The URL can be used to link to this page

Home My WebLink About11-20-06 PETITION FOR GRANT OF LETTERS OF ADMINISTRATION Deceased. No. ~ \ D lo l ()d-51 To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Estate of Jacqueline M. Hoffman also known as Social Security No. 192-30-0608 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, applLtes pendente lite (d.b.n.; pendente lite; durante absentia; durante minoritate) the above decedent. - for letters of administration on the estate of Decendent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 1622 Holtz Road. Enola. PA 17025 (list street, number and municipality) Decendent, then 67 years of age. died September 22, 2005 m Harrisburg Hospital, Dauphin County, Pennsylvania .:lq:9 - 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.reai estate in Pennsylvama situated as follows: 12.500.00 $ $ $ $ Petitioner_ after a proper search ha2- ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name Relationship .. Residence Ben;amin F Hoffman Snouse 1622 Holtz Road, Eno:QE, P 2 ~... . cr- . ;?~ . 6&~ i'i;j -~ ;'n~~ N _J m c-z. C) . ..:'"2 __;~_ U) /'- :;c )U -,:! --.,'"}" :::J: A 17025 >)C- -- -:0 THEREFORE, petitioner(s) respectfully request(s) the grant of letters of admini~1ton in tke .Y"-- ___ appropriate form to the undersigned. .-- ~ ill U .:: o "Cl.-- ov.;e 0.... ~~ "Cl0 dO';:: crjO.=, 3~ 0.... 30 OJ .:: 01) Ci3 Benjamin F. Hoffman 1622 Holtz Road Enola. PA 17025 - fJEcr '~.A~ .J ,Y:; OATH OF PERSONAL REPRESENTATivE COMMONWEALTH 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 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 affirmed and subscribed before Ple this . .;;}:o . day of l000e.f''\'\b.-- t'" . -'J:b'--f ~4>-7;, ~ . p..v-_ - '. . ister fQ~~~ I L .-.. tf.l '-' ~ I-< ::s ...... ~ I=: I:ll) CI3 No. Estate- of JACQUELINE M. HOFFMAN , Deceased GRANT OF LETTERS OF ADMINISTRATION AND NOW do I0D0fu'()6-r ttdct:l,q, in consideration oithe'petition on the reverse side hereof, satisfactory proof having been presented before me, INS DECREED that BENJAMIN F. HOFFMAN isl are entitled to Letters of Administration, and in accord 'Yith such finding, Letters of Administration are hereby granted to BENJAMIN F. HOFFMAN in the estate of' JACQUELINE M. HOFFMAN ,~~ Register of Wills ' . FEES Letters of Administration ..... $ Short'Certificates( ).......... $ Renunciation ..... ic p~'{\..:h.., ~ TOTAL _ $ Filed.... .l.l.\~9.\l?~...... A.D. \S,cl) '1~. 00 19_ Michael Cherewka, Esquire #35613 ATIORNEY (Sup. Ct. LD. No.) 624 North Front Street. }\DDRESS Wormleysburg, PA 17043 tDb.cb . .;l Lt. 60 232-4701 PHONE YltMu/ {k~-ft- RL\ This 1~ to certJi\ that the information here given is correctly copicd from an original ccrtificate of death duly filed with mc 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. W,-l, 1 "'1 "",~ ',r) Ii ';:) 8 ,. l ! I HJ ,;;..Ie od ..,,'..... "'-"> ,,,",, ~ No, ~'''"ii/7i/7;;'/~ ...;I"Wi' U OF "'" IIIIIII~",\\ r:..-![,f-,--_. /'#/, ~'~.;\.\ ;1~;tj! ~~\~\ It~i ~ \,~% ~~f ;r~;, : ~ ~ w\ . ,,{~}, . h~ \" *-" '~,' ....',' -,' * ~ ,,&,\ 'C'~ '~I \.~ " ,/~\\/ - ~.-?~ /,-\\.'<- " "'--., IMENf\\\ "",~I\ ~...I",;"/;U/IlI1f/III"" tkn-'!,~ Fee for this certificate. 56.nO SEP 2 7 2005 T ft6'" Au f-.,> c:::> 2 ~ 6 L.Ut::f3A!.INr jJ,<.D.~~~ ~ ~ ]:? hJ Do' #' J qL - 30 ;;..;. ~L>~ ~'--.joo ,'"-)0"'" :--.) c: ,- ~ -0 J;> Date .." ::Jt ~\-bto- \ odCf - .. . ...~) .r:- 3 Rev, 21B7 COMMONWEALTH OF PENNSYLVANIA' OEPARTMENT OF HE.t.L TH . VITAL RECOROS CERTIFICATE OF DEATH STATE FILE NUMBER SOCIAL SECURITY NUMBER 3. 192 30 0608 NAME OF DECEDENT (First, Middle Last) 1. Jacquel ine M. Hoffman AGE (Last Birthday) SEX 2F2male BIRTHPLACE (City and PLACE OF D State or Foreign Country) HOSPITAL; Ha 1 i fax P A rOp.tiM' fir] 7. 8a. FACILITY NAME (If not institution, give street and ntomber) TH Check anI one. se instructions ERfOutPa..tlenl 0 DOA [] R6&idenceO 8b. Dauphin DECEDENT'S USUAL OCCUPATION (~r~lc;;tfW:~d~~tau~rir~~ir~)st Be. Harrisburg KINO OF BUSINESS / INDUSTRY BdHarrisburg Hospital AS DECEDENT EVER IN DECEDENT'S EDUCATION U.S. ARMED FORCES? (Spady only highest grade completed) yON :g ElementarylSeC<Jndary College 12. es 0 13. (O'f2 (14orS.) ~~:~ify) 0 RACE, American Indian, Black, White, et (Specify) 10, White 11a. Purchaser 11b. Dupout Elect;lfonics DECEDENT'S MAILING ADDRESS (Street. Cityrrown, State, Zip Code) DECEDENT'S 1622 Holtz Rd. ~~~~t~NCE En 0 la, P A 1 7 0 2 5 ~~,e;t~:~t';!~~o) ns 17b. 16. FATHER'S NAME (First. Middle, Last) 1L Charles Maneval INFORMANT'S NAME (Tl'Pe/Print) 20a.Benjamin r. Hoffman METHOD OF DISPOSITION DATE OF DISPOSITION aurtal KlCremation ~emoval from State 0 0 (Month, Day, Year) Other (Specify) 21b. September 27, 200 L S VICE LICENSEE OR PERSON ACTING AS SUCH LICENSE NUMBER 22b. FD 012774-L MARITAL STATUS. Married, Never Married, Widowed, Divorced (Specify) 14.Married SURVIVING SPOUSE (If wife. give makMn name) F. Hoffman 17 a. State PA 17c. ~Yes,decedentjivedin East twp. Did decedent live in a Countx..-.Cumb e r 1 and township? 17d, 0 ~~h~e~~~l~~~if~Of rMUr~ER'S NAME (First, Middle. Maiden Surname) - 119. ,'1artha Neuman citylboro. INFORMANT'S MAILING ADDRESS (Street, Cityrrown~tate. ZiQ Cod'll 20b. 1622 Holtz Rd. Enola, rA 1/02':J PLACE OF O\SPOSI710N- Name of Cemetery, Cr€'"latory or Oth~r Place LOCATION. Cityrrown, State, Zip Code Church Cemetery NAME AND ADDRESS OF FACILITY 22c. Richardson F.H. Inc. 29 S. Enola Dr. Enola PA 21d. Silver Spring Twp. PA 17025 fMWOIATE CAUSE (Final dfs'e~e or condition resufting in death) --. DATE SIGNED (Month. Day. Vear) 23b. 23c. WAS CASE REFERRED TO A MEDICAL EXAMINER ICORONER? 28. Yo. D No )ia : Approximate PART U: Other significant conditions contributing to death, but . interval between not resulting in the underlying cause given in PART I. : onset and death liCENSE NUMBER Sequentially list conaitions (f any, leading to immediate cause. Enter UNDERLYING CAUSE (Disease or injury that initiated events resulting on death \ LAST I: d. DUE TO (OR AS A CONSEQUENCE OF)" Natural Jg o DATE OF INJURY (Month. OilY, Year) TIME OF INJURY IN.IURY AT WORK? DESCRIBE HOW INJURY OCCURRED WAS AN AUTOPSY WERE AUTOPSY FINDINGS MANNER OF DEATH PERFORMED? AVAILABLE PRIOR TO COMPLETION OF CAUSE OF DEATH? Yes 0 No IfP I Yes 0 28.. 28b. CERTIFIER (Check. only one) *f~~~F6~~tGor::'~~~~~~Jrgh~S~~:~hc~~~~i~%a~U~: tDJ ~.,e:~a~~;~(~)~~jrJ~X~i~~a~ h:t~r:~o.:~.~~.~ .~~~~~. ~~~ .~~.~~~:~~.~ .i~~r.~ ?~.).........., Homicide D o [J 30.. 30b. M. PLA.CE OF INJURY. At home, farM, street. factory, office building, etc. (Spt!cify) 30e. Yes D No D 30e, Accident Pending Investigation .MEDICAL EXAMINER/CORONER ~:~~:rb::i::t~~~~.~I.~~~I.~~. ~~.~~~.r. ~~~~~~~~.~~~~.~:!~ .~~. ~~i.~:~~: .~~~~~ .~~~~~~.~, ~~. ~~.~ .~i.~~.'. ~.~~~.', ~.~~ .~~~.~~'. ~.~~ .~~~. ~~~. ~~~~.~~.(.~~ .~~~.. 0 31a. REGISTRAR'S SIGNATURE AND NUMBER 1~/r-;r:... 11/112,/ /1 , NoD Suicide Could not be detetmined 29. *PT~~~~:s~l~fGm~Nk~~;I:J'~:~e~t~~~~~~:~ ~~~~:i~;~ne:d:t~r~~~U~~~,~~~h d~n: t~e~~i~~ut~e~j~)~~~ d~:~~er as st2ted. ...... . 0 34.