HomeMy WebLinkAbout06-04-07PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Gt,~M,~er[ G/t~ COUNTY, PENNSYLVANIA
f^~ Pi p~ eJ"' File Number ~, ~~
Estate of 4.
also known as 1 ~~ 5D "'~~~~
. Deceased Social Security Number
Petitioner(s), who is/are 18 yeazs 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.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
. Grant of Letters of Ad
(!f applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durante absentia; durante rn~nontate/
Pfd
(COMPLETE IN ALL CASES:) Attach additiotta[ sheets if necessary.
Decedent was domiciled at death in C µM5 ~' ~ R ^ ~ County, Pennsylvania with his /her last principal residence at
1Atl.~ ~ c ~ °SO
,n
(List stree! address, town/city, township, county, state, zip code)
I~e~-sl.~h r/l~d~`~w) Ge~,~t~
Decedent, then years of age, died on S a I v at
Decedent at death owned property with estimated values as follows: $ ~~ ~ Q , o G
(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 ~ ~ `~`
$ ~ r.
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'ih.ti4e apptop{iate form to
the undersigned: .~
__-,
V~
1
t~
named in the
Page 1 of 2
Form RW-0? rev. 10.13.06
Petitioner(s) after a proper seazch has /have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
,4iln,;ni.ctration. c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF ~ h~(~Pr l G r7~
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirme~~andJ subscribed
before me the "L~j day of
7'F1 i l V ~LX.~~v~
Signature ojPersonal Representative
~" For the Register
_(
Signature of Personal Representative '- ~ r
J
Signature of Personal Representative -l= "
,,
- ..
File Number: ~ ~ - ~ ~ ' ~ ~ Jc' c~~
('`~
Estate of \ ~- ~ r o ~~ ~~ ~ ~~ ~~ DO ~ ,Deceased
Social Security Number: ~ ~ LO ^ ~ Date of Death:
AND NOW, ~ ~~ e ~ ~~ , in consideration~of the fc~Qing~tition, satisfy itory
having been presented before me, IT IS DECRE`ED~th_at Letters ' "'
are hereby granted to ~ O S ~ YV r, e-~~-r
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of cedent.
FEES ~
Register f Wills '
Letters .......... ~ $ r ~ '
Short Certificate(s) ...../.. $ ~ l.D • ~U Attorney Signature: /
Renunciation(s) .......... $
~ ~ $ I`> ~ Attorney Name:
(~ ~- ~~~~ ~ (N~ ... $ 5 • LIU Supreme Court LD. No.:
... $
• Address:
... $
... $
... $
... $
••• $ Telephone:
... $
TOTAL .............. $
Page 2 of 2
Form R6V-r re~~. x'0.13.06
105.805 REV 1/OS
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 for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 13355353
~~
~-
Local Registrar
M~ 3 2ti0/; =.
No.
la Rtv tv2ooe COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
PErPRMrt tN CORONER'S CERTIFICATE OF DEATH
fRMANENT !Sven inwMrMinnr wnA werwennlws nn rwvwrwwl STATE FILE NUMBER
1. Noma d Itenden (FF+t~ nadle, Mel. euaal 2. Sea 3. Sodel SewMy Number /. Dab a Datll (Montle, dry, riot)
Annette M. Wheeler ,male 176 -50 -3424 May 21, 2007
5. Age (l,u 9Yagar) lMar 1 lhrtler 1 M. Dre d Sdh ( 7. BNMglew and ema « ~ ea. PMa d Dan oa
ra»,r ~' a... atiew 5/22/66 Harrisburg, PA ®
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Dauphin Derry Hershey Medical Center (Mr nn,P~iwrfoD~.rcJ ( White
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8 Black Pine Dr A°~Ra~a t>L9r. Pennsylvania L°ft1wei°in°`"' n~
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Bonnie H. Benton
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8 Black Pine Dr. Mechanicsburg, PA 17050
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