HomeMy WebLinkAbout06-06-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Deceased.
No. Of.c') ~ ,,') ~ l.,
To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Estate of Charles M. Goodyear
also known as
Social Security No. 174-05-3915
The petition of the undersigned respectfully represents that:
Your petitioner(s}, who_are 18 years of age or older, appl Y
for letters of administration
on the estate of
(d.b.n.; pendente life; durante ab~entia; duranle minoritare)
the above decedent.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h is last family or principal residence at Hill Strept. Mt-. Roll y Spri nge: > PA
(list street, number, Twp. or Boro.)
Decedent, then 7 'i
at
years of age, died
Ortnh"'r ?8
,19 81
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:
$ ~o;...
$
$
$ 10.000.00
Petitioner~ after a proper search h~ ascertained that decedent left no will and was survived by
the foUowing spouse (if any) and heirs:
Name Relationship Residence
G
r~.. "
THEREFORE, petitioner(s) respectfully request(. the grant of letters
appropriate form to the undersig,.
//
.-... /"",/
~ c~ ./ ~,/'
u .... C.o'" ,.../
~ 1 '~
'1:1__ .
.:;;~ CharI . Goodyear
~ ~ 101~ rystal Creek Circle
'1:1._
;.: Mechanicsburg, PA 17050
~ct
li'....
~Q
..
C
ao
fii
of administratiolt-'in the
, !
-. '-")
o
OJ~'\ aJd~L~,VV1 Q.../\..A,ZO (~
Deborah K. Morrison
1017 W. Trindle Road
Mechanicsburg. FA 17055
Spdngs, PA
17007
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
} ss
The petitioner(s) above-named swear(s) or affirm(s) tbat tbe
statements in tbe foregoing petition are true and correct to tbe best
of the knowledge and belief of petitioner(s) and tbat as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law.
J
L
i
~
I
US
No. ~ - OlJ; - [\3/t0?
Estate of
CHARLES M. GOODYEAR
, Deceased
GRANT OF LETIERS OF ADMINISTRATION
AND NOW:~~\~ Lc ~ dOCie, in consideration of the petition on
the revc:ne side ~. satis~q; proof bavb>& been presen.ed befOl'f me., J. . .
IT IS DECREED tbat" '~') C:>DJ'dC' ~ ' '\ . K r Gu ~. (~r t ,Iv'-<. ' V\J I t'fl.,L'\..
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Admini tion
~'f<
t\L "C' " (.'~/
are hereby granted to \..1\ r, /\ ~ 2 ;:;,.U )~X /\,) :~)... ) \.-:J.1, y-..,'~1 ~_ J.--.. "~ '{VIe 1._;\'A':"o>(""
_~.C\ t,_.;,.~h~,-~~,-"', _'__,
. h f {"'';,'~-=---~: .
m t e estate 0 '. \' G::W\. ';i ~ '}. I(Y'. .:', './ r", ,: YL"-
)
FEES
Letters of Administration ..... $ Y 5 (,:..
Short Certificates( ).......... S
Renunciation ..... ScP' . . . . . .. $ ,u .,:.
o~\.:-"'..;~ ..'''' S #,- . v ~
TOTAL _ S CoiL) ,'::..
cd i.J;,. V;Jcc', AD t.Q
FiI .............-....-........ . .~-
1', ,; '; I !
'/Ij;, :,) \{ ~1 l T-iw (0 i --
,>>t'h'\I.--,I')c.-i^iJ~( . \ / /) j(tt1/~'-~l.~'.
I ,," _,
R.qister of Wills ~/ (,~' ~(. :+
, ,}JJ
. Iti \
~...--. 'oJ ~~,_ l"~-. --,
t!) -"'7"-~J--',.'-."
17013
ADDRESS
(717) 249-2448
PHONE
H105.905 REV.(OIl04)
GL. .JLl;
This is to certifY that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, ] 953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ (JJ.. II~
No.
Charles Hardester
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
AUG 1 6 2003.
Date
~~ljrlll~~'~~~''il~lIl!llf~''''''''''~;~.~~~~~~';'1I,!,,\\~,ft~''''it~<\i~;lrli'li,f~.f,*,~4~;"{;A:.'i!!t;iJ.j:*,'d";'~~'
.'~',.,...." '.' .......... ......_,.....~'.' .... ........>>. ,..:','.._.,..".......,. -...."",.....'."._-:...,-....-,.-:~....~.-;f..'..".;"..,\'_,' ....~.,'..~~:!::.~,~~~w~.!<'....'. ..,.... ,...... '~,_..'.. ;......,..., .... ',:" '--",- '" ">-":'-", ""'-""""".,::.'" ."""~'\:'. '~;~;:.:...;..'"O",;i."" "(i\'-~,.,""";".~~..,._
. .. '...... .. ---~ ,~
I.
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, .....
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT or: HEALTH
VITAL STATISTICS
CERTIFICATE OF DEATH
(Phy.i cian)
C")
o
090450
FRIMP.HY OIST NO
Type or
Prif'tt in
Permiln?flt
lr1k
1\:2mc uf decea~ed
(First)
(Middle)
(Last)
Goody"ec.r
If under 1 yr.
Mos Di!Ys
If under 1 day Da~[' of bitlh, Mo,D;.!y .YF Stat~ or for,.,'')'' country of
Hours Min. birth
5C. I eA. 'J,_6._o~ 68 ~(~"" "'(1
HOSpital or In5li,ulion (If nol either, 91V~ street address)
,)\
OECEOEIH
7A
C UL!bld
78, Carlisle
7C
Cd.rlis~e ~=OSp:.ta.2..
~hilt'19 Addrr:sc, (S'IPC! or RFD No.)
(City or Townl
(Stiltl?)
:-L~..ll .3tree:. tIt. ~~oll ~/ Snr::'~~t~.s.
C'l'..en 01 WhJI COi.Jl1trv' W;tS dl'ccd>!r,l ever in U.S. Armed Forces?
o Yes ~ No $l!rial No.
?~.
(Zip Coold
17J6~
I
i
I-~~
) \,.:h~'~" (:irJ a. Slale
~l~;.'I:'~I~r~?: ,."')
15 b. Coun:y ~~~:,1;c"""'1 ~l""'r.~
, r::,-,~h"r's 'l.)mc (Firs:) !.'v'lddlel
Socii::li Securl!y NiJ'T'lj)'?
KI,.,:j of b<.Hln"~~ or lndu-;trv
?g Y3.
13,; -<J,_,'""\::-:-=.2-.....,1 r:'
Diu -::eceaSl'd live 0 y~; deceased lived in
in J to~...n~hlp ~ ~o, deceil'-€C iiv'!d w~lhln aC1~all:mi~s-cf
1148 E1Gctro!lics
f'ni rl(}LL'{ SP;? IrJGj 'j"
tow.,~h,o.
12,
C;ly cr b0~(1.
~
Ilas~ )
~,tlorht'r's !-.Jldc1'1 ~lame
(Firsti
('.1,ddle'
! la~rl
PA:=!ENT~;
16
-':!illiarn
Goc,rj~,rsar
17
~Sfree~ o~ RFO No.1
:tosie
(Ctyor Town)
~.lVeD
CERTlF'IER
~:nfo'~d"!'<. q;H"'f' ;T'fpe O' Prlllt;
)HlA. Cl:erl~~.s ?:.. Good~"ear
~ [XJ 8J~ 0 Rf:'O'()\I,,1 ~;Ile 01 bw,al. ere
! 19,4. DC~r!Ma!;ol1 OO!~er 19B.1J-30-21
i 'Srg'1aturf' of feral direCTor ~ I:cense num. " ,
~~. - .e~., It/ / .;;{~ /
IR,'Qi:;lr& .gnaturf' oJ :~. Bal tirT.ore /.:...VC
".-' '\ ' '\ \' <:\ \ ---\ ( .
I21AB'Xu.~ \\. \~~,C\t:\.:Slj~\[)Q~'S.e^-_ ~"~)\-:J.\,t.:; Hol2.y Sprinss, Po.. l7J65
ri;-- To the best of T;1y knowledge, death occurred at the titr~Jate <lnrl plaCY. and due to .' :.:.:.:.:.:.:. ..;tt~. ~t.)o~t~.:>>X~~ '~~'>>>>;->>M*:*,:':~Mtt):(t:~:~~;
~ < tho cause I,) "'''d. " ::li:~.:::::::::::m~~~m:I~)!J~~I~I~::::;::::;:::::::;:::;:;:;:::::::;:::::::::;:::::::::::::::;:::::;:::;:::
n /} / q.. . MD.;>;;' L........................................................................,
In { ~~: '~:~:~'::'Q D,y y, I Hou, 0 ~ ~ ~ ~o ~i~~~~~~11!=~~~:~~~~~~~~t~~~~~~?E~~~~~~~~~~~~~~~~~~I~~~~~~~~~~~~~~~~f~~~~~~I~~~~~~~~~~~~~~~~~
~' ~ t ~ 22R io - AS-- - rl ~;~th -=- ;.~' ~j~i~~rMt~ftt~~}tjtttr~t~ ~mtIrrrrrrI???~;~;~~mtIj
u -
;:'24 _Jf-,./!t:5-;':;'V"~E"m'oe!!::-7.I;:;::;'TY:5~/711.-j f I ,,1"-. ~__
r 26 rIA'lmrnf.'d1all! Cause: E~H'_r.O~IY on; cause ~ 111'.e for (A)/iB~"':I~1 '" J ~ _ !ote""t b<>tweeo 00"" aod death.
~ N~o ~~~- ~ I //1-1 ~f~
PAtTj ~~;' to, 0'''' ",""qu.oc. ot. ~~ ! Inte,.., """(?..;'" d.,'h '
D"e~' a come'1U'o," ot, ~ I'ot"", "',weeo 00,., and d.."h
I
IICI I
PA RT I~ a-her Sigrificant Conditions - Conditions contributing to death bUl nOT related to cause given iT'l Part t (al
InformJnt's
Mailing ~ddress
18B.
(STille)
I ZIP Ccdt-')
2ill StY"Oct
~ r.1..
Holl:,,~
Sor:;.:;.;::s
Pa.
1'7J5~
~;.i.v ..
Name of c~m(.";>ry or c'f'mator'l-
LocJt1on
(City. horo, h...p.)
(StJlI')
D~SP'CS1TlCN
19C1.:t.
;-rally ST)~'inbS
C e:;-;et2:-Y
19D. ].it.
;-~cl2.y'. SDr'J..!"12S.
P"l.
l?J6.:;
FO -I 7111" 1 71
1-0
Name and addre~" of /~.merJ; e~tabli~hm~rlt
Jos. ~,'[. GibSO:1 F;~nr2ral
7JrotT'C't
ll......~~~.....
C-ondrt;(1'ls
If An'f
V,'h:d, G,II/('
Ri~ 70
tmm!?'di.jtf'
':ause
Statirl9 The
Undl'flving
Cav~ LHt
....
CAUSE
OF
DEATH
Location
IStr~t or RFD No.)
(C~~y, Bora, or 1 wp.:
:Statel
I
l-iT Acc, Sl1l(~, Undel (Ir
Dl'ncl ng tnvl's'rqatlon ISpI:'clfyl
2tJG.
~yat{Vcr"'?
79E DNa [] Yes
Dale of Injury (~1o., DO!y. Yr.l
HOL'r of
Injury
29C.
A.M.
?~.
Descri~ how injury occurred:
29B.
Pla':e o~ Injury
290,
29F.
29G.