HomeMy WebLinkAbout04-25-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of cHes TeA
also known as
L-~ Y 0 c U ~ No. ~ \ - 05 - 0 3 lr3
To:
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. (q 1- ;( 1(-/ ft, "7 f?
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 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-U 1/1) 13 E /f J /9 /f/ J:j County, Pennsylvania, with
h I <; last family or principal residence at /1.( b r=: ~"cU<;'T~' /l1 G'cjfAA/IC~E,(/-1':;
(list street, number and municipality)
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:
$ '3~DO <lO
$
$
$
Petitioner_ after a proper search hL- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
Relationship
Residence
c
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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170!7:!7
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF tU-\'!1bpn In: nd
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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.
Co
affi~n and
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No. ,2/- 05- cJ3gj
Estate of 0 In O}\b 1
/... l(tlCIA 1\'\ J
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~ .-l c;;) 5 ;){y)5 -W"_, in consideration of the petition on
the reverse side hereof, satisfactory pr of having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Admin trati n, and in accord with such finding, Letters of Administration
are hereby granted to f'f\0Ju 0' ~~()r j" .fv'-
in the estate of C I h .Ui/-JiA L ( lOr (A (Y"---.J
I
~"~~'~~k~L
Register of . vJ)
~1
FEES
Letters of Administration ..... $30 .00
Short Certificates( ).......... $ '1) . () 0
~~fp.$ ScJO
.j(1{J $ NY. {\)
TOTAL _ $ <)'3 uf)
Filed .. .If:-:91-S--. 05. . .. A.D. 19_~
ATTORNEY (Sup. Ct. J.D. No.)
ADDRESS
PHONE
~ '.: '-\
This is to certify that the information here given is correctly copied from an original certificate of death ~uly 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.
Fee for this certificate, $6.00
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ate
Hl05143RlIV 2187
c2 J - 05 - 3S-3
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
(..~,
TYPElPRINT
,.
PERMANENT
BLACK INK
CERTIFICATE OF DEATH
STATE FILE NUMBER
SOCIAL SECURITY NUMBER
,193 24
}
~ 77 Yrs
COUNTY OF DEATH
NAME:. Of DECEDENT fFIIl;t, Middle, Last)
1 Chester
AGE (last Birlhday)
AT
,. Cumberland
,<~ast Pennsboro
KIND OF BUSINESS I INDUSTRY
Of.CEDENT'S USUAL OCCUPATION
(Gr..I<ln<lOIINOI1<<JorM~~~
Bus".ll'r'tver"'. '" Transportati on
l1a 11b
DECEDENT'S MAILING ADDRESS IS~1. Cilyrrown, Stale, Zip Code)
140 East Locust Street
l~echanicsburg PA 17055
fATHER'S NAME (First. Mlddlu, Last)
n Harry C. Yocum
INFORMANT'S NAME (Type/Print)
..,
METHOD OF DISPOSITION
Burial lil CrumaliOCl ~llmoval from Slale 0
OlhlM(Specify)
FU E
DECEDENT'S
ACTUAl
RESIDENCE
(Seein6lructioos
ooolhersidu)
lwp
l1b. Countv
citylboro
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PA
1705
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DUE TO {OR AS A COHSEOOENCE OF)
WERE AUTOPSY fiNDINGS MANNER Of DEATH
AVAILABLE PRIOR TO
COMPLETION OF CAUSI:< Nalural
Of DEATH?
"'"Idtlnt
Pi
D
D
DATE OF INJURY
(Month. Oav. n",)
TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
HOmicide
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o ;~CE OF INJURY
b,,"d",g,alc.(S~clly)
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'PRONOUNCING AND CERTIFYING PHYSICIAN (Phy:;'lcianbolh pronOlmcinll dlldlh iiod ~t1lfyioQ 10 CiiUse 01 doalh)
To the but 01 m~ koowhtdu"', d.aU, o<:cun." ilt the lime, dat"" alld pllIC., ana due 10 tna coll....f.) and maona( a. ..Iill.d,
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