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HomeMy WebLinkAbout10-18-12PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of Michael C. Norris No ~ I - ~oZ ~- 1 l 2~ also known as To: Deceased. Social Security No. Register of Wills for the County of Cumberland ~ the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl ies for letters of administration on the estate of (d.b.n.; pendente (ite; durante absentia; durante minoritate) the above decedent. Petitioners is the surviving parent of Decedent. Decedent's mother, Susan M. Norris, having predeceased him on 05/23/1999. Decedent was domiciled at death m Newyille. Cumberland County, Pennsylvania, with h i.;~ last family or principal residence at 83 E. Main Street. Newyille . (list street, number, Twp. or Boro.) Decedent, then 32 years of age, died 08/15/12 at 83 E. Main Street. Newville. PA 17241 Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ 3.500.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Petitioner after a proper search has ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name I Relationship I Residence 60 Minnich Road (last known address) 52 Mountain View Terrace ~.~ Cw! c~ m C -~ ~ r,~ ~= C7 C.? . ~ -r~ -r . ~ ;r-' ~~ ~ 1V "ri THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form to the undersigned. . ~~u~ 3100 Liverpool Court Chambersbur4 PA 17202 Jo Norris ~~ x; ~~ ~ ,o N'~ ~a ~ o a en ,. OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland SS '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 lrnowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. ~.~ a c-~ .-~ -v W p ~~c_:.: r'' © C--. ~ ~' , 0 ~~ -•-1 t v y of r .OQ No. ~ ~ - I ~ - l l~-~ Estate of Michael C. Norris ,Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW `9n ~~ ~~ ~ ~, 2a ~ 2 , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that John Norris is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to John Norris in the estate of Michael C. Norris FEES Letters of Administration . $ ~ . Short Certificates (, j) . $ In2~m A~.~ $ TOTAL $ Filed .. .. ... A. D. _~ ~~ ,-~, ~~; v ("~'f i ~ ~-~-= m ~~ T Register of Wills ~r v/ v John W. Frey i C~~~~u V ATT NEY (Sup. C . No.) 119 E. Baltimore Stree Greencastle PA 17225 ADDRESS 717-597-0200 PHONE NIOS.ROS RF_V ro/I n LOCAL RE RTIFICATION OF DEATH ~~~ WARNING: It is i ~~ !-Ei~ili~~this copy by photostat or photograph. Fee for this certificate, $6.00 ~~~2 ~~~ ~ 8 This is to certify that the information here given is correctly copied from an original Certificate of Death duly tiled with me as Local Registrar. The original i,;_~~;~~.. certificate will be forwarded to the State Vital QR~~a'S Records Office for arms nt filing. P 18850382 ~~~~~ Certification Number Registrar Date Issued TYpe/-Nnt In .erman<nt #33-319 COMMONWEALTN OF IENNSVLVANIA ~ DEPARTMENT OF NEALTH ~ VITAL ACCORDS LFRTIFIIt:ATfF AC f'fCeTY 1. OKedent's lease Nama (First, Middle. latt. SuNlx) 3. Sex 3. Saeial 3e<urlty Number . O, Oate Or Death (Me/Dw/'rrl (Spell Mol ' Mlohael C Norris Male 117-72-3769 Au cast 1S, 2012 Se. Aq•l.ast i/rthOwy (Yn) Sb. VnOer year Sc. Under 1 Ow 6. Date el ilrth (MO/Day/Year) Iipell Month) Ja. ilrthplace ICity and State or Fortin Ceuntry) Months Days Neura Minutes Br eW ~ 32 Janus 2, 1980 Jb. ilRhplace /Ceunay) is ResKlnee (S to er Farelin Ceuntry) ib. Reildance (Street arW Number -Include Apt Ne./ M. Did Decedent Live In ! Township ~sanay~vania QYa,. decedent lwetl In 83 E. Main Street two, R c id w es en<a egnty) t . Cu$b er slid M. Residence (Zip Code) No, deeedem Ilved wrchin (knits o/ Mar-+.rt l l s <Ky/bore. f. Ever In VS Armed sercesi 30. Marital Status wt Tlme o1 Dealh MarNld W ewe 11. SurvlNni SpOUw's Name It1 wile, irve name prier to Ont marrlwtel Q Vas ®Ne Q Unknown Q DNOrcad ~ Never Marrle0 Q Vnknew 3 F Mr's aNme (First, Mbdle, last. Su ex) ~ o'~i 13. Mothei s Namm Prbr t0 First MwrrlaRa (Pert[. Meddle, Lart) . J n Norris Susan Moritz 14a. r mant'f Name 14 b. RelatlOnship t0 ptlenl 14c. In ermant's Maldni Addnsf (Street and Number, City, State. Zlp Code: J h N i f 8 o n orr s ather .3100 Liverpool Court, Chamberaburg, PA ......................................................... .............._...................... tee a eat en y en4 ..............................yR ........ . ..........:........................................... ....................... ................................... II peach Occurred in w Neaplul~. ~~ InOwuent -t(1f Oewth Occurred Semewhsre Other Thwn w Nosp141: y ~Mgplee Facility ~ Detstdene's Memo ime ROpm/OUtpetlent geld On ArNgl • Nunl Nome/Len -Term Cwre Faclll Other (S Cclf In VOhkPe ISb. PMI ty Neme (I/ not Instltutl0n, live scree[ wntl number; Sc. Crcy pr TOenn. State, and Zip Cede iSd, oVnry a Death 83 Eaat Main t N tnrL/ill PA 17 41 1N. Method Or DNliesitlOn eyNll CrematlOn iW. Otte M DIfOONtion lac- PIPCa OI D4PNrcwn (Neme oT rommtlry, cremmtorv. er OLher Pbce) Q RempYnrromse.te Q ponaebn O -2012 Th L G i OtMr i/y) omas . e sel Crematorium ]id. Leeetlen D ipgltlon (City or , Sgte, and Zlp 1 !. 51 wt Or Mee Ueenfee Or Parson In Cheri! o/ btermenl 1Jb. License Number Chambersburg, PA. 17202 -013391-L 1Je. Name end Complete Address e1 Funeral FacRlty Thomas L. Geisel Funeral Home 3 11i S yin Road Chambersbur PA 17202 ~ . ]i. Decedent's Fduutlon - CMek tM Lspx eMt best describes the 13. Decedent M NlsPenic Orliln - CMck tM 20. Decedent's Mce - ChKk ONE OR M011E races w indlote whet hiihsrst dgrN er IevN o/ schpel completed et the time e/ death. box [Mt heft deserlMa whether tM decetlenl tM decedent <Onsldered hlmsell or herself to be. Q ith fired! Or less Is Spanlah/HlfPenlc/La<InO. GhlGk the -NO- 1i~ WhRe Q KOtlen Q Ne dipbma, fth - 13th trade box If deeeden[ I n t S l s e pan sNHispanlc/Latino' iJ ilwck Or AMCan American Q Vletnames! Nlih seheel irsdueN qr GED completed ~ NO, net EpanishMlspaM4tatlno Q ArrleNUn InOiwn or Alwska Nativ! Q OtMr Asian Q Same ee1NH credit, but no decree ~ Yea, MNlun, MNlun AmeNean, Chicano Q AFMn InO4n Q Nettie Mawalian l • A t d aaN a e ~ ecree (e.i, M. ASI ~ Yes. Puerto Rlun [Tersest Q evamanlan or Chamorro Q ischebr'f d r iA Ae l i5 0 g w e.i. , . Q Yea. Cuban Flliplne ) Q Samoan M 1 d Q lMr ecree (e.i. MA, MS, MEni, MEd, MSW, MtA) Q Y<s, other Spanish/HlspanlUl.atlno Q 1ePanmse Q Other PacHic islander Q Deeterate (e.i. PhD. EODI or Prefessienal dlirN (Speel/y) Q OtMr (SpeNfy) . MD DDS DVM LLt /D 21. Oeeedent's Senile Mee Sell-Oeflinetlon - C ed ONLY ONE to Ind1<ete what the N<edent considered himself or herself to be. 32a. Decedent's Vsuwl Oeeupatbn - Intll t <e e type or work ~ White Q )epaneu Q 3amean done durln meet f w kl Ilf i or O ni e. p0 NOT VSE RETIRED. Q ibekOrAtNbnAmerlbn Q Korean Q otherPa<in<I,Lneer Q AmerlGn mdlen Or Alaska Nettie Q Vletnamefe Q Dent Knew/Not Sure Materials Handler - Q Aalen Indlen _ pHrer Asiwn Q Relused 23b. Kind e/ eusinesf/Industry Q Chinese Q NLNve Mawwllan Q Other (SPeelly) Q Filipino 1 Q r3wmanlenorlTamerro Crane M8nuf8Cture T ! MPLET! 38a. Date Preneunced ONO tMO Day • . Slineture o Person PrOrtoun ttt DNth Only when applleable, 33c Vcanse Number iY [IISON PRONOUNCES OR w DUTM AU Vat 1 $, 2012 13d. Otte Siined (Me/Day/Yr) 3a. Tim! of Death ' A X. 3: A.M. 25. was Medleel Examiner Or Cpren<r eonteetedJ m Yes Np CAUSE OF DEATH 35. PaK t. inter the Chairs of !„lots-difewsea. ln)prlea, or cpmpllcetlona•-LMt dIRR1 APProximate y caused the death. 00 NOT enter terminal lygnts such es cardiac arr rt l Interval: resPiratery arrest, er ventricular Rbr111PHOn wltMut showini the etloleiY- p0 NOT AEBREVIATE. Enter only one cause on a line. Add addidonel lines 1/ ne O cessary nset to Dew<h IMMEDIATE GUSE ---_____> Carbon Monoxide Potaoning ~ (Final msease er rondlpe^ out ee ter as . eonfequence on: resurcini In dovq - b. 3equent1a11Y Ilft ecOndrclenf. Due to ley as w eensequence ef): H an V. Ifedlni to tit! caYFe Iirted en Ilne •. Enter the { < VNDlRLYINa CAUSE Oue to (or of • eensequenee a/): --(disease pr InJury that Initiated the eventiVCSUltina d. In death) LAST. Due to (er as • ronfpuence en: 6. Part 11. Enter Other 1 nIR dice Nb 1 d hbgt net resultlni In the uncle NYlnR <wnse (IWn In Part 1 r 3J. Waf an aYtOPSV perfOrmldi ~' Yes Ne 2i. Were autePSY fin irtis wadable to romplete Lhe cause of drwthi 2P. If Female: Yes No 30. Did TOWeee Vse Contribute to Death? 31. Manner Of Death 0 Net Preinant wlthln Past yNr V es O U Q Natural Q Hemlcide. 0 Preinant et time el ONth No kob 0 ,~ n wn Q 4celdent Q PendMi Inveftiiatbn Net peinan<. but preinant wlthln •2 days e/ dNtt m Suicide Net r C ld t b Q ou P einan , not M determined ut prlinant •3 dayf [e 1 year b!/ore doatt 33. Date e1 InJury (MO/Day/Yr) (Spell Month) Q Unkn N own Dreinwnt wlthln the Deft Year 3S. Time e/ Inlurv August 16, 2012 Approx 3:30 A 34 Pi M I _ . . . ece n)pry (e.i, home: <enatrpctlon lice: firm; s<h001) DS. Lecatkm oI Inlnry (Street and Numbly, City State Zip Code) , . In Vehicle 63 Eaet Main Street, Newvllls, PA 17241 Sd. InlOry et Work DJ. If TrwnsPprtetbn lnlury, SPecIN: Si. 1lexrlbe How InJury Occurred: p Yea Q Driver/oper.eor p Pedestrian Intenttonal Inhalation of Auto Exhau t s m Ne 0 Passenter Q Other /9Pecify) 39a. CerNRer (check only on!): Q GRlTylnt Physlclwn - To the best o/ my knpwledie, death eceurred due <e the cause(s) and manner stat d e Q Prerwunclni-6. ClrtlMni physlc4n - Te th! hart 0/ m 19pwledie, ONth eecurred at the time, date and place and due to th Ol l m M , , w e uuse(s1 end Tenn! stwted l Examiner/Cerprurr _ Ors Lty ~sl o exa 1 6 ntl/or InveftlEatlen, In my oplnbn tlNtN eccurretl at tM tim d r , e, ate, wnd p4ce, wnd due to the cause(s) and manner atatee Slin.eure o/cernnlr; ~l% retie of <aroner: ACting Coroner _ Ucens! Number: 3%. Nwme, Address and ZIP Code o/ Perfon CemPletini Uuse a Death (Item Zi) l9c. Date Seined IMO/Day r) MattMw S. Stoner Actin Coroner 6375 Besehoty Road, Suite 1, Mechanicsburg PA 17050 ' , Auflust 15, 2012 40. Reilltra r f OlftNeL Number 41. Reilrtrar' a3. R ilstrar Ill ale /MO O!V r 43. AmerMmen[f r Dlslsesltlon Permit Nn. 2 / ~J~~ ~FS_~ HIOS-143 REV OJ/3011