HomeMy WebLinkAbout08-11-06
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of L{Acuvt I-h,(oe \"\ No. ~ \ - D \,0- (:::,'1 \"1
also known as To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
, DeC;f,()s,fd.
~;ocial Security No. L/q4 - 44 -/)'ic,}-...
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decedent wfs domicilyd at deatj1 in{Jt 11 6e~ Glr ~County, Pennsxlvania, ~ith hl..:L last family or principal
residence at ,tit?; 'J{) f {ev..( ;Uu.:) I 'le, t(~ c ; [, K! - ( Cv~ [,'~y /:/1.
(list street, number and municipality) I I
Decedent, then {~Lf years of age, died
( c<-l 't
,2- (
, 20 Ol.r , at ;0 . .'] c ,; ....,
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:
.J::' (/'(/'0, C. Q
$
$
$
$
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name
THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the appropriate form
to the undersigned. ' ,
c_-=)
Signature( s) of Petitioner( s)
'_.~4 . ---.,
/4/ A{)/'Ij(~fJ? 0rtlidve'1 /1/:/78/'0
Residence( s) of Petitioner( s)
"
r:.T'..
~_. ~,.
~/ -~ :/__-/''7 -A'. ("' , _~
'../
C'j
\.0
.
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 bel ief 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.
{
rJ) /V14ii! ;/L; j:(~
/
f/1
0;'
::l
0'
2'
...,
'"
'~
/
'. ,.Of1(JP
No.
~ \ -DIe - () I \ ~1
Estate of i- {' / C; /1 ,-I /-/';i '7,,' c ". ,e. , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW I \ \.=)I.-~":~'} 2((tc , in consideration of the petition on the reverse side
hereof, satisfactory proof having been pr ented before me, IT IS DECREED that the instrument(s), dated
, described therein be admitted to probate filed of record as the last will of
; and Letters are hereby granted to l '\ \ 'i (", W"' \ C..... k,y..
o
.f) Jt
' ,I
UUUA" lcz.c::tuU{ \
Register of Wills
'--
t~\l()rFJ lLe
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation....................... $
Short Certificates ~) ............ $
JCP.................................. $
Automation Fee................... $
Bond................................. $
Total~ $
Filed t\ r-\1J.~).....;t 200(J;
2:>\).00
Attorney (Sup. Ct. J.D. No.)
5.(6
r, ',r,
t:'), (.'...
i (). <::(:;
S~. l.:'()
Address
~-'6 ,( C
'1
. ,
Phone
.\
<...0
tLltlili ncrc !\'cn j", l..'i)'Ti.....l]\
,ill
::.11
il
",";t1i .~;tl' \\il; he r\\['\\.~lld\:'d
\<.,>,.;;d: ()II
,,',/ ARNING: It is illegal to duplicate this copy by photostat or photogr:,ph.
,
',..
.,.;:~\-~\~~,~'G,:"p/t/<
/'$~" ~.' ~~\
~ ~ -~""~, ~ 1'\
2, r-' ~. /':"",-, ".,.;.:::.r
~ '* ,<~'." /,fi,~ '.. ~~" ... ,:-',
""a.. ~ ,~.
,"- "...0 ," ';/
"c 4,9, . . ",'-'r-v,'
'~--<:;~ F;~',J'\ ~~,..'
LL~.~~~~~
,-'n I ~(i Nt
p
12726417
~JUL_ 2 4 (T)OQ,
t,.L)
Hl05,143RevO!1OO
TYPElPRINT IN
PERMANENT
BLACK INK
1 Name c(!Jecedenl (Firsl. mlddle,lasl)
';A\, Dlo'OI\l
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH STATE FILE NUMBER
I
41
!
i
October
Missouri
o Residence 0 Olher-S ci
10, Race: American Indian. Black. While elc
/SpeciM '
White
7, DateolBirth Monlh,da , ear
8, Birth lace C
Cumberland
S.Middleton Twp.
Care Health Services
12 WOlsDecedenteverintheUS
Armed Forces?
o Yes IX No
Decedenl's
Actual Residence 17e Slale
13, Decedenl's Education S eci on hi hest rOldeco leled
Elemenlary/Secondary (0.12) College (1-4 or 5+)
11
14 Marrtal Slatus: Married, Neller married, 15. Surviving Spouse (If wife, give maiden name)
Widowed, Divorced (SpeCify)
divorced
PA
Did Decedent
Uveina
iownsh~?
17C,XX Yes,Dt!1Cede~IL!\Iedin~SnlJth IVIjorllet'O'1 Twp
940 Walnut Bottom
PA 170 3
17b. County
-Cumberland
17d 0 No. Decedent Lived w~hin
Acluallimltsol
Citytfura
18 FaJner's Name (First, middle, last)
Wallace Hanock
19, Mother's Name (First middle, maiden surname)
Virginia Huffaker
2Oa.lnlornanl'sName(Type/print)
2Gb, Inlormant's Mailing Address (Streel, cityl1cwn. slate, zip code)
Virginia Fox
i
5J
'"
=>
'"
""
::J
""I
14 North Crest Dr., York Haven, PA 17370
21c, Place 01 Disposition (Name 01 cemetery, crematory or olher place)
21(1, Location (Cityl1own, slate, zip code)
Pa 17404
Home
PA 17013
. l!ems24.<'6m!JS!becomp~tedbypersvn
_ whopronc'urocesdeath -
24 Time of DeBlh
.J.U6(.
~em 27. Fart I: Enter the chain of evenls - diseases, injuries, or complications -lhat directly caused the death, DO NOT enter [erminal events such as cardiac arrest,
respiratorl arres!, or venlrK:ular fibriltation withoul Showing (he etiology, DO NOT abbreviate, Enter onfy one cause on a "ne
lMMED1AfE CAUSE (Final disease or ~ b ~ ~
conddion resu~ing in death) ----;:.. a
0"" I"" '''"''Qu'"",n. f" .
Yes 0 No
/l{lproximale inlerval Part II, Enler a/her s((Jflilicanl conditions conlrmutina 10 death, 2a, D~cco Use Conlribule 10 Dealh?
onset 10 death butnotresu~inginlheundertyingcauseglVeninPar11. ~Yes 0 Probably
o No 0 Unknown
..
d
30tL Were Aulopsy Findings
Available Prior to Complehon
01 Cause of Death?
DYes 0 No
31. MaflnerolDealn
g( Nalural 0 Homicide
(0 Acciden! 0 Pending Investigalion
o Suk:ide 0 Could Nol Be Determined
328, Date 01 Injury (Monlh, day. year)
32b. DeSCfibe how InJury Occurreo:
29 If Fernale:
o NOlpregnantwdhinpaslyear
o Pregnantat1imeoldeath
o NOlpregnant,bulpregnantwithirl42days
o(dealh
o Not pregnanl,bul pregnant 43 days to 1 year
before death
o Unknown rtpragnanlwrlhin Ihe past year
32c PlaCE! ollnlury: Home, Farm, StTeet Factory, Office
Building, elc,{Specifyj
Sequenli<11y lislcondrtions, if any,
leading to lhecause listed on Line a
- Enter the UNDEJ:lL YING CAUSE
(diseaseminjurylhal inniated the
events re;u~ing in death) LAST
Dueto (or as acoflsequence oQ
Due 10 (or as a cOhseQuence oQ
o Yes! No
32d, Time of lnlury
0,
30a, Wa~; an Autopsy
Per1ormed?
321
32g, Locallon (Stre6tcityl1own,$lale!
M.
r-
15
5J
~
o
u.
o
w
'"
""
z
33a Celtifier (check only one)
CertIfying physician (Physician certifying cause of dealh when anolher physician has plOnounced death and completed l1em 23)
To the best 0' my knowled~, death occurred due to lne cause(s) and manner as slaled...... ...............1
Prooouncing and certifying physlclan (Physician bolh pronouncing dealh and certifying to cause oIdeetn)
To the best of my knOWledge, death occurred atlhe time, dale, and place, and due 10 the cause(s) anQ manner as stated........ .... ..... ................0
Medicalexamir,er/coroner
On the basis of examination and/or investigation, In my opinion, death occurred at the time, dale, and place. and due \0 the c<luse(s} and manner as staled.. .....0
35 Dale Filed (Monlh. day. year)
~ 1'~III6-I\ I(il
l '~O \ 0 (:t\y-L 33dO:fr~t(drO''(;
34 Name and Address of Person Who Completed Cause 1)1 Dealh (1lem 27) Type~rlnl
Darryl Guistwite, DO
522 S. Pitt St., Carlisle, Pa 17013
- 010.0
Register of Wills of Cumberland County
RENUNCIATION
I .- \ ' 'II 1) '\ k
Estate of ,_i<:: lOJi( nOS Ie e,c " ~
Also known as
No. d-, \. ()[, \:,'ll:l
, deceased
To the Register of Wills of Cumberland County, Pennsylvania
The undersigned /-: Q L \ Q. ( \ ell..:
(Name) (Relationship, \ (Capacity)
of the above decedent, hereby renounce(s) the right to administer the i:!ltate and respectfully request(s) that
Letters
. f, '
be issued to \l \ -::' G . \ " ,<2.-
,,\
~C;:X
Witness my/our hand(s) this ~...,.h day of
Affirmed and subscribed before me this
6th day of CL', {if (,..c.c+
,Xl'(;; :J
,-.Ji (A.{: ~~<-D'\Y;Jc",.}t(c~
Notary P OMMm~WEALTrl OF PENNSYLVANIA
Natalia! Seal
issiOif~"ppensteel. Notary Public
New Cumberland 8.9'0,. Cumbel1and County
Cl'j {f ISSIO~ t:x;ilres Aug. 14.2007
Member. Pennsvlvania Association Of Notaries
(- (Signature) CPe.CiS L( i
31~O 'SrE:.lNG e.Of=lO - l(Jl "1A - pn \ IOl3
(Address)
vJ;~9(A :f~
../
.' '\ {/"'1
/L/ (Xy.H: (~r(J/\ 'J?)
(Address)
/")
:l\T(
(Signature)
Or
'11
''y/,:' li1. I.L~I., ,r I ~'l'
,\...... \ (\U.V'<-
/i')7C
Affirmed and subscribed before me this
_ day of
(Signature)
Register of Wills
(Address)
Deputy
(Signature and seal of Notary or other official
qualified to administer oaths. Show date of
expiration of Notary's commission)
\.D