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Home My WebLink About06-25-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of BANG V. NGUYEN File Number ~~ ~ ` (~ ~ •- (~ also known as ,Deceased Social Security Number 586-54-3535 MaryAnne T. Nguven Petitioner, who is 18 years of age or older, applies for: (COMPLETE 'A' OR 'B' BELOW.) ~ ~ _.F.., ^ A. Probate and Grant of Letters Testamentary and aver that Petitioner the Execut named in the ~s~Vill of tl~beced~er~t :::-- i,,_~ ~ C ~_ ~ , dated • ,..~ 3 ~ ~ -- _ :-_ , (State relevant circumstances, e. g., renunciation, death of executor, etc.) -~ ~Y ~ ~~r~ r~ _i ~..A ..... Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiorCdf~tmstru~(s) offerec~<<~' for probate; was not the victim of a killing and was never adjudicated an incapacitated person: N/A .~~,1~ :``~ ^ B. Grant of Letters of Administration m (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante minaritate.) Petitioner after a proper search has ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of heirs.) Name Relationship Residence Ho-Thank Nguyen Spouse 1750 Yorkshire Place, Enola, PA 17025 Michael Nguyen Son 1750 Yorkshire Place, Enola, PA 17025 MaryAnne T. Nguyen Daughter 155 Hunters Ridge Dr Harrisburg, PA 17110 (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Lancaster County, Pennsylvania, with his last principal residence at 1750 Yorkshire Place, Enola, East Pennsboro Township, Cumberland County PA 17025 (List street address, town/city, township, county, state, zip code) Decedent, then 67 years of age, died Apri130, 2010 at Holv Spirit Hospital, Camp Hill, PA 17011 Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ 0.00 (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania $ TOTAL $ 0.00 situated as follows: None Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of Letters in the appropriate form to the undersigned: ~~ ature T ed or Tinted name and residence MaryAnne T. Nguyen c/o Blakinger, Byler & Thomas, P.C. ~~t~{ Q~~~~ 28 Penn Square a Lancaster, PA 17603 Form RW-02 rev. 10.13.06 Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF LANCASTER SS The Petitioner above-named swears or affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law. Sworn to or affirmed~and subscribed before me the ~5 day of Signature c~'Personal June , 2010. ~- o the Register Signature of Personal Representative Signature of Personal Representative File Number: Estate of BANG V. NGUYEN ,Deceased C-:~ ~~ ~ `~j ' - t.~., -~y~ {`,. ~, i.~.7 ,~~ -,-~ r= . _~~~ ~ ~~~ Social Security Number: 586-54-3535 Date of Death: Apri130, 2010 r~ v C ~- _ _`j~ ra3 ~: w ~, _; ,_;_~ ~. 3 ~~' AND NOW, ~^ ~ , 2010, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to Mar~Anne T. Ngu~n in the above estate and that the instrument dated described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters (to $2,000) ....... $ 20.00 Short Certificate(s) (2) .... t;,.„~ ~ 8.00 i n nn , ........ Extra Pages Q ........... 0.00 Citation ................ 0.00 Copies, if any ........... 0.00 Exemplification ......... 0.00 .... T 0.00 i1aalVilL~.11~~/ Judicial Computer Project 23.50 Automation Fee ......... 5.00 TOTAL ............. ~~-i630 ~~t~ Form RW-02 rev. 10.13.06 r I ~'~~ Register of Wills ~ (~' G ~ CL~ ~~ Attorney Signature: 'fi'n Attorney Name: es H. Thomas Es uire Supreme Court I.D. No.: Address: Telephone: Filed: 19524 Blakingler, Byler & Thomas, P.C. 28 Penn Square Lancaster PA 17603 (717) 509-7267 Page 2 of 2 #558523.1 OCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Fee for this certificate, $6.00 P 1649~2~.6 Certification Number 105.144 REV 11/'1006 TYPE !PRINT IN PERMANENT BLACK INK ~b32-253 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 cerrificate will be forwarded to the State Vital Records Office for permanent filing. -- L___ Local R istrar Date .Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER ~ ~~ ° ° ;~~ ~- ~ ~ r~1 _J,r R C J\ 4- f.'. ~ _ ~ C.l1~ _ : 1: : 7 ;~ . .. ,, . . - , - - r ( '~ t~ iy: - • C~ r 1. Name d Decedent (First, middle, last, suffix) 2. Sex 3. Social Security Number 4. Date d Daath (Month, day, year) Bang V Nguyen Male 586- 54 3535 April 30, 2010 5. Age (Last Birthday) Under 1 year .Under 1 day 6.Oate of Birth (Month, day, year) 7. &nhpace (City and slate or for eign country) 6a. Place of Death (Check only one) Munms Days Hours Mnales Hospital: Olhef: 67 Yrs. July 2, 1942 Nam Dinh, Vietnam ^Inpatient I~ER/Outpatient ^DOA ^NUrsingHOme ^Residence ^Other-Spec9ty: 6b. County of Death Bc. Cny, Bor Twp. of a1h 6d. Facility Name (If not insladan, give street and number) 9. Was Decedent of Hispanic Origin? ~,No ^ Yes 10. Race: American Indian, Black, While, etc. pf yes, specify Cuban, (Specify) Cumberland East Pennsboro Holy Spirit Hospital Mexipn,PuenoRican,etc.) Vietnamese 11. Decedent's Usual Occ fiat Kind of work dome d ur moll of wor Nfe. Do rat state refired 12. Was Decedent ever in the 13. Oecedenl's Education (Specify onty highest grade comp leted) 14. Marital Status: Married, Never Married, 15. Surviving Spo use (If wife, give maiden name) Kind d W Service 'technician Kira o siness / Industa ~ectronics U.S. Armed forces? ^Yes [~JNo Elementary /Secondary (0-12) College (1-4 or 5+) 4 Widowed, Divorcetl (Specify) Married Ho-Thanh 16. I)ocedera's Mailing Address (Street, city /town, state, np code) DecedenYe Did Decedent East Pennsboro PA Liva kr a 17 St ^ ~ D c d t Li d i T l li id 17 l A 1750 Yorkshire Place Enola PA 17025 c. s, e e en ve n ence a. a e wp. ctua es Township? 17d. ^ No, Decedent Lived within 17b. County Cumberland , Actual Limits d City / Boro 18. Father's Name (First, mdcfle, last, suffix) 19. Mdher's Name (First, middle, maiden surname) Nong Nguyen Can Nguyen 20a. Informant's Name (Type /Print) 20b. Informant's Mailing Address (SUeel, cdy /town, state, zip code) Ho-Thanh Nguyen 1750 Yorkshire Place Enola, PA 17025 21 a. Metfad d Disposition ~ ~ CrartwUon ^ Donation 21 b. Date of Dispositron (Month, day, year) 21 c. Place of Dispositon (Name d cemetery, crematory or dher place) 21 tl. LOCaUOn (City !town, state, zip code) ^ Burial ^ RenavalfromState ; wacrematiorralbneUonAuMrodzed ' ~ May 8, 2010 Hoffman Crematory Carlisle, PA 17013 ^ Other - Specv ty: by IASdical Examirtar / Coronerl ( Yes ^ No fur Funeral Service Licensee (or person acting as such) 22b. License Number 22c. Name and Address of Facilely - FD-13845-L Gilbert L. Dailey Funeral Home 650 South 28th St. Harrisburg, PA 17103 Complete Hems 23ac only when CeAitying 23a. To the best of my krawledge, death occurred at the time, date and place stated. (Signature and Utle) 236. License Number 23c. Uate Signed (Month, day, year) physician is rat avai4Mle at time d death to certity cause of death. Hems 24-26 must Oe completed by person 24. Time of Death 25. Date Proraunced Dead (Month, day, year) 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than Cremation or Donation? wla proraunces death. 2:15 A , M. Ap r i 1 3 0 , 2 010 Yes ^ No CAUSE OF DEATH (Sea instructions and examples) r Approximate interval: Pan II: Enter other Sjgroficant cortdtwns cantobutino to death. 26. Dd Tobacco Use Contrletrte ro Death? Item 27. PaA I; Enter the chain devents -diseases, injuoes, or complications -that directly caused the death. DO NOT enter terminal events such as cardiac arrest, r Onset to Death but rat resukmg in the urxleAying cause given d PaA L ^ Yes ^ Probably respiratory arrest, or ventricular fibriaalion without sfawing ate etiology. List only one cause on each Una. r r ` ^ No ^ Unknown IMMEDUITE CAUSE Fktal disease or r CrNNlitiOrl reSUklrig kl tn) --~ a. Acute Abdominal Hemorrhage 29. If Female: ^ Due to (or as a consequence of): ~ - SegwntiaN list conditions, A an , Y r b. C omA l i c a t i o n s Following IaprOSCOpic Cholecys tectoniy Nd pregrwurt within past year ^ Pregnant al Gme d death le to the cause ksed on kne a. Enter UNDERLYING CAUSE Due to (or as a consequence oq: ~ ^ Nd pregnant, but pregnant waNn 42 days (dsease or injury That irutiatetl the r events resurong m death) LAST c r d deaM Due to (or as a consequence op: r ^ Nd pregnant, bW pregnant 43 days to 1 year d. ~ before death ^ Urrkrawn i pregnant witlwr the past year 30a. Was an Autopsy 30D. Were Autopsy Findings 31. Marxrer of Death 32a. Date of Injury (Month, day, year) 32b. Describe Mow Inpuy Occurred 32c. Place d Injury: Fkxne, Farm, Street, Factory, PeAormed? Available Prior to Cornptelbn ~Nalural ^ Homicid - Office Building, ek. (Specityl of Cause d Death? e Yes ^ No ~ Yes ^ No ^ Aaident ^ Periling Investigation 32d. Time of Injury 32e. Injury at Work? 321. If TranspoAalion InNrY (sP~tyl 32g. L d Injury (Street, city /town, ) ^ Suicide ^ Could Not be Determined ^ Yes ^ No ^ Dover /Operator ^ Passenger ^Pedestrian M. Other • Specity: 33a. CeAitier (check only one) 33b. Sgnature and Til • CenilyMg physklan (Physician cenilyxtg cause of death when arather physician has pronarncad deam and completed Item 23) I - e r To tM best of m know se() y kdge,dathoccwrodduetothecau sand manner asstotsd.,-------------------------------- ^ • Pronouncing and cerUlying pfrysklen (Physician both prorarxaing death and cerktyirg b cause d death) T ^ 33c. License Number 33d. Gate Signed (Monts, day, year) o lM best d my knowledge, death occurred at ule tlme, date, and place, and due to the uusa(s) and mariner as stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ k • May 4 , 2 010 Mad al Examktsr /Coroner On ilia basis d examination aril / ar Investigation, in my opMlon, death occurred at the time, dale, and place, and due to tM cause(s) and manner as eleted_ ~ 34. Narpq ardJtddre;s,d Per~CWhoeCorropladLau; d DeaUl_ Lllemn 1 _ype /Print l C I ll'O Qe I .O I 'O e C • 1 0 Q l Q 35. Registrar' ure trip ur er~ hl.~~,,' [- p l ~ l l A r t ~ ` 36. pale FiledJMOnM,day,yaar) ~ o r e Rd . , S U i te ~ ~l 6 B 3 75 aseh ' ~ - ~/ ~ ~ f l~' -CI ~ .~- -o~O1D Mechanicsburg, Pa . 17050 Dispositon Permit No. ~./ { ~"~.f-~ RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of BANG V. NGUYEN I, HO-THANH NGUYEN (Print Name) ~ ^~ k,,J -~ `~ ~ J C.... - -y ~. r ~ ~l ~ _ . ..~... :~ c~ f - ~ -.~, --~ ~, ~ w - .. ~.. r ~r, ~ ~- ~ ~ ~`~ t'O "' .~ Deceased in my capacity/relationship as surviving spouse of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to MaryAnne Nguyen ~yN~ q, ~oIO (Hate) (Signature) (Street Address) (City, State, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills 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 S' '`~`' day of .Jvr.e- Zc~/a --~ ~~~- otary Public My Commission Expires: /o - z y -~Z (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 COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jarod Buck, Notary Public Upper Allen Twp., Cumberland County My Commission Expires Oct. 24, 2012 Member, Pennsylvania Association of Notaries RENUNCIATION .REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA ~ -cv - ~ ~~ Estate of BANG V. NGUYEN son _~ ~~ r"'~~t"' (~ l~ ::, _~1 E~ ~~ ,~,:_~ =---., I, MICHAEL NGUYEN (Print Name) c-a ~_x C,~....~..~+. i:.~7_-._ :, _1t ~_ w .,.::~ LI7 = i :' J (. _ ~! r-. ,, ~~=~ -.-~c6:~ Deceased in my capacity/relationship as of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to MaryAnne Nguyen ~ ~v (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills (Signature) (street Address) ~~ ~~~ ~ ~~ (City, State, ip) 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 purpo es stated within on this _,~,~ da y of v~ ~o/O otary Public My Commission Expires: /~ _Zy~-~ Z (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 COMMONWEALTH OF PENNSYLVANIA Notarial Seal Jarod Buck, Notary Public Upper Allen Twp., Cumberland County My Commission Expires Oct. 24, 2012 Member. Pennsylvania AaeoGation of Notaries