HomeMy WebLinkAbout07-06-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Nancy A. Lego
also known as
No.
To:
J \ - 0 lo - OSCJi
Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 178-50-3223
The petition of the undersigned respectfully represents that:
Your petitioner(s), who2i~are 18 years of age or older, appl ies
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante ab~entia: durante rninoritatc)
the above decedent.
Decedent was domiciled at death in Cumberland . County, Pennsylvania, with
her last family or principal residence at 3 Edgewood Drlve, Mechanlcsburg Boro
(list street, number, Twp. or Boro.)
Decedent, then 58 years of age, died June 28
at 3 Edgewood Drive, Mechanicsburg, PA 17055
2006
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: 3 Edgewood Drive, Mechanicsburg. PA
~ I.-/I/{
$ , /{,O(~'CJ
$
$
$ .115-rOO& g 7, sc>o ~
17055 ~
PetitionerlL- after a proper search ha ve ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
Son
1610 Orrs Bridge Road
Enola, PA 17025
Son
Court
, PA 17050
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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: g 1 h 1 () Orr!':: Rri c1gp. Road
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David A. Lego
803 Highland Court
Mechanicsburg. PA 17050
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CDMBRRT.ANIl
} 88
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
before m-~ 1'-1-- day of
41; . ~ 'M .\~~t.o;c
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No. J 1- 0 (0- D S9'-f
Estate of N~n('y A T pgn
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW (::-z. :2 --..fl.i.JfL, in consideration of the petition on
the reverse side hereo ,sat" actory proof having been presented before me,
IT IS DECREED that To~pph T T.ego and Davi d A. Le~o
:mare entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Tn~pph T T,pgn ::mrl n:nTi rl A T,pgo
in the estate of N~n('y A T "'gn
FEES )
Letters of Administration $ , (;; 0 - tf/)
Short CertificateS(J .. . . . .. . .. $ 11.1 .1TJ
Renull~iatieR ~. .frf:r-;j..... ~ I~'
,/ . TOTAL _ $ ~C(/
Filed ..7r~//).b.......... A.D. -1-9_
4a~r:& c;ti4~ c9'n~,tc7/~
~t:{ € /~~J ~
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Lawrence J. Near~J' Suprp.mp. aOllrt I.D. 25827
A TIORNEY (Sup. Ct. LD. No.)
108-112 Walnut St., Harrisburg, PA 17101-1609
ADDRESS
(717)238-4798
PHONE
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This is 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.
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Fee for this certificate. S6.00
Local R.eilistrar
P 12625050
JUL 0 1 2006
Date
V. 0212006
liNT IN
~ENT
INK 1130-271
,. N,""" 01 Decedent (First rriddIe.last, suffix)
Nancy
5, Age (LasI8ir1hday)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
STATE FILE NUM8ER
3 Edgewood Dr.
Mechanicsburg,PA 17055
18 F_s Name (FIISt middle. last. suffix)
PennRylvi'lnii'l
Cumberland
4, Date of Death IMooll1, day. year)
June 28, 2006
A
Lego
6. Dale oIBirlh MonIl1, da ,
7. 8irlh ace Ci and state or I
58
Vrs
June 27, 1948
Seoul,South
Residence 0 Other . Specify:
10. Race American Indian. 81ack. While, etc,
(Specifyl
A.sian
Bb, County 01 Death
Cumberland
&I. Facitity Name (11 not institution, gi.. street and number)
3 Edgewood Drive
most oI_i ife, Do not state retired,
Kind of Business I Industry
housewife own home
16 Decedent's Mailing Address (Street. city I town. slate, zip code)
12, Was Decedent ever in the
U,S, Armed F roes?
Dyes
Decedent's
Actual Ftesidence 17a. Stale
13 Decedent's Education (Spedfy onty highest grade completed)
Elementary I Secondary (0-12) College (1..4 Of 5+)
12
14. Maritat Status: Married, Never Married,
Widowed, llivon:ed (Specify)
widowed
17b, County
He. 0 Yes, Decedent lived in
17d)sL. No, Decedent Uwd will1"
Actual Units of
Twp
City I 8010
Jin Ro
19, Moll1ers Name (First, middle, maiden sumame)
Hwa Ro
2Qa, Informant's Name (Type I Pmt)
2Ob. Infonnanl's Mailing _ss (Street, city I town, state. zip oode)
1610 Orr's Bridge Rd.,Enola,PA17025
Joseph Lego
21a !OIDisposilioo 0 Cremation 0 Dooation
Burial 0 Removal from Slale : Waa Cremation or Donation Authorized
o . Specify' : by _cal En",;ner I Coroner? 0 Ves 0 No
of Funeral Service Licensee (or peo;on acting as such) 22b, License Number 22c Name and Address 01 Facility
~,~~ FD-013163-L Musselman
Gem _ 23a-<; ooly when certifying 230 To the best of my knowtedge, deall1 occurred al the 'me. date and place staled. (Signature and ,lie)
physician is not availab6e at time of death to
certify cause 01 deall1
Items 24-26 must be completed by person
, who pronounces death
21b, Dale of Disposition (Mooth, day, ye"1
2006
210. Place of Disposition (Name 01 cemelery, cremalory or other piace)
Rolling Green Ce,
21d, Location (City I town, slate, zip oode)
Camp Hill,PA.17ffi1
FH&Cs,324 Hummel Ave.,Lemoyne,PA17043
23b. license Number
230, Date Signed (MooIl1, day. year)
2:08
P.
M
25. Date Pronoonced Dead (Mooth, day, year)
June 28, 2006
26, Was Case Referred to Medfcal Ex::rniner I Coroner tor a Reason Other Ihan Cremation or Donation?
M Ves 0 No
24. Time of Dealh
CAUSE OF DEATH (See instructions and uampl.s)
Item 27, PART I Enter the~~. diseases, injuries, Of complications -lhatdirecllycaused the death. 00 NOT enter terminal events such as cardiac arrest.
respiratory arrest. Of ventncular fibrillation without showng !he etiology. List only one cause on each line
: Approximate interval:
: Onset 10 Death
Pwt II: Enter other mnificMl r:nrvIjlinn~ mnJnhutioolo death 28. Did Tobacco Use Contribute to Death?
but not resulting in the underlying cause given in Part I 0 Yes 0 Probably
o No D Unknown
29. Hemale
o Not pregnant wrthln pasl year
o Pregnant at ~me 01 death
D Not pregnant but pregnant wilhln 42 days
01 death
o Not pregnant, but pregnant 43 days 10 1 year
ofdealh
o Unknown if pregnant within the past year
32c, Place of Injury: Home, Farm. Street, Factory,
assailant OIfice8uildlng,elc. (Specify) Home
=~~~~~:~~J:~d~~
Gunshots to Chest
Due to (or as a consequence of)
=ntialfy list conditions" it any,
~nter"'3: =~tNG J.."'(,~
(d~ase or "jury that initiated lhe
e_1s resuitlng " deall1) LAST.
Due to (or as a consequence of)
Due to (or as a rortsequence of)
D Ves 0 No
31 Manner of Death
o Natural 'l&l Homicide
o Accident 0 Pending Investigation
o SUicide 0 Could Nol be Delermlned
32b. Describe How Injury OCcurred:
3Oa. Was an Autopsy
Perlormed?
:JOb Were Autopsy Findings
Available Prior 10 Complelion
01 Cause of Death?
June 28,2006
o Ves )21No
32d. Time 01 Injury
2:08 P'M
Dr.,Mechanicsburg,PA
330. Cartifltr (check ooly 009)
Clrtllylng physician (PhyslClen certifying cause of deall1 when anoll1er phYSICIan has prooounced death and compleled Ilem 23)
To tho best of my knowledgl, duth occurred dUI to tho cau..(aland manner II atatfll_ _ _ _ _ _. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _. _..D
Pronouncing and cartffylng physician (Ph}'SICian both pronouncing death and certifying 10 CalSO of dealh)
To tho best 01 my knowledga, death occurred aI tho tlmo, dati, and p1aco, Ind due to tho CIUI~I) and manner II ltat!'l.. _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _..D
Medk:11 Examiner I Coroner
On the basil of .xamlnalton and I or investigation,ln my opinton, death occurred at the lime, date, and pIKe, and due to the cauS'(I) and manner II st.tfCt _
Coroner
~
~ /I~I/ 1/ 1
33d. Date Signed (Month. day. year)
June 30, 2006
34 ~c1tmol~1foCo;rrSc:use~~~thJ~m~~ Type/Print
6375 Basehore Roadr Suite III
Mechanicsburg, PA 705U
(See instructions and examples on reverse)
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