HomeMy WebLinkAbout09-18-06
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of L.INDA L, StlfhllJN
also known as
No. r.2J -{}L, - ~ &J
To:
Register of Wills for the
County of (! t/ mJJnetA.JJb in the
Commonwealth of Pennsylvania
Deceased.
Social Security No. ~/O - fIJ- :J.~~
The petition of the undersigned respectfully represents that:
.
Your petitionerO(, who is! ~ 18 years of age or older, appllQ.c
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Cum lM.,../.nd County, Pennsylvania, wlth
h ~ last family or principal residence at fIlSI' C4.rlisk Pi Ke..1 meeb..n,csI,u.r-Lil/lrtr SfJ"iltf7;p)
(list street, number and municipality), ~
AUf It sf 12 , ;(';~" ,
Decendent at death owned property with estimated values as folllows:
(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:
$ SOO,'o
$
$
$
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
,,~
5~
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of admirp~tration in rtJje
appropriate form to the undersigned.-~:> g
'~J, (/)
-Q C;]
~
'*
u
I::
U
:E'Ui'
"'~
U'"
~u
I::
",,0
c"':::
CU.p
~~
'<1....
:;0
ti:i
I::
OIl
Vi
\.0
"~ i.']
:E
::'-1
(.0
N
~
/71)S"()
i'4~
::~)
- ~,:5
!j i,3
".-.J
)',
- -7'1
: (.~
In
<:':,)
11
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF e. lAm 8FtU/MJJJ
} 58
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 decedent petitioner(s) will well and
truly administer the estate according to law.
y~);,.~'
M./e€ '1. S~'+I1I~
---
'"
'-"
Q)
...
='
.....
tV
i:l
bO
ri5
No. ~\ -04 - ~JJ
Estate of
~~ r!( , L O-~'("'- Jj
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW '- L ~ >- \'~ )9: ~\q in consideration of the petition on
the reverse side hereof, sat' factory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to ~u..... ~ &~-""--~
in the estate of ~ ~ t'J~ tJ. _ ~ . ~ a. 1'l'- 4.Jr-'
~
FEES
Letters of Administration ..... $c20 .00
Short Certificates(~) . . . . . . . . .. $ '8',~
Renunciation ................ $
"J~Po.....rl()~~$ 10 5~C>
TOTAL _ $ 43.00
Filed . .~.ll'?1. . .... .. .. . . .. A.D. l>9 ,.:1(JOlo
(lLt~~ f. ~.lP m;-
AITORNEY (Sup. Ct. I.D. No.) (.3t!:./.JJ
~ (!IPu5Lr lttllJleelJanlC-S/II1J(j fJA /7oSS-
ADDRESS
71 '/- 71P IR -I) ZtJf
PHONE
U'n:".~n:" ~r::v 'jn,:-
This is to certify that the information here given is correctly copied from an original certificate of death d~ly filed with me as
Local Registi"ar. The original certificate will be forwarded to the State Vital Records Office for permanent'filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
No.
~'''d<hLl ~~
Local eglstrar
p
12827726
Cf:::1~(d /~ AC'-o t;
Date
r-...)
=
=
CJ"
(/,)
r'1
v
-::l
.-::0
In
(-)
~(~
J
6"1
-'0
" (~=;
-n
;:"5
;-r-I
=>
, \
ill
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE FilE NUMBE1f
~:i
C,J
Illu51<lJRev 01:06
TYPE/PAIHT IN
PERMANENT
ILAe"1NK
1 Name 01 Oecedenl(Filsl. nQjle, Iasll
N
5 Age (la~ blrthda~1
51 y"
8b County 01 Death
7 OaleorBirth Month.da . ea,
40
';)00 (.;,
Linda
L.
Seaman
15
DE
Olho,
lien! 0 OOA 0 Nut Home 0 Residence 0 Qhe(.
9. r':c~:~s~~~utwl, 10 (~Mtaficanlndian.8Iack,While,.1c
M".... p,.,.. A<an, 8Ic I W hit e
14 Mallal SlaWS: Maflied, Nevef manied, 15. SUf'lIilling Spous. (If wife, give maden RamlI
w_,_(~
r
..
Cumberland
East Pennsboro
;
6586 Carlisle Pike
Mechanicsbur PA 17050
18 hitler's Name (hst, riidle. lasl)
II, S~I. . ___.P.A_
Oido.c_
....... 17e X' yl$,O'C_l.... _-5i LlLe.l"_. Sllr.in9-- T....
Town~?
17d. 0 No, Oeeedwlllivtd wihill
ActuallitWol__~_.,,~____~_~_.____ ._______C..,.,Bofo
17b. COU"~J:~!@~r l~ [I.A____
Emory
Seaman
19_ Malhe"s Name (Fir'st middle, meiden SUfAlme)
Barbara Deardorff
Alice Potteiger
2Ob. Inlolmanrs Mailing Address (Slreel:, c~nown, stall, zip code)
lOa Inlotmanl's Name (TYP6'ptlflll
Cl
W
U)
=>
U)
""
~
6586 Carlisle Pike Mechanicsburg PA 17050
21c. Place ~ Disposition (Nil"" 01 cemlllary. Cllmaloly or OCher place)
stown PA
HOME E MAIN ST~~echanicsbur
23b. lhn51 NuniMlr 23c. Date Signed (MonIh. day, rw)
.1
--g
C
-.(
CAUSE OF DEATH ISM lnatndonIand .........)
118m 27. Pall I EnllI Ihe ~ - diseases, injUries, 0' COfIl)Icalions -Ihal direell)' caused !he death DO NOT entef lerminal.veflls such as cardiac arrest,
'1$pirJ1ofy anltSl, OIvent,itulat tbnlalion without sho\IMg the eliology_ DO NOT abbrev1all. ENet only one cause on a line.
==~.t,.;'~'::~:::-~. At.~"~t." CIlU..ddSI,S__u__.__
D~Io(Ot-asacons.qumoij:~..--------------~-.-..--
26. Was Cue Re.....ed to I MedicaJ Exaninef/Cofoner1
DYes ....""
wolimaleimefval
onsetlodealh
Pall U: Enlerolhel sianificanl condilmsconlrilulina Iodlalt1,
bulnoIresulingi\theundtttyingcalJllgiYtninPartI
28 OidTobaccoUseConlribulelo0ealh1
~g=
29 ~~egnanlWltlinpastW'....
o Pfegnanlltltm80ldNltl
o Not pregnanl, buI Pl'egnanl wltWI 42 days
ol_
D Hal PI'.~nt. but pregnant 43 da)'s 10 1 ,ea,
betli.duah
o Unknown jI P'egnanl within 1M paS! yea,
32c PWeollnjury:tbnt.Farm.SbeelFlCtory,o.::.
_."'I~
SeqwtnUally list COIIdiIions, if an)',
)Uding 10 lhe Cluillis&ed on lifle a
. Er.lertleUMOfRlVIIGCAUSE
. (dlSeastOlinturtlhal~1ed1he
evlflts rlSUlillg in dealhj LAST
Due 10 (or IS. consequance of):
Due 10 (or as a consequence of)
30a Was an Adopsy
Perlonned?
o YII .-INo
.
n W.e Aulopsy Findings
Available PtiorloCortplebon
04 Cause 01 Oaalh?
DYes 0 No
31 MaMef oWealh
~ral OHon.::1de
o AccKlenl 0 Pending Invesliglllion
o SUICide 0 Goold No! Be Delem'lined
32a. Dale 01 inJUry (Month, day, yeal)
32b DascJibe how injury OccUfled'
<:::
sr.
~
"i
Vj
32d_ Time olin;ury
328_injufyaIWork?
DYes 0 No
J2C tl Tfan$pOf1allon Injl.ry (Sped'>>
o D,iv8l'~aaor 0 Passenge;
o Pedestlian 0 Ohet - SpeClfy.-
330. SqI8lure aAd Title 01 CefIifiet
?r-- ~
32g locali1n (Slfeet. ctyllown, slalt)
1-
15
Cl
w
'-'
UJ
Cl
u
o
UJ
:>
""
z
33a CIItlfieI(ctledlonl'fone)
Certifying phJsk:ia" (PhysICian Cef\llymll cause 01 dlldlll lIr'tlen another ph\,sician has pl'ooounced dealh aod COIfllIel8d hem 23)
To lhe bello' my knowtedge. death occ:wreddue-to lhe C.lUH(').Ind manne'.I1 llated .......,.................. ............._....... ..... ......... ........__._.......... ..... . ......... ...............0
~~o==;:,a= ::~::~~::,~~~ ::~=~~:~~e::,~:= ~~::.~: manner.lS sl.Ited. .....,...... ......... ................._,....... ........ ....r/
Mediule..mlner/(:olone,
On lbe bu" ol'lamINllon andla, InvestigaUon, In II1J opinion, death occlJrrecl al the lime, d.ite,.Ind place. and due to the UlJse($).Ind m.mner as suled ........0
'l'~'::;,~.O'~'~\~_ .J1. =-- ~ LL I~ IIQU Ja;:~T;;'~::~
M- (See instructions and examples on reverse)
M
33c llCenseNuntl8f
,!AO-()~tb 'c..
34 Name and Addfess'ol Person WOOCon-pleled Cause 01 Death (llem27) Type/Pnnl
WJJ.~ J~.s",J,)1~
33d Dale Signed (Monlh. da)'. year)
_._~-_._.. -----.-.-"..--. ... ..,". _..... ~- "._._*.~-*_._-,.,