HomeMy WebLinkAbout07-06-06
Estate of DERWOOD D. STEIGLEMAN
also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No. 21-06- Lo 0 'd--
To:
Deceased.
Register of Wills for the
County of CUMBERLAND in the
Commonwealth of Pennsylvania
Social Security No. 203-10-9460
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl ies
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 Upper Frankfrod Township County, Pennsylvania, with
h is last family or principal residence at 405 Potato Road. Carlisle. P A 17013
(list street, number, Twp. or Bora.)
Decedent, then 85 years of age, died 6/19/2006
at Carlisle ReQional Medical Center. Carlisle. 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:
405Potato Road, Carlisle, PA 17013
$
$
$
$
25.000.00
25.000.00
Petitioner after a proper search ha S
the following spouse (if any) and heirs:
ascertained that decedent left no will and was survived by
Name Relationship Residence
4 PEACH ORCHARD ROAD
DAVID E. STEIGLEMAN SON NEWVILLE PA 17241
PO BOX 711
JA YNEE E. HUBBELL DAUGHTER ALTAVILLE CA
4 PINE STREET, LOT 2, MT.
DEBRA K. CAMPBELL DAUGHTER HOLL Y SPRINGS PA 17065
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the
appropriate form to the undersigned.
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4 PEACH ORCHARD ROAD
NEWVILLE PA 17241
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYLVANIA
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SS:
COUNTY OF CUMBERLAND
Sworn to or affIrmed and subscribed
B'fm~d; It' f-- , 20 crt'y of
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:/ ~ rVl.Regj.jer))-<;? ,
~ If Q No.2J- 019. OIfO?-
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Estate of I j(J i/J.Jl!4f 1)' J Ie fl, Deceased
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 Jha~ as personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate accordirtg to~aw. .,
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GRANT OF LETTERS OF ADMINISTRATION
AND NOW (p 200b, in consideration of the petition on the reverse
side hereof, satisfactory proof ing been presented before me,
IT IS DECREED that I)d v, if c S f--e '7 Lf' J"'l-t c__;
is/are entitled to Letters of Administration, agd in a<;.cord With7such fmding, Letters of Administration
are hereby granted to 0 tl v I tA c . (~ I-e, 7 ~ ,,,{ c,t...-/
in the estate of
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d;kA. a /J, 7,-,/'-c/v Dr
Rlgister of Wills :/
FEES
Probate, Letters, Etc. ............. $
.:wnt':':............................... $
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Renunciation... . . . . . . . v::-. . . . . . . . . . $
Short Certificates ('D ............ $
JCP. ... . .. . . . . . . . ..... ............ ... $
Automation Fee................... $
Bond. . . . . . .. .. . .. . . . . .. . .. .. . . . . . .... $
Tltal $
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:tUN 21 2006
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Hl05143REV 0212006
TYPE I PRINT IN
PERMANENT
BLACK INK
1. Name 01 Decadent (Flrsl, middle, last ~uffix)
Derwood D. Steigleman
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
85
April 8, 1921
J Social Security Number
203 10
4. OateolOeath (Month, day, year)
June 19, 2006
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6. Date of Sinh Month, da . ear)
7. Birth (ace Ci
5. Age (Last Birthday)
Carlisle PA
Bit CounlyofOeath
Sd. Facility Name (If (lOt inslilulion. give street and number)
o Rasldence 0 Olher . Spoofy'
10 Race: Amencalllndian, BlacK. While. et..:
ISpeo~)
White
I / .
Cumberland
Twp.
11. Decedent's Usual 000J ahoo Kind 01 worl<. done dun most 01 wor1<in life. Do nol Slate refired
Kind of WoriI Kind 01 Business I Industry
Molder Metal Forging
. 16. Oecedenl's Mailillg Mdfess (Slreet. city /lown, slale, Zip code)
405 Potato Road
Carlisle PA 17013.
'2. Was Decedent ever in !he
U.S. Armed Forces?
4lYes 0 No
Decedenl's
ActualResi<lence 17a. Slate
11 Decedent's Education (Specify ooly highest grade completed)
Elementary'Sdilr'/(0-12} College (1-4 or 5+)
14. Marital Status: Married, Never Married,
Widowed. Divorced (Specify)
W~dowed
PA
Did Decedent
Live in a
Township?
Hc. IE Yes. Decedent Uved in
17d. 0 No, Decedenllived withlfl
AclualLlffillSol
Upper Frankford
Twp
17b.Counly
("nmnlOrl::1inn
19 Mother's Name (First, middle, maiden surname)
Mary Ellen Glass
2Ob. '"4P~~cl,-oi~h~'~dR~~d';"e)Newville PA 17241
City/Boro
18. Fat\1e(s Name (Fif'.il, middle. last, suffi,;)
William Steigleman
2Oa. Informant's Nama (Type' Print)
David Steigleman
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22c. Name and Address of Facility
Hoffman-Roth Funeral Home, 219 N. Hanover St., Carlisle PA 17013
21a. MethodofDisposilion
Kl Burial 0 Removallrom Slate
21c. Place of DiSposition (Name 01 cemetery, crematory Of olller p1oce)
Westminster Cemetery
2td. Location (City / town, stale. Zip code)
Carlisle PA 17013
CAUSE OF DEATH (See instructions and examples)
Item 2]. PART I: Enter the ~l1(r:J~!1Js.. diseases, injuries, Of comphca!ions - Ihat direcUy caused \he death. 00 NOT enter Iarminal evenls such as caTdiac arrest,
respiratory anesl, 0( ~anlriculaf flbr~laIioo without showilg lheeliology. Usl only one causa on each line
Com~le Items 23a< only when certifying
physician is oot a~aiIab1e at time of death to
certify cause of death
lIems 24-26 must be completed by pel'SOfI
. who pronounces dealtl
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: Appro:Kimateintetvaf:
: OnsettoOealh
Pa/1 U: Enler olller sianilicanl conditions contributino to death
but not resuUillg in !he underlying causa given in Part I
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Due 10 (Qf as a consequl!lnce of)
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28. Did Tobacco Use Contribute 10 Death?
D Yes ~"bably
o No 0 Unknown
29. If Femaia'
o NOlpregnant wi!hlnpast year
o Pregnant at time of death
o Not pl"egnant, but pregnant within 42 days
otdeath
o Not pregnant, bul pregnant 43 days to 1 year
ofdealh
o Unknown if pregnant Wllhin the pas' year
32c. Place of Injury. Home. FanTl. Street, Factory
Office Building, atc. (Specify)
=~~~S~~;~~dise~
<':"~"'-"'''N"'-( h,"'-,'ti'-v \~;.'<A"~
Due \0 (or as a consequence ~ .>
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Sequentially list condibofls, if any,
~rif:~: ~~~(~~ ~~~~
(disease Of Injury thai initialed the
. eveols resultirg in dealh ) LAST.
Due 10 (ar 35 a consequence of)
\\-( 1" ~'<vv>o\ ""
D Yes D No
31 Manoor of Dealh
~atural 0 HomICide
o Acc:idenl OPendinglnvestl9alion
o Swcide 0 Could No! be Determined
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3Oa. Was an Autopsy
Pertooned?
JOb. Were Autopsy Findings
Available Poor 10 Completion
ofCauseo/Death?
Dyes ~
32d. Time of InJury
32g. Locahon of Injury (Street cify ftown, slale)
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33a. Certifier{checkon!yone)
Certifying physician (Physlclarl certIfying cause 01 dealh when another physICian has pronounced death aM completed !Iem 23)
To the best af my knowledge, death occurred due to Ihe caulejl) and mann&!' a. ltalesl_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Pronouncing and certifying physician (PhysiCian Ilolh pronouncmg death and cenilying to cause of death)
To the be1t 01 my knowledge, death OGcurred al the time, date, and place, and due to the causeis) and manner as stat!,d_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ J]
~~~eea~:;~f:~~~f~~t~~~ and I or investigation, in my opinion, death occurred al the time, dale, and place, and due to the cause(s) end manner as Itat!<1_.lJ
Ob
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36~iled (Month, day, year)
I~I ( I ~I ! I() I :iu ;ti 2-00(,:,
(See instructions and examples on reverse)
34 Name and Address of Person Who Completed ~5~ of Death (lIem 26.T ype { Print
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From:IRW1N LAW OFFICE
717 243 9200
06/28/2006 09:00 #803 P.002/002
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
RENUNCIATION
Estate of DERWOOD D. STEIGLEMAN
No. 21
06 - [CJ o.?-
also Known as
. Deceased
The undersigned,JAYNEE E. HUBBELL
(ReIation&hip)
(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 DAVID E. STEIGLEMAN
Witness my
hand tn'~ dav of ~U,N~ '1 ~?08 ,
_l cZ/ II '/; , fJ/L(
, :-c gnalu
JA, E UBBELL
p' X 1 AL TAVILLE CA
(AddI9&B)
(Slgnalure)
(Address)
(SigrlBW"')
(Address)
Sworn to or affirmed and subscribed
before me this :J ~~ day of
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Comm. # 1468675
PUBLIC. CAi.!FORNL~
, . '.=:\;(~r;.'j'~ c:)ur:ty
Notary Public
My Commission Expires:
~~~a11( -{)- Z{j/!za;J~
(Signature and seal 01 Notary or oU1er
officlil qUllllflBd to Bdmlnlelllr oelhs. Show
date of expiration 01 Notary'S commfsslon.)
NOTE: Renundatlons executed outeide the Office of Register of WIlls are
required In 80me counties to be notanted.
RW-3
RENUNCIATION
Estate of DERWOOD D. STEIGLEMAN
No. 21
06
( ~, c;:2-...
also known as
, Deceased
The undersigned, DEBRA K. CAMPBELL (Daughter)
(Relationship)
of
(Capacity)
the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that
Letters of Administration be issued to DAVID E. STEIG LEMAN
Witness our
hand this
day of JULY
2006
(Signature)
DEBRA K. CAMPBELL
4 PINE STREET, LOT 2, MT. HOLLY SPRINGS PA 17065
.~ G {Ad"M'1
Je} a- ~~~ iJck~
5 1rL~1L ~ _2 _
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me thi:; l~ '7
,
~.A..-'Yz..L-.
db~
Notary p~-
My Commission Expires
day of
NOTARIAl SEAL
CHERYl 0 SMtTH
Notary Public
Mt HOlLVSPRfIlGS BORO. CUM8ERlANOCNlV
My Commission Expires Feb 18. 2010
(Signature and seal of Notary or other
official qualified to administer oaths, Show
date of expiration of Notary's commission.)
NOTE: Renunciations executed outside the Office of Register of Wills are
required in some counties to be notarized.
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