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HomeMy WebLinkAbout07-08-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF COUNTY, PENNSYLVANIA Estate of '~~ JV~ ~ ~ 1-{~/ ~i1 S ~ ~ T ~ File Number ~~ C O ~~,~ also known as ,Deceased Social Security Number 119 ~ - 7 ©- as 3 S /Jo „ c vvtb e r l S ~~ c 3 Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (~C,{O,NIPLETE 'A' or 'B' BELOW:) IJ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the named in the last 'vVill of the Decedent dated and codicil(s) dated (State releva~tt circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child bom 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: Q B. Grant of Letters of Administrate (Ijapp[icable, ewer. c.t.a., d.b.n.c.t.n.; pendente lire; durante absentin; durante minoritate) ~3•~~ s (CO.NIPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in \+' ~t? wQ~ • County, Pennsylvania with rs her last principal residence at ~ y~ (. .Mt a. o~ a ws ~ . N ~ w y 1 l \-C ~ fl t -7 ~ c( 1 (List street nddress, town/city, township, county, state, zip code) ~cv3 Decedent, then ~_ years of age, died on ~~ at n ~ ~ ~ r .jam ~ ' Decedent at death owned property with estimated values as follows: ~ ~ V ~ .-~'tT ~ ` t ',i r' - (If domiciled in PA) All personal property I ~ , ~.% 3 ~ - 7 ~ ~p - t (If not domiciled in PA) Personal property in Pennsylvania . ', $ ; ~ r. C: ~° ---~ (If not domiciled in PA) Personal property in County ''~~`~ Z -- Value of real estate in Pennsylvania D ~ _J , , ~- C!i situated as follows: (V 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: Sienature Tvoed or printed name and residence • ~ ~~ ~~~~ Form RW-02 ren. 10.13.06 Page 1 Of 2 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: (lf Adtrtittistratiott, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~ l~l..Wf b-~~' (a.v~c~ 'The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and con~ect to the best of the 9cnowledge 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 affirmed and subscribed before me the ~~`1 day of ~ o~-L ~` ~ C ~^ \ For the Register `~ Signature ojPerso~tal Representative r~.s n c°~ Signature of Personal Representative ; .~~ -"S'~ ~ ~~T~ i"' t ::_t Signature of Personal Representative ~~ ~ ~~~•t7 ..~+~- I, :c= File Number: ~\ V~ v~~~ Estate of ~ t ~'1 ti ~ 1~(~ ~~ ,Deceased ~ ~ `: .t -_ _ .__ ~ ' f.11 N Social Security Number: 1 ~Q~ r~~ C~~}O~'~~j Date of Death:_~ ~S ~ L.~ AND NOW, Jul ~~ , in consid a 'on of th fore oing Petition, satisfactory proof having been presented before me, h(T ,DEC ED th\at,~etters ~ IY1~ ,n are hereby granted to 1 \~'rt ~~' l~~ 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 d Codicil(s)) of Decedent. FEES ~ _~~ l~ Register of Wills Letters ....... ~.~.,~!^~.. $ Short Certificate(s) .. !..... $_ ~,o Attorney Signature: Renunciation ) .......... $ $ Attorney Name: . • • $_~ Supreme Court LD. No.: ... $ $ Address: ... $ ... $ ... $ • • • $ Telephone: ... $ TOTAL .............. $ For,n RW-0? rev. /0.!3.06 Page 2 of 2 EPARTMENT OF THE ARMY REPORT OF CASUALTY ALEXANDRIA, VIRGINIA REPORT CONTROL SYSTEM 22331-0481 DD-P&R(AR)1664 1. REPORT NUMBER 2. REPORT TYPE 3. DATE PREPARED 03-04330 Final Report 21 Nov 2003 4. SERVICE IDENTIFICATION a. NAME (Last, First, Middle and Suffix) b. SOCIAL SECURITY NUMBER c. GRADE/RANKIRATE d. OCCUPATION CODE Hayslett, Timothy Lawrence 164-70-2235 SGT 19K20 e. COMPONENT f. BRANCH g. ORGANIZATION Regular USA HHC 1 st Battalion 37th Armor, APO AE 09081 5. CASUALTY INFORMATION a. TYPE b. STATUS c. CATEGORY tl. DATE OF CASUALTY e. PLACE OF CASUALTY Hostile Deceased KIA 15 Nov 2003 Baghdad, Iraq f. CAUSE AND CIRCUMSTANCES Hostile Action: Explosion. g. DUTY STATUS Active - On Duty h. FLIGHT STATUS Not Applicable i. BODY RECOVERED Yes 6. BACKGROUND INFORMATION a. BATE OF BIRTH h. PLACE OF BIRTH c. COUNTRY OF CITIZENSHIP 17 May 1977 Winston Salem, NC United States d. RACE e. ETHNICITY f. SFY g. RELlG70U5 PREFERENCE White Other Male Baptist Churches 7. ACTIVE DUTY INFORMATION a. PLACE OF ENTRY b. DATE OF ENTRY c. HOME OF RECORD AT TIME OF ENTRY N/A OS Jan 1998 Newville, PA d. DATE TOUR COMMENCED e. PRIOR SERVICE INFORMATION f. RECORD OF EMERGENCY DATA FORM DATE N/A N/A 10 Ju12001 S. PAY INFORMATION a. PAY GRADE b. BASIC PAY c. INCENTIVE/ADDITIONAL PAY (State type) HaZa)-BOAS Dllty pay $225,Q0 E - 5 $1,903.50 9. INTERESTED PERSONS (Nance, Address, and Relationship) Kori L. Hayslett, 165 Pine Lane, Barnesville, OH 43713-1430 (Wife 1, 2, 3/SGLI-100°/D) Gracy Hayslett, address same as above (Daughter) Kaitlyn Novick, c/o Ms. Kara Broug, 5 Mount Rock Road, Newville, PA 17241-9414 (Daughter) Guy L. and Mary Hayslett, 481 Meadows Road, Newville, PA 17241-8734 (Parents) 10. REMARKS (Coutinue on separate skeet if necessary) "OPERATION IRAQI FREEDOM" ra C~ ~ C© ~ ~ , ~... `?~~ rte- i; .-, f `J "1'I ~ ..? C - -' ~ FOOTNOTES FOR ITEMS 9 AND 10 ~~ ~ -'-1 ~ l d +~ 1. Atlult next of kin. ~ [ _ 2. Beneficiary for gratuity pay in the evert there is no surviving spouse or child - as designated on record of emergency tlata. ~ ~ " 3. Beneficiary far unpaid pay and allowances - as designated on recoN of emergency data. 11. REPORTING INFORMATION a. COMMAND AGENCY b. DATE RECEIVED c. REPORT FOR VA TO FOLLOW CDR 3d A1~RCOM, Kuwait, APO AE 09304 15 Nov 2003 No I2. DISTRIBUTION 13. SIGNATURE ELEMENT KNOX BY ORDER OF THE SECRETARY OF THE ARMY: MEADE / ' 1 W / "~~ NOTE: This form may be used to facilitate the casning of botxl5, the payment of commercial insurance, or in the settlement of an other claim in which root of death is re wired. DD Form 130(1, MAY 2000 Previous editions are o6snlete