HomeMy WebLinkAbout11-14-08PETITION FOR PROBATE AND11 GRANT OF LETTERS
REGISTER OF WILLS OF C_u /bl~n~n ~ a. ~d COUNTY, PENNSYLVANIA
Estate of ~.J ~1 t e~
also knownlas W ~ ~I
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i 2~ ~ fit'.' . ~ ~ ~ ~ ~ o.Mn.. .Deceased
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File Number ~ ` ~~ ~~~~`1
Petitioner(s) ater 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 W'il[ in Section A above and complete list ofhelrs.)
Social Security Number ~~ 3 - 5 T- ~ 023 1
\ ~ T~
Petitioner(s), who is/are 1 S years of age or older, apply(ies) for:
(COMPLETIs 'A' or 'B' BELOW:)
^ A. Probate and Grant of Letters Testamentary and aver that Petitioners} is /are the ~,~ named in the
last Will of the Decedent dated and codicil(s) dated ~ o ~ s `-;
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) ' ; m "' '
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiod:pfxh~-ir;strun~pt(s) offered.~s
„4-} '~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
~~ .. -. _
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}„~ B. Grant of Letters of Administration m
( (Tfapplicable, enter: e.t.a.; d. b. n. c. t. a.; pendente lice; durante absentia; durante ininoritate)
rs ~
Decedent was domiciled at death in ~ ~ /~1 County, Pennsylvania with his /her last principal residence at
z 4 a., ~ i i, vac'
(List street address, town/ ,township. countti~, state, zip code) ~-~~~,~~ ~
~ D~cede~~nt, then 5 5 year ~ f~age, died on ~2~~-`=~1~~Q~at o~421 {eo ~ ~ ; ,,mac ~~ 1 ~ ~~
.1.~D~esce~de_nt at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ a~.~'~• O o
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania
situated as folio
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 undersil;ned:
~,~
(COMPLE'TE W ALL CASES:) Anach additional sheets if necessary.
Form RW-01 rev. 10.13.06 Pa~Te ~ of
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OP '~v~n~~r ~a~
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
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ~ ~ day of
~ci<;v' ~~C"~4J`i2 i ~` ~~
~~~~ ` ~ i
r the Register
Signature of Persona! Representative
Signature ofPersvnal Represendative
File Number: ~ ~ ~ s,~ ~ ~~
Estate of ~--~1~~~ ~'='~~'nSo~~
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Deceased
Social Security Number: `~~3 `~ y ~ ~3~ Date of Death:_~~~~~~~ ~~ ~-
AND TJOW, 'i'~ _ .(`(~~(~ ~~ , in consider tia 'on of the foregoing Petition, satisfactory proof
having been presented before me, [T IS DECREE at etters m\r ~S C`'1
are hereby granted to ~~~~ ~~~~ ~ e ~~`C-~
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 Witl (and Codicil(s)) of Decedent.
FEES
Letters ... ~1~5~', .. , $ ..~C~
Short Certificate(s) ...~? ... $ a~
Renunciation(s) .......... $
`~.~~~ ... $ s
$
...
.. $
.
... $
... $
... $
... $
... $
TOTAL .............. $ ~~~ 0
Attorney Signature:
Attorney Name:
Supreme Court t.D. No.:
Address:
Telephone:
Fern Rw-o2 rev. 10.13.06 Page 2 of 2
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LOC/~~w REGlSTR~,R'S C~R`~'~~ll '~Tl~~tV O~ ~~~TR
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See instructions and examples on reverse) ~..r~ <„ ~ ,,,,,,,,,.,, ~ \ (ti ~ (I 2u
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1. Nua d Deadaa (First. midM. mu. w16z1 2. Sea 3. Social Secunly Nanbu 4. Date d Deem (Mmm, my, yea)
William R Schmiedin ~ Male 443 - - September 11, 2008
5. Aqe (Last ekmaay) undw t llrabr 1 m 6. Date d BIM (Mwm. eul 7. C' ut0 etas a ~ aaaa ) Be. Pba d Deem Knack ana)
55 tawww an rba. 1lospaal: Omer.
yn November 19, 1952 Houston TX ^lnpatbm ^ER/Outpatied ^DOA ^Nasirg Ylaa Residence ^gner. Speary:
SD. Caaay d beam &. Ciry, Born, wP. 1 beam 8a. Faday Nunn (N rat kw0lWOn. pva seeel erq nn~ B. Wes Deamd d Hispanic Orpm7 ®No ^ Yes to. Raa: Amerlan kxtian, Black, Wtab, uc.
Cumberland Upper Allen (q yes. wedhi CuMn, I~al')
2421 Rollin Hills Drive Meaicarl, Puerb l4can, etc.)
11. DaemnYS lkual aeon KaM d work done da' moo d ~ kle. Oo riot state rear 12. Wes Deamd aver ro me i3. Deaded'e Eduatlon (Seedy say ngMU Breen wrrobteat 1/. Muibt 9Ma: Monied, Nava Marred, r5. SawWp Spouse (N wen, Pre maiden rnrn)
NkW d Nlak Knd d Banes / Ydu4ry U.S. Armed Fomes7 Elementary / Seca,mry (612) CoNeBe (1 J a S.) Yfaka~red. Ohvaced (Seedy)
~~ of ^ra ~° 4 married Susan Klick
IB. Decemd's Maakq Address (Basel, rnY / roan, slate, zp Deist Decedenra Did Decamd
2421 Rolling Hi11S Drive r
Aceul Resabnce 17a. state Un lire Ina 17c. ~ Ya, Daemn, lived ~ ~4-rTr.~r Al1~n Twp
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Mechanicsbur PA 17055 na.[]No,Daaea,tla,eawiwn
17o.County CumY3PrlaTlf~
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1B. FaNler'c Name IFru. rtiidde, Wt, wNal 1B. MoNbr'a Name (Piro, middle, maidn aware)
William Robinson Schmiedin
20a. InlartNnYs Name (Type 1 Pdnq 20b. YNamenYS MaknB Address (StraaL rnY / bwn, qab, zip aide)
Susan Raick 1 11' H'll 'v Mechanicsburg, PA 17055
21a. McNnd a Disposition ~Cremetlon ^ Dalemn 21b. Dale d Dapailron (Homo, my, year) 21c. Pbca d Dapoaim (Name d
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RENUNCIATION _ ~, ~ ~,
~,-
- - . ~_~,
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REGISTER OF WILLS r-~~:-~
,;~::~
COUNTY, PENNSYLVANIA _.%~
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Estate of w > > ~
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Deceased
in my capacity/relationship as
(Print Name) _~
~~a, ~ ~ ~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~~s~~
(Date)
_-~- ~~..
(Sign(ature) ~ t
(Street Address) ~
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
befare me this day
of
Deputy for Register of Wills
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~or the
purpo es s at d within on this ~_ day
Notary Public
My Commission Expires: i ~/y~~Cl~ ~
(Signatwe and Seal of Nntar~ or other ofFCial qualified to
administer oaths. Show date of expiration of Notary's Commission.)
_\
Form RW-06 rev. 10.13.06