HomeMy WebLinkAbout02-02-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Robert William Merideth,
Deceased
No. ~ I - D It -- ( D 9
To: Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 299-64-8275
The Petition of the undersigned respectfully represents that:
Your Petitioner, who is 18 years of age or older, applies for letters of administration c.t.a. on
the estate of the above decedent.
Decedent was domiciled at death in Southampton Township, Cumberland County,
Pennsylvania, with his last family or principal residence at 339 Whitmer Road, Shippensburg,
Pennsylvania.
Decedent, then 47 years of age, died on December 26, 2005 at Wheeling Hospital, Wheeling,
Ohio.
Decedent at death owned property with estimated valued as follows:
(If domiciled in Pa.) All personal property $
(Ifnot 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: 339 Whitmer Road, Shippensburg, P A
2,000.00
32,500.00
Total
$
34,5QQ-~()O
_~..:J
-~
-T1
Petitioner after a proper search has ascertained that Decedent left no original~:Will ~pd was ~ I
survived by the following spouse and heirs: . f'0
)
Name
Relationship
Residence
Katherine Jean Merideth
Jessica Lynn Merideth
Hunter James Merideth
Wife
Daughter
Son
339 Whitmer Road, Shippensburg, PLt" 17257
339 Whitmer Road, Shippensburg, P A 17257
339 Whitmer Road, Shippensburg, P A 17257
THEREFORE, Petitioner respectfully requests the grant of letters of administration in the
appropriate form to the undersigned.
~
Katherine Jean endeth
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
SS
The Petitioner above named swears or affirms that the statements in the foregoing Petition
are true and correct to the best of the knowledge and belief of Petitioner and that as personal
representative of the above Decedent Petitioner will well and truly administer the estate according
to law.
Sworn to or affirmed and subscribed :
before me this ;A day of :
r I213r<UMZ '-/ , 2,o?61 _ . . 1) ·
J~DD J~m:~:
~ Reglster pttvm :
NO. ~ I - 0 LP - 0 I Oq
Estate of Robert William Merideth, Deceased
'1{~L "'~/Y~iorA.
Katherine Jean erideth
:"->"',")
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I.:
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,---.-
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GRANT OF LETTERS OF ADMINISTRATION
AND NOW, F~, fA , 2006, in consideration ofthe Petition on the
reverse side hereof, satisfactory proof having been presented before me, ------.--.-.
IT IS DECREED that Katherine Jean Merideth is entitled to Letters of Administration, and in accord
with such finding, Letters of Administration are hereby granted to Katherine Jean Meredith in the
estate of Robert William Merideth.
FEES
Letters of Administration.......$ Q ~~. n h
Short Certificates (2.t ............$1W
Re~nUl.eiation J.tP~......$ 15. 00
$
TqTAL ~ $ I i 3. {TV
Filed ...~:.~:.O.LL.... A.D. 2006
':5:A
Sean M. Shultz, Esquire
Attorney LD. No. 90946
11 Roadway Drive, Suite B
Carlisle, P A 17013
(717) 249-5373
WEST VIRGINIA DEPARTMENT OF HEALTH & HUMAN RESOURCES
BUREAU FOR PUBLIC HEALTH - VITAL REGISTRATION
PHYSICIANS I MEDICAL EXAMINER'S CERTIFICATE OF DEATH 020209
ROOM 165, 350 CAPITOL STREET, CHARLESTON, WV 25301
0,.. STATE FILE NUMBER
r"-~MJ.>,'d.;.NT
~:_'-... 11M.
10. MARITAL SlATUS _
_ --.-.
Diwrc:ed (Specify}
OiCL~(\ Il~cO
130. Rt:SlOENCE-S1lt.TE
PA,
e.rl),s,ol' Wo...S1e. Re.movd-.lQ.o.
13d.:I3Eb;NDWh j f m c: (' ~Oct.&
16 DECEDENT'S EOUCATION
(Specify ","y h>ghosl - _I
CoIlege\1.4orS.1
168
Je+h
.1 ').,57
OH-.
22 )jA"IE AND AOORt: S ~ACllITY \ \ \
l:.-I eo.. <' \J.. e.. J- \.A. V\ -e ".."'- 1'"1'" Om .e
~~ Ma...\' n S,...\orOV1 +-0 b>>.43<tl,1/
23b DATE SIGNED
(Month, Day. Ye.:. J
Sequentially list conditions.
if any. leading to immedMUe
ca_ E_ UNDERLYING
CAUSE (Disease or i~ury
that initiated events
resulting in death) LAST
b
~'\.l~A-bOI&. WAHe~
M.t;>
OMS 24,26 MUST
:OMPLETEO BY
<SON WHO
.~CESOEATH
24 TIME OF DEATH
''log
fM
27 PART I Enter the diseases. inturies, or comphcabons that caused the death 00 nol enter the mode of dyir9. such as cardiac or respirat'Ofv
arrest. shock. or heart failure UsI onty one cause on each line
IMMEDIATE CAUSE IFinaI
dilease Of condition
resulting in death)
~
d
PART, H ~ sianihcant ~ conlrj~ting to death taJt not reSUlting in the underlying cq:use gi...eri in Part I
28a WM, .... AUTOPsY
PERFORMED?
(Yes 0#' noJ
29 MANNER OF DEATH
~tUlal
o Aceodenl
o Suoc1de
o HomlcKle
31' CERTIFIER
(ChecJ< only
ale}
:n. DATE OF INJURY
(_, DBv. Yew}
:Db TIME Of'
INJURY
3)c INJURY AT WORK?
(Yes or No'
no
26b WERE AUTOPSY FINDINGS
AVAILABLE PRtOR TO
,COMPLETION OF CAUSE
OF DEATH? (Yes 01 no)
o PendIng
InvesttgaltOn
o Could nol be
Determined
M
:J'le. PLACE OF INJURY - At home. larm street. factory. office
buildong. .Ie (Specify}
CERTIFYING PHYSICIAN (P/tys>cian eendl""9 cause 01 _h -. """""" physK;"'" has ~ _.h .-.1 """"""'"' """",;;) ..' ii .. .-
- I', . t
To the best of I'I?f knowledge. death occurred due to the cause(S) and manner as stated". "-~3 ~ _.. :~'.. '':::
- - - - - - -- - - - - - --- - - - - -- - - - - - - - -- - -- -- - - - - - -=-r - - - -E:~- - - ~....::..:~- --
o PRONOUNCING AND CERTIFYING PHYSICIAN (~.." bo/tllJRYlOUllC"'lI _ .-.1 ""'tiIymg to cause 01 _hi
To the best of my knowledge. death occurred at the <<me. date. and plaCe, and due 10 the cause(sl and manner as stated ..;f";'-.
-----------------------------------------------~---------
o ~ EXAMINER/CORONER
On the basis of exan"Hnation and/or Investigation. In my QOlOIOI"l. death occurred at lhe Iln~. date. and place and due 10 the cau~sl and manl"lef as staled
Form V5-002 (Rev. 6/92)
STATE COpy