HomeMy WebLinkAbout03-20-07
Estate' of
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
UtF/l/...O VIGil f111/2K No. 4J-cJ(X)'7-dr03
also known as
It, - 31- ~({)Oc(
, Deceased
Social Security No. /16-61' / J( tJ~
Petilionefc.l, who ~ 18 y_ of ... Of aIdet. ......yfi..llm
(COMPLETE "A" OR "B" BELOW:)
~
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut_ named in the Last Will of the
Decedent, dated and codicil(s) dated
s.. ..........t 0I--*,. ..,.. ~. .. of .._Of. etc:. (~? g
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after exec~~f the dQ;;mentS::cifier~d
for probate: was not the victim of a killing and was never adjudicated incompetent: _ __,' ;-r~ p~';; ,
:~:; ~r; e;
~
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Ie.t.... d.b....c:.t...: ,......,1. lit.; .....1. ........i.; du..... ~ _ \
Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survlV;-eai,y the fOUowin9spb:~~e
(if any) and heirs:
B. Grant of Letters of Administration
-0
'/((J!<.S2t#8K
Ylltt
rcR
Name
Relationship
necessary.
Decedent was domiciled at death in
residence at
.. --. ........ ..... rnunicitMlityl
Decedent, then 9/, S years of age, died / ~ ,. 31-
County, Pennsylvania. with his/her last family or principal
,20g}fat
I~I
. Decedent at death owned property with estimated values as follows:
(If domiciled in P A) .AII personal property .............................. $
(If not domiciled in PAl Personal property in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . $
(If not domiciled in PAl Personal property in County. . . . . . . . . . . . . . . . . . . . . . . . . . $
Value of real estate in Pennsylvania ............................................... $
Tot" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
Real Estate situated as follow:;:
soc. Of?
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the
appropriate form to the undersigned: .
Typed or printed name and residence
I.
r-
J
RV-1
6r ~ ;J~3
Oath of Personal Representative
COMMONWEAOL TH OF PENNSYLVANIA SS f~ ~ ~
b hc1d 1 Or') ::f~
. .. :~'Jt.
COUNTY OF 'JJfl Df. _ _ _ .,:t p ;co;
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are trueo~~~rrect~the be~t,~(~
the knowledge and belief ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(~)~~~'tell ~ truly
administer the estate according to law.
f'-"....:).
Sworn to or affirmed and~cribed
before me the c5IO day of
J&iJ~~~
~
Signature of Personal Representative
Social Security Number:
:M fi-f::7 - ~:3
Estate of {1 - () 1m
\ % -- (QB - l c/{f1 Date of Death:
~
, Deceased
are hereby granted to 2
AND NOW, '1!1() It cA
and that the instrument( s) dated ,-
described in the Petition be admitted to probate and filed of record as the last Will
Attorney Signature:
FEES 0 cO
Letters ............... $ ~ .
Short Certificate( s) . . . . . . .1. $ W. 00
~......... $ 506
. ... $_'6'(0
. .. . $ 5,cD
... $
. ... $
... $
.. . $
.. . $
. .. $
.. . $
TOTAL .............. $
Attomey Name:
Supreme Court J.D. No.:
Address:
Telephone:
Form RW-02 rev. 10.13.06
Page 20[2
";..:.: ;.:n::;; ~,,=,\,: 0/'fN-"
Thi~. is to certify that the information here given is correctly copied fro~ 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 filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph. .\!:~. 6l J{, ~
CJ
~~
Lo Registrar
Fee for this certificate, $2.00
No.
i - ~- doO~
Date
;'
p
11073657
~#t=It / - fI2 tl-1l. ~p7&'CLtCA-
....'.l
2
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"'-i......
....;:",.
I 29-410
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
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Hl05.'44 Rev. 1/11
TYPURlHT
..
flEAIIIAHENT
BLACK INK
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clty,t.
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Ru 71ei!..
Athrosclerotic Cardiovascular Disease
OUI! 10 (OIl AS A CONSEOUEHCf OF):
DUE 10 (OIl AS A CONSeQUENCE OF):
0UE1O{OR ASA CONSEQUENCE OF):
W1NAU1'OPSY FlNDINGlI
AMAILE 'flIOfl1O
COWlEl1OHOF CAUSE
OF Dl:RH1
MANNER OF DERH
... 2IIl.
CIIl1lNII~~~
.C8lTFtING 1'HftIClAN(PhrIicien<*1il)<ing-.d_ _ ~ phl'liCitn,...~ _ _ c:<JmlllMcS""" 231
To..._..My...-.....____....~.)end-.-.. ......... ...................... .................. ..,
Suic:ida
21.
HomIdda
PendIng~
CouIdIllllIla___
ORE OF INJURY
(MonlIl. OIly. __I
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O PlACE OF INJURY .AI_. tann. _~. oItIca
IluiIding. ate. ~ _
2Oa.
TIME OE INJURY
INJURY 111 WOAK? DESCAI8E HOW IHJUAY OCCUMEO.
NoD
NaIurII
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On......... of...-lMllon MdI<< ~.In Illy aplnlOll. dMtIl occunacI.altle tfme. cIabl. and pIac.. and due to ,/Ie cauM(') and
-- -.................. .............. . ..... .................... ..... ...... .. . . . ..... ..... ..... ...... ......
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AEOI8TJWI'S SIGI'IAI'UflE /IIIIJ NUM8EA
~~~p.~1
Coroner
SlGNEO(Mom. Day. _I
o 1. 1. January 2, 2005
f ANO ADOAESSOF !'EASON WHO COMPlETEO CAIJSE OF DEII1H
(Kam21)TypeorPrint Michael L. Norris, Coroner
~ 6375 Basehore Road. Suite #1
~ Mechanicsburg, Pa. 17050
llII1E FILEO(Moroll. Day._,
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'JWlIIOUIICING ANI) CM1'I'YlNGI'KY8ICWI {PhfIiI:iIln -1l'OllO\IIldng lMlh Ind c:ar1iIying 10_ d_l
.........ofMy~.___....._._._plaoa. end...IO...cauaa(a)end___..........................
34.
-3~ dJOS
'tJ1-.,
Register of Wills of Dauphin County, Pennsylvania
.. Estate of
RENUNCIA TION
Mil!?/( f3;J- PIf r!vO tI Jell
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also known as
1J6eEJVlI3EJ2 3~ 200~eceased
-
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The undersigned,
1jJ[F-E - O!v?-A .5tfL/Jv!//fkOI/G/(bo'
(Relationship) (Capacity)
the above DeCeden~. hereby :nouncelsl the right to administer the estate and respectfully request(s) thatl . V,i
letters. I \ <[, ) i/V/yfAlltfNeissued toZ HIINIIIJ t4.t.i'tJ.tJ{~ T(itftf? ~LIIl..{tJ '(!II
Witness 2,"#AA/~ this !l
J('tl/!?ji;a/~ O/go
'I. ,{;:
day of )I /l~L// ., 20l: 7 .
g 4wiv a ,.&J,j ,1~
(Signature)
(Address)
(Signature)
(Address)
(Signature)
(Address)
Sworn to or affirmed and subscribed
before me this day of
o
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Allison E. Kapp, Notary Public
East Pennsboro Twp., Cumberland County
My Commission Expires Oct. 21, 2009
Member, Pennsylvania Association of Notaries
. Notary Public
My Commission Expires: JD I~ \ I Q II
ISl9nMu.e _ .... 01 NcKary Of othet ollicial
NOTE: Renunciations executed outside the Office of Register of
Wills are required in some counties to be notarized.
qu~f"" to -..-.. _.. StIow d..e 01
..pI'-":In 01 NoIlIfY'. ~.......,
RW-13 (Rvsd 9/92)
tIlJL-