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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of r::Ll 2..A.(J"U-'"7'1-.{ A ~ l....1.... ( <;;.
also known as &-c--rV
:2.. - :2 I - c> .:.t Deceased.
Social Security No. 18".;l 'l- ""f f- ~ (
No. J, 1- 05... tJfD:(t/7
To:
Register of Wills for the
County of <:'u~due.(..4M.() in the
Commonwealth of Pennsylvania
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.
Oecendent was domiciled at death in (lurvt.&~ County, Pennsylvania, with
h i;:fi- last family or principal residence at 2/5"'0 S 2~ $-r-_ _)""'cICL"-f"Q"-f ,/.Xl t:Ie {~
(list street, number and municipalrty)
~...
years of age, died TF~IJ..(J.""'~<.f Q. ( -
.0 ,alfA ~.jJ }..(. Ll._ iJA
,~ 200 "-I,
Oecendent 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 penns?vania
situated as follows: N .A
$
$
$
$
I OoD. 00
I
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
~ame
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administrati~IT in fut
appropriate form to the undersigned. C.~)
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF 0u...mhJ:ll\.\a...rtd
} S3
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. f. ~
sworn. to o. r affirmej.c\and subscribed f ,J\~ .
befo~. e thIS . 3 day of
, ,'it ;';'0fJ"
J~~~. M/lO-n " J
~" ~ ~~ Register L
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No.AI- 05 - Oloqf)
Estate of E'u L.(:l..~~~
~ ~'\L(.S
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW bAtt L-} 6r018~, in consideration of the petition on
the reverse side hereof, atIsfactory proof havmg been presented before me,
IT IS DECREED that (' ?O..r~ \...... \..>.::), \\\5
is/are entitled to Letters of Admimstration, and in accord with such finding, Letters of Administration
are hereby granted to GG.. 'l~ \..- \}..:j,\\,.s,
in the estate of E"'L; Zp (:2,(, H ~ \.r...::>.\ \\~
FEES
Letters of Administration $ 8D . (::C) -
Short Certificates( ).,........ $ Y . 00
Jt<W1f'f:i~()..uj-.~~\Gn. $ 5. 0'()
~~ (.) $ \() .0"\:)__
TOTAL _ $ 54. ()Q_
Filed .~-: ~~ .0.=;,..... ..... A.D. 19__
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
......'---.-........"............'.'-..'
Register of Wills of Dauphin County, Pennsylvania
RENUNCIA TION
Estate of E ".t"2A '3~""~
tlB
also known as liZ.-r-rl.(
It
A. lJU_'-fS
No. .J I - 05 ---au,q ~
fw
FEAe.UAt.2Lf .;11 ~ I 2oo~
, Deceased
The undersigned, ~mES Il... J'LL(~ -:fA-. (S~ ')
(Relationship) (Capacity) 1
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
L. khL('(~
Letters 01= t\J)f)1I1.JiSTIl4Ti o.u be issued to C/A 1<'1
Witness
hand this
Sworn to or affirmed ~ subscribed
~ this A5 day~
, 20 () ~ .
~~
My Commission Expires: '7--3-0<-
lSignatUle ;,nd seal 01 Not31V 01 olhe. ollidal
4uahfied 10 adrninislel oaths. Show d81e 01
eXpHBllon 01 NOIlHV'!I corllrnission)
RW-13 CRvsd 9/92)
,20 ~f).
(Signature) :;t:J
"2-1 t.f ~k LI...../ ^c~y
S-~~~J :;:;; '7 ~p 5' C>
(AeJdress)
(Signature)
(Address)
(Signature)
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(Address)
e
ASHLEY FOLSOM
NO~~~j Public, State of Texas
My Comm. Exp. 7 -3-2006
:>':1
ell
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NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
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Register of Wills of Dauphin County, Pennsylvania
RENUNCIATION
Estate of 'E L.. t 'Z..A. <3 ~ f~ A. J, '- L. ( S
No. r:2.\ - OS- - O\oq,
also known as
1.(.13 ,.
~E--cry
F'E8..R.. 0A Il.y :2. (rr J.. 00 s;-
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, Deceased
The undersigned,
~lf
jJ. 01LU S ~.$D"-l)
(Relationship) (Capac y)
of
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
letters ~11I1A.tt s-r72.A7'i DA..t be issued to L. ~ LL-( S
Witness
hand this
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(Address)
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... I"" MYRNA TRUJILLO .
\"". l~.o"'t I~otary Pubic. State of Florida , ,
z 0 My comm. expires Oct. 16 ,we
No. 00158560
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~Signcnurp. ilnd seul 01 Nota~v 01 o,hel ollicial
NOTE: Renunciations executed outside the Office of Register of
VVills are required in some counties to be notarized.
4UfllIfled to adminisler oaths_ Show date 01
t!Xpllfluon 01 Notarv's conunissiofl.l
RW-13 (Rvsd 9/92)
Register of Wills of Dauphin County, Pennsylvania
RENUNCIATION
Estate of
;::: i... ('2.A~E/~ tl. U L L / S
No. :21-0~- DlA'7
~ {j /t
O'E-rry
;}./ ~ 'J. DOL{
i
, Deceased
also known as
FE6J!.UA~
The undersigned,
JJ O~tV..A ~'E A.u Q R. A UL.
(Relationship) (Capacity)
( DA<Jt:i #{-r~ )
the above Decedent, hereby renounce(sl the right to administer the estate and respectfully request(s) that
Letters OF AOfl1.~l'Sl,QA"1i~ be issued to
QA~'f L \ LJL.LlS
Witness
hand this / I ~
20 oS'
day of --.JUk ~
,j)C~XI rAz~t1 6A.Q,c/.)
, (Signature)
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(Address)
(Signature)
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Sworn to or affirmed and subscribed
before me thiS II --IJ.. day of
~u"e.. :-20~.
Nota,%f?t ;4?
My Commission Expires: ~~ /~, rOO')
~OMMONWEALTH OF PENNSYLVANIA
NOTARIAL SEAL
ROBERT J. GOLD, Notary Public
Hampden Twp., Cumberland County
My Commission Expires July 10, 2007
(Signmure ",nd !leal 01 Notary 01 olhef ollicial
NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
qualified to administer oaths. Show dnltl 0\
t:xpll1ltlon of Notary':!! comrnission,1
RW-13 (Rvsd 9/92)
of
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fl 105).;05 REV i.}/X6
This is to ~crtify that t~e informa~i.?n here. given. is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The ongtnal certlftcate 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. $2.00
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HIOS.143Rev.2J87
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COMMONWEAlTH OF PENNSYLVANIA" DEPARTMENT OF HEAlTH" VITAL RECORDS
CERTIFICATE OF DEATH
TYPElPRINT
IN
PERMANEHT
BLACK INK
SEX
::::--
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SOCIAl. SEWRITY NuMBER
73
.. Female 186 - 24
I"~CE Of OfA TI1Chedl only one . 1M insuUcIlON on otl'lef We)
HO~IT~
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fACILITY NAME (It R:IC inltilutlOn. illY. Sir....;Jnd number)
~ID
AGe (Usl: EkMdaYI
,<S.
S.
CQUNTI OF DEATH
I:are
OECeOENrs
ACTUAL
RESIDENCE
(SM ntruaioI\I
on otMf SIde)
1h.$t4Ile
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$
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3605 Kohler Place
,.. Cam Hill, PA 17011
FATHER'S NAME (FiQt, MIcld&e. L.asl:)
IL Adam F e
INfORMANTS NAME (T~rinl)
.... Mr. Ga L. Willis
METHOO OF OlSPOSITlotL,
" 0...... u """"""" 00 R""",,~I~S.... lJ
00f'\IlI0n CIttw I~'
. 21'.
'StGHA~ FUNERAL ~Rv~1SEE OR PERSON ACTINQ A!. ~ty\
u.. --U(/~ C )...../ ZZb.
c.omp-. .-ns n.e ON,-......... C*bfying To the ~ of my know4eI)ge, cHI" ~ a1lhe tmfI, au.-nd ~ lIal80
pfryIOoan it rCll av..... .. timlI 01 iHaIh 10 (SignabI. and Title)
.~QUMoIdealJ\. 2.\1,
TIME t:J' >:>eATH
Cumberland
17b. Counly
7771
21 2004
MAA.IT"'1.. ST...T\.I~
Nevet~.WidooWld.
o.vo"*, (Speafy)
AACE...rnencan IndiMl. ~ Wfllte. eu:
($peaty)
I. White
SURVIVING SPOUSE
(If wit_, gi.... maiOen NIne,
Widowed
O~
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liv.in'
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17c.D 'l'ft-.~Ii\jeein
17e1, IX) ~~I;';;:::OI Camp Hill
l;Il~,OC".
MOTHER'S NAME (Fir6I, Middle. Maiden Sur~l
It. Christina uacka
INFQRMANrs MAILING AOOReSS tsw.. CitlifTOOM\.. ~., Zip CaI1e.
...1150 South Second Street Steelton PA 17113
PLACE Of OtSPOSlTlON . Hame 01 c..rn..ry, Crem*'Y
Ot Other Place
o
24, 2004
12:28 am
I:
oue TO (OR....S... CONSEQUENCE OF):
WERE oWTOPSV flHO\.NGS
AVAIl.A8Lf PRIOR TO
COMPLeTION OF CAUSE
01' llE.'otH?
t.Ur.HHER \)F DEATH
DATE OF INJURY
lMotth. Day. Y8M)
00
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PLACE OF INJURY....t hon'l.. f.ann, Weet. la::IOfY. olfa
buldltlQ..' (5peo'Yl
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Xl<. ""'.
LOCATION (Street CilyllO'M't. SUteI
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PendVlg lnveMigation
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..00
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Co+.lId not be aMennined
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CERTlFIER(Check only one)
~E~'a::~f ~y~:;~~,:= :ce:u~ :~': ~~~:t:) :.:~~s~~as~~~~~~~~~_ ~~~l~. ~~_ ~_~I~_~ ~l_e~_~~~.
*PRONOUNClNQ AND CERltFYtNG PHYSlClAN {Ph~MI both pronounang deiilth and certifying to cause of death)
To the b..e of my knowl~g., d..ath occuned .alUM. tkM, d.aI.,.aOO place, 'nddlM 101M colu.e(s).and manneru.sta.tad...
*MEDlCAL EXAMNERlCORONER
On the b..I. of e..amlnallon .and/or Inv.sUg.llon, In my (.plnton, d..lh occurred .t lilt time, d.te,.and place, .and due 10 th. causals) and
rnanrler as stated. .__ _... .____.. .____.... _ _ __. _ ._.,. _._.. -._., __._. .___. __. _ ..__._ >__.. _..,. ___.... -. _._... _.. - -. __._.... -. -. ..
J;1.2l.2 D~
17109
...!Xl
Appollmate
....~al~
I 0I\M1 and 4Un
PMT I: Other ~rll;;Jt1 ClllI'ldIliClnI ODfaIIb&.tlfllJ tel Geath, ~
nocrHUllinginh~cauMON''''''''PAFtTI
()\'", \\~tt'r Vl1e (r I 't~( r
~\'1 t+> Ir' (l'/,' 'IP"1 ,"1J
TIME OF INJURY
INJURY AT WORK? OeSCRIBE HOW INJURY OCCURRED
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