HomeMy WebLinkAbout06-20-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of LESLIE K. BENTZ
also known as
No.
To:
~ / . 0 (P - D S LI )
Deceased.
Register of Wills for the
County of Cum berland in the
Commonwealth of Pennsylvania
Social Security No. 179-66-4842
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.
Decendent was domiciled at death in Cumberland County, Pennsylvania, with
h~r last family or principal residence at 228 Green Hill Road, Newville, PAl 7 24!
(list street, number and municipality)
Decendent, then 21 years of age, died May 19. 2006
M Camp Hill, Pennsylvania
, 19
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:
~ ,000.00
$
$
$
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following ~~~~eirs:
Name Relationship Residence
Thomas E. Bentz Father 228 Green Hill Rd., Newv
Dorothy L. Bentz Mother 228 Green Hill Rd., Newv
ille, PA
ille, PA
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
t~ fTh~~~~nC: 16.~
~ g 228 Green Hill Road
;E Newville. FA 17241
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYLVANIA
}
COUNTY OF CUMBERLAND
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 ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner( s) will well and truly administer the estate according to law.
...J- ~-M) {J~: 6
,,~MJg diUfL,,-S};t.r;,puf-
ftA-~ C{;l!V~egiS~er ~
jl^ }P No. 2}-- bitr 0 5l( I
Sworn to or affIrmed anJj. "scribed
BefOreI~rhiS L f( day of
v...... , 20 0 ~
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Estate of L-e.sll e. A.. &nf-L. Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ~v-? 0 20~ in consideration of the petition on the)-e'yerse
side hereof, satisfactory proof having been presented before me, '.)
IT IS DECREED that I hO,)1 [;\.~~ r;. ly~17 '"
is/are entitled to Letters of Administration, and in accord with such fmding, Letters of Administration
are hereby granted to
{tt () rn.Ct. j t, Ie #1 rL
in the estate of i.-(S 11<'" f<. . 11-e~ h-..
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation.. . . . . . . . . . . . . . . . . . . . . . $
Short Certificates ( ).. . .. . .. .. . . $
JCP.................................. $
Automation Fee................... $
Bond.. ................. .......... .... $
Total $
Filed ~ ( '). () - 20R-
)0
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l 0 00
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Regiifer of Wills
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Attorney (Sup. Ct. J.D. No.)
L( h, (V~,v~ ~"-
Address ,./)
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Phone
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This is to certifv that the information here given is correctly copied from an original certificate of death duly filed with me as
I.ocal 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.
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Local Registrar
Fee for this certificate. $6.00
P 12535497
MAY 2 4 2006
Date
\..0
Hl05.1<U REV. 02J2(U;
TYPE / PRINT IN
=~T #30-245
1. NameatOecodeot(F..~_,lastsutlixl
Leslie
5. />9!(laslBifthdayl
21
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
Vrs
6. Daleol8ir1h Monlh,d
7. 8'
Ci and stale or
STATE FILE NUMBER
4. Dale of Death (Month, day, year)
May 19, 2006
K
Bentz
Feb. 2, 1985
Car lisle, PA
6d. Facility Name (If no! iostilutioo, give s_ and numbe<1
81>. CoonIy 01 Death
I .
Cumberland
PA Rt. 581 W/B, M/P 6.2
11. lloc:edenr. U9Jal mosl 01_' 110. Do not stale relied
Kind of WOI1< Kind of 8....- / Induslry
Student Mawr College
. 16. lloc:edenr. Mailing Address (Street city Ilown, slate, zip code)
228 Green Hill Road
Newville PA 17241
18. FatI1er's Name (Firsl, _.Iast, suffix)
Thanas E. Bentz
200. Informants Name (Type/Pml)
Thanas E. Bentz
21a.lAethodofOisposltion
UlSUfial 0 Removallrom SIaIe
o Olher - Spodfy
220. Signal'" at F
12. Was Decedenlever in !he
U.S. Armed FOICeS?
OVes :KINo
_1'.
AduaI Residence 17 a. Sliile
13. Oecodents Education (Specity only t;ghesl!Fade oompleted)
EIemoflIaryI S<<ond3fY (1J.12j COIIog'I1-4or5+)
3
17b. Coooty
PA
Cumberland
14. Morilal Slatu. Married. Never Married.
W_, Oi-roo:od (Specify)
Never Married
Did Oecodenl
Uveln. lie. ia VllS.OecodeoILivedIn West Pennsooro
TO\WIship1 17d. 0 ~ciu=~UY8dwitt1;,
Twp
City/Bore
Cl
3
~
. ~
2Ib.DateofOlspoa.lioo{Mor\".day.yea')
19. MoI/1e(. Name (First, middle, ..- Stlrnamel
Dorothy L. Dick
201>. Informants MaIIng Address (S...I, dty 1 town, Slal.. zip axle)
228 Green Hill Road, Newville,
21e. Place 01 Dispositioo (Name of """"'Of\', cremaloryor_place)
Cumb. Cnt
PA
Complete Items 2Ja.o only wilen Cl!!tifyirq
physidan ~ 1101_ at tirre of death 10
Cl!!tify cause 01 death
lI!ma. 24-26 musl be compleled by person
who proooonces death
Mt. Zion Cenetery
220. N.... and Address 01 F ""'ity
EWing Brothers Funeral Halle, Inc., Carlisle, PA 17013
occuml<! althe time. dB" and place s\aled. (Signature and Iille)
23b. License Number
23c. Dal. Signed (Monlh, day. year)
24 T..... of Doath Ap rx . 25. Date Pronounced Deod (MonIt1, day, yearl
4:50 P. M May 19, 2006
CAUSE OF DEATH Is.. inelruction. and ...mp\e'&)
Item 27. PART I: Enter fhe~. di$eoses. .....nos. or mmplications . that dWectly caJsed the dear, 00 NOT .nter _Inal.vents sudt as cardiac arrest,
respiratory arrest. or ""'Incular fibrilabon wilt10ul showing the .tioIogy. Ust only ono caua.o Ol\ Bach II\e
~~~;l~d~~ Multiple Traumatic Iniuries
Due 10 (or as a consequence of)
Motor Vehicle Crash
Approximate interval:
Onsello Death
26. Was Case Rererred to MedI:at ElamineJ I Coroner for a Reason 0Iher tha1 Cremalion or Donation?
Ill( Yes 0 No
Part It: Enter o!her Wlnifr..,1 mfV'Iitions; cootrihutinn In death 28. Did Tobacco Use Contritute 10 Death?
bul nol resulting In the undeflylng cause glvon '" Part I 0 Yes 0 Probably
o No 0 Unknown
29. ff Female
o Noi_i wiIt1in past year
o Pregnanlallirre 01 death
o Not pregnant but pregnant within 42 days
oldealh
o Not pregnant, 001 pregnanl43 days 10 1 year
oIdealh
o Unknown if pregnant within the past ye6
operator, 320. ~aceoflnjufy:Home,Fann,S"",Faclory,
by tractor Office8uidi'iir~A~y
32y. Localion ollnjuly (Street. city / town, sfate)
PA Rt. 81,Camp Hill, PA
~. . Iist_.,~any,
tJcauselisCedon~a
Enlef UNDER\. VING CAusE
(diseose or iI)iIlI'( thai iritiBled Ih.
events resulirli n death) LAST.
Due to (or as a consequence at)
Due to (or 85 II conHquence of)
~V" ONo
~YllS 0 No
31. MannerofDealh
o Natural 0 Homicide
)d Acddeol 0 Ponding Invesllgation 32d, Time oIlr1ury
Aprx.
o Suidde 0 Could Not be Oeterm<ned 4 : 50 PM
Coroner
300. Was an Autopsy
Performed?
3lI> Were Aulopsy Findings
Av_ Poor kJ Completion
of Cause of Dealh?
!z
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33B Coflifler (check on~ one)
~~J'~~":==:::''::u:;~~';=~=~~~~~~~_I~~~___ ______ _____ _ _ _ JJ ~
=-=~"~~:~ ~~':; ::t::"':;'::~.:ir:t:=~~~d mannOfI' ltattd_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ JJ
=~~n:~= and I or inves'tigltion, In my opinion, duth ~urred at the time, d.., .nd pIK" and due to the ClUH(') and manner I' IgIN, _ .J8!
35. Reg; ~lure and 'lIl1li<:l.Nf"'" t.. ~ \ 36. Dale Filed (Month. day. year)
~ H ~~~ . Id. I \ tc1. I \ I 0 I
33c. UCense Nu
33<1. Dal. Signed (Monlh. day, year)
2006
May 24,
34. ~'m1"mrffPr:':" ~~'f~~,&~gi:-TypeIPrin\
6375 Basehore Road! Suite #1
Mechanicsburg, PA 7050 '
2 /-0(0' 05""'(;7
Register of Wills of Cumberland County
RENUNCIATION
Estate of LESLIE K. BENTZ
Also known as
No. ~)- () & .- 0 5t{ 7
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned Dorothy L. Bentz, Mother
(Name) (Relationship) (Capacity)
of the above decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration
be issued to Thomas E. Bentz
Witness my/our hand(s) this l ~ T'\ay of June
,2~.
~oi~n~ ~
AffWYY9 and su~ribed before me this
,-/#Qayof UJl~
2Do,t. ,
'1 '7
v
228 Green Hill Road, Newville, PA
(Address)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Shelly Brooks, Notal}' Public
Carlisle Boro, um a unty
My Commission Expires Aug. 5, 2009
Member, Pennsylvania Association of Notaries
fl- y- 2atf/
Or
(Signature)
(Address)
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
Deputy
" '-J
(SignatIlre alid seal of Notary Dr other official
qualified to adiJ.l1nlster oaths. Show date of
expiration of Notary's commission)
(Address)
\.0
17241
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