HomeMy WebLinkAbout07-13-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF (' CAMkr (~IlJ
~Y.
E.we of ..., n 2; [~"h~ .:Jr
also known as 1 ~kl"l
. Deceased
COUNTY, PENNSYL VANIA
File Number
~1-Ol-lJ~o
Social Security Number I 9ltJ -Cf i' - 'f 'J.{)f'
Petitioner(s). who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B' BELOW:)
o 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
named in the .
(State relevant circwnstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not many, 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:
01 B. Grant of Letters of Administration
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c... . ::T o.w k:, f
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration, c.t.a. or d.b.n.c.t.a., enter date o/Will in Section A above and complete /ist o/heirs.)
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Name
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Relationship
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er last principal resiill:~~
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Decedent, then
50
years of age, died on
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(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
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Decedent was domiciled at death in
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(List street address, town/city, township, county, state, zip cade)
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Decedent at death owned property with estimated values as follows:
(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 real estate in Pennsylvania
N
$-.8, <<10
$
$
$
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situated as follows:
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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:
T or tinted name and residence
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Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
( CA^~,-to..f\ J
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 Decedent, Petitioner( s) will welI and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the _1 :1,.1") day of
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Q'~ c Guc~
Sign e of Personal Representative
Signature of Personal Representative
Signature of Personal Representative
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Estate of lArl\.n...- l-\-. (nl+~tfhn ,Jr ,D~-C
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Social Security Number: Date of Death: J;:. -l _
AND NOW, l 1i ~\~"J3 . ).../'Y)"1 . in consideration of the foregoing Petition, satisfa~ry proof
having been presented be~me, IT IS DECREED that Letters t!. fumlf'\\.~-h Df'\
are hereby granted to :'\e Cll"'\~ ( ,--:Y"l rri-l:5
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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 (
Letters ............... $
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
.. . $
.. . $
.. . $
... $
... $
... $
.. . $
... $
.. . $
TOTAL .............. $~
45100
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FEES
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
\.17 j)
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10.OD
5.00
Telephone:
Form RW-02 rev. /0.13.06
Page 2 of2
HI()5.~().' REV IOlm7)
~l 01-~D
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
Certification Number
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.
~ /?l ~.. JUN 1 ~2007 /
Local Registrar Date Issued
P 13550342
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PRlHT IN
iANENT
;l(INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions snd examples on rev.....)
l._al_(J'iIII._,iIII,_1
"Barry"
5. Ago (WI BifllldIy)
50
William
e. Dolo d I!II1h
H.
Colteryahn, Jr.
7. Indltitlor
- 4208
STATE FILE NUMBER
4. 0010 01 Doo\ll (Month. diy, year)
June 8, 2007
Yo>.
Nov. 28, 1956
81. PIoco d DooIh CI1Ick one
Hool>IIat. Olho<
Pittsburgh, PA O~ [lER/OoIpollonl OOOA ONonlngHome 0_ OCllhor-SpOClly:
IlllFdly_(1f,,"_gNo_lIldrunbot) 9.__dttoprilOltglft'/ KINo Ov.. 'O.~:"""""'___,oIc.
.. IWyoo.oplICIlyC_, (SpociIJol
BrookVl.lle Hosp1tal -'__''''.1 White
'2. 'NIl __Intho 13.llocodonI'I_ (SpocIfyonlylipllgradl ~ '4. __ M<-. __, '5. SlovNIng Spouoe (WwfIo, giYe _ nomel
u.s. _ Fon:oo? EIomonluy I SocoIldoty (0-'2) CoIogo (,-<I 015+) _lliYon>od (SpociIJol
OYII [JiNo 12 4
llocodonI'I
AcIuIIfteIidInoe l7..SIate
81>. CoLolIyollloelh
Jefferson
,7b. CoLolIy
Pennsv1vania
Cumberland
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'9. MoIlor's_(fi1l,_,__)
Carol n J. Hartman
2Ob.1nIcmlInI'a-.g_lSlratt,cllyl_, -,,,,cede)
1608 McCormick Drive, Mechanicsbur PA 17055
2'c.PIacoal~~d_,_0I_pIacol 2,d. LacalionIClly/_,_, zlpcedel
Evans Crematory
Schaefferstown, PA 17088
220.
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23b.Uc:oI1ION_,
New Cumberland PA 17070
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9:18 PM M.
CAUIlE OF OEATH (_ _.. .nd............)
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June 8, 2007
26. 'NIl CaN _10 _ ExanWw I Coronollot. Rauon Olhor _ C..- 01 Donation?
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===-..=.../0I-......,1lIy....-__1I...__, IIld ~...........cauao(.)..._..__ [J
, Coroner
33d. IlIIo SIpd 1_. diy, JIll!
June 9, 2007
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34._IIld_al_WhoCclr4ltotodCauoaolrMd\(IIom2711il>e/Plinl
Bernard P. Snyder, Coroner
P.O.Box 206 Re 1dsvil1e, PA 15851-0206
OlopcoitiooPenrMNc. ()lI'1lu/
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RENUNCIATION
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REGISTER OF WILLS
C l.Ar'\~rto.nd COUNTY, PENNSYLVANIA
I,
"5o..f(l r Wi II; O\M H. Co 'kryttht} {Jr.
!1 "'-ry . C-.. Pro WAA I
(Print Name)
siskr-
, Deceased
Estate of
. in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
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(Signatu;e~
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(Street Address)
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(Date)
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(City, State, Zip) J /
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this I / day
of *~-::J ~~_'" ~7
Notary PublIc r, -
My Commission Expires: ~/" ';>I1Z r
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Deputy for Register of Wills
Form RW-06 rev. /0.13.06
Notarial Seal
Robert J. Raae. NOW)' Publle
~ Spri". Twp.. Cumborl.... ~ .
MyC~ilaion Expirea A.... lo.::~
RENUNCIATION
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REOISlER OF WILLS
lU~lA.,,-J COUNTY, PENNSYLVANIA
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. Deceased
I, _jJV,..(~ek Col~uo. ~ -:ro<+ . in my capacity/relationship as
, ~ri1ftN_) --.I
S\c;.~ of the above Decedent, hereby renounce the right to
administer the Esmte of the Decedent and respectfully request that Letters be issued to
-d <:..O-n.n~ Ccl t-~ j o..~V""'\J ea.co ~...s
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~, Address)
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(City. SltrIe. Zip)
(10 'Z../l)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out 01 Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the relllBlciation for the
purposes tated within on this a "1 +-~y
of .;too 7
Deputy for Register of Wills
~
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(Signature and Seal ofNola1y or odter otf"lCial qualified to
, adminisrer oalhs. Show date of expiration ofNolary's Commission.)
Form RW-06 reJI. 10.13.06
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