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Home My WebLink About01-03-06 . Register of Wills of Cumberland County PETITION FOR GRANT OF LETTERS OF ADMINISTRATION No. ~ 1- OLP- aD 04- To: Estate of. HYUNG JOO BAIR also known as :=?g Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social Security No. . Deceased. 521-60-0892 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl~ for letters of administration; on the estate8f''1 :---.. ~-') c..~) 1'0 (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. Decedent was domiciled at death in Cumber lanQounty, Pennsylvania, with hE last family or principal residence at 76 North Old Stonehouse Road, Silver Sprinq Township. (list street, number and municipality) Decedent, then 66 years of age, died December 2 Stonehouse Road, Silver Sprinq Township ,2005 . at 76 North Old 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: 76 North Old Stonehouse Road $ 140,000.00 $ $ $ 190,000.00 Total: S 330,000.00 Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Residence None is THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form to the undersigned. Residence( s) of Petitioner( s) 219 East Main Street, Mechanicsburg, PA 17055 ~ /"-." C.'::':> C:':.:> en , W Register of Wills of Cumberland County RENUNCIATION Estate of HYUNG JOO BAIR NO,~\ - Ote -ouO 1 Also known as , deceased To the Register of Wills of Cumberland County, Pennsylvania Warren G. Klunk, representative for the Commonwealth of Pennsylvania, Department of Revenue, apparent statutory heir per 20 Pa.C.S. 2103 (6) ,__ (Name) (Relationship) (Capacity) of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that of Administration The undersigned Letters be issued to Marlin R. McCaleb Affirmed and subscr' 6? (t.-f..A day of ______ .io~:J- ~ /' / ~--.'-a~~A(-~~ .,N~t;r; ~~kI~AI,fj;j eli "IiNN!ilr~~NIA , , NOTARIAL SEAL My C10!tlNsM:1~'eifg~:NOTARY PUBLIC CITY OF HARRISBURG, DAUPHIN COUNTY MY-C.OMMtS~EXPIRES APRIL 07, 2008 Witness my/our hand(s) thisdei.fday ofYc?~d1~e,e20~~ I~~~ Warren G. KlunK, representative for the Commonwealth of Pennsylvania, Department Revenue, BureaU(Address) of Individual Taxes Dept. 280603 Harrisburg, PA 17128-0603 - of (Signature) Gr (Address) Affirmed and subscribed before me this _ day of c_ (Signature) Register of Wills Deputy (Address) t ~, 10. . (Signature and seal of Notary or other official qualified to administer oaths, Show date of expiration of Notary's commission) H II\):-;i):'\ KL\ This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Loeal 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. Fcc for this certificate. $6.00 p 11q'~Ll'11 _~~.~.l~ , ""b"""... ~ No. /:,iIr7i1iiH7;;// ~1"t'~~\H OF it;;---__ 111~'\.1"/ ~-f:IO' - III~,// 'J'r>~~ 'I' =/ '\~- /~\\~I . ~iit.~\ If~,/ . . ~ '\~~ \% BI, ,l:~ ,,'h$ .. " , .' -. ~ \~*~...-......_, *~ \7:. ~\ ._.......~- .. / ~/ "';.~~ ..' /~", ~ At..f"- /~\.'<' I' ~"'"--_ I"MEN1\\\" IIIIII ........."./""00/1/1111/0'1 '~7?~L, Local Rl'gistrar ore 1 52005 Date \ ( 1130-131 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) r.. Rev. 1/91 SEX ISOCIAL-SECURITY NUMBER 2. Female 13. 52 1 - 60 - 0 892 UNDER 1 DAY I DATE OF BIRTH I B!RTHPLACE (City and PLACE OF DEATH (Check only one see instructions on other side) Hours Minutes l~ful(MyOnth Day Year) Stale or Foreign Countr,/) HOSPITAL IOTHER: 13 , 1939 UNK. / Korea Inpahent D ERIOutpat;ent D DOA 0 ~~~:g 0 7 88. CITY, BORO, TWP OF DEATH IFACILlTY NAME (If flo' insti~ulion, give street and number) IWAS DECEDENT OF HISPA. NI.C ORIGIN? Silver Spring 76 N Old Stonehouse Road No[)\) VesDltyes,spe"'fyCuban, . MeXican, Puerto Rican, ate Be. 8d. 9. DECEDENT'S USLAL OCCUPATION KIND OF BUSINESS/INDUSTRY we,~.DI~~~6~b~~~~~NT Isnec9te~~!D~iN~~~t~~a~~~~~~eted\ I MN~~~~A~a~~~~~id~::~~,d {~iV:o~ikj~~\l~~rjod~~teu~~(:~ITr~J)t lFonrer IceL-;md Prcxiucts I Yes 0 No [] I Elementary/Secondary I College I Divorced (Specify) . 11a. Fish Packer r,;b. ~chan~csburg, PA 12. 13. 12(0.121 (1.40r5+1 14. Divorced DECED7E6NT"SStMoAneIUNhGouADDsReESRdS (51. reel. CitylTown. State, Zip Code) ~~~0~CNT'S 17a. Stale PA _ Did 17oXX1 Yes, decedenllived in Silver Spring . RESIDENCE deCedent Carlisle, PA ]7013 ~~e~t~n::rs~~fns Currberland :~=~~~iP? 17b. County NAME OF DECEDENT (First, Middle, Last) ,. Ryung AGE (last Birthday) I UNDER 1 YEAR Months Days STATE FILE NUMBER Joo Bair I DATE OF DEATH (Month. Day, Year) 14. December 2, 2005 66 Vrs Residence ~ g~:~ilY) 0 5. . COUNTY OF DEATH 115. I:RAC~ - American Indian, Black, While, elc (Speclly) 10. Korean SURVIVING SPOUSE (If wile, give maiden name) Cumberland 8b. twp. 23a. Items 24-26 must be completed by TIME OF DEATH IDATE PAONOUNCED DEAD ~MOf1th, Day, Year) person who pronouncas death. 24. UNKNOWN A.M. 125. December 5, 2005 27. PART I: Enter the diseases, injuries or complications which caused the death. 00 not enter the mode of dying, such as cardiac or respiratory arrest, shock or heart failure, List only one cause on each line. 17d.D ~~h~e~~I~~:i~~~ of MOTHER'S NAME (First, Middle, Maiden Surname) Unknown 1.. INFORMANT'S MAILING ADDRESS {Street, City/Town, State, Zip Code~ 20b. 6375 Basehore Rd. Suit III ~chan~csburg, PA 17050 PLACE OF DISPOSITION. Name of Cemetery, Crematory I:OCATION - CityITown, State, Zip Code or Other Place ,/ 21c.~chanicsburg CerrEtery 21d.~chanicsburg, PA 17055 INAME AND ADDRESS OF FACILITY b2c.Richardson F.R. InC. 29 S. Enola Dr. Eno1a, PA 17025 LICENSE NUMBER I~ATE SIGNED (Month, Day, Year) 23b. 23c. WAS CASE REFERRED TO MEDICAL EXAMINER/CORONER? Yes DCJ citylboro, 16. FATHER'S NAME (First, Middle, Las!) 18. Unknown INFORMANT'S NAME (Type/Print) 200. Michael L. N:Jrris METHOD OF DISPOSITION ] I:DATE OF DISPOSITION . Burial rn Cremation 0 Removal from Slate 0 (Month, Day, Year) . 2';':.~etionD Othe,(Spedfy\ D 21b.LeceniJer 20, 2005 SIGNATUR.E OF FUNJRAL S;~'CE LICENSEE OR PERSON ACD!JIG AS SUCH 1 LICENSE NUMBER . 22.~11. ~ ,-' /' 0 ./);:l~/' l22b. F0012774-L ~~~:~ j~e:~ :;~~~I~I~it;;; ~r:~~;~To t'~~~:t~:~~fdirtl~)oWledge, death occurred at the lime, date and plaCf1 stated. certify cause of death, IMMEDIATE CAUSE (Final disease or condition resulting in death)---+- Occlusive Coronary Artery Disease DUE TO (OR AS A CONSEQUENCE OF) 28. ~ ~pproxjmate I Interval between i onset and death , NoD PART II: Other significant conditions contributing 10 dealh, but not resulting in the underlying cause giVen in PART I COPD, CRF Sequentially list conditions if any, leading to immediate cause, Enter UNDERLYING CAUSE (Disease or injury that initiated events resulting in death) LAST b. DUE TO (OR AS A CONSEOUENCE OF): DUE TO (OR AS A CONSEQUENCE OF), WAS AN AUTOPSY PERFORMED? d. WERE AUTOPSY FINDINGS AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? MANNER OF DEATH DATE OF INJURY (Month, Day, Year) TIME OF INJURY INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. Natural ~ Homicide D D Pending Investigation D D Could not be determined D Ves D NoD Ves D NO~ Ves D No 0 Accident 3Qa. 30b, PLACE OF INJURY - At home, farm, street, factory, office building, elc. (Specify) 30e. M, 30C. 288. 28b. CERTIFIER (Check only Of1e) .CERTIFYING PHYSICIAN (Physician cer-tt;ying cause of death when another physician has pr0f10U!1Ced death and completed Item 23) To the beat 01 my knowledge, death occurred due to the cauae(a) and manner a8 stated. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ , . . . Suicide 2.. 3Dd. ILOCATION (Street. CityfTown. State) 130f. / SIGNATUA~~"~ D 31b. /' ~~ ~#'/=--------- Coroner UCENS~UMBER I DATE SIGNED (Month, Day, Year) D 31c. 131d. December 12, 2005 NAME AND ADDRESS OF PERSON WHO COMPLETED CAUSE OF DEATH (Item 27) Type or Pr;n1 Michael L. Norris, Coroner 6375 Basehore Road, Suite III Mechanicsburg, Fa. 17050 *PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both pronou!1Cing death and certifying to cause of death) To the best of my knowledge, death occurred at the time, date, and place, and due to the cause(a) and manner as stated.. . .MEDICAL EXAMINER/CORONER On the basis of examination andlor Investigation, In my opinion, death occurred at the time, date, and place, and due to the cause(s) and manner as stated.. . . . . . , . . . . . . . . . . , . . . . . . , . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . , , . . , . . . . . . . , . . , . . . . . . . . . . . . . 318. REGISTRAR'S SIGNATURE AND NUMBER / /hl"" ~ %:1."''' -tAJI-4Z. ~ ~ / ',( '<"00-.-1'- 1~/[Yt/,/1 ~ 32. DATE FILED (Month. Day, Year) 34. j) ~/~(j /~ ,:5<rJ t1 5- 33. 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 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 accor~ to law., ,:) ~ _ ,,/) Sworn to or affirmed and ~bscribed {~l[/4/~ Before me this \ '1 day of Marlin R. McCaleb \~1~11~~ - \~~.~~iJ r~V:!~~ Estate of Hyung Joo Bair , Deceased en 0<;' :; po 2" ..., A ~ GRANT OF LETTERS OF ADMINISTRATION AND NOW 0,~ LA.. ~ '-f3 20--.2..9 in consideration ofthe petition on the revefse side hereof, satisfactory proof having been presented before me, IT IS DECREED that Marlin R. McCaleb is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration are hereby granted to Marlin R. McCaleb r.' in the estate of Hyung Joo Bair FEES Probate, Letters, Etc. ............. $ Will................................. $ Renunciation....................... $ Short Certificates (~ ............ $ J CP . . . . .. . . . . . . . .. . . .. .. . . .. .. . . . . . .. $ Automation Fee.. .. .. .. .. .. .. ." .. $ Bond................................. $ Total 5 $ Filed JfrN ~ 20 0 lV ~::t;~lC~il[ OlJo.{ln ~f' .1-1 53) . Attorney (Sup. Ct. I.D. No.) 219 East Main Street Mechanicsburg, PA 17055 5.00 ~. O~ In.o 5.Uu Address 3 X~. lTu 717/691-7770 Phone