HomeMy WebLinkAbout01-09-07
Estate of John G. Stone
Also known as
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
No. ~ \ D~l DoaL\
To: Register of Wills for
Cumberland County in the
Commonwealth of Pennsylvania
Social Security No. 171-38-7283
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, applies for Letters of
Administration f\\'('f\tA. ~\a\f)e on the estate of the above
decedent.
Decedent was domiciled at death in Cumberland County,
Pennsylvania, with his last family or principal residence at 1205 Gunstock Lane,
Mechanicsburg, P A 17050
Decedent, then 52 years of age, died October 3, 2006 at
Holy Spirit Hospital at East Pennsboro Township, Cumberland, Pennsylvania.
Decedent at death owned property with estimated values as follows:
(If domiciled in P A.) All personal property $ NONE
(If not domiciled in P A) Personal property in Pennsylvania $
(If not domiciled P A) Personal property in County $
Value of real estate in Pennsylvania
Situated as follows: $ NONE
Petitioner, after a proper search has ascertained that decedent left no will and was
survived by the following spouse (if any) and heirs:
Name
AnQela Stone
Alex Stone
Allison Stone
Relationship
Wife
Son
Daughter
Residence
1205 Gunstock Lane
Same
Same
The wife of John G. Stone at the time of Decedent's death nominates Petitioner to act as
Administrator on its behalf.
THEREFORE, petitioner(s) respectfully request(s) the grant of Letters of Administration
in the appropriate form to the undersigned.
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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 the best of the knowledge and belief ofpetitioner(s) and that as
personal representative(s) ofthe above decedent petitioner(s) will well and truly administer the
estate according to law.
Sworn to or affirmed and subscribed
Befo~ me this OJ day of
~ ~~ 2O'O'Ff
_JlNlQ - -- l~OChlJJ~ ev:&
. RegIs er
C) ~tL ~
No. ~ \ () rl Ot0.L..\
Estate of
John G. Stone
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
'l
AND, NOW, ~uo..-~ q , 2O'O'i, in consideration of the petition on the
reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that
ANGELA STONE is entitled to Letters of Administration, and in accord with such finding,
Letters of Administration are hereby granted to AMGELA STONE in the Estate of JOHN G.
STONE.
~ordt~ ~II{)W~
Register of Wills
Filed
JCP & ~k
A.D.
$ dO . 00
$ LtO.QO
$
$ IS-DO
20'0'6 -'-S.cO
~Cg.l'Clll~
Attorney #350'73
624 North Front Street
Wormleysburg, PA 170'43
717-232-470'1
FEES:
Letters of Administration
Short Certificate(s)
Renunciation
ol05X05REV 1/05
This is to certify that the infonnation 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.
No.
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Local Registrar
Fee for this certificate. $6.00
P 12934984
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
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8 8lr\hplace (C~ and stale or braigl cOuntry)
Mechanicsbur9L PA
6d facilily Name (II not insuMion, give wee(.md nwrber)
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H10$143Ht1v 011:16
TVPE/PRINT IN
PERMANENT
BLACK INK
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STATE FilE NUMBEJi,:
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J SocialSecurIy Nuntler
- 38
- 7283
01."
D UVOU liun! 0 000\ 0 NUl lionw 0 Re$lOent. 0 0U'lef ~
9. Was Decedent of HispanI: ()rigWl.? 10. RiIce. Am8Ian ildiIn.~. WtlM,IlIl:
J( No a 'tes(lfyes.5p8CifrCOOan. <~
........--."'1 White
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o Yes If No
:u::e~~:ideoce 17a Stale R~Y~~!:!!C!
,. MaruISlatus.Walr1ed,NeverRllilnied, 15. SurvfMgSpouM{.",~.nIWd9nn;une)
_....~<ed(_
Married In1rl<nilis
:Din~edenI 17t~ Yes,OecedenllNedin_ ~eI'!___
To~?
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17' C<l,",,_ ~lar1C!
l1d 0 No, Decedenl u.,ed 'IIItWl
Adual LmIs ol
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Id Falhe(s Name (Fils!, middle. last)
19 Uother's Name (First, rrIddfe. maiden Sl.Knamel
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Angela stone
Betty Beam
2Ob, Inklimant's MaWlg Address (SUeet,clyl\Own. slate, zil coOe)
1205 Gunstock Lane
Mechanicsbur , PA 17050
21c Place ofOisposition (Harre 01 cemetery, cremalory orolher placeJ
Floyd stone
lOa InlormarlfSNarntl (T ~pe'pllllll
Tri County Memorial Gardens Lewisber PA
22c Name."'''''',.....Faci<y 8 Market Plaza Way
Malpezzi Funeral Hane Mechanicsbur PA 17055
230.li:....N_ 23<. ___."'._1
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l1~m27 Part' toldllhe ~9!..11..2!~ ~ dl5eases, MI,.lIles, Qr coc\Vlic.allOns - Ulal dlfElClly caused the death 00 NOT t!l1lef 18/fTlll1al e~ents such as caldlaC autls!,
rf:splrafufya(fesl Of "~nlll:ul,H htm.ll.:i1lOn wahOut Showll'\\,1lhe llllOlo'in 00 NOT abbu,~~te Enlel onl,!, one cau~ on a lIne~
IMUEOLATEC"USE(~ulaldlSe",s8ol ArT) ti~
~oooWlllesullllDl/ldol..Jh) --7 it /~(/~ -- - ~- - --
Due 10 (01 dS aconStlqueoce ~
::ll.quenlldll) kslGonJtllOOS Ilany
lo.ladl/l~{ottldC4uSs/lsfedollllmla Ouela(OIitSitconS8qIWllCtlof; -- - -
.. EnltHlMUNOERl-.INGCAUSf
. tdiseassOl'II'\JUl)'lhatll\i1laledtl'le
events u:sullOg ill dealhlLAST
:WO~lIfIdlelOteNal
: onset to death
26 Was Case ABlened 10 a ~ E.lanwlerkoronec1
DYes }(No
Part II. lntel ollier sionilicaRt conUfions COntltlulM>> QeatI
bulnotlesuliogintheundeftyllgcausagiwel'linPartI
28 Di:lTobaaXlUse~100eaia1
o '{es 0 PJubiibtf
......, 0_
24 TimeoIDea~_
25 Dale PTonounced Dead (Month. day. yeal)
1/!:f2
--CAUSE OF DEATH (See Imtructions and e.ample$)
11M
Oc-f~,;(t:Jot
o PendmlllnveSI1\JdUon
o Cluld Nvl Sol DeleriRned
32. 0""",,,,, (Mooth. ,",-:y.a;;=--r 32b 0""".,..... ""'~ aa:""..
32d T"';"Oii~"" J320';;"".,Woi,,-- '.21. UTlansport.atk.M'llnfUfY(~
o Yes 0 No 0 Drivel~a$Of 0 Passen\l'llf
M 0 Pedestllilfl 0 0lhuI-
--- 33b Signah.lleandlilleof
29 Mf eRaIe
o NolP'ewwfll~pa.sty..
o PrEllJllWllalldlotdealb
o NoIpr~.bUIp'~""42Iiil)'$
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D Nlipl8(flalll.bi.llp'~43daysloly(lal'
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o lJrlknorM'l'P'~....lhltpastyeat
32t. Placaof.-,:Horha.farm.Steelf.:lOft'.OfIce
..........oIt.(_
Due 10 lor as a consequence 00
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n Wele Autopsy Fiodiogs
'walldble Ptiollo ConvIehon
of Cause 01 Dealh?
DYes 0 No
31 Mann61 01 Death
~al o HonlClde
3Dawasan-AU!Ops}'
PerklHned'
o "'=,,jtjnt
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32lJ locaon(SlIee1.c<<y~..~~~-
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33a ~Itf (cheCk only one)
Ceftitying ph)'sician (Ph~SlCliln cef1t1~lny cause of ullalh when anothel physICian has. Pl()fI(lUfiCed dealh and wn~l8d nem 23)
To the bat of my knowledQll. de.ilth occurred due to the c.ilU$S(11 and IniInAer.il$ slated.....
Pronouncing and certifying phY$icioln (PhysICian LolI1 proootJllf.;fOg dedln and Gefti:ylng ID C<!lISb 01 death)
To the but 01 my knowledge, death occurred at the time, date, and place, and due to theca~sl and manner as slalf!d ..... .
Uediu.1 e..,m4nerkoronet'
On the basis. 01 uamirulion .ilndku invesl~tion, in my opinion, death QCc\JIred al the lime, dale, and pl.ilce, and due t.o the Ciuse(S!.illnd JlWnnel'.ills lUted.. .....0
35 Re ti~S:;=N""~Q~ .&q ~. ~ll.k2lLiMJ C9d~(-~'''~'~
\ ~ f (See instructions and examples on reverse)
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33d. Dale Sqled (UooIl. day. yearl
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34 Na7~~~mlsonr~~~ot~~llemml~
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