HomeMy WebLinkAbout01-12-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF C hpi~p~,/ COUNTY, PENNSYLVANIA
Estate of mr re anec h/ OQ, O~I~O
-~ ~ ke
also known as File Number tSG/-t / V
,Deceased Social Security Number 3ZS - b~_ ~2Jf
--_ _%~~~~y zo~_
Petitioner(s), who is/are 18 years of age or older, apply(ies) foe --- -
(COMP/.ETG 'A' or 'B' BELOW:) l
A. Probate and Grant of Letters'pestameutary and aver that petitioner(s) is /are [he is er,tf p~ ~ fi=x Pd {y~ ~
last Will of [he Decedent dated ~~ I ~ I -zpp % 7c named in the
and codicil(s) dated
(State re(evanl eircurnstanees, eg-, rernmtiatian, death ofesecu[or, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of [he insllrtmen[(s) offered
for probate, was not [he victim of a killing and was never adjudicated an incapacitated person:
B. Grant of Letters of Administration
(/fapp(icab(e, enter: eLn.;d.b.n.af.a.; pendenteli(e; duran[e ¢bsentia; dumnte mirtori[nteJ
Petitioner(s) after a proper search has /have ascertained [hat Decedent left no Will and was survived by the following spouse (f any) and heirs: (hf
Adrninislratioa, c.ea. or db.mct. a., enter date of WiL[ b[ Section A above and complete List of heirs.) -
Name Relationshi
Residen rv
,~-]
'~-• [-
,_+
(COMPLETE IN ALL CASES:J Attach additional sheets ifnecessary. _ (+
^.
Decedent w+s do iicile at d Ih in ~ 'r% a
r
'M 2( z"~^ County, Pennsylvania wtth his /her last principal festd~~k5ee at '~ l
/List slr--eel adrb rx (orvn/cid~ mwnslup. ceun[y. scale, zip code) 17A1 ___. _._______-_ __~ -
t
Decedent, [hen q // l I V `s
~z years of age, died on I Jr O at (7L/__ /igr~' u~ ~ SP ~~ r
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) .411 personal property
(If no[ domiciled in PA) personal
(If no[ domiciled in PA)
Value oCreal estate in Pennsylvania
situated as
property m Pennsylvania
personal property in County
$ r ~
Farm RW-03 rce l0.1306
Page 1 of 2
Wherefore, Petifioner(s) respecttiilly request(s) the probate of the last WiII and Codicil(s) presented with this Petition and [he giant of Letters in the annm~.rinra v,...,, .,.
the undersigned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
~ SS
COUNTY OF ~1>„r~~s ~~ n
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hve and con~ect to the best of
[he 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 afG rrricd and subscribed
~ r~V' ~
before me the ~ ` day of
(k•4u~eee ~. -~C '~
CfA ~ ~~ftL
For the Register
U ~C.<.,C CCCd-s
Signnltve of Persona!
ajPersonnl Represenmtive
Signnrtu'e oJPersonn(Represertmtive
File Number ~j- O /- ~~
i-
Estate of L., YL~~,
r~~~~
Social Security Number- ~~ Date of
AND NOW,
having been presented efore ,IT
are hereby granted to __
and that the instrument(s) dated ~ -
described in the Petition be admitted to probate and filed of rerord a I c lost Wil (and
FEES J'~t}J
L
t c
e
ters ............... $
Short CertiScate(s) ........ $ ~~ W
----
Attorney Signature:
Renunciation(s) $ '
~~i ~~ _ . $- ~~ ~-- Attorney Name:
" $~
$
~ Supreme Court LD. No.:
__
-.
.. $
Address: _
$ _
TOTAL .............. $ • Telephone:
Form RW-0Z rev lU.l3.Oh
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foregoing Petition, satisfactory proof
:n the above estate
~~.
Page 2 of 2
OCAL REGISTRAR'S CERTIFICATION OF DEATH d~ 3U
WARNING: It is illegal to duplicate this copy by photostat or photograph„
Fee for )his certificate $6.00
P 15038063
Certification Number
HIOSIa]NFV 11/IVM
TYPE/PHWiIN
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3818 Hearthstone Road
Hill PA 17011
rE PameYa wmY lPpd. maa., MY.mm~l
Paul R
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Barbara J• Lis
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This is to cenil}~ that the information here given is
correctly copied from an original Certi Cicate of Death
duly filed with me as Local Registrar. The original
cer)ifi rlte stirill he forwarded to the Slate Vital
Records Office for peGrmanent filing.
Local Registrar Date Issued
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CERTIFICATE OF DEATH
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LF235.04
R235-04
LAST WILL AND TESTAMENT
BE ITpKNOWN that I, ~' M I ~- l E /~ , ~ ~ N j, C. t ; (_
~ll~ ~V 1 ~ ~ ~' /yCc.//Aty/$ Ci uQ C~ Y ~ U ,q,~ ~ t: 2 Lta N~ , a residentof
(7 ti., ,Count of , in the State of
(~~P(N S ~L VA Nth /7055'. being of sound mind, do make and declare this to be my Last Will and
Testament expressly revoking all my prior Wills and Codicils at any time made.
PERSONAL REPRESENTATIVE:
lappoint U/~~ P~A~~ -T ~ i S of.3~/~ N~1~2T/~ S/ONE ~Gr
~m /~ /f s L,L, /~q, / 7 0 !/ , as Personal Representative of [his my Last Will and Testament and
provide that if this Personal Representative is unable or unwilling to serve then I appoint
LiNp~ S C~~aD,trrNO of /os' /~/, 3b'_" STQF4
I'1 AQ IQ / 5 S ~ Q Ca P/~. ~7 / O y , as alternate Personal Representative. My
Personal Representative shal(be authorized to carry out all provisions of this Will and pay my just debts, obligations
and funeral expenses. i further provide my Personal Representative shall not be required to post surety bond in this
or any other jurisdiction, and direct that no expert appraisal be made of my estate unless required by law.
II. GUARDIAN:
In the event I shall die as the sole parent of minor children, then I appoint
as Guardian of said minor children. [f this named Guardian is
unable or unwilling [o serve, then I appoint
as alternate Guardian. ~ a
=0 :v
III. BEQUESTS: -.n c,
.~ ~,
c7 ~
I direct that after payment of all my just debts, my property be bequeathed in the manneP fol~ti~ing
__,.lC TV ;;,...
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~~+~~~ ~~~
J ~-- ,c.- - ~ J IN
~d~~~ ~ ~Lo.Ce,•-C,~ ---i~~,cw~~ 4.,~,.~ ~,1a-u~-e.~/
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Gi-~ ,mac ~~ U~~ ~~~c.¢- L -~-(~~ ~w C=~t.:~{G~r-~-~%
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Testator's Initials
Page of pages
Execute and attest before a notary.
Caution: Louisiana residents should consul[ an attorney before preparing a will.
19922IX71 Made GZ Products', Inc. Rev. 10/0l
Thie product does nol constitute the tendering of legal advice or services. This pmduct is inlcndeA for infin'mationul use only and is not u wbsli Wte for legal
advice. SLAV; lows vary, s'o wnsult an attorney on ull legal ma¢ere. This product wus no[ nuexsanly prepared Ay a pervun licensed to practice law in your state.
AKAK
IN ~W~I,T~N,/ESS WHEREOF, I have hereunto set my hand this /~ day of ~~' ~,51
O~ (year), [o this my Last Will and Testament.
Testator Signature
IV. WITNESSED:
The testator has signed this will at the end and on each other separate page, and has declared or signified
in our presence that it is his/her last will and testament, and in the presence of the testator and each other we have
hereunto subscribed our names this ~£j day of ~~~ y,ST~ , 20~~
6
~ fitness fig ature
~~ ~ ~~
Witness Signature
Jv~~ ~ c -~,r,
Addr . s
o (a ~~ e'S( ~~ ~9iv~.
C~ ~, ~t~/ "~ ~~~°~I
Address ~
WiNess Signature Address
ACKNOWLEDGMENT
Stateofl'~'NNS7L/pnl/%+
County ofCG~ w,Dl= R L/a h1 ~
we, Gj17/G/E ~~~i?~EC',LE IJ~?/~~-7L~ ~ /~TJ'~
and ~~/ S // S/l7/ /~ ,
the testator and the witnesses, respectively, whose names aze signed to [he attached and foregoing instrument, were
sworn and declared to the undersigned that the testator signed the instrument as his/her Last Will and that each of the
witnesses, the presence of the to rand each other, signed the will as a witness.
~~
Testator. Witness
dQ ~~~
Witness
Witness
~ ~~~~~ F"~i.
On ~~~~~ ~~y~~/-y~j before me, ~/~ ~ / ~° ~_,t
appeared /G/Ei// -1~~/VEC/~E 1l/~ir~ r~ .,'~/fJ/~ ~!7 LG~~s ~ //97/Tj
personally known to me (or proved to me or1'the basis of satisfactory evidence) to be the person(s) whose namely)
is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/hedtheir
authorized capacity(ies), and that by his/hedtheir signature(s) on the instrument the person(s), or the entity upon
behalf of which the person(s) acted, executed the instrument.
WITNESS my hand and official seal. /~
NOTARtAI SEAL
J MES E. GREEN, Notary Public
Camp Hill Bono, Cumberland County Page
PPK :u*nniission Expires June 6, 2009 ~
Affiant Known ~ Produced /ID
Type of ID,~V .~'~, ~r~ ~i4~
(Seal)
of pages