HomeMy WebLinkAbout12-06-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
N d I - OS--!05J
o.
To:
Estate of ETHEL E. WILSON
also known as ETHEL ELIZABETH WILSON
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. 165-56-5826
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appliES
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
hER last family or principal residence at 820 L1SBURN ROAD. LOWER ALLEN TOWNSHIP
(list street, number, Twp. or Bora.)
Decedent, then 88 years of age, died 11/11/2005
at HEAL THSOUTH SPECIAL SERVICES - 175 LANCASTER BLVD.. CAMP HILL. PA 17011
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
situated as follows:
$
$
$
$
1.000.00
0.00
0.00
0.00
Petitioner after a proper search ha S
the following spouse (if any) and heirs:
Name
ascertained that decedent left no will and was survived by
Relationship
Residence
121 PARKVIEW ROAD
NEW CUMBERLA PA 17070
BARBARA W. PIRNIK
DA GHTER
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THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the
appropriate form to the undersigned.
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(BARBARA W. PIRNIK
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121 PARKVIEW ROAD
NEW CUMBERLAND
PA 17070
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA }
ss
COUNTY OF CUMBERLAND
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 ofpetitioner(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
. before me this I O++--. day of
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No. cO I -os- - Ins 7
Estate of ETHEL E. WILSON , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~ (I ,,~O^ 12 1;2{)O~ , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that ~rhlL'rTJ.... Lo PI Rn\ k
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~r 'ocr YO. l A-) P, !<.(IJ,; k
in the estate of ETHEL E. WILSON
FEES
Letters of Administration. . . $;.)D ' [) D
Short Certificates ( )...... $ X' .OD
ft..<..~._ . f' Q~~~\ ,,,,,-- $ 5 W
K't"-'~'ll ~ . ....... y ~ -: ,
~cP $ 10. dD
TOTAL _ $ 43.clb
Filed .\ <!: -. ~.: .~90::;-:-: A.D.
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-'/~~~~EKLETSKI
40486
ATTORNEY (Sup. Ct. LD. No.)
414 BRIDGE STREET
NEW CUMBERLAND PA 17070
ADDRESS
717 -774-7435
PHONE
II JII.'i,.'\ll.~ R1:\/ Ii/)5
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 Vita] Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 1193257
No.
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Fee for this certificate. $6.00
Local Registrar
NOV 142005
Date
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
"-0
DATE OF BIRTH
IMonrtl. Da'l-', ....ean
STATE ;:ILE :-.IUM8e.~
ISOCIAl SECURITY NUMBER
2 female L165 - 56
BIRTHPLACE IC.IV and PLACE Of DEATH (O'.(>(;k 01"11'( Qroe -- .,ee ,nSlnlchons on Olhel sIde)
Slale ()( Fcrelgn COIJnflV) HOSPITAL
Bethlehem, PA Inp8'''o'O
7. Ila.
FACllrrY NAME (II nol 'r'-SNuIJon, QfJe streel ana r\umben
en -'C"
'~r ~j
DATE OF DEATH \Mcnth. Oa-r, '(eaf)
A~EDENT {F',~s-;-M-idd7;~'-'~--'-'---_.'-'-'---~'----'--"------~--- SEX
Ethel
Elizabeth
Wilson
5826
.. November 11, 2005
:GE (LaSI Binhday)
UNDER' YEAR
Montha Days
UNDER t OAY
Hours Minules
RACE. Amenc&n Indian, BlaCk, White, ate
,Spec;,1
DECEDENT'S USUAL OCCUPATION
(G.....p.lund 01 work done rlunng m('$1
01 working life; do not use retIred.)
1.. Phlebotomist "b. Healthcare
ECEOENT'S MAILING ADQRESS (Street CityfTown, State. Zip Codel DECEDENT'S
ACTUAL
RESIDENCE
(See Instrucllons
on other srdel
KINO OF BUSINESSItNDUSTRY
HealthSouth Special
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
Ye. 0 No IXI
EAJOJJf.p.aIl&n1 P
DOAO
~~,ty)O
88
Yes
OUNTY OF OEAfH
..
Cumberland
&c. Lower Allen Twp.
10.
white
..
\THER'S NAME (First, Middle. last;
James Alton Seacrest
820 Lisburn Road
Camp Hill, PA 17011
12. 13.
17..Sla'e Pennsylvania
,..
MARITAL STATUS - Married
Ne'>'er Married, Widowed.
Oivorced (Speclfyj
widowed
SURVIVING SPOUSE
(If wde. gwe maiden naMel
17b. Coun
0'<1
.jecedent
IMina
Cumberland township? f7d.D :hi~~ntll=ot
MOTHEA'S NAME (Fir$l. MidOle, Malden Surname)
Ethel Frances Grubb
17c.1XI Vet,d6cedentlivedin
Allen
"'Il.
Cltylboro
s.
tFORMANT'S NAME (Type/Print)
Barbara W. Pirnik
,..
INFORMANT'S MAILING ADDRESS (Street, CitylTown, Slate. Zip Code)
2~. 121 Parkview Road, New Cumberland, PA 17070
PLACE OF DISPOSITION. Name otCemetery, Crematory LOCATION. CityfTown, Slate. lip Code
or Other Place
1one!"",0
...
/GNATU
'".
ETHOO OF DISPOSITION DATE OF OISPOSITION
Burial 0 Cremation 1RI Removallrom State 0 (Month, Day, Year)
Olhe,(Spec,ty) 0 21b. November 15,
RVlCE LICENseE OR PERSON ACTING AS SUCH LICENSE NUMBER
22b. FD 012
2005
21c.
Evans Crematory 21d. Schaefferstown, PA 17088
NAMEANOAOORESSOFFAClllTY Parthemore FH & CS, Inc.
nc.P.O. Box 431 New Cumberland PA 17070-0431
LICENSE NUMBER DATE SIGNED
(Monltl. Day, ",arl
848 L
To the beSt of my knowledge, death occurred at '''e time. dale and plBC& s!aled
(Signature and Tille)
~ms 24-26 must be completed by
!Irson who pronounces dealh.
230.
TIME OF DEATH
QATE PRONOUNCED DEAD (Mor\th. Day, Year)
23b, 23c.
WAS CASE REFERRED TO MEDICAL EX~INEAJCORONt;R?
26. Ye. g]~ Y '\-~ No 0
I Approximate PART II: Other significant conditions contributing 10 death. but
: lnlervat betWeen not resultinQ In the Underlying cause given in PART I
I onset and death
I
I
,
2'. II :35 M. 25. November /I 2-(j)'5
r. PA.RT t: Enter 'he diseases, irljuries or CDmplicatlOns which caused the death Do not enter the mOde of dying, such as cardiac or respiratory arrest, shock ~r heart failure
List only one ciluse on each line
fAS AN AUTOPSY
ERFOAMED?
d.
WERE AUlDPSY FINDINGS
AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
.MEDIATE CAUSE {FInal
sease or condition
suiting m dealh)___
9QuenliaJly liS! condittons b.
any, leading to immediate
IUse. Enter UtrmERLYINO
AUSE !DiseaS8 OIlI'ljUfy
at Inlhaled &\Ients
'SUlllng In dealh} LAST
MANNER OF DE.ATH
DATE OF INJURY
(Month. Day, Yeat)
TIME OF INJURY
INJURY .<<:r WOAK?
QESCRIBE KOW INJURY OCCURRED.
.... 0
No g)
Yes 0
NoD
Natu(al ~
Accidenl 0
Suicide 0
Homicide
o
o
o ~~CE OF INJURY. At home, lar';~~eet, factory, office M.
building, etc. ISpec11'>'}
JOe.
Yes 0 NoD
Pending lnvestiga(ion
'MEDICAL EXAMINER/CORONER
On the b..is of examination and/or invesllgalion, In my opinion, death occurred at the time, date, and place, and due 10 the cause(s) and
manner as stated
1..
AEGI'!'rA'; SIGNA:. JURE A.ND NUMB. ER
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~'?;:1'"i_.- /".l/ X?/J<<.~./L...
o
~I/'tiili/~ I
3Dc.
Could not be deTermmed
la. 28b.
EATIFIER (Check only onel
.CERTIFYING PHYSICIAN (PhYSICIan tl'lrlllymg cause of death wtlen anOlher phYSiCian has pronounced dealh ana completed Item 23)
To the M.t 0' mv knoWiedge, death occurred"i:tue to the cause(s) and manner a. stated. .
2..
.PRONOUNCING AND CERTIFYING PHYSICIAN (F'tlySlClan bolh pr~nOUflCing Clea!t1 and certlrYlng 10 cause of death\
To the best of my knowl.dg~, death occurred at the time, datil, and place, ,nd due to the cause(s) and manner as slated.
3'.