HomeMy WebLinkAbout04-01-10pFTITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cum_ be=land
Estate of Todd Michael Gingrich
also known as ,Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
COUNTY, PENNSYLVANIA
File Number ~~ ~ ~ ~) r ~~~
Social Security Number 203-54-385?
N
~ _
C7 0
T ~ -~tiAmed in the :
A. Probate and Grant of Letters Testamentary an and codicil(s) d• tedr(s) is I are the
last Will of~the Decedent dated
~~c
-~^{~
(State relevant circumstances, e.g.. renunciation, death of executor, etc.) ; ~- N
was not divorced, and did not have a child born or adopted after execution of th~mstrument(s)~fered
Except as follows, Decedent did not marry, ~ ~'
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
] a licable, enter: c. t. a.: d. b. n. c. t. a.: pendente life; durante absentia; durante minoritare
B. Grant of Letters of Administration (f PP
--- i
,.
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Petitioner(s) after a proper search has /have ascoe ~T'ill d tSection A above and co~mpletde list of heirs) by the following spouse (if any) and heirs: (lf
Administration, c. t. a. or d. b. n. e.t.a., enter date f
Residence
n.,~.. Michael Rossiter
Name
Son
Carlisle, PA 17013
(COMPLETE LN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal residence at ~-.
214 Stonehouse Rd. Carlisle PA 17015
(List street address, town/ciry, township, eounry, state, zip code)
February 13, 2010 at M•S. Hershey Medical Center
Decedent, then 43 years of age, died on
Decedent at death owned property with estimated values as follows: $ 4,500.00
(If domiciled in PA) All personal property
Personal property in Pennsylvania $
(If not domiciled in PA) $
(If not domiciled in PA) Personal properly in County
Value of real estate in Pennsylvania
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
Tuned or onnted name and residence
Si nature
Ryan Michael Rossiter 1888 Mary Lane, Carlisle, PA 17013
Page 1 of 2
1888 M
Form RW-02 rev. 10.13.06
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA SS
COUNTY OF Cumberland
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
fore me the ~- day of
~~
1 ~, ~ ~ ~
Fort Register
Signatur Personal Representative
rv
c7 °-
~~ °
Signature of Personal Representative ~
Signature of Persona! Representative
_ts
File Number: ~ / ~ ~~ ~ ~~~~
Deceased
Estate of Todd Michael Gingrich
Social Security Number: 203-54-3852
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i~d--==`` ~ "~
~~,
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Date of Death: February 13 2010
~ ~~- ~~ ~~~ ~ ~,'~ , in consideration of
AND NOW, y ~
having been presented before me, IT IS DECREED that Letters
are hereby granted to
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of
FEES
Letters ............... $ '
Short Certificate(s) ........ $
Renunciation(s) .......... $
(~-~ ... $
... $
... $
... $
... $
... $
Attorney Signature:
Address: 104 S Hanover St
... $
$ Telephone:
...
TOTAL .............. $ ~~,`Z1~6-_
Carlisle, PA 17013
717-243-7437
in the above estate
Page 2 of 2
foregoing Petition, satisfactory proof
Form RW-02 rev. 10.13.06
Supreme Court I.D. No.: 37076
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~t (:~~ ~ii,~~~i ~~, r,~a~(~~~~~ ll~9i+r ~; .x~,~f day' ~S~l~ata~lat 0~ ph0tor~ratl=~.
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse) STATE FILE NUMBER
2. Sex 3. Social Sepoly NuMer 4. Dew d
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H10S143 REV 1126W
TYPE I PRINT IN
PERMANENT
BUCK INK
1. Name a Decedent (Rel, ^
5. Age (last &rmday)
43 Yrs.
_ ~. Canry a Deam
". a , III ~ ni .li ~ ,lZkl~ , ,Iil,~ ! t' t}~ 1) 1rj1
+~ C {~
Ir y" Cl. t~i~lt 1 l.i
~ ~. c`: i ~:'(~ i,~ 111 t. ~ E11 c' .;1'
~`' f t c 1~1T til~l71 1111?rn
~" ra ~ ~ .~~ I ~ ~Lf+.
1<, t r_i~ ~ t ~ -
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,:, ,.
r 201,
~~ i . _ .1 RI~_ s .-.. `~~_~~ l~r'.
Todd Michael Gingrich
_ cn - ~a5~ Fel
~Y• Ymr)
13, 2010
l1Mnt m Ualerl &Daad BiM Mmlh,
1966
11
t
"'~'"° °°^' "°'"' """"° w .., d---.-_._._..-__
Mechanicsburg a PA Hoapitel: OMer:
a ^ ER I Oulpetiem ^ DDA ^ Nursing Noma ^ Residence ^ Der ~ SPedN:
I
tl
.
Sep , e
npa
10. Roca'. American Irdian, Bladt WMw, etc.
Was Depderd d Hlapank. Origin? g] No ^ Yas
9
Rao, 7vq. a omen
cm
ac 6d. Fsairy Name (N not insldullDn, 9^'e sbmt end number) .
PI vas, core, (White
,
.
Derry Twp.
M.S. Hershe Mexicm, Pmrro Ryan, ek.)
Medical Center
Medial Swale: Herded, Never Merced,
ted) 14
l
yen Hama)
15. Sumvirg Spoiwe (lf xifa, 9N• rtw
1 12 Was Decedent aver m the 13. I)acedenrs Education (Spedly Doty hIA e
~ ~ carg .
~' DNOrpd IsPeaN)
Kind a work dew dun most d wale Me. Do not swm U S Amwd ForceaT Elemermry I Secondary (612) College (1J a 5+) ~ led
,,,,,__~..__-KiM dWark Knda BudmmnnaraM ~ ~ Never rr
lH vm ^ ND 12 ad Depdent
Warehouse Maria amen Rubber Mf Middlesex rwp.
DepdenCa pA five Ina 17c. LJ Yes, Oecerwnt Lived in
16. pecadem's McNing Admme IStrea, city I tam, aorta, rip carol AcNel Residence 17e. Stave 7ownsMpT
214 Stonehouse Road c`T,mherland na.^~~pa~~matrvaa wimn (MylBore
fro. ca,mr
Carlisle, PA 17015 ,s.MDmeCaNeme(Faai,middle,meidensumame) Susan Pugh Spears
18. FanwCs Name (Fret, midrle, vest. minx) gene Michael Gingrich
2gb. InfomwnCs Metlirp Address ISrrmt dry I rovm, stew, ap code)
20a. IaormanCS Name (Typal Pdnt) 1888 Mary Lane, Carlisle= PA 17013
Jennifer Rossiter ~pIe~u ~g~aIpan~rtwa~~ ame ~ep~~ z,a.lapnon(cityrrowm,stew,=ipaaae)
~7 2m. Dawa Diapaition (Monet, der. y'md 21 tipi~marl_KOLr1p2r~~ tlOme & Carlisle= PA 17013
21a. Memod of D'nppwon ~ yq Cremetlon ^ Dananm
2010 Crealato Inc
^ Baiet ^ RenxrvalimmSwle i ~u~ ~~/T V~^ ~ Feb. 17,
w ^ omer . ~,. I;cenm Number 22a. Name ens adareee d Feaiy Hof fman-Roth Funeral Home & Crematory y Inc
z2e. B Fawml Servip Uranaee (or edarg m such) 13144E
• - 23b. tkense Number 23c. Dew Signed (Hoorn. deY• Year)
Camplele 23e<oay when prdlying 23e. To tlw hest a my m ocprted et the 6nw, dew end qap sorted. (Sigwlure endntle)
pnygklwl ~ na avelHHe at nma of dmm iD
cweM pose d mom. 26. Wee Case Retorted ro Medical F~alwmr / Canner fa a Reason Omer man Gemeaon a Dawtim.
21. Time d Deem 25. Dew Pronounced Dead (MOnm, day, Ymr) ^ Yes ^ ND
Iwnw z4~z6 must ha axipleted bf Pare^^ ,, Il ~ P M. f ~ i ... c, / ~ '~ t ~ '~ d / ~' ~ .
• wive prarouncm deem. 26. D'd Tobeao use Canabuw to DmmT
t Appreximaw Iaean: Pad II: Eaer Dena ~ pum gFren in Ped I. ^ Vas ^ Prohehry
Oiwet to Deem hul as rmuMng h the uraw
CAUSE OF DEATH (See Inefructbrte eM exempbe) , Na ^ Unknown
~, a ti^^a - mat drecdY pueed the death. DD taOT enter rmmal evens such m cadet ertmt, I
Item 27. Ped I: Eaer ma chakl d event,- dweems, kips ~ ~ aHOlogY. ~ ~ aw pose on etch law.
respretary arrest, a ventnpwr tlb9wtion wwron showing 29. If Female:
^~/_ a/ tO ^ Not pregwnt wimin pen Year
IYMEdATE CAUSE tFnel disease or L~ VC
cabiban rmuamg'm death) ; ~C! ~!H ~ ~ ^ Pre9rwnt er dme d death
s. Due to Ia m a dl: ^ Not PreTea, but pegnenr witlwn a2 days
m Fn pndaons, n any, h. ~ d mom
~ng b tlw pose Fated m Frw a. Dp ro IDr as a corwequarx:s o9: ^ Na Ixegnent ad Pre9mm 13 pVs ro t year
Eaer the UNDERLYING CAUSE ~ bed may,
(disseee a injury tlrn nwewd the u I
evens resdmg m death) UST. Dm rD (a as a prove Werme of): ^ Unknown n prepwnl witlJm the peat year
d. ~ 32c. Plae d Inryry Moms, Fenn, Strael Faclay,
32a. Date a InWry (Room, day, Year) 32b. Dexnbe How IMay Occurred Olfice Bundxg, eve. (Seedy)
30e. Wee an Aumpey 3gh. Were Adapey Fndusp 31. Healer a Dmm ,.
PedamwdT AvaiwNe Pear ro Canpletlon I~(NeWal ^ Hoaldde 329. Caption of iMmY (Steel. dry I IDwn swwl
d Caum a Dean? 1" 32s. IrXwY et wodcT 321. n rranspodana iniun l~hl
^ Aa^idant ^ pmdrg lnveeligalion 32d. tans d Injury ^ No ^ UNer/°per1o` ^ Pmaaypr ^ Petlanden
^ Yes ~NO ^ Yes ^ No ^ Yes _-
^ SWdde ^ Could Na he Determined M. Oma - Syavy:
33b. SigneWe arld ~ /
33a. Cereaer Icheck o^IY awl has imounpd dmtll eM canpwted non 23)
pose d deem when enema Iwysldan D - 33d. Dare Slgiwd (Madh, ay. Y•a) .
CartNylrq PNYe1aw^(PhYaMaa^ce^ItyNg ___________________ ^ 3~~~Numeer
_____
To the and mrkmwHdP, seem oauned due MtM puea(al admen ens mroM^9 to puseddeem) -- ,Z ~,/ G
Praaurwin9 em D«,,,rn9 PM'Mcwn (PAyeiden bdh prDnDi.wi^9 -- - - - -- O TOlZ 3~ -
~ ' Tad»ben~ my bwwlMg., deem Gamednm.tlme,dsN, ma piece, end due tD tlw pu.a•)e^d m.nneru ebMd_____------
• asedk l Enmirwr/Coroner n, In my opkdon, deem ,armed n tM Hms, deM, sal plate, and due m dre pu,ra(s) end menmr ee snHd_ ^ 34. Noma end Aamma d Person Wtw Comlawwd Cmse d Death Ilrem 27) TYDe / Rot
u, ~G'P /~~,, Z M.S. Hershey Medical Ctr.
° on me met.aex,mlrotlDD.rMI«mvmd9nle ate Feed(MDdh, ~yo~ G/1 to
~ _ ~I `U V
LLD 33. Rsgiabefs uM Dheid Nu90x'-\ I ~ I i I [~ I I I O I 7~Lf~ ~,( .~(~
C Dupositisn Pemul No` y,' 1 3._kJ o5