HomeMy WebLinkAbout05-23-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No. :) 1- OLD - Y4g
To:
Estate of EDWARD W. BAKER. JR.
also known as
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. 191-40-9059
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appliES
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with
h IS last family or principal residence at 1290 NEWVILLE RD.. NORTH MIDDLETON TWP.
(list street, number, Twp. or Boro.)
Decedent, then 58 years of age, died 5/10/2006
at CANCER TREATMENT CENTER OF AMERICA. PHILADELPHIA. PA
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:
$
$
$
$
5.000.00
0.00
0.00
0.00
Petitioner after a proper search ha S
the following spouse (if any) and heirs:
Name
ascertained that decedent left no will and was survived by
Relationship
E
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the
appropriate form to the undersigned.
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1290 NEWVILLE ROAD
CARLISLE PA 17013
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH 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 ofpetitioner(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 affir~'WP subscribed
~!~ day of
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No. ~/-OU - ()J-/L/q
Estate of EDWARD W. BAKER. JR.
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW~lo ,in consideration of the petition on
the reverse side hereof, satl actory proof having been presented before me,
IT IS DECREED that BEVERLY G. BAKER
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
BEVERLY G. BAKER
in the estate of EDWARD W. BAKER. JR.
FEES
Letters of Administration. . . . . . $ ()O . CO
. ( 3 $ I:;), CO
Short Certificates ). . . . . . .
~~-\:o~~W$ 5_LD
~~p $ 10.00
TOTAL _ $ 5~. <.D
Filed ~.~~. . . .. A.D.c9~
ATTORNEY (Sup. Ct. LD. No.)
414 BRIDGE STREET
NEW CUMBERLAND PA 17070
ADDRESS
717-774-7435
PHONE
T hi, is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
LOCI; 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.
tk~ IJ? tf;5.4~1~ ~
Local Registrar //
p
12411854
MAY 1 5 2005
Date
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'PfIPIIINT IN
EAII-.NENT
lLACK INK
1 Name ollleeeOen\ (Fil.\. rriddle. la'l)
:=:cMo..v d
5. iVJe (La.1 binhday)
tl / - Dtr> Lj yg
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
<::)
a
17a. Slat.
Did Decedenl /
Liveina 17c. iP"Ves,OecedenlLrvedin
T own.hiJ?
Twp.
, 7b. County
17d. 0 No, Decedent Lived wiIlIin
Aelual limits 01
Gltyllloro
21b. 0.18 01 Disposition (Month, day, y..~
21d. Location (Cltyllown, .lale, zip code)
FD 012 848 L
Evans Crematory Schaefferstown, PA 17088
220. N.meand Add,essof FaClllly Parthemore FH & CS, Inc.
P.O. Box 431 New Cumberland PA 17070-0431
23b. License NUni>er 230. Dal. Signed (Monlh, day, y.ar)
~
26 Was CaH Refe11'ed \0 a Medical ExaminerlCoroner?
o Yes ri
11M,
C-.USE OF DE-.TH (See InsllUctlons .nd .""",ples)
hem 27. Pan I: Enler the ~ - dis....., injuries. Of ~tions -lhal diroclly caused the d..th. 00 NOT ani", l",minelevents such a. earo..c an..l.
respiratOl)' .n..t, Of v.nV""ler Ibrilalion witheut she' th. eliology. DO NOT _eviole. Enle' only one cause on eline.
"MEDIATE CAUSE (Fila' dis.... or " ('
con<llion resohing in d..lh) ----? a.
Sequentially list condition., >>eny,
leading 10 th. cause isted on Line a.
. EnI'" the UHOERL YlNG C-'USE
. (diseas. or injury that miliated the
events lesuking in dealh) lAST
: Approximate inlerval:
: onset to death
Part II: Enter other sionificanl eonditinns contrilutina 10 death,
buI not resulling in the undertying cause given in Part I.
28. Old Tobacco Use ContOOulo to D..lh?
~~. g 0~=
320. Dete 01 Injury (Month. dey, y..r)
32b. Descrile how tnjtJry Qocuned:
29. If Female:
o NoI pregnant within pa.1 y..r
o Pregnant at lime of dealh
o Not pregnant, but pregnant wlthin 42 days
01 death
o Nol pregnent. but pregnanl43 days to 1 y.er
before death
o Unknown If pregnant wiIlIln the paSI year
320. Place ollnjtJry: Home, Farm, Streel. Factory. Otfic:e
Building. etc. (Specif>>
c.
Due 10 (or as a COfISIlqU8IlCe 01):
300. ~:~~
o Yes (\ No
d
~. Wm Autopsy FWldings
-...lIable Prior 10 Complelion
01 Gause ol O..tll?
o Yes 0 No
31. ,,,.... 01 Death
fl4. NelUnll 0 HorRcide
o Accidenl 0 Per<fing Invesligation
o Sui:ide 0 Could Not Be Oetemined
32d. r"""oflnjury
J2g. location (Slteel, citynown, 'lale)
k!.
1338 Certifier (chad< only one)
. =::".:i,:~,,::n,=Iy'::::"~1IIa-:':,:::::=~d"~~_mmp~~~_~___._ .___._.. .._.... ..___.............. '
. Pnlnaunclng Ind cOl1lfyIng physlclan (Physk;an bolh pronouncing _and CllfIilying 10 cause 01 death)
. To lhe besl of my k-ae, death occuned .11lla time. claIe, and ...-. and due 10 1IIa caUll(s) and manner.s slllId__.._. .._.....__.._...._....._._...__ _._0
Modlcal examlnerko_
- On the bills 01 ........,IorI._In...tIgallon, In my opinion, cIaIh oc:cuned lithe lime, _, ifill place, Ind due 10 the caUll(s) and manner II staled __0
Aegis"ar Signalure and Dislri:t Number 36. Date RIed (MonI1\, day. yea,)
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