HomeMy WebLinkAbout03-17-06
.
Register of Wills of Cumberland County
Estate of. Chad Hichael Derr
(Llso know)1. as
..late o:t
Shlremanstov..'Il oorough Deceased.
Social Security No. 188-64-9320
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
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No.
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who ware 18 years of age or older, appl~ for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent Petitioners are the sister and brother-in-law of the deceased.
Cumberland
Decedent was domiciled at death in County, Pennsylvania, with his last family or principal
residence at 10 East Green Street, S.turernanstown, PA ..l701r- .
(list street, number and municipality)
Decedent, then i C; years of age, died Mflr...h C;
Hospi tal, Camp Hill, pp~
,20 On
,at Holy spirit
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
situated as follows: None
$ 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: No spouse and no children
Name Rei ati onshi Residence
Sv 1 via B. [Err Mother 69 Caravan Court, i>11 etown,
rr Father 2039 Eshelman St. Middletown,
7057
17057
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THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
Si nature(s) of Petitioner s)
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Residence(s) ofPetitioner(s)
2252 Pinetown Rd., I.ewisberry, PA 17339
2252 Pinetown Rd., I.ewisrerry, PA 17339
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Register of Wills of Cumberland County
OA TH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMBERLAND
COMMONWEALTH OF PENNSYLVANIA
ss:
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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.
Sworn to or affirmed and subscribed
B,e(ore me this 11 . day of
yr,A1'CtP ,20 Olp
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Estate of Chad t,tichael I:er;!; Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW March 17, 20~ in consideration of the petition on the reverse
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Laura A. Richards and Philip C. Richards
il!/are entitled to Letters of Administration, and in accord with such finding,)..etters of Administration
are hereby granted to Laura A. Richards and Philip C. -Rlchards
in the estate of
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FEES
Probate, Letters, Etc. ... ... . .. . . . .
Will ... ... ... '" ... ... ... ... ... ......
Renunciation..... ... ... ... ... ... ...
Short Certificates d,) ... .. . ... ...
JCP............... ... ...... ..........
~vtomation Fee... ... ... ... ... ... .
B.O-tld... ... ... ... .. . .. . ... . .. ... ... ...
Total
Filed
Register of Wills
$ ~'O.C()
$
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$ . ' I
$ \5.0-0
$
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Victor A. Neubaum #29159
Attorney (Sup. Ct. I.D. No.)
42 S. Duke St., York, PA 17401
Address
717-843-8001
20_
Phone
Thl." !~, to crt
Local <11,
infOnndtion here given is correctly copied from an originalcertJ!I\,:;ilC 01 death duh flied \^, (II
cnti fleak' wi II be fOr\varckd to the Slate Vital Records Office tor r'ennanent hi
WARNiNG: It is illegal to duplicate this copy by photostat or photograph.
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P 12478453
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H105143 nev 01!06
TYPEJPRINT IN
PERMANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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8tJ COUlllY~ Dedit) ,~--~-- - ~- &Cl~, rXJr~rw~~r LJe~-~--- - ~- - -- - ---I /j;.J t JCII~N~(l~ (II fll)llllstllu~~. grve slfe~l d~ nUlltlet) -- - -~--- -- - - r \~'.JS LJt.'(~tl~1t;1 ~iiS~~.lfi~ Orlyuf?,- ---J:IU FI.J~~-AII;~-.ICJr~ 1;\\!l..1rl Hkl~"'--~Vt~te. elc-~-
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II 16 Decedent's MdlllllQ ALlJrtss (Slrt:d, clly,lll~n, sidle, lip code) lJld Lh:cetJclIl
A:lual HeskJenee 17a Stale lIVe In <f
lo....nsh~'J
SlA1L FilE NUM13E:fl
10 E. Green St.
Shiremanstown, Pa.
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18 Falhe!', Nan" (rll51. Ill,JuIe 1a51)
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Yes. Decedent I ,....\:KIII)
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lIb County
Cumberland
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No. lh::ctK.h:llllJ\led wllhm
klu.lll'lil/bul
Shiremanstown
Cdy.HvlU
19 Molhet's. NJllle (hf ':)1 , Il/kJdle. nutdefl su/name)
Taint's T. _Derr._____
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2Gb Inlumltinl s M.:uling AJdI~SS (~lllecl. cllytlO.....Il, ~Idl~. IIp cooe)
20a Inlmman!'::. Name (lYPc.'pfllll)
James J. Derr
46 Eshelman St., Middletown, Pa. 17057
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. 21a MelllOO 01 D"~51'<on - .,210 Dalo Ot[J"~'"lUfI (Mofllh day year)
~ ~~:: spec~X'.fl1dllOfI 0 Re/TlO'al~oIllSlate 0 DOlldl<on _______1 3/1] /06
'??; ~slgna~ 01 Funeral SelYlCe t lCensee (Ot person ach/lg <it:. such) -~2.:.'b lICense Nuni:lcr
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Ii .....;;v '\\.'_.-1\.... ~'1.">..,.:> '" _ ~ ~_ 0.=-l.o098-L
I. COllvlete lIerns 23a C ontv. wtlerl tertltyUlY 2Ja 'Tu1ht;bt!5tw.(my ~lluwledtJt: ~eaUl ocl,;ulled Jllht lime dille dnd pktu: 51JI~d (SI9flalUle and htle)
. phYSICIan IS nol avalldbl€ dlllfflt! 01 deJllllo """
.. certify (<fuse of dealh
: ~~.~~~:~~~~:~:~:Iekd::_ 24 T'"~4~~;=Ii~___ _[~~)d-m;;d~JM~~~2~@
CAUSE OF DEA TH (See instructions and e"mplesj
21c Pta~e 01 D~,posi"'~-INafOe ol;:'o"..le<,/ e~.-'~kll~';;~-;;;;;;;;-~I:;Z~---- -I" '2WL;;;;"!;;0((:'ly.l0W" ,Wie l,p WJe;---
~XJ:!._C_!:"~~a_t<:,D'_ _ ______ _ ."_ _Gr~ n t~~J)_~_C1.'--__
-F NdfHe and MdfesS 01 f acdlly
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I' 'L 1 W"c NUII"e. " rx Ddle S'w'L~I~~"lhday yeall
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: on~ello d~.Jlh but nUlll'SuhullJ In ltlt: Ulldt'd~'UhJ Cduse YI"'~f+ III fJdll1
IMMEDIA TE CAUSE (Filial dISease or
condlllon resunlllg In death) -~ J
Ilem 27 Patll Efller the ~tl~!n 91 ~~_~Q!} - cJl~t?ase5, IntLJrit!S, or cornplKAJllOflS - IIldl dlrt:Clty caused ltl~ delilt1 00 NOI e:fller lefllllflJI events such JS cafdue dlh:!51
ft;splralory arlest, OllJenlfLUwr IJl:JIIUJhun wl!tlt)ul SIIOWIUQ Ihe elt0lo~JY DU NU I JbOtevldle ll1ler only one cause on a hue
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Due 'CMO';/'E"Oet!-tJ-vi'C )'f!o:: K
Due lu (Of a~ J cOIl~equence 01)
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DYes rI No
30b Were AulOpsy Findings
Avalldble ['fIOr to Con(JlehOfl
01 CdUS~ of Death'J
DYes 0 No
31 Mdflnel vi Dedltl
32a Ddle of InJuf)' (Munlh. doy, year)
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29 iIf'~."- ~
o Not ~regoaflf wdtllfl pdsl yea,
o Preyrwnl at lime 01 Ut-'illh
o Not ptegnant, bulpregnanr 'to'lthlfl 42 days
01 death
o NOI plegn.3:nl bul pregnant 43 days 10 1 yea'
bolole dealh
o Unknown II ptegflc1nl ....!thln Ihe past yeaf
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DYes 0 No n OrIVer/Operalor 0 Passenger
o Pedeslrlan n Oht;r Spet.:dy
33b~S'\lf)alu;-e ar.ll"i;;;ICC~. /J~-- --
n
:uc -llCer C ntJe-;-~ --- -- --- - - -- Jk1-6aie-SllJned (MoIlII~-ddY year)--
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.. .....D 34 NdIT.e and Add'e~s OIP~b~1l W~ C~lJ.lI~led (~a~;ol [)f;:.J1t1 (I1~rJl~/) IYJ-lt:iPr~I~-
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Sequentially ~st condlllClns, II any
leading 10 the cause listed on Line a
~ fnler Ihe UNDERL YING CAUSE
~ ~~I:~~S~C~~;;:l~~nl~:lal~~~I;1~he
Due to (or as a consequence of)
30a Was an AoIOP5Y
Pedorn~d?
o Nalu, al
o ACCidenl
o HOfl)~ de
o Pending Illvesllgallon
o CoukJ Nol Be Dele(n)lned
32d lime ollflJury
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33a Certifier (check only aile)
Certifying phY$idan (Physician (:ertltylng cause 01 death when aflulhcr phYSICian has pronounced death and cOfl~leled Item ?3)
To the besl of my knowledge, death occurred due to the cause(s) and manner as staled...
Pronouncing and certifying physician (plrysnlll both p,ollOuflClng dealh and certlly,ng 10 cause 01 dealh)
To lhe be.t 0' my knowledge, death occurred allhe time, dale, and place, and due 10 the cause(.) and f11Jnner as sl.1ted..
Medical examiner/coroner
On the basis at examinalton and/or investigation, in my opinion, death occurred at the time, date, and place, and due to the cause(s) and (Nnner as stated
35 Aeglslfar s Slyr131Ul arj 0l.S1'1C1 NUntler. _.... ...._... --- . ~'e F....-d (Monlh, da_. .Y.' year)
~ru.JJ_C~O 0 Q Q i ~~~=--I ~~~-LL ? -0 lp __.
~ ; (See instructions and examples on reverse)
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Register of Wills of Cumberland County
RENUNCIATION
Estate of
~ #All yvtlC#Ael- OEM
No.
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned ~y l. V/A g. () a<f<...... jMc-rHt=/Z
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters ~jJJJ.'#1 s-rJ.A'fj..N
be issued to _~. 4. ~lLI1~L..45 ~ fJ.J/itll c. (l.,IUl4A.4S
Witness mylar hand~) this /l~H\ day ot fILii,) /' I.>~
, 20(:::i,.
Affirmed and subscribed before me this
l'i fit day of )! 1>t'/t f.A
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(Address)
Notary Public
GOfvlMOI\lVliEALiH uf' IJENNS VL VANIA
Mfco~ssion 1iI&~ -::--1
1 Marion F. Graham, Notary Public I
! Middletown Boro, Dauphin County' i
i MY UJrnmISSIOn t:Xplres Apr. 18, 2009 __.I
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\1.{~n,b,~.~ c<~l-)r"F'-\)iv;\n~F:,b._~S0C;.i1:i~)n of Notarior.~
Or"'..".
(Address)
Affirmed and subscribed before me this
, day of
----t:'7---- wi
(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)
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Register of Wills of Cumberland County
RENUNCIATION
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Estateof C#4(J ;41}al4EL 1)1:fJ/(
No.
Also known as
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned VA ~ <1. 1etfJ..... - T1TH~
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters fir AIJ~/JJ, ~i4.(f1o~
be issued to t-A /,fILA 4. f<lt.JI4l1.lJ ~ a~ (J Jil/',I L I2IU1f ~ 11-4 S.
Witness~:kr hand(~ this /61-11 day of }jLtl./ll/~
, 20 .1:.
Affirmed and subscribed before me this
/ (;- /11 day of ,} /C~.ll'l~"
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(Addre'ss)
Notary ~c..O' NW.... , ""
r /VI I I:AU t'l 1.)1- Pc.:.NNS'{LV,<.\i\lIA
MYC4mmis~w~SealNobnl " 1
J. , """Y PI.J.bUc !
.. Mlddleto,~ 80m, Dauphin County I
" My CommISSIon I=~~lii Apr. 18, 2009 I
,1embpr Oer'nP/"I',1ni" :\;,'./l;'I?iic,tI of Notarie~
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Or
(Address)
Affirmed and subscribed before me this
day of
(Signature)
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Register of Wills
Deputy
(Address)
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
.e~piration of Notary's commission)