HomeMy WebLinkAbout01-0752
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of aULiA/[ F ;rOl)t~4W.f~
also known as
No.
To:
~\- DI-IS~
,~
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
Deceased.
Social Security No.1 b S - 0" -- 7 7 g, 1
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl
(ES
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 C UMtERJ..A ~/J County, Pennsylvania, with, ,f)
h e12.. last family or principal residence atCVAt l{A Alb t'JRo.5Si.v(;. / k>lt/'{)Ol~ ~y CA/fLI5J../ r'A-
... (list street, number and municipality)
Decenden~then ~" years of age, died A"'Gu~ r ).. ,)If :loo J,
at ~~ i.. "5 _;- .4f # JJ. Oe;../1Z"A'
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:
$ ~ J LIS: 00
$
$
$
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
in sr OA~~is&..~
~THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} 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 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. /J. '.
~:f:~ ~~ t~~ Aaffirmedd'Hd S;b~~':~11A/:;. f. /i~
RegISter ~ ~
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N 21 - 01 - 752
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Estate of
PAULINE F RODEMAKER
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW AUGUST 14, 't~ 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that BENJAMIN T RODEMAKER
is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
in the estate of
BENJAMIN T RODEMAKER
PAULINE F RODEMAKER
are hereby granted to
FEES
Letters of Administration
Short Certificates( 3) . . . . . . . . . .
Renunciation ................
JCP
$ 40.00
$ 9.00
$
$ 5.00
TOTAL _ $ 54.00
Filed . AUG #. .1.4,. . . . . . . . ., A.D.)@x2llill
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
Mailed letters to Administrator on 8-15-01
,. n,.~n;
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Th. is to certify that the information here given is correctly copied from an original certificate of death dul~ filed with
I.o~:l Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
me as
No.
Li- t\.~~~
Local Registrar
Fee for this certificate, $2.00
p
7578208
AUG H:; 6 2001
Date
'1105. :<3 A.. 2187
COMMONWEALTH OF PENNSYlVANIA · DEPARTMENT OF HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
IT
I. Pauline F. Rademaker
SEX
2. F
STATE rilE NUM8EA
SOCIAL SECURIT'Y NUMBER
170. SlaM
3. 165 - 03 7783
H
(
NAME Of' DECEDENT IF... M><ldIe. ....,
AGE (L.. 8orlr>aay)
UNOER I YEAR
_he 0.10
UNDER I DAY
Hour1I 1 Minu'..
P...cE Of' DEATH ICt'<'Ck ""'Y "". -- ..... ,nSl,u(;I.",. on OIf'e' _,
HOSPtTIIL:
1_ ~ ERIOulpot.o". [j
=.....,0
86
Yrs.
$.
COUNTY Of' OENH
PA
MARITAL STATUS. M.rriod
N_Marriocl. W_.
0-.,.., lSPIc"vl
14. Married IS.Benjamin
17c.a:o ......__in South Middleton
RACE . Amencon lnO.n. IlIoc:k. Whilo. oIl:.
(5-",)
10. White
SUAVlVING SPOuSE
1"-.11"4__1
DECEDENT'S USUAl OCCUIWlOIC
(~...=: ~"= ':::'::'f
Store Clerk
k. Carlisle Boro. ....Carlisle Regional Medical Center
IUNO Of' auSIHESS/fNOUSTRY Wl<S DeCEDENT EVER IN DECEDENT'S EDUCATION
U.S. AAMED FORCES?
.....0 HoG
T. Rodemake
1710.
Did
--
llwo In .
Cumberland -*"II? 17d.0 :;"'~=OI
MOTHER'S NAME IF;'!!. Middle. M_ Sur"..,.,O)
tt. L:>uise A. Seidel
IHFORM.o.NT'S IoWUNO .o.DORESS ISlreet. C.....IlOwn, $Iete. LOP Code)
2 426 N. Pitt Str., Carlisle PA 17013
P\.ACE Of' DISPOSIT1OH . N..... ol CometOfy. c,.....1Oty lOCRION . City(Town. Sl.,o. rip Code
Of 0lII0r P1ac:e
IWp.
ciIy/boro
21.cumb.
21d.Carlisle PA
~~
Brothers Funeral Hare, Carlisle, PA 17013
lICENSE NUMBER DATE SIGNED
2 b. \UJ - 5-z.8~{., 1- L ~.o.y.~+-- 2, ZOO/
Wl<S CASE REFERRED TO MEDICAl EAAMINERICOAONER? ..../
..... 0 HoE:!
H.
I Approximate
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I
PART II:
0lII0r sign;f\eenl _ contrlluting 10 doo"'.1l<ll
not _ing .. "'" undor1yW>g _ _ in ""'" I.
M. 2$.
27. MItT I; Ent... rN diMe.... inrunn Of compIicIItiona wfticft eausecl tne esellh. Do not Inl.r lhe modi of dying,
LiaI onty one ca:UN on MCh line.
! ::
d.
WERE AUTOPS'I' 'INOtNGS
A""'lAkE PRtOfllO
COUPt.ET1ON Of' c.o.USE
Of'DEJO'H?
(!).t-i~'u~k'~ ~,/~
~?4''''''~ "~~'l-A
C~~ ~
.....0
:~:R OF OEd'
_... D
o
DIITE OF INJURY
IMonth. 0..,. ......,)
TIME OF INJURY
INJURY AT WORK?
DESCRIBE HOW INJURY OCCURRED.
Homicide
o
o
o PL.o.CE OF INJURy. AI """'o.l.rm. S1'_. tad"",. ofllce
building. OIC. ,$pec,tvI
JOe.
..... D NoD
Pwnding Invnfig81iOn
HoD
Suicide
COuld not be delenn'ned
M. :JOe.
.UEDICAl EXAMINER/CORONER
On the b..is ot ..amination .ndlM investigation. in my opinion, death occurred at the time, date, and place..nd due to the c.use(s) Ind
mA""er .. SIA1M.. . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . .. . . . .. . . .. .. . . . . . . . . . . . . . . . . . . .. . .. .. . . .. .. .. . . . . . . . . . .. ..
31..
". REGISTRAR'SStGNATUREANDN~ . "'. ~.. . , t\J
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ae.. 2tll.
ClllTWlEA 1Chect< or;., onel
-CEJllTIf'Y1NG PHYSICSAH (PhySIC:.an c~ caused dlNth whet't .l1'\Olf'\ef' phvs.coan hes ptonounc.ed dealh af'IQ ccmptll'ltK111em 23)
To.. bn. of "" know...... ftllth ooeurntd due to.... cauH(s) and "'a""e'.. .tated. . . . .
21.
'~NQ IINO CERTIFYING PHYSICIAN IPhyo.c.an ""'" ;><onouncong "..,~ and Ce<1.vong 10 CollUS. 01 ".a""
To 1M Met of my knowl4tdOfl, d.athocc",recr .,the lIMe. da.e, and place. and due to Ihe ca"..(.) and manner.. s'ated.
34.
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CERTIFCATION OF NOTICE UNDER RULE 5.6(A)
Name of Decedent: ~ uJ..iA/e r ff()DE.AAAkEA
Date of Death: AuG.-us r ~ ~ ;2 00/
Will No.: IVOA/E Admin No.: ,)/ 0/ 7S~
., -
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
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:/ /-} i -(J /
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Signature
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Address
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Capacity: Q1 Personal Representative
o Counsel for personal representative
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STATUS REPORT UNDER RULE 6.12
Name ofDecedent: !? 0 17 ~.Ad A k E'I? /Jf () 1 {AlE
Date of Death: 8'-;2 - 0 1
~v'
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Will No.:
Admin. No.::L OO/-007j~
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. State whether administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. lfthe answer to No.1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
YesX No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? Y es ~ No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date:7-fII-O~ ~ T ~
Signature
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Name
fo Box "40 j-
CAll Li~ ~ kl. f,4
Address
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(7//) J 1t?:J 7.2.1
Telephone No.
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Capacity: 0-Personal Representative
o Counsel for personal representative