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HomeMy WebLinkAbout02-04-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~um~¢~~Q r~ `o - ,,~ II COUNTY, PENNSYLVANIA Estate of _ ~ (~(~ I YQ Y-~ ~j O ~ ^ ~~~ also known as File Number 7 // q ,Deceased Social Security Number/ ~ U ' ~fT7 - ~ J Petitioner(s), who is/are IS years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) 0 A. Probate and Gran[ of Letters Testamentary and aver that Petitioner(s) is /are the last Witl of the Decedent dated y - / / -~ / ~}9f~ h ~ I f ~ ~rned in [he -~_ and codicil(s) dated e _;~a .~ ~., fp ; ':,, (State relevant a}cums[ances. e.g., renunciation. death ofesea¢or, e(e.J T C ~ -1 r ' 7 Except as follows, Decedent did no[ marry, was no[ divorced, and did not have a child bum or adopted after execution of~~~ ~ r uJ for probate, was not the victim of a killing and was never adjudicated an incapacitated person:- ~ ~en[(s offered C:_. (~ ri ni B. Gran[ of Letters of Administration ~~ ~ <. m [-y (/fapplicnble,en[ec c. (. n.; d. b. n.cra.; p¢ndente lire; durnnte absentia; durnnre nrinm~itntej Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by [he following spouse (if any) and heirs: (/f Adniinis[ration. c. t. a. or 2 b.n.c[.a., enter dare of Wi!! in Section A above ¢nd complete list ojheirs.) Name Relationshi Residence (COMPLETE lNALL CASES:) A1[ach additimralI__l sGeets ifnecessary. Decedent was domiciled a[ each in ~ U Yrl (~' ~ Q r\~ County Pennsylvania with his /her last principal residence at _lD` t,~.~n~~z. [rCt~ ~srp 170/3 ((. uY street oddr'ra~s. lowu/citoy, townsh,p, count), state, aip code) ~-~`~'-~~ _ Decedent, [hen / ~~ years of age, died on /~- ~lG' - (~ b ~ ,t OC7 at PM 0.f u~VN OcQI~fE'S5 Decedent at death owned property with estimated values as follows: (If domiciled in PA) ~j~Ak cl ce. cunt` All personal property $ ~ O L7CJ. OU (If no[ domiciled in PA) Personal property in Pennsylvania (If not domiciled in PA) 5 Personal property in County $ Value of real estate in Pennsylvania n $ ___ situated as follows ~ ~s~ /Z ~ tt 1~ ~' Wherefore, Pe[i ~ioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in she appropriate form to the undersigned: cu name and residence h cP,Q~ ~3er,lo~s Keller- ~s~~ Shu ~~ zr,~ i Cac I(s~el p~~ /7~/s ~i ~~rr.bn Non r~ ~aFf C ~t ~~YiS/.~, c~>i / vw ~f V~ i7o~ 3 Furor R4V-p? rev-/0_(3.06 Page 1 oft Oath of Personal RepresenCative CONIYION4VEAL7H OF PfiNVSYL VANIA SS COUNLY OF ~ l.A Yv1~,1 ~ n ~.~ "The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hzie the knowledge and belief of Petitioner(s) and that, as personal representative(s) of tl1e Decedent, Petitioners administer th estate according to law. Sworn to or affirmed and subscribed before:. me the _~ _ day of For the Signature ofPers'ortnl Represerunti ve Signature afPersonnl Represervanve Signnture ofPersonnl Reprereruntive N 7 a n _ _ ' ~~ ~ f~ _` ~ W ` ~~ r :? ~'~ _ ~-br~ect to the bestm>: ] ~ ~ i ~i ~clland£dly ._ , 1..~ ~ N ~ '~ ~ ~ .. t0 File Number_ .L,~- ~G~~_ ~/~b/ Estate of ~ (~~(~ ~ ~«~-~-- //)~ )) / ,Deceased Social Security Number 71Y~'~CO -~j~~ " Date of Dcath: ~ / - ~~'- ~~ v .U /I AND NObV, r ~/- ~GU~ t co asideratio of the foregoing Peti tioq satisfactory proof having been present be ~ re me I IS DECRE that Letters ~~ T//IC1~/ are hereby granted to ((1 d LS / a ~ ~n~ t~}i // r io ~ (, v; ~. ~. i r'-'_ acid (hat the ins[rrnnent(s) d.tled __ SPQ~ described in the Petition be admitted to probate and filed FEES Letters .............. . 5_~~UU Short Certificate(s) ..... ... $ ,DO Renunciation(s) , . $ i $ lu`7. ~ C $ ~ O, "~ _ .. $~J.Ob $ _ 7orAL ........... .. ~ ,~~ ~ `~ O _ _ _ the last R%ill (d,u))d ~`C~nod~^ic~,il '~ ~WV tYJI Attorney Signature: Attorney Name: Supreme Court LD. No.: Address: Telephone: wars in the above estate Form RVK03 rev. 10.13.05 Pabe 2 of 2 ~~- iii LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fce for this ccrtificntc. $6.U0 P 14999809 Certification Number X1XE~1<9 qEV I VA.'6 tvPEr Fgwr lx PEWMNEM BIAp(INX 1. wlYmo.wY„I~ ,ma., ml. Yln•I ~- fi<celuamM,ory Ida Eliza t IAgw1 Wy 9 5 4i Vn BE.CMIYWLbeN fie.' &N.TR.WP Cumberland Carli n.paMV.IwX IY awn Brxe wmawne r rcMeawwl Kmaso Hous wif - IB.oxuBenr.ewEwemY.lsl..l.mrm.~l.~.l•.roo+tl.l ~ 1000 West South Street .,~ Carlisle pa, 0 Ifl F•mereNmreIEIM. MOUe. Xet wlfip 0 m.. Imoolur. Mw nw r F.Xp Vern zl.. MemmaoXpwfiu, ~ ^ fiMa' ^ Pemxtl M1rm Beb ^ oB.r~sprmy y 3 = zza sMwnwFm.nlsmy'imm°In YY~~ ii' 'I~hix is to cerlily Ihal the informulion here given is eorrecdy copied Gum an original Certificate of Dea[h duly piled Ta~ilh nu• ..u Local Registrar. The original certi l7cu(c will be Forwarded to the S[u(c Vital Kecords Office tilt penuanem filing. ~_~. R~~K~,~_~ x i 2ooa Local Registrar Dale Issued ~~ fir -i7 ~~~ c~g© U~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS CERTIFICATE OF DEATH (Sea inatruo[lona ens exemplea on reverse) STATE FILE NOM6Eq 1.Sn aSwrelSwlhwnax aoele aoaem lM B. oeMa XMn (MmlB.nw,...~ ...__ ._. 160 - 16 - 5575 .. _-. Jun=_ 28, 1913 ~' PoFaJYr WnefMmA M1aI sle Sarah A. 11x eBX Pa. 1m coq (`nmhprl r1 Nov, 1g 58 "°Plu'wemeBeeR ~ aooo pM I•wlo,. YV w, Ito Z rU (^ 8 raµleElay r~Ilq~w~wAlwyra MM~µ'Imn-~~•A veweM4rA WNbF~~mYW ennMar,AY aW wsl. ~ N4e~ Mlwn mYXS InnN9 MaMI~Y~ +~am ~hY. WlnryTmMmeXh Ye. RYIbMP -- 'R~No ~wm.aBOl.,nem, n f °~ ~V~ X IXItlm Xk.. YX~puFryAXLY~[p yyllglE~ Oueblo'Ye ttne:plmy al: whInNAAntlnM~lA9i. Ougp(vuewruwumy q. e wmn, FewM loan Mrl tll 1.. MaIIW 9WU'. Myiye. 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