HomeMy WebLinkAbout06-21-05
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Register of Wills of Cumberland . County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Mark D. Coy No. d 1- 0 5 -Q~o<(
a/so known as To:
Social Security No. 163-60-5362
, Deceased
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ied
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
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Decedent was domiciled at death in Cumberland County, Pennsylvania, with hjL last family Or princip"
residence at 336 N. Bedford Street. Carlisle. PA 17013
(list street, number and municipality)
Decedent, then 42
1 :03 PM
years of age, died September 20
. 20 05
, at
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
(Ifnot domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
o
$
$
$
$
I
i I
I
D
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survive~! by the
fo Hawing spouse (if any) and heirs: '
Name Relationshi Residence
Belinda R. Coy Wife 336 N. Bedford Street, Carlisle':
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in thi~ppropr4~e form .
to the undersigned. f\>:
l'\-Di
Residence(s) ofPetitioner(s)
Belinda R. Coy, Administrator
II
336 N. Bedford Street. Carlisle, PA 17013
II
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
SS:
COUNTY OF CUMBERLAND
Sworn to or affmned~bscribed
Befqre me ~his day of
L~_ -tD~ .20 05
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true alnd
correct to the best of the knowledge and belief ofpetitioner(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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No..21-05-0"iES'
Estate of Mark D. Coy
1
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. Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW OQ. +oh 1) ^ 'I . 20,Q5, in consideration of the petition on ~e revers~E
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Belinda R. Coy
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Belinda R. Coy
in the estate of Mark D. Coy
FEES
Probate, Letters, Etc. .............
Will........................... ......
Q
Short Certificates ( ).. . . . .. . .. ..
JCP....................... ...........
Automation Fee...................
Bond... ............... .......... .....
Total
Filed ~-td::):;U\.
$
$
Renunciation.... .. .. .. . . .. . .. ..... . $
$ ,'~L/ .CO
$ IO.CC>
$ 5.00
$
$ 5q .CO
2005
717-249-7780
Phone
II
HIO"i:\(}"> RFV I/O'.
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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Local Registrar
Fee for this certificate. $6.00
No.
SfP 2 2 2005
Date
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H105. ~43 Rev 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
TYPE/PRtNT
'"
PERMANENT
BUCk INK
..
COUNTY OF DERH
42 v...
SEX
STJl:I'iEFtLE~"'BEA
SOCIAL SECURITY NUMBER
,Mentl'!. Oa.,. .~,
NAME OF DECEDENT (F-SI
.. M
>. 163 - 60
AGE (LaS! 8irlhdllly)
BIRTHPLACE (C.t'/' end Pl..*oCE OF oeATH rCt>eck ootv 0I'\e '>ee ,nstruc!oOffl on othet ~l
$1a18 01 FCltlIC}n Country) HOSPITAl
InQal;.ncD
7. eo.
FACilITY NAME (II MIII'\51'IuT'OO.1)lve street and nlJmt>ell
:::",,0
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'" Cumberland
oeCEDENT'S USUAL OCCUFWION
(~~r::lii:':io~~'~,~
".. Construction Worker "..Hunter
DECEDENT'S MAILING ADDRESS ($IrNl:. Cilyllbwn, StoIM. ZID Code)
MARITAL STnus . Married
N8VW Married. Widowed.
Oivofced (Specify)
Married
RAe rnanc.n~.n,~White.etC.
,-I
1.. White
SURIJMNG SPOuSE
(11 '?IIlIa. ~vemalOM namel
336 N. Bedford St.
10. Carlisle, PA 17013
FRHER'S NAME IFirsl, Midde, Last)
Dennis R. Coy
Co
Cumberland
l>d
-...
liWIirU
lOwn$hip1 H'djXl :;'=':::01
MOTHER'S NAME if:it'sl. MlClcAe, Malden Surname)
Barbara M. Paulus
_.
t7b. Cou
Carlisle
citylborO.
RarnowIlrom Slala 0
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INFORMANT'S MAILING AOOAESS (Street. Cityfiown, S\lIe, Zip Codel
.... 336 N. Bedford St. Carlisle PA 1701
PlACE OF DISPOSITION. turn. Of Cemetery, Cramatory LOCRtQN. CityfTown, St.'a. Code
"'O"..P,.... Perry Coupty
Qung's United Meth. Ch. Can 1.. Sherrnansdale,
NAUE ANO ADDRESS OF FACILITY
.li.Win Brothers Funeral
LICENSE NUMBER
PA
...
27. PART I: Ent.r!he diseasu. inluries Of complicatIOnS wtIil::h caused the dea
list only one cause on eaCllline
Co- .; [LSc~lOJ-.
DUE TO (OR AS A CONSEQUENCE OF):
~
...
I Appraltimale
:intllfYat~n
lonMIanddecth
,
:
PART II:
I :
DUE TO toR ASA CONSEOUENCE OF)
DUE TO (OA AS A CONSEQUENCE Of)'
WERE AUTOPSV FINDtNGS MANNER OF DEATH
AVAILABLE PRIOA 10 ~.
COMPLETION Of CAUSE 0
OF DEA'rH1 Natural Hom.cida
Ace","", 0 Panding Investigation 0
v_ 0 No 0 Suic:ide 0 Could not be .-lemllf-.ed 0
DATE OF INJURY
(Monlrl. Day, 'Marl
TIME OF INJURY
INJURY ,J(f 'NORK1 DESCRIBe HOW INJ V OCCURRED
'- 0 NoD
a.. 21b.
CERTIFIER (Check onIv noe\
'CERTIFYING PHYSICIAN (Ph)'SIC.an CP.flllylng catJ$e ~ oealh whEm anOlf1E!r pf'lVSIC,anl'las pt{)(lOtJnced deam allO compll~led lIem 23)
To IIMl best 01 my knowledge, de.th oc:eUl'Nd due \0 lhe e'UM(S)and manne,.. stated. . .
>t.
30.. 3Ob.
PlACE OF INJURY. At home. farm, stree" rador" office
building, a.e. ISpec,lv}
,...
AEGISTRA.I=!'S SIGNATURE AND NUMBER
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IDJ \ IrlJ I 10 I
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'PRONOUNCING AND CeRTIFYINQ PHYSICIAN (PhysICian boItl OiH:>nout"lClng Qedlh ana cen~y,ng 10 cause or dMIl'1\
To fh. blMt 01 my knowledgfl, dealh occurred al the lime, d.le, and place. and dualO 1M CaUfIe(I,.nd milnner IS slaled.. ,
'MEDICAL EXAMINER/CORONER
On the basi, of e1l8mln8Uon and/or investigation, in my opinion, death occurred at the lime, dalfl', and place, and due to Ihfl' causfl'(s) and
m.nnef as stated.. ,.,. "." , "..,..., ... . " . .,.., " .. ,., , . '.... ,..,." ..,.. .,.
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