HomeMy WebLinkAbout09-27-06
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Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of. It!.,.. r- V G, ]) \J hilL No. ~ \ D to 0 ~
a/so known as I I To:
, Deceased.
S '/ S 'ty AT I tlS 0' .;-:J a ~ " it;
OCla ecurz JVo..' { - L r"" (L
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner( s), who is/are 18 years of age or older, appl ie...5 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 inC~Alri~unty, Pennsylvania, with h.1s last family or principal
residence at -g,;(, if '- J j 8 '" /l)) R IJq ]) -1J 3 t) Jell 111/ )./ /l.l.-, J? /f , 70//
(list street, number and municipality) , . .
years of age, died /I
kGY
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: I)
So, tJ~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
D.
TIIEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate form
to the undersigned.
Residence( s) of Petitioner( s)
::P" u is / /TF ~d 'OJ UNv ldJ8V~nJ
n c. 18n088JNHdl:fO
.:10 >18310
+t I :~ Wd L Z riiS 900l
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'-,'('1 JnJ J VI "]~y:! Jr.;:,,::
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.
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COUNTY OF CUMBERLAND
COMM:ONWEALTH OF PENNSYLVANIA
SS:
The petitioner(s) above-named swear(s) or affinn(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 petitionel{s) will well and truly administer the esiate accor~ ~
Sworn to or a:fIrmed ~ subscribed {X ~
Befo~me this ~ I f'1-. day of
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No. a \ D \0 o~"l.f
Estate of \\o...'f'ft..\ b. \>....'d., e... Deceased
, ,
GRANT OF LETTERS OF ADMINISTRATION
AND NOW d. ,.s.,~~.\ 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 A9mjn.istration, and in accord with suc!1 fmding, Letters of Administration
are hereby granted to ~o...\.y-\ u ~ t::>~'d.~ ~ ,Cu..;, \
in the estate of
\\o....~ ('I. \. G. ~I..\ ~ \ e...
\ \
FEES
Probate, Letters, Etc. .............
Will............................. ....
$
$
$
$
$
$
$
$
200lD
Renunciation...................... .
Short CertifIcates OJ ............
JCP................................ ..
Automation Fee...................
Bond. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ....
Total
Filed '1~,
~~.~
Register of Wills ~
qc.(j)
Attorney (Sup. Ct. J.D. No.)
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5.00
Address
\\'O.{)O
Phone
: II)~S()~ REV I/()~
This is to certify that the information here given is correctly copied fro~ an original cer~ificate of death dul~. filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records OffIce for permanent flhng.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
/J ~ t/i/
~ %.A<U1"~
Local Registrar
Fee for this certificate, $6.00
p
12627931
SEP 0 1 2006
Date
5. Age (Us! 8i1hd8y)
.d ,
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STAlE FILE NUMBER,)>
4. Dal8 01 DeoIh (Monll. dll)'. yeorj
August 29, 2006
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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88
VIS.
May 4, 1918 Harrisburg, PA
Bel. FecIIly N_ (II not InsIluIion, ~ IIinIoIIIld runberj
81>. CoIIlly 01 DeaI1
Cumberland Camp Hill
11 DeoodentslJtu8l rnoo101 Ie. Donot_lllIIred.
Ki1d 01 Work Ki1d 0I1UIness 1 Industry
Administrative State Government
16. Ooc:edonh ~ AddnIu IShol. cty I """', _, zip code)
1700 Market Street
Camp Hill, PA 17011
18. FaIIlOI's N_ (Fhl. rnWe.Ia&l.!IUIIIx)
Harr G. D bUe
20a l1bmanI's Name [fype I PrInt)
Patricia D. Arcuri
210. MelhadolllilpoolliJn Doru*ln
. D BurI8I D RsnlCMIIlmm Stale
Olhor . SpocIy. en \1:). /\P ~ fI r
228. SIgna\Ire 01 F (or
~ 0
Coo1lI8le Ilsms Zl&<: c:ertifyiIlg
phyIidlrl is not MilII:IIe a11me 01 deaIl tl
corIIy ClIJlIlI 01_.
Ilsmo 24-28lT111l be ~ by """""
who pranoooc:es deaIh.
Manor
12 W.llotedent_ln...
U.S. AImed Forces?
IiIv.. DNo
Deoedont's
Actu8I RllIIdonce 17.. Stale
Care
13. DecedanI'I EducaIon (SpacIy any I'lPsl grada ~
EilInenUwy 1 SecIlI1dlIy (0-12) CoIogo (1-4 or 5+)
12 4
Pennsylvania
Cumberland
170. D v.., llocodonl Uwld In
17d[iJ ~~oIUwld"""
Twp.
17b. County
Camp Hill
Crtyllbo.
19. MaIlefs Name (Fisl,lliddIe, m8den.-nel
Jean M. Mullen
D. InIcnnanI's MIllIng AddnIu (Sboet. city llown, sIalo. zip code)
950 Gleneagles Drive, York,
210. PIoco 01 D1spooiticn (Namo 01 """"""'Y. aomaIcry or _ ploce)
Rolling Green Memorial Park
PA 17404
21d. l.oaltion ICily IIown, lIt8Ie. Dp code)
Lower Allen Twp., PA 17011
22c. Name IIld AdlmB 01 FdIy
Parthemore FH & CS, Inc.. P.O. Box 431, New Cumberland. PA 17070
23b. Lk:sn8a Numbar 230. 0aIll SIgnad (Month, dAy. \Ml
~1o.
28. Was c..e Refen\ld to Medc8I Ell8IIWler / Comner~ I Reason 0IIIt 1hal 0emIIicn or DonaIion?
D v.. IX! No
35.
~
lOti II ~ /i /1
32g. l.oaltionrilnjlly(~ciyl"""',_)
~ 11IIrvII: Plrtll: Enlerol1er """"1DllIIlmo__ kl_
0nlIIl to 0saI1 but nclresulling iI the lIlderlying ..... giYon In PIrt I.
=lstcondllons,hnV,
tl_lioIsdcn...a
EnlIr IlNDERl. YIlG CAUSE
(__or ~ IhlII iiiaIsd the
......lsl8SlJtingrldOlllh)LAST.
b.
Due m (or.. . _uonco 01):
Due to (or . . oonuquence 01'):
d.
300. Woo.. Al*lpsy
Perlannod?
o v.. yr;,
301>. w.... Al*lpsyFi1dlngo
A...... PrIer 10 CcmpIalIon
01 Cause 01 Daoth?
OvOl~
31. Manner ri DesIh
~ D HIxnk:iJs
o Aa:Idenl 0 PendIng IrMlsIIgsb 32ll. Tins of IriLrY
D - 0 CcuId Not be ll8Iarmi1ed
M.
o Pedestti..
33a. ~I_onlyono)
. CIItIIyIng phyoIclon (Physicir1 cortifyIng ClIUSI ri doaIh ....., II1OIlor p/1ylic:ilI1 has pIllIlCllI1COd de8Ih In! ~ Item 23) ti-
To tho bootal my knowtodgo,dooIII occu....t....lotho ....-(.)ond monlll'lIlIloIo5I_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _..D
. ~=:~O:=:'~n~~=:==:F~monnnllatl<L_________________..D
. ::: =- ~c;, ond 1 or InvootIgolIon, In my opinion, dooth occu....t II tho limo. dolo, ond pllCl, ond duo 10 111. co-CO) ond _.. otoItt _ ..D
2.co.&.