HomeMy WebLinkAbout01-15-09PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Harold Thomas Sims
also known as
Harold Thomas Sims Deceased.
Social Security No. 187426567
The petition of the undersigned respectfully represents that:
No. ~ ~ - ~~~ U~~
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Your petitioner(s), who is/are 18 years of age or older, appl ies for letters of administration
on the estate of
(d.b.n.; pendente liter durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at 18 Ross Avenue. 2nd Floor. New Cumberland PA 17070
(list street, number, Twp. or Boro.)
Decedent, then 56 years of age, died 12/22/2008
at 100 Block of Bridge Street New Cumberland Penncvivania 17070
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ 2 000 00
(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:
Petitioner after a proper search has ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
1007 Bridge Street
A i i r 7
509 Fifth Street
Kri n i h r rl P 17
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned. '-~
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~~( C%'~G-~'~`-~ ~(..<-/G'C~ y~.t,.~1007 Bridge Street ~' C~
New Cumberland ~A 17070 tV
Adele Marie Sims
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF Cumberland
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The petitioner(s) above-named swear(s) or affirm(s) that the r- ~
statements in the foregoing petition are true and correct to the best _~'- r-;
of the knowledge and belief of petitioner(s) and that as personal -
representative(s) of the above decedent petitioner(s) will well and ~s
truly administer the estate according to law. _. ~-.-~ ~_'
Sworn to or affirmed and subscribed
before me this ]2th day of
ia~~~a~~ Anna.
Register
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No. ~J ~ - L)q - ~ (? ~ ~
Estate of Harold Thomas Sims ,Deceased
GRANT OF LETTERS OF ADMINISTRATION
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AND NOW ~ ~ ~ (.}~l 1, in consideration of the petition on
the reverse side hereof, satisfacto pro having been pres ted before me,
IT IS DECREED that Adele Marie Sims
is/are entitled to Letters of Administration, and in accord with such fmding, Letters of Administration
Adele Marie Sims
are hereby granted to
Adele Marie Sims
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in the estate of Harold Thomas Sims
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eg~ster of Wills
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FEES ~ ~~~
Letters of Administration . $ ~=SL~„~
Short Certificates (~ ) . $ ~ ~D .~ U
Renunciation . $
'~ $
~L~"~ TOTAL $
Filed .. .. .... A. D.
Mark Thomas, Esquire
41301
ATTORNEY (Sup. Ct. I.D. No.)
101 South Market Street
Mechanicsburg PA 1705
ADDRESS
717-796-2100
PHONE
L•9CA~ ~iEGlS1'RAR'~ ~~~~T1F~~~A~i~N ~~ ~'
WARNING: It is illegal to duplicate this c~p~,, by photostat or ph~tcgra~tr.
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P 15 0 0113_x_
REV 1112006
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K INK X131-418
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse) CTA7F PII P X11 ~xxAFA
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1. Name of Decedent (Frst middle, last, sudix) 2. Sex 3. Sbcial Security Number 4. Date of Death (Month, day, year)
Harold T Sims Male 187 - 42 ~ 6467 December 22, 2008
5. Age (Last Binhtlay) Under 1 year Under 1 day 6. Date of Birth (Monts, day, year) 7. Binhplace (Ciy and state or fo reign country) 6a. Place of Death (Check only one)
56 ""°m'"a pays "~"~ M'~"" June 13
1952 HOephaf: other.
vra. , Kingston, PA ^In anent
p ^ ER /Outpatient ^ DOA
^ Nursing Home ^ Resitlence Other ~ Speay.
6h. County of Death &. City ro iwp. of Death ed. Facility Name (If not instbution, give street and number) 9. Was Decedent of Hispanic Origin? ®No ^Ves 10. Race. Amencam Ilbldn, Black, White. etc.
Cumberland New Cumberland 100 Block of Bridge Street nr yea, apepiry Cuban, Ispecliy)
Mexican, Pueno Rican, etc) whit e
11. Decedent's Usual Oau etbn Kind of work done Burin most of workin life. Do rwt state retired 12. Was Decedent ever in the 13. DecedenYS Etlucalion (Specify only highest grade completed) 14. Marital Status: Marred, Never Married 15. Surviving Spouse (II wife, give maitlen name)
Kintl of Work Klntl of Business /Industry U.S. Armed Forces? Elementary /Secondary (0-12) College (1 d or 5+) Widowed, Divometl (Specify)
Com uter Anal st Federal Government ^Yea ®NO 12 y Married Adele Marie Karasinski
i6. Decedent's Mailing Address (Street city /town, stale, zip cotle)
Znd Moot'
8 Ross Avenue
1 Decedent's Ditl Decedent
Actual Resitlence 17a. State Pennsylvania use ;na Fairview
nc
®ves
Decedem Lived In
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New Cumberland
PA 17070
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.
rwp
Township?
York 17d. ^ No, Decedent Livem within
nb.ceprty
, apwaulmnaof city!Bpm
16. Father's Name (First middle, last suffix) 19. Mother's Name (First, middle, maitlen surname)
Paul Sims Margaret Price
20a. Informant's Name (Type /Print) 20b. Informant's Mailing Atldress (Street city /town, slate, zip cotle)
Kristen Sims 509 Fifth Street, New Cumberland, PA 17070
21a. Methotl of Disposttion ®Cremation ^ Donation 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or other place) 21 d Location (City !town, stale. zip cooe)
^ Burial ^ Removal fromSYate WasCrematbnorDOnatlonAUthorized
^ Other - Speary: ~'~, by Medical Examiner I Coraler? Ves ^ No December 29 2008
x Evans Crematory Schaefferstown, PA 17088
22a. Signs rvbe censee (or person acting as such) 22b. License Number 22c. Name and Address of Facility
~ FD 012 848 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Complete Items - Doty wren cenitying 23a. Tb the best of my knowledge, death occurretl at me time, date arts place slaletl. (Signature orb title) 23b. License Number 23c. Date Signetl (Month, tlay. year)
physician is not aveila6le at lime of death to
certify rouse of death.
Items 24-26 must be completed by person 24. Time of Death
Aprx
8:15 A 25. Date Pronounced Dead Month, da ,year)
December ~2
7L008 26. Was Case Referetl to Medical Examiner! Coroner for a Reason Other than Cremalior, or Donation?
wnp prWWnCa Beam. .
. M , ~vea ^No
CAUSE OF DEATH (See Instructions and examples) r Approximate interval: Pad II. Enter other significant cond't'ons conMbufnq to tleath, 26. Dld Tobacco Use Contribute to Death'+
Item 27. Pan I: Enter the chain of events -diseases, injuries, or complications - that direary caused the death. DO NOT enter terminal events such as cardac arrest, Onset to Death
• bN not resulting In the undetlying cause given In Pad L ^ Yes ^ Probably
respiratory arest or ventricular Abnllation without showing the etiology. L
ISt only one cause on each line,
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IMMEDIATE CAUSE Fi
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^ No ^ DnknbWn
sease or
na
ppntlaion resulting m earn) ~ a C 1 o s e d Head Trauma zs. a Female
^
Due to (or as a consequence o
~ Not pregnant within past year
e Crash
Sequentially list oxbilions, if any, 6 MO t O r V2 hl C ~
se listed on line a
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ca ^ Pregnant at time of tleath
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. Due to (or as a copse uence of
Enter the UNDERLYING CAUSE q ):
^ Not pregnant, bm pregnam wrthm 42 days
(disease or injury that inuialed the c
events resulting In death) LAST. of death
Due to for as a consequence of)' ^ Not pregnant, but pregnant 43 days to '. year
before tledih
d' ^ Unknown if pregnant wimm the past year
30a. Was an Autopsy 306. Were Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, tlay, year) 326. Describe Haw Injury Occured 32c. Place of Injury. Home. Farm, Street Factory
Penormetl?
Available Prior to completion
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DeC. 2c, 2008
Pedestrian Struck b Auto
y ,
oHine Bplldinq. etc. rspec;ty)
of Cause of Death? atura
ombi
e Roadwa
^ Yes ~ No ^ Yes ^ No ~ Accident ^ Pending Invasligation 32d. Time of InjuryAprX 32e. Injury at Work? 32f. If Trenspomation Injury (Specify) 32g. Location of Injury (Street, city /town, state)
^ Suicitle ^ Coultl Nat be Determined $ ; 15 A
M ~ vas ^ No ^ Driver / Operetor ^ Passenger ~] Pedee,nan Bridge s t ,New Cumber 1 and , PA
.
. ^ Other ~ Speciy:
33a, Certifier (check only one) 336. Signature and 7t i ier ~
• CertHying physican (Physician certirying cause of death when arwther physician has prorwunced death and completed Item 23) ~ _ C o r o n e r
To the bat al my krawletlge, death attuned due to the cause(s) and manner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
• Pronouncing arts certHying physician (Physician both pronoundng death and certitying to cause of death)
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^ 33c. b e tuber 33tl. Date Signetl (Month, day, year)
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On the basis of examination and / or investigation, in my opinion, dam occuned at the time, dale
aM place
and due to the cause(s) end manner es steted
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_ ~ Na a and A dress of Person Who Completed Cause of Death (uem 271 Type /Prim
ic~Tae~ L. Norris, Coroner
35. Registrar's Signature an i is Number ~ ~
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/ `I 3s. Date Fi d (Monm ay vas
^ 6 3 7 5 Ba s e ho r e Road , Suite 4i 1
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,~, t`? Mechanicsbur PA 17050
Disposition Permit No. /~ ;~(~ `"1 ~ C9