HomeMy WebLinkAbout02-10-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of 5 tji:"lil~/I./ (?, Ru- e=5:-t6.-
also known as
No. ~ \ - <::J ~ - '0 \ '7> ~
To:
Register of Wills for t.he \
County of ~~~~'\~~d\ in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. J (~r; .Lf 0 t:):3)( 'f
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl I ~ S
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in etA m /J! J3/r< L ~NO County, Pennsylvania, with
hIS last family or principal residence at352 I t== ()./ t/ L.t}. pcA-r) , I\/-Pf/)\,.-d/e...- t:7ttJ-J
. (list street, number and municipality) I I
Decendent, then 4- 7
at
years of age, died ~ e ~ ~Ui'\ 1/'"-1
t
, 1'"" :200 ~
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $ J..-C; 00,
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania -1J ' , $
situated as follows: 35c...1 erv<J/14- "Fi?e;?4-~ /)/<.J?IAJI/'/(~ P4
1-.0t- /2. - / '""'3 -~ CV'ee"'l Mop..! d ~ I.U OJ') /v ~
~~) Dt?6
.000
,
Residence
A
CJjA-J'e U ~23..
1('<1-.151..'=
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
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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.
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Sworn to or affirmed and subscribed
before me this ,,~ :.,.\-, day of
~~;:~
No. ~,-~~ - ~\-~~
Estate of ~\~~<U'" ~. \( ~~~ ~~ ' Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~~'<~~~~ \~) 'd:~~~ bt ,in consideration of the petition on
the reverse side hereof, satisfactor~ proof having been pre nted be(ore me,
IT IS DECREED that ~,,~.; -:S.. :II. ;'<'. ~ ~ 't.\ ~ ~ ~ ~ ~
is/are entitled to Letters of Administration, and in a cord with such findmg, Letters of Adml istration
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~~
are hereby granted to ,,~~ '\ ~ --S . 'X. \).. 't.1\.. "'" ~'" \ ( "\I ~\ ~ ~ "3
'Io~ ~
in the estate of ~\:~..~ ~ ~. ~~~'\
G~r~~ ~~~ ~,.....~~\~ "
c:'7\ Re~'ster of Wills " ~. ~~
~" ~.. '< ~ ~.. ~
\
FEES
Letters of Administration $ ,,~S.
Short Certificates('-\) . . . . . . . . .. $ \~.
Renunciation ................ $
~~~ ~ ~~ ~~::, $ \$
TOTAL _ $ '\~ ,~
Filed ...A-~>~::~~..."" A.D.'~-
~
~ ~~ ATT~~Y (Sup. Ct. I.D. No.)
ADDRESS
PHONE
11111___</'_
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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
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
p
12269624
No.
HtOS.144 Rev,01r1>6
TYPElPRINT IN
PERMANENT
BLACK INK
2:i.....~. ~~~
Local Registrar
FEB
5 2006
Date
l-'-)
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1130-172
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH (CORONER) STATE FILE NUMBER
1 Name 01 Dacedenl (Firsl, middle, last) I~~;:e , Social Sacurity Nuntl8f /4. D..", D..1h (Moolh.do,. ''''I
Steven C Ruegg 167 - 40 - 0384 February 1, 2006
5 Age (Lasl birthday) 6. Uoder1 ear Under Ida'f' 7. Dale 01 Birth Monlh,cIa , ear 6 Birth lace C' andsla,eOlkWllii1rlco Sa_ Placeo/Death Chackon "".)
47 I Months I Days Hours I Minules I Feb. 13, 1958 I Carlisle, PA I Hospital: o DOA I ~h~~rsinrl Home lit 011,,,. Soed;;,
y" o Inoalient o ERIO.rt lien! o Residence
- Sb, County of Death Be. Oy, Bor~fDealh Bet Facili1y Name (II 001 insl~ulion, give slresl and nurrber) 9. Was Decedenl 0' Hispanic Origin? 10, Flaca: American Indian, Black, While, ete
Cumberland Silver 1-81 NIB M/p 53.2 1M: No 0 Yes (II yes, specify COOan, (Specify)
Spring Mexican, Puerto Rican, ele.)
- White
11 Dec9denl's Usual Occooation Kind of work done durin roost 0' workin life; do fI(ll stale relired 12. Was Decedenl ever in the US 13. Decedenfs Educalion ,,' " h"hest radeco "'''' 14. Marital Status: Married, Never malTiecl, 15. SulViving Spouse (If wife, give maiden name)..
Real Es"'t\.t~ Agent IJack G;~~r;;;'irealto Armed Forces? I ElemenlarylSecoodary(D-12) I College (H or 5+1 WIdowed, Divorced (Specif>>
o Yo. MN, 12 Never Married
~ 16. Deceden"s Mailing Address (Slreel, cityllown, stale, zip code) Decedent's PA Did Decedanl :LcMer Frankford
3521 Enola Rd. Ac:lua'Aes~ence 17a, Slate livekla 17c.iX: Yes, Decedenl lived kl T"",
Township?
. Cumberland 17d.D No, Deced8rl1 lived wilhin
Newville, PA 17241 17b. Collnty AcluafLirms0' CitylBoro
16 Falher'sName (First,mlddle, Ieslj 19 Mother's Name (Am', middle, maiden surname)
Philip J. Ruegg Evelyn J. Sillers
2Oa, Informant's Name (Typelprinl) 2Ob. Informant's Mailing Address (Street cilyllown, stale, zip code)
Philip J. Ruegg 14 Garden Drive, Carlisle, PA 17013
21a. Method 01 DisposWn 21b. Dale 01 Disposition (Month. day, year) 21c. Place of Disposijion (Name 01 cemetery, cremaloryor oIher place) /2Id. localion(Cilyl1own,slale,z~codel
. &. Burial 0 Cremalion o AernovalfromStale o Donation 2/7/2006 Ashland Caneterv Carlisle, PA 17013
000...5....,.,.,..
~ ~~'/7.~~ /22'. ;~.. ~~;633 I"'. Namo.nd Add,,,, 'IF....'"
- L EWing Brothers Funeral Hane, Inc. , Carlisle, PA
CofT1llele Items 23a-c onty when certifying 234. To Ihe besl of my knowlecp:'"ilealh occurred althe lime, dale and place staled. (Signa lure and litle) 23b. license Nurrber 23c. Dale Signed (Monlh. day. year)
physician is nolavailable al lime ofdealh to
certify cause 0' dealh.
. Iterre 24.26 musI be CO"llle!ed by person 24 Tmeo'Dealh /" Dale Pronounced Dead (Month, dl~, year) 26. Was Case RelelTed 10 a Medical Exan-ine'lCoroner?
who pronounces death. 6:08 P. M February I, 2006 )If. Yo.
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CAUSE OF CEATH (See Instructions and examples) Pwroximeleinler'r'al: Part 1(: Enler other sianificanl conditions conlribulina 10 dealh, 26. Did Tobacco Use CoolrllUte 10 Dealtl?
Rem 27. Palt I: Enle'Ihe~-diseas8S, i~s, orcolllllicalions-lhal directly caused lhe dealh. DO NOT enler larminaJ events SllCtl as cardiacarresl. onsetlodeath buI tlo\ resulllng in Ihe llnderlying cause giYen in Parl I. o Yo. o Probably
rElSpValory arresl, or venlltular Iilrillalion wilhali shawilg ttJe etiology. DO NOT abbreviale. Enter only one cause on a fine. ON, rII uo_
IIII1EIXATE CAUSE (FtnaJ disease or Head Trauma 29. II Female:
condition resulling in death) -? .. o Nolp'etmntwithinpastyaar
Sequentially Iisl conditions. it any, II. oueto~~t~~S~holcle Crash o Pr!!Qnanl at time of dealh
leading 10 the caus. lisled on lWIe a. Due to (or as a cOllSeQueoceof): -- o No! pregnant, bm pregnant within 42 days
. EnIerlhe UNDERLVlNG CAUSE of death
. (disease or injury lhat iniIlaled the c. o Nol pregnant. but pregnant -43 days to 1 yea'
8Yenls '8SUlingin dealh) LAST. Duelo(orasacons&qU8OCeof): bebredeath
d. o Unknown it pregnant wlhin the pasl yaar
30&. Was an Aulopsy 3Ob. Were Autopsy Findings 31. Manner 01 Dealh 32a. Da'e01 In;,Jry (Month, clay. year) ,21>. _,..h'W'""~O,,:u.": Unoel !=-ed o~erar:or 32c. Place of Injury: Home. Fatm. Str&et. Faclory.OfIice
p- Available Prior 10 Coollletion o Nalural o Homicide Feb. 1,2006 BtJilding,eIc.(~
olGauseolOealh? ~~;~o~~adway, struck bri ge Highway
o Yo. )I. N, DYes o No )l. Ace..., o Pendinglnvesligalion 3ipr~f~njllry ,,,.'o,u~atW''''' 321. If Transportalion InitJry (S,oeciM 32g. localion (Street,cityt1own, slale)
o Suicide o Could Nol Be Determined o Yes 0 No )I: OriYerlOperalor o Passenger 1-81, Carlisle, PA
5:35 P. M o Pedeslrian o ClIher - Sp&cHy:
331. Certine.. (check onty one) 33' . ,
Certifying physlcl,lIn (Physician certifying cause 01 death when another physician has pronounced deattland completed Item 23) . /'v'-- Coroner
To lhe besl of my knowledge, dealh occUlf8d due 10 the cause(S) .IKI mlnner IS stated __..__._.....~._....._......_......_......__...,,_._ ..........-...-.....-.......-......- .............0 "/ -.4
Pronounclng.nd certifying phySician (Physician both PfoflOUncing death and cerlf!ying 10 causa of dealh) 33c. license Nurrber 33<1. Dale Signed (Month. day, year)
To the best 01 my knowleclge, death occurred al the time, d.te, and pllce.,nd due to the c,use(s) and manner as stated.~._ ......~._._..._,_....,,~....._............_.__....D February 3, 2006
Medical exaninerlcoroner
On the basis of examination and/or investigation, In my opinion, death occurred at the Ume, date, and place, and due to the cause(s) ancllJ1;lnnet as stated ......-J' 34. fwrrc~~ro'f::son1fO~r!I=~co,jDr~1!;.ef) T~I
,..)'t~".~t\~~::.~ _\.~ _ ~ I":'> 1\ IAI I I (j I I~~'~"'~~~ 6375 Basehore Road, Suite #1
Mechanicsburg, PA 17050
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(See Instrucllons and examples on reverse)