HomeMy WebLinkAbout01-03-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYL V ANfA
"""00[-\1 ~ 4~ ~. ph ,(~, e,
also known as y L. Hn C K -Ph I ( II r,
, Deceased
File Number d r ()fj- (XY)S-
Social Security Number .:J ~'<7) - :3)? - 096 7
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE '.-I' or fB' 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 circumstances, e.g., renunciation, deatl, 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 instl1lment(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: r;;;
() =
~~;O .:=
-~l3n ~
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durantEiijiiiliijitQte) I
~~.~) W
Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spd}l~e-J.lf any) and heir~: (1{~:')
Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete /ist of heirs) -, '. -i -0 ' ,
-:...
o B. Grant of Letters of Administration
j.':~~
I': '.')
) ,'~-~)
;', '..:]
-- .,' ,....".."
:::-f
(CO/~JPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
Qecedent was domicil~d at death in \:... ~ Count~Pennsylvania with his / her last principal residence at / 5'1f 0
VJ ;' C: r Vof' I Q V\ I C,;]J) u. ~6 05
(List street address, town/city, township, county, state, zip code)
Decedent, then 0 ,:)
years of age, died on Dx...c. J 7, 10D;; -B.oJ U 0 11 V {l, +
, \ f""
l--b'S ,
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PAl Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value of real estate in Pennsylvania
~O()6 .cJc)
$
$
$
$
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
~{)I C.
Forlll RW-02 reI'. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
/i C u-01M bx'(o r-<J)
COUNTYOF (~c...\.l~v
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
SS
administer the estate according to law.
Sworn to or affirmed and subscribed
'~rd
before me the '=.J
XYl1r.i~ );/- ~cb/J
Signature of Personal Rep;:esen ati e
Signature of Personal Representative
Signature of Personal Representative
C)
......,
c)
r:::::>
<::0
<-
:-:.-?,..
:;:;~:
TJ
IT1
,--)
\
..
AND NOW,
File Number: ()/- t11- OOC)S-
Estate of -f) (((I C;:. (\ L 0 L{ -1.) In I 1\\ pc:",
'J). . -r-+'
ecurity Number: .;). 99 - 3 'i? - &:, ?~ 7 Date of Death:
3
d.a..YZ , in consideration of the foregoing Petition, satisfactory proof
before me, IS DECRE~D tha. t Letters ftcLfY)/n/~+f11+'(JY\
.tY\~ \ /'} ,
\ ,~. I ~Sr::.. _ ( 0.. ol c...r
-:' ~:5
-'J-? ~~~-)
.: ~._q
,,,J,-:
. -"-'-~~
I
(,.)
; '._-j
-~)
I I
\)
, be~sed
_4
/ d /t/7i/~ '7
( .
"v
o
1_..';
)
having been presel te
are hereby granted to
in rhe above estate
and that the instrument(s) dated -< .
descnbed in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent. _' .
FEES ,Ji)"--.e)o-;Jo. 4$/Uulh~4,'{V~
L'tt'''' ............... $ ,;/0 .CD R'g."" Wd/, '-12;..., (ff'U'1,~
Short Certificate(s) . . . . . . . . $. ~ L{ . {)() Attorney Signature: ..o~_ . ( J;.-;r
Renunciation(s) .......... $ 5 l:J1\ il
_KP $ ,O./JU AttomeyName:
('~lJ"(Y'e.~~.. $ 5.t'il.) Supreme Court LD. No.:
.. . $
... $
. .. $
.. . $
$
$
$
TOTAL .............. $ U 4..{ . UO
Address:
Telephone:
Forlll RW.02 rev /0.13.06
Page 2 of2
RENUNCIA TION
"",
~"':)
I."'.......
'i REGISTER OF WILLS
\ c<Jnb~o(" Ia n:J COUNTY PENNSYLVANIA
,
co
I
W
"
Estate of
UeQC\L\ LoG.. JfJ~\I((l'\DS
\) 0 , ~
N
o , '
-, Deceased
I, \=0; th C Cx.Y( \ +ee:~ ~ Co if \ V'YI ' ~lXACk - !JJc~ l+,~~~y capacity/relationship as
. (Print Name)
_(y~ L\ e., Il.+ e 'C G \'yJ, ~~ r, of the above Decedent, hereby renounce the right to
)
administer the Est" te of the Decedent and respectfully request that Letters be issued to
\ \ \ ~ l ~ ~"5 A- L I II (" v (' \ <2 V
1/3/c)~
(DatJ)
~(lJLJh~
~ignature)
;< ~_ :j-,;/ -tT1'{{';1-. , -(.. -'I:r /1:;2
) ';)~S-o LU d \ \ () rv l S C:z 0("0 V 1:' t120 -:ti.-/ / 3
Y'v\ ech CAn lC:;, ~)G\ V'q ~')p. ) JaSS-
7 d. ~ch Q rn /;u ,--:c) b II r(~ r j) .4f-+ k
(Street Address)
(~rat.tp15 ~8 fY) / 73:2S-
Executed in Register's Office
Sworn to or affirmed :'fd subscribed
before me this 3r day
ofJ.U.\~ ,dOO'8.
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 day
of
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths, Show date of expiration of Notary's Commission,)
FormRW~06 rev, 10,13-06
Hl05R05 REV (OlIO?)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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.
DEe 2 0 2 7
Fee for this certificate, $6.00
P 14079450
"'--...
!:':2
(~.::,'
03
<-
:t~~_~
~''7'-JoO
......-:.:....
H~I...3I1l[".IVltCI
f'.1'E/PMfT....
pt,..MEtt1
IIl.JlCr.MC
COMMONWEALTH OF PENNSYLVANIA' DEPAR"TMENT OF HEALT>1' VrTAL RECORDS
CERTFICATE OF DEATH
(See insuvctkKIs and eun"ptes on rever..)
I
<....1
" <~ )
T........O":""".,.,............!Iil6.I
Pezc L.
.........-
~i1'7
62
v"
i ~
.. C..,do..r.
CUIlOO rIa nd
n.~u....~ ....... ...De......
lCiNot..... ~tI......./.......".
truck Driver Trans rtation
.."i553"G1iii:="'G'~v":. t~d. Lot 113
Mech~nicsbur&. PA 17055
II. ,...\.... ...........,-.~
Carl Houck
"--,
_____~ 11.. 9N
17), c.ltf
Cumber 1 and
It, Ml:iIIM(~ .....(JftI. ...........~
11\ Idred Ct 11ial1
............ ......,.......CStw.IIty,............
201 Callpbell Road, Newport. PA 17074
tlCoAn..DliIp:tIiItIlI,.......(......II.,.~cr.....,. N.UnIbl~ItI.......$cMI'
f7c,~t'~l....
',40.....~U.~
......l.....
Monroe Twp.
....
"",-
Carder
Hollinser Crematory Mt. Holly Springs. PA
Coc.kli~ 'Punera! '0_. Inc.
30 N. Chescnut ~treet, D1 lsburg, PA 17019
n........ tftf~..,............... __........ ~.... _...s....-.""...........,
m.lt-.........
%Jr. 0...,..,.. ....... ,...,
=='~=~
~.._.....
=..=.;..~a
=-..:.=r. ":..."'"mt...
r........a
I""~"""'-:
: 0..." 0..
.
.
.-
.
.
.
.
.
.-
,
21. ....r..lWMWR-,..,...EMllMw/c-...~ ~ OIlefllWiC--.. DMMtrI
0'" aD'"
Plnltr...,.,....... 1 ~...... a.IH,...u.c........"~
....._....___...... 0'110 0-
O...~
Ill......
~--...-
0_......._
D ..._...__.._
..-
O_pIIIIIp*lf.tu...,.......,..,.,.,,...
-
0-.__........
*===-="'F~
.......-1
ZOO.7
d.
a._..~
-"
....w..~'...
~f'rbIDC""'"
flc..."~
0'110
0'" 0'"
~1.~o.tIII
~ U-
n.- 0'__
D- 0..........-..
Ji!Id r...,.....,
:
.;
; ~
..~
'~
J
*~P<<*...,~
. ~ ~~c.,.,c.-d.... ...,...,...,,..,......,........,ad.......~lMlnt
1iIi......fII..,~...~...,.......__..........."III'e... ._____ _..... ___~ ~.... _. _.. _.. _.. _ ____
~==.":::'~::~-::~~:..:.=............____. ..____ ___.... ~ 0
....... r...-,I ~
0110.. "'"" ef.~...,............. ill "" ..,................. ........,...... _,*"aM 1M ....~...._......... 0
PA J.r]o u"
r:wv..." ~..... ~l.
1IIr.__,_____,_....... 'R ..~.._..____..._..I__._...."',,"~~~-...,