HomeMy WebLinkAbout02-23-06
PETITION FOR PROBATE and LETTERS OF ADMINISTRATION
, deceased
Social Security No. 264-26-8251
No. ')..000-011/
To: Register of Wills for the County of
Cumberland County in the
Commonwealth of Pennsylvania
Estate ofJ. Robert Dougherty
Also known as
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 ofthe
above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his last family or
principal residence at 18 Wiltshire Street, Carlisle, PA 17013, South Middleton Township.
Decedent, then 73 years of age, died February 8, 2006, at Carlisle Regional Medical Center.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
Situate as follows: 18 Wiltshire Street. Carlisle. PA 17013
$20.000.00
$
$
$100.000.00
Petitioner_after a proper search ha _ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name
James J. Dougherty
Relationship
Residence
18 Wiltshire St., Carlisle, P A
17013
Son
THEREFORE, petitioner( s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
n~ffiU}d ~ 1)~~
.fumes J. Doughertv
18 Wiltshire St.. Carlisle. P A 17013
Z ~~,: :,:'; ! ,1
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and
correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the
above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
Before me this L3 day of FebrUrL-ry
2006. ~
~~,~ \
Register .
~<C~.~~\~~ ~
J2::1 g~~r!f-
No. 'J.-OO{f; - 0),1
Estate of J. Robert Dougherty, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW, Feb(Uaf~)...3 ,2006, in consideration of the petition on the reverse side
hereof, satisfactory proof having been presented before me,
IT IS DECREED that James J. Dougherty is entitled to Letters of Administration, and in accord with such
finding, Letters of Administration are hereby granted to James J. Dougherty in the estate of J. Robert
Dougherty.
FEES
Probate, Letters, Etc.. .... .. . ....$ liJo po
Short Certificates (0)............$ 2..4.00
R08tlfteiatiofl. .!.~f'...............$ 10.00
auto $ 500
TOTAL $ z.qq,oo
Filed. .f.<;:J?r.l:l.0:r:j.. .?-.~, ~5?9. ft?............
16453
R nald E. Johnso
7J West Pomfret
Carlisle, PA 17013
717-243-0123
-").." .;' 'I:...... I ;-
(r (.J ":~ + I ,'".
Thi" 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.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.00
No.
,.~~.-n_I-1l ~14-1-VP-~
Local Registrar (
p
12225745
FEB
Date
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IA9'Y.01.,0\J6
PRINT IN
!ANENT
CKINK
1 Name of Decedent (First. middle, last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATE FILE NUMBER
r<, "',
I'.....
r<)
12
3. Social Security Number
.t, Dale 01 Death (Month. day, year)
J. Robert Dougherty
264 - 26
February 8, 2006
5, Aoe (lllSI birthday)
7. Daleo/Birth Month,da , ear
8. Birth lace C" andslateorklr
Cumberland
Carlisle
Other:
o ERfOu\ alieni 0 OQA 0 Nursin Home
9. Was Decedent 01 Hispani:: Origin?
~ No 0 Yes (II yes, specify Cuban.
Mexican, Puer10 Rican,elc.)
o Residence 0 Other" S
10. Race: American Indian, B~ck, WMe, etc.
ISpeci/j1
White
Ves 0 No
Decedent's
Actual Residence 17a. State P A
h' hast ade co kited 14. Marital Status: Married, Never married, 15. Surviving Spouse {If wife, give n-aklen name)
College (1-4 or 5+) Widowed, Divorced (specfftl
Widowed
DldDecedent
Li\leina 17c.O Yes, Decedent Livad in Twp
Townsh~?
17b. Co,"~ Cumberland
17dj)
No, Decedenl Lived within
Actual Urrits of
Carlisle
CiIy/Boro
18 Falher's Name (Firsl,middle,lasl)
19. Mother's Name (First, middle, rmiden surname)
Gus J. Dougherty
Orpha Dock
2Ob. Informant's MaMing Address (Street, ci(yl1own, state, zip code)
208. Informant's Name (Typelprinl)
Sara Strong
405 Walnut Bottom Road, Carlisle, PA 17013
o Rerroval from Stale
o Donalion
21c. Place of Disposkion (Name of cemetery, crerralory or other place) 21d. Location (Cityllown, slale, zip code)
Cremation Society of PA Harrisburg, PA 17109
220. Name and AddrOSS.1 Faciliy Auer Memorial Home & Cremation Services rnc
4100 Jonestown Rd, Harrisburg, PA 17109
23b. License Nurrber 23c. Date Signed (Month, day, year)
Items 24-26 fIllsl be CO"l'leted by person
who pronounces death.
24 Time 01 Dealh
DYes 9" No
d
3Ob. Were AUIOflSY Findings
Available Prior to ColJ1llelion
of Cause 01 Death?
DYes 0 No
31 Manner of Death
~atural 0 Homicide
o Accident 0 Pending lnvestiQalion
o Suicide 0 Could No! Be Determined
32a, Dale 01 InJury (Month, day, year)
26. Was Case Referred 10 a Medical Examiner/Coroner'?
~ Yes 0 No
ApproKimate interval' Par1l1: Enter other sionificanl conditions conlributina 10 death, 28. OK! Tobacco Use Contrtlule 10 Death?
onselto death bul not resufting in the underlying cause given in Par11. 0 Yes O. Probably
o No .Ef Unknown
29. !I Fen-ale;
o Not pregnant wilhin past year
o Prellnantallimeoldealh
o Not pregnant, but pregnant within -42 days
oldeath
o Not pr~nant, but pregnanl 43 days 10 1 year
beloredeath
o Unknown if pregnant within the past year
32c. Place 01 Injury: Home, Farm, Slreel, Factory, OfOCe
Buildinll, ek:. ($pecif)1
32b. Describe how lni\Jry Occurred:
Sequentially list condiOOns, if any,
leading 10 the cause listed on Line a.
. Enter the UNDERLYING CAUSE:
. (disease or injury that irftialed the
events resuhing in dealh) LAST
b.
5E(>S/\
Due 10 (or as a COnSeqUfl~oEi
l- 'I Pif"v'1>t
Due to (Of as a consequence oQ:
Dueto (or as a consequenceoQ:
32d. Timeollnjury
321. II Transportalion Injury (Specif}1
o DriverlOperator 0 Passenger
o Pedestrian 0 OIher - Specify:
Jab. Signature and Tnle 01 Certifier
,-e.., ~
32g, Location (Street, citvAown, slate)
308. Was an Autopsy
Performed?
M.
33a, Certifier (Check only one)
CertifyIng phYllclan (Physician certifying cause 01 dealh"when anolher physician has pronounced death arM:! co/Tllleted lIem 23)
To the best of my knowledge, duth occurred due to the cause(s) and manner as stated ........................... ..........
Pronouncing and certifying physician (Physician bolh prof\Ouocing death arM:! certifying to cause 01 death)
To the best of my knowledge, death occurred at the time. date, and place, and due to the cause(s} and manner as stated..
Medical examinerlcoroner
On the basis 01 examination and/or Investigation, in my opinion, death occurred at the time, date, and place, and due 10 thecause(s) and manner as stated ......._0
.................0
33c. License Nurrber
33d, Date Signed (Month, day, year)
.......$"'
'3(4!
34. Name and Address 01 Person Who Co"l'leled Cause of Death (lIem 27) TypelPrint
C::,~ ,. s) e <I/-v'ld<--e
Cr~~/.-s It 1'.4.
M1J C! (p,.t GeL
35
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