HomeMy WebLinkAbout07-18-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Melissa Anne Potter
also known as
No.
To:
,JI-D C:;-Ofa,1 '7
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No.
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl Y
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 Cumberland County, Pennsylvania, with
h er last family or principal residence at 30 East Main Street, N"wville
(list street, !lumber and municipality)
Decendent, then
at North
18 years of age, died Mav 23
Newton Township, Cumberland Countv,
,>W2005
Pennsylvania
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:
$ 100.000.00
$
$
$
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Petitioner~ after a proper search h~ ascertained that decedent left no will and wassmvived Q)<)
the following spouse (if any) and heirs: ) ,.., ..
Name Relationship Residence' \.D
Caroline Anne Pot~er
Dou las Allen Potte
le,PA 17241
e,PA 17241
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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/ Caroline nne Potter
30 East Main Street
Newville, PA 17241
ouglas Allen Potter
310 Sawmill Road
Newville, PA 17241
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
CUMBERLAND
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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.
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Sworn to. or affirmed and subscribed f
before me this / jj fA. day of
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.~....H~.A./ ~JC'I""'),
Register ~
No. ;21-05- [)~37
Estate of
Melissa Anne Potter
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW P.l~, in consideration of the petition on
the reverse side hereof, sat fact proof having been presented before me,
IT IS DECREED that Caroline A. Potter and Doulgas A. Potter
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Caroline A. Potter and Douglas A. Potter
in the estate of Melissa Anne Potter
FEES ~
Letters of Administration ..... $ dl/o.
Short Certificates(3) . . . . .. . . .. $ /::l. qp
R .. -"'Cp. .-f't; $ /0 <1!2.
SRl:lReuttl9n .. .u~ . . 7, . .
~$ $.00
TOTAL _ $.;13700
Filed ...~..\2t/,..... A.D. F9~Oo6
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Registerofwm:- . --I - - -.~~
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--Susan J. Hartman
ATTORNEY (Sup. Ct. I.D. No.) 65184
1 Irvine Row, Carlisle, PA 17013
ADDRESS
717-249-7780
PHONE
Thi', is to certify' that the information here given is correctly copied frorn an original certificate of death duly filed with me as
1:K"~t1 Registrar. The original certificate will he forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Local Regislrar
Fee for this certificate. $6.00
MAY 2 7
Date
2005
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
Hl05,,44Rev.119,
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2.Female
SlIUEFILENUMBER
SOCIAL SECURITY NUMBER
OI'J'EOFOEATHIMonlh,Oa~._1
4. May 23, 2005
,. 210 - 70- 1433
UNDER 1 DAY
Hours Mlnuu,.
DATE OF BIRTH
IMornh.Oay,Yeer}
BIAl"'"PLACEICi'yand PLACEOFiJEATH(ChookOtl'y""" _in"'ucOOnoonottl",,;""1
Stol"OIFo'.ignCounl"ll HOSPITAL;
Carlisle PA 1"".11&1>10
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I'ACIL'T'lNAME(llno';n"i''''"''',gi".,"'''''.<'I(in'''''_l
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CITY,SDR
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RACE.Am."I""nlndlen.B",,,k,WI\It<o..tc
(Speo:ify)
white
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Cumberland
North Newton
PA Rt. 533 & Oakville Road
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DECEOENrS ~AILINGAOOflESS(Sl>-~, Cilyl1i>wn.S4ele, ZOpC_1
OECEDENT'S
ACTUAL
RESIDENCE
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111.SIlil.
PA
170.0 Yeo,.xoo..dIntIMld..
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30 East Main St.
II, Newville, FA 17241
Douglas Allen
Caroline Anne
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livein.
Cumberland _1p7 17dd~io~='I:"~of
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:~..~~Sf'OSrrION.N~m.o!c_'Y.c,"m"'my L~~~TYier"V!eo.r 7 2 41
rospect Hl11 Cemetery
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l!P.tODip:Uffe'f1 Home
.ewville PA 17241
LICENSE NUMBER
Newville
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TIMEoFD€ATH Aprx. DI'J'E PRONOUNCED DEAD!MDnlh,Oa-y,Voo'1
24. 7:20 P. M. 25. May 23, 2005
27. AART I: Enll't""d_....It1,.._Orcompl"""kln.wl1Ic~""ulldrn......rn.Dono'ont..'homOd.01dylt1g,.uch...""'dIec<J<'"opi'.IO'Y.........~od<<J<h...nfallutl
lJII1Ot1'YonIIca.....""..chlln.
Head Trauma
DUE TO(OR ASACONSEOUENCE OF)
Motor Vehicle Crash
DUETO(ORASACONSEOUENCECIF)'
23b. 230.
-.sCASEAEFERREOTOME~LEXAMINEfVCOODNER?
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,ApptOl<'mo1O PART~, Othe.-.lgnlficontcond~lo,,"contfibuljnglO_.but
lln,""",l~n "",.--.~lt1glnl""U~~OI.....gMm'nPARTI
10l'l0etanddnth
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OUETO(ORASACONsmUENCEOFj'
,
WEREAUTOPSYFIt.lOINGS
AVAILABLEPRKJA10
=MPLETlONDFCAUSE
OFOE!J1.l7
No!ursl
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May 23.2005
OESCRIBEHOWINJURYDCCURRl:'O.
Belted passenger,vehicle
ran stop sign, struck
oadside
LOCIillON(Sit...., Ci'Jo:fTown, SI""'I
. A R . ~33. Newville,
PA
MANNER OF DEJOJH
DATEOFi!>L.tURY
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POndinolnlltlsligotlon
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CERTIF1eF1~""'Y",,",)
.CERTlFYINGPNYSICIAN(l'!lyoiciancertilyifl\lCOu..ord"'l~wt'lenanotl1..physici""h.a.pt""""""edd..,h"ndC<lmplsladIlBm231
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Could"",bodOll""""'d
Coroner
'MEDICAL EXAMINER/CORONER
Olllhebaal.ol Uaminlllonend!orinvelllgellon, in myopllllon, deatlloccutnld II lllellme,d.'e, ond pl_, Illddualoll1a ceuee(e) end
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AEGlSTRAR'SSIGNAfUREANDNUr.lBE
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OATESIGNEDIMonh,Oay,"'o'l
o no. ald. May 24. 2005
NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEAI"H
~t""'27)TYP"o'Pflnt Michael L. Norris. Coroner
~ 6375 Basehore Road. Suite #1
p. 32. Mechanicsburg, Pa. 17050
DATE FILEO(Monlh, Oa~. "'.r)
'PRONOUNCING AND CElffIFYING PHYSICIAN (PhysICian borl1 pronounc;fl\l dea,h Ond oenilying 10 """"'01 d...rl1J
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