylvania Association of Notaries
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RENUNCIATION
IN THE ESTATE OF LOREANE M. ENSMINGER, deceased, of 5650 Charlton Way,
Mechanicsburg (Hampden Township, Cumberland County), Pennsylvania.
To the Register of Wills of Cumberland County, Pennsylvania:
I, Lloyd H. Ensminger, undersigned son of the above named decedent, hereby
renounce the right to administer the estate of the decedent and respectfully ask that
Letters of Administration be issued to my brother Thomas R. Ensminger of 5650
Charlton Way, Mechanicsburg (Hampden Township, Cumberland County), Pennsylvania
17050
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County of' . (-9 d... )~~.
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I, t=: a~..e.-.....e ~\ ~ q ~ ,a NQtary PllbItc.'-'1,
for said County and State, do hereby, certify .
that k.Lo~r\ E (\ $..-n I ~er
personally ap ared before me this day and
acknowledged the dtJe execution of the
foregoing instrument.
Witness my hand and official seat.
this the J v --:I:n day of (y\ ctl-&-.. . ~OOI
month year
rnA~.p- ~~J
IignaIure of notary public
My commission expires ;L~... 4 . ~ ~,I. 9
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