HomeMy WebLinkAbout09-20-06
Register of Wills of Cumberland County
Estate of Julie A. Laidacker
also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
A \ () lo - oX\ 1
No.
To:
, Deceased.
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsyl vania
Social Security No. 194 60 8904
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 was domiciled at death in Cumberland County, Pennsylvania, with h~ last family or principal
residence at 6408 Glenwood Street, Mechanicsburg, PA 17050
(list street, number and municipality)
Decedent, then 31 years of age, died August 5,
6508 Glenwood Street, Mechanicsburg, PA 17050
,2005
, at
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(lfnot domiciled in Pa.) Personal property in Pennsylvania
(lfnot domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
$
S
S
S
o
o
o
o
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name Relationship Residence ~
Jason L. Laidacker Husband 6408 Glenwood Street, Mechanic.sburg, PA 17@
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THEREFORE, petitioner(s) respectfully request(s) the grant ofletters of administration in the apprAAriate for~
to the undersigned. . -=: 0
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Residence(s) ofPetitioner(s)
6408 Glenwood Drive, Mechanicsburg, PA 17050
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
}
SS:
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 personal representative(s) of the above
decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or ~ffirm;;;)!1d. anq s bSCribed. {~ ~ d~ JI ~-'/
Before me t~ m 1 day of ~
~ ' . ,20 ol 0
~~~A
No. ~ l . ()lo- 6 ~tl
Estate of Julie A. Laidacker
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW /q ~I~ 20~, in consideration of the petition on the reverse
side hereof, satisfactory proofh ing been presented before me,
IT IS DECREED that Jason l. Laidiacker
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to Jason L. laidacker
in the estate of Julia A. laidacker
FEES
Probate, Letters, Etc. ............. $
Will ................................. $
Renunciation....... ................ $
Short Certificates (~ ............ $
JCP.................................. $
Automation Fee................... $
Bond................................. $
o \ Total $
Filed~l\q - 20o\.p
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Attorney (Sup. Ct. J.D. No.)
Schmidt Kramer PC
209 State Street, Harrisburg, PA
Address
17101
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10,00
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(717) 232-6300
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Phone
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This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. 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.
11774324
No.
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Fee for this certificate, $6.00
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DECEDENT'S USUAl OCCUPATION
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAl. RECORDS
CERTIFiCATE OF DEATH
(Coroner)
TVPE/PRINT
IN
PEfl.....NENt'
BLACK INK
1130-059
A
Laidacker
SEX
2. Female
STATE FM..E NUM8Ef'
SOCIAL SECURITY NUMlIER
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3 194 60
8904
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BIRTHPlACE (City and PlACE OF DEATH (Olec::k onty one - see InSl'UClions on other side)
Slale 01 ':01'1'9" COVllllV) HQSPtTAL:
Harrisburg, PA Inpal... 0
7. ...
FA,CllJTY N~Me (11 no( inshlullon. give .reel and nurnbef)
g::.YI 0
RACE- ""'-'lean noan. Black. While. M
(SpoOty1
...
10.
White
Cumberland
6408 Glenwood Street
Mechanicsburg, PA 17050
II.
Fo(J"HER'S NAME (1'.... MillclIo. lasl)
DECEDENT'S
ACTUAl
RESIDENCE
(s.. inlarUC1ion1
on '*'"' _I
t 7.. Slale
PA
MARITAl. ST..aUS. Mofflod
_ .......... w_.
~-(Spcr;)
14. Married Jason L. Laidacker
ITC.!li1....__in Hamoden Two.
SURVIVING SPOUSE
(at wile. c)Ye maiden name}
12.
17b. Cou
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Cumberland -...nip? ITd.o :::=:::.,
MOTHER'S NA.ME (f'WII. _. MaiOan Su'namoj
Barbara A Hollen
~.
Jack P Hall
Aug 12, 2005
LICENSE NUUBER
11.
INfOfUAANT'S """UNO ADDRESS (SIt.... CltyIlOwn. SIaIa. IIp Coclo)
6408 Glenwood Street Mechanicsbur , PA 17050
PLACE Of' DISPOSITION. ......., ~"'Y, C'.....,ory lOCATION . ClIyf'bwn, Suol.. Zip Coclo
0< 0Ih0< PIeco
21.. Rolling Green Memorial Park
NAME AND ADOIlESS Of' FACILITY
22.. Michael J. ShalDnis Funeral Home 206 Ma
UCENSE NUMBER
Camp Hill, PA 17011
Jason L. Laidacker
~a1 from Stale 0
Pulmonary Embolism
DUE TO (OR AS A CONSEOUENCE OF):
Dee Vein Thrombosis
OUE TO lOR AS A CONSEOUENCE OF}:
23l>. no.
Wt.S CASE REfERRED 10 :~ EXA.MINERICORONER? No 0
21.
IApptOXim... ''''1 U: ~Mc' stgnif'oClont cor6tions conl~v-.g \0 dMlh. bul
:inl..-v" betwNo noc ruuhiftg in fhe ~ cause gHen in PAAT I
; onMt and dMm
sville. PA 1705:
22b.
To lhe 01 my knowledge. dN1h occurred at lhe lime. dill. and place .ated
(SiQnalur. and Tide)
011825-L
230.
TIME Of' DEATH DATE PRONOUNCED DEAD (Monon. Day. 1'00'1
,., 2: 00 M 25. Augus t 5, 2005
27. PART I: Ent.... the diHuef" injut.., or complicalion. wf\K:h cauMd thrt dNth. Do noc ene., lhe mOOt of dying, such AI catOiac: or rupWatoty arrest, shock or hNtt fa_uti.
List 0fl\t1 OM cause an aach~'"
DuE 10 (OR AS A CONSEOUENCE OF}
d.
WERE AUTOPSY FINDINGS
-.v.lll.E PRIOR 10
COMPlETION Of' CAUSE
OF DEATH'
MANNER OF OEATH
DATE Of' INJURY
(M""on. Day. _I
TIME OF INJURY
INJURY AT WORK? DESCRIBE Hem "'1JURY OCCURRED
YN~
Accident
g
Homicide
2". 28b
CERTIFIER (Chock only one)
. CEATWYWG PHYSICIAN (PnySllCfan cerlil')lll'\Q cause of aealh when another phvsician has-1)f()(\(lYnced Oeall'l and. compk!JIed Ilem 23)
To the bMl or MY knowtedge. ...th QoCcwrH due 10 IbIt <<uH(s).nd rn8nnet' ..."'ed.
Suicide
2..
o
Cou6d not M- determined
o
D
O PLACE OF INJURY. AI nome. larm. SlrNt. taClory, oHa
""...."'lI. Ole (SQec:"Y)
_.
Yes 0 NoD
Natural
NoD
Panding In.,.sligation
Coroner
'"EDICAL EX.....,NERJCOROHER
On lhe~. of ex.wnHultlon and/or Investigation, In my opln'on. de.th OiCcutTe<l at 1M time, de'e, and place. Ind due 10 lhe c.uM(s) and
manner .. at.tad. .
:lh.
REG
DATE SIONED (M<lnt>. Day. _I
D 31.. 31d. August 8, 2005
.....ME AND AOOAfSS Of' PERSON WHO COMPlETED CAUSE Of'DEATH
(IIom27)Tvpeo<Prin' Michael L. Norris, Coronel:
6375 Basehore Road, Suite #1
p( 32. Mechanicsburg, Pa. 17050
'PAONOUNClNG AND CEftTIFYINO IttlVSICtAN (PhYSlCI~n oocn Dtonouncing death and Cer1ityfn910 cause 04 fJeelhl
To the bnl of mykno_l4dge. ...th occufTe'd .11....1....., dal., and pIKe. and due 10 the cauae(') and "',"'net ,. ,"Ied..
DATE FilED IMOI'OO1 .,...-,
34.
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