HomeMy WebLinkAbout06-15-05
Register of Wills of Cumberl
PETITION FOR GRANT OF LETTERS OF AD
), ~ No. ai-05-- 'tv
Estate of J '-kphln}. - Onson
also known as To:
Register 0 Wills for the
, Deceased. County of umberland in the
Social Security No.O or) -:;. do ~)ou S- Common ealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl~ for etters of administration
n h k .' on the estate of
(d.b.n.; pe dente lite; durante absentia; durante minoritate)
the above decedent.
"..)
Decedent at death owned property with estimated values as follows: -"""-
(If domiciled in Pa.) All personal property $ (.,:''';
(Ifnot domiciled in Pa.) Personal property in Pennsylvania $ -""'"
(Ifnot domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $ ,,'
situated as follows:
I.,';:;
Petitioner_ after a proper search ha_ ascertained that decedent eft no will and was survived by the
following spouse (if any) and heirs:
Name
\
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of ad inistration in the appropriate form
to the undersigned.
Signature(s) ofPetitioner(s)
G~fE ftv-MSCVl 3 ?A \lO~
,
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Register of Wills of Cumberl d County
OATH OF PERSONAL REPRESE TA TIVE
COMMONWEALTH OF PENNSYLVANIA }
SS:
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statements in t e foregoing petition are true and
correct to the best of the knowledge and belief ofpetitioner(s) and that as perso 1 representative(s) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and Escribed {
BefoF I 5 -t day of en
~.
,2005
~
ffioDA~ J:b1D"~ A
~
~lI. ~ . Register
No..:l,1 -05, ~'53b
Estate of~~tul~Of'-~ (I."/I.'o..h^,,-, De eased
GRANT OF LETTERS OF ADMINIST TION ---,-.,-
AND NOW 20~, in consideration of the petition on the reVerse -...,.
side hereof, satisfact y proof having been presented before me, ..
IT IS DECREED that ' ,
is/are entitled to Letters of Administra . on, and in accord with such finding, Lett rs of Administration f'.)
are hereby granted to \'"'Ie. o Y1S;O I{'\ \',';;"j
in the estate of
J
FEES
Probate, Letters, Etc. ............. $ cQO.DO
Will................................. $
Renunciation...................... . $
Short Certificates ( \ ) ............ $ 4,00
J CP .. .. .. . .. . .. . .. .. .. . . .. .. .. . . .. . .. $ \(),00
Automation Fee................... $ 5,l)\)
Bond............................. .... $ ,9000
Total $ -3 c\ . <Ji0 01\5
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Filed S - rs - cS 20 D5 Phone
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, , ,(-,,; '.'fl'~
This is to certify that the information here given is correctly copied from an origi al certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Recor s Office for permanent filing.
WARNING: It is illegal to duplicate this copy by phot stat or photograph.
"-
Fee for this certificate, $2.00
p 9964504 ~AN) (. ~) "'n"'4
t 1
I. I'. \_.1 r,) ~',j;J
No. Date
.,>~
105.143 Rev, 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VIT
CERTIFICATE OF DEATH STATE FILE NUMBER
T NAME OF OECEDENT (Firsl. Middle. Lest) SEX
1. 2. Male 52 -
AGE (Lesl Birthday) BIRTHPLACE (City and
State or Foreign Country) HOSPIT~
. 54 Yrs Louis,M Inpatient DOAD ::cifylD
5. a..
COUNTY OF OEATH FACILITY NAME (If not institution, give street and number) RACE - American Indian. Black, Wlile. et
. (Specify)
ab. Cumberland ~. Pennsboro White
OECEDENT'S USUAL OCCUPATION MARITAL STATUS - Married, SURVIVING SPOUSE
(<:~~~~d::.~r~1r:3it Nev~v~r~is~~)ed, (If Wife, give maiden ollme)
14, MarrJ.ed Janet King
. 171. Stale Pennsvlvan:ha East Pennsboro twp
34 Greenmont Dr decedent
live ina
18, Enola Pa 17025 17b. County C'nmh",rl ::Inn lownship? cilyJboro
FATHER'S NAME (First, Middle, Last) Michael MOTHER'S NAME (First, Middle, Ma
1a, Aronson 18.
INFORMANT'S NAME (Type/Prinl) INFORMANT'S MAILING AOORESS Slreal, Qtyrrown. SIale. Zip Coda)
20.. Janet E. 2Ob, 3 4 Greenmon Dr. Enola Pa 1702
METHOD OF DISPOSITION PLACE OF DISPOSITION. Name of LOCATION. CitylTown, State, Zip Code
. Bunql 0 CremationOemoval 'rom State 0 or Other Place
Donation 0
. 21a. Olhll( (Specify)
SIGNATURE OF FUNERAL S VI
. 221.
Complete Items 23a-c onI en certifying
physician is nol avail8ble t time of death to
certify cause of death.
24.
IMMEDIATE CAUSE (Final
di$ease Of condition a.
resulting in death) ---+
Sequentially Ust conditions F DU
if any, leading 10 immediate ~~
cause. Enter UNDERLYING
CAUSE (Disease Of injury
that initiated events L...Q..
resulting on death) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS DATE OF INJURY TIME OF INJUR INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
PERFORMED? AVAILABLE PRIOR TO 0' (Month, Day, Veat)
COMPLETION OF CAUSE Natural Homicide D
OF DEATH? 0 D
Accident Pending Investigation
Yes 0 No \ YasD NoD Suicide D Could not be determined D 30.. 30b.
PLACE OF INJURY ~ At home. farm, street. fact
28.. 28b, building,elc. (Specify)
28. 30e.
CERTIFIER (Check Only one)
.~~~~F:~:Gor~~\I~J.71.~~:rh~~~m3~u.:: t~ :he:~~~~:(:r~~r~~~~a~. h~~r~~~~~~.~.~~~~~ ~~ .~~~~~.~.i~~~.~~~ ..... ....
.p~Ot~~~~~I:fGm~Nk~;~:~:.~~~J:~~~~:: i~~~:i~::.ne~~tr:~~~,~8::rd~t~;::Z~u~~~):~~ ::~~er.. .tmed. .. .".... .... ........ 0
'MEDICAL EXAMINER/CORONER
On the ball. of examination and/or Investigation, In my opinion, death occurred at the time, date, and place, and due to the cauael(s) and
m.nnera.at.ted........... ..........."........................... ..................... ............. ............ ........... ...........".......... ...... ........ 0
311.
REGISTRAR'S SIGNAZZAND NUMB~ ,f<'1/~1/(1
33, ~
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