HomeMy WebLinkAbout01-04-05 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~ L~_{-~ ~ ' ~-~J~o. '~ ] -'-0
also known as To:
Register of W,j~ls for ~the.
Deceased. County of ~.L~.~,~..P~O,~\~ the
Social Security No. ~ t~ - ~ ~ - %__~. ~' Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl [ e. ~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in ~)AJ~,'x~~~--~ County, Pennsylvania, wi. th
h ~.~r-- last family or principal residence at oQ-c~_ ~'~ ~ , fzoO,..Q-'lCl' ilAO £ o._~-t--
(list street, number and municipality)
Decendent, then F~ years of age, died ~ 0 ~/. I tat-
at
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ '1
(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: ~4~ ~' _~k]. '~o~7¢OVlO'x~ca~, ~.~[~ :/~fi~--
Petitioner after a proper search ha e.~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
.3 am~.~o Relationship Residence. t ~
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COUNTyCOMMONWEALTHoF ~OF PENNSYLVANIA } 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 knowledge 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.
Sworn to or affirmed and subscribed c->'~/~/9/.
before._xlxe this q4h .day of_x- [/~-
:~ C R~gister.
!
No. c~J' 03--tOt'S?
Estate or ~V~, ~ ~C ~ ~X,. C_x_~o [ %~, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~'~&r~oO, t' V q~ A'eg~2~O6~.l~n consideration of the petition on
the reverse side hereof, satisf~tory proof having, been ~resent~.before me,
IT IS DEC~ED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Admi~strafion
are hereby granted to
in the estate of
Register of Wills
Letters of A~inistration ..... $.
Short Certificates( ) .......... $ A~OaNEV (Sup. Ct.kD. No.)
Renunciation ................ $.
$' ~ADD~SS
TOTAL .~ $
Filed .................... ' A.D. 19
PHONE
P~U~CI~ION
deceased.
To the Register of Wills of C ~o ~,~ ~
County, Pennsylvania.
of
the above decedent, hereby renounce(s) the fight to administer the estate and respectfully ask(s) that Letters
~i~u~to ~-~%~ ~ c ~ ~~
WITNESS .~A,~ handthis ~ dayof ~ .~.9.~.~
(Signature)
· (Address)
(Signature)
(Address)
(Signature)
(Address)
qi, i:- ~o ccrlifv thai lhe information here given is correctly copied from an original certificate of death duly filed with me as
1. ~,ll !-icgislrar. The original certificate will be forwarded In thc Slate Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
H105.143 Rev. 2~87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
wP~m.T CERTIFICATE OF DEATH
IN NAME OF DECEDENT (First. Middle. Last) S~^IE F~LE NUMBER
3.204 - 03 - 4595 ~. 11/14/2004
AGE (Last Bi~hday} ~ UNDER 1 YEAR UNDER 1 DAY DATE OF BIRTH BiR~P~CE (Ci~ and 2.
~ite
DECEDENTS USUAL OCCUPATION ' '
245 W. ~lt~re St. [~[S~OtNC[
~s~llsle, PA 17013j ~rl~d IZd.~ Uo, d~edentlived
~ o~.r side) 17b. Cou.W to~.~ ~rlisle
~. Jo~ P. War~cker
~NF~NFSMAILI~ AD~RE~S (St~t.
=0,. ~r~ N. ~ulson ~0~. 36 O~Par~ ~.; ~r~s~e, ~ 17013
~ Donati~ ~ Burial ~ Cremation
~ ~.. o,~,~(s~c~) ~ ~,. 11/18/2004 ~es~nster ~. Gr~. :~. ~rlisle, PA 17013
~ SIGNA EOF L SERVICE ti ORP ONAC~NG~SUCH
- 22bFD 012633 L =~g Brokers ~eral H~, Inc. ~rlisle, PA
phys~., is not ~.;,able at time of death to (S~natum~e~. -- ~ ~ -- L'C~SE NUMBER
..on~ ........... d ....
disea~ or c~di~on
CAUSE cause·Law' ..dlng to i-- Enter (~.as. UNDERLYING or ,nju~ ....
~ ·