HomeMy WebLinkAbout11-15-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
COUNTY, PENNSYLVANIA
Estate of Timothy Craig Madeiras, Jr.
also known as
FileNumber i2J -Ol-IDl.J-r
. Deceased
Social Security Number 185-74-2645
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Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B' BELOW:)
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
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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
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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:
IZI B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; db.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: (If
Administration, c.t.a. or db.n.c.t.a., enter date o/Will in Section A above and complete list o/heirs.)
I Name Relationshin Residence I
Timothy C. Madeiros Father 97 Quigley Road, Newburg, PA 17240
Kathleen A. Madeiros Mother 97 Quigley Road, Newburg, P A 17240
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his / her last principal residence at
97 Ouiszlev Road. Newbursz (Mooewell Townshio. Cumberland County) PA 17240
(List street address, town/city, township, county, state, zip code)
Decedent, then 15
years of age, died on October 19, 2007
at Chambersburg Hospital, Chambersburg, P A
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(Ifnot domiciled in PA) Personal property in Pennsylvania
(Ifnot domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$
$
$
$
situated as follows: None
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant ofLetters in the appropriate fonn to
the undersigned:
d or rioted name and residence
Timothy C. Madeiros 97 Quigley Road, Newburg, PA 17240
Kathleen A. Madeiros 97 Quigley Road, Newburg, P A 17240
FormRW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
SS
COUNTY OF CUMBERLAND
The Petitioner(s) above-named swear(s) or affinn(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.
before me the \ ~
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day of
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Signature Of Personal Representative
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Sworn to or affirmed and subscribed
Signature of Personal Representative
to..)
25
Signature of Personal Representative
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. Deceased
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File Number: .Q..\. - 0 I - I oLj 11
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Estate of Timothy Craig Madeiros, Jr.
Social Security Number: 185-74-2645
Date of Death: October 19, 2007
AND NOW, ~v~ \ oS . ~o'1 . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Timothy C. Madeiros and Kathleen A. Madeiros
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) ofDecedeilt.
FEES
Attorney Signature:
Letters............... $ c:lO. CD
Short Certificate(s) . . . . . . . . $ Ot(')' G0
Renunciation(s) .......... $
~~ P ... $ \[) .l1..)
rL.~Tr'n{\..... $ S.6\~
... $
... $
... $
...$
'" $
. .. $
...$
TOTAL .............. $
Attorney Name:
Hamilton C. Davis
Supreme Court 1.0. No.: 10264
Address:
20 East Burd Street, Suite 6
P.O. Box 40
Shippensburg, PAl 7257
Telephone:
(717) 532-5713
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Form RW-02 rev. 10.13. 06
Page 2 of2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 13774920
Certification Number
This is to certify that the information here given is
correc'tly 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 .. ing.
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H105.1<W REV 11>2006
TYPE I PRINT IN
PERMANENT
BlACK INK
..N...ol_(FIrII,_.lut.~
Timothy Craig MADEIROS Jr.
5. 19 (1aI 1lll1I1day}
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and axamples on reverse)
STATE FILE
19. r.tlCher's NIme (fill. mIDdle, rreidIn 1Umame:)
Kathleen A. Ricca
2Otl._.Mali'!l_~dly/_._.zIp_)
97 Quigley Road, Newburg,
2'e.PlIc:eol~l_oIeemo1oly.-.y,,_place)
15y~.
lb. County 01 Doall1
Franklin
'2.Wu_n1_~1ho
u.s. _ Fon:es1
DYtI KINo
Deeedenf.
Actual Residence 17.. &ate
'Th. eo...<y CUll1berland
6. Date 01_ (Mcnth. dIy.
7._
tnd_or
April 28, 1992
11.OIcedInI'su..1
Kind 01 Work
Student
16. DococIonl'>MoIlng-' l-'clIy/-.-.zIp-J
97 Quigley Road
Newburg, PA 17240
18. F.... Nome (Fb1. _.loIl.1lAIIx)
Timothy C. Madeiros
2OI.W_. Nome fIYpo I Print)
Timothy C.
Klndol
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Kind 01 BuoInou IInduslry
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24. Tine of Death
25.0oIo _1lNd (MonlIl. dIy......)
06:20 PM. October 19, 2007
CAUSE OF DEATH (See Inotrucllontl and aumplea)
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OOIfliaIory_.or__Ilon_.-.glhe"Ology.Us1~..._",_Ii1o.
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t Onset to Death
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~~~~~~~ a. Multiple Blunt Force Injuries
Due to (OJ ..alXlflMqU8llC8 01)'
b. 'Unrestrained Rear Seat Passenger
Due to (or as. consequence 01);
e. 2 Vehicle MVA
Due to (or It . canaequel'lCe of):
d. Vehicle Broadside Into Pickup Truck
300. Was In AuIopIy 3IIb. w,~ AuIopIy Findngs 31 Mannor 01 Ooattl 321. Dale ollljUly (Monlh, dIy. yoar)
- _Prior"'~ October 19, 2007
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23b. Ul>>nH Number
26. Was Cue Ae1efted to MedceI Examiner I Coroner lor . Reuon Other thin CnIm11lon or Don8lIon?
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Part II: Enltr 0Ihtr IlMificanl mnriiIirlM tmIrhJIW! 10 dMliI
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DllffloI/OpoI8l" I!!l"-r Dp- Area of 3524 Letterkenny Rd, Chambersburg, PA
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. c.rtHying ""*iIn (Physician certifyng cause 01 death when anolher physician has pronounced deelh and ~eci hem 23)
To the btlt ot my knowIecIge,duIt'loccurredduelotheceuH(.I'lnd NnlWU atatecL __ __ _ ______... _________.. _______ _ __ 0
. =:,n:::~=occ=~=-:e~':":':o~:~:~~".nner IUlllecL_____________......... 0
. Mldlcal EumlMf/ CoIoner
On 1M bu. 01 UlnlinaUon
Conner, Jeffrey R., Coroner, Coroner
3"'.0111, s;gned<_, dar, 1"")
October 21, 2007
34. Name lAd Adltes:s of Plrson Who ~ Cause 01 Delth (Item 27) Type I Print
Conner. Jeffrey R.. Coroner
1497 Loudon Rd.
Chambersbur . PA 17201