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HomeMy WebLinkAbout01-02-09IN THE COURT OF COMMON PLEAS OF, CUMBERLAND COUNTY, PENNSYLVANIA In re: :ORPHAN'S COURT DIVISION K.R. and R.R. : NO. °~ ~ GCS -DOOR GUARDIANSHIP -MINORS PETITION FOR GUARDIAN OF MINORS NOW comes the petitioners, Kierstyn Rodriguez and Ricardo Rodriguez, Jr., by their attorney, Karl E. Rominger, Esquire, and files this Petition for Guardian of Minors representing as follows: 1. The proposed Guardian is Amy Suzanne Rivera, an adult individual, residing at 525 Spring Garden Street, Carlisle, Pennsylvania 17013. 2. Your Petitioners are Kierstyn Rodriguez, hereinafter K.R. a minor child, aged 13 years, who currently resides at 525 Spring Garden Street, Carlisle, Pennsylvania 17013, and Ricardo Rodriguez, Jr., hereinafter R.R. a minor child, aged 9 years, who currently resides at 525 Spring Garden Street, Carlisle, Pennsylvania 17013. 3. Petitioners are the biological children of the proposed Guardian, Amy Suzanne Rivera. 4. Petitioners have no knowledge of any Court within this Commonwealth which has appointed a guardian for them. 5. The proposed Guardian has no interest adverse to the minor children, and has agreed to act as guardian of the children if this Honorable Courii..~ c~ ~__~ shall so appoint. .,-~ _,, ~ ' ~_ ~~: 6. Pursuant to the Cumberland County Rules of Oroharrs __ urt rv 12.5-2, attached is a Consent form and statement of the proposed guardra[~ _-: -~, ~_~ r - ~: -~ t~ y ._.. rn -~ ;_ _ _ ; y - ._., ,y -; ..' a c 7. The appointment of a guardian is necessary as the children's father, Ricardo Rodriguez is recently deceased and the Social Security Administration requires the appointment of a Guardian. WHEREFORE, petitioners respectfully request this Honorable Court set a hearing at which the averments of this petition may be documented and the appointment of Amy Suzanne Rivera as guardian for the minor children, K.R. and R.R. may be considered, with notice thereof to be given to such persons as this Court may direct. Date: ~ 1'' Respectfully submitted, ROMINGER ~ ASSOCIATES ,--- Karl . Rominger, Esquire Attorney for Petitioners 155 South Hanover Street Carlisle, PA 17013 717-241-6070 Supreme Court ID No. VERIFICATION Karl E. Rominger, Esquire, states that he is the attorney for Petitioner, K.R. and R.R., in this action; that he makes this affidavit as attorney because he has sufficient knowledge or information and belief, based upon his investigation of the matters averred or denied in the foregoing document; and that this statement is made subject to the penalties of 18 Pa. C.S. Pa.C.S. §4904, relating to unsworn falsification to authorities. Date: I ~,~- (~`"j Karl E. Rominger, Esquire Attorney for Petitioners OCAL REGISTRAR'S CERTIFICATiION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14649471 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death iuly filed with me as Local Registrar. The original ;ertificate will be forwarded to the State Vital 2ecords Ofi°~ce for permanent filing. ~• C"ea,,~~'~,~ JU 2 2008 >/ocal Registrar Date Issued `~~ TYPE / PRINT IN H106~143 REV 712006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PERMANENT BLADK INK CERTIFICATE OF DEATH (See Instructions and examples on reverse) 1. Name a Decetlenl (Prat, miMb, last, sWfix) STATE FILE NUMBER RI CARDO RODRIGUEZ z. s°' 3. salal secmry Number a. Date of Death (Mgmh, day, year) 5. Age (Lear eirdttlay) Untler 1 year Urltlar 1 my 6. Dale of Binh (Month, day year) , einlt c Ma 1 e 13 2 - 54 - 5 901 Ju I y 2 5 , 2 008 gym, Gaye Noun M ~ ~ pace ( Iry ell stare a lorelgn country) 88. Place of Daalh (Check on one) _ 43 vra. July 11, 1965 New York NY Hospital: Orner: Bo. County of Death &. Ci ty, Boro, Twp . of Deelh fid. Faaliry Name (II not inslll , tg i ®Inpatie nl [] ER / Oulpehem ^ DOq ^ Nursing Home ^ Residence ^Other ~ speciy- Dauphin Derry Twp. u n, g ve street ant number) . S Hershey Medical C t 9. Was Decedent of His g paniq on in? ^ No ®Yes °' Y°°, specify cdban, . 10. Race: Amancan Intlian, Black, Whhe, arc. ,,. Decedent's Usual lion KkM a work done tlurin most a womin Ina Da nor state a d . en er Maxicen, Puerto Rken, elc.l Puerto Rican (sper;M Whit e KIM of Work Truck Dri . re re Kill al Business I IMuslry 12. Was Deceeent aver in the U.S. Armed Forces? , 3. Decedent's Educallon (Speclly Elementa /Second 0 7 only hi ghest grade completed) 14, Mental SIGNS Merrieq Never Married, Wie d DN r 5. Surviving Spouse Qt wile, give maiden name) ver Trucking lea ^"° ry ary ( - 2) - college (1d or 6+) owe , orced (Speci7h 76. Decedent's Marling Address (Brae(, city /town, stale, ziP cMe) Decedent's - -'1-__------ Divorced 21 Conway Drive AaualResidence na.slala Pennsylvania DiODeced ent _ Live in a 77c. ®Yes, Decedent Uvad N ? ~ Ow r w Middletown, Pa 17057 nb.cp°nry_ Dauphin row,tahi°? rid^Np,DarademuVedwnhm Twp 16. Fame's Name (First, mitldle. last, sWfix) 19 M ' Aelual Limns of CiN / Boro c rotary cause of death. Hems 24-26 must be carpletetl by person 24. Time of Death 25. Dale Pronanced Dead (Month, day, year) who pratwtCes death. ~ ~ 1 ~ (~M M. _ CAUSE OF DEATH (See Inslruotlons antl eaamplas) hem 27. Pan L Enter Ina chain of events - diseases, irqunas, a complicatlons -mar directly tlIA°Bd the daalA. W NOT enter taminel events suet as cardiac artesl, r Appro~knele inter respimlory enesl, or ventMnAar fibnllalion witlmul sftowing the etbbgy. tiu only ore reuse on each line. On Ito Daam IMNEDUITE CAUSE IFinal disease or mndilion resukmg m death) , 'T -- a. ~1 Due to,or as a consequence of)'. Sepuregnfiely list coMAans, n any, b. `~_ y` Ear ma°UNDERLYIN CAUSE ° Due to (or s a consequence oQ: (~saase or ktjury That inlnalatl the mrs resauirtg m cream) usT. Due m (a s a consequence Dry: e. 30a. Was an ANOpsy 30D. Were Autopsy Fillings 31 Master of Dealn 32a. Date of Injury (Monet, day, year) 32b. Describe How Injury Occurred Pedomtetl? AvailaNe Prior to Complelpn of Cause of Death? ~ral ^ Homeka Q'1'es ^ N '~ ^ Acadanl ^ P ' Feliberto Rodriguez, Sr, meta Norma (Frsl. mitldla. maldan aameme) zoa.lmormanrsName Ana Orellana (type/Pnnq 200. Informant's Meinng Adtlress (SYreet, city /sown, stele, Zip cotle) Francisco Rodriguez zta. Method pl Diepoadron 166 Lakeview Ave. West Harrison NY ^ Banal ~ CfB1^•a^n ^ Donation 21b. Date el Dieposifion (MOnln, day, year) 21c. place a Disposition (Name of cemetery, crematory or omar place) 21tl La ^ Removal from Seale ;j Wee Cremellon a Dautbn Authorized ^ anar.speary byaeam.lEx.minerrcarortez '~y,a^~ July 28, 2008 Hollinger Funeral Hare & Crematory Inc. Mt. 22a. Sigreture era) Service nsee rson aamg as such) 226. Lcense Number ?2c. Name antl Address d Faaliry FD-012909-L Ronan Funeral Home 255 York Road, Carlisle, Pa 17013 complete a z3ac Dory wean cerMyinq z3a. r° me best pr my knowledge, deem eawetl al me ume, dale aria piece stelae. (signature ant line) phYsiSan is cal avadepla al lime or deem 10 23b. License NamMr m, state, zip code) Springs, Pa 17065 23c. Data Signed (Monet, day, year) 26. Was Case Relerted toto Medical Examiner /Coroner for a Reason Other Ihan Cremation or Donation? ^Yes UrJ Nn Pan II'. Enter doer sioni =m ~Md . a- ~ a .. =.a tort ' 26. Did Tobacco Use Cantnhule to Death? Out not resu tlng In me underlying cause given in Pan L ^ Yes ^ P rob any ~ ~ ^ No sp unknown 29. II Femek: ^ Not pregnant wimin pest year ^ Pregnant at time cl deem ^ Not pegnam, Dal pegnam wimin 4z Gaya of death ^ Nol pregnant, bN pregnant 43 tlays to t year balae tleath ^ Unknown if pregnant wnhM the past year 32c. Place el Injury: Horne, Farm, Street, Factory, Office Builtling, etc (Specify) ©' as ^ No ending Invesbgafion 32tl. time a Inlury 32e. Injury al Work? 321. If Tren onation In u ^ Suicide ^ Could Na bB Delenninad Dnvarspl I ry (~adltyl 32g. Loralion of Injury (Street, cnY 1 town, stale) 33a. canine, (area, any one) M ^ Yea ^ N° ^ ~+hremr ^ Passenger ^Peiaeman omar - CMlying phplcun (Physiaan ceniryvtg cause of death when anaher h 33b. Sig wre rote \ To th beet of m krlowkd Math occurred tlue to the ceu p ysr°en has pronourtcetl tleath and romplaretl Hem 23) -~ "'- Y ~~ ea(s),ntl manrlerm eteeatl_________________________________ ^ • Pronouncltg end tlerltlying physklan IPhysiaan bom pmmunarg deaM and cerdrying to cause of death) ? To the best of my knowbtlge, death occurred et Ina time, date, end place, erM due to the tau 33c. License Number _ 33d. Dafe Signed (Monet, day, year) o Metlkal Examiner/Caorter se(s)eM menrrx es staletl__________________ ..... ._. v Dn the basis of eaaminmlon and / a InvestlgaNOn, in my apinlon, death occunetl et the tlma, data, arM place, antl tlue to the cause(s) antl manner as steled_ ^ ~ ~ ` 34. Name and Address of Person Who Completed Cause cl Death (Item 27) Type 1 Print 35. Regis) r' ignarure a I C ~(~ s - `~: e-~..C.JI~ Dale Fled (Month, day, year) ~ ~ ~ N ~ J „` M. S. 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J hit R1 La ~ ~ cnam !'4i ~ N om ~ ~ o- 0 _o w L"'S H .Ar !~S ~{ ll -~ma ~ ~ ~~a cczcl ~~ 1'7 P-T :U xxsr M ~,~} ~Q~ +~ a a 1 +~. m ~, cn a r*- r~r ~ ~., r m ro ~ 3T fU ~" O ..0 ..D ~J W l~ M a~ ~~ x .Q H l~ ma ~a c~ o m~ ~3 D ~ ~ L7 7Q G'S ~-, Ri ~~ C am c +~, m t '~ a e~-s CR r~ a- 0 w RECD ~~ u'N 1 aS 1995 T O O 7 m ~ n = 2 ui d o 7 d ri ~ n D -i m v m D -~ 3 n m rr1 ~~ o _ T D ~ Z r D p =m ~ D = ZO v v~ ~ or o y ~ D o rrt r D~ -1 ~ v= r D W O -D.I O A m RECD ~~ ii~N ~ aS 1995 ~+a r m e n Z /i N O V_ D -i m O m D z -~ ~ n m m ~~ o _ T D ~ -r-I =m D 2 0 ~ T o r' y C om r D W rn ~ v -~ r = D W O D 1 O m N Z O x O D 0 n ~ REC'D ~.; u N 1 aS 1995 . e T p ~ ~~ ~ 2 2 H o O ri Z T D m O m D -~ ~ n m m ~ ~ O ~. T T 2 DD z o =m ~ D = 0 O D TI ~ o r- o ~ ~ D om r v= r D W O D -~ O A m ti