HomeMy WebLinkAbout10-28-05
.
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estateof TimothyP. Moses No. ,!).I-05 -OQS3
also known as To:
Register of Wills for the
County of Cmnberland in the
Commonwealth of Pennsylvania
. Deceased
Social Security No. 210-40-1950
The petition of the undersigned respectfully represents that:
Your petitioner(s), who Ware 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.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with hjL last familY,or princip&1;6
residence at 330 Hollow Brook Drive, Carlisle, PA 17013 . .,:.i,
(list street, number and municipality)
Decedent, then 55
Residence
years of age, died October 15
.2005
.,. ;"1
c..:tJ
. at
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa) All personal property
(Ifnot 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:
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$ 75,000.00
$ cb
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$
$
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs: .
Name Relationship Residence
Janet L Moses Wife 330 HoIow Brook Drive, Carlisle, PA 17013
Leslie Anne Frey Daughter 327 Franklin Street, Carlisle. PA 17013
Andrew J.W. Moses Son 435 First Street, Carlisle, PA 17013
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate fonn
to the undersigned.
Signature(s) of Petitioner(s)
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Residence(s) ofPetitioner(s)
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.
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
ss:
COUNTY OF CUMBERLAND
The petitioner{s) above-named swear(s) or affinn(s) that the statements in the foregoing petition are we 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 tmly administer the estate according to law.
y8a~ 1. 1Jn&dJ2<1/
Sworn to or affinned l!!l4 ~ribed
B~.e me this (~ 'C'= day of
C::t6 hQ........ .20 OS
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~NO.~I-05.C/153
Estate ofl\{Y~~ 9 (\\0&5 . Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW D.. ~ d-<i? 2005: in consideration of the petition on the reverse
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Janet L Moses
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Janet L Moses
in the estate of Timothy P. Moses
135 cO
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FEES
Probate, Letters, Etc. .............
Will...... ......... ............. .....
$
$
$
$
$
$
$
$
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5.oD
Attorney (Sup. Ct LD. No.)
1 Irvine Row C'.,
Carlisle, PA 17103 . n
Address
Renunciation.................... ...
Short Certificates ( ). . . .. . . . . . . .
JCP... .................. .,. ..........
Automation Fee...................
Bond.................. ......... ......
Total
Filed \0' ~ <;{
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Iqq.c:O
717-249-7780)
Phone 'J
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HIOSXOS RFV \10':;
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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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fee for this certificate. $6.00
No.
OCT 1 8 2005
Date
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H105.144 Aev. 1191
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
TYPE/PRINT
IN
PERMANENT
BLACK INK
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SEX
P
Moses
O,ll\fE OF 81F1'TH
(Month, Day, 'tI3ar)
2.
Male
DATE OF 0 J'H (Mooth, Day, Ye8-r)
OctDber 15, 2005
UNDER 1 DAY
Hours Minutes
BIRTHPLACE (Cily and
Slalfl or Foreion Country)
Harrisburg, P.
g'~,D
ardner
two
17b. Coun
cltylboro.
O~E OF otSPOSfTlON
(Monlh, Day, 'rtlarl
D 2,JO /18/2005
RVICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER
22Q115f\().T~ Holli
To the besl 01 my knowledge, death occurred allne time. date and place staled,
(Signature and Title)
230.
TrME OF DE..u-H prx . DATE PRONOUNCED OEJl.O (....onIh, Day, 'tear)
24. 7: 30 A'M. 2'. October. 15, 2005
27. PART I: Erner lne dIseases, iniuries or compUcatlon.s which C8.\l$ed the death. 00 not enl9l'lhe mode of dying, such as cardiac Or respiratory IlIrrest, shock or hear1 faUur&.
LISt only ooe cause on each line.
Probable M ocardial Infarction
DUE TO (OA AS A CONSEQUENCE Of):
23b. 230.
WAS CASE REFERRED TO :~f\ONERlCORONE
26.
IApprolCimale PART II:
: inlerval between
! onset and death
b.
DUE TO (OR AS A CONSEQUENCE OF):
DUE m (OR AS A CONSEQUENCE OF).
d
WERE AUlQPSY FINDINGS
AVAILABLE PAIOR 10
COMPLETION OF CAUSE
OF DEATH?
Natural
~
D
D
DATE ill' INJURY
(Month, Day, Year)
v..
MANNER OF OEATH
INJURY' AT l,VORK?
CCURREO.
Homicide
D
D 3". . M.
O PLACE OF INJURY - At !loma, 18rm, street, factory. office
building, etc. (Specify)
3...
Yes 0 NO~ YeB 0
2". 28b,
CERTIFIER (Check only one)
*CERTlFYING PHVSICIAN {PhysiciEln certitying cause 01 dealh when another physician has pronovncfld death and completed Item 23}
To the best 01 my knowledge, dHth OCCLlrred due to the cause(a) and manner as stilted. . . . . . . . . . . . . . . . . . " . . . . . . . .
NoD
Accident
Pending Investigation
Sl-llcide
20.
Could nol be determined
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.PRONOUNClNG AND CERTIFYING PHYSICIAN (Physician both pronouncing death and certilying to cause of death)
To the bMt of my knowledge, dNthoccluT1td at the Urne, dlite,and place, and due 10 the CIIuse(S) and manner.s stated.. ...
D 3'b.
lICEN
Coroner
D
*MEOICAL EXAMINER/CORONER
On the biI.l. of examination and/or Inv..tlgatlon,ln my oplnlon, death occurred at the Ume, dlrte, and place, IIInd due to the cau..(a) and
manner...tated.....,......,...................,.....................................................,.......... .
31..
REGISTRAR'S SIGNJIJ"URE AND NUMBER
~I' 1&\101
34.
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