HomeMy WebLinkAbout10-02-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~ v,.M\H,,,..\o...vJ
COUNTY, PENNSYLVANIA
Estate of
~e~
~- D",\ ~
File Number
~'-07- ()fqh
Social Security Number d. ~ '\ - ~C) - ~ ~ 0 1
also known as
, Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
""')
() =~
'~:O ~med int~~,_:
';;;g g ,~_.,}
-'-:1:0 --1 ',;
(State releval/t 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 Qfl~men~ offer~d' '
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ," ~ p.,) ">--~
5
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
o
\D
~ B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; d:b.n.c.t.a.: pendente lite; durante absentia; durante minor/tate)
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.lI.c.l.a., elller date of Will in Section A above and complete list of heirs.)
Name
~~\
(COMPLETE IN ALL CASES:) Attach additiollal sheets if lIecessary.
, Qec~ent was dom!fred at death in s.. \J.._~"l' \...,,~ County, Pennsylvania with his I her last principal residence at
~ ..h.....-\ ~ft\\O'N"\. ~~o.o.. S\r.:,~~\"'v-"~ , ~~ \..,J.S~ '
(List street address. tOWl/lcity, township, cOllnty, state, zip code) ..J
Decedent, then (g'l years of age, died on ~\. 'l. \
~~\
at
<: '" \~~\-(
~~ow~\
tv\~l,(.J.
~~
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 ofreal estate in Pennsylvania
$ \'5\000
$
$
$ aO,t)o 0
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:
T ed or rinted name and residence
Forlll RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF C '-'.V'I\ \)( r \o..",d
SS
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hue and con-ect 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 affim1ed and subscribed
before me the ~ N~
C)c..\<:l\~~ . ~O()"1
LflIWtwt2 ~
day of
Signature of Personal Representative
Signature of Personal Representative
Estate of
a/ -()J -Of9&;
~f'\'f'I\.Q~ W. ~r ~
~\)u.. - ~() - ~~CJ~ Date of Death:
00
File Number:
Q
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, Deceased
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AND NOW,
, in con~ider~tion of the fQ.regoing Petition, satisfactory proof
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codlcil(s)) of Decedent.
FEES vJ& f)ci..Jl U-tUtfllJ1) ~J\ !J,~.J
:~DOO' RegIster of W,lls ~
Letters ............... U
Short Certificate(s) . . . . . . . . Attorney Signature:
~on(s) .......::::
W1-nTf\Qtrn1t . . $
$
$
$
$
$
.. . $
$
TOTAL... .. .. . . ... . . $ 1t.{S, (;}D
having been presented before me, I
are hereby granted to
/f). CD
\:5. (y)
Attorney Name:
Supreme Court J.D. No.:
Address:
Telephone:
Forlll RW-02 rev. 10./3.06
in the above estate
Page 20f2
u'n:"."u,:" "T?V rn'/f"):\
d/ -()7-()fi&
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 13774778
Fee for this certificate. $6.00
H1Q6.'43 REV ,,_
TYPE IPRM IN
PERIlANEHT
BlACK INK
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Certification. Number
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COMMONWEALTH OF PENNSY.LVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERllF1CATE OF DEATH
(See Inatructlons .nd llll8mples on _I
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