HomeMy WebLinkAbout03-27-06
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estateof I? Lt 1 It c ( if/?7 No. ~ \ . ~~ - ~ ~'S 1:>,
also known as To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
?rJ/) I L (3 L?h G c: Clq"""lDeceased.
Social Security No. ) 9' r;. ~ 1'---) ~ C] / ') :J
The petition of the undersigned respectfully represents that:
Your petitioner( s), who is/are 18 years of age or older, appl
for letters of administration
on the estate i)f
(d.b.n.; pendente lite; durante absentia; durante rninoritate)
the above decedent.
Decedent was domiciled at death in
residence at
(list street, number and municipality)
Decedent, then K3 years of age, died ?r1.A /? (' !l d I ,20 a (; , at :2.~'.y s~ A 'JJJ
County, Pennsylvania, with h_Iast family or principal
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:
$'JeI/ G(}{);"OO
$
$
$
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name
~:~
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned.
~ignature( s) of Petitioner( s)
/(,JL(/) /) ~ f r; flU /}/
Residence( s) of Petitioner( s)
I d J )\1 /J -eel Fo /? cI ~ J. r A,.f / /s I 'E'
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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SS:
The petitioner(s) above-named swear(s) or affmn(s) that the statements in the foregoing petition are true and
correct to the best of the lmowledge and belief ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner( s) will well and truly administer the estate accor~ to law.
Sworn to or afflrmed and~bscribed {7< ';x/ ~(/~ /J '(> 1--:;: C ( 0 11 7
Before me this ~ ~ . day of
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Register
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No. ~ '\ - ~ ~ - ~ J.. S'"\
Estate of ~ ~-i \4 ~ \...~ \'~ , Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 'A ~ '\I... ~ ~ ~ '\ 20 'J ~, in consideration of the petition on the reverse
side hereof, satisfactory proof having been'presented before me,
IT IS DECREED that "'\0~~~ t:. ~\~~
is/are entitled to Letters of Administration, and in accord with such fmding, Letters of Administration
are hereby granted to "0~~~~ ~. ~ \\)-~
in the estate of ~~~\-., ~ \ ~
FEES
Probate, Letters, Etc. .............
Will............................. ....
$
$
Renunciation.. . . . . . .. . . . . . . . .. . .. . . $
Short Certificates (\) ............ $
JCP........ ... ..... .................. $
$
$
$
20~
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Register of Wills
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Attorney (Sup. Ct. J.D. No.)
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Address
Automation Fee. . . .., . . . . . . .. . . . ..
Bond............................. ....
Total
Filed ''}".. ~~ "\
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Phone
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Thi', is to certify that the information here given is correctly copied from an original certificate of death du]~, filed w\h
LOC,1] Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
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me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
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12270500
M~R 2 4 2006
Date
No.
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w-',
Hl05.143Aev.Ol,oo
TYPElPAINT IN
PERMANENT
BLACK INK
1 Name 01 Deced8l11 (Firsl. middle,last)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
5 Aqe (Lasl birthday)
T"p.
3. Social Security Nurrber 4. Dale of Death (Monlh, day, year)
Ruth M.
196_14
Glunt
arch 21, 2006
7 DaleofSir1h Monlh,da
83
v"
o Residence 0 OIhel-
10. Race: American Indian, Black, While, ale.
wfl"r~ e
Bb. CounlyofDealh
~I
Cumberland
11 Decedenl's Usual Oce alion Kind 01 work done durin most of workin ~fe; do no! slate r&liI'ed
La~~~~~ canri10~geSsl1ndUSlry
16 DececlenJ's Mailing Address (Streel. cityllown, slale, z~ codel
1709 Walnut Bottom Rd
Carlisle PA 17013
h" hast radeco leled
College (1-4 or 5+)
14. Marilal Status: Married, Never married, 15. SllrvMhg Spouse (Ilwife, give maKlen name)
Widowed, Divorced (Specifyj
Widowed
DYes
Decedent's
Actual Residence
Did Decedent
Uveina
Townsh~?
PA
Cumberland
17c.)Q Y85,Decedentlivedin Penn
17a. State
17d. 0 No, Decedlll1llived w~hin
Actual llmils of
17b. County
CitylBoro
18. Falhef'S Name (Firsl,rOOdle,last)
19. Mother's Name (First, fOOdIe, maiden surname)
Lenora Mitten
Clarence Fahnestock
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2Oa. Inlol"mant's Name (Typelprinl)
2Ob. Inlormant's Mailing Address (SlrHI, cityllown, slate, z~ code)
121 North Bedford St.
Carlisle, PA 17013
Duane E. Glunt
o AerrovallTom Stale 0 Donahon
21c. Place of Dtspo,srticn (Name of cemetlK'f. cremalory or olhef place)
Prospect Hill Cemetery
~~'l!!'!"~r\l@lj!Yal Home Inc
ewville, PA 17241
23b. License NllntJer
23c.OateSigned(Monlh,day,year)
. IIems 24-25 must be co""leIed by person
:' whopronouncesdealh
24. Time of Death
26. Was Case Reterred 10 a Medical ExaminerlCoroner?
;)."15 PM
o Yes toYko
Approximate interval: Part 11: Enter other sianifJcanl condihons conlribulinolo death, 28 Did Tobacco Use Conlrilule 10 Death?
ol15Bllodealh butnol resuling inlhe underlyWlg cause given in PaJ1 I. 0 Yes 0 Probably
o No 0 Unknown
29. If Female;
o Not pregnant wKhin past year
o Pregnanl a\ time of dealh
o Not pregnant, but pregnanl 'MIhin 42 days
oldealh
o Not pfegnant, but pregnant 43 days to 1 year
beloredeath
o Unknown if pregnant wlHlin Ihe past year
32c. Place 01 Injury: Home, Farm, 5ttH!, Factory, Olfice
Building,elc.(Specify)
Sequenliafty Iisl condkions, if any,
leadinglolhecauselistedonlinea
. Enter the UHDEAL YlNG CAUSE
. (disease Of ilJ,lry that in~ialedthe
events fesUlting in dealh) LAST.
Dueto(orasa consequenceo~:
-t- c?V'V>
Due to (or as a consequeoce o~:
309. Was an Autopsy
Performed?
d.
3Ob. Were Autopsy Findings
Available Prior to Co~etion
01 Cause ot Dealh?
DYes 0 No
32g. Localbn (Street, cilyl1own, slalel
31. MannefolDealh
tJ""Natural 0 Homicide
o Accident 0 Pending Investigation
o Suicide 0 Could NoISe Delermined
32.1. Date 01 Injury (Month,day, year)
32b. Describe how Injury Occurred'
DYes >yNO
32d. TImB 01 Injury
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33a. Certlfler(cl1eckonlyone)
Certifying phYllclan (P~sician C9f1ifying causa 01 dQalh when another physician has pronourw::ed death and COTTllleled Ilem 23)
To the best of my knowtedge, death occurred due to the Clluse(S)llnd m;anner as slated_.
Pronouncing and certifying physician (Physician both pronouncing dealh and certifying 10 cause or dealh)
To the best of my kl'tOWtedge, death occurred at the lime, date, and place, and due to the cause(s) and m;anner as stated
Medical examlnerJcoroner
On Ihe basis of examination anellot investigation, In my opinion, dellth occurred allhe lime, date, llM place, and due to the eause(s) and manner as staled .."_00.0
3. : ~~'Si9",1~:~~:~:'~~~ 3~"FiI"(Moethd'Y"")
3:ld.OateSigned(Monlh,day.year)