HomeMy WebLinkAbout09-20-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Nancy L. Richwine
also known as
No. ':J.. \ -'\:) OS - ~ '-\ ~
To:
Register of Wills for the
Deceased. County of C'nmhprl ",nrl in the
Commonwealth of Pennsylvania
Social Security No. "0" _ 4 R _ 1 ~ 4 7
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.
Decendent was domiciled at death in C'nmhprl ",nrl County, Pennsylvania, with
her last family or principal residence at 765 Rrll t i morp Pi kp, C:;r1rilnpr~
(list street, number and municipality)
Decendent, then 43 . years of age, died :1'", nn '" ry ~ 1
at 1a.m. (H "f'''LdrnLeJ
,.. 100E; ,
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:
$ C')
;--,
$ -~,~
$ ,
C~
$
"
-...-.
(.)
CJi
Petitioner_ after a proper search hlLS....- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE, petitioner(s} respectfully request(s} the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (':~~\'.<......\~~
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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
before me this <>;).":l""" day of
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No. ').\-~S-~\.\3
Estate of
~~~,'" L
~\'',-\\N\~~
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW "S-'>..~ ~'o''i. ~ ~ ~~ \'t.S ~ , in consideration of the petition on
the reverse side hereof, satisfactory roof 'having been presented before me,
IT IS DECREED that . ~~ ~ ~. ~ \ - .
is~ entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to '~ ~~~\... \.:\
'<<.\~~~\~~
in the estate of
~"'~,~ L Q\,-~~,~lC.
FEES
Letters of Administration $
Short Certificates( ).......... $
Renunciation ................ $
$
TOTAL _ $
Piled ..................,.. A.D. 19_
~~~,~~ ~~J\ ~~~~
Register of Wills '
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ATTORNEY (Sup. Ct. I.D. No.) I ()<.
\SS S. ~\\OJ(' Y o-\Y-ee+ C(:l'(\\~li, lll.V]
ADDRESS
( I; ~c9Y \ - Lc O~O
PHONE
H10S90S REVWI/041 ";}., \ _ ~ S _ ~'-\ ~
This is to certifY that this is a rrue copy of rhe record which is on file in rhe Pennsylvania Division of Vital Recotds in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ ~ II~
Charles Hardester
S tate Registrar
Calvin B. Johnson, M.D., M.P,H.
SeclHary of Health
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No.
JUN 1 0 2005
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Date
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BlACK INK
H105.144 Rev. 1191
-FINAL
#29-432
COMMONWEALTH OF PENNSYLYANIA . DEPARTMENT OF HEALTH. VITAL ReCORDS
CERTIFICATE OF DEATH
(Coroner)
CITY.
SWE FILE NUtMIER
sex SOCIAL secURfTY NUMBER
2. Female .. 206 - 48 - 1347
1;7. 7~ 7
~
~
L
UNDER 1 DAY
.......-
BIRTHPLACE (CiIY and
Stale or Foreign Country)
ORE OF DERH (MonIh, Day. '$ar)
.. January 31, 2005
:::." 0
Ie.
South Middleton
DECEDENT'S USUAL OCCUFlUION KIND
~~~~~u~~::f
1 Haranaker , . Her own heme
DECEDENT'S MAlUNQ ADDRESS (STIeel, Cilylbwl. Stale. Zip Code) DECEDENT'S
ACTUAL
RESIDENCE
(Sooln9lructions
onolhefllide)
17..Stal:8
Did
-
"'In.
Cumberland ~? 17d.D ~~-'='or
MOTHeR'S NAME (FWSI, MidcIe, IMiden St._I
". Ardella R. Warner
INF<lRMANT's.....UNGADDAESS(Sllp!'\ike~-,G_,Z~Codo) p'~ 17324
765 Baltirrore ; araners, '"
PLACEOFOISPOSITION Namlofee.n..y,erem.tory LOCRION -CllyfIbwn, Sbde. ZlpCOde
~""'"'-
lilt. Holly Springs Caretery "..Mt. Holly Springs, PA
NAMEAND ADDRESS OF F"AClUTY
.win Brothers Fimeral Hare, Inc., Carlisle, PA
LICENSE NUMBER DArE SIGNED
(Monfl.Oll.y,'lMr,
MARITAL SWUS. Mlm.d
....... MarNd, WIdOwed.
Ma~ Kenneth W.
14. 1.
17,.Ci1 .....__In South Middleton
Richwine
,...
""""
....
llME Of= DERH prx. ORE PRONOUNCED DEAD (Month, Day, h'l
24. 1:00 A. M. H. January' 31, 2005
27. PART I: Enter tM dIll6aIeI.lnJurlnOl oompIIcaI_ whichcauMdtl'le liuth. 00 not enter 1M modeofdylng, 1UCtl.. ~or r"'Plnltory."..., 1hock0l '-1tdln
LiIIontyonecauMon~line.
.,
Db. 23c.
Wt.SCASE AEFERREOlO ME~ EXAMlNERICORONER?
....)"i. NoD
H.
!=::..n MAT II: ~~~U:==~
! oneet aod dNth
0,
DUE TO(OR I<S A CONSEaUENCE Of);
d
WERE AlflOPSV FINDINGS
.......LABLE PRIOR TO
COMPlETJONOFCAUSE
OF DEArH1
MANNER Of DE.VH
N......
1&
D
D
Dm OF INJURY
(MonItJ, D8y. hr)
TIME OF INJURY
INJURY 1J WORK? DeSCRIBE HOW INJU~Y OCCURRED.
--
.... 0 NoD
!i
w
g
~
I "
"'" ~ NoD
... 2Ib.
CUTIFIIR (Check only one)
-CERTJFYIrIG PHYSIC&AN (Physician oertifying cause or d8elt1 when anoIhar physician has pronounced death and complaled Ilem 23)
1b.....ofMy~, dNlhooturNd..totMc.uN(.)end__..........'.... ...................
"",Jl{
NoD
-..
PenclinglllYWtigatlon
CouIdnotbe~
s,_
It.
Coroner
-PRONOUNCING AND CERTlFYING"",1aAH (Pt1ysician both pl'onounciny dvall1 and OOl'liIyirlQlO c8used death)
TD... beet ofmr~. dMthOOOUrNdMltletlme,"', ttnd__. .nddMlIlltIe c-..M(.) and ,.............. .. ...
_.sID1I....OFFlCI_3 7-000
DATE SIGNED (Month, Day, 'lesf)
D "" ". May 20, 2005
NAMe AND ADDRESS OF PERSON WHO COMPlETED CAUSE OF DEATH
Olam2nT"",,,,Pdnt Michael L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
~u. Mechanicsburg, Pa. 17050
ORE FllED(MonIl, Day.......)
.IIEDICAL~ER
On_butloI~""OI~.1n rnyopimon,..DCCUrrecI..thetIrM....Md p&.ce..nd"'tothe~.)1Ind
.............a.tIIcI..................................................................................................
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