HomeMy WebLinkAbout04-27-10PETITION FOR GRANT OF LETTERS OF ADMnINISTRATION
Estate of Mary K Cook No. ~~r _ ~(~ ~(~~~~`
also known as To:
Deceased.
Social Security No. 237-80-2064
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
'The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, apply for letters of administration
on the estate of
(d.b.n.; pendente liter durance absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
her last family or principal residence at 4 Thornhill Court Carlisle PA 17013
(list street, number, Twp. or Boro.)
Decedent, then 69 years of age, died 4/20/2010
at 4 Thornhill Court Carlisle PA 17013
Decedent at death owned property with estimated values as follows: ~/ 6~
(If domiciled in Pa.) All personal property $ U ~ `~~~ J
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $ ~
Value of real estate in Pennsylvania $ ~ ~ ~ L~°'~' ` c ~
situated as follows:
4 Thornhill Court Carlisle PA 17013
Petitioners after a proper search have ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
I I45 Liberty Drive
1908 Burchstone Drive
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r- 1, S -{S -c,
m c,~.r- m . CCU ~ tc~ r.~.- e n ~ s ~ v n . ~ e S ~ eri-I - ~,
-rYl Gas"~'YV~ C,~G,(F' ~ Y..; r __
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
V
°' Ma . Coo
a ames D. Cook
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45 Liberty Drive
Mt Holly SRrinas PA 17065
1908 Burchstone Drive
Orlando FL 32806
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OATH OF PERSONAL REPRESENTATIVE
,_...:,
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COMMONWEALTH OF PENNSYLVANIA ss ` } c~
Cumberland - } -r' ~r'
COUNTY OF ~, ~~ `~' `~~
_~~; ! T
The petitioner(s) above-named swear(s) or affirm(s) that the , -; -,;
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 -.~ _.i ~ ~ '= ?
representative(s) of the above decedent petitioner(s) will well and iv
truly administer the estate according to law.
Sworn to or affi ed and subscribed
Yfore Xrt this ~ ~~ day of
_ ~~~
Register
- ~ G- C:~Cx.:~
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No. ~l " ~~ ° a~~~
Estate of Mary K ook ,Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW , in consideration of the petition on
the reverse side hereof, satis tory proof having been presented before me,
IT IS DECREED that Ma M. Cook and James D. Cook
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
Mar M. Cook and James D. Cook
in the estate of Ma K. Cook
FEES
Letters of Administration . .
Short Certificates (ifl~ ).
Renunciation . .
TOTAL
$ i.C?L~
$ s~,n ~ ~v
$ __~
Filed . . A.D.o~~.1r~1L~
n~,~~~ ~r~~ ~~.~ ~~~l~d~.t ~L
~~_
t Re ister of Will ~ ~~ N,~ ,-~1 ~~
/l.~Jl ~C~~_ ~~~/ t/ L=am,
William J. Peters, Esquire
Attu I D #09983
ATTORNEY (Sup. Ct. LD. No.)
2931 North Front Street
Harrisburg PA 17110
ADDRESS
717-238-7555 extension 101
PHONE
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H1os.ta4 REV nn0a
TYPEIPRINi IN
PERMANEM
BLACK INK ~i32-247
i. Name al Decedent (Bret middle, lest, suffix)
Mary K•
5. Age (Last BiNdaY) Uakr 1 Yeer UMe
Month Days Hors
69 Yra.
• fih. Camry of Deam &. CAy, , rw
~ ~ ~ Cumberland South
11. Decedent's Usual Ipn Kind of work dale M' most a x
Kind of Woa Nerd
Hou ewife D'
16. Decedent's Maillrp Address (Sheet, cNY I town, stale, LP code)
rn 4 Thornhill Court
°~ enlist P 1
n. te. Fame's Name IFire6 mMae, lest, su6x)
UI
In
'r D^'°+H ~ ~,~' ~' _ I '... .,_ Ull~?i;l;il ( ~)ii~ l.` of j)f ('
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMBER
2. Sex 3. Serial Security Number 4. Date a Deem (Month, day, year)
Cook Female 237 - a;i0- 2064 April 19, 2010
MrwN, December 2, 1940 ReySer, W. Va. ^Inpetlent ^ER/Oulpanent ^DOA ^Nursing Home ~Residane ^Omer-5{rec"b'
Deem BO. Fadny Name IN ~ ~~~ ~e area ~ numAer) 9. Was Decedent of Hispanic Origin? .~ Nc ^ Yes 10. ` ricmi Indian, Black White, etc.
(n yes, seedy Cuban,
Cddleton 4 Thornhill Ct. Medmn,PUenaRiaan,eta.) White
Ida. po eat slate ~ 12. was pemdaM ever n me 13. Decedents Educaaon (Spedry Dory highest grade mrtpleted) 14. Wen~~ ~ :~ a(dS~~r Marred, 15. Survivhg Spouse (If wile. gne maiden nartle)
esiteu / IrxWShy U.S. AmtM Forces? Elementary / SecorMary (012) College 11 d or 5t)
^Yes W1dOW
R S t 1 C Did Decedent
Deaedents Live in a 17c. ~ Vas, Decedent Uved In Cn M i ~ r-l 1 ~ nn Tu7Tl - ~~
Actual Residence 17a. Slate p -. Township?
17d. ^ No, Decedent lrvad within City I Rao
17b. county f`t'n mhG r l A Ty (~ Actual Umits of
1 19. Mottefs Name (First, middle, maiden Sumama)
206. Iaorment's Manirg Adtlress (Sheet, cNY I rown, state, ip ode)
45 Libert Dr. Mt.Holly Springs, Pa. 17065
21 b. Gate a D'eposiliort (Monet, day, YNar) 21c. Place d Disposition (Name a cemetery. aemamrY or dnar place) 21 d. Laanon (city /town. slate, zp code)
Memod err Diapositbn ~] ClNmNIdN ^ ~~" y p s. P a .1 7 0 6
^ Bunel ^ Removal ham Bata was CremsUOn a oan.non Autltortrsd
omen byMsdkNEsrnlneryCaone,? glraa^Na April 22, 201 Hollin er FH Cremator Inc. Mt.Hol q
tea a Funeral Setdm ~ (a ~ as such) 22h. license Number 22c. Name and Address a FactXty 5 01 N . R a 1 t imo r e Ave .
p _ _ Hollin er FH Cremator Inc. p~ Date Sgned (Month, day. year)
23b License Number
to Items 23ac any when amm/in9 23e. Tome a my gawladgN, deem oamrted at the time, date end PIacN stated. (~~ ant tlde) ~ .
'an ¢ not evanahle at lime of dorm ro
cerlNY cause a deem.
Case Referted to Medical Examiner /Corone
e
s
26. W
r for a Reason Other than Cremation or Donation?
leted W perem
at be com
426 za. Time a Deam prX . 25. Dale Pmrwanmd Dead (Manor, day, Year) 11
s.,,--
~~
Yes ^ Nc
p
mo
Items 2
naunaeadaam
h 10:30 P. M. April 20, ZO10
DM Tohecco Use CoMdaute to Deam?
m
29
t
d
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.
w
aPm u
I
t
S r Approximate interval:
cnons end examples) .
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ee
Pad II: Emer Omer ,'~„^
vie"'",.+~,., ~.-.^i^^` con~
.~'""
Yes Probabl
^ Y
Pan I
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i
r
na
ee
CAUSE OF DEATH (
irytsias. a mmplimuons -mat dtracNl' caused me death. DO NOT enter terminal evenh such es mr3ac anesl i Onset to Deam
the chain of aveme -diseases
t
P
n I
E .
n
ven
bu nor restatng n the undadying cause g
^ No ^ Urwrawn
.
n
er
a
:
hem 27.
respiratory arrest. a ventnWar Immktbn without showing me eaodgy. Usl Doty err muse on each one. r
' DM, Remote CVA 29. If Female:
A-Fib
IMMEDIATE CAUSE IFa lasmsea Valvular Heart Di^ue i5@ r
r
th
d ,
^ Not pregnant wilMn bast year
) -~ a
e
condnan restating in ^ Pregnem el time of deem
Due to (« as a mnsequenn of):
~ ^ Nd Pregnant. hu pregmm within 42 tlays
Sequeaietiy tiA caditbns, a anY b. of dorm
~e6nq to me muse listed m Ina a. Due to (a es a ansequenca aQ: l
Faster fhe UNOERLVING CAUSE t
l ys year
^ Na DreAtNa• but pegtanl d3 der to 1
(disease or injury mat naieled ma c. _
events resulerg m deem) USL Due to (« as a consequence of):
r harore dorm
^ unlmowm n pregnaa wimin me Peel year
d. 32c. Place a Inlury: Home, Farm, Street. Factory,
Were Autopsy Rrx,ngs
30b 31. Manner a Deem 32a. Date a Injury (Manor. daY. Year) 32b. Describe How Injury Occurred Odice Ruling, ac. (Spedyi
30a. Wes an AaopsY
Penomwtl7 ,
Available Prior to Campbtion
of Cause a Deem? p(Nalural ^ Holrcade
J°l,
l Woa~ 32f If Trensponanon Inury ISPaahl 32g. Locatlon a Iryury (RUeeL +N / mwn, stale)
^ Aaidenl ^ Pending lnvesligadon 32d. Tine a Inryry 32e. Inpry e
^ Yes ~NO ^ Yes ^ No ^ Yes ^ ~ ^ Driver I Operela ^ Passenger ^Pedestnen
^ Suldtla ^ Count Not ere OetelmNtetl M Other -Sped?
33h. Signature ant Tine o1 Cerafier r
33a. Certifier (dredc mty ar(e) ~~. Or
• CerMymg phYslden IPlrysician mrtilyirg ceuse a amm when anomer pnyddan has MaaxncNd tlmUt ant mrrlpaed Item 23) - - - - - - - -- - - - - - - -- ^ -
Tome bell a my Mrwwkdge, deem etturmd due to the atwgal ~ manner m s1e1M„ _ ... _ _ - - --- - 33d. Date Sigurd (MOnm, daY• year)
• Pmnoundrg eM cerlnylrp piryaklan IPMsiden boor PrNnaNNnN9 dNNNt Nnd cNrNNNg ro cOUNe a deem) 33c. License NwOer
Ta me beslamy gpwNdge, deem occurred at me tlme,daM, and plsx, and tluarome ausa(a)endnmvrer ss aYkrL____ _____________ ^ April 22, 2010
• Medial Examiner / Canner 3q. Name and Atlaeas a Person wIr CortnlMetl use a Deem (Nan 27) Type / Pdm
oamebeal.a.x.min.non.td/an...Rg.non.Ln myopmlan,d..moa«r.a.tor.tLm.,era,.napL...,.da.mm.«aeac•).ndm.ntwr..alned- Todd C. Eckenrode, Coroner
-Regwmr a,~'`,anao~a~t 3e.o.MF4ed(Manm,my.yea) 6375 Basehore Rd., Suite 111
((~}~ 1~111.0.1~ Ic~l
DleposlUcn Pannn No. ~ _: