HomeMy WebLinkAbout08-12-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of IYlary C. W. l~r vwA No. ~" - '\:\S - "\ 1.."3
also known as To:
Register of Wills for the
Deceased. County of rUIII1I2..--rklo-l in the
Social Security No. :2.0(" - 32 -1XJ.>'f Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl r~ for letters of administration
R on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in ClAfI1~ r~ County, Pennsylvania, with
h e-y last family or principal residence at ,210 Re.,Ji) /IrV e . /'Jew C(,IOI ~t7(.uAo1/
(list street, number and municipality) -zt>O~
" J\.I.,I'1 I~
Decendent, then years of age, died ,~ ,
at .2LO (1ff v-Jo MlIii /V1:f".v c-<./ '" 1$ In c..+vp
Decendent at death owned property with estimated values as foIllows:
(If domiciled in Pa.) All personal property $ Il!lflJ(JD
(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:
Petitioner_ after a proper search ha.2- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship
0 u-~ P.;
lJYI ~~ -'^-.D
I '1 P.4-
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
"" ~Dt1 ~ [' YttM
" 1.4 N<.,,,, t......kWfll
~ 107 SNrl.vvvJ
"
:g~ c'd
~-
""
"'~ ._,' I
-g.g "~L_-"." ~~,.':';',<;.J\~O
~''':: j::J ;:;~]IJ
3~
"~
~ 0
~ S':i .,- "d Z 1 "'I'J eral
"" 'V;I' .....J " "I,.'
Vi
.'-'- ..-
, -0
,[, .....('" \ '0 n-'n', ;['!\-
:j,.) ],JljJJ \JjUjU~}Jt
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF -1()M1l\:JtT 't4.w1
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.
Sworn to or affirmed and subscribed f ~~~ ~
before me this '\ ":l:"" day of ~
~
..,
~~~ ~ ~
::l
-
~ ~ "S:,.~ _"~ I os
"
co
~ ~. '<..~, ~~ Registe ' l i:il
No. -::.. " - \:j S -"'11. ...,
Estate of MC11Y Cl W;IM~ , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 'I;::.~~"'" \'J. , .)..:<:>~5 )@, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that ........"''^~'''~ ~. ~~~I:'"
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to "l.."""',","''''1> ~ V\~~...'"
in the estate of "''''~ '" "" \L~~'i... "'~.... ...
~~~~~.
Register of Wills )
~,,~.'K~\ ~~
FEES
Letters of Administration ..... $ '\S.
Short Certificates('\) . . . . . . . . ., $ \.... A"ITORNEY (Sup. Ct. I.D. No.)
Renunciation ................ $ ~
'11:~'" '""-"'" ""l> $ \S
TOTAL _ $ ~\ . ADDRESS
Filed.... .~.-~~:~S....... A.D. 19_
PHONE
. Register of Wills of Cumberland County
: .
,
RENUNCIA nON
Estate of MaN c. IAtlldu~ No. J.. '\ - <;:) S -\ 13
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania .
BV'.."", (Ylo.;Jj G.,.., 6 \.(.fl.VlVI",""" :;'~4l.IAlC'f'
The undersigned !<ury, w.lcUt~ ':>~Cl-...te<... >v ~Vl \101'6 s.. g i...\ N6-
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce( s) the right to administer the estate and respectfully request( s) that
Letters
be issued to ~a 'f VY\O ~ E t1~vch
Witness my/our hand(s) this 1 tJh day of ~'INj..... ~T , 200"5':
~ and s~ibe~before me this _ef'UeAr1 ((, fV1cwvL
(Signature)
\ day of ....~ ,
'Ykli 113'1, S I3ilw",-,,1 sf- e,. i l-i>>-crNl .M J)
9~ (Address)
. .
Notary Pubhc
COMMONWEALTH OF PENNSYLVANIA ( j) "'" (s l \. \ ~ Qo~ 0 L--..-.ru ,~.k
~yCommissi~
William D. Wierrr!an, Notary Public w --...>
New Cumbe~and B,,'o, Cumbe~and County (Signature)
- ,2008
Member, Pc'!nsylv-"nia As,',ry;iatioll Of Notaries lJ.7 C <lYI~ VU ~..v-:3 I...-rr'(T PA-
Or
(Address)
Affmned and subscribed before me this
_ day of ,
- (Signature)
Register of Wills
Deputy (Address)
':)
, '.~ _.<0 I
'"
,', -, _'v
(Signature and seal of Notary or other official ::::J >[:J::nJ
qualified to administer oaths. Show date of
expiration of Notary's commission) SS:t; l!d 2 I 5rW SGOZ
.. 'j
',' 'i" ~, ....
'1")'\ I d
'-,-..." -'~
:10 381:l:l0 Q30tlO83o
HI05."05 REV 11<15 ":I. \ - '\l S . '\ L ~
This is to certify that the infonnation here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for pennanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, S6.00 ",,,"'1\\"0/:'''-''''--- ~ m 1~r--
"~,:.:.\.\-.\. p(~;:-,_ ' I(
i~"'. ... "-- "~"\. .
l~~--_ -c,', ~\ Local Registrar
!:iE _~ -.- - ~i
~~ -~:' l.b~
P 1169763 7 ~'?'!.n\~\.;~l JUL 1 6 2005
~..'''ENl u ",,1
No. """,##111111 Date ,.....:)
g :::L1
Q ~ I):j
~c_:,;;O :r;:"' (-)
- ------ ------- ---.-.,,-..-.--. .J,~~I_C) ~ 6
~--- ----- --: ~ N }g
----.---.-..-.- __H ..-.- 81 -U .- ~~
":1 (....') rn
-::.:, .. -,<:::)
Rev. 1191 COMMONWEALTH OF PENNSVLVANIA . DEPARTMENT OF HEALTH. VITAL RECORDS U1 "T1
CERTIFICATE OF DEATH <J1
(Coroner)
1130-048 SW'E FlLE NUMIlEA
NAME QFOECEDENT (First. Middle. Last) SEX ISOCIAL SECURITY NUMBER IOME Of' oe.'rrH (Month, Day. Year)
.. Mary C Wildermuth ,. Female I.. 206-32-0059 I.. July 12, 2005
AGE (Last Birlhdlly) UNDER 1 YEAR UNDER' DAY OATEOFBlATH BIRTHPLlCE (Cilyalld PLACEQI' DE.I\I"H (CI>eci< only one see illSlruclionson other sicIa)
MOfllhS DayS Hours Mlnutell (Monlh.Day,'IIlar) Slate (ll"FOf6lQnCounlfy) HOSPITAL IOTHER:
5. 61 y~ 2ct.29,19437. EnolaJ PA ~~3tlenIO ERIOuIPBI"lnID OOAD I~O A8lIidenr:e.DQ =ilyjO
.. COUmYOFDEATH CI ~ POFOE,IJ"H I:FACllITVNAME~fnol;n.mution.givelll'eelandnumberl I:WASDECEOENTDrHISPANlCOfIIGIN? I:RACE-Arneric:lInlndi8n.81llCk,WhQ,elC.
Cumberland New Cumberland 210 Reno Avenue NoD. Yas0 II yes, IIlleCIfYCubIln, (Spec~hite
.. MeB-.PuertoRlcan,etc
lb. Be. 8d. I. 10.
OECEOENT'SUSUALOCCUP~ON KINOOFBUSINESS.1NOU$TRY WAS DECEDENT E\lER IN I "'_ OECEDE,NT'SECUC.'J"lQN I MARl1l'ILSTATUS.MlInWd [, SURV!V1NGSPOUSE
(GivekindofWOfkd""edurinllmO$l I. U,S.AAtlEOFOHCES1 onIvh h8BI om NelMrM...ied.~Mj. (lfNil...~vel1lllldennarn.J
DfrtlClnglRe;donotlJ9,8firlld,) 0 Cl I.ElementalYl'38<:r,ndslY I Coltege I. ........-
.. 11.. Del.ivery Person l1b.Photography 112.. Vas Holt' 13.1'}(Cl-l;>J I (''''0.5+) 14 15.
oeCEOONT'S MAlUNG ADORESS ($1rget. CityrTown Slate. Zip Cede) oeCEDeNT'S
210 A A 1 ACTUAl 17..SI.'e P.,.nn~yl'7::lni~_C'id 17c.DYes,decedllnllilledln lwp
- Reno ve . p t AeSlDENCE dllCed8nl
(SeemSlructiot1s I"",'ne
New Cumberland, FA 17070 011 olner akM) (' 'h 1,.t township? ........ No,d8Cedllnll/lled __ .
11, t7b.Co lIm.,.'1'" ::In 17d.kJ within lICtual IImil$ 1\1_ n, cllylbofo.
RIl'HER'S NAME (Firnl. Middle, Last) MOTHER'S NAME(Rrsl. '-liddle, Maid,," Surname)
11. Raloh E. March 11l.Mar~aret W. Snader
INFORM.a.NT'S NAME (TypelPrinl) INFORMANTS MArLING ADDRESS (51", CityfIbwn, SIBle, Zip Code)
_Raymond E. March 1_707 Sherwood Rd. New Cumberland, PA 17070
METHOD OF DISPOSITION I~ OF DISPOSITION Pl..ACE OF DISPOSitION. N.me 01 Cametery. Cramaloty l~oc.ulON _ ClIyITown, S1aIe, ZIp C<Ide
.. BUrlBlO. CrMlallonlil FlemQvalfmmStateO (Month. Oay. \'een Ol'OIhEIrPlace
~~D oo;~ty\ DCb. Julv 19. 2005 21".Con-O-Lite Crematorv .Schaefferstown FA 17088
. SIGN.&:l1JRE SERVi,*---UCENSEEOR PERSON ACTlNGAS SUCH L1CENSE,MBCR INAMEANDAOORESSOFFM:I~arthemo e FH & cs I
- . ~ .~~ ".. r.$ 0 - L 1"".P.O. Box 431, New ~umjjerland, pA ~570-0431
Complet8~tfT15 ncaflllylng 1b1h8 beslolmyknO....hldge, death oocumtd81lhetime, dat. andplaca stated. LICENSE NUMBER DIirESIGNED
p/ly8lcianl.nole... 1lme00de81nlO (SigM1u.eendTll..) (Montn,De;o.Yeer)
. certlfyeauMoIdeath.
2311. 23b. 23C.
ltema24-2fimuMbaeoonpletedby TIMEOFoeRl-l .H..PL4. IDATEPRONOUNCEDDEAD(Monlh,Day,Year) WASCASERE.FERRE.DlOME~LEXAMIN~~ ~~NER?
parsonwhopronouncasdll81h u. 10:00 PM. 125. July 13', 2005 2$. VealS by FD !'OK. NoD
V. PART r, EnterlhediMeaaS,~U""90l'COmpllcaUo""whicllClluaadlhlld...\h,Donotenlerlhllmodlloldyln;'8uch88cardIacO"lIIlplrll.lory.rrest, shock Ol'iIelI.rt 11l.1Iu<e 'Appruximll.llI PART II: Othar~~ ~ iDnsconlrlbullnglodeath,t>ul
L~orIyOAllcallMonHChltne, tinl_"'~ nolr""uIllnglntMunde<Iylngcauseg"'-"inPARTI
ton!l8tanddaath
IMMEDIATE CAUSE (Final I
=jn':)_ II. Occlusive Coronary Artery Disease i
DUETO(ORAS ACONSEQUENCEOF)' !
~tillllylistcondltiOnll b I
Nany,leadlnglolmmedlere DUElO(OR AS ACONSEQUENCE OF): I
uu.. e_uNOaILYING :
CAuse (Di8eaMDr,n",ry c.
thalin~ilI.tedevents OUElO(ORASACONSEQUENCEOF)- I
resulllrogindealh}LAST I
,
Wt.SANAUtOPS'V WER€AUTQPSYFINOINGS MANNER OF DEJJH . . ORE OF INJURY TfIdEOF INJUR'V [NJURY/fJWORK1 DESCRIBE I-lCIW INJUR'VOCCURREO.
PERFORMED? AVAILABLE PRIOR lO (Monlh,Day,Year)
COMPLETION OF CAUSE ~
OFDE.ATH? N.tuftll A Homldde D _ 0 NoD
;a, AocIdenl D PlIndlngl....estog8l1Of1 D 308, 3Ob. M, 30<:. 3011.
Yea 0 No Yes D N" D 0 0 PLACEOFINJURY.Athorna,larm,stnHlt,faclory,oIIIca L()CJQ"ION(SI_.City:iT/""""SllI.tel
Sulddll CollIdnolbadlllermlrllld bulkllng,etc(.:pecity) ....._.
.... ,,,.,,. .... ~~y.--y
ceRTlFl!ft(Checkor1lyone) , , , . . SIGN'-:I"UAEAN ~ R
.=~~t:;:~~c.::u~C:::~==.i=~=:=~~~dMthaodcompll!ted~.~~).,................... LJ 31b. '/..... Coroner
L U R IDRESIGNEO(MOnth.Day,'lUr)
'PAONOUNCJNaANDCElfTIFYINGPHYSlClAHlPt>ysicilI.nb<>ll1pro,"'lll"dnodaalhandcertilyingtocau...ordaalhj 0 I.. July 14 2005
TDthaballtofmy~,dlIathoocurradlllthatlme,data..ndplac.,.nddloelOthacauaa(.land.....-rasstll.tad... 310;:. 31d.'
NAME AND AOORESS OF PERSON WHO COMPLETEO CAUSe OF [)E,qH
'MEDICAL EXAlltNEAfCORONER (Item 27) Type or Print Mic hae 1 L. Norris, Carone r
~":r~~=~I~~~..,ndI~~~~~~.~~.lnmy~'.n.t~:~~~~~~~~~~~~..~~~:~~,~I~~:~~.~~~~~~~}.~~ ~ ~;~~a~i~:g~~eg R~:d, 1 ~o~6e fl1
31.. 32,' .
REGI~'SSraNR~~ U ~r.( I o.o:re:~LED(Month.Oay.'VIlarj
" U/wn.... / <: :0./~,""'- YO.., ~.~. /..<"
(/ ,