HomeMy WebLinkAbout05-17-07F ,
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ,~~~~Y/~Yt~
also known as
^~~ tN Deceased
COUNTY, PENNSYLVANIA
File Number ~'" ~ ~" ~`I
Social Security Number ~/ / l ~ ~~ ~ 3 0 ~ g
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.J
,~-~
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution Q€~}te instrumerr~ offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~.' °~~ s_ ' --
s __
l ~
S. Grant of Letters of Administration ~" ~ - ..d -
((( "` (Ijapplicable, enter: c.t.a.; d.b.n.c.t.a; pendente life; durance absentia; duranter{ttnorTinte) ~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spoifany) at~~teirs: (ff ~
Administration. c.t.a. or d.b.n.c.t.a., enter date o{Wi11 in Section A above and complete list of heirs.) ~a
101 ~
(COMPLETE INALL CASES:) Attach additional sheets if necessary.
pecedent was domiciled at dea t Cga~nty, Pennsylvania with his /her last principal residence at
Ilq~ ~w't'~r~tex' ~•,r,~ H-i ~ 1'I~l \''1011
(List street address, towidcity, township, county, s ate, up code)
Decedent, then ~_ yeazs of age, died on ~ ~ 0 at t'-~'~'~ S~G t-YC)`~C~~"0.~,
Decedent at death owned property with estimated values as follows: _[~
(If domiciled in PA) A]1 personal property $ ~1
(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:
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:
named in the
For•rn RW-02 rev. 10.13.Q6 Page I Of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and convect to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
befoie me the ~ ~~ day of
-,~!
For the Register
Signature of Personal Representative
File Number: ~l~ - U'"l - C~~-l q ~
Estate of Deceased
Social Security Number: ~~li-1• - yO' ~y~.- Da e of Death:rJ " 3 - O`i
AND NOW, ~~ ac~n°~, in consideration of the foregoing Petition, satisfactory proof
having been presented befor e, IT IS DECREED that Letters h~c~YY1~ n t6'4Y'0.~~ ~M
are hereby granted to ~-
inthe above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of recprd as the last Will (and Codicil(s) of Decedent.
FEES
,y\
~ Regis er of Wills
. tJ~~JJ
Letters ............... $
Short Certificate(s) ........ $ ~ • CX7 Attomey Signature:
Renunciation(s) .......... $
-~~ ... $ l ~ , OD Attorney Name:
} ~ ~~ • • • $ 5 • U-O Supreme Court I.D. No.:
... $
$ Address:
... $
... $ ~'
• • • $
Telephone: c., ~
- ='~ -~' -
=~`
$ ; _
' _..
TOTAL .............. $ `~Cl • OZ7 r n
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F~,-„, Rw-vz ,-ev. iv.13.o6 ~
Page 2 of?
~+gnanrre o~ rersorsa~ aepreserscaave
HI05.R05 REV (01/(Y71
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
=. WARNING: It is illegal to duplicate this copy by photostat or photograph.
'•~ ;.,..
Fee for this certificate, $6.00
• .. ;.
'P ~ 13610990
Certification Number
N,as iaREV Iv2aoe
nnE / rRUrr w
PERMANENT
BIACN WK
This is to certify that the information 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 f/or permanent filing.
~~~~ ~ S o7
Local Regi tray ~~ Date Issued
~,
C7 ~
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B "`~'
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS ~~ ~
CERTIFICATE OF DEATH ~''
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