HomeMy WebLinkAbout10-21-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of c.SS'tt-E' J.. vY\
also known as
AVlPP:..8
N '-)... ~ - ~ S . ~ 3 '"\
o.
To:
Register of ~~lls f~r the 1 ~ 0
County of ~ in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. ~(J~ - y ,- C) fl-Gf ~
The petition of the undersigned respectfully represents that: . P A
Your petitioners),. ~o isla e ]8 years of age or older, app';:> ~hc:3or l~tters cJ~~stration
, on the estate of
Decendent was domiciled at death in
h last family or principal residence at
Decendent, then f 0 tl"'ii\ ye~s of ~e, died 7 - ,
at ~ sf ~ U-\~J'c-~ r--7 \Y
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:
,+9-5)00 :<-
$
$
$
$
n (~$t:-7V~
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
e.- }'Y)~.Jf9
V.S' _(\
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF c=: UW\ ~~~\A~
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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 affirm~ and subscribed
~me this c2 I day of
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No. "'l." - ~ S - ~2>'\
Estate of S ~r=> J '1(\ ?r V\ "'.., !? . Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~ 1';:. ~ . 'J.. '\ I ").. '\:) ~ s :W, in consideration of the petition on
the reverse side hereof, satisfactory proof havirig been presented before me,
lT IS DECREED that :,~~,,~\\""Z. ~ ~ ~~~S
is/ are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~~\~ \\ \\.~ ~-1.. ~
~ "'~x~
'S~\::;.~ ~
~ ~~~S
in the estate of
Register of Wills
FEES
Letters of Administration $
Short Certificates( ).......... $
Renunciation ................ $
""':S"~~ , ~"',~ $
TOTAL _ $
Filed.... .y~.~.~~\-.~.$..... A.D.
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ATTORNEY (Sup. Ct. I.D. No.)
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19_
ADDRESS
PHONE
;~O~1 r~E\..'-8't\e
EE FOR TrilS
'EP,T\F~C,,;TE S2.0G;
WARNING: IT IS ILLEGAL TO ALTER THIS COpy OR
TO DUPLICATE BY PHOTOSTAT OR PHOTOGRAPH.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH VITAL RECORDS
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
CERT. NO. T 5 4 151 71
Name of Decedent
SYED
M.
Middle
First
Sex
MALE
202-46-5898
Date of Death
Social Security No.
Date of Birth
2-14-43
INDIA
Pennsylvania
DERRY TWP.
Birthplace
Place of Death HERSHEY MEDICAL CENTER
DAUPHIN
). \ - ~ S -~ ~ l\
7-02-03
Date of Issue of Tn,s Certification
ANRRS
Last
7-01-03
Facility Name
County
City. 8orough or Township
Occupation HYDRAULIC ENGINEER Armed Forces? (Yes or No) NO
Decedent's
MARRIED Mailing Address 3605 DWAYNE AVENUE MECHANICSBURG
Number Street City or Town
Race WHITE
Marital Status
PA
State
Informant SYED M. NASEEM Funeral Director BRENDAN J. McGLONE
Name and Address of
Funeral Establishment COBLE-REBER FUNERAL HOME, LTD. MIDDLETOWN. PA
Part I:
Immediate Cause
(a) RENAL FAILURE
(b)
(c)
(d)
Part II: Other Significant Conditions
Manner of Death
Natural tJ
Accident 0
Suicide 0
Describe how injury occurred:
Homicide
Pending Investigation
Could not be Determined
o
o
o
Name and Title of Certfier
GREGORY CAPUTO. M.D.
Address
HERSHEY MEDICAL CENTER
HERSHEY
(M.D., D.O., Coroner, M.E.)
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Interval Between
Onset and Death
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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.
~
7-02-03
25 IRIS CIRCLE
36 338
Distric~ No
ELIZABETHTOWN
Street Address
City. Borough. Township
D3tc Received by Local Registrar