HomeMy WebLinkAbout01-0204
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No.
To:
~J-O'- ~o'l
Estate of
also known as
fY),96{)A 13t2Ejst;)
Social Security No.
Deceased.
/Od - ()O - 1()~7
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner{.s1. who is/are 18 years of age or older, appl
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in CUJYi (36'(2 u9"');; _ County, Pennsylvania, with /)/"1
h c<<- last family or principal residence at 1700 j"Y).q((JCl>1 ~T' CFJMP!-i Ii- L- J. rl/
(list street, number and municipality)
Decendent, then 9 -3 years of age, died .J'fJ/l.1 5' ,19 0 (
at nA;VOI< C~ R-b #u(2$ /('jG flotrJ L
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
!::!:.
$
$
$
$
foo
- 0-
- 0-
, 0-
- 0-
Petitioner_ after a proper search haL ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Sd
f?/;
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
i y~~ ~~
~ 3 75'{ /l '-'06/1) VI t:. 1//
~ ~ ;7JE GII A~ /G5 13 C/R-(,." PA
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
} 55
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 of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
and
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N 21-2001-204
o.
fY....
EstJite of
MAGDA BRETSEN
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
..:ANDNOW -~,,::..;. Februarv 21st, P9x 20Qfu consideration of the petition on
the reverse side hereor,- satisfactory proof having been presented before me,
IT IS DECREED that MAGDA BRETSEN
islaPe entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
NORRIS BRETSEN
i;the estate of.--t#:GDABRETS~--~
FEES
Letters of Administration
Short Certificates( J) . . . . . . . . . .
Renunciation ................
JCP
$18.00
$ 3.00
$
$ 5.00
TOTAL _ $26.00
Filed ~~.Q1='.l.J~;cy..21. 2.00 1\.D. 1~0 1
ATIORNEY (Sup. Ct. J.D. No.)
ADDRESS
PHONE
MAILED LETTERS AND ORDER TO ADMINISTRATOR
H10).oO) REI' ~/~"
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.
No.
",lIllf"".I""",,;,
\\","~~\.1\\ OF PEl----__
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Local Registrar
Fee for this certificate, $2.00
P 7174279
JAN 0 9 2001
Date
21-2001-204
ev 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT (first. Middle, last
SEx
SWE FILE *JMBEA
SOCIAL SECURITY NUMeER
~lo
..
AGE ILasI e""",,,y)
UNOER . VEAR
-- Days
a. Female 3. 102 20 - 1227
BIATHPl.ACE (Cofy arod PlACE OF DEATH ~Cf\e(:k 0f'IIy f)(I8 -- iN ,(I$I,ucbOOS on orhel SlOe)
SlaIe Of fcre.gn Counrrvl HOSPITAL;
NoIWay ,.-- 0 ER/Oulpo._ 0 llOI\ 0
1. ...
FACllrTY NAME (11 not If\SHUllOf'\. Qlve $treet and numtlIfl
RACE.__ _. WhiI.. ole.
(~)
5. 93
COUNTY OF DERH
v...
Cumberland
DECEDENT'S USUAL OCCUMKlN
~=:-:.,"=::~~
"L Housewife "..
DECEDENT'S MAILING ADORESS (SIr... Cily'-'. Sla. z"c_,
6115 Westover Drive
Mechanicsburg, PA 17050
...
_R'S NAME IF.... lot..... Last)
DECEDENT'S
ACTUAL
RESIDENCE
cSee JOSIrUCIlOna
on oltIet SIde.
ManorCare Health & Rehab. Ctr.
....s DECEDENT EVER IN DECEDENT'S EOUCRION MARITAL STATUS._
u.s. ARMED FOACES? com ed N..... Marr.. Widowed.
'1. ....0 NoXX .:~ (1c::r., ... Wi=~
17LSO- Pennsylvania [);d 17C.o ....--..
-
livein.
-' 17d.{!g :...-==='"
MOTHER'S NAME (FW". """"". """"'" SuI"""",)
...
White
SURVMNG SPOuSE
(It....... QMI maden l'\IIf'I'Ie)
IlL
Ie.
"'P.
....
Cumberland
Camp Hill
Gundine Smith
~.
'0.
INfOIlMANT'S NAME (T YI*P'inI)
Molf Syvertsen
10.
1Nf00MANT'S MAILING AllIlRE55 (SIr.., CilyITown, s..o.. Zip ~l
Norris Bretsen
IoIETHOO OF DiSPOSITION
~C'_o _......SI...H
0IMr
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IlL
_UIlEOFF
DArE OF DISPOSITION
(_.Coy. -I
o 1-9-01
11..
LICENSE NU'tfi'2755_L
aa..
IN beet of my knowledge. Math OCCUlted allhe lime. dale and pac. SIlted
. e and Tile)
New York
.-.alATE. CAUSE (final
cMIIIM or condibon
'-*'0 In dUlhl---"
ZO.
I ApptoxiIMI.
I in1eMII between
: onMl and'"
,
I
,
Po\RT.: ""- ~ __...........10_.... buI
no( fMUIbng in..... undIrIying QUM gMtn in MAT t.
.
-..--
W..,,-.gto_
_.__YKG
. CAUII!(lloMoM"'......
..~...,.,.
'_"_II.AST
[".
c.
d.
DUE mtOR AS A CONSEOUENCE OF),
DUE mtOR AS A CONSEOUENCE OF),
:. 0 ~ a....V" 0
ClllTFa ICheck only onel
-CERTIFYING PHYSICIAN (Phys.oan cer1lfytnq cause d death whet' another Dhvs.c,an has Pf()(l()Unced dealh ana completed Item 23)
To......of...'knowlecl9t...thOCCUf'Nd........cau.e(.).ndm.nner...~............................ .................-
Noj1
Nar.... .A'
......../ 0
o
DATE OF INJURY
("""".Oay,-,
TlMEOFINJURY
INJURV IiI WORK? DESCRIBE HOIN INJURY OCCURRED.
....s AN AU10PSV
. PERFORMED?
WERE AUTOPSY FINDINGS
-.....sl.E PAlOIIm
COMPI.ETlON OF CAUSE
OF DERH?
MANNER OF DEATH
Pending Investtgalion
o
o
o PlACE OF INJURV. AI home,farm, SlrlMl. tac:tOl'Y. omc.
-.....,-,
_.
... 0 NoD
Homicide
Suicide
Coutd noI be delermmed
o
",.
.PAOHOUNClNG AND CEATl,ytNG PHYStclAN (Ph'fSICllin tloIh ;lfOOOUOCIf'lg death and cen1lylt'lQlo cause of dealh\
To.......' o'mykno~.. death occurred a' the....., dale, and piece, and due lolhecau..(.) and manM' ...Iated
"YEDICAL exAMINER/CORONER
On the b81.i. of examination .nd/or inve.tigA.ion. in my opinion. de..h occurred ."he lime. d.... ~nd place. and due'o'he cauM(s) and
manner.. .t.ted.. . . . . .. . . . . . . . . . . . . ..... .. .. . . . . .. . ... . . . . . . . . ....... . ... . . . . . . .. . .... . .. .... . ... . . . ... . . . ... ....
;t,..
33 REGISTRAR'''N.ATATUUAREE AND NUMeER ~
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
fY)/I C D R
]3;<67 S irJ
Will No.
\r;AI S
)
0;06/ - 00:20 <I
~G()i
Date of Death:
Admin. No.
r2/~. ()/- 0 J. 0 y'
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on
Name
Address
10 1/ i;
() E 5' 1/, -r c Le' F T /1 FTI/L
pu J/ En.I9L & P i /\/S- ;:.
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
Signature
Name ~_ AA4~
Address
/(13
GM NT J-Il7r11 ?n /70 ~ 7
j:3Y/
po
Telephone ( 7 1>7 76 t,
Capacity: ~e"onal R'p''''ntative
_Counsel for personal representative
JRD/June 30, 1992/1 7858
JUN 1 2 200~,\
In Re: Estate of Magda Bretsen
Late of Camp Hill Borough
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
Estate No.: 21-01-204
NO.
NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A
HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT
ORPHANS' COURT RULE
Personal Representative: Norris Bretsen
Counsel for Personal Representative:
Date of Grant of Original Letters: February 21,2001
Date of Delinquency Notice: May 31,2001
The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6,
Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of
Common Pleas of Cumberland County, that neither the above named personal representative nor
the above named counsel for the personal representative have filed with the Register of Wills or
Clerk ofthe Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court
Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court
Orphans' Court Rules, was given by the Register of Wills on May 22,2001, and that the ten (10)
day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6( e) the
Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a
hearing to determine whether sanctions should be imposed upon the delinquent personal
representative or counsel for the delinquent personal representative.
Date: June 11, 2001
Distribution: Personal Representative
Counsel for Personal Representative
Estate File :;rt1
.1..I'{))
A hearing is scheduled for)ur at q',30 in Courtroom No.3. If the Certification of Notice is
filed prior to the hearing date, the hearing will automatically be celled.
tD~1
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II
STATUS REPORT UNDER RULE 6.12
Date of Death:
(1/1GbA !3<E- lS ~;J
;J;tJ 5, z~o (
,
Name of Decedent:
Will No.
Admin. No.
;), 00(- oo~o 1./
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1.
Staterhether administration of the estate is complete:
Yes No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the per70nal representative file a final
account with the Court? Yes II No . CIS 66013l./93t
C(l/~iC ~I / DO 7 9/9)1
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
/
J
c. Did the personal representative st~te an
account informally to the parties in interest? Yes V No
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date:
/2,-/" CJ /(J~
I
.~~
Signature
A/t/M /5 r;JP-E7 SLJ
Name (Please type or print)
PO /'13 J CR/1Nr!If}fY) P-A
Address
(Jl7) 1~6- :33gLj
Te 1. No.
I rnr (J.,r<kA ftft ;rW
~d;'. hfv~/~~
~'~~~;l;~
~,.//~/~ ft~
(f?v ~ !:r fl~c{apacity:
Personal Representative
h ~/AM3)
Counsel for personal
representative
ry{3
Cumberland County - Register Of Wills
Hanover and High Street
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/06/2002
NORRIS BRETSEN
754 ALLENVIEW
MECHANICSBURG, PA 17055
RE: Estate of BRETSEN MAGDA
File Number: 2001-00204
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/05/2003
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~m~/d:
MARY C. LEWIS
REGISTER OF WILLS
cc:
/~ile
Counsel
Judge