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Home My WebLink About04-28-05Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of DONALD H. SCHWARTZ Also known as ,Deceased No. Z-I-~~S - CI`iG~Z Social Security No. 168-36-6585 JUDY M. WOOD and KATHY L. SMITH Petitioners, who are 18 years of age or older, apply for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioners are the executors named in the Last Will of the Decedent, dated and codicil(s) dated State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: IJ B. Grant of Letters of Administration (d.b.n.c.t.a.: pendente lire; durante absentia; durante minoritate) Petitioners after a proper search have ascertained that Decedent left no Will and was survived by the following heirs. The remaining heirs are also the Petitioners. Name Relationshi Residence JUDY M. WOOD Daughter 305 Georgetown Road Mechanicsbur , PA 17050 KATHY L. SMITH Daughter 40 West Baltimore Street Carlisle, PA 17043 COMPLETE IN ALL CASES: Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or principal residence at 25 Sussex Road. Camp Hill, Lower Allen Township. Cumberland Countv. Pennsvlvania (List street, number and municipality) Decedent, then 61 years of age, died March 11, 2005, at Holv Spirit Hospital. Camp Hill, Cumberland County. Pennsvlvania (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property .....................................................................$ 3.000.00 (If not domiciled in PA) Personal property in Pennsylvania .....................................$ (If not domiciled in PA) Personal property in County ....................................................$ Value of real estate in Pennsylvania ......................................................................................................................$ 30.000.00 Total ......................................................................................................... $ 33.000.00 Real Estate situated as follows: 25 Sussex Road. Camp Hill. Lower Allen Township. Pennsvlvania Wherefore, Petitioners respectfully requests that the grant of letters of administration in the appropriate form be granted to the undersigned: Si nature T ed or tinted name and residence ~' ~~ ~ ~ ~ ~~ j~~~ JUDY M. WOOD 305 Georgetown Road Mechanicsbur , PA 17050 -~ KATHY L. SMITH ~~ ~ '~ 40 West Baltimore Street Carlisle, PA 17143 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioners above-named swear and 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 Decedent, Petitioners will well and truly administer the estate according to law, Sworn to and affirmed and subscribed ~~~ ~~ ~~ JU M. OD Before me this Z~ day of L--~ {~P R i L _ , 2005 ~ ~- y, r-- j KATHY L. SMI ~~' ~ 1-05- 0402 Na. Estate of DONALD H. SCHWARTZ ,Deceased Social Security No: 168-36-6585 Date of Death: March 11.2005 AND NOW, ~~ I L- Z~ , 2005, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to JUDY M. WOOD and KATHY L. SMITH in the. above estate. FEES Letters ........................... $ Short Certificate(s)-1 Renunciation .............. Affidavit ( ) .................. Extra Pages ( )....... Codicil ............................ JCP Fee ....................... Inventory ...................... Other..~~~T~':.. i-ZE.. D • l.l.~ $ ~ ~~-~~ $ 10-pC~ $ 5 - ,n TOTAL......... $ IZ~ • UZ~ Attorney: JERRY R. DUFFIE I.D. No: 09601 Address: Johnson, Duffie, Stewart 8~ Weidner, 301 Market Street P.O. Box 109. Lemoyne PA 17043 Telephone: 717-761-4540 This is to certify° that the intiormation here given is con•ectly copied from an original certificate of death duly filed with me as Local Registrar. "~'he original certificate will be forwarded to the State Vital Records Office for permanenh filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ~~~~~~~~ N<~. TYPE/PRINT IN PERMANENT BLACK INK N a a H O w O O z L1~r~l Registrar Date COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH H1U5193 Rev 2167 NAME OF DECEDENT (First, Middle, Lasl) SEX SOCIAL SECURITY NUMBER DATE OF DEATH (Month, Day, Year) Schwartz Donald H ~9ale 168 - 36 - 6585 , - . 3 , ~ ~ ~ AGE (Last Binnliay)- UNDER 1 YE R UNDER 1 DAV DATE OF BIRTH BIRTHPLACE (City and PLACE OF D ATH Ch o n - in t Ilion on other i0 MonNs Days Hours Minutes (Month, Day, Yoar) State a Foreign Country) P A Ho9PITAL: OTHER'. I O ~~ ^ ^ Yre 61 ~' - 2 -19 4 3 ` npa mt EmQWpa6.OI DOA Nur•Irp Omer ^ Hea,e•nca ^ ^ s. 7 Ham. (9p.aM1) ' COUNTY OF UEATH CITY, BORO, TWP OF DEATH FACILITY NAME (If not institution, give street and number) WAS DECEDENT OF HISPANIC ORIGIN? RACE -American Indian, Black, While, el No Ves ^ If yes, specify Cuban, ® P C u m b e r l a n d € a s t P e n n s b o r o Mex , PueM Rican, etc W fl l t e 7U Bb B BC U DECEDENT'S USUAL OCCUPATION KIND OF BUSINESS /INDUSTRY AS D CEDE T EVER IN ECEDENTS EDUCATION MARITAL STATUS -Martied, SURVIVING SPOUSE I Q~v x~r,a of woM eon' aun~~qq t U S. ARMED fORCES7 (speury only nipneu 9raea complaMe) Never Martied. Widowed, In wn•, a~+• maaen Hamel f wvrhlnp ule: ,fo n" u•e ralneEl yea ^ No ® EI•menterylaacon4ary Cdle9a Divorced (Specify) - ,,, CPA „b Accounting t2 „ Ij'~ '~'""' ,4 Divorced ,s DECEDENT'S MAILING ADDRESS (SUeel, Cily7Town, Slate, Zip Code) DECEDENTS ,7a. Sale Did ® Lower A 1 1 e n decedent lived In M p A 17c Yes `L5 Sussex Drive , p ACTUAL RESIDENCE decedent live ina (See inslru lions Cumber 1 a n d township? 17d ^ No, decedent lived ithi t l li it f N id C t t3. m Hill P A 1 7 0 1 1 on o er s e) 17b. oun y w n ac ua m s o my/boo FATHER'S NAME (First, Middle. Last) MOTHER'S NAME (First, Middle, Maiden Surname) Millis P Schwartz Margaret Ru ,6. ,g. pp INFORMANTS NAME (TypelPNnq INFORMANTS MAILING ADDRESS (Street, CitylTown, Slate, Zip Code) 2oa. Jud M Wood 2gb.305 Geor etown Road Mechanicsbur PA 17050 METHOD OF DISPOSITION DATE OF DISPOSITION PLACE OF DISPOSITION- Name of Cemetery, Crematory LOCATION - City/Town, Slate, Zip Cetle II--~T~ 8udal ®Crematoon LJ<cnwval hom State ^ • °oid1xin^ (kbnq. Day. Year) or Other Place ther(Bpelfy) ^ 2ta. 2,b. 3-17-2005 2,~, Mechanicsburg Cemeter ,dMechani csbur PA 1705 ~ SIGNATU F FUNERAL S ELI PERSON ACTING SUCH L1~`iT~O"1"~T$'6 2 - L fMrytEL NpiDDRESS.OE FACILYTY H o m e Mechanicsburg P A 17 0 5 f~, UU ~~~I CC f~ G I . 22a. -'~"t 22b. 22c. plate items ly when ~rying o the my knowledge, death occured al Ne time, date and place stated. LICENSE NUMBER DATE SIGNED physician is not vailable at lime o/death to (Sign and Title) (Month, Day, Year) certiy cause o/ deep. 23a 236. 23e. Hems 24-26 must be comDleled by TIME OF DEATH DATE PRONOUNCED DEAD (Month, Day, Vear) WAS CASE REF ERRED i0 A MEDICAL EXAMINER /CORONER? person who pronounces death. n - ~ Ves ^ Nd M 25. () 26. 24. ( 27. PART I: Enl•r q• 4h•••.•, glen•• or compsuuon• wMCh c•u•W q• a•aq. 0• nor.m•r q. m•e• or eylna, •ucn a caralu or ••Pb•tory •rr.•t anocs or heart r•ner•. ~ Approxlmele l h n l l PART II: Olhsr slgnilk:ant conditkne contnbuang to death, but t 0i i th d d i i i PART I u•r on y •n. c•u•• on ••c n•. .interva De wee onset and death ng cause g no resu ng n e un e y ven n . IMMEDIATE CAUSE (Final ~ L k disease «condiliun C_a/~ /O PN/G ,S 7 d7- esultiny in death) _f DUE TO (OR AS A CONSEQUENCE OF). • b ll li t diti S i y con ons equent a s ' d any, loading tc Imnledlale . OUE TO (OR AS A CONSEQUENCE OF,: ause. Enter UNDERLYING • c CAUSE (Disease or injury ' Ihal imaalnd events OUE TO (OR AS A CONSEQUENCE OF). resulting on death) LAST d. • WAS AN AUTOPSY WERE AUTUPSV FINDINGS MANNER OF DEATH DATE OF INJURY TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. PERFORMED? AVAILABLE PNIOR TO COMPLETION OF CAUSE Nawral ~ Homicide ^ (Manm, oar. Year) OF DEATH? Yes ^ No ^ Acddenl ^ Pendiny Investigation ^ 30 a. 30h. M_ 30c. 30tl. Yes ^ No Yes ^ No ^ Suicide ^ Could not be determined ^ pLACE OF INJURY - At home, farm, sueel, factory, office LOCATION (Street, Ciry/Town, State) 2Ba. 2Bb. 29. deep. erc ISpecay) 30e. 30/. CERTIFIER (Check only me) SIGNATU AND TITL OF CERTIFIER -' ' +'1 7 ~ 'CERTIFYING PHYSICIAN (Physician cunilying cause of death when anulhnr physician has pronounced deeth and wmplelnd Hem 23) ^ o Iha but of my knowledge, duth occurted due to the causea(a) and manner as staled.... ........................................................... - 316, <C! _ • a0i til i t f d d h d ~ ' LICENSE NUMBER DATE SIGNED (Monrti, Day, Year) ) y ny o cause o e eat an ca PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronouncmy death occumd at the Ilme, tlate, antl plow, and dw to the cause(s) end manner ae elated ...................... ^ To the but of my knowledge 31c~ ~ ~ Z-~ 4 ~ O 3td.~•%i P'c ~ y 5 Z r~ , , NAME AND ADDRESS F ERSO W MPLETED CAUSE OF DEAN LD~~~ C//'a~I A'r%N~ r Pdr Il 27 T 'MEDICAL EXAMINERICORONER • On the bads al aaaminatlon and/or Inveallgatlon, In my oplnlon, tleath occurred at lh• tlme, data, and place, and due to the causea(a) and . y ) ype o ( an "lT ZG(2CJ Nhr~-~ '~ J • manner a.alas.d ......................................................................................................................................................... ^ n,. _ 7 ~ / a 32. r ___ REGISTRAR'S SIGNATURE AND NUMUER I DATE FILED (Month, Day, Year) '~'4 r a~~` ~!A/' ~~ ~ ~ ~ y ~~ / ~~J I ' ~ si-J / u ~ l.•1 ct~~ / LaC /.,i~rdrf. ~`~"~"'~L] 3a. ~ _. / U