HomeMy WebLinkAbout09-01-06
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THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in theF;JPriate f~
to the undersigned. <.n
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Residence(s) of Petitioner(s)
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Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estateof~IAM A. &AV!5-1JAS No.;) t.- 0 tp,. 0 71Cf'
also known as To:
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
Social Security No. 1"1<l ~Def~~9
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.
as QO~' ed at d th in W(()C,fJe. tf;1Jb p.
residence at ' r;
(list street, number and municipality)
Deceden~ then:t- :1R.ears of ag~ed JJ ~ ~ \ 'tb .20 O~
{~~f/\O U~'S iAJtSt Ru
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' P
s' a 11 ws'
Petitioner_ after a proper search ha_ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name
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Register of Wills of Cumberland County
OAm OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
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COUNTY OF CUMBERLAND
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 per at representative(s) of the above
decedent petitioner(s) will well and truly administer the estate acco 0 I
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Sworn to or affirme~d.subSCribed
Before me this €.~ day of
CLQ(fJ J;r ,20rN
tM..i/li1 tL. J0 (JUL ~~<S ~t
f%^ c \rvu.~ ~er i
t') 1-" . -1\)79
No. CJ- u 10 V f
EstateorWIWAfYJ. GA..V~sed
GRANT OF LETTERS OF ADMINISTRATION
AND NOW ..Je1.4 f 2rJ/b, in consideration of the petition on the reverse
side hereof, satisfactory proof having ~en presented before me,
IT IS DECREED that /11a 6 /I vepoJ
is/are entitled to Letters of inistration, and in accord with such finding, Letters of Administration
are hereby granted to tl'} j...r.5t.. If (;-,;; ~.r c-- 1
in the estate of tlt/'i/ ,'Il..6< II ~~/.- c-J
FEES
Probate, Letters, Etc. ............. $
Will ............................ ..... $
Renunciation... .,. . . . . . . . .. . . . . . . . . $
Short Certificates (5) ............ $
JCP........:t. fl.!':~.............. $
Autullldl)m~ Fee.. .. .. e .c .r.-!.l?.. . $
Bond................................. $
Total $
Filed-11 ( I () ~ - 20_
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Register of Wills P f?7j C ,,~ ~
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Attorney (Sup. Ct. I.D. No.) gj:gp. ra
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Hl05.905 REV. (0 1/04)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records ill accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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No.
Charles Hardester
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
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3787184
t1AY 24 2006
Date
H105.143 Rev. 2/87
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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Cumberland
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'TYl'ElPRINl'
IN
PERMANENT
BLACK INK
STATE FILE NUMBER
5. 78 y"..
COUNTY OF DEATH
SEX
2. Male
BIRTHPLACE (City and C TH
Slate or Foreign Counlry) HOSPITAL,
7. Kingston. PA ::- 0 ERKlu_, 0
FACILITY NAME (~not institution. give street end number)
NAME OF DECEDENT (Firs~ Middle. Lesl)
1.
AGE (Lest Birthdey)
lb.
DECEDENl'S USU"l OCCUPATION
(C:-~~~=:r
- 11.. Telephone worker 11b. Bell Atlantic
DECEDENl'S MAILING ADDRESS (Slreel. CitylTown. Stale. Zip Cocle)
k. Middlesex Twp.
White
17b. Countv
DId
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Cumberland ::..~? 17d.D ~'::;:of
MOTHER'S NAME (Firs!, Middle. Maiden Surname)
1'.
MARITAL STATUS - Married.
Never 104_, Widowed.
DiYorced (Spec:ily)
14. Widowed
He. ~Yes. decedent lived in
SURVIVING SPOUSE
(If wifI;, give m..n narTl8)
AS DECEDENT EVER IN
U.S. ~Jl FORCES?
Yes~ NoD
12.
17.. Slate P A
twp.
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cltylboro.
William A. Gavenas
Mary L. Gavenas
NY 10019
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Sequen!ialy list conditions b
· eny.leoding to immediate ! c.'
couse. Enter UNDERLYING
C"USE (Disease Of injury
. lhat initiated events
resulting 011 death ) LAST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AV....LABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DUE TO (OR AS A CONSEQUENCE OF):
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A<:cident
MANNER OF DEAJI
Neturel [9'
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DATE OF INJURY
(Month. O.y, Yur)
TIME OF INJURY
INJURY I'.T WORK? DESCRIBE HOW INJURY OCCURRED.
Yes 0 No
Yes 0
No C1:'
Suicide
Homicide
Pending Investigelion
CotJld nol be determined
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PLACE OF INJURY - Al home, 'enn. street, Ioctory. oIIice
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3Oe.
280. 21b.
CERTIFIER (CIled< only one)
'~~~~fJ~~~~~.:'::=~~~(~er.f'=:,h:~~~.~~~~.~~.~~~.~~?~.~................. 0
29.
'PRONOUNCING -'HO CERllFYJNG PHYSICIAN (PhyS;aan both pronouncing deeth end cet1iIying to cause of death)
To the be.t of my knowtode-. d_ occurred ot tho tl..... doto. end pl.... end duo tolho cous..(o) end _nnor.. .toted......................
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. Register of Wills of Cumberland County
BOND AND SURETY FOR PERSONAL REPRESENT A TIVE
Estate of WiLLIAM A. GA~Eld1lS
No. 5431150
Also known as
William A Gavenas
, Deceased
KNOW ALL BY THESE PRESENTS, that Mary Lisa Gavena$\s principal(s) and
National Grange Mut:l.lal as surety (sureties) are held and firmly bound unto
the Commonwealth of Pennsylvania in the sum of Fourteen thousand dollars
($14,000 ) to be paid to the Commonwealth, for which payment we do bind ourselves, jointly and severally, our
heirs, executors, administrators and successors, the condition of this obligation being that if
Mary Lisa Gavenas
fiduciary capacity) Adminis trator
William A Gavenas
as (state
of the estate of
, deceased, or any of them, shall well and truly administer the estate
according to law, then this obligation shall be void as to the personal representative or representatives who shall so
administer the estate and his or their surety or sureties; but otherwise it shall remain in full force.
31st
August
, each intending to
Signed and sealed this
be legally bound hereby.
day of
National Grange Hutual Ins Co
_ (Seal)
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Attomey-iri-~t
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Signature of Personal Representative
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~NGM INSURANCE COMPA:N'Y
A __ alllle M8In SINlIl Anwica Group . ,
,~OWiR OF AT+dAAB~'
....96~.Q:d3t..2.5.2
KNOW ALL MEN BYJl.teSEP~;e~~f4iTS: T~tNq~Ihs*anoe\S6ffiPany, a Florida corporation having itspnncipal
office in the City of Jacksonville, state of Florida, pursuant 'to ArtiCle IV, Section 2 of the By-Laws of said Company, to
wit: "'.> .....,....,..... ...... ............" ....'.....,.'........
"Article IV, Se~tioh 2. n1ebo~fc:t()fi~irectofs, the president, any vice president, secretary, or the
treasurer shall have the power andauthority.J9app~ip.t.a.ttQrpeys-ih-factand to authorize them to exe,cute
.on behalf of the company and affix the s~ali6ftbecompanythereto, bonds, recognizances, contracts of
indemnity or writings obligatory in the natute of aoon(l, recognizance or conditional undertaking and to
remove any such attomeys-~7tactiafanytitn~:aPdrevok~*e p(jwer andiau~ority8i,yentotbe~.1'"..,'
does hereby make, constitute andappoint.~tbY$ ~iQ'k~y Robillt 8uflll1iselSliune Sm.ll" .... ."
..". ......... '.. .. "....'........,.'.' '., ........'.,.'...' ......'.. ".....,.... .'," . .......,
its true and lawful AttomeyS-in:.fact,toriiake, execute, seal and deliver for and on its behalf, and as its act and deed,',
bonds, undertakings, recognizances, contracts of indemnity, or other writings obligatory in nature of a bond .subject to the
following limitation: '. ( '.. .......,......... ..'.,...,......: ...........'... ........
1. No one bond to exceed Five Hundred ThOUs'Il(I:D~llal'S($~OQ,OOO.OO)., '
and to bind NGM Insurance Companyth~~,~b~ast\dly ~Jld to th~sam1ex~~n~~s ~fsPQh instl11Jllentswer~$ignedJ:>y the
duly authorized officers of the NGM Insutta~ce C~rnpavY; the act$.of said:Attijrn~yare herebY'ratit1edan(lc:onf~ed.
This power of attorney is signed.ari.tts~~tt~ by facSiI11ile~nd~ra;dhYtpe authority of the following tesolntion adopted
by the Directors of NOM Insurance Company at arri~etihgdulyeaUed and held on the 2nd day of December 1977.
'. .' ,:""", .'"',""""'..'
.. .. '." ..,'
Voted:Thatthe~ignature oi~y (jff1cyI" ~~thoriz~d by the By-Laws and the company seaL may be affixed by
facsimile to any power of attorney or special power of attorney or certification of either given for the exeGution of
any. bond, undertaking, recognizance orothe~wr~t~en9bUg~~pn~tl"the nature thereof;.. such signature and seal, when
so u&ed being hereby adopted by the companYI'.s t~e ~tig~al,$ignature of such office and the original seal of the
company, to be valid and bin~ing upon the compantwiththesaI11e for~.andeffe~t ~s thoughma~uaU~aff1Xed.
IN WITNESS WHEREOF, NGMilnsura.11c~,~omB~~~:'bas cause~,th~$epre$e~~st(Jb~ sigfi~abyjtsC()rPorateSt?cretary
and its corporate seal to be hereto affixed tlHs, , Ist'dayoflMarch, 2006. .,.. '. ..... .. .,....' .. . ......... ......... ... ........ ....... .... ...., \ '.
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NoM INiS~RANcE COMPANY By:
//i..9U....,......................i............~..'....'...................'/$...........'..:..'...............................
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State of Florida,
County of Duval.
On this March 1, 2006 before the sub~qdber~.N9taryP~blicof Statt:.of.Flotidain:~tldX6t~e COUllo/.of Dtiv~ldulycoWmissioned
and qualified, came William C. McKen~lit6ffA~.1iPM:JrtStl(~ce Compa1.1Y' to m~pe~~o~allYknown tQ'.Qe the.officer~esf9b~ h~rein,
and who executed the preceding instrutuent,aridhe ackno\Vledged the execution of same; and being by me fully sworn, deposed and
said that he is an offiCer of sajd Gotp.,a~y,a~oresaid;ithat the seal flffi~e,d.t~ the preceding instrument is the corporate seal of said
Company, and the said. corporate seal and his signa~r~as:<,ffilZer",ere4#lY affixed and subscribed to the said instrument by the
authority and direction of the said Company; that Article 1",Section 2 ofthe By-Laws of said Company is now in force.
IN WITNESSWHEREOt:, I have hereuntosetmYll~d ~nd affixed my official seal at Jacksonville, Florida this 1st day of March,
2006. LlI.L// . A f) CD'''.. A. H.......
~ liI." . . . Commi$8ion.' 0D484125
..............i .. ','.. ~..~~1~""
I, Brian J Beggs, '{iee Presidentofthe~GM Insurance.Cot'fipany,do hereby ceI1ify thatthe.above and foregoing is a true and correct
copy of a Power of Attorney executed1jy~~idCottlp~ny W'p:i~~is still in fitJI f9fceangeffect> ....... .......... .. .'. ...... .. .... ..................
IN WITNESS WHEReOF, I have her~Mnto$~~ ItlY ~and:~q.~laffixed ~~sea1.ofsaidpoJtip~y at Jacksoflvill~, F~Oliida t~is
31st day of August , 2006. .. .i.~
William C. McKenna
Corporate....Sec.ret:ary