HomeMy WebLinkAbout03-16-05
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of l./eOYi\Jre. Snl.Af 1;V)i
also known as I e. 0 Y\ 0 re.. '
c.. . ~
Social Security No.
No.
To:
9-1-(5 ~ -6?-;?-C)
Deceased.
- Cfh" ~.3
Register of Wills for the, j
County of C (.(n.t bt!f-rCivt in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or jer, appl<1 S
d I:,( r Cfl1 r..e --C\ l!j~ c: III ; a J,H"
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in C U VV\. b er- {Q. VI ~ County, Pcynnsylvania, with
h~r' last family or principal residence at CfG UQ,S; ioS Dr.'lIe- Ca...,ra(e, P-A" t?(}/j
(list street, number and municipality)
for letters of administration
on the estate of
1{013
,~ .lo{jb,
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:
t
$ If, fJ.l,
$
$
$
en'"
&11 II 11'\1S
chtcl. .'1'\1
f-trS(JIla.L (dof~e[, 'f/',
\: Fu.r" j ~";
tdo",;E
Petitioner_ after a proper search ha-s---- ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
THEREFORE, petitioner(%1 respectfully request<J1 the grant of letters of administration in the
appropriate form to the undersigned.
'"
<l.l
~ S h~ f e~ t . J.-J; /I
l~ C} : U Q.r" I,' (J S' .D rl ve.
~;g
]:g ;X ,jiiA/J-' C~.1/4
3~
<l.l '-
50
~
'"
OJ)
Vi
~ ~. l-iiff
v-I:( P 4 f 7 () I...:}
, ___._.li"~: 'iJ
,',. '."..J\..\i.' I
.'-~UV
--.~~ --:\
~- .......
\ r.1
L \ :2\ \l8 ~ \
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (lAm}J-&1!{)/hd
} ss
The petitioner5t> above-named swear(t) or affirm(;) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(fl and that as personal
representative(j) of the above decedent petitioneryr) will well and
truly administer the estate according to law.
Sworn to or aff~~p and
befor me this ,......
J, ,
J 1- ~?' <': .4~
l
-
en
'il
.....
;::3
.....
cO
s::
OJ)
Ci5
Estate of
C}/-6 (fJ --07) q
E1e,",(e.. Sp,.,~I,'!'\7
GRANT OF LETTERS OF ADMINISTRATION
No.
, Deceased
AND NOW ...2 ! I 5' yf~, in consideration of the petition on
the reverse side hereof, satfsfactory proof having been presented before me,
lT IS DECREED that Sh l' 1"'/ ~'1 IE. - 1-/:"
is/.... e'j:'<? to V,;ters ol:dm!n~stratio1{nd in accord with such finding, Letters of Administration
1 1 1 "'61) e ~.+ , a...- Sp
are hereby granted to S /it " 1'1 e.'1 t. .' 1/
in the estate of J- / e d i'l G fe.., S tlu. r I ,'V\ r
I
~kk rfi7~S7/?tJ~pU;I-
a4 utt~f./A 7rl~~v1
f Register of Wills
FEES WO -Or)
Letters of Administration $
Short Certificates(..,.t) . . . . . . . . .. $ t. O'U
R .. $ ?:fD
enuncIatIOn ................
J L f ~ trv rb $ I 5f/n
TOTAL_$ L
Filed... ..3./.'. )./O.Y...... A.D. 19
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
.
Register of Wills of Cumberland County
RENUNCIATION
Estateof Z:"/('()Y10(€- ,~[jurl;h c,
~I
Also known as E I eO Y1 'J'{-(
(1 t Ii C' /,
,)C ? Y l)\:'. ., , )Du r I tV) , deceased
I ,
No.
{}/-()h -6/7;
To the Register of Wills of Cumberland County, Pennsylvania
Theundersignc<l tdLC'A-J11 R. SfJURL f N~ SO/J
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters f')F ItNTl'IJ\J;S~IrrI'oJJ .. -nUQ.fJ;vl E ft~&.;d;,' f1 SIIq#
be issued to ..s14 /RL EY' .E l J-Jil L ( S J5.Tf 12 ) .
,
Witness my/our hand(s) this i () 1\.y of f1'1cLvclA
, 20 ()/,.,.
Afti{med and subscn"bcd before me this
1{)f~1 day of Mti n tL
;J..W0
fl:JtL i 1J;( tU;dM;
No Public
~
{{)jJ~Q~~,
'7 J 0 CLEIIFL~~) (J ;~2
i;f ~f)JlFT() 7) /<~e · '::~~C2
My Commission Expires:
1~ /{)-()7
(Signature)
.~,._~
Or
(Address)
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
(Address)
Deputy
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
\\\\\\lIHIJII'
",,<( M. VvI....;II//
~"-~\......,.'rp. "'...
" ~~. ,.I"/.. "
~ ~"~O''''RV S~"'~~
== :. -. ~
~: ...-.-- ~ ~
-:.: .. .:~:-
~ tPj;" "or1.Rf~,..:~g
~ Iff:." " O"'V~
~//. ~ OFM\~rs,...,~
1/,,,,,,,, \\\\\\
Janet M. Wirths, Notary Public
State of Missouri, County of Cooper
My Commission Expires July 10, 2007
1"--.)
::::;;:-..:l
C-::;:'.')
0""
c..Jl
-0
1',)
0''1
Thi' i~ 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.
No.
~~.~~~.~~
Local Registrar '"
Fee for this certificate, $6.00
p
It'J1'"'1698 r-("'.
c.t:.. '_ >00
i=ER 2 0 7006
Date
u'l
-0
r,)
-.l
Ht05.143Rev.OllU6
TVPEIPRINT IN
PERUANENT
BLACK INK
1 Name 01 Decedefll (Firsl middle. last)
Eleanore S. Spurling
5 Age (Laslbirll1day)
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEA TJ:I STATE FILE NUMBER
86
10,
3. Social Security Nurrber
216-~0-958~
4 Dale 01 Death (Month. day, year)
February 18, 2006
y"
7. OaleofBir1h Monlh, da ,
8. air! ce aOOstateOfbt
i \
CUmberland
Carlisle
Carlisle Regional Medical Center
o ~k!erK:9 -0 o.h6l"
10. Ra<:e: American Indian, Black, While, etc.
1-
White
atl. Coul'lty 01 Du.t"
30 Regency south
Carlisle, Pa 17013
12 Was Decedent e~er in the US
Armed Forces?
o Yes ~ No
Decedenfs
Actual Aesidence 17a. Stale
13. Decedent's Erlucation
E1emenlarylSecondary (G-12)
nest ade co leted 14 Marital SlahJS: Married. Never married.
College (1-4 or 5+) WKIowed. DiYorced (SpecHy,
15. Surviving Spouse (lfwife. DiVe maiden name)
11. Decedent's Usual Occ lion Kind of work done dur roost 0' warkin ~Ie; do not state relired
Kind 01 Work Kind of Businessllnduslry
Restaurant
16. Decedent's Mailing Address (Slreel. cltyltown, stale, zip code)
17b. Counry
PA
Cumberland
Did Decedenl
Live in a 1k IX Yes, Decedent Lived in
Townshp?
Middlesex Twp. T.."
17d. 0 No, Decedent LNed wilhin
Adualllnits of
CiIy/Bofo
Alfred Schroer
19. Molher's Name (Firsl, middle, maiden surname)
Elfrieda Schroer
18. Falller's Narrw (Fll'sl, middle,last)
208_ Informant's Name (TYfWprinl)
2Ob. IniormBnts Mailflg MdrBSS (Slreet, cKyAowfl, s~le, z" code)
Shirley E. Hill
95 vasi1ios Dr., Carlisle, Pa 17013
63
en
::>
~
~
21c. Place 01 Ois{lasilkm (Name of cemetery, ctematory Of olI'Ier plece)
2~d. Location (Ctyll.own, stale, ~ code)
Yorktowne Cremation Service
22c. Name and Address of Facility
23b. licenseNurrter
. Mems 24-25 mJ5I De colT"plefed by person
who pronounces death.
24 TIme of Death
O.s;cC:.$,..... ';l.-'-..
26. Was Case Relerred \0 a Medical Examiner/Corotler?
Ol'-\ Yes !:i 1'lo
Part II: Enter olher sianifr.anl rJ'lndillnns conlrihlJlino In death, 28. Oid Tobacco Use Contribute 10 Death?
but l'Ot fesul~ in the \lflder1y1ny cause gr..,en in Part , 0 Yes 0 Probably
'E!""No 0 Unknown
'-'.0" pM
CAUSE OF DEATH (SIt Inslructions and e~mpIes)
lem 27. Pari I: Enl.r!he ~ - diseases, injuries, or corrolicaliJns -that direcfl\l caused !he dQllth.. 00 NOT enter ~1'Ia\ lW&nls suet'. as tlldiac aneS1,
respn10ry 8rrest. or ventreular (i)rillalion wihoul showilg Ihe etiology. DO NOT abbreviate. Enleronly one cause on eline.
IIIMEDtA.TE CAUSE (Fml disease or
cortd~kln fesuling Wi death) ~ a.
;~roX"imeleinterval:
: onset to death
DYes ~
d
JOb. Were Autopsy Findings
Mailable POOr 10 ~tkm
01 Cause 01 Death'
CI Yes 0 No
31 Manner 01 Death
g....~aiura\ 0 Hofnk;ije
o kcklent 0 Pending InvesliQation
o Suicile 0 Coukl Not Be Delermined
32a. Dale 01 Injury (Month, day, year)
,_...,.................
32b. Descrbe how Injury Occurred
~.."'S .~..
29 " Female
~ pregnant within past year
o Pregnant al time 01 dealh
o Not pregnant, biJ pregnant within 42 days
01 death
o Not pregnant, but pregnam 43 days 10 1 year
beiofedealh
o Unknown if pregnant within the past year
32c. Pllce of Injury: Home, Farm, Street, Factory, Office
Buildino. etc. (SpfciI}o)
b.
..5 ir~O)'-'" (,-y~ '"
Due to (or as a consequence o~:
/-,. J.;o..,....'- Y:.. '.:.<"-. "'o.. .,.,.. n....
DLIElIo (or as a consequence oQ
'\')"'3...r"'~.:", 'L \ '1: ~
Sequentialy' II:sI condmns. ij any.
leacmg 10 the C8usaltsted on line..
. Enter the UNDERLYING CAUSE
. {nisaase Of Wl)1ry 1\18t TInted the
event! resuNing in dealh) LAST.
\.~X\">.Z"--- ~"",""".l.,--"_
_\,,...~.... '- ..:".:.......~"':;:'r....~___ L
.j)
J
\
C
r-
;:,
~
Due to (()( as a consequence oq
ald. TmI ollnjucy
321 IfTlansportaoon Injury (Spea1}J)
o DriYerlOperator 0 Passenger
o Pedestrian 0 OOler - Specify:
33b. S~dleOfCerti5er
32(1. l.oeatlon(SlrElel.citynown,slate)
3OlI. Was an Aulopsy
Perfotmed?
M
330. Da\eSignedMon\h,d y,year)
?-- i I:, ~6.
34, Name and Address of Pen;on Who Co~le<! Cause or Death (1lem 27) Typelflrinl
'\~r""<" ./'. ~~_.......'::?>-.~
"1.. L- "';"-..1' "I.. ~..:..- -........,..
'-^>'"'-\_ ..'-'>- h (_ -: <'.:"
I-
:z:
w
o
w
&l
o
u..
o
UJ
::;
"'"
z
338.. CertIfier (check on~ one)
Certifying phySician (PhYSician certifying causa 01 death wtJen another physician has pronounced death and CO-'ad Item 23)
To the best 0' my knowfedoe, death occurred due to the cause(s) and ITllnner IS stated .._.......,.... ..........._....."............_."............,..... ,........._..._....'''...".. ....,,0
Pronounelrlg Ind certifying physk:lln (Physician both pronouncing dQll.th and certifying 10 cause 01 death}
10 thebes1 01 my knowledge, death occurred allhe time, date, and placa, and due 10 !he CIUSe(S)and manner as stated...._,....,
lledlcal eXlmlnerleOt'Oner
On the basis ot ex:aminatkln and/or lnvlStigatkln, in my opinion. death occurred at the time, date. and pliCe, and due 10 the cause{s) and mal'lr\8r as slated ........0
I~r'ss;"n.~~~ 3G. Date Filed (Monlh.d8",..,}
..........._..~
,;J I-c) b- 0 i),.? 1