HomeMy WebLinkAbout01-17-06
Register of Wills of
Cumberland
County, Pennsylvania
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Deceased
No.
Social Security No.
a /- 0 &, - {) u 98'
185-12-9428
Estate of
MARION L. LANDT
The Petition of the undersigned respectfully represents that:
Your Petitioner who is 18 years of age or older, applies for Letters of Administration on the Estate of the above
decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence
at 2203 Page Street, Borough of Camp Hill
Petitioners after a proper search have ascertained that Decedent left no Will and was survived by the following spouse (if
any) and heirs:
Name Relationship Residence
Linda L. Niziolek Niece 68 Ochs Avenue
Milltown, NJ 08850
COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent, then 85
years of age, died
December 4, 2005
at Manor Care
(Location)
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 ...................................................................................................$
88.000.00
NONE
T otal......................................................................................................... $
88.000.00
Real Estate situated as follows:
NONE
Wherefore, Petitioner respectfully requests the grant of letters in the appropriate form to the undersigned:
Signature
Typed or printed name and residence
LINDA L. NIZIOLEK
68 OCHS AVENUE, MILLTOWN, NJ 08850-1464
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Oath of Personal Representative
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
The Petitioner above-named swears and affirms that the statements in the fore,goIrg Peti~!on are true
and correct to the best of the knowledge and belief of Petitioner and that, as personar represer:lt€ltive of the
Decedent, Petitioner will well and truly administer the estate according to law. or.-
~ X ,.
L1ND~~ZIOLEK~
Sworn to and affirmed and subscribed
Before me this 11
No.
&(-C~-O{)C]b
, Deceased.
Estate of MARION L. LANDT
Date of Death: December 4.2005
Social Security No: 185-12-9428
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AND NOW, fW--et '",/ , ~ in consideration of the Petition on the reverse side hereon,
satisfactory proo having een presented before me,
IT IS DECREED that LINDA L. NIZIOLEK is entitled to Letters of Administration, and in accord with
slIch fmdmg, Letters of Admmistration are hereby granted to LINDA L. NIZIOLEK m;c: above sstate.
FEES ~ r;:fi/?/}?J2-G .S /Z cr,,; 0l'!J C
Letters......................... $ () I D~' (!J/&t jrJ11lHtw!.j
/ Register f Wills (/
- to
Short Certificate(s)
Renunciation..............
Affidavit ( )..................
Extra Pages ( ).......
Codici I............................
JCP Fee.......................
I ruLeAtory......A..II..tQ....
Other ..........C?.t~.)>...
TOTAL.........
$
$
$
$
$
$
$
$
Attorney 7l:d :P!:t:
I.D. No: 20558
Address: Johnson, Duffie. Stewart & Weidner.
301 Market Street. P.O. Box 109, Lemovne. PA 17043-
Telephone: 717-761-4540
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Thi" i" to certify that the information here given is.correctly copicd from an original certificate or dl'~lth duly riled with me as
Local Registrar. The original certificate will be forwarded to the State Vital Record" Orfice for perl1lanent filing.
WARNING: It ~s illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, S6.00
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Local Registrar (}'
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; Rev. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATE F!LE NUMBER
NAME OF DECEDENT (Firs~ Middle, Last)
1.
4 AGE (Lost Birthday)
-4 85 Yrs.
~ 5.
:: COUNTY OF DEATH
1
~ Sb. Franlkin
.. DECEDENrS USUAL OCCUPATION
~larion 1. Landt
SEX SOCIAL SECUR,TV NUMBER
2.Female 3.185 -12 - 9428
P CE OF 0 TH Check on n. see Inst Clion
HOSPITAL
Inpatient 0
Sa.
FACILITY NAME (If nJt institution, give street and number)
DATE OF DEATH (Month, Day, Year)
4. December 4 2005
{~7::~~~~:O ~ ~rir~?w:gt
BIRTHPLACE (City and
State or Foreign Country)
7.A1 toona, PA
ERfOutp~Uenl 0
DOAD
Residence 0 ~~~fy) 0
RACE. American Indian, Black, White, et .
(Specify)
Sc. Chambers burg
KiND OF BUSINESS {INDUSTRY
10.
White
SURVIVING SPOUSE
(lfwif1!l, give maiden name)
..,.
.)
~ 11.. Homemaker 11b.
. DECEDENrs MAILING ADDRESS (Street. CllyfTown, State, Zip Code)
. 1070 Stouffer Ave.
Chambersburg, PA 17201
16.
FATHER'S NAME (First. Middle, Last)
1S.
INFORMANrS NAME (Type/Print)
20..
METHOD OF DISPOSITION
Donation 0 Burial ~ Crem~tjon Gemoval from State 0
, 21a. Other (Specify)
SIGNATURE OF FUNE RVICE L1CENS
AS DECEDENT EVER IN
U.S. ARMEO FORCES?
YesO NOOO
1~ 1~
17.. State Pennsylvania
MARITAL STATUS. Married,
Never Married, Widowed,
Divorced (Speciiy)
14. Widowed
DECEDENre
ACTUAl
RESIDENCE
(See Instructions
on other side)
17b. counlVFranklin
Oid
decedent
live In a
township?
17c. 0 Yes. decedent lived in
17d. Q ~~j~e~~~~'~i:t:sd of
twp.
citylboro
Charles M. Baish
MOTHER'S NAME (First, Middle. Meiden Surname)
19.
INFORMANrS MAILING ADDRESS (Slreet, CityfTown, Slate, Zip Code)
20b.68 Ochs Ave. Mill town N 0
PLACE OF DISPOSITION. Name of Cemetery, Crematory LOCATION. CityfTown, State, Zip Code
or Other Place
Stella Mitchell
27. PART I: Enter the di......, Injurl.. or complleatlons which caused the death, 00 not enter the mode of dyIng, .uch a. cardiac or ,..pl,..tory arrut, .hock or h..r1 failure.
WIt only on. ciluae on ..ch line.
21d.
eam
Hill
PA
22a.
Complete items 23a-c 0
physician is not availabl
certify cause of death.
Items 24.26 must be completed by
person who pronounces death
24.
~.I
26.
: ApprOXimate
I interval between
: onset and death
Other significant conditions contributing to death, but
not resulting in the underlying cause given in PART I.
IMMEDIATE CAUSE (Final
disease or condition
resulting in death)--+
p ..._'- 'IJ ,~\.A
OUE TO (OR AS A CONSEQUENCE OF).
c..... or ~ ,.. .~ I>.- 1$ , .", l-
DUE TO (OR AS A CONSEQUENCE OF):
Sequentially list conditions r b.
if any, leading to immediate
cause. Enter UNDERLYING
CAUSE (Disease or Injury 1
that initiated events
resultIng on death ) LAST :'.
CUE TO (OR AS A CONSE~UENCE OF)'
WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH
PERFORMED? AVAiLABLE PRIOR TO ~ 0
COMPLETION OF CAUSE NaLuraJ Homicide
OF DEATH? 0 D
Accident Pending Investigation
YesO NoD Yes 0 NoD Suidde D Cou}d not be determined D
DATE OF INJURY
(Montl'l, Day, Year)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
2S.. 2Sb.
CERTIFIER (Check only one)
.lg~~F.r.:~tGor::'~~~~~~W~ls~:~h~~~~~aadU~ t~ ~:~\~~:~(:r~~3r~x~~a~.h:t~re~~?~~~~.~ .?~~~~.~~~ .:?~~:~~.i.t~~.:~~,............ ....
29.
30a. 30b. M.
PLACE OF INJURY - At home, fann. street, factory, office
bundlng, etc:. (SpecIfy)
30..
Yes 0 No D
300.
RE IS~'S SIGNATU~~BER
33 ~ / '(' /cI4<!.t').....t.JP..~<-
r,
w~I/(1
30d.
LOCATION (Street, CityfTown, State)
30f.
GNA TURE ~TLE OF CERT~R. 0 .-;:;)
31b. '="~ r-q-
LICENSE NUMBER DATE SIGNED (Month. Day, Year)
310. ~ [} C ~ t\ 'l.-C f\- 31d. ll.-- 'C -0 ..
NAME AND ADDRESS OF PERSOtt.WJ-IO <;OMP'I.P~D OF 0 H
(Item 27) Type or Print p lQ. -1"1"IlJ L. l/.
L/z.'Z5' 1-,'V\.~11I\ W~ e4.
32. .. ~Vl' \\c. ,.,~ l"2 '2.2.2-
DATE FILED (Month. Day, Year)
'P~~~~~:.~I~fGm~Nk~;;1:J197.~.~~HO~~~~ ~i~:i~l~e~~~t~.".:~~U~~~,d:~: d~n.d t~~~~u~e':c~i:~~ d~:~~.r a. .tat.d.... .........,........ D
'MEDICAL EXAMINER/CORONER ,
:::rb::t:t::8~~~~I.~~~i~ ~~.~~~ ~~~.~~~~~.~~~~.~: .i.~ .~~ .~~1.~~~~: .~~~.~ .~~.~~~.~. ~.t. ~~. ~.~~:. ~~~~:. ~~~. ~~~.~~'. ~.~.~. ~.~~. ~~ .~~ .~~.~~~~.(.~~ .~~~.. 0
318.
34.
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