HomeMy WebLinkAbout08-12-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
&W~~ MICHAEL A. DREWETT. JR.
also known as
No. a J - 0 s - () 7 () J
To:
Register of Wills for the
County of CTTMR F~ T A tolD in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(lO. who islalte(18 years of age or older, appl ING
for letters of administration
on the estate of
(d.b.n.; pendentc lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in CUMBERLAND County, Pennsylvania, with
hIS lastfamilyorprincipalresidenceat6249 STANFORD COURT, MECHANICS BURG
(list street, number and municipality)
Decendent,then 6.1 years of age, died TITTY 3, ?on'i
at 6')6.9 STANFORD r:OTJR'T' , MF.r:HANT(~SRTlRG
,X<1X
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: NONE
$ 21,500.00
$
$
$
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
NANCY DREWETT
Relationship
MOTHER
FATHER
50
MICAHEL A. DREWETT SR.
320 LISBURN ROAD
CAMP HILL PA 17011
THEREFORE, petitioner(s) respectfully request(s) the grant
appropriate form to the undersigned.
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of letters of admmlSj:{'ajlOn In "i'l\e
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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. --?J. .'/) , 7lJ--
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Estate of
MICHAEL A. DREWETT, JR.
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 19_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that NANCY DREWETT
isXaltecentitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
NANCY DREWE'IT
in the estate of
MICH HI. L DR EWETT, TR
FEES
Letters of Administration $
Short Certificates( ).......... $
Renunciation .....,.......... $
$
TOTAL _ $
Filed. . . ., . . . . . .. . . . . . . . .. A.D. 19_.____
407 NORTH F
HARRISBURG, PA
171"1
(717) 238-3
PHONE
Register ofWiUs of Cumberland County
RENUNCIATION
Estateof~\Y:-~\ ~~~~1~'
Also known as. ~ \ :;~
'\ , deceased
rJl-CJr- - 07;;< /
No.
To the Register of Wills of Cumberland County, Pennsylvania
Theundersigned ~,,~..)~.S'~'ble.1\: 5~(1i"~~~~
(Name) (Relationship) , (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters
beissuedto NJo.-~~'" &>..~::~~T
Witness my/our hand(s) this
\.:;.~~f ~ ~~1 ,20~'S
~
s (Signature)
~~~~~~ ''1(:))\
(Address)
NoIariaI Seal
MIcheUe C. Martin, NotaIy Public
I.oYier Allen Twp., Cl.l'llbelWx1l'''''.....
My ConmssIorl Expres -"y
, n~or~
My Commission Expires:
1)~/tf?/J
Or
( Address)
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
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(Address)
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Deputy
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(Signature and seal on,fotary or other official
quaiiiit:Q LO acirninisler OZ1lbS. ';i:tuw ~iiLe of
expiration of Notary's commission)
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This is to certify that the information here given is com:clly copied from an original ccrtific~te of death duly' filed
Local Registrar. The original certificate will be forwarded to thc State Vital Rccords OttIce lor pcrmancnt tIl1l1g.
with mc as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this eertifieal~. $6.00
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Loeal Registrar
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"1.2187
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
43 Yo>
~ "'SEX
.__ e.l<:v6 .rL________
UHClEM , DAY DAn: OF BIRTH r S,IRTHPLACe. IGI~ and
Houn ....ir.IJtM~Monl"'. Clav. 'll'al'l I. 5taleC'f Fcre.grICoun'fVI
Decewb.er 3, Harrisburg, PA
.. 19tJ1 7 "'-
CITY, BoRD. TWP OF DEATH FAClur'Y NAME (II no: 1r.$l'l\.Jll(Jn. gIve Slle'!' !I',ll nUIT'tlefl
STATE filE mJWBER
SOCIAL SECURITY NtJMBHI
196
58
7142
3, 2005
ERIOutpau.nt 0
DOAO
OTHER;
:m~D
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~::tIy)O
..
COUNTY OF DE..uH
lb.
Cumberland
IeHampden Twp.
KINO OF ~USI"'ESS'INOUSTRY
6249 Stanford Court
'-vAS DECEDeNT OF HISf'ANJC ORIGIN?
NaIZl vesDlI.,....IP6ClfIrCuban
Me:o;icatI,P...ertoR;c.n."c
I.
RACE - Amencan Indian. B/aclll. While. llle
(Spec....,)
white
oeCEOE:NT'S USUAL c.crUP,qlON
_.--(GlVe~ C<I WU"~ oone cJ""fl9mosl
of 1IiIfOl'klng~: do I'>Ot 'J5e rO!!lI'ed j
~'JAS Oe:CEDfN"r EVER IN I --.-.nECEm:~EOuCATION
I JS~OW:~E~? ~;7iF~i f~Ccm ~
~l&____,_=--.J~__--.&-
11.. S1a,___Pennsyl vania Did
""_N
w.in.
Cumberland lOWnShip? l1d,O ::"='=:of
MaTHEA'S NAME (Fits!. Middle. MalCleo Sulnamlll
".
11.. Caregiver '111. Healthcare
OECf.DE.NT'S MAILING AOOAES$ISlreet. c.rylTowo. StaIII. Zip Cooe) DECF.DENT'S
ACTUAl
RESlOEhCE
(Seelflslruc\1orl$
on oIhe, Side)
MARITAL STATIJS. fh,....;.d
NO___~
Di\/ofced !Specify}
14~ever Married 15.
l1c,[1I;J Yes.cMCedGnlliv'edin. Hampden
'3')P.\lIVI~ ~~s!::
(If WIle. 9'~ m.JlOen name)
....
6249 Stanford Court
,0. Mechanicsburg, PA 17050
FMHER'S NAME (First M~. last)
Michael A. Drewett
l1b.C:l
/bon>
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INFORMANT'S NAME (T ypeiPrioll
.... Nanc S. Drewett
UETHOO OF DISPOSITION
Burial 0 CrematiOn l!;J RemolralIfOm Stale 0
O!;he;r (Spec~VL
IMMEotATE CAUSE (final
dlS8aStlOfcc...diIion
resullinOinC'ealt1I--
f";jc,~1 <,<;'h~
a._~_ DUE (ORle:1ACONSE.Oufi;;jCF~--~~~~----
21.. Con O-Lite Crematory 21.l'chaefferstown, PA 17088
I.......EAND-'Ol>>l.SSOFFAClLlTYParthemore FH& CS, Nc.
I~.p.o~. Box 431, New Cumberland, PA 17070-0431
IllCfNSE NUMBER IDATE SIGNED
(Monttl. Day, ~)
23b. b3c.
'o"iAS CASE REFERRED TO MEDICAL ~MINERfCORONER?
,.. .... N.\~U ...0
I Apt:lmximale PART il: Odulr 5iynif\caN CMdIion$ tonlribulWlg 10 death. but
:mla!'Yat~n 001 fftullingirllhe undettyingClll.lHgi\>...,inPAATI.
I On$lJf l\nd dnth
,
i
~
,
,
--------_.~-------~_._._._-----~----------'--
DUE)UIORAS#.CQt.~E'CUENCEOf)' I
i
DUE TO(OAAS-A'COOSEOUENCE &i~'-'----------:-.--~-'-'- .------T---
--"--
TIME OF INJURY
2005
LICENSE NUMBER
FD 012 848 L
:130.
IMEOFOEATh. 'r. O,qE?RbNi5UNCEOOeAD(Monlt;,iJay,~&'r)------~
C~" ~ -- I ." 2.'''''''C:
_ .. " ___~~_. 24: ~_r?~~_-1:...K... 2~.-.i111.+s2.-il~_
27. PART I; Enlllf the dlseaslls, Inrur~ or r.omplocalOl')OS ....hiCh cause<' the 1eat~, 00 :1Ol enler lhe mocw 01 ctv.rog. ,uch..s tllf'.Jiac or r,l.1p1fstNy .f,ll!Il. 3htlCIo: Of ho!I~rll8Jurlt
liSt: onlY one cause on each h.
S8quemiAlIy I~ condillon!l
if any, teading to ,mmediate
cautIIJ. Emet UNOERLYINQ
CAUSE ~seOlIn,ury
thalinllbted6\lenls
I-...no.... dAlIlt1J LAST
(:-
WERE AUTOPSY fiNDINGS
AVAlLA8LE PRIOR 10
COMPLETION OF CAUSf.
OF DEAfH?
....0
",,1ZJ
Y.. 0
",,0
Natural [j HomicicM 0
AecKldn' 0 PendinglrwestigaliOl'l 0
Suicide 0 Coold!lOt be delllfm....ed 0
DATE OF IP-.JlJAY
('-400111 'J.a\, Yea.)
INJURY }iJ' WORK?
DESCRI8e liON INJURY OCCURRED
WAS AN AUlOPSY
PERFORMED?
MANNER JF DEATH
....0
",,0
... 28b,
caRTWiEA lel1ed< 0flIv onel
.CERTIFYING PHYStCIAN (physICIan cerlilytf'lg cause ~ death whllf'l anolher phySICl8n has pronouf'oCflCl Clf!ath ..no C<'lfTlpleted 118m 23)
To the _t of my knowledge, d.ltt. occunwd due 10 u.. CIUUo(S)lnd mlnner I. s,.led.
...
3011. 3Qb.
PlACE OF INJURY AI nomll. farm. Sll'1!et. lactOf'V. otfice
buildnQ,eCC.ISper:;11vl
....
.. --
o
DEATH
M.O 3 U<./......t Si- S....,{;.2olV
flJ n D'-/ .3
.PAONOUHCING AND CERTIFYING PHYSICIAN (Ph'(3lCl8<1 bolh Jr~ouncong death and certrlYlng to cause 01 dealtll
To the; b.flol my kf1O""I.-dg"', d.athoccur.-.d al the d~, dll., and pile., and du. to lhe cause{I)lnd mlnnlr al ,tated..
o
"MEDICAL EXAMINER/CORONER
<;~~~~~::i:.:::rmin.ti~n an~/or \nYest,ga~ion. in my opinion, death o~e~rre.~ ~~ t~f1 ~Ime, dale.. ~~~.~I~e~: ~~~.~~~ ~~ ~~~ ~~~~~~~) a~~ 0
31, J
AEGIST~~S SIGNATURm ~ljER
C..!.~1/':'-'l.~". / .-:.1...;~'j'...(J~ ;-'i':"-.:--. ~ /r::::ili /(' !
33 - --1.1_ _ ______ 3-4.
d,tjL? $'"