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PETITION FOR PROBA TE AND GRANT OF LETTERS
REGISTER OF WILLS OF
COUNTY, PENNSYL V ANL~
Est~te LJf~~~ \ ^ N
also known ~,
\
~ (\1\... \ 'ER-
File Number
).\
015 ()'1SI
, Deceased
Social Security Number I 5' q - S /)- 45;;;) I
Petitioner(sL \\ho is/are 18 ye~rs of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o .-\. Proh:tk :tnd Crant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Lkced<:nt dated and codicil(s) dated
named in the
(State relevant circumstances. e.g., renunciation. dealh 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:
~B. Grant of Letters of Administration
(If applicable, enter: c.t.a.; db.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 of Will in Section A above and complete list of heirs.)
C
'R\.l ~~'S C l\
Name
M.-1 \ l [. fZ-
\='
Relationship
\-..tl1-
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in tv...", b (R 'Al\\ ~ County, Pennsylvania with his / her last principal residence at
.
(List street address. townlcity, township, county, state, zip code)
Decedent, then t../ S-
years of age, died on j/-').S-;;,M'i at d.. ~d- .stAtE st. EASt- Pc~}}:5bDf.u
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
$dOD
$~-O
$ -'-::0
':'
$ .~:CQ
i"<l
c::z,
?is
b..
-0
-u
'c;. ,'-n
(jC; ~.:-:: f'\)
situated as follows: '. .-, W ':r:
'- f )_. -, . ,--
", ....")
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant off..;et.t~~nllte appr~ate fm-into
the undersigned: __ ~ -
c
~U
.J.-~
Ty ed or printed name and residence
Rvc;st.l \ A, tJ\-1 \\€~ ~~A lfMA~
For'" RW-02 reI' /0./3.06
Page lof2
Oath of Personal Representative
COMrvlONWEALTH UF PENNSYLVANIA
SS
COUNT)' orC '-', "" 'b~R.tA\J ~
The Pelitl<;l1er( \ I abu\ e-!u:neJ s\\ earts) or a ffirm(s) that the statements in the foregoing Petition are true and conect to the best of
the fdW\A !ed~e ~Ild belief of Petitioner(s i and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the :;).. J
"Rw Gsell It
Signature of Personal Representative
M 111e.('
day of
Sigmlture of Personal Representative
Signature of Personal Representative
Estate of \3 p., \ P-- 0 'D .[\1\-, \ \ G L-
Social Security Number: t ~ q - 50 -1..\-5 d- \
AND NOW, ~ \ 1.3 , 2.d>'R'
having been presented before me, IT IS DECREED that Letters
are hereby granted to ~1AS.'Se II A M \ (lfr
File Number:
2.1 025' 6Y,~-7
, Deceased
Date of Death:
/l-J,5-;;AOD,/
, i~sideratiou of troregOing Petition, satisfactory proof
ffi( \'\. ",\-reA:: (J f\.....'
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed ofrecor
FEES
IDO
Letters ....,..."..,.. $
Shon Certificate(s) . . J. . . , . $
Renunciation(s) .......... $
~tD ~
$
$
$
$
$
$
$
TOTAL ....,....,.... $
Forlll R W-02 rev 10.13.06
~D
'i
;'f
Attomey Signature:
Attorney Name:
I D
5"
Supreme Court I.D, No.:
Address:
Telephone:
3~
Page 2 of2
1<.1'\
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph\"-;
Fee for this certificate. S6.()()
Certificatint1 Number
#{~"/OFP~,._
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l,;~W~';m /,
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............'"c U JI"! t:.r.;> ;/'......-,,'
~~0flm~J L' I'R~' ~
oca' cglstrar'
This is to certify that the information here ~iven is
correctly copied from an original Certificate (~f Death
duly filed with me as Local Registrar. The uri}!lI1al
certificate will be forwarded to the State ~ ital
Records Office for permanent filing.
r
P 13895629
1t:X /5 /~?
Date bSllcd
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions and examplas on reverse)
104 REV 1112006
E / PfllNT IN
RMANEIlT
lAC~ INK
D
Miller
6.OItodllOl1h(_.dIl. ,,'
Oct. 28. 1962
2'r1a 7
Harrisburg, PA
80. Ccunoy d Oodl
Cumberland
Id.FICilyNomoII ""_gNO_andnumbor)
232 State Street
11.OIoecIertlUlull lI'lOItol IiII.Conal'"
Mechan~"'- Auto"1-1a~=nce
. '~~t:l:Sr:"'cily/-'_Zip-1
. Enola, PA 17025
ItF_'-JFiool,_l"!'._
Russell A. Miller, Jr.
200._,f9mo{f)llOIPm)
Russell A. Miller,
12. WaI 0Ic8dInl ever in ..
U.S._F_l
DYes Q9No
-.r.
AcUI ReIidIncI 17.. SIIit
'1b. eo.ny
Pa
Cunber land
~~ 17cDtV..._lMd~ tJp!':t F.<lirvipw
T_1 17d.o",_lMd_
_LmIId
r.
CIr'-
1I._.NomoIFnl.___1
Patricia ers
2I>>~'llaiinQ_l_cilyl-'_.Zip_)
oL4 Lemar Avenue, Harrisburg,
2'cP\oco"'~INomo"'_._"_"""1
Churchville Cemetery
PA 17112 .
21" LocIIbl (Clyl-' _. Zip~
Oberlin, PA 17113
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___bl~"'_ 24.T_"'00dl 2S.DoIo_Oood(Uonll.cIay.yoor)
....__ UNKNOWN M. December 1. 2007
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FACKLER-WlEDEH\N ru, 23rd & Derry Sts, Harrisburg, PA 17104
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