HomeMy WebLinkAbout02-11-05
Estate of BARBARA L. CROSSLAND
also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No. .2/- 05 -133
To:
Deceased.
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Social Security No. 186-34-0370
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appliES
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with
h ER last family or principal residence at 236 WALTON ST. LEMOYNE BORa CUMBERLAND
(list street, number, Twp. or 80m.)
Decedent, then 61 years of age, died 1/25/2005
at 236 WALTON ST.. LEMOYNE BORa. CUMBERLAND COUNTY. PA
Decedent at death owned property with estimated values as follows:
(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:
236 WALTON ST., LEMOYNE BORa, CUMBERLAND COUNTY, PA
$
$
$
$
6.000.00
50000.00
Petitioner after a proper search ha 5
the following spouse (if any) and heirs:
ascertained that decedent left no will and was survived by
Name Relationship Residence
34 WEST GREEN STREET
ALFXANDRA M. GREENFIELD DAUGHTER MECHANICSBUR PA 17055
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THdlliFORE, petitioner(s) respectfully request(s) the grant oftetters of administration in the
appropriate form to the undersigned.
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11: ~M. G NFI~~
34 WEST GREEN STREET
MECHANICSBURG PA 17055
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYL VANIA}
SS
COUNTY OF CUMBERLAND
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 affir~~ subscribed
~re me this day of
'1i~~:'~~'L:~"\--n' ."
. Cu...o"t- Register
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No. ...21- os- - 13~
Estate of BARBARA L. CROSSLAND
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW
the reverse side hereof, satisfacto
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
c::l..txJS- , in consideration of the petition on
proof having been presented before me,
are hereby granted to
ALEXANDRA M. GREENFIELD, Administratrix
in the estate of BARBARA L. CROSSLAND
FEES
Letters of Administration. . . $ \ 35 . CI.:)
ShortCertificates(3 )...... $ 12.00
~oia1i8Il.~~\~. $ 5. <:)C
~~p $ II). fit)
TOTAL_ $IW.Qu
Filed.J."": C\. ~ 0$ . . . " A.D.
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~ Reg;sterofWil~ ~
~-:s.roNE
#39785
ATTORNEY (Sup. Ct.!.D. No.)
414 BRIDGE STREET
NEW CUMBERLAND PA 17070
ADDRESS
717-774-7435
PHONE
)I;i\".~i\' In:v Iii.\';
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will he forwarded to the State Vital Records OtTice for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for lhis certificate, $6.00
p
11332~j67
No.
thn- /1 tf:'~
Local Registrar
JAN 3 1 :'105
Date
'.~
IOS.1<<Rev,11ll1
..:2/- OS- - /33
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
#29-430
NAME OF DECEDENT (finl. MiddlOl. LallI)
1. Barbara
AGE (\..8IiI Bir1hdlII'l UNDER 1 YEAR
..... ....
Crossland
,..
2. Female
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lIWEFILEttlJMBER
SOCIAL SECURITY NUMBER
186 34 0370
DATE OF DEA'J'H(MonIh. DIly,.....)
4. January 25J 2005
s.
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(HDf5+)
61 y,..
UNDER 1 DAY ORE OF BIRTH BIRTHPLACE (Cky and PLACE OF DEATH (Chook onIV ()"lll _ in8lructiona 00 oIh... sicIlI)
Hourt MInul_ (Month. Day. \"88r) StateDfforeign Counl'l'l HOSPITAL:
Dec.16J1943 LemoyneJ PA InpaIlItI"IIO E~iIInlO
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CITY, aoftO. TWP OF DE~H FACILITY NAME (l1 nol inslilulion, gi\i1l 8I'eel and oun'lber)
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Cumberland
Lemoyne
236 Walton Street
DE S USUAL OCCUf'lIlfION
(G!vtiklndol\lllDfl<a;..,.dl,lringmoll
Assrllt"mfl"~l".".'"
KINDOfBU IN
Wl'.S DECEDENT EVER IN
U,S. ARMEDFQACES?
. "..0 Nolf]
..
171.$w.
DECEOENT'SEDUCA11ON
"
EiIIm~~ry
1. {G-12} 12
Fed. Gov't. FoodSv
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DECEOENT'SIIIIAlLING AOOAESS (SI""". CitvfTown. SIate,lJp Code)
236 Walton St.
Lemoyne, PA 17043
.e.
FotITliEA'SNAUE (F..L Midde, LIlli)
DECEDENT'S
ACTUAL
RESIDENCE
(Saelnslrucliona
onolher8idej
lAAAlTAL STJIItUS. ManWd
~M..-riIId,~,
"'-'"'-'"
divorced
SURVMNG SPOUSE
(l1wih1,givemlldlonllllll8)
17c.O'lW,~Ilv.d'"
FA
Cumberland
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liwln.
towllllllp? t7cl.1XI~~=oI
MOTHER'S NAME (first MiddfI. Mliden Sul"lIlIme)
,
11. Miriam Miller
INFOfl"fANTs MAlLIHGADDRESS(SlfMl. c~, Sl"- ZipCQdel
. J4 W. Green St. Mechan1csburg, PA 17055
PLACEOf"DlSPOSIT!OH-N_of ,c..mltory LOCRION. ,Stni,ZIpCodlt
DfOlhll'PIIC;l
Gon-O-Lite Crematory Schaefferstown, PA
21~ ~
NAME AHD ADDRESS Of FACILITY
ufarthemoreF.H,&C,S.Jlnc.NewCumberland,PA 17070
LICENSE NUMBER ORE SIGNED
(Month,OIv.Viler)
''''.
Reynold I. Martz
Alexandra M. Greenfield
UETHOO Of" DISPOSITION
aun.JOc.....~RIrrlovalItumSttqO
--..
LICENSE NUMBER
"b. FS-012849-L
To~bMloImy ~,dNlhocc:......-.dMlllllllml.d.te Indplll~aw.d.
(Signalurlanctndaj
....
TIME OF DEATH prx . ORE PRONOUNCED DEAD !Mordh, Day. 'IN.)
24. M. January 27, 2005
2'7.PIlRTI: Enl..tNcIMaMa,ln/urlMor~wtlIChCIIUMd1hlid8alh.DonollllllltN~ofdylng,IUCh&lc.rthc;orrnplrllOrv'''',lIhocIcorhnr1fdur8
LiIlonlyoneca.-on~HIlI.
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Alcoholic Cirrhosis of Liver
DUE TO (OR AS A CONSEOUENCE OF):
DUE TO (OR AS A CONSEOUENCl: OF):
OIJE TO (OR AS A CONSEOUENCE OF):
,
WERE AUlOPSY FINDINGS
......l.ABL.EPRlORlO
COMPt.eTlONOfCAUSE
'" DEATH'
MANNER Of DEATH
OAT"E Of" INJURY
(Monltl.DaV,\"88r)
Pi
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TIMEOFINJURY
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17088
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Wl'.SCASE REFERREDTOME}t"""
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,Appraxlmlll PIlRTII:
linltmllbllw-. nol
!OlIMtanddHtll
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Couldnolt..dettormlned
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o .
o PLACEOFINJURY'A1homl,larm,etl'8Oll.l~o~
building. llIC. (Specily)
,,,.
Nature!
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211. 21b.
CERTII'IER{ct>eckonlyonej
"CERTIFYlNO PHYSlClAH(PhvIiciiulcertifv''lgC8lJl801d8B1hwhetlenolh..-phvacianhesprcnounoed daalhendcomplBt<od 111m 2i)
To........oIl11Y~dMttI~...to...cMIM(-Jendmen...r&ldMed. ..... ...... ....... ....... .....
'1"l'lONOUHClNG AND CERTIfYINQ PtfY8lCIAN (Physiclan bolh prDllOOndng d8B1h.rId certifying 10 cause 01 Oealh)
To"'bsIIloflllY~.""'oe>curndlSt...tlIIM.Hte,andplloc.,lndcru.tothlClUH(')lndmenne,..dMed
'MEDlCAL EXAlIUNEAlCOAONER
Onlhe .....oI..Ill/Ylln.atlon -.dIor In"",lgaUon. In myoplnlon, d.alh OCCUl'fedallh, 11111', data, and place, and dU.loth, UU"{I' and
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t!i'(.,.i, Ii/I
SlGNIl1UREANO
O ,CoZ:.o'ner
SIb. . .
LICENSE NUMSER DATE BlGNED(MonIh. 0.,., Vurl
0310. 1 Januar 28J2005
NAME AND ADOReSS Of PERSON WHO COMPLETED CAUSE OF DEATH
(Hem 27) Typaor Prinl Michael L. NorrisJ Coroner
6375 Basehore Road, Suite #1
Mechanicsburg, Pa. 17050
OREFlLED(Month. Day, Year)
~..
DESCFIleE HOW INJURY OCCURRED.