HomeMy WebLinkAbout11-03-05
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PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of /< ~ ~tZ-y A-. 5 H [N I( No. c2 / (J(5. (If} 'I?
also known as To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
, Deceased.
Social Security No. ;12- - JI.:. -1'-I5~
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl {I::S u 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 etA. M 8UZl-A,v,)(;ounty, Pennsylvania, with h_ last family or principal
residence at 13 /!;E.t.cIJe/tF? l>lLlllf.. S,LV"Gt2.. $r'~/tV'c.. -("wt>
(list street, number and municipality)
Decedent, then :) 7 years of age, died No V. I
,2005
, at/.oME
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All perBonaLproperty
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
. Value"ofrealestatei:nPehhsytvania
situated as -follows;.
$ UlJluJOLU/\/
$
$
$ llAJ ,uvot.>> IV
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the
following spouse (ifany) and heirs:
Name
D el\l/" I S 1Vl. .s t4 /i..N t<-
Residence
/()95" 1..c#fi,S t;,A-fJ ;l?.d. UI?_-'...u.Lf:. 1'4 llol
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
.X
Residence( s) of Petitioner( s)
/ eJ '1o?--d 'IL(i .:s ~ /9 ,tJ A.!)
~,eL-J 5~f5;~) >Cfl / J
(,J,
I'
OATH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMBERLANI} .~.
COMMONWEAL TO OF PENNSYLVANIA
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 ofpefitioner(s) and that as personal representative(s) of the above
decedent pet,tione<(S)WiI.1 wel~and truly administ... the estate accom::,:"aw. -;7/ .4 /l/'
Sworn to o. r affirmedJY1;d rbscribed { )( tL ~ ~
Before me this ~ I C day of
/dO~i'i)lb(" , 20 05
JJ/'Cfl '
/'pc/\ B.
}
(/l
60'
:::l
'"
2'
.....
,!t
~
t )
egister
'.. l~ri"~'1 Noo{-)() -oS;7R17.'--~' un
Estate of.Kt'!tA(j" A ..3rlcflK , Deceased
GRANT OF LETTERS OF ADMINISTRA nON
AND NOW .) IOllC nlbl'" J-/ 200~in consideration of the petition on the reverse
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that DL'L-..\-L-l) \\ '\ ,SilLI1K
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to \:)~'f\"""':> \1, SI1L'll< .................................
in the estate of k c.. \. '\ . L~
FEES
Probate, Letters, Etc. .............
Will...... ......... ..,... ............
Renunciation..... ... .. . ... ... ..' , . ,
Short Certificates ( )............
JCP. .. .. . .. , ... .. . . .. .., ... ., . .. . ....
Automation Fee...................
Bond.. . . .. . .. .. . . .. . .. .. . .. . .. . .. . ...
Total
Filed
20_
Bond... '" ...... ......... ... ... ......
Total
Filed II- L I
$
$
20DS
P\. ~ h C (J k(
$
$
$
$ ;JO' Ol-)
$ Ie' .nO
$ S.C'(,
$
$
\ m.w.ooMa..ct1 II,' %/:trui:.n, '1 t. -peA CAr.(t wi-
Register ofWilIs ~Jf u u
5AC4Lt.!~AlL A. VLI<.^,~. &,,, 2'5/~ 7 . d
Attorney (Sup. Ct. I.D. No.)
dO ,CC)
4t.f S. HMo\l~ ST
Address
LA.rz-4s.L'l.. )/.4- I 7()' 3
I
"'~ :>
I
, I
'1'7-~43-q'9o
Phone
Phone
(0'
~,
This is to certify that the information here given is correctly copied from an original certificate of death d~ly
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fili
me as
H!O).kO:<;; J<rv um
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
..,eM........;.... 't.d Ih I /ruM
Local Registrar .
Fee for this certificate, $6.00
p
12064851
7{V-uL'hf .tu t...J 3, .;2..P1~":J
Date
-J
.,
en
H105 144 Rl;I.. 1/91
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
(Coroner)
TYPEJPRINT
IN
PERMANENT
BLACK INK
...
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o
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A
Shenk
SEX
2. Male
STATE fILE NUMBER
SOCIAL SEClJRITY NUMBER
3 172-36-1455
BIRTHPlACE ICIly and
Slate or r oleUJII Country)
Resdlllce ~ =dYl [J
R - American Indian, Black, White, ete
(Spopl,)
. Wh.<.te.
SURVMNG SPOUSE
(II ."me, Qlv8 maiden name)
~pJt..{ng
"'"
citylboto
o
w
'"
::l
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::;
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23b. 2
Wf,S CASE REFERRED TO MEDICAl EXAMINERlC
Ye'~ NoD
Cardiomyopathy
DUE ro (OR AS A CONSE()UENCE Of)
26.
IApprollimate
: interval between
! onsol and death
PART H; Othet a,ighilicant collddionll tXIIltfibuaing JO dNth, blA
n()C resulting in ItMi ~ftying cause given in PART I
HTN
b__-OUEW(OO ASACONSEOUENCEOfi~.---------_._--~~
d.
WERE AUTOPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION Of CAUSE
Of DEATH?
MANNER OF OEATH
!
-_._------~~.-:
__ L
TIME OF INJURY
Coroner
I;__~_u
DUE 10 (OA AS A CONSEQUENCE Of):
Natural
~
[]
[]
OATE Of" INJURY
(MonUl. Day. 'foal)
Ye. [] No rfl Ye. []
2... 2eb.
CERTIFIER (Choc.... only orl~)
.CERTIFYING PHYSlaAN (~'I'Y~CI"il <';"'I"j',"fIU C.lU.;,O; L)t ,l<::;dh ""tlUlI arllJlIll"1l .>lly~iilrl tld~ ~<.Ill<lllllC..:u,h,..ttl eliltJ L'lInp'oll;:{IIlI~I\ ?:l)
To u.. .tol f1'I~.IJO.,..\ -.'h oc(;ul1eddua.olhecau.ej.'and manNl.. .,.ted. .
No [J
At:;cldenl
Pending Invastigallon
[]
[J 300. 3Clb.....
[] ~~~~~~N(~;:~~~:lh-;;-l-;e:'arm, Sfreel. lactoq. office
300.
Homicide
SUlCll1e
2..
Could not be aelenmued
.PRONOUNClNG AND CERTIFYING PHYSICIAN (P1Ir,*-kJl\ t}(JlI\ pllJrlOl.lllC.llkj u\jdll, arlel corlilylllY If) t:;iJlJ~ ulll&..nl)
To the be., 01 my knowlctdge, death occuned at the UnMt, dale, and p"ce, anddu. to ttMtcaUM(a)and manner a. .t.led..
[OJ 31b.
[l ::::~~~~~__~__~___J:~Sif~~~"~~~~: 2005-~-
NAME AND ADDRESS OF PERSON WHO COMPLElED cAf.jlf" Of DEATH
(llem27)T,,,.o<P'intMichael L. Norr:lls, Coroner
6375 Basehore Road, Suite #1
Mechanicsburg, Pa. 17050
34.
.MEDICAl EXAMINER/CORONER
On the b..ls of ...mlnaUon and/or Inve.tlgatlon, In my opinion, death occurred., the time, d.'., and place, and due 10 the cauae(.. and
mann.ru.t.tad.... _.... _......,..... _,.... ........ ................,...........................................
31a.
REGl5T
~32.
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