HomeMy WebLinkAbout01-14-08PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Esrare of Debra K. Smith No. c~~-o~~D " Q ~i%vr.~.
also known as To:
Register of Wills for the ~~- ~ c._
Deceased. County of Cumberland ` - -~ ~ ~ the=~-"
Socia! Security No. Commonwealth of Pennsylvaniai ;~ ~.~; -'
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The etition of the undersi p y p '"` "~
p gned res ectfull re resents that: r#
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Your petitioner(s), who is/are 18 years of age or older, appl ies for letters of admmistration`p
Debra K. Smith on~$e estate of~
(d.b.n., pendente hte; durante absentia; durante mmontate) - ~
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
her last family or principal residence at 344 Old State Road Gardners PA 17324
(list street, number, Twp. or Boro.)
Decedent, then 51 years of age, died 10/4/2006
at Carlisle. Pennsylvania '
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $ 67
(If not domiciled in Pa.) Personal property in County $ ~~
Value of real estate in Pennsylvania $ ~ ~
situated as follows:
Petitioner has after a proper search has ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
Lero D. Smith Jr. Relationship
Husband Residence
344 Old State Road
Gardners PA 17324
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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344 Old State Road
Gardners PA 17324
OATH OF PERSONAL REPRESENTATIVE
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COMMONWEALTH OF PENNSYLVANIA ss ~' ~ J ~ ~ ,
COUNTY OF Cumberland } ' ~'' „~-
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The petitioner(s) above-named swear(s) or affirm(s) that the ~ ~ _'
statements in the foregoing petition are true and correct to the best _ .~'-
ofthe Irnowledge 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.
Sworn to or affirmed ~J1,' scribed
befor his ----~% Ada
e ster
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No. ~I`u~W~ /~
Estate of Debra K. Smith ,Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~ , in consideration of the petition on
the reverse side hereo satisfactory p f having been presented before me,
IT IS DECREED that Leroy D. Smith. Jr.
is/are entitled to Letters of Administration, and in accord with such fording, Letters of Administration
are hereby granted to
Leroy D. Smith, Jr.
in the estate of
FEES
Letters of Administration . .
Short Certificates ( ) . .
Renunciation . .
TOTAL _
Filed ..............
6u
..$
. $
$ _
n $
A. D. '
Karl E. Rominger
81924
ATTORNEY (Sup. Ct. LD. No.)
155 South Hanover Street
Carlisle _ PA 17013
ADDRESS
717-241-6070
PHONE
IOS_Rpg N8V I/OS
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 filinrg}. ~{ (,,
WARNING: It is illegal to duplicate this copy by photostat or photograph. `~ ~ ~ '"
Fee for this certificate, $6.00
P 12727675
No.
Local Registrar
OCT 0 62006
Date
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
1. Name d Dsudem (First. nedd6, last suldx) 2. Sar 3. Sadel Seuaiy NaMx -. . _ . _•. ••••.•• 1`Dae m Dean (Mwn, day, wart
Debra K Smith Female. 202_ 46- 7418 October 4, 2006
s. Abe (Lal BaadaYl Undet UMaI 8. Daad9kn Mwn,d 7. 9irtli ~ and stale« ~ n Ba. Placed Dean Check on one
"mn' p"' "°"' 'a"'~ April 16, 1955 HupNd: odNr:
$1
Yrs
Carlisle, PA ^~~, s„,a ^ppYt ^,~,,, ^Rasidenu ^Dna Y:
BE. C«Wy d i?eaM &. City, Death Bd. Fealty Name (II not nsdktkon, giw strut one number) 9. Was Detetlenl d Hispanc Orgn? ~NO ^ Vea 10. Rau: Anencan Wien, &atlr, WNn, ab.
Cumberland South Middleton Carlisle Re tonal Medical Center ("'Ba''PeO~p~' !1
g Mexican. PuM Rican. eb.) Whit e
11. Daudenys Uwal ~ Kkd d wxxk acne ~ moq d work 41e. Do nil stale redrtl. 12. Was Oxsdenleve n the 13. DeutlenYS Educakw (Spedly oily hgtrE(9•d• mmpleted) IL Madul Suns: Maned, Clever MarieQ 15. SiWiving Spouse (" wMe, give maiden name)
Hind d W«k Neil m Bosoms I kbusey 11.S. Amiod Forty? p
Widowed
Diwrcea lSpedr
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amonlary / Sec«dary (0.12) Ctllege (1~ «s•)
House ^Ym ~"°
16. Deudwds Mailkg Adams (Street. dry / bwn, sus, =o code) Decatlent's r
Did DawdeM
344 Old State Rd. acnal Reabace 17a. sole Pannc~l Vani a tivena 17c. '~ Yes, eecemd caved in nl (s 1C7 noon 7wp.
Township? 17d No, Deceann lived w;nn
Gardners
PA 17324 17°~°°^n r
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Pr
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Acnal timisd cdy/IYoro
18. Fatlsfs Name (Prat midde, lest. su8a) 19. Motlwfs Name (Post middle, maiden surname)
20a. Inbmlads Name (Tyw / Pmt) 28b. nfanwnYS MaiMg Addees (weal. dY / ban. uae, np meet
Lero D. Smith Jr PA 17324
21a MenoddDupoeilion ^p ^Oonakw 21b. DaledOispmilbn (Mann, day. wai
Sunal ^ Remwai born Stan 21c. Place dpiswaikon lNamaduireWy, cremanry«olher plan) 21d. Lacaim (CMy/own, sub,sV woe)
; Wa Crenlbn or DarWSOn Aulh«ixM
^~-swag ~~r~~aa••yc««w7 ^rm^hm
Mt. Holly Springs Cem. Mt. Holly Springs, Pa
22a SigndraamFuural Sarvis Liumee(«perew acbigmsunl 226. License NUnber
'~ aM Harass dFadkty
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• 011589E Hollinger Funeral Home & Crematory Inc. Mt.H Spgs,
ConVnle Norm 23ac pray when 9 To lie beudmr knoakdge, death awwred al die Eme, dale and puce sand. (Signakae and tile) 23b. lirmss NumW 23c Dale '
Sgiea IM«n, day, rear)
physdan o m evakabu s rre damn n
a«uy erne dean.
Mans 24-78 nnN he mmpleled by parson 24. Time d Dean 25. Dan Rarnunped Dead (MUM. day, war) 26. Wm Case Rekmed b Medical Exanner / Car«ar for a Raasm Oilier tliat Crenwtlu «Donadw7
"'"0agp1Y1~°°an 5:55 A. M, October 4, 2006 ^ ~
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CAUSE OF DEATH (Sao irofruetlons and oaampNo) ..
Appro~anale ireerval: PM II: EnW dha ~ 20. Ditl Tdxswo Uae Contnbun b Dean?
Nam Ty. PART I: Enter dw U~D-.dax~Gi. disemes, injures, «mmpkuY«w- dial a•caY nosed db dean. W NO7 sour uminal evens such as cardiac arrest, Onset m Death bn nil rmuNig n dw widaAyvig cane ryven b Pan I. ^ Yes ^ Probeuy
rmpxabry crest «venino9r 1igiAaNon wdhaa sMwbq de eadogy. Liu ony one came an earn liw.
- ^ No ^ Unkrown
Try w9n~~1d~"-~ Seizure Disorder with Coronary Artery Disease ~' "
Dw m (« m a aweaoa.na. aN. ^ Nd pregnant wNhn pmt war
kstoddlbws, it any, b.
^ Pregrunl al erne ddean
b cane ksud w krw a. Due m (« m s eon•qunu ob'.
En~U11DERLYMIG CAUSE
dam, but pregnant winin 42 days
^
(doease «syury dW kksasd dw
d
evenlsrmdlMgndean)LAST.
Wem1«macan
ae4a•nce o9'
^ Nd Pregnant bd pregnan143 days n 1 war
a. d dean
^ Unkwwm M pregnant wnNn dw past yea
30a. Was an Aubwy 38b. Were lwnpsy Fkbkgs 31. Mann d Death 32a. pan d
Pedonned? Avaiude Prior b ComPnNon nA+Y (Mann, day. Year) 32b. Descrbe How Inpay 0«arred: 32t. Puce m I
ripey. Home, Pam. Street, Facbry,
d Cause al Death? ~laNral ^ llomicae 08iu 8uadng. eb. (Seedy)
^ Yes ~No ^ Ym ^ No ^ AmOenl ^ P•"d^91n"~"9~n 32d. Time d nFvY 31e. Injury d Work? 321. If hanspondian hQury (Seedy) 32g. laradan d Inyuy (Street. city / bwn, sots)
^ Vm ^ No ^ Dover / OPaabr ^ Pmsange ^ Pedmnan
^ SuiciOe ^ Cadtl Nil he Denrrrikwd
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33n. Cetlnx (dKd«ay one) 33h. Sgnanre and riled
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• CertBysp phYakisl IPhwidan caralytriq cause d tlean when another physxiai has praxwwed dean am fomDnW Nam 23) -~ '" Coroner
To IM beet m my knowledge dean owwred aw so lM aaaNN aM manner a sWa~_ --"-- -"--' --- -- --' -' -' -' _ -- _ -' _
• Prenoorxbq and conilykp phyudn (Physidan hon VOriourcm9 death and nrlMykig n cause d deah~
To tls boat d my NnaaNdq, aeon occrxrW at 1M IMre, ilea, artd place and ew n no caueo(e) and manner a aul~ _ _ _ _ _ _ _ _ _ . _ _ ~
_ _ _ _ _
. Liwrge Nwroer 33d. Dan Signed (Mann. day, wag
. M.acretamin.r/c«an« 1~L
On lM bate doxaeYnaMaraM/«lnvealq.lion
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