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PETITION FOR GRANT OF LETTERS OF ADMJNlSJM'J",Q~c
", "1 r ' . no' . , --' , \\__/.__ ... -,
Estate of ~,jI ff-~ e S/'?'/ rlf
also known as
~)-O 5-1 ~3
No - f" l'i. C:4
. "l!j,( r::~~ ~}~t;: ,:~ ..)
To: L.jiJJ t ,_Cj .....
Register of Wills f<)f th~. ,/, ;
County of~;n~H'477")JJ"tl~e
Commonwealth of t>~rmsylVa:.rtta .;.: :
Deceased.
Social Security No. ./ 9 ~ -/1' - /7 ?tS-
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl r
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 a,V ..?1 ~ ~..v L County, Pennsy-lyania, wit~
h ar last family or principal residence at -1 CL'~~/.Z.. S'r-.. .4) T; ~ ~//,,yp
?/l / ~ crt 5 (list street, number {nd municipality)
Decendent, then Be; years of age, died ..7';>,J~~ / <::: '. , g O~
at ./tf'. -5f::) S' / ~ ",y~. c;>.6~'; ~~ev5', ~Yr. . /;:>-17 I ::;-// .3 .
, ,
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: -4 C~ S)
a..-........ c. ~ ~ -
j
j
Relationship
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Lf)
~4~
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } 55
COUNTY OF &//J~~/Y'c!
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
~re It thh ~ tf!.
}VIJa~' j(j
. " ~11kegister
No. ~ /- 05-1 f 3
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Estate of
~/V/V4-f, S/Yl/~
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW P \ZB R u PrR.. " z. -1 ~~, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me, ~/
IT IS DECREED that ~7---' e, >.-/~.< ~.z Gi..-?--::? L., ~"/,,?
~/are entitled to Letters of Administration, and in accord with such findlOg, Letters of Administration
are hereby granted to .Ko :14-h
.e, .s""h?? r-~ ~l d;~/2...J
e--:--~~-~ ';:>ece/J-sc0
L, C...-:n... '17(
in the estate of
/J------"9-
Letters of Administ~~:~ ..... $ ~O' 00
Short Certificates( ).......... $jI-
Renunciation ....."... M . .. $ .
~y ~ $'
TOTAL _ $
Filed ..................... A.D. 19_
.}jll[J[JJU~~
r ~ffl1~
k;)/;"In S;,f~/ed" .#:27'?3S-
ATTORNEY (Sup. Ct. J.D. No.)
-L N. #CA'/6r;. /~, A:?S-
~,z.{.Ji-4.. ADDRESS' pP9- /9P1 ~
7-/7- -?-~3 -383/
PHONE
Register of Wills of Cumberland County
RENUNCIATION
Estate of
Also known as
~~NA E. SMITH
1-1-05-ol~3
No.
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned
Affkm.w-and subscribed before me this
J~ay-of F:r2tf/'v~ ,
~ Lf2
~r. ~
A ~, ~
Notary Public
VT~KT SMITH dauihtcr
(Name) (Relations ip) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters -of Administration
~~~ed~ my hrn~h~rs, Ro~er E_ Smith and Cary L. Emith
Witness my/our hand(s) this I ~ of r.-/~~"'1 /"'-1 ,20 d-.S
t' .
~U~
VICKI SMITH . (Signature) j) 'S
/dOJyJV3 //l/)/O~S~fQ )~tf741
(Address)
My
(Signature)
NONW. SEAL
WllMM s ClWEls
~"'EIIOIOUGlH.~~COUNI'Y
Or "'~I r IJ ._Oct"... 'I
Affirmed and subscribed before me this
_ day of
(Address)
(Signature)
~()
( /Registet of Wills
(Address)
C',:
Depu;ty:
({J
C-"" f
(SignatureaJ1dseal of Notary or other official
qualified toildrninister oaths. Show date of
eXJ!!~ration of~otary's commission)
1:;:::.-,::)
(....,' ~
..,~
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z
Register of Wills of Cumberland County
RENUNCIATION
Estate of
ANNA E. SMITH
2.1 -- D5-1 fj
No.
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned JOSEE HA WBAKER daughter
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters
be issued to
~mith and Gary l Smith
rljL __
Witness my/our hand(s) this / r -day of h kv /?ri ,200'.5
~&~~ .
oy' ~ fJA"lcl1 SI.11t//lalt~ ~6fLJ_
(Address) 0- fb ' /)0:,5
of Administrtttion
my hrother~, Roeer F
Affirmed and subscribed before me this
/r day of ~~
----
M~'
Notary Public
~
My C~.... ilii:~- Pxpires:
f,.(HAI.'I.,
(Signature)
'i'IIIA"" ;,.
WI'OIV PI.l .,1<.
rJf")1 -I'~"""'I
' .r./ \("
Or (~")6 Jet 19.2008 j
Affirmed and subscribed before me this
--"
j
(Address)
_ OJ
ftCl......L tML
....... ....
....., IIl.Mc
.... Oct It. 20DI
(Signature)
-
, ,.....
e
...
Depu..~
(Address)
(,';
(S~griaturearidseal of Notary or other official
qu,~lified to ~Il1inister oaths. Show date of
ex::pij:ation ofNptary's commission)
C"',J '", ,
~ .C v__
Register of Wills of Cumberland County
RENUNCIATION
Estate of
Also known as
ANNA E. SMITH
No. 21 -D5 -lr 3
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned
OT A NF ~OTFT T 0 da)l~hter
(Name) (Relationship (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters
be issued to
of f~dministration
my brothers, Roger E Smith llnn Gllry T ~mitb
Witness my/our hand(s) this J 0
dayof p~ ,2005':
~,:' -' . Jw~ A~~-' ~
(Signature)
Affirmed and subscribed before me this
10 dayof F~
;).00-)
~~}<7J~
Notary P lic
DIANE SOTELLO
(Address)
My Commission Expires:
O~9-?)J.()OB
(Signature)
Or
(Address)
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
(Address)
Deputy
In
tr)
(Signature ahCi seal of Notary or other official
quaHfied tbMminister oaths. Show date of
expiration ~NQtary's commission)
(-")
COMMONWEALTH OF PENNSYLVANIA
NotaI1aI Seal
Tanvny Kay Meals. Notary Public
Mt. Holly Springs Boro, Cu11berIand QxM'lty
My Commission Expires 0cl29, 2008
Member, Pennsylvania ASSOCiation Of Notaries
Register of Wills of Cumberland County
RENUNCIATION
Estate of
Also known as
ANNA Eo SMITH
"2.1-05 -' Ig5
No.
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned Raymond Smith Elon
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of l\dminiotration
be issued to my hrnt-hpr!': 1 RngPT R
cG) '(f..f
Witness my/GUIO hand(.s) this ~ day of
S~ith and Gary L. Smith
Affirm~nd subscribed before me this
8AaYOf~. '
k~ ~
Notary Public
1C-8~7,20 4S-
J -
~Aa~f_L~
RAYMO D SMITH (Signature)
9JfJ~/~ ~JOCV
4Address)
My~
O~~;.","'
(Signature)
NONW.IIAL
WIWMIIIWaS
CM_..ouatI.OllIHMlftCOUNlY
Or "'<:1 _.L.!lf ....Oct19. zoae
(Address)
Affirmed and subscribed before me this
_ day of
.u::L-
tC)
(Signature)
R~gister ,0fWills
(t:
D~ty
('.I
(Address)
,"'.......,
. .......:..
, .,""'''.
,..", . .
,. , '
(S,i~ature arid l[~al of Notary or other official
q~nfied to administer oaths. Show date of
expiration of Notary's commission)
Register of Wills of Cumberland County
Estate of
Also known as
ANNA E. SMITH
RENUNCIATION
2-1-D5- If3
No.
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned JODfE GAT J,OW A Y c1::l1lghtpT
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration
be issued to my brothers. Roger E. Smith and Gary T, Smith
'1#
Witnessmy/ourhand(s)this <9 day of r~/2U~ ,20 ~
~ed and subscribed before me this
h day of N:.brl.J.-C.lfL~ '
~d~~~
No ry PublIc .
My Commission Expires:
Or
Affirmed and subscribed before me this
-tf7 day of
--10..
Register of.\ViUs
C'~I
Deputy
L/"::,
(Si~ture and sbit of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
~t&V~::tte)
1(/:3' 5, 8a{l;t~CY1i ftue.
(Address)
/fYJ.fi, tI~ ~JA1/ ;Oct') /70to:;-
(Signature)
(Address)
(Signature)
(Address)
05.805 REV 9/86
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 be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph. '3
11 ~ 0 5---/ g
No.
~~. ~b,)..~~~
Local Registrar
Fee for this certificate, $2.00
p
11018159
JAN 1 9 2005
Date
f",.~)
en
(J"t
H105.143Rev.2JB7
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
'PElPRlHT
IN
RMANENT
LACK INK
,. Anna E. Smi th
AGE (laal Birthday) UNDER 1 YEAR UNDER 1 DAY
8 9 Yra. Month. Days Hout8! Minutes
8WE FIlE NUMBER
SEX SOCIAL SECURITY NUMBER
..Female 196-14
NAME OF DECEDENT (F1l'St. Middle, la8I)
BIRTHPlACE (City and
Stale or Foreign Country)
..
COUNTY OF DEJ(I"H
Dauphin
...
RACE . American kdan. Black, WhIte, etc.
ts_
White
,..
DECEDENT'S USUAL OCCUPJQ"ION
~~I~~U:r~r~
SURVIVING SPOUSE
(II wiIl!!I, givemaiden name)
!z
w
c
w
o
w
C
lL
C
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z
4 Cedar st. 17065
,~t. Holly Springs, PA
F1JlfER'S NAME (FirBl, Middle, last)
15.
INFOR
Old
decode'"
Ilveln.
_,
....
17b.Cou
oily......
RemovaIIrom Stilt. 0
fil
"'
=>
~
::l
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NoKJ
a-.-~ VC'-?JrJ-- a~
DUE TO (OR AS A CONSEQUENCE Of):
21.
I Approximate
I IntIN'Vlll betWeen
\ oneet and death
I
I
PART II: Other sIgnff\cant condlllon8 conlributlng to death, but
not resulting In the undefIyIng cause given in PART I.
t :
DUE 10 (OR AS A CONSEQUENCE OF):
DUE 10 (OR AS A CONSEauENCE OF):
WERE AUlOPSY FINDINGS MANNER OF DEATH
A\AILIoBLE PRIOR TO
COMPLEllON OF CAUSE KI D
Of' oe.<rH1 Now"" _de
AccldenI D Pendng Irweal:lgatlon D
YuD NoD SUlclde D Could not be determin9d D
O,llJ"E OF INJURY
(Month, Day. Veer)
TIME OF INJURY
INJURY /fJ WORK? DESCRIBE HOW' INJURY OCCURRED.
\'eo D NoD
2Ib.
CERTIfIER (Check only one)
-CERTIFYING PHYStcIAN (Physici8n certifying cause ol death when another physician has pronounced death and completed hem 23)
TotbebMIofmyknowledge,dNthoccurNddulllotbeca&.lM(a}8ndftUlMel"_.&ated...,..,.".......,.,..,.,.,..,..,.... .
21.
. ...
PlACE OF INJURY -At home, farrn,lltreel:, factory, oftlce
building. .... (Speclyl
-,
lOC/fJlON (Street, CitylTown, Stale)
-MEDICAL EXAMINIERfCORONER
On the buIa of eumlnatian MdJor InveetlptIon, In my optnlon, dnth occurred" the time, dM., and place, and due to the cauH(a) end
m....ner......ed......,..."."...............,.......,.....,......................,.,...,.....,.,.........,..... .
318.
REGISTRAR'S SlGNRlJRE AND NUMB~. . . c.
.., LJ.U- ~. ~~~
,/
l.:).1( hl.11 Id
D
D
-PRONOUNCING AND CERTIFYING PHYStcIAN (Physic:ian bo(h pronoundng de8th and cer1iIying to cause 01 de8th)
101M bMtotmy~, dNth~..the....,....., and piece, and due to 1M ceuH(a) and ...."........,.."..,.,.,.....,.....,
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