HomeMy WebLinkAbout03-07-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of
a/so known as
I/AR62b
11, 'k/-< fA-
No.
To:
~ 1- () 5 0 [Cjq
.
Register of Wills for the
County of Q;, "" c" >( \6 ~C\ in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. ,I If 9 -;;. r;, - .;;, 10
The petition of the undersigned respectfully represents that:
Your petitioner(s), who islare 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 C,-( M b e r ! A A/ D County, Pe,nnsylvania, )Yjth
h last family or principal residence at <'/"0/",,11$61.{ /Q;), !Ie,,{tl, (~..e c.e.-;'1 (ell:!.....
, (list street, nu er and municipality)
Decendent, then 71 years of jlge, died t:~1 :::: ,10 ~s-
at .) ),'4'h"'Sb<.oO? '" 6/E....fJl'-t, (>"'.1'1'" __~('_
I d
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:
$-I1;y
$
$
$
'i'{' I, Q Y
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
/0/1
e
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of admi1:"f..' tration in.~he
appropriate form to the undersigned. . ;,';'::;:;
'-.,)"J
,
.
.".
u
"
v
i13
V"
a:V
"
-00
~''::
<';1'0
3~
V~
~o
"
"
"
V5
-YW- Co ~~O--
, .
(/
::~)
/",
,
C,)
~.tJ
-.~ j
FS5
C)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF D,)""~\~,,,~
} 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.
Sworn to or affir~ and subscribed f +-. CJ.L
before me this ,C:;; day of //
:m:e~rg~'k W_ t/
."> ruV\. /In....~ I
~ '-\r ~ Regist l
lll~
12- ~Ja.
~
~
~
"
~
::l
..
C
OIl
<Ii
No. ;Z1-05- 1Cl,C\
Estate of \-\Q5\o'cl
NI, I<\A \0
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~..c Ir-.:?:' ,:)r-nS W_. in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that :\ o'n " '" {Y\. Ku \0.
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to \,,"'''"' "" '0f\. '1<."'-\0-
in the estate of \~ ,.\ .'1'1\ ~ '1<,,\0.
~- CArolel
\.... -
"''''-,,~'<:(.,...... FEES
Letters of Administration
Short Certificates( )..........
Renunciation ................
-.lQJ' $ 10 .C~
TOTAL _ $ <:ie. CO
Filed 3.-.3..-PR......... A.D.~_
,kJX.tnrlr. ~()J\n <-' 1tnnJ)~OM1
Register of Wills ~. . . t-
.~
5.00
$1..\500
$dD.O<O:>
$ \D .00
A ITORNEY (Sup. Ct. J.D. No.)
ADDRESS
PHONE
In Re Estate of
c.u m..be r /a /Jd
~rgistrr of ~i1ls of ~lll1' tlf aIouuttr, 1f1ruustrhnmin
~ruuudntiou
.HO--y'dd. .Ml'.I':C.L<iCL-............................
deceased.
;BI1ytrtU13, +faxo./d.. 14 ikC-C!.aJ.... late of CL{mb~r.'~nJ.....
(!,cnt,. ntV. . . . . . . . . . . . .. ............................ died . /(J.- testate, where-
by the right of the jdministration of the said estate devolved upon :.J o.h.lJ. . M./.k. U./q,..)
.ca1.~J Sharp.!eSS... a.n.d J)tlJO(~s.. J3.1./z.2-ard....
as the {jIcJ.m;rJ.j~trcLt(),rS.. of the said estate.
~ofu ~uofu, for divers good causes and considerations to . . YfJ.e.. . specially moving
. . . . X. . . . . . . . . da hereby release all . . . . m.y . . . . . . right and title to the administration
of the said estate, and would respectfully recommend the appointment of . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . cJ (J. h fl . M./.I:< u.l Q. .. . . . . . . . . . . . . . . . . . .. . . . .. .. . . . .. . . . . . . .
;BIitUt1313 .... .ml......... hand this W~~. day of ~./~. .,~.O~.
(Signature) (Address)
~ t~....~.t~..~~/.~f!4.r~~O)
~.t~.~.........................................,I,.....::....'.'
~'" 9n~'J.fA. J.$~9.!......................................... :... Gl
~~"':'; ~,)
Cl
................................................................................."... .
swam to and Subscribed before me
............................................................................ ..
~ 16th dafllFebVj;~o5........_.. _
.. . ..1;0' ........~................ ...... .' '. '.' . . . . . . . . . . . . . . . . . . . . . . .
r~ . .'.. ..... .
RW7(,89).'..'::c~ '~'.o,
eiJJ7? b er / () I?d'
~rBi$trr of ~iU$ of ~ (!fOUttt!!, Jetttt$!!hmttia
~ettuttdatiott
In Re Estate of . . Hartl/d. . .lvJ.LI1.U!Q........................... deceased.
;m4ereas, Ha (oJ d . M; f{U(CL . .. late of .Cum fx:r / cznd . .
. t!..{).Un.1j!. . . . . . . . . . . .. ............................ died .1.11 7" tes~ate, where-
by the right of the administration of the said estate devolved upon .,,)oh /7- .1\1 / kJ.QJ,
.(!ar.-Ci( Sf^lo. rpJ CS.5... .and .])6. / ores 13/12 .La.rd....
............................................................................. .
as the a.d. m.i.(). J :S.tV'.aJ~O.r. s. . of the said estate.
~l1fu ~nl1fu, far divers good causes and considerations to . . m. e..... . specially moving
. . . . . . .r. . . . . . do hereby release all . . . . m y. . . . . . . right and title to the administration
of the said estate, and would respectfully recommend the appointment of . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . 0o.h.n . ./Vl.t/x uj ~ . . .. . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . .
~J ?-':_ / ..2. &> C S-
;mttness .....rnl......... hand this ../p day of .:-.4"..C!~?(..('t.7,J:9.....
(Signature) (Address)
~.~.~ ~~E.;;;3L~~~~~........ .E:-..~ ...-2i.8X. .~~.
STATE OF ARIZONA } 88. ~. ? ' .... (;" ::~".,
::OUNTVOFYAVAPAI . . ~ p-. ',' Z'
. .. . I 1 rumBntwmcknowl ~~ty e. l'tl1US~i5Jj........... . ~ .-'r .;;;;.~ ;;;.~'t; ?t. ..1
Iloess ereol rew' set my hand and offiCial seal . -[1
......... . .. . ..NOTAllY.PUBlIC................................,....:;....
, . ' -..-
J t'.,j
, ..
C::J
............................................ .
........................................... ..
............................................................................. .
RW 7 ('89)
Ij Wi ~n'i 11.1\ ].'I!'
This is 10 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.
No.
Ifllllffllll""""'",,,,,,
\I\lll.l~~\.\" OF PEj,"--,...._
",~.r.-.."
/~~!!ft. ~\
~:tEI, .. I~;::
~ ~I ~1I;~: . !i:~
'*~"" ".::'2"*l
;.4.' ,,(.~\'
~~. ~\\\
'".!-ft" --~(~\.'f",'"
-'I"",,:"fNl \\ Ifllll
"""""""",//1111'
(]~W~A.
Fee for this certificate, S6.00
Local Registrar
FEB 11 2005
P 11388118
Date
::,,]
<.J
r".)
o
H105,143 Rev, 2187
;21- 05-\QQ
COMMONWEAL.TH OF PENNSYL.VANIA' DEPARTMENT OF HEAL.TH. VITAL. RECORDS
CERTIFICATE OF DEATH
TYPE/PRINT
"
PI!IIlMANI!NT
BLACK INK
"
z
w
c
w
o
w
c
.
c
w
.
~
NAME OF DECEDENT IF'I'II. Middle, Lilt)
,.
AGE (LaIIBi/1Mey)
'"
2, Male
STATEFIL!NUMBEIl
SOCIALSECUFlITVNUMBEFl
~. 189
26
2610
MQnlhl
I. 71 YI'I
COUNTY OF DEATH
lb. Cumberland ..l.. I
DECEDENT'SU$UALOCCUPATION
.~~<lO~."t;~,:':i"'
111. Never Em 10 ed l1b.
DECEDENT"SMAILlN ADDRE$S($I<8el,CltyfTown,~lele.Z'p
. 121 Walnut Bottan Road
Ie. shippensburg Twp
KIND OF BUSINESS I INDUSTRV
MARITAL STATUS. Married,
Ne~'V~~dl's~~?;;'ed,
14.Never Married
l1a.Slllla
Pll.
Did
dacedlnl
liII.lna
IOWMlI1lp?
17e. [gI V.s, dlCedent Ilvad In ShinnP.n!'lhllra
17c1. 0 ~~hl':;"~~~11~i~ or
.,
17257
11b.coumv
Cumberland
citylbolo
~
,
~
o
<
MOTHER'S NAME (Flrll. Mlddl., Maldln SlImilma)
18, Amelia Bashnan
INFORMANT'S MAILING ADDRESS (Slm!. CityfTo....n. Slat., Zip CCldeI PA 18301
2Ob. 4 Kiwanis street, East S-croUdsburg,
PLACE OF DISPOSITION-Nama 01 C8mllllry, Cr""'810ry LOCATION-C'lylTown, Slata. Zip Cooe
o.-OlhafPlece
210. st. Mary. s Cemetery
NAMEANOAODRESSOFFACILlTY
22c. P
LICENSE NUMBER
noP,Jv3;2.13C,(;,L
'k
WASCASEREFERREDTOAMEDICALEXAMINER/CORO ER?
2t. VIS 0 Nof::J
: Approximate PART II: Olher lign~":anl cQr>dltlon. contributiMg to daalh, bul
:'nt8rvllbalw. nOlre'u~lnginlhaunde'lylngc,ul.givenlnPARTI
:onl.llnddUlh
\j
.."
21.0
27. PART I: !nt....dl.......!rtjurlo.or'omp_"".wt.icIo....odlh.d......Do""'.m.rlh.mocl..,dyl"ll,...cII....rd..'.'ro.plnllory."".'..h..~.rh.m'.II."'.
LI.'...ty.......HO....hl.....
~
'-
P"c:~
M
...:
::'l
S.q\llnl"lyi5100ndltions
n.ny.l..cllr\9lotmm..:llal.
ceull. Enter UNDERLYlNG
CAUSE (Dill". or Injury
tllllllnl~elld"""l'
rewlingMdulh)LAST
WAS AN AUTOPSY WERE AUTOPSV FINDINGS
PERFORMED? AVAlLA8LEPFlIORTO
COMP\.ETIONOFCAUSE
OF DEATH?
E
0(OA5
(
Vas 0
MANNER OF DEATH
~
AOcld<>nl D
o
N.\\I<8l
HQml<:lclo
P..,~I~ In"..~g"iOn
Could t'IOl lle <!Illlflnlned
DATE OF INJURY
(M.oth.Ooy.V..rl
o
o
o
TIME OF INJURY
INJURVATINORK? DESCRIBE HOW INJURY OCCURRED
"0
Suicide
'h.
PLACE OF INJURY
bu~<If1g,'''.~'''lyJ
30.,
yuO NnO
3Gb. M 30c.
AlhOme,fanl1,streltlaclory,olfoca
".
A
281. JID.
CERTIFIER (Checl< orny OM)
~~;':h~";;';:~IGor~'I.'~~.\fohl.l~~:l'h~~gafJ:~lh.la:r.~:~:r~3~~~:~lh~~~.~.~.~.I~..~.~.~~~~.~.'.t~~.~~)....
D.
.P:oOI~~~~11~,G~Nk~~~:':a~:a~~H~~:.c~~ m~:ltl~~:d~t~,";~~~~~.':n~hd~I~~~U~~~:~~~ ~:~~Ir II stlllld..
'MEDlCALEXAMINERlCDRON!R
On Ill. Dul. oIlnmlnallon Indloflnv.llllgatlon.ln my opinion, Illllh OCCulTld II thlIlml, c1t1l, 1m! pIIC., Ind du. 10 lbl clua..rl) Inll
m.nnaruatalld..
~1..
REG1S1ll.lR'SSIGNAT~N~N~MBER .
,,~_ l.sroI3li'-1>1