HomeMy WebLinkAbout07-21-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of Daniel Whare
also known as
No.
To: c21- OS - c2-l.c3
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
. Deceased.
Social Security No. 177-42-1047
The petition for the undersigned respectfully represents that:
Your petitioner(s) who is/are 18 years of age or older, applied for letters of administration (d.b.n;
pendente lite; durante absentia; durante minoritate) on the estate of the above decedent.
Daniel Whare, Decendent was domiciled at death in Cumberland, County, Pennsylvania, with
his last family or principal residence at Claremont Nursing Home, Claremont Road, Carlisle,
Pennsylvania.
Decendent, then 54 years of age, died on July 13, 2006.
At Claremont Nursing Home.
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $6,000.00
(If not domiciled in Pa.) Personal property in P A $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania
situated as follows: None
Petitioner, Amy Heller, daughter of decedent, after a proper search, has ascertained that decedent
left no will and was survived by the following heirs:
Michael J. Whare
36 Otto A venue
Carlisle, P A
Amy Heller
4 Hickory Tree Place
Dillsburg, P A 17019
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THEREFORE, petitioner respectfully requests the grant of letters of administration in the
appropriate form to the undersigned:
" ~
~ler
4 Hickory Tree Place
Dillsburg, P A 17019
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 of petitioner(s) and that as
personal representative(s) of the above named decedent, petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed before me this
day of
,2006.
I
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Amy Hel1~
Register
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Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMffiERLAND
}
SS:
Sworn to or affIrmed and subscribed
Before me this day of
,20
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The petitioner(s) above-named swear(s) or a (s) that the statements in the foregoing peti. are true and
correct to the best of the knowledge and belief of pet! . er(s) and that as personal represent . e(s) of the above
decedent petitioner(s) will well and truly administer the es according to law.
Register
No.
Estate of
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 20_, in consideration of the petition on the reverse
side hereof, satisfactory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such fmding, Letters of Administration
are hereby granted to
in the estate of
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation... . . . '" . . . . . . . .. '" . . $
Short Certificates ( )...... . . . . . . $
JCP.......................... ........ $
Automation Fee........... '" ..... $
Bond............................. .... $
Total $
Register of Wills
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Address C.. I" I'I/It. 1#
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Filed
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Phone
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Register of Wills of Cumberland County
RENUNCIATION
Estate of Daniel J. Whare No.
Also known as
, deceased.
To the Register of Wills of Cumberland County, Pennsylvania.
The undersigned, Michael J. Whare, son of the above decedent, hereby renounce(s)Jpe
right to administer the estate and respectfully request(s) that Letters of Administration
be issued to Amy Heller, daughter.
Witness my/our hand(s) this ~V- day of ..JI./ Iy
Michael J. Whare
36 Otto Avenue
Carlish, PAl 70 13
,2006.
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Affirmed and subscri ed before me this
;JlJ (."/'- day of "
2006
.L /LJ J:y-J J J~ ,'77 fl~~
Notary Public i'
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(Signature)
Not;-Ti~:': i::\,'oJ
UndaJ. JlllTif~' NO"",ry P;J~c
CaI1isIe 80m, ClInhel1arY..l C:oonty
My Cormliss!on E:qjros JIiy ~!3. 2006
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12726254
JUL 1 4 2006"
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Hl05143 Rev,Q1106
TYPElPRINTIN
PERMANENT
BLACK INK
1 Nameol Decedeflt (Firsl,middle, lasl)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
3 SocialSecurrtyNurrber
Daniel J. Whare
177 - 42
- 1047
13 , 2006
5 Age (Lasl blnhday)
April 13,
7, Dale of Birth Monlh,da ear
54
Olher
o ERlOul alient (J DQA Nursin Home
9 Was Decedellt01 Hispanlc': Origin?
~ No 0 Yes (Itye-S. specify Cuban.
Mexican, Puerto Rican,etc.l
v"
o Resideflce 0 Other.S eo
10 Race: American Ifldian, Black, Wh~e, elc
(SpeCify)
White
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8b Cour1yolDealh
Cumberland
Middlesex Twp.
laremont Nursing and Rehabilitati
Center
12 Was Decedenl ever in the US 13. Decedenl's Educalion S eci h' hest rade co leled
Armed Forces? Elementary/Secondary (0-12) Cotrege (1-4 or 5+)
o Yes IX No 12
Decedenl's
AcluaIAesidence17a.Stale__~
17C.:lCJ Yes, DecedenlLNed in ---Middlesex_______ Twp
11 Decedenl's Usual Occu alien Kind 01 work done durin masl at workin lile; do not stale retired
Kind 01 Work Kind of Businessllndustry
Bookkee r Private Club
:;: 16Cle~~~~~tdrNti~~'frign'~~dPcR~hab. Center
1000 Claremont Rd.,Carlisle,PA 17013
14 Marital Slalus: Married,Never married
VYKlowed, Divorced (Specify)
Divor d
15 Surviving Spouse (Uwite, give maiden name)
Did Decedenl
Liveina
Townsh,,?
17d.O
No, Decedenl Lived wilhin
AclualUmilsot
City/Boro
Cl.lmberland
17b Ccunty
18, Father's Name (First. middle,lasl)
19, Molher's Name (Flrsl, middle, maiden surname)
John E. Whare, Jr.
Jean M. Steinhauer
20a Inlormant's Narne(Typefpfinl)
20b.lnformant'sMailingAddress(Street,cityllown.slate,zipcode)
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Amy L. Heller
4 Hickory Tree Place, Dillsburg, Pa 17019
21c Place ot Disposition (Name of cemetery, crematory or other place)
21d, Location (Cityllown. state, lip code)
. Ilerns 24-26 must be compteled by person
wtlopror.auncesdealh
18, 2006 Yorktowne Cremation Service York Pa 174 4
220 N'"","dAdd,,,,,,,'F,,ility Hoffman-Roth Funeral Home
219 N. Hanover St., Carlisle, Pa 17013
23b. license NurrtJer 23c. ate Signed (Month,day, year)
f< N' 3'-1 3i5cL j 3 2('01.0
26. Was Case Rererred to a Medical Examine ICOfone
13 2 C)(;(p ,}\~ Q N,
: Approximale interval Par111: Enter other sianificant condrtions contributina 10 dealh. 28. Did Tobacco Use Conlribute to Death?
: onselto dealh butnotresu~inginlheunderlyingcausegiveninParT.1 0 Yes 0 Probably
o No 0 Unknown
Item 27. ParT I: ElVer the chain 01 evenls - diseases, in'/.,Jries, or complicalierl$ - that directly caused llle death. DO NOT enter termmat events such as cardiac arrest
respiralory arres!. or venlricular f1briltaliofl without showing Ihe eliology DO NOT abbreviate, Enter only one cause on a line
IMMEDlATECAUSE (Final disease or ~ ,,1IJ 1..-1 t c ,,~,rl,.iJ' /.,- (J Jl." ~~~I"t.." 1;"41
conddlor1resultlngmdealh) ~ ... __~~__ ,__~_~..k].,._____~'---.~____
_DUeIO(OraSaconsequenc~:..._"__.._ . II" ,
SeQuentially Iisl condillOns, if any . . _ . __ {,L-
leadmglo Ihe cause lis!edon line a Dueto (or as a consequence oij
- Enter Ihe UNDERL YtNG CAUSE
(disease or injury Ihat inillated the
events le5ultingin death) LAST
29 If Female
o Nolpre\lnantwlthiflpaslyear
o Pregnan1allimeotdeath
o NOlpregnanl.bu!pregnantwrthin42days
01 death
o No1pregnanl,bulpregnant 43 days lo 1 year
beloredeath
o Unknown if pregnant withinlhe past year
32c. Place of tnjury: Home, Farm, Street. Factory, Office
Building, etc. (S.oecii}j
Due to (or asa consequence oQ
308. Was an Aulopsy
Performed?
d
30b. Were Autopsy Findings
Availabte PriOf 10 Completion
of Cause 01 Death?
DYes 0 No
32g.l~!ion{Stleet.cilYllown,state) .0
}()'{l() C levv }fiC,",'" :I<,'J..
C~Vj /,L,'J e p If
/7{/I?
33d. Date Signed (Month. day year)
7 f I '-f~:?t::?
31 Manner of Dealh
R( Natural 0 Homicide
o Accident 0 Pendinglrwesligation
o Suicide 0 Cculd Not 8e Delerrruiied
32a.Dateoltnlury(Monlh,day,year)
32b, Describe how Injury Occurred.
DYes 2t.No
32d. Time ot tn;ury
321
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33.1 Certifler (check only one)
Certifying physician (PhYSICian certifying cause ot death when another physician has PfOOOUrced dea1h and compteled flem 23)
To the best of my koowledge, death occurred due to the cause(s) and manner as stated.... ..............a
Pronouncing and certifying physician (physician both pronouncingd ealh and certifying 10 Clluse oldealh)
To the best of my knowledge, death occurred allhe time, date, and ptace, and due to the cause(s} and manner as stated .......".._...... ........................................ ........0
Medicalexamlner/cofoner
On the basis of examination and/or investigation, In my opinion, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated _._.0
.>-.II,~ I \ I d I \ I () I
Ken Harm MD
1830 Good HOpEl Rd., Enola, Pa 17025
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