HomeMy WebLinkAbout03-07-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of 9./Li-rlvl.A~A) ~k4U~
also known as ~f,~/l~ r ,~-t.-./.Af~
Deceased.
Social Security No. I 7 ~ ~?f 7!:J- g- (,
No. C(p ~QO~
To:
Register of Wills for the
County of in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appJ, / L/1J
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 C:P<-:V'~~ County, Pennsylvania, with
h~{b last family or principal residence at .6 / / {J ~.Al.1 .I;J k~-, ~A 3'(~~-f )/~
(list street, number and municipality)
J~~ , ~ ~{)O ~7,
'14
years of age, died
Decendent, then
at
Decendent 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: /Yl...t.17I'~
$ ~ 000. o-V
#
$
$
$
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs: J:, 3
Name_ /J / Relationship .ResidenceCL~
/1 /c<.-c/f1./~ t:f . La
1
7l-cu, III /701}
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 PENNSYL VANIA
COUNTY OF c.'J rllbPV-lClf--d,
} 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 ~r affirmed an..d SU..bscrib..ed.. f~:: }/ ~:;; ~
before me this 2<!.' d{)',~ 'R~ '0'
~~ ~ f:3 6 ," N' ~- .J!,-<~B
.-'" ilL Cc ~ 1~U ~ ~<--,} . I ~
. 'I ~e;;~el l ~
yul jLQV,UL( L"L I "ur4
Estate of
No. ()Cv -;JL~
~cf,~nclt i Zl'charrt~
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW I( lch IJtJ }l'xJ.rct) rcJCi)k, in consideration of the petitiooon
the reverse side hereof, satisfactory pro f h ving been esented before me, .
IT IS DECREED that f-
~ are entitled to Letters of Administration, and in ccord with such finding, Letters of Administration
are hereby granted to /J~nY1 /-I {} LI7'-( -- IZltri-r:rn1-S
in the estate of F,,/rI~r{ eM F<-tdYllrd ~
FEES J Q CJ)
Letters of Administration $
$ 1~<Cl)
Short Certificates( ).......... --
Renunciation ...... 'JC"/:]' . .. ~ A'J O~
TO;ffltlrD $ ~iJD
Filed"" '3f 1'( ot;""" A.D.;;! c()
ADDRESS
?, I 'ls-;!? 67
PHONE
II(I~ ~II' RLV ! II"
This is to certify that the infornlation 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, $6.00
p
12365462
No.
Hl05 143 Re. 01.06
TYPEJPRlHT 11/
PfRIU.HEHT
BLACK INK
1 NoIn. 01 Decedenl (hs!. middle. Ias!)
"
/?1,h~ q /f':f:u:U!utiuiL
Local Registrar
-,..
I
Date
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH STA1t ALE HlUBER '
3. Soc:iII Seariy NuIrtIel
1 72= 2 8 - 7586
Frederick
Richards
5 Aqe (USllII'thday)
7 4 yrs
lib. Counly 01 0ealIl
11b. CounIy
Cumberland
19. MolIWs Name jfaI. middle. niden-I
18. Falhef's Name (firsl. middIe.lul)
William Richards
W
14. ...... S1aIu5: 1iUrried. Newt manied. IS. SuMmg 5pouM (I'" riIe......-1
w.tow.I. ()iwIl*I (Speoi')j
Married Jean Shaner Curr
Did Oecedenl
1M ina 17e. 0 YIS. OecedM!..MId iI TIIp
TOMl$IlC1? 11d. d{ No.o-knl.iwedwilhil Camp Hi 11
AcUI t..miI5 01 ~
Mary Stevens
2OlI. lnbmInl's Iotaiing Addr-lSHIl ciyIIown, .... ~ ClldI)
201. 1ntlm8nI'$ Name (T ypeIpml)
o
UJ
(/)
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311 April Drive, Camp Hill, PA 17011
21e. "'- 01 Di&poUian (Name 0I~. CNIIIIIofy 01 oIlIf pl;a) 21d. l.ocaIiQn ~ .... ~ ClIde)
Magdalene Crematpry Ringtown, PA 17967
22l:.Nam..nd~oIFdlyJane Clifford Ritz Funeral Home
19 E. Mahanoy Ave., Mahanoy City, PA 17948
2311. Li:en&e Nuntler 23c. Orale Sipd (WonII. day. ,..,
Jean S. Curry Richards
21b. Dale of ~ (l.lonlh. day. yeal)
2/26/06
22b. l.i:ense Nwmer
FD 010598-L
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CAUSf OF OEA TH (See insInIctIonI and examplu)
..... 27. Part t Enle< lhe ~ - diseases. injuries. 01 COIf1lbIionl-ltIIl diredly caUSlCl tI\e dealll. DO NOT tnlef teminaI-u suclI as canIiIc alf85t,
lespnlory anllSl, 01 vllllltul;ar fibrilalian wChoul sIlowftg lhe ellOlogy. DO NOT abbr..,ialt. Enler ol'Ily one calM on a line.
IMMEOIATE CAUSE (Final disease 01 ~ / t1'
condaion resuling ill dMlIIl -? 1I ~.
OueIo(orasa~u 0I):~
SequenlialyliSl~.~any. ~_ _
IelIdInO 10 tI\e cause is*! on LN a. DIIe 10 (01 as a ~ 01): 4? 0 _
. EnIer tI\e UHOERlYlNG CAUSE ~
. ='::::iI ':...~ lie Due 10 (or as a consaquence 01):
v
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~
-0
~
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IA
---
v
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:lOa Wu an Al*lpsy
Per1ormed?
d.
n. W.... A&*lpsy FII1dirlgs
AvUabIe Prior 10 ~
01 Cause 01 Death?
o YIS 0 No
32.. ~ II WoIk1
o YIS 0 No
31. MlIlIltf 01 Dealh
'9' Nalural 0 Homicirlt
b keiHol 0 p~ Irwtslig;llion
o Suicide 0 Could No! Be 0eItriiWItd
."
321. 0aIt oIlnjury (MonIII. day, yNI)
o Yes ~
32d. Tille oIlnjury
...
331. C4IUfier (chedl 0Ittf one)
Cet1JfyinG pllrslclan (Phy$ician Ctflilying calM 01 delIIh wlltn anocher physQn has pronounctd dNlII and ~ ..... 23)
To lht IIalIlf lIlY lIMwledQt. death o<<umd due 10 the call14l(sl and INMIII" as slllled ._....._____.____._.__._
PnlnouncInI and cenlfylng physlclan (Physician both ptOllOUllCing dNl/I and teIIiIying \0 cause 01 dNlhl
To lht IlesI Of "'Y knowIerIve. tIeath o<<umd at lht time. cIlIle. aAd place, and due 10 lht caUM(s) and __lIS sw.d
Mtdicaleu~
On lht buis 01 eu.....1lon ancUot Invesligation, In my opinion, death oceurred allht lime. dale. and pIKe, and due 10 lht eauH(s) and _lIS SIlIled -0
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3S 7;;::-2nd.~d,~~c:tJ
36. 0aIt Filed (WonIh. day. v-l
..:.~ --< ",'" G
~- I~ IY- 17,9',
(See instructions and examples on reverse)
26. Was c.. Aellrrecllo a Medcal ~
031. 9J::No
PIlI .: &III oIlIf sidnik:ionI CXlndiIillns all1Irillb1o 10 deall
1M IllIl fISI6lg iI tie ~ cause ~.. Parll.
28. Did TctJaa::o UM eor.tJule to DeaIr?
g=~
29. .FemaIe:
o Hal ~...._,..
o PrllJ1llllallimt 0I1IeiIII
o Hal pnllPWlL 1M prwgNIlI.... 42 days
01 <<*II
o Hal pr...,.c.1M jn\JIIIlI43 days III I ,..
..... cIeIII
o u.m- i....,.. .... lie pal ,..
321:. PIlla 01"" Homa. fIIIll. ShIl FalIy, 0Ib
Iluiring. *- (Spd)!
~~
lJ~ ~~
3211. o.:rtM how Injury Ollcuned:
~
321. ITIlIIIIpIIlaliIn Injury (Speoi')j
o ~ 0 PastengBI
o PwdesriIn 0 011II- Sp.giy.
33b.~~ I1f)
33c. \Joerwe Nwmer
/11 (J(?ldfl- rt3
33d. Dale Sipd (WonIl. day. ,..)
~~ '.J,)~ ~oot:
32g lDcalion lSHIl cilyo\:loMt. __I
n
3C NIme and Address 01 J;rson WIIq ~ Cause 01 DMlh (lam 27) T~
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