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Home My WebLink About05-08-09Intestacy PETITION FOR GRANT OF LETTERS OF ADMINISTRATIOtN, Intestacy Estate __JeffreyE,_Mackey---------------------------------------- No.---------c~~---~~~-`--d---i---------------------------------------- also known as n/a To: --------------------------------------------------------------------------------------- Register of Wills for the --------------------------------------------------------------------- Deceased. County of Cumberland in the Social Security No. ,_1.59-60-4150_______________________________ Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioners are 18 years of age or older and apply for letters of administration on the estate of the above decedent. Decedent was domiciled at death in Hopewell Township, Cumberland County, Pennsylvania, with his family or principal residence at 16384 Cumberland Highway, Newburg, Pennsylvania 17240. Decedent, then 46 years of age, died May 2, 2009, in Hopewell Township, at his home located at 16384 Cumberland Highway, Newburg, Pennsylvania 17240. Except as follows, the decedent did not marry, was not divorced and did not have a child born or adapted after execution of the will offered for probate, was not the victim of a killing and was never adjudicated incompetent n/a Decedent at death owned property with estimated values as follows: (if domiciled in Pa.) All personal property $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 10,000+/- _ _ _ _ _ _ _ _ _ _ -------------------------------------------- (if not domiciled in Pa.) Personal property in Pennsylvania $ -------------------------------------------- (if not domiciled in Pa.) Personal property in County $ -------------------------------------------- Value of real estate in Pennsylvania $ ___________________________none __________ Situate as follows: none Petitioner, after a proper search has ascertained that decedent left no will and was survived by the following heirs: 1. Jill D. Conyers daughter 10352 Rowe Run Road, Orrstown, PA 17244 2. Scott E. Mackey son 640 Mickey Inn Road, Chambersburg, PA 17202 3. Tyler Mackey (minor) son 10303 Muddy Run Road, Orrstown, PA 17244 WHEREFORE, petitioner(s) respectfully request the grant of letters of administration in the appropriate form to the undersigned. B•U Signature(s) and Residence(s) of Petitioners r _~ ~~r-~ . ~ ~ ----- --------- --- ~!~~y'-`~----------------------------------------------------------- z~----'-~'' -- ---- Jil D. Conyers 10352 Rowe Run Road, Orrstovt ~~~_PA 1244 -- __ ~ ,~ ''=T; ~ Scott E. Mackey ~ 640 Mickey Inn Road, Char~er~burg, PA 1 ~~02..' ~-- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND The petitioners above named, swear or affirm that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the above, petitioners will well and truly administer the estate of law. Sworn to or affirmed and sub- _.. _ ~ __ _ - ~~Cy-- - r ~ - - --- scrib d before me this . ~... day of J' 1 D. Conyers ~ ~r ~~ ... .. . ~..-- - - 7, ~ /'~fJ~~yJ~ T- . .......... : ..............2009 .. ~,. .................. Scott E. Macke , -~ ~ ~ - y .- _ - ra:: -- ~ ' - ~ For the Register ~ __ _ + ~. -! ~ "-"' _ ~r. .~- Estate of Jeffrey E. Mackey Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW . ............................................................ 2009, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED Jill D. Conyers and Scott E. Mackey are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Jill D. Conyers and Scott E. Mackey in the estate of Jeffrey E. Mackey. Documents Attached: Oath of Subscribing Witnes(s) ^ Oath ofNon-subscribing Witnes(s) ^ Oath of Witnes(s) to mark ^ Renunciations(s) ^ Register of Wills vi . Spang (# 194 1) A Y (Sub fCt. I.D. No.) 247 Lincoln Way East Chambersburg, _PA _17201 __ __ Address 717-262-2185 -------------- --- --------- Phone IU5.805 REV lUI/071 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 - This is to certify' that the information here given is correctly copied from an original Certificate of Death ' duly filed with me. a Local Registrar. The original certificate will he forwarded to the State Vital Records Office for permanent filing. e ~ ~ g~ a c a] Registrar ~~ ~ Date t~~ued _,,} rte- '{ - '; ~ ~ ~ , ~.. ~ _ -. ,, - t-- - ;__ =`L`i ~ _ _ c_- - -- ~ u -~ N ~-' Certification Number H105.1M REV /1f1W6 TYPE / PRIM IN PERMANENT BLACK INK a/zry_nnQ w U 0 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS , CORONER'S CERTIFICATE OF DEATH a, \ 6x10`-~~-~~ (See instructions and examples on reverse) STATE FILE NUMBER ~ 1. Name d Decederm (Rm, middk, Ian, 6uKu) 2. Sez 3. Sodel Sewriry Nimher 1. bets d Death (MOnm, tlay, year) Jeffrey E. Mackey Male 159 - 60 - 4150 May 2, 2009 5. Age (Lan Birmtley) UMer 1 r Under 1 day 6. Dale d Binh (Mash, de , ear) T. BuBiplace (Qty and stets a foreign cganry) ea. Place d Death (Check on are) 46 '"°~'~ °e" "°"" """` Jan. 19, 1963 H05p"8k _ omar: p{ Chamb Qltb bung PA ^ i N R id d ^ ER / O ^ DOA ^ N ^ W S , urs ng ome (y ence ier ~ ty: Inpelienl utpaliem es pe Yrs. • Bti. Coumy d Death &. City, Ba T Death Bd. FecNKy Nerve (Knot innilulian, give great aM number) 9. was Deodent d Hispank origin? ~] No ^Yas 10. Race: Amerk:en Indian, Black, While, ek. Cumberland Penn 24 Peach Orchard Road (11yres,apeciryCuban, (seedy, Medcen, Puerto Rican, ek.) Ulh~.te 11. Decedem's awn Oa lion Kk0 of wok tlare tl most d wak Me. Do rat stns retiretl 12. was Deatlem aver m the 13. Deodem's Education (Spedly any highen grade mrtpdeQ) 14. Memo slaws: Marred, Never Martietl, 15. Surviving Spouse (K wxe, Bh'e maiden name) Kind d Wwk Kind d l3uskress / Indalry U.S. Anrred Forces? Widowed, Divorced (SpedlN Elementary /Secondary (0-12) Cdlege (1-4 a 5a) Canperlteh. Corlb~.ueti.on ^Yas 1K]Nn 11 yeanb ~,i,voneed 16. Decedem's McKkg Address (saeeL ceY /town, arse, aP soda) n Decedem's Did Decedent p~ }{OpeWe4.Q TWp . T PA Live m a ,TC Yea Decedem Lived n w s 163 84 Cumb en,2and H ' hwQ '~ y . , D .p3 Adual Reneance ,7a. we Pand Townshp? 17d. ^ No, Decedam Lived wKha CUmb e~l c Neurbun PA 17240 . t7b. ourtly ACaral Limits of CKy/Boa 18. Fatlrer's Name (First, mi0ae, lest, sulfa) 18. Momer's Nems (Fkn, middk, maiden wmeme) John E. Mackey Ve~ca C. KnaZta 20a. IMamam's Name (TYPe / Pnm) 20b. Inlorment's Mating Address (Baser, dry /town. Hate, by coda) Scat i:. Maehey 640 M~.eke Inn Road Chambeh,abun PA 17202 21a. Medad d OaposKion ~ ~] Cremation ^ Daruaon 21b. Date d Dispa"ion IMa"m, day, year) 21c. Place of D'spceKion (Name d cemdery, crematory a Darer pace) 21d. laration (Cdy / lows, sMe, zip azk) ^ ^ B,m~ p Removal l`°n' sera j ~ M a ~min° i"t' ° ^ Yea ^ No 5 -b - 0 9 Sm.i~hb b C2ema~onium Sm.ith.d b M1J 217 k 3 ~ 22a. ~ tors ~ see (a person edkq ss such) 22D. License NuM1er 22c. Name and Address d FedlKy . ~ FD-012984-L Fo eCaan eh.-Bru.eh.en~ Fulnena.f'. Home Inc. Sh.i enebun PA 17257 Complete Kars 23ec Dory when cerBykg 23a. 7o me ball d my knowledge, tlBath ocartatl et Kre time, tlak and place slated. (Sgrektra aM title) 23b. Lkane Number 23c. Dale Signetl (Mmlh, day, year) phyekden k not eveNebk n rime d tleam m centy ease d death. Kerns 24-28 must ore wrrpidetl q' Derscn 24. Tme d Death IOrX . 25. Date Pmauaed Deatl IMo~• ~Y• Yea) 26. Was Case Reared to Metliol Examiner /Coroner for a Reason Other roan Cremation a Donetan? ,' wta praauncas dann. (D ; QQ p , M. May 2 , 2 009 ,Yes ^ No CAUSE OF DEATH (See Instructions sod axsmples) r Appmxnrete'rderval: Pen II: Emer other ~ 23. Did 7drecco Use Cannbde to Deem? Kan 27. Pen I: Enter me drea~ d events - diaeesss, kWdea, a ampgcatkns-mn drMly causetl the deem. DO NOT ads lemunal evenm such as cer6ac arten, i Ousel to Deem bd ml resulmg in the uMenykg cause given n Pan L ^ Yes ^ Prob~y maprakry arrest, a vwmriculer fibdaatan wdhM showkg the etidogy. wet aNy one Doss on each Noe. ^ No ^ llnkriown NIMEDUTE CAUSE 1Fkrel disease a ~ r ceMikon madllrg mdeam) ,~ a, Probable Myocardial Infarction r CHF Remote MI , 2s.nFemek: ^ DUe r0 (a a6 8 COh%gUenCe 0~: 1 sawam~NyNnc~ndiliare,dam, b. Occlusive Coronary Artery Disease i Nd pageant wKhkt pest year ^ Pmgnamaukreadeam leadrg to Kre cause tined on Noe a. Erna me UNDERLWNG CAUSE Due b (a as a consequence off: r ^ Na pregnant. but pegnanl wimin bz days d tlea"i ~~IWreeSea~e a injay mar idtktetl me c ~ evens reanlmg m deem) LAST. D r op ^ Nd pepienl, but piegnenl43 days to 1 year : ue to la u e cauequence r bdore death d. r Unknown K pmgnad wNun the pan year 30a. Was w Autopsy 300. Were Autopsy Fktlirlgs 31. Mama d Danh 32a. Dale d Inryry (MaM, day, year) 32b. Describe How Injury Oaurted 32c. Place d Injury: Home, Ferm, Slreel. Factory, Wise Bugdmg ek. f5pecily) Perkmred? Available Prror b CorrNklion d Cause d Denh7 bl Natural ^ HorNpde ~L . ^ Yes ~NO ^ Yes ^ ~ ^ Asides ^ Penditg Imeelipatbn 32d. 7xna d Inryry 92e. Injury at Work? 321. II Transpalatkn Inryry (Speedy) 32g. Lacatkn of Inryry (Strad, dry /lows, slate) ^ Suidtle ^ CouU Nd be Oelermnal ^ Yes ^ No ^ Driver / Operotor ^ Pesserger ^Pedealdan M. Omer. Specyyy; 33a. ~a (dtedc onry anal 336. Signature and T r Cor one r • Candylrg physkkn (Physidan cenifyirp Deice d death when another physiaan has pranaxaed death eM c0111pieled Item 231 desM Oaurrcd tluekthe auee(e)sM manner essMed--------------------------------- ^ To Bre bestdnry knorkdq , , • Proraundng eM andying pryskien (Physaien bdh proraurxJng deem and cenKyinp toc~use d tleam) ^ 33c. Lice r 33d. Dale Signed (Monet, day, year) -- - - - - - Toth b..tdmy kraakdge, dash orxwretl tithe dme,dm,entl plso, and duerothe ceuee(a)end msnneru etate4_---___--- • Msdkwl Examina /coroner May 4, 2009 On the ltssls d exeminstbn end I a InvestlgMlon, k rnV opmorr, ooumd n da tune, dsk, and pko, and due to Hte oase(s) sM tnenrrer ore slatad_ ~ ~ pt,me end Address d Person Who Cortpkled Cause d Death (Kam 27) Type / Pnnl , Coroner Michael L Norris 3s.Repdror'aslgneturoa r 'I a2 1 ~ 1.~1 l Z I / DeleFded(Momh,day,year) . , 6375 Basehore Road Suite 411 X . . F Z 7050 Mechanicsbur PA 7 7, DispMiticn Pamal NO. O 33 IJV~