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Home My WebLink About11-01-05 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate of .:Sa rYlu<:::.\ C. J (} m; L"c.,r"tJ also known as ~... No. To: 'J.. \ ~~ S -S\:,\,o Deceased. Social Security No. ;:) 0 g - I.::J - <111 '( Register of Wills for the County of 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; C ':> 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..u IV"'Ihe..r-\ ~ d County, Pennsylvania, with h i5 lastfamilyorprincipalresidenceat 405 lL,tb 5h-<-e...-t- ".ki.0 GrrlJe.{\Gnd fA I"lO'lO (list street, number and municipality) Decendent, then '1 e, years of age, died OcA-ch-e...\ I ~ at ('f'), '::/ \-\-cI.-< ~h~l YY1"'<.":d; Cc... \ C~ , 19 .:.J ClC :) , 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: 'iDS 11.:,T1-. .:s+,CL-+ tJ~iA.J Curnbex-IG-t\cl $ "500. DO $ $ $ fA tlolO ) (0) tDO ,00 Petitioner_ after a proper search haS- ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship Residence ~ Q.. ~ 'u ~ \)~u Q,. ~h::..u....o "..' '-.\ Ct.,..-.r, \ C$u.-.... Gvc..rd~>,", ( 'So 1'\ THEREFORE, petitioner(s) respectfully request(s) the grant appropriate form to the undersigned. 39 l)o(1V\J~n ~A 3(::)~S~ G...r'YI ~ fA 110'7~ e....e..: L~ fA 110'-\3 ;\- . ~,~ Cu be.rb,'d fA 110,0 An", S>T'.. fW1-. & .",,', oak tewf' fA of letters of administration in the '"105'1 '" 'a:i' f2......__ .. ~ 2 .,:j~G.N\U Q kJU vrO '" .... cr:~ "g,g ro';:: 3~ '" '- ;:;0 ~ t:: Of) Vi I()l S ~ur:~:-)-E'S IY\ \\ Qd. _ ~~~e..r~ fA 11?~q , ..-1 OO.l!I:'j 1--", ')LLi OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ '('I V\ ~ ~ $ l.:~ ~ $ } 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 affirmed and subscribed J'-j. St ~G N\ '1 \l G - Da\ tel before me this I\, '".;( day of ~'\. ~~~ 1~ ~~ ~ 1'o..~~~1 ~ ~ _ $~\ "U~ Register L --- CIl '-' 11) .... ;::l .... ell ~ ~ en No. ~\ -~S - '" ~\c Estate of 'S ~V\~x\.... sc:.. -S ~~\E.~'$~ , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW ~ ~N . \ \ ~~ ~ S *--, in consideration of the petition on the reverse side hereof, satisfactory proof ha~ing been presented before me, lT IS DECREED that 'S,~~~~~\<;;;. \:>, ~~'\ Ii\) is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to ~\~~\\~~\~ ~ ~~~ S:> in the estate of "S ~ '" "'~ L ~. -:s. ~ \J\'~ -S~ ~ ~~ ~~I'~' ~ C'Y-._~~, <>~~~> ~~ FEES Letters of Administration $ lu~- Short Certificates(l.,) . . . . . . . . .. $ ~". Renunciation .. ~~). . . . . . . . ., $ \S. -:s.~~ ~ ~~~ ~,,~~ $ \S_ TOTAL _ $ \. '\~ .~'\) Filed... .'\\:-.'\ :~........ A.D. "W_ ATTORNEY (Sup. Ct. 1.0. No.) ADDRESS PHONE Register ofvVills of Cumberland County RENUNCIATION Estate of ....5;"':';/c...iu<:L ~ J4;1..//(:60N Also known as E ..!:J No. ~ \ - ~ S - ~ \ ~ , deceased To the Register of Wills of Cumberland County, Pennsylvania The undersigned ...:t:.:J'\kJ~':} L. /-h,:"1M':;' ....t),.;..Jt-IGHr13.e. (Name) (Relationship) (Capacity) of the above decedent, hereby renounce( s) the right to administer the estate and respectfully request( s) that Letters be issued to SrC-A-I/-J^,1 t::- 13 o'i!:) Witnessmy/ourhand(s)this .AJf dayof ~t/e-~L ,20o.:::r.- ~->5. U~~ (Signature) ~4'S 'If!(a-j~ i. L,(I( . iAddress) '7;.t (r A.I~, ..R:.!t ~-. ...30.;<.5,;;;J.. ribed before me this ~~". ~~~, Notary Public My Commission Expires: (Signature) Or (Address) Affirmed and subscribed before me this ~ day of ""~\l "'\..C:l~,:: ~,., ~~ ~ ~,,~~.....~ Register of Wills ~~~"\ ~~ ~~~ ~~~ De uty ,~ ) - ',,""" .~ (Signature) (Address) (Signature and seal ofNolary u!" other official qualified to administer oaths Show date of expiration of Notary's commission) .' rJ o Register ofvViHs of Cumberland County Estate of !>>am u-e.- ) (I L.. 1\ {/ Also known as FU RENUNCIA TION f lQm'~ll) No. "J... \ - ~ S - '\ ~ \0 , deceased To the Register of Wills of Cumberland County, Pennsylvania The undersigned CL/NhIQA-. ;v1~ 4CkVn ~9~-/Py/ I (Name) (Relationship) / (Capacity) of the above decedent, hereby renounce( s) the right to administer the estate and respectfully request( s) that Letters F$.)yJ . be issued to 6-fefJ{\.o..F\/ t:., A- I Witness my/our hand(s) this 1.ee day of () 0W~ ,200::s- Aff,4~d and subscribed before me this ~ day of C~ 11\ n-.... < IA-J{ - , .- NOTARIAl. SEAL Cathy l. Youngblood, Notary Public lemoyne Boro. Cumberland Counly foIr.t Commission Expires June 22, 2006 ~~){j--71I~ ~)t2 /LJ (Signature) _, f Cc.(-3 /;:.. tela! rHJ/:_ ~c;{ ~~ / . fA (Address) J 707-8 My Commission Expires: "~~,~l,..~.. o,-.......^..!~.......;'" ~ '!......~:.."if\1"j nf r.Jnt:1npl."" (Signature) Or Affirmed and subscribed before me this _ day of (Address) 1lI!-<' (Signature) Register of Wills Deputy (Address) '--) (Signature and seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's commission) -',~i CJ o Register of Wins of Cumberland County RENUNCIATION Estate of ,<)-:un LULl E, Jam ~ S6 n Also known as Ed No. ":l. \ - ~ s - '\ ~X> , deceased To the Register of Wi lIs of Cumberland County, Pennsylvania The undersigned ~ -tn' l!--I fA.. f t1Ll r Ifl M'1 (Name) (Relationship) apacity) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to 1j1.r(~ COMMONWEALTH OF PENNSYLVANIA l SEAL BETTY K. HOOVEN, Notary Public Q AL l,. 1..< Lemoyne Bora.. Cumberland County C 10 I) e.r , 20~. My Commission Expires May 27,2009 LjJ~i,-~ t; 19 S-!ou ~ L fYl (J\JIU flLl11J/3 (Address) T J Witness my/our hand(s) this cJl[ day of My Commission Expires: ~WurS4~ Yf){,{} :; ~ blJ~ cr Or Affirmed and subscribed before me this _ day of ~.. % ,~ ~0u~lA:t\D Pf\ (Address) lto-lD ~ J~ig",1i;;;"( :) 5 '"I )J Ju 4./ S'r- AJl T ~ mil) Q<.f~[o...J U j!') IJ /1(.1 s 7 (Address) Register of Wills Deputy ._~.J -u (Signature and seal ofNolary or other official qualified to administer oaths. Show date of expiration of Notary's commission) C) C) ) j': II"" "" fl'\' ~ \ _ ~ S _ '\ (Iol.c This is to certify that the information here given is correctly copied from an original certificate ,1' deah duly lileel with me as Local Registrar. The original certificate will be forwardcd to the Statc Vital Records Office for permancnt filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate. $6.00 11986826 No. ~~,;,~ P I OCT 1 7 2e05 Date r~~-.J .'''''''',-'~ -) \ H105.143 Rev. 2/87 " TYPEIPRINT 'N PERMANENT BLACK INK COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH ;~~') C:') 78 STATE FILE NUMBER ,. AGE (L.st Birthday) NAME OF DECEDENT (First. Middle, Last) Samuel E. Jamieson DATE OF DEATH (Mooth, DRY. Year) .. Oc t. 13, 2005 .. 2.2.. . COUNTY OF DEATH y", BIRTHPLACE (Cily and Slate Of Foreign Country) 7 Harris!J.n:g, PA 7. a8. FACILITY NAME (If not inSlitutioo, give street and number) ResidlrlC8 0 ~:::~fy) 0 RACE. Amerian Indian, Blad, While, et . (Specify) 10. White SURVIVING SPOUSE (lfwila.llMl maldlln "lime) Bb. B,. ~ :> '" .. :; .. DECEOENrs USUAL OCCUPATION KIND OF BUSINESS / INDUSTRY fGiYe kirtdofwofll dona during ",o.t 11~~~1~y~notuMr.lired' 1~ectroniCS . D1i6gE16~S)~~RESS (Street, CityfTown, State, Zip Code) New a.mIDerland, PA 17070 16. FATHER'S NAME (First. Middle, Last) lB. James Jamieson INFORMANrS NAME (TypelPrint) 20.. Sandra L. AdanE METHOD OF DISPOSITION . Donation 0 Burial K3 Cremation ~emoval from Slate 0 . 218. Other (Specify) <Wp 17d. fa ~~h~e~~~7\1~:sd of New Cunberland Borc. MOTHER'S NAME (First, Middle, Maiden Surname) 1.. Hanna L. Jamieson dtylboro Inc. l.ll DA IGN D (Month, Day, Year) 23b. 2Jc. WAS CASE REFERRED TO A MEDICAL EXAMINER /CORONER? V" 0 No Ii9 27. PART I: fnt..Itl. dl..a....lnJun.. or ~ompliution. whl~h ~.UHd the d..Itl. Do nol.nl.r the mod. ofdylnlJ, .ueh.. eardlK or ra.plrllory .rr..t, .hoek or h..rt failure. PART II: Other significant conditions contributing to death, but U'I only one cau.e.." ..en IIn.. not resulting In the underlying cause given in PART I. SeQuentially lisl conditions { ,b.. il any. leading 10 immediate . cause. Enter UNDERLYING CAUSE (Diliease or Injury . that initiated eventl resutting on dealh ) LAST d. WAS AN AUTOPSY WERE AUTOPSY FINDINGS PERFORMED? AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? Yes 0 NO'W" Yes 0 28a. 2eb. CERTIFIER (Check only one) .l~~~~~tGJ~~~;~~~~~l..~:rhc~~~~gadU':: tr: r::~a=~(:r~~:~X~~8~. h:I~r.~~~~ .~~~~~.~~ ,~.~~~~~~.~ .i~~~ ?~)...... ::::~R OF~TH Accident [) o DATE OF INJURY {Month. D.,."...) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Homicide o o Yee 0 No 0 30a. 30b. M. 30c. o PlACE OF INJURY - At home, fann. street, factory, aKa bulIdIng,etc. (speclfyl JO.. .0 Pending In...esllgation No ~r Suicide Could nol be detennlned 0- "' o "' u "' o "- o "' :; <: z 2.. .PRONOUNCING AND CERT1FYING PHYSICIAN (Physician both pronouncing death and certifying 10 cau&e of death) To the belt of my knowledg.. death occurred at the time, dale. and plac., and due to the ausH(S) and manner.. stated. OMEDtcAl EXAMINER/CORONER On the bull of .xamlnatlon andfor In.....I113al1on. In my opinion, death occurred at the time, dat., and place. and due to the caulesjs) and manner al slated................... ....,............................ .......... ..... ..... 318. R )S?1i( 33 ~ Ity~~ 1'1 os-