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Home My WebLink About10-14-05 Register of Wills of tt'4-v/W]) 44 Pennsylvania Petition for Grant of Letters of Administration Estate of /(A~J,k. $"/I)~5~;t(, No. & 1- as-oCtln a/so known as Deceased. Social Security No. /&"1'- ?~- ~1' The Petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl//S- for letters df administration (d. b. n. ; ptmdente lite; durante a bsen till; durante minoritate) . Decedent was domiciled at death in &# jSc.-;7? ~ b County, Pennsylvania, with h/-:$ . last family or principal residence at ,///6' Av~&X ffiLL If! ~.6ef/ &.fh//1 /7&//~/~3 ~ ~ .-- 7 (/1st street, "umber an{j-;Jumc/PtJllty) . Decedent, then ~years of age, died _ J?!/f/~ 7---7- ' 2-el::!L, on the estate of the labove decedent. 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 (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania $ ,~ IY-!J'r $ $ $ situated as follows: Petitioner _after a proper search ha ~ ascertained that decedent left no will and was survived by the ollowing spouse (if any) and heirs: 7if4ar-- ;,; .. "'... "C -.. 02:2 e,:J .... 0", ",= .... e,., >>" f-oE .. = ///h c'tf%-~ce Name Relationship sht/5'~- . ~N .5Jd : i:-~ ] ! : 1 ,~) Therefore, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriat~ f~~m t _ .~.~ e unde~~ed. - . r'r7J ., .. .. z .. = .. <ii Oath of Personal Representative Commonwealth of Pennsylvania } ss County of The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true "ana correct to the best of the knowledge and belief of petitioner(s) and that as personal represe tative(s) of th above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed + 2 ~ a .. ~ .!!l> '<l before me this Estate of fYYl R 1<.... Fees Letters of Administration. . . .. $ (fO. ~1.OS.OqIO R ~~ l~AL , Deceased Short Certificates ( )....... $ Renunciation ............ $ ATTORNEY Filing Inventory . . " . . . . . . ." $ (Sup. Ct. I.D. No.) Filing D & D's .. . . . . . . . . .. $ $ ADDRESS TOTAL $ PHONE Filed 19 OATH OF PERSONAL REPRESENTATIVE CO MONWEALTH OF PENNSYLVANIA COUNT subscribed f day of 19_ I Register L No. <::21-05 - CC\ to Estate of f\'Y1 r 1-< K. (St 1 >--oepr , D~~eased ',,;) ;.) .:J .j"! GRANT OF LETTERS OF ADMINISTRATION AND NOW Q~ t')b.QJ\ \~ c{)(1)5 ~_, in consideration of the petiti ~. ~n the reverse side hereof, safsfactory proof having been presented before me, lT IS DECREED that is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administ are hereby granted to 12-- in the estate of I Yurt< -r< ,'Y.~9pR- FEES Letters of Administration $ L.J 5. (')0 Short Certifisates( ).......... $ GJo ..CJD .Remt~_~~ \-~~. .. $ S. aD -dJC'P $/0.00 . TOTAL _ $ 8"(lOO Filed .10.-: J.:: .~.$......... A.D.~_ , }j~~~~YVA ~P~T\G\-- Register of Wil~ ~~. 'n :-:-\- II W../l I J ATTORNEY (Sup. Ct. I.D. No.) ADDRESS PHONE ~ I PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of also known as No. To: Deceased. Register of Wills for the County of Commonwealth of Pennsylvan' Social Security No. Your petitioner(s), who is/ar 8 years of age or older, appl rs of administration on the estate of (d.b.n.; pendente lite; durante absentia; the above decedent. Decendent was domiciled at death in h last family or principal residenc County, Pennsylvania, with Decendent, then at , 19 Decendent at death owned property with estimated (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in en sylvania (If not domiciled in Pa.) Personal property i Coun Value of real estate in Pennsylvania situated as follows: $ $ $ $ Petitioner_ after a proper search the following spouse (if any) and hei Name left no will and was survived by Relationship Residence etitioner(s) respectfully request(s) the grant of letters of admim tration in the o the undersigned. II 1I11';I~;{~\i~";O certifv that the information here given is correctly copied from an original ce:t.ific~te of death du~~. ~iled with L()~al Rcgistrar~ The original certificate will be forwarded to the State Vital Records Office tor permanent hlig. , , me as WARNING: It is illegal to duplicate this copy by photostat or photograph. P I 11(""1 lV~ --<' .L ,'" "",. <e,1 No. II"',. 1" 1:- ~,,J ;::J ~ /?J ~~P:?- Local Registrar . (j Fee for this certificate. $6.00 .:i SEX .. male Date c; ") i 43 Rev. 2/87 .2/-05-CPtlO COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH STRE FilE NUMBER SOCIAL SECURITY NUMBER UNDER 1 YEAR Montfl8 Oays .. 187 58 2005 42 v,. COUNTYOFOERH 8tRTHPlACE IC.t'f ~.d PUGE. OF' DEATH let>€<:" only l)f>8 -- .;ee ,(lSlrucloOrlll on othel 5Il.Hl) Stale Of fcr8oo:}O COUOIIV) HOSPITAL Harrisburg,PA 1........0 E~"... 0 ",,"0 7. ... FACILITY NAME (II nol .ololofUtlon, gIVe stree( ar.d oumOef. :=".,,0 .. Cumberland J;. Pennsboro Twp. .... KINO OF eUSINESS/INDUSTRY 1116 Oyster Mill Road DECEDENT'S USUAL OCCUPAnON (G.w kind d WOfk dOne dUfll'IQ mosr O'....k... w.; do naI UM rewed) . "L Owner/Operator ".. Carpentry ilI:CEQENT'S MAILING ADDRESS (SI,.... Cilylblwn. SIaI...l1p Code) DECeDENT"S ACTUAL RESlDENCl: (See","""""", on OCflef SIde) w..S DeCEDENT EVER IN u_s. ARMED fOACt:S7 ....0 Nolia DECEDENT'S EOUCATtoN I h adecom ElomenWylSocondolV CoIIogo ,..12 (1}121 (Hew 5') ... Pennsylvania Q;d 17..00.....__. -- ....in. Cumberland _7 17d.o ::...~.::.. MOTHER'S NAMe iFul. MIddle. Mcuden Surname) to. Janice J. Es enshade 1Nl'00000T"S MAlUHG AOOAESS (51,.... C<<y/T<Mn. 5/010. Z'..CoOoI 1116 Oyster Mill Road, Camp Hill, P PlACE Of= OISPOSJTION....,... of CerMtery, C,emaIOfY lOCA1lON. CilyI1i:JMt, Of Othef PI<<. Ebersole ". 11_. Slale _. 1116 Oyster Mill Road ,a. Cam Hill PA 17011 FR"H€R'S NAME (FirS" MKde. l.ulJ ... George Sweger 1NF00000000'S HAWE (T _P""l Kara K. Swe er METHOD OF DISPOSITION _lSD c,........ 0 .......... __ 51.,.0 0Ih0< (Spec"'" 17b. Coun - July 2, 2005 .... Mt. LICENSE NUUBER FD 013 340 L 17070 .... IME OF DEATH ... '1: 35 lA ... . uY1c:.. 2-'1, l005 27. PART I: Ent.t ,.... diMtlMs, inJuties Of compticaliona which caused lhe deach 00 noleole' lhe roodII 01 dying. such as cardiac Of tespitalOfy ann!, ShOCk or l'I8att f.dut. L_ ontv one cause on each line. t3b. 230. 'M.S CASE REFERRED TO MEDICAl EXAUINERIC ....0 '"' c.e..r- DUlE 10(00 AS A CONSEQUENCE Of): Q/(y\ ... I Approximale 'inl8RIII befwMn : onset And deelh I : PART I: .. DUlE 1O(OOASA CONSEOUENCE Of): DUlE 10 lOR AS A CONSEOUENCE Of)' d WERE AUlOPSY Fl"OINGS ,Al"Wl..A8LE PRIOR m C,,",PLETION OF CAUSE OF DEATH" WANNER OF DEATH DATE Of INJURY (Moo.... Day. 'Mar) Tlue Of INJURY INJURY IiI lNOAK1 - 1ZI o o Homicide o o o PlACE OF INJURY. AI home. ratm~;eet. faclOfy. o1fiee M. buikjng. MC. lSpeotv) 300. v.. 0 NoD ........ _nO Pending tnv.uigahon JOe. HolXl v.. 0 HoD Coukf noI M delermlOed _. ..... CERTIFlER tC"8df onty 0fWI .canlFYlMG PHYSICIAN IPh~ c~ ~ r:J de8lh whetl anot"er Dh~SlC.an has pronounced dealh ana compleled llem 231 TothebNIO.""knowledv-,de.thaccurNddUe......Uu-Cs).ndm.anMr...tat4Hl........................ -..... ......... -....... ... o .PfIONOUHCING AND CERTIFYING PHYSICIAN (Ph'fSIG1;IO bolh Olfonounclf".g oea.... and certdy.ng 10 cause 01 deatN To the ~ o. my II.now'*lge, dealh occur'''' ..the time, d.te. and plec:.. and due 10 the cauM(.1 and menM'" .t.led... . . . . o "MEDICAl. EX....INER/CORONER ~~:r~:i:t::~~~~.i~t.~~...n.~~ ~~~~~t~~~t.~: ~~ ~.y. ~~i.n.i~~: ~:~~~ ~~~~~~~~ ~~ ~~~ ~I~~'.~~t~: ~~~.~I~~~: ~~.~~~ ~~ ~~~ ~~~~~!~).~~ 0 31.. REGISTRA 'S ,.,.,TURE AND Ij!!~~ ~/-' JM~':"~~ lotI/P?,/11 ,..