HomeMy WebLinkAbout05-30-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
01/ _c7Jd'i15~
Estate of Ian Paul Dagan
also known as
File Number
. Deceased
Social Security Number 591-96-3858
Petitioner(s}, who is/are ~8 years of age or older, apply(ies} for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s} is / are the
last Will of the Decedent dated and codicil(s} dated
named in the
(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 instrument(s} offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
IZJ B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pende.nte 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: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete /ist of heirs.)
I Name Relationship Residence I
Paul P. Dagan father 11 Beagle Club Road, Carlisle, P A 17013
Vema J. Dagan mother 11 Beagle Club Road, Carlisle, P A 17013
. .
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
11 Beal!le Club Road. Carlisle. Middlesex Townshio.
(List street address. town/city, township, county, state, zip code)
County, Pennsylvania with his / her last principal residence at
Decedent, then 16
years of age, died on February 14, 2007
at Lehigh Valley Hospital
Decedent at death owned property with estimated values as follows:
(If domiciled in PAl All personal property
(Ifnot domiciled in PAl Personal property in Pennsylvania
(If not domiciled in PAl Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
100.00
situated as follows:
Wherefore, eetitioner( ~) respectfully request( s) the probate of the last Will and Codici1( s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
T d or rioted name and residence
Paul P. Dagan 11 Beagle Club Road, Carlisle, P A 17013
Vema J. Dagan 11 Beagle Club Road, Carlisle, P A 17013
Form RW-02 rev. 10.13.07)
Page 1 of2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
Oath of Personal Representative
SS
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 belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmedtilUbSCribed
before me the ~ day of
JfJ1J1~
Signature of Personal Representative
File Number:
c2/" ~O()'1- ~.53
Estate of Ian Paul Da~an
. Deceased
Social Security Number: 591-96-3858 Date of Death: February 14,2007
AND NOW, '71/J? ~ ~ ..;;v 0 Jill consideration of the-foregoing Petition, satisfactory proof
having been presented before m , IT IS DECREED that Letters of AdmlDlstratlOn . .
are hereby granted to Paul P. Dae:an and Vema 1. Dae:an
in the above estate
and that the instrument( s) dated none
described in the Petition be admitted to probate and filed of recor
FEES
Letters
$
20.00
12.00
Short Certificate(s) . . . . . . . . $
Renunciation(s) .......... $
JCP ... $
Automation . . . $
.. . $
... $
.. . $
.. . $
.. . $
.. . $
.. . $
TOTAL .. . . . . . . . . . . . . $
10.00
5.00
47.00
Form RW-02 rev. 10.13.06
Attorney Signature:
Attorney Name:
Supreme Court J.D. No.: 77052
Address:
SALZMANN HUGHES, P.C.
354 Alexander Spring Road, Suite 1
Carlisle, PAl 70 15
Telephone:
717-249-6333
. Page 2 of2
105.805 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'I1,07S3
WARNING: It is illegal to duplicate this copy by photostat or photograph. ()
.
No.
.~~;~.~~
Local Registrar
Fee for this certificate, $6.00
p
13311209
MAR
5 2007
Date
HIO!i.l.... FlEV 1112lJ06
TYPE/PRINT IN
PERMAIIENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
'. 0,118 of Death (Mon1I1, day, l"flr)
2/14/2007
O&ced8nls
Adual RMIdof1c& 110. Slale
17b. Coonty
PA
CUntlerland
l1C.o Yes. 00c0dInI Uvod in Middlesex
17d.o No,IJeoedenI Uvod wilhill
Actu8l LInItI of
TW!>.
CirI / Baro
18. FIII1of's NOlIllI (fInI. ~.1DIl. .uIIlQ
Paul P. Dagan
2Oa. lnIonnInI'a N8Int (l";pt / Pllnl)
Paul P. Dagan
21.. MeIlOd ofllosposillcn
19. Molher'a Nome lI'irat. middle. I11lIidoo> IUmamei
Verna Barrick
2011. lnIormont's Milling Alldms (SIrool dly liown,Olll1l!. 2lp code)
11 Beagle Club Rd., Carlisle, Pa 17013
21c. ~ of DIspoIiIIon (N.1rM 01 camttery, ClWIIlIIaIy or _ place) 21d.localKllI0ly! lOWll. Slll1e, 2ip code)
~
!2
~
estminster Memorial Gardens
Hoffman-Roth Funera are
Carlisle Pa 17013
2311. l.lc4nse Number
Pa 17013
23c Dal& Signed (Month. day, YNIl
__muslbeClllllliloledllJflI'IOI1
- polllOIIlIlH--
25. 0aIt Protnn:td Dead {l.lon!Il. day. ytatJ
M. 2/14/2007
CAUSE OF DEATH (See Instructions II1Cl eXlllllples)
IIIIIl 27. PorI t EnIor 1lle ~ - chea8l!l, 1r$dS. or c:ampIcaIiJn$ - thai dirt9Clly c_1lle deaIlI. DO NOT enter ""ninal...nts stetl as CllIdiac 1II111S1.
reepiI1Iary trrISI. or ~ IbIalion W1~ sIloWInlI1lle eIIoIogv. list MIl 0l'4l _ "" _line.
24. T1me 01 Death
7:55 AM
26. Was Case RoIerrod 10 Medlc&I Exalftnor 1 Comneo fDI . _ 0100' IhM COIl...lton or llonllion1
V.. 0 No
c:
m
DVM il No
:lOb. \Vera AuIopor FhiIlgo
AVIIIble PrIOrID ~
of Cause II o.aGl?
Ov.. oNo
31.llonnor of lJoaI1
o Hotural 0 HomIcide
~ -- 0 Perdng InveslIgaIi>n
o SuIcido 0 Could Hot be Oelominod
ApproldmaI8 tnl8IYaI: PIll II: ErOr~ _I <MIll.... __10 - 28.~. TOlll!19C<lrdr1bule to 0lI8Ill7
CJ!lsel to Oeillh .1lUl1Vl! rfSUIIIng III 11M> undodylng caoJSa ltJa'11n Plrt I Ves Proll&ll!J
No ~
29. If FomoIe:
~Not ~...I_pulyw
PI1gIllli 8l1lrn8 01 _
Not pl89laIlI. but pt8glInl Yol1hIn 42 days
01 dtIth
DNot prtllJWII. but pt8glIIlt 43"" 101 yw
O=.n '*:' pII9fIIIlll wtilllM> pes1 year
32c. Placa:= Hom= S1rioI. Facklrj.
Stepped on downed high voltage electric line R':"dway Ole. j .
32B.k1jtIIyalWOlt(/ 321.IlTranspclf18Iionm;ny~J ~~".ItWY(~cilyll'""l.tI4!tl
0..... Driver / Opeqlof 0 PaosIllfl8'~'" SherWOOd RCI" Al>Prox. 300' East of '1YFlle Rd
Ve. 14 No . Sjlfc/Iy: LJ --. Middlesex Twp.
33b. ilrd T" 01 C8t1Ier
~~=i-::;'
8. Complications of 68% Full and Partial Thickness Eleclrical Bums
Due III lor lI$ 8 ~ oft.
b.
OueIll(or..a~oIl:
SeauenIidY Ilol COIdliano, W any.
1Nliilla1D1ht_1SI8d0ll1inla.
Ei'IIIr'" UII:lelll.YINCl CAUSE
=-~..-:...~Iht
DueIO(OI"'_oIl:
d.
300. W. en Iok1psy
Perfonn8d?
~
i
~
i
33a. CIIlIer I....... cny....)
. c.1IIytIlg ""'Ildon IPh,licien oor1lfytng caa of _ _ __ pIly&IciIn I18a prtI'lOllf1<ed deelll and completed 118m 231
TQ..beololIlY1cIIo-.o,__.....lOtIltOlll8l(..1Ild _aalllld.. _ _ ___ _ _ __ _ ___ _ _ _ _ _ _ __ _ _ _ ___ __ _ _ _ 0
, "-'dng lIId criytag..,..... ~ bolI1 Pftlf1llIIICtlo _ and corIifyIng III """" d ~
To the _ 01 "" Imowftdot,.....h __ 811ht...... dalt, l8ld ploce.lIld due 10 the ClllllO{a'"lld __ .. sl8lIll.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
, ...... Euminor IC_
011.. beola of.-....... and 1 or IrNN\lpIkIn, In Ill)' 0lIlnl0n. dIIIh occurred III Ihtllme, dft,1Ild pl-.1IId duo 10 die c:IUJI(lllfId -.. -- [l M. Name and _ 01 Pefson Who CMlpieIod Ce".. 01 08IIlI (IIIIIl27} TYI" I Print
Scott M. Grim Coroner
501 W. Hamilton Street Allentown, PA 18101-1501
Coroner
3M 0Ih0 SiQntd llJonlh. dtly. .,....,
2/14/2007
1<:9. I I IC)., III 0 1
Dispoeitaln Permit No. () I fJ5 4-'1 '6