HomeMy WebLinkAbout01-27-05
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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
l1R.i s'T. f1ARRlS
Estate of
also known as
Social Security No.
Deceased.
19'0-N-...3/~.s_~
No.~I-05- OOIo~
To:
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appllZS
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
It F R.. last family or principal residence at
Decenp~nt, tllen 7 q years of age, died
at HEALfu Sou-th
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(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:
$
$
$
$
/ &" ;2, O()
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
me
IS
Relationship
-SoN
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ARRIS
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,nIERE~, petitioner(s) respectfully request(s)
~C.~ _,.'
a~opriate fru:m to the undersigned.
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the grant of letters of administration in the
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF G;,,,,,,,'o.aA-\G..x"\6
} 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.
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Sworn to or affirmed and subscribed f
bef~~e t~is .:lI..5T ~ day of
,~~e:.. ~\Qp..,,\u i
~ ~ _ ~egisfer l
No.cll- 0.')- 00&AI
Estate of"""1::Pri.5. "I... \.40 ~,-<;"
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
~_. in consideration of the petition on
een pr~sented before me,
are hereby granted to' I")od.n, 'tr ~ \-\0..""":,5
in the estate of llii:....~. ~~
~nda _~AYlRA~'\~
RegisterofWillS~ca-.~
~~l\\)~o...o\CIOOo-- FEES :;.00
Letters of Administration $I,(),CJ:::::>
Short Certificates(,).) . . . . . . . . .. $ '2 .nl")
~~\rn:-.~~ $ 5. {)O
..)C!.P $ 10 .00
TOTAL _ $'8"~.oC>
Filed h?1!:-..c? .5":". . . . . . . .. A.D. ftl_
ATTORNEY (Sup. Ct. LD. No.)
ADDRESS
PHONE
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Register of Wills of Cumberland County
RENUNCIATION
Estate of')'Q~\ 5 =:I . I-\. f\,,\~\' f
No,..2I-D5 - OOl04.
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
Theundersigned V 'A1('lL M \-\f'.eR"< S'VN
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters n ~^ 'J1:J\c, tl ~ '^ ,
be issued to ~C;C\T'\-<", K \-\0.. cY,..::,
\
Witness my/our hand(s) this<< \ ""
day of ]'ANIAl'>.i<."I
I
, 20QS-:-
Affirmed and su!lli;ribed before me this
~ day of :::h:>dv_"qt;,j
20.,,"
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(SIgnature)
c;< 9 W i"'Di~.J6R=k 70"'" jJAf"\0"""~ ,tJ3' DlLj\ '1
(Address)
Notary Public
My Commission Expires:
(Signature)
Or
(Address)
Af~ed an~cribed before me this
i:~~ay 0, ""r. ^. ;y- ,
(Signature)
(Address)
;:.0':>"", 'UQ
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(Signature and seal of Notary or other official
qualified to administer oaths, Show date of
expiration of Notary's commission)
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This is to certify that the information here giv'cn is correctly copied frolll an original certificate of death duly filed with me as
Loca] Registrar. The original cerlificate will be forwarded (0 lhc Slate Vilal Records Office for permanent filing.
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1. Doris I..
AGE (LaSlBO/1t>olIy)
~OFOECfOENT(f~... "-4oddle, ......1
..Cumberland
DECEOf:NT'S USUAL OCCUPlIlnOH
l~~w:'';'~':::':l.'=r
l1L Homemaker 11b.
DECEDENT'S UAlt.1NG ADORESS (SlJ__CCyIlOwn, s,w., L9COOe\
335 Wesley Drive Apt. 306
Mechanicsburg PA 17055
,.
FMHER'S NAME (FilS!. MddNIr. lase)
II. Wesley Baddorf
1Nf0000000'S NAMe: (T fplllPfin')
H..Mr. Recine R. Harris
MeTHOD OF DISPOSITION
8utIalOCt.....lion(!t"'~lromSlal.O
OlhIrlSf*:IIy'
79
COUNTYOFOf-RH
Harris
UNDER 1 YEAR
~ D.Y"
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WARNING: It is illegal to duplicate this copy by photostat or photograph.
fec for this certificate. $2.00
avn... /l(? '%:i<:1/U/.3';?Z.
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LOGll Registrar
JAN 1 8 2005
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10900080
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Date
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COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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ST"'TiF'lE~UMBiR
SOC''''l SECURITY NUM8ER
O"'TfOFOEATH.Mcr>II1,Oa~. ''''-1
:I. Female
,. 196
4.Januar
13. 2005
-14
3653
UNDER I O!l:f
HounI Mi/lUIH
OATE-OFBIRTtt
."-4""'h,Oay'''''''1
OTHER:
~o
Raoda,-O
g'~IO
P1...ACi OF DfATH IC~"". ""VOl'8 n "'" .nWud.o... on """'" 0/d0l1
HO$PIT.o.L. -
I.....'....' u;v" ERIOutPa"WIl [J OOA 0
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F"'CllITY NAME Ifl MI ,n"'"-"",,o. 0"''' "'~ aM roumtJoOo
BIRTHPlACE 1C"y oIAd
Stalf!/)ffc'"'9"Loun"YI
1L kens
PA
....Lower Allen
WAS~C9lENT OF HISPANIC OfIIGIN?
No IU'. 0 "rM-"*'''YCubtI...
MoI.o:an.PuMlORiCao.IIlC
.,
AACE............,..._n,lllKk.WI\iI..IIlC
",.,."
White
SUIWNINGSPO\lSE
(11-.0'''''''''''''''-1
KINO OF BUSINESSIINPUSTRY
MAFlITAlSWUS,t.w.-s
~\Ill/ Mar,"", W-.d.
~C<<l(SOecIly)
.Widowed
11,c.8""V.,_lr-.dio Lower Allen
u,
PA
...
17..$lio..
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..,..,n......1 I1d.D =~=o'
MOTHER'S NA~ ,F.>!. Moddle, Ma.Ool<ls...,oarnel
lJ:\yra T,h>.ist
)NFO~MANT'S MAILING ADDRESS 1$)'''''1. CilYlbvn. Slln., lipCodllI
~ 22 Stil~s Drive ar sville P
PlACE OF DISpOSITION, N..... 01 C.........,. C''''''''lCIIy LOCMlON
OfOl"..PIK.Crem?tion Society of
1'... PA
170
CiIy/TOwn.Slal..Z"IpCodao
Cumberland
.......
l1b.COIJo
OATE Of OlSPQSIllON
(MOIl'h,Oay.....l
o
:l1b.
OR PERSON ACTING AS SUCH
on
ZTd.Harrisburg PA 17109
NMolEAHDAOORfSSQFFAClllTYAuer Memor a Home & Crem8t
:l:lc.Services rne. Harrisbur PA 17109
lICENSE NUUBER DAlE SIGNED
(MooIh.Oay.""'1
lICENSE NUMBER
n.,FDI38202
u..ba"olmyk/lOwlMd<Jl,daatll~f""at\M\_.dllU'./IOpla<;lI~a\.ll
lSignaIu'ellndTi/lel
"..
lUE~OE,(J"H
23b, 23c.
WASCASf REFERF'lED TO MEOICAl EXAUlNERlCOROHER1
~.I!3'MEB
..0
24. 4: 10 P,M 25. .005
21. NftT I; EIll.,ln. _...s. ioj""e5o/ COmplicallO/l$which (;iIuslKllh. 60lalh 00 001.,,1./ Ih. fI'IOd8o'dying. such uca,diacOl 'e.,malo", a"e.t .hocko, hu<ttaiW,.
UIlO/ltf_~0f\1IW>_
..
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WERE: AUlOPSY FINDINGS
-.LABLf PRIOR 10
GOMP1.ETION OF CAUSE
Of DENH1
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.:r. is
OUE~J:"~EO"''''EO"
~p{, J-,(
OUE 10(00 AS "'CONSEQUENCE-Of)
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I~and_
,
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PART\!'
Clt>M1>q.iI\l:UII~CO/\lIibuIlng.o....tl'l.bu1
.....1HIIIlin9in.,.loIIIdMlying_~inPARTl
C0r
OUElOCOR AS ACONSEOUENCE OF)
..rt
MANNER Of OEATH
..~. 0"" Horn;c",," 0
Ac:c\doOM 0 P1IIlding_ligahoo 0
SlJici08 0 Could 001 btI dltl..m,oed 0
TIMfOFINJURV
O...TEOf INJURV
IMOrtIt1,Pay,vea.-)
",,0
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loA. )Dc.
_. 21b,
CERTifIER IChlldc O/"Oy 0/l0I)
.CEIUlf'YtNG PHYSICIAN <PtlyOoc"", c""~I"'''J cau'" '" <It'a'h ...I'~o ~"..~'" ph~"';"'" ha. pro.->ou.-.;:.o Ile..'h aM comP'<<fed Item 23,
T.._tooa.I01...y"""""'-<lu-.dulh"""u...edd......Ih.c.u..'.I.od....on.r.....led_.
,",
PlACE OF INJURY Alhom.,fa,m,wen'aCloty.OIf\c:.
building, .Ie_ (Spec~vl
..,
.Pf'O~JI.HOCERT\F'f\NGPM,.SlCIANIf'h""SO::""'[lO'h"'OOCOJ<"""911e~lhandc"'l"l"og'oca".....ae..'~)
fo_~.o....yk_....dll..,dulhoc"u'red.l#latl...., d.t.. &ndpI1lC.. anddu.tottl.UU"C.,.od",.ooe/...I.ted.
.UEDICAl EXAUINER/CORONER
onlh.b.al.o'.&.mlnallOllandlotlllvesllgllion,in,ny opinion, de. Ih<><:c"t/edallh.U",..d.t...ndplace,andduelo.hec.uu(.j.nd
m.n.......l.'ed.,.
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~EGIST
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