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HomeMy WebLinkAbout04-20-10PETITION FOR GRANT OF LETTERS OF ADMINI'SfTRATION Estate of Jess?e E. Johnson No. c~.r - to - "L r~ also known as To: Deceased. Social Security No. 17 7- 7 4- 9 0 2 4 The petition of the undersigned respectfully represents that: Register of Wills for the County of Cumber 1 a n d in the Commonwealth of Pennsylvania Your petitioner(s), who is/are 18 years of age or older, appl i e s for letters of administration on the estate of (d.b.n.; pendente lice; durante absentia; durance minoritate) the above decedent. Decedent was domiciled at death in Cumber 1 a n d County, Pennsylvania, with her last family or principal residence at 476 Stonehouse Rd, Carlisle, Dickinson Two. (list street, number, Twp. or Boro.) Decedent, then 17 years of age, died 4 / 4 / 2 010 at 1.Ann Rln~k Walnut Bottom Rd,_Dickinson TWD, Cumberland County, PA 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 (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: Petitioner after a proper search ha ~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: ra c~ , ~ y. •-- N r,.., i.r..~. O is-i r.7 "'F't N r'F i ~ ' ~ ~' ` THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the ~ appropriate form to the undersigned. Vl U D N 9 ~yi Qi ~ 'O G C O ~ 'G H y ~~ ~ ~ .... 0 _~ $ 100.00 $ 0.00 $ o.on $ 0.00 476 Stonehouse Road Carlisle PA 17015 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA l °F SS CIIMRFRI AND J '~~ ~ ~ COUNTY OF G j r ~ ~}:; The petitioner(s) above-named swear(s) or affirm(s) that the ~~ i`ce' ~ tV © {^tti i. T~'t ' ``~ `" } statements in the foregoing petition are true and correct to the best ~"~~p -`~' -fl . ~ - of the knowledge and belief of petitioner(s) and that as personal ~~~ ~ C7 ~ representative(s) of the above decedent petitioner(s) will well and ~ tv m ",~, ~ truly administer the estate according to law. ~ ~ Lit s Sworn to or affirmed and subscribed h be ore me this ~ day of ~o Registe No. ~ 1 - lU - t-I, lb Estate of Jessie Johnson , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW 2010 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that James M • Johnson is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to in the estate of •~O«7° F• Johnson FEES Letters of Administration .... .. $ 20.00 Short Certificates (2 ) ..... . $ 16.0 ^ Renunciation .. .......... $ 5.00 JCS/Auto $ 28.50 TOTAL $ Filed A.D. 69.5 3425 Simpson Ferry Road Camr~ Hill PA 117011 ADDRESS 717-763-1121 PHONE ATTORNEY (Sup. Ct. I.D. Nd.) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 16355581 Certification Number 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 filing. ~~t+e~trte,~c" AP~t 7 /2010 Local Registrar Date Issued N --- ra ' 3s r =; ~~ n :.:~ ~ .~ t N -i ' r s : T 1 ` " ~~ ~~ ~ _,.. ' ~ ~ _ `'~ 4. r~ ~ O '~ ~ ^ _'.1.." COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (S!a Inslnsctlom and sxetrlPlaa On reverse) STATE FILE NUMBER L ~nas.tr REV nnma rnE r FRwr IN eaac #32-235 1. Name a oeraee (R4 nYOre, Imo, dr) z Sr s. 5air 9eaeay NuniMr ~. Dab a Own (Ham, de%mA Jessie E Johnson Female 177 - 74- 'A'ril 4, 2010 s. rep I~r BYtlwr) Utrr t IArw t 6. Dwa elm t. are ere « a. Fwa d Dart Chad ale beih d,te ua,e Yaer alter. 17 res. January 4, 1993 Lancaster Pa. ^Imatd ^ERrowrrs ^Da ^rwwy ^ om.,•svdr es. carer a o«m x. an, T'sp• Drat ed FsrJq Nr. In nr Yrrrah pr sere rr snarl e. wr oredsa a Nrprtle Odpn? ~] Nd Yee la. Nea: Anrtlrn mn sane, ws+le, elc Cumberland Dickinson 1800 Block Walnut Bottom Road Iw~wnbn~m,rcl lWhite n. osndrRe Iler a rate dare mar a are. D, na rre 12Yrr Deaedre evr h M l9 DeoednaY Ealaron (sp.rN «N a•~~I u. MrNr seas: Mrde0. Nwar ~trded, m. spars In wAe, area inrdrt nrrl IDeadwaa leldaelarr/bdury U.e. Amrd Fas? w~d• °"01pa (~+dM Ernwllerylseaerrylbl2) CoNaellj«s.l Student E t' ^'^~ Never Marr as. D.om.n MitpMea lsaet dY! nen.r,, ap aqe) hlnlNeraeo lts.9rb na _ l~M In ems na ®ne, o«sare uwl In ~ n i rk i n enn Two _~ 476 Stonehouse Road To~q? 17tl'^ ~"'i0"~t ,m. C Tmhaar] anA Cayleao ~ a 1a. FrMre Nrr (Rn4 mldse, lrt rllrl 19. Moaw'e Nrr IFltu mltldls, nrbr wmeme) James M era F linedinst za a+att.re Name fMe / Fatq 2dD. hdanwa'e Mrrtn Addre i9eeeL dry! awm, rer,>ip areal d Carl s e Pa. 17015 zas erana a orpaerm ~]Gblrem ^ oaear zla ore a orpoeYOn (Haut. der, YeN x1c Race a Orprrm (Nrr a annrny. Y «aaw prrl z+ . moon Iplr I ben, rr., zp mdel ^ o^m. Rnnoerhansrr YeN~lE,swrbw ~ $Iws^Na Aril 9 1 Hollinger FH/Crematory Inc. P{It.Holly Spgs.Pa.1706 aFare(s.nbe lb.w. ala. uowwNmier 22e. Name rrAddlesa Rr/y 501 N. B~Iltimore Ave. - FA-011 n 17 65 a,me z9es arr atslt c«Mq Z3L To M hul rarsda,, dart axund r M tlme, der end prw errs. Is4ras rd w.l 23a. tkam Nrtlaer 2sc ore Slpnd M~,n, are, Yr,] r rt.wrle r rr a area b plryarredd,rl. rrzsaemre.anq.raMV~ 2/. Thn a Owh TR. P a5.Ore Pmon«d Deed (Mmin, aY~ YrA 29. Wr Cw Rehmd b Medaai EWiMrI!Caarr br a Rwon Onrr arri CmWlon «Dantlrt? ~~rordt+~ 7:30 P. M. April 4, 2010 ~`'" ^"a CAUSE of DEIUN Iew rareeeMne nr •aslewbel , kpaunw YMpvet Pad Ih Erraarr 7B Db Tabaae Ur C«ebtM b osrt? Irm 27. M I: Een M fLThdaral-rerer~ Y~ere, «lalploetlale-M diw4!' cnnr M dMt DO NDTenrrtsmiW aveae ash r aerdea emeL ~ Orel b Deee br w twlrp r ale mdnryaq areaNr N Pr I. ^ Yr ^Praaeay twpeerry ener. «wY4Mr aMrm trltor eltoaYp M rbloar. Ur «h ate elre m eecn M. ~ ^ No ^ Urotaet t ~.. rho ~ ~ ,. Multivle Blunt Force Trauma ~ a' ~„r,,,p„t,,,a grbl«reaweprce ~: i ^ Pnptefartllradeeb s~rratm.,wbtr, e. Motor Vehicle Crash ~ ^ Nr peir~hul prepare •itlYit e2 deye b rararr anbe. Orblars EnYr m m an a u e e s n ~d1~ , dart i y r e ~ M Y~ y e. ~ab~nan~d~W L718f. - ' ' ^Na PeOrr.W P~NrtpM•blyw Dr b ~« r a aeragrbe aq: i ~ a~ a ~ ^ urmnlnprvrstrNnMprrrr sd.Wr rhngry aas.Wwe htq/Rn6y st rrawaoeest dx.. areaMarl~+,. dsn re,) sze.oewes xow bprom.ra Be to passenger,ve c k effi Rerda~,Y Nar, Feint aiw. Rbbd. Renanrm {l R d °E`s '1' ~ b ~4wat ~ oa t 'r ^Haoitla Apr.4,2010 crossed centerline, struck utility pole aD ,s,a o m ^ ar ~ ,,r T" ^ No y2sl ~a ^ P~9 a,+eeeoenan rare Tbr a NanAprx. sz.. rhN r wan sx,. nTlerparaai lnlan lsaaYl szo. lnrum a ear I bnL arr) ~r'e ^ Na Y~' ^n° ~Na ^~ ~ ^~~ Walnut Bottom Rd. , Carlisle, PA ^~ ^cowNaaeoamnsd 7:30 P . M. sn. CeMn (rted~ aeY onq • Dawawvarralrn+m~,~v~adert.drtrr~«amaeahrpawutrdart.tdcamaredlNmz,1 ToM awrsy aneerdye, dera srmsa drbMarbelN end nreewrrr.a__-----~~------------------------ ^ Coroner - d Aarubap elr aMllrbG P,7w,e„ (~ aaa plablatrlp derl eal ~'Nq b pure d dwhl ^ 39c. lkere Nurt« sgaed (MOntll, M. neo -- _ _ - _ A MOwrgbleebdae,araomrMrMMRdre~endpb,enddrbMaueelel rd ererrreYbL__-______-_ • Ibear Barr«ICaanr ItA rr dwbMarnelq end mr.trrerbi to On Mary rrrrran rrl«breaPmn b mY opYian deeatawmdrMtlse ab end rae /AM T , , , , P u. a yap Cv, aem ype "1od°~i0°fr': ~°clcenr~"d°e, L~Oi tot'bn ssRgr.r. .m r .t'~ f I C I l ~ saarArnaet.ar,>+•l 6375 Basehore Rd., Suite #1 , l a; I i a l - . Mechanicabur Pa. 17050 Drpa.Nan Penes NO. ~,'~- O'~C10tP~1~?'0 C) N O :. ~~ " - ^.~^ ~.; ;y T 1 ~ RENUNCIATION ~~->a ~ ~= ~-' r''t y Cr7 ~ C/' _l7 ~ r ~ C` ~,:., ,_.j..t ~~~ REGISTER OF WILLS ~°~ p -o `~ CIIMRFRI aND COUNTY PENNSYLVANIA ~ ~:~~ ~ , Estate of '~°`'T` E JOHNSON ,Deceased I~ T F R r- c e ~. J O H N S O N , in my capacity/relationship as (Print Name) M A T H F R of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~_ day Deputy for Register of Wills (Signature) y,76 STONEHOUSE ROAD (Street Address) caRi Tcl F PA 17015 (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this day of Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 IN THE OFFICE OF THE REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYVLANIA WAIVER OF FIDUCIARY BOND Estate of JESSIE E • JOHNSON No. ~ ~ "4Q - `"'~.(~ also known as ,Deceased The undersigned, who is/are at least eighteen (18) years of age, being alUsole residuary Legatee(s) or next of kin of the above Decedent, hereby waive(s) the posting of any Bond by JAMES M. JOHNSON who is the Petitioner for grant of Letters of Administration (d.b.n.c.t.a.). Witness my/our hand(s) this ~o day of APRIL , 2010 t. _ p G~' t--~ ignature) r~ ,.:.., N Cr ` `_~ _ u..pL~.~ 476 STONEHOUSE ROAD ``" Q"' ~~~ CARLISLE PA 17015 t.... ~ N ~- ~ (address) ~} u~ pr U~ C; :; i'PC_. c;:~~ O~ ~.. o ~- (Signature) cs N 476 STONEHOUSE ROAD CARLISLE PA 17015 (Address) Sworn to or affirmed and subscribed before rrte((#his._.~1L_., day of Notary Public My Commission Expires: (Signature and seal of Notary or other NOTE: Waivers of Bond executed outside the Office of Register of Wills are official qualified to administer oaths. Show required in some counties to be notarized. date of e~iration of Notary's commission.) RW-5