HomeMy WebLinkAbout09-06-07
PETITION FOR PROBATE AND GRANT OF LETTERS
~~W
~~ f\\\(~\t \\\. ~~~N\~ cl~
REGISTER OF WILLS OF
COUNTY, PENNSYLVANIA
Estate of
File Number
~\ ~\ D~~\
Social Security Number ;J tJc." . '3 \.0 - \ ~ " ~
also known as
, Deceased
~ t..",(\~\~ ~\. . S~ ~{'t\.\ t\ \-
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o 1\.. 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 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:
[tJ'B. Grant of Letters of Administration
o
f'.".~
=
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; duranteEz itate) -......
. C/)
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spou1~~y) anfro:eirs:
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.} " . ::::; ~ I
;cr;~ 01
..,;~9.
_.':.1
..(.:.
, .
~ _.~)
Name
Relationship
"(If -.:::1
::- ":~)
---:
( ~F:
1
___J
.-)
~
(COMPLETE IN ALL CASES:) Attach additional sheets ifnecessary.
~e..t S"'~ ~ dJ,,; c Q.). 0-.-r f\~
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in P A) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
$
$
$
$ \\ ~ Db~
,
situated as follows:
Wherefore, Petitioner(s) respectful1y 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:
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYL VANIA
ss
COUNTY OF
0~.9 r<"'c.or~
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
Lo
day of
Sworn to or affirmed and subscribed
~!f>\~"('(\.~(\ ,d:)D"\
()~~~.,
Signature of Personal Representative
2
..0
<~::o
~~~I..)
-. ~; 93
...J ./ ~............
_> ~3 ~~
j
~D
-,-1
r- '
<:::>
=
--.:
(/')
PI
"'U
I
en
Signature of Personal Representative
. I
)
-0
;""1
~.~
-
File Number: at b\ C)~~\
Estate of r;e.'r\ne.. ~ ~ s'd...vY\ \ ~ \:
W
N
o
, Deceased
Social Security Number: ~ cYl ?..In \ ~ I ~
Date of Death:
b 'X )dl \D'l
AND NOW, ~~n~~~
having been presented before me, IT IS DECREED that Letters
are hereby granted to ef")-- \
, in consideration of the foregoing Petition, satisfactory proof
~
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 Decedent.
utiQo~~'~~~voJ" p
Register of Wills 1
FEES
Letters ... \ ,:S.. o<::P, $
Short Certificate(s) . . . . . . .. $
Renunciation(s) .......... $
~C-~ .,. $
~~ ... $
.. . $
.. . $
.. . $
.. . $
.. . $
.. . $
.. . $
TOTAL.............. $
~~O
~
Attorney Signature:
\D
S
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
3S~~
Form RW-02 rev. 10./3.06
Page 2 of2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
~ARNING: It is illegal to duplicate this copy by photostat or photograph.~
HlOS,80S REV (0]/07)
(.I)
rr1
-0
I
0"\
,:'.)
C)
-']
. I
:'-)
:"
Fee for this certificate, $6.00
;:
P 13709907
Certification Number
--aBQ1!1)~~d-:_~
-_'~-:20
.> \...-' -or.
)c::
-::0
--j
-0
:Jl:
W
.-1,&3 REV , VolOOI
~PE I PAINT It
'ERlolANENT
BLACK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERnFICATE OF DEATH
(See Instruction. .net .um,,- on rev_)
7.~1 __.,
Nlllflli$~~. p,..
1IIp.
Clr/-
3'#01 ",,,~Er S1:
231>. Li:onoI_
PA. , 1/1/
(A~ ..,,'-... .p", nOli
23c. -llpd(llDolll,"""
35, AofjotlIt'.
..
~d.iJ.~ 'j)- I
~_No 06
32d. r..."...,
a_c-_..__,c-lor._Olhoo_c..-..,_l
Ov. aQNo
AppounaII_ ","U:&w_~--"- 21.DId_UII~"_l
0n00I"_ IlIA noI-.g............._gioonin""'l 0 "" 0"-'
81100-
ai_
D 110I__-"'",
o "'-"_.11-
o _--.IIlI___42....
li-
D 1IoI--.1IlI,..,..41......',..
--
0_1__.....,..
311c._III11j111y:_~""'~
cao-............"
:tIg.lacIIicn"_I_,",I__
_24-a_"_III_ 24. r...oIOo11h 25. OIII_llOIdt_...,..1
..._- O'~l. A lot. lIetu~"{ 'L'1 2,001
CAUROf' lllIATH 1-- _~)
1Ionl27,""'l &w..~-_~.,.........-.......,_.._ ooOOT____.__
--.,.......,_____...-..liII.,.,--"'--
~-==-=.
~.._."'"
=~C:::~
=-~~
L S4;; P!;. \(.
Due"(orM.__"!):
b. c..\~~~
Due"(orM._oI):
c,
Due.. (or M._oI):
......."-
-
d.
3llb,_~FinOingI
-_..~
.. c...o,,_?
o Vol IX! No
31._"_
~- D-
O- D"""*'v......
0- oCCllclNol.._
II.
D'too I1J No
33I.~_""~
. ~....-i_~_"___,..,-....__IIld_...231
_"'_"11I .........-_.......COlIOO(Il..._.-.- __ ___ __ __ __ _ __ _ _ _ __ _ __ - -- -- - - - - 0
. =:=."":..::::=.::"'...~=.....::.:::_M__ __ __ ____ ____ _____ l2ll
. =='- ...1.,.............in...........__lIllllo_._..............Io..._....._.-. 0