HomeMy WebLinkAbout01-12-05 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
also known as To:
Register of Wills for the
Deceased. County of ~,,~6~a-,ql:> in the
Social Security No. 1~'~ - ,~l~ - ~.~1~ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl 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 ~.. ~,tl,~ ~ ~'~C.a. d ~ County, Pennsylvania, with
h i~P.- last family or principal residence at ?_%-~2 4r",.r-~ .~r-m~'~.r', ~.E-,~.,t,a/~
(list street, number and municipality)
Decendent, then '70 years of age, died ~,r'~,~.d~-~. ~ ,1~ ~o0~ ,
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ I~, '*-q'". ~'*
(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 ha ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
<-:> '~" .ff_HEREFOi~E, petitioner(s) respectfully request(s) the grant of letters of administration in the
c -.: appropriate;~form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ( ss
COUNTY OF ~b(~v~/~L~f~
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
before me this 1~_ day of
No. 0 I ~ iL:~ 5 ~ C.C~ I
Estate of ~'-f~'-lE A ~..7,~ i~T , Deceased
GRANT OF LETTERS OF ADMINISTRATION
O5
AND NOW ~T'~ ~ vl._]3~__~l I c~._ ~Jl , in consideration of the petition on
the reverse side hereof, satisfacLory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~CC> FT
in the estate of ~ ~E
FEES
Letters of Administration ..... $
Short Certificates(~ ) .......... $ 12, O 0 ATTORNEY (Sup. Ct. I.D. No.)
Renunciation ........ ~0¢: '~ .... ~ $~~$~-
TOTAL ~ $ ~ ~' [ C)- ..... ADDRESS
Filed ..................... A.D. 19 ....
PHONE
:"i %!) r_._
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
- ~ ~ ~ I~rl¢c~ ony on~- see n~ruc ons~oher sd~
COUNTY OF DEATH ~ CITY, BORn, TWP OF DEATH ~ FACILITY NAME (If not inst~tution, give street and number} [ [ O ~ ~WAS DECEDENT OF HISPANIC ORIGIN? ~RACE - American
... .... Dau~hzn' ,,~L°wer Paxton Tw~adOommunz ty General Osteopath z d Mexcan. Pue~R,can. I Whzte
- , ' / · /9,
o~CeDem.s USUAZ OCCUPATIO~ I Xt~ O~ BUS~SS ~OUSTRV ~ AS DeC~Oe~r eVE, ,~~ oece~e~r's eOUCAr,O~ ~A~AL STATUS- ~r~.a I SU~V,V,H~ SPOUSe
I
,,. Homemaker ,~. Home I~z/ve~ ~o~ I~s'l ~[ I~ ~ ...... > I~,~.. arr zea ~o,¢.~ (s~.~e) ~arl H. Banker t
752 State Street I~es,o~c~
tivein a No. ~e~aent I,ved Lemoy~e
Lemoyne, PA 17043 (s..,~,~.c~on~ Cumberland ~o.~,p~ ~.~ ~,n,~t~*,.~,~or
~. c~arles P'. ~lller 1~9. Helen v. sonnet
~0, Earl ~. ~ankert ~0u ~P ~TS~ ~7%~, [~6~e,PA 17043
~'1. ~ Olher(Spea~) /2 DI2~ept. 9, 2004 12p=FH Crematory J2~o Grantville, PA 17028
SIGN~U~E OF FUNE~RVICE LIC~ PERSON ACT~AS SUCH L CENSE NUMBER I NAME AND ADDRESS OF FACILITY
~2. Q~ ~ ~/~ [~ 22~ FO 012342-L [~one&MurrayFH408 3rd St New Cumberland,
So~e items 23a-c only when ce~iyng ~ ~ b~t ~y kn~ledge death ~curred at the time da e and p ace sta[ed LICENSE NUMBER ~OATE SIGNED
~'$;u';;~; ;;:,tl~bl. at time o, I~ ...... ~d T,Ue) ,(Mon h, Day. Year)
I
DUEWO(ORAS ACONSEQUENCE OF) ' I ~ ~' ~ ~ .I
m
CAUSED ........ ,nju~ ¢~ ¢~
I
NAS AN AUTOPSY ~ ~RE AUTOPSY FINDINGS I MANNER OF DEATH t DATE OF iH JURY I TIME OF INJURY INJURY AT WORK~ DESCRIBE HOW N JURY O~CURRED
YesU N°~l Yesu No~ I Suicide U Could not be d ........ O n~ ~ M 50c. 30d,
To the best of my kno~edge, death ....... d a, the time, date, .od pi ...... d duetoth ....... (s} and .......... tared ~lc.~Ot 0 [ o%L ~ld.~~
O. the ba.is o, .... ,nati .... d/or I.vesfl.atioo, in my opi.,o., death ....... d at the ,ime. d ...... d pi ...... d d.e ,o th ....... (s) and ~2.~~'~ ~0~ ~ ~.
Register of Wills of Cumberland County
RENUNCIATION
Estate of
Also ~own as '
, deceased
:_
To the Register of Wills of Cumberland County, Pennsylvania
rheundersigned ~ ~. a~d~**- ~oq~
(Name) (Relationship) (Capaci~)
of the above decedent, hereby renounce(s) the right to administer the estate and respect~lly request(s) that
Letters ~
be issued to
Witness my/our hand(s) this l~- day of ~,./~-~'~-*/ ,20~.
jFmed and subscribed before me this ~
day of ~--~r:il~j~'~'Y~-~/ , (Signature)
7 3
(Address)
Notary Public
My Commission Expires:
(Signa~e)
Or
(Address)
Affirmed and subscribed before me this
~ dayof~C(~>[ ,
~ ( ~ /~& (Signature)
Regict~ills k" ~- ~ -
~t ~' t'};~(~.~~'; (Address)
Deputy ~ ~ {~
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)