HomeMy WebLinkAbout02-04-05
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Register of Wills of Cumberland County
Estate 01 Mae R SWl'trt:
also known as
PETITION FOR GRANT OF LETIERS OF ADMINISTRATION
No. 21-0S--IO<j/
To'
, Deceased
Register of Wills for the
County of Cumberllllld in the
Commonwealth Dr Pennsylvania
Social Security No. 2()()'22-5771
The petition of the undersigned respectfully represenlS that:
Your petitiono<(.), who is/ate 1& y..... of age or older, lIppl...!!!......... fur Jetters of administration
on the eslate of
(d.b.n.; pendenre lito; dUlSnte absentia; duranto miooritate)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsyl\'llllii, with h.!L, la.t family or principal
residence al1713le\c11wQrth Road. Camp Hij\
(list street, number lIlld municipality)
Decedent, then 89 years of age, died Janua/Y 20
Messiah Village. Upper Allen. P A
.2005
,at
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(lfnat domiciled in pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in CounlY
Value of real estale in Pennsylvania
situated as follows:
$
$
$
$
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Petitioner_ after a proper s....ch ha.!.- ascertained that decedent left no will and was survived bj<Jhe
fOllowing spouse (if any) and heirs:
\k
Name Relationshio Resl nee
; Roy L. Flint brother 30 Raven Drive. Coloni", NJ mOO7
THEREFORE, petition..(s) respectfully reque.l(s) the grant ofletterS of adminislnltion in the appropriate limn
to the undersigned.
SianalUre(S) ofPetitioner(s)
X (fl1 F~
Residence(s) ofPetitioner(s)
30 Rave~ DriVEl. CoIOl1ia. NJ 07067
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Register of Wills of Cumberland CoWlty
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
S&
COUNTY OF CUMBERLAND
The petitioner(s) obov....amed swcar(s) or ofiinn( s) that the statcmomt> in the foregoing petition are true and
correct to the best of the knowledge lIlId belief ofpetitiOller(s) and that as personal representative(s) of the above
decedent petitioner(s) will well and ltUly administer the estate acconling to law.
Sworn to or aff''1nne~"b",ribed {>< rp "'( 1 cI ~
,B9fore me this d' U day of
~b~\..u~~ .20{)':>
Ut \...' "
~\(,,"- t~- ~Cv.-'<'-"-'-~~C\ "I.", ~I.-..--
Regil'te~ ~_ ().wS'c ~'\I;
No.21- 05'"-108
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2
. estote of Mae R. SWatll:
t Deteased
GRANT OF LEITERS OF ADMINISTRATION
AND NOW ~~ _:~ 2oQ.S, in consideration of the petition on the reverse
side hereof, s.tisfa""'l)' proofha~ been presented b<:fore me,
IT IS DECREED that Roy L Flint
is/are entitled to Letters of Administration, o.nd in accord with sueh finding, Letters of Administration
are hereby gro.nted to Roy L Flint
in the eslate of Mae R $WStll:
Register OfWills~~ .rs..;:;:s::;
Breit 8, 1Mlinstein.Esquire 78686
FEES
Probate, Letters, Etc. "'.,,__..... S
Will..."""".".."........___".. S
Renunciation"""""""...".... $
Short Certificotes ( ) ".."".... $
JCP""."......""."....."""". $
Automation F...._____..."'''.... $
Bond""""....."....__.........." $
~TOtal $
Filed~ ..3 20_
q() . (R)
Attorney (Sup. Ct. LD. No.)
705 W, Del<alb Pike
King of Pru..~. PA 110406
Addre.ss
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610.337-3733
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Phone
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- . Register of Wills of Cumberland County
BOND AND SURETY FOR PERSONAL REPRESENTATIVE
Estate of
Mae R. Swartz
No.
R-24476883
.
Also known as
Mae R. Swartz
, Deceased
KNOW ALL BY THESE PRESENTS, that Roy L. Flint Asprincipal(s) and
CNA/Western Surety Company as surety (sureties) are held and firmly bound unto
the Commonwealth of Pennsylvania in the sum of Fifty-thousand --------- dollars
($ 50,000 ) to be paid to the Commonwealth, for which payment we do hind ourselves, jointly and severally, our
heirs, executors, administrators and successors, the condition of this obligation being that if
Roy L. Flint as (state
fiduciary capacity)
Mae R. Swartz
Executor
of the estate of
, deceased, or any of them, shall well and truly administer the estate
according to law, then this obligation shall be void as to the personal representative or representatives who shall so
administer the estate and his or their surety or sureties; but otherwise it shall remain in full force.
Signed and sealed this
be legally bound hereby.
3rd
day of
T"ebruary
, 20~, each intending to
I_J .~
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N
c:::>
Q1* ;fr/~
Signallire of ersonal Represental1ve
C"")
Signature of Personal Representative
Signature of Personal Representative
c-
CNA/W'~~tern Surety
(
Signature of Bondin Agency
Attorney-ln_Fact
POWER OF ATTORNEY
Know:.lll M!!n by These Presents:
That tbis Power of Attorney is not valid or in effect unless attached to the
approving officer if desired. That Western Surety Company, a corporation, does
3, I authorized individuals:
D INDIVIDUALS
(Irrevocable)
BOND No. R- 24476883
A- A-
bond which it authorizes executed, but may be detached by the
hereby make, constitute and appoint the following
in the City of CARLISLE
lawful Attomey(s) in fact with full power and authority
one of the followin bonds.
An ORIGINAL bond required by Statute, Decree of Court or Ordinance for:
(A) ADMINISTRATOR REFEREE IN PARTITION
EXECUTOR COMMISSIONER TO SELL REAL ESTATE
PERSONAL REPRESENTATIVE TRUSTEE OR RECEIVER - In Bankruptcy (ExcJudlnli: Chapter 11)
GUARDIAN OF INCOMPElENT CURATOR
CONSERVATOR OF INCOMPETENT/CONSERVA1'EE
COMMITTEE OF INCOMPETENT
SALE OF REAL OR PERSONAL PROPERTY _ When this company has quallfying bond or when it is a separate
bundfor accoUlltlng of proceeds of sale only.
,State of PENNSYLVANIA , with limited authority, its true and
hereby conferred, to sign, execute, acknowledge and deliver for and on its behalf as Surety,
MAXIMUM PENALTY
(E)
COST ON APPEAL
(EXCLUDING OPEN PENALTY, STAY, SUPERSEDEAS OR GUARANTEE OF A JUDGMENT)
(8)
(C)
(D)
GUARDIAN OF MINOR OR CONSERVATOR OF MINOR
NOTARY PUBLIC RECEIVER (In Slate Court Only)
PUBLIC OFFICIAL AND DEPUTIES TRUSTEE (Te><\amentary Only)
PLAINTIFF'S COURT BOND -. Banks. Savings & Loan. and Trust Companies
(Except Restraining
Order and Inunction) All Others. except bonds rohihited by "NOTE" below
(F) LICENSE AND PERMIT EXCEYf BONDS WHERE THE UNITED STATES OF AMERICA, A FEDERAL AGE-TIlCY, OR A STATE IS TIlE OBLIGEE
(G) \)1)llds are authori.red where the state of
, ,.' ,
L IQtj "''''*'''..'''**'''** *** ****** "'*.,.*."'****** "'.*. ****
AUCtIOfi COM~AIIIY AHO AUClHIN 110USi: *****..**U"'.**
PRIVATe DEleCTI'll: .**.*..***"'*****.******."''''****'''
**************"'**.***************"'********"'*"'''''''.'''
**********.*************"'*********.**************
SPECIAL FUEL USERS
(H) ANY BOND OR INDEMNITY provided there is attached to. this Power of Allomey. written ,authorit;: in the fonn of an endorsement, letter or telegram. signed
by the SeruOt Underwriting Officer. Underwriting OffICer. PreSIdent. Vtce President. Asslslant VICe Pre_'ldent, Secretary. Treas.\lTeI or Assislant Secretary of Western
Suret co~anso~fu'~~~~~ ,...uthori:rir,g Its executIOn. For conflnnatlon of the necessary wonen amhority, please contact our Underwriting Department at 1-800-331-6053
NaIE: .' , j:'l) . /.QR OPEN PENALTY OR STAY BONDS ON APPEAL OR GUARAN1EE OF JUDGMENT OR BAlL BONDS OR CONSTRUCTION BID OR CONTRACf
,;''<saNDS OR BoNbs FOR DEFENDANTS OR UTILITY DEPOSIT RONDS OR StTE IMPROVEMENT BONDS ARE Nor AUTIfORlZED BY lHIS POWER OF ATIORNEY,
; ,'_> ~oepC;'~ : pf{lVi<;Ied';rt':$ection (H)
wf;StERN,.SUltttY.'C6MrANY further certifies that the following is a true and exact copy of Section 7 of the By-Laws of Western Surety Company. duly
~P!'ed arid now in force, .ttHvit: "Section 7. All bonds, polides, undertakings. Powers of Attorney. or other ubligatlOns of the COIporatlOn shall be executed in the
COrporattLllame of the',CctflPany by the President, Secretary, any Assistant Secretary, Treasurer, or any Vice Presldent, or by such other officers as the Board of
~i'ectors may authorize. The :President, any Vice President, Secretary, any Assistant Secretary, or the Treasurer may appoint Attorneys in Fact or Agents who shall
~vd 3\,lthority to j,ssue .b'm\li~~' poli.cies, or undertakings in the name of the Company. The corporate seal is not necessary for the validity of any bonds, policies,
untiertlllOv.g~,' Powers Qf: Atti'fliley or r obligation of the corporation. The signature of any such officer and the corporate seal may be primed by facsimile."
: EST ERN SUR ~; ; ~ ANY
~esident
"'IMPORTANT: This date must be t1lled in before it is attached
to the bond and it must be the same date as the bond.
Form 99-A-9-99
Thi -, j, lO cerlify that the information here given is correctly coricd from an original cerlificate of death duly riled with me as
1.,0(',1! Registrar~ The original certificate vvill be forvvarded to the State Vilal RlTords Office for permanenl filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fee for this certificate. $2.00
p 10900321
JAN 2 1 2005
Date
)
,
(.,)
i!~. 2'87
COMMONWEALTH OF PENNSVLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
..
Mae R. Swartz
.-~si ST~TEF'lENUM8ER
~~efllal~-'--I:~c;~~cURlnN~;8~R .-=--5771
.Ii _.... '.~'
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IDAfE OF 09,l'H ',Mc~lrI, !1l';'i:~~~,I........
I'Janua)'v 20:'?OOs
NAME Of DECEDENT IF,;StM';;;;;'.,-:'_J
UNDfR 1 YEAR UNDER I OAY '~1~~7~Dl~a81, R,J.:;I ~~~}~~~~(E,n'~'~,~>:?, ~H'OCACso, ',.,0: DEATf;,Ch",," (l"I~ on" ._ "'.I".(;I...."'_'<Jlt>e~"r.le""~ .
Monlh, Da~ f;OUfl !:, Minul.. ' .." L OTH-ER:
5. 89 Yo'$' ..12-4-15 .,Lexington, VA :~'"""'10 ERIOu\j>an.~1 [] DelAO ~~~H R.lodoofl30
. :~:::;;and k. u~;rRO:;;:~AIH l:ll~;:I:n:~:~t'cn'if:i'i::,wm~" 1~:[~~.n~~::;':~~=~1
DECEDENT'S USUAL OCCUPRION KINOOf BUSlNESS/lNDUSTRY "e~D;~~~~~~~~~~iN I -;_ ~IE~~ID~NT'S,~D.U~~~N"'I <l I ~~A~~~:~U. ~::~:.<l I
IG...km<lol"""kdo<ledu"ngmool 1 -. -
ol......kll>o;1lh; do rlIII use ,el"OO) 1] LX IE*,,-nt;'(1se<on~ary r Col...... L [lMltced(Spec.lyl
11'. Homemaker 1111. 12. Yu. No u.11 2) (140/5>1 1.. Widowed 15.
OECEOENT'$MAlUNGAOORESS(St'eool,Cdyffown.Slal.,bpCOd$l Il,DECEDENT'S P 1 . c, U,)De All
100 Mt. Allen Drive ACTUAL l1e.Slal.~SY van18 Did l1C.lJ\IYeI.~liYedin r en
RESiDeNCE <IIl<:""~1
IIS....,n'ln..<:!Ion1 10""..,
It.Mechanicsburg, PA 17055 jOl\OlhnOel l1b.Coun'" Cumberland IOw",nil>? 17d.0 ::=:::::el
MOTHER'S NAME ,F,,:;! M.dalol, M~I,*\S"rn""'el
Willie Mae Lindsev
AGEllast8.-1Mayl
~=Iy)D
I~ACE - Am.,",." Indian. CIlKk. Wl\ft., .Ie
ISpeedy)
10. Whi te
SuRVlVING SPOUSE
11110'., ~"'tlma.oenn""'e)
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FATHER'SNAUE(f"Sl,M"l(1le,l3",)
...
lNFOfIMANT'SNAME (lYP8'P"nl)
Haywood T. Flint
...
INFORMANT'S MAlUNG ADORESS (5I'eel, C,ryiTown, $l...., Iii' COOe)
,~. 30 RaveD Drive Colonia NJ 07067
PLACE OF DlSPOSITION. N&m4toIC.......I.ry. C"malOry [OCATION. CiryflOwn. Slals. Zop Code
O/onNI/P1ac.
,,,Rolling Green Cemetery". Camp Hill. PA 17011
jNAME ANO ADORESS Of" FAClLlTY
1",Mvers-Harner FH 1903 Mkt St CH PA 17011
liCENSE NUM8ER I~ATESIGNEO
[MonltLOaV.Y'Oll
2311. 231:.
WAS CASE RE'FERREDTO MEDICAL EXAMlNERJCORONER?
~.O
...G:V
_.
METHOD OF DlSPOSlTION ] I~ATE OF DISPOSlTlON
. eunat~ Cr_IQfIO R""""'all,omSl&I.0 (Monln,Da~,YearI
. ~_O Ot.....(Specty, 0211>. 1-26-05
. SlGNATURi'OFF\J~RVIC~~ORPE) SONACTINGASSUCH lICEN5ENUM8i::R
.1_.. <7~ ....."'''' ,...01275S-L
Complal.".....~nIywhen~rt'tying TolheboolCelmyknowllll!ge.deatnocc"nlldall!>elim...dal..noplac8.laled
p/lyaiclan_noIav. .....ll_ofdt..1I10 (SognaltJ,eandhle)
caon'lyc.a....oldtll. .
,...
n..... 2.-28....... boo tompltl'" by TlME OF OEATH lOATE PRONOUNCED DEAD\Mu.'lh. Day, Yea,)
pellIOnwhopronouncNdtalh 24. If. 05 A.M In. JOl'\.IAa(v,Jo ~-oS
27. PAftT I: E,'Il"lh.diHU",inju'..SOICQmphcabo.."whichcau.e<llhedt.th Do 1101 9nt.. tne mu<l''''dyi''ll,...enasca.&iacQf'.SjIi,alorya''''I. sho<l<e,l\ea"l ail",.
lOllONfonecauH 00 hC/'l1ine
Roy L. Flin t
IIlMEOlATE CAUSE IFonal
d_orcOflOllOl/\
'-.g,n_)_
ASc...v()
DUE TO lOA .0,5 A CONSEQUENCE Of)
"
'Awro.imat.
:im.rvaI_
lansetanddtllh
,
i
PARTtI:
Otn.,signitlcanlQOndilionoOllfll.ibullnglOdnlh,bul
nol'.....inginlllllundefttinllCl...giwnirlPARTI
$eque<olialtyliMcondilioN
i'any.-..g..._l.
cauM. EnI..UNOERLTINC]
CAUSI!lo.-O/",lU'V
'1IIaI~_
'esuIII\Q "'_I LAST
-S AN AUTOPSY
PERFORMED?
.
!:
WERE AUTOPSY FlNDlNGS
_LA8lEPRIOATO
COMPlETION OF CAUSE
OFOEATH7
DUE TO(OR ASACONSEQUENCE OF)
OUE TO(OAASACONSEOUENCE Of}
"'ANNEROF OfAH1
Nalur.ol
~
o
o
DAIE OF INJURY
(Muurh,lJav.'fllarl
TrIolE OF INJURY
INJURVAT WORI<?
OESCRl8E HOW INJURY OCCURRED
110m,e.
o
o
o :~;CEOFINJURY Alr.om.,lirm~;e.l~!~ory,olflc. Iol.
building. e1e, ISpoc,I.1
,~
'" 0
~O
~. 0
~ui
--,
Pan4in\l'n""sCig.tion
....0
'00
Su>cicle
Cooldnofbed.l.rm,ned
,
ILOCATION (511_ C,ryllown, Sta18)
bOlo
5lGNATlJREANOTrTlEOF CERTrFIER
o ,.. .($l Q):L, 0\ G rr-i., ",{)
_ lICENSENUIol8ER . '11 E:- IOATE,SIG~Ollolont!l.Oy.~a'\r
L~ ",fl\{) 0 \., ).. I".. I / ')..0 II l'-,
NAME AND ADORESSal' PERSON WHO ~9)-IPlEIEOC..w~ ~ DWli
111em271TypeOfPUIlI Pl.... #~'O'- I~C'-'L'<-/'"'1-U
J Cl8 (..oeWiJ\t:,.C,"Sjt
LeV/oYNIIi, ;1/\ If 0'-/5
".
DATEFllEDIMonlh,Dav""all
,~.,.l /. .,,(~?',['
a... Uti.
CERT.FIEflICI'>"""ono~onel
'CEflTrFYlNGPltVSlCIAN (PhyS"""nC...-I"Y,ng causeo' <lo>atl> ""''''' aMtI>ar phy"'"'dl\has plO"ooroced tJedlh aMcomp'810<l1l....... 231
TO.....be$loIIIIYknowledll..d..lhoccuo'J'IlOdd...lolh.c.u..(lj.ndm."...'...I.ted..
...
'PRONOUNCING AND CERTlFVlNG PHYSICIAN (Phys>c,an bOlh ",""ouloc.n~ us.'1l a~d C"l,ly,n\jlo ca"'a 01 Oaalh\
To tIM bul of "'y knowr.dg., l;Iealhoccufted .1 11'1. Ilm., d.le, and pl.ce. .nd due Ie lh. ceu'.(IJ.nd m.nn.,.. ...l.d
'MEDICAL EXAMINER/CORONER
On Ih. ba,l, 01 ,umin.lIon _OOlor Invesllgation, in my opinion, dUlh oecllfted alltl. Ume, dat_. and place, and dlle 10 Ihe eall~t1\s) and
31am.nn.r...lal".... ,.... .. ...; .... ....... ... .......,............ ..... . ...'.-,-..........,........
AEGISJI?)JiSlGNATU~~ifEf' ~ .
'I14"';t.;n... / :/ J(P24! kx', /P(, /, 1
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