HomeMy WebLinkAbout02-01-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No.
To:
~kO (o~/ 03
Estate of k A !-17 M /~ P !-I 0 /! G ,4 Y7
also known as
Register of Wills for the
County of ClAmBl.921cJn /J in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. /7-3" 0 =?" 2 3 7- q
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 estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Oecendent was domiciled at death in eLl/ll !3Gf{ L;;:Jncf County, Pennsylvania, with
hER-. last family or principal residence at q/5 mora I jf. Ile IJ..) eLl rn!a-L-1 (dAd /1CJ 7.0
(list street, number and municipality)
Oece,ndent, then 90!jJf'!(y]' years of age, died &alnfLut 2'--1IJ, ,~ 2{)()-S:"
at 915 J114.rl:::'lf ,,-~jret21 /1~w Cumfu.A../;]hcl ;JA l7-lJ 7-0 C02 [flit} 0-/ C-Lun(jL:;:2t-14IVjJ
, -' ~
Oecendent 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: (\e..wWYY\tlR...ddn6 ......!f:l/ fJl~rfJ!AiJ 6WL0 PA ;
$ / 2 I 600 V'
$ ~ f\DnS
$ (lD(1G.
$ illl~OOO <9-0 E-S{{llULtcc/
F/ond2,
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name
tJ/2611 n
/I);
Relationship
?
SF
Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of adminis)tration in ;.the
appropriate form to the undersigned.., c..,
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF r!,/U m 13 (Ie ~ifcJ7JD
} 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 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 affirmed and subscribed f" --fl,1i41e rlJ 1:.
before ~e this /0 r day of
'--e bv 7J.. a ~ 1-9: ,2()()&
~--nota I)/lM 0h~L j
tv- CuL~A /l1 "fYLr-rr Register L
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Estate of
No. fj 1- D 10 - I 0 ~
liD/.- &11f!V I f:-ftTH ~k IN ()
,
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
r= . 5~ WU~
AND NOW /'-(' P t'1A-O 'I ( .1-9_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that m ; r; Ie r; k. Inrr 9 u ,..J
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
;n ,. 5tc>~ /<.. I{CJ /t..'j a..-
are hereby granted to
k a:fheYl/\ 0 f /+0 ~5 4""
in the estate of
8&;k
< ~ A~ 17~~ ~ HJ21,1k~__
~ c~W7I ~-
FEES
Letters of Administration
Short Certificates( 7 ~ . . . . . . . . . .
RelH!Miation .c:J . <;... .1: &J.ft( . . . .
$ ;}&D
$ a 6-DO
$ /c;.dV
$
TOTAL _ $_-
Filed ... K b/)J.C{'). .t. . . . .. A.D. ~.2QUl.a
ATTORNEY (Sup. Ct. l.D. No.)
ADDRESS
PHONE
~()_.;; f{[\' 1:'05
This i" 10 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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fee for this certificate. $6.00
Local Registrar
P L '" ~'I (~ ," ./
~ 1.3'Jl~,.~t).
DEe 2 9 2005
Date
...~~ 0 ~ '1~3
. ! ~-:
.2/87
COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
f \,.~,
NAME OF oeCEDENT jFltst Middle. Lasr.)
I. Katherine P. Horgan
SH
.Female
STAT E FIlE NUMBER
SOCIAL SECURITY NUMBER
1.173 _03 _2379
OA.1E OF DEATH IMcnttl. 08.,. 'leal)
pecember 24, 2005
Cumberland
...
RACE - Amertcan IncNn, Slack. White, etc.
(Spoclty)
White
AGE ILasI 8""""y)
UNDER' YEAR
Month. Days
UNDER 1 0l1li
Hours MhIt"
BIRTHPLACE (City and PU\CE OF DeATH ICl'leck aNy one -- ie& ,nSlrUClllJOS on OItoer ,1ChJ1
3tale 01 FcrEtlQll Cou'"rYl HOSPITAl; ~TtfER:
ranklin CO. P 1np.....ntO ERI~i..nt 0 llOAD =''''90
7. IJII.
FACh..lTY NAME (II <\01 InSl1Ubof'. Ql'..e Slf.ee1 and nurnt'en WAS DECEDENT OF HISPANIC OR1GIN?
No lli' .....0 "YM.Oj>OCIi)Cubon.
~xiCan. P..no Rican. ole.
9.
RulCMlnc. ~
="YIO
9 0 Y..
S._ ~____ .
COuNTY OF-DEATH
WAS DECEDENT EVER IN
U.S. ARMED FORCES?
Yu U 'jo.KJ
D~CIiDENT"S EOUC.<rION
SI h6Slacomed
ElementalylSec.ondary CoItege
13. 10-12) t1'.4~+'
"""'ITAL STATUS. _
Never ""anield. Widowed,
wt~WS~
10.
SURVMNG SPOUSE
(If WIle. grve maoen l'1ame~
17a. State_
PA
I..
I7C.O ......__in
""P.
l?b.C
~ld
-
iwlina
Cumberland -.stNp? I7d.e:9 ~""::'~oI New Cumberland
MOTHER'S N.AME {F"tlSl. hAidch8, Maden Sufname)
~Della Irene Bailey
INFQIlMANT"S ~NG ADDRESS (Slreet. Cilyf1"own. SIaIo. ''I's;c<lel .
_?-E GLoucester St., tlarrlsburg, PA 17109
PlACE OF OIsPQsn IOH - Nomo or C_.'Y. Cremo_ LOCATION . CilYllOwn. Sta'., Zip CoM
Of' 0Uler PIKe
CiIyJbofo.
2006
If'nS 24-26 mUSl be completed by
aon who pronounc:es death.
=t=ATESIGNEO
_.Day. _I
21b. 23c.
WoIIS CASE REFERRED TO MEOtCAi. EXAMINERlCORONER?
.....~
NoD
AS A CONSEQUENCE 01):
...
. ^pp'oximate
: \ntetWI bMween
I 0f\Mfj and death
,
:
:
,
PART H:
00Ie. ~ condilions conlril>uling 10 "..dI. DUl
not resuftinQ in IN UftdM1y;ng cause QIYtn in PART I.
IlE'IllATE CAUSE (Final
ease or conc:tdion
uIing In Oeathj----'
~~=:. I b.
... Erler UllDEA\.YING
USl! (Oooeuo or """,y c.
iniItiafede\ltNlts
'""'V '" _111) LAST
d.
DUE TO (OR AS A CCNSEOUENCE 01),
DUE 10 lOR AS A CONSEOIJE NCE OF),
S AN AUTOPSY
lFORMEO?
WERE AUTOPSY FINOINGS
_U\8LE PRIOA TO
COMP\..ETION Of' CAUSE
OF DEATH?
MANNER OF OEAf/
-..... .e::J
DATE OF INJURY
(Month. Day, Year)
TIME OF INJUAY
INJURy.... WORK?
DESCRI8E HOw INJ\JRY OCCURREO.
, 0 No
YaaO
No6
--
o
o
HomCido
PondHIg lrwosIigaIion
o
o
D ~CE OF INJURY. AI nome.larm~;.... lac1o<y. ottlca ...
""ildIng,_.I~dv)
100.
..... 0 NoD
IEDlCAL EXAMINERlCOAONER
tn the IMai. of ..amlnaUan and/or In"esUg.alion. in my opinion, death OC'Gurred.' the time, dat". IlId plac~, and due 10 (he e.use(.) and
'.nnet' as stated........,..,......,......,... ...,...,...,..........................,.........,.,............,....
lEG'ST'[b. IGNATURE ~~U~~E.R:: '" ,. "~"".~, ,,-1'-" .
.~.?,2/J1..... /' l'o;>'.'-,,,,,;v.A..t ..:r~
U
1-<1 /I~I ,If I
3Oc.
s..c;o.
Could not be detemuned
_.
TlFlEJllCheck only one)
:ERT1f'YlMG PMYSIOAN f,P11yslCl8n c.erllf9Jng cause d cJeath """'8l'l analher Qtlys..c13n has PfOnounced dealt! ana ccrnpleled tlem 23)
ro... tte.t of my know~, oe.'" occUlTed due to Ih. cau.e(sl and manner ,. .taled. . . . . .
.,.
lftONOUNCtNG AND CEATIF'1INQ: PHYSIC'AN (Pt"VS!Cl3n boln P(Onounclnl~ oealh and certlfy..ng 10 cause 01 death)
'0 the .,... of my knowtedg4t, death occurred at Ihe lime. cUte, ~nd place. ,and du. to the cauM(st .nd mlilnnet aa s1.ted,.
30.
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