HomeMy WebLinkAbout09-29-06
.
Register of Wills of Cumberland County
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of4'{) 6: ~ ~ . M" M IV IJ C Ie No. ~ \ alo 0 ~,
also known as To:
. Deceased.
Social Security No. /., 1.1 - 7 ,- 2. 4 ~ ~
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Yourpetitioner(s), who is/are 18 years ofage or older, appll c.... ( for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent. /. ~
" f'....,
Decedent was domiciled at death ~ C - ~ C County, Pennsylvania, with hi!last family or principal
residence at I c) (I S ~ V t r ~ ~ ". / .l tiC Co .. ", If. 1(. /I. / 1 ' I r
(list street, number an~ municipality) ,
Decedent, then 2.. r years of age, died 7 e ~. I 7 . 20 ~ r . at C:"" I/- J I,. ,,~
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/ ~1Co' '"
$ --
$ --
$ -
-
Petitioner_ after a proper search ha~ ascertained that decedent left no will and was survived by the
following spouse (if any) and heirs:
Name Residence
l*.. (/11' r __ N"'" II~
~.J';v M c._....... ~ ~ e:.-
Me,...." ... ~ "
THEREFORE, petitioner( s) respectfully request( s) the grant of letters of administration in the appropriate form
to the undersigned.
Signature( s) of Petitioner( s)
~~()j-hf /lALLnuL
IJ t' ~ rf1c,.- I"'" L .,;1,' ~/(
Residence( s) of Petitioner( s)
).,4 ja B ~/'<~/
~CF..,~( /_
C'r
/7/D j
RECORDED OFFICE OF
REGISTER OF WILLS
2006 SEPT 29 AM 11 :44
CLERK OF
ORPHAN'S COURT
CUMBERLAND CO., PA
.
Register of Wills of Cumberland County
OATH OF PERSONAL REPRESENTATIVE
COM:MONWEALTH 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 belief ofpetitioner(s) and that as personal representative(s) of the above
decedent petitioner( s) will well and truly administer the estate according to law.
.~ t/;aLhrL ntflnltL
Sworn to or affirmed and subscribed
Before ~ thf..t~ '1 day of
~RfW-- .20 ~L()
\~'!m1W-~
Register .
Estate of
{
tn
I"
o
~
......
No. d \ blo cao{
. Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW .. ~ q . h~1Y" ~ 20& in consideration of the petition on the reverse
side hereof, satisfactory proof having be!\\esented b~,
IT IS DECREED that mi("\ ~ OV'--
is/are entitled to Letters of A .. tratio and in accord with such fmding, Letters of Administration
are hereby granted to ~
'Afio ~ ~ "~L
in the estate of
FEES
Probate, Letters, Etc. ............. $
Will................................. $
Renunciation....................... $
Short Certificates (5) ............ $
JCP. . . . . .. . .. . .. . . . . .. . . .. .. . . . '" . " $
Automation Fee................... $
Bond. . .. ....... .. ... . ................ $
Total $
Filed G\aq - 200(P
~.oO
dO.CC
lb .00
5.00
loes.oO
~~~
orney (Sup. Ct. I.D. No.) '", 1 / 7 F
f <) } .) C, L~ II C/'i ~... /,L-
Address;tllt/I"" tl-(/' /.. f? / I .2-
7 (/ - '7 / - (~ '
Phone
HI05.905 REV. (OIf04)
This is to certifY that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
1
WARNING: It Is Illegal to duplicate this copy by photostat or photograph.
~ ctJ. )/aJ,A
No.
Charles Hardester
State Registrar
CalvinB. Johnson, M.D., M.P.H.
Secretary of Health
3486336
MAY 26 200S
";06T rt-l ~L-
..
~ #29-421
ACK INK _ Of' DeCEDENT (F", Middle, LaoI)
Adam
&thdoy)
~\()loQ~\
COIIIIONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL MCORDS
CERTIFICATE OF DEATH
(Coroner)
T"\_._
RECORDED OFFICE OF
REGISTER OF WILLS
2006 SEPT 29 AM 11 :44
CLERK OF
ORPHAN'S COURT
CUMBERLAND CO., PA
Of'DEAI'H
Wormleysburg
IlIII'TIPLACE (C1Iy ond
Adesra~Counlry)
7. Australia
~-(Ifnolinolitution, giYe_ondnumbot)
1005 Yverdon Road
fnIIIEl'ILE ..-..
SOCIAl8ECUI'ITY ~
I. 194 - 76 - 2464
Pt..ACE OF DEAI'H (ChGokonly... __on --l
HOSPI1l\L: OTHER:
....0 ~1onI0 ~O ~O
/;)7!-tJ
ORE DEAI'H~,Coy.~
~ January 17. 2005
~
~
B
SEX
I. Male
UNDER 1
HourI _
~O
IGNDOF
Blain
AE1IIDENCE
(See-
on__l
171t.
C\mi)erland
.....--
1 ___
MOTHER'a_IFnI, _. _Sunwne)
. Janet Howe
ItFORMANT'~LNi~~-:,"crpt'
OF . -c1Cen.-l\
or 0IIIer_
1 ~orktowne crematory
NAME AND AIlDfE880F
.....,
!
219 N.
CASE
:JrEXAMlHE NoD
MM.: OIIIerolgnlllcont_......-...._1IuI
noI-*1ngInIlle~_""'In_1.
)
2005
Inhalation of Pro ane Gas
DUE ro (OR M A CONSEQUENCE OF):
~
,--
1-- Met dMIh
I
DUE ro(OR M A CONSEQUENCE OF):
DUE ro (OR M A CONSEOUENCE OF):
-~
OII"_al'__"'~'''*Y............__..........._._._plKe.__to''''-..c.,_
--_..................................................................................................
31..
ORE OF INJURY
(Month, Coy, ~
o _ 0 Jan. 17.2005
o PendIng~ 0 11:00P
'rill 0 Pt..ACEOFINJURY'Al_,farrn._~_
_ _. :t"* "" CouIdnat"'~ ~1IC.(Specily) Home
~~.:=..(PhyIicionoortilying-~--.........phyliQen'-~_ond~_23) S1BNRURE
......-"'..,--....---.....--caI-___..................................................... 0 1 C~oner
LICEN ORE IlIONED (Month, Day. ~
o 1 A ril 15 2005
-AND_OF~WHOCOMPl.ETE)CAU8EOFDEAI'H
(ltem27)TyplOI'PrtnlMichael L. Norris. Coroner
~ 6375 Basehore Road, 'Suite #1
~u. Mechanicsburg, Pa. 17050
ORE FILED (M"",~. tI'h
M. ArJ{ 2 8 20n~
d
WEflEAUroPSY FINOIN08
~PIlIllRro
~OFCAU8E
OF DERH'/
M
OF DEAI'H
TIME OF INJURY ,
Aprx.
INJURY /fir MR<'I
...0
NoD
-
--
... 0 No~
DE8CRIllE HOW INJURY OCCURRED,
Intentional inhalation
of propane gas
Hill.
PA
'.-Rcnc UIICln;ANDCEIl1'IfY.o_(Ph~ bolh~_ondcertilyingtooa...d_)
......-"'..,--....--....-.-.-.......--.....--caI-___......................... .
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