HomeMy WebLinkAbout09-16-05
II
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
D<<eosed.
No. ..dJ -05 . 08'33
To:
Register of Wills for the
County of C-nmhf'rl.qnn in the
Commonwealth of Pennsylvania
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for letters of adminis.Jation
on the est.te of
Estate of Pauline Goodyear
also known as
Social Security No. 163-24-8879
The petition of the undersigned respectfully represents that:
Your petitioner(s), who Ware 18 years of age or older, appl y
Cd.b.n.; pendenle lile: duranle a~n1ia: durante minorilate)
the above decedent.
Decedent was domiciled at death in Cumberland County. Pennsylvania, with
hPT last family or principal residence at 20 East FroQ.t St., Shiremanstown (ER.~t Pennsboro
(Uatstreet, number, Twp. or BOlO.) ToWnship) PA
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Decedent, then 7L.. years of age. died i\l:AY ?lJ.
at HoJy Spirit HO!'lpitR.l C-nmhprl.qnn r.mmry ~A
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Decedent at death owned property with estimated values as follows:
(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:
S -o-
S
S
S 10.000.00
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Petitione~ after a proper search h~ ascertained that decedent left no will and was survi cd by
the following spouse (if any) and heirs:
Name Relationship
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THEREFORE, petitioner(s) respectfully request. the grant of letters of administration ~~ the
appropriate form to the undersigned. i
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K. Morrison'
1017 W. Trindle Road
Mechanicsbur~. PA 17055
Box 31
17007 I
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss
ne petitioner(s) above-named swear8i) or affirm(l,) that the
statements in the foregoina petition are true and correct to the best
of the knowledse and belief of petitioner{s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate accordins to law.
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No. a. \-05- O~33
Estate of
PAULINE GOODYEAR
, Deeeased
GRANT OF LKfl'ERS OF ADMINISTRATION
in the estate of
,W ~.J.G. ~AAL<' I M'\ao~
~ '?'^C) 'l-J ~
~QF4
..3$-1./'1'1
A Y ($up. Ct. 1.0. No.)
I ~ &1 J./....,-'1 1I1,cli' ~&...&".e: ~A ,101)
ADDRESS
1 "-;1.."1 't.- '2.C4'"t f
PHONE
, ,FEES
Letters of Adminisuation ..... s.!:I5.. OCl
Shon Certificates( ).......... S
Ra_ haivri].~.".::r~l'f<<~~ I}~.~ S S (..~
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q _ i lo _ TO~~ - S
Filed........ ..3/~.-'.:.J.... A.D. 19_
1I]())..'\l)"i R.I-:\' IJ/Xfl
This is to certify that the information here given is correctly copied from an original certificate of death duly fikd \ ill me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen.,t filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fec for this certificate, $2.00
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1.037188/:
No.
{(4~AAj~ Aj.~ ~~, -~_.
Local Registrar I ~
111'1 ~~
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Date
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sElI'emale
2.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
SOClA'15~RITY ~BER 8879
..
H105143 Rev 2187
TYPE/PRINT
IN
PERMANENT
BLACK INK
STATE FILE HUMBER
NAME Of DECEDENT (F.... M_. Lut' Pauline Goodyear
,.
AGE (l.st Birthday)
BIRTHPlACE (City and
Adglmoe'8\1ll~r."j!l\!iY) -tizt
7. aa.
FACILITY NAME (If not institution. give street and number)
.,. i fbsp;kl
74
..
COUNTY OF DEATH
v"
.b.
DECEDENT'S USUAL OCCUPATION
(':'i'~m~?~
11a. 1ib.
DECEDENT'S MAILING ADDRESS (Street. CitylTown, State, Zip Code)
. 20 East Front Street
Shiremanstown, Pennsylvania 17011
,..
FATHER'S NAME (First. Middle, last)
.. I p.my Schoff~lall
17a, State
E~~r
,..
pennsy vania
DECEDENrs
ACTUAL
RESlDENCE
(See instructions
00 other side)
17b. Count...
Cumberland
White
MARITAL STATUS - Married
Never Married, WdoWed.
Dl"WI8'~~1:l
Old
_n1
Uveine
townlhlp?
17<;. 0 Yes, decedent lived in
lwp
17d.1]I ~,,"=\i~~of Shiremanstown
cllylboro
MOTHER'S NAME (First, Middle, Malden Surname)
Ii. Mae Miller
~:ORMA10.~t8'~ A~~iSt~~~oIk cC~d~ sM~~'h~~i~sbur . Pa 1 050
PlACE OF DISPOSITION. Name fA Cemetery, Crematory
or Other Place
21.. Conolite Crematory Schaefferst wn Pa 17088
NAME AND ADDRESS OF FACILITY
220.
E
V1.ERE A.UTOPSY FINDINGS MANNER OF DEATH
AVAILABlE PRIOR TO
COMPLETION OF CAUSE N8tura1
OF DEATH?
DATE OF INJURY
(Monlh, o.y, V_I
LICENSE NUMBER
DATE 51 EO
(MOl"llh, Oa Year)
2..
:=:;m~
: onset end death
QthM SIgnificant conOltlon conlnbullflg to death but
not resulting in the under1 og cause ~lIeo in PAIH I
TIME OF INJURY
INJURY AT W)RK? DESCRIBE HOWINJU Y OCCURRED
ACCident
51
o
o
Homicide
Pending InveStigation
Could not be detennined
o
o -O~O
30a. 3Gb, M. 3OC.
o PlACE OF INJURY. At home, t.ro. Itrtt8t, factory, offtce
buiklng,etc(Spe~)
....
....
LOCATION (Street. CitylTown, Slate)1
.... '
Yes 0 No rt
v.. 0
NOD
Suicide
28.
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28.. 21b.
CERTIFIER (Check ordy 008)
.l~':tUF~GJ~~~l.':ib~=:=~.:=:r=r~~~r~ah.:.r:a..~~.~.~~~~.~~.~~?~~.~.i~~.~~).....
.PRONOUNCING AND CERTIFYING PHYSICIAN (Phylk;ian both pronouncing death end certlfying 10 cause of death)
To tht beat 01 my knowledge, de.th occurnd" the Ume, date, and pl.et, and dut to th. elu.es(a) and manner.. Itated,..