HomeMy WebLinkAbout09-08-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~~'^ Re e r-.J (
also known as
F\s~G" No. -4-1 -0:;-- 0'113
To:
Register ofc::ills for the
County of \)... T")-.{Se l1., \ P"'~ in the
Commonwealth of Pennsylvania
?: C- pe~sed.
Social Security No. "\\0\ q 0 "\0
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 1 yea
e
(d.b.n.; pendente lite; durante absentia; durante mi
the above decedent.
Decendent was domiciled at death in C '\) 'Y'}-.~ e YL \ ~ ~"" 'V County, P~sylvaQia, with
h e (L., last family or principal residence at"f 1.-\0 C; y.:J e~ 1...\), \ , ~ R)-:) '- ~-<L h\ S;) h-
(list street, number and municipality)
~-;l d-o ,~o s ,
Ce ~ T"\. 't'r
for letters of administration
on the estate of
Decendent at death owned property with estimated values as folllows;
(If domiciled in Pa.) All personal property $ '()e::(::).(j0
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate i~ennsyl~aQi8,. _. "f \J ) \ $
situated as follows: ') ,,\0 5 }-)~\ <; ,) ~(l..)? Gru '\ \ \ e.
. '0--S M~ ~f - e $L~ - ... f? ~(.1"\e ~ L-
I
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived *y
the following spouse (if any) and heirs:
Name
As'1f elL -:s 61.. '1'-\0 S
c:>i
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration qti' the
appropriate form to the undersigned. .r:-
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF c.\ .Urn b~\\ Q..,y~\
} ss
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 affirmeq and subscribed f ~~ ~~
befO'~~ >o~d_a~ ~i - ~
J1Qg-,,' - aD~ '0 1
~ C}- GA.../)\ ~Re ler l
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en
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Estate of fY',<)...iv>\.~ '2.
No. dl-05 - ()~73
1=\s p.q (
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~~lof!\ \:Yl. i'-. 3c> ~~S:-in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Ju\-o.... ~ \=\s\~y- \ ~.
is/are entitled to Letters of Administration. and in accord wIth such finding, Letters of Administration
are hereby granted to ~u"(-..,.-, ~ \~ 2:> (>?,- \ ~-
in the estate of '{"(''>-.lv..1\-'" LV-- C. p.. S(L1' ~-
$ .\.l 0,
l 'nb Cv~\ l'-':l.b.1{1100 ~
Register of Will~r . Ul..'-'. )t:.
'U~
FEES
Letters of Administration $ ,.:).l::C' . C'f.~
Short Certificates( ).......... $ q. ex.:;
~~O.;.-.....,.~~\O'<., . .. $ '5 ~
~~p $ \ 0 ,>=:,
TOTAL _ $.J.'7<i .00
Filed . q:.~~.. .-?:-~'.:...;'?.. A.D. ~---
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
H105.112 REV 1/05
(FEE FOR THIS
CERTIFICA TE S600)
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5958444
~
Date of Issue of This Certification
September 23~ 2005
Name of Decedent
Maureen
Asper
Last
Date of Death Sept.-i20 2005
E.
First
r-,'1idd'e
Sex
Female
161..34..0904
Social Security No.
Date of Birth
July 31, 1942 Birthplace
Newport, PA
Place of Death
M.S. Hershey Med. Center Dauphin
Derry Twp.
City Borough or Townsrip
Facility N8me Count".
Race White
Occupation Homemaker Armed Forces?
Decedent's
i'iarried Mailing Address 7405 Wertzville Rd.
(Yes or No)
Carlisl$
Oty err Town
Marital Status
Numb'3r
S:rcet
Informant John W.
Name and Address of
Funeral Establishment
Asper Jr.
Funeral Director
Sally A. Hyers
David Myers Funeral Home_L.",Newport...... PA 17074
Interval Between
Onset and Death
Part I:
Immediate Cause
(a)... Adul t Respiratory Distress Syndrome
(b) Sepsis
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(c) Cholecysti tis
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Part II:
(d)
Other Significant Conditions
I'
Manner of Death
Natural r~X
Accident 0
Suicide
Describe how injury occurred:
s:-
o(
[-1
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Homicide
Pending Investigation
Could not be Determined
[]
Pennsylvania
No
PA 17013
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Name and Title of Certifier Dennis Johnson ; M. D.
(M.D., D.O., Coroner, M.E.)
Addffiss M.S. Hershey Medical Center. Hershey. PA 17033
This is to certify that the information 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 permanent filing.
Date ReC8ivP(j by L.ocal Re~listlar
Stree! Addres;;
New Bloomfield PA 17068
City, Bcrough, Towrsl'j~
Sept. 22, 2005
101 Barnett St.