HomeMy WebLinkAbout02-18-09PETITION FOR P OBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~~~~i~~__ COUNTY, PENNSYLVANIA
Estate of Jr7 I/T// /~' rG E/NE't r~.Q
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CO,YIPLETE 'A' or 'B' BELOW:)
File Number ~/' U / - ~~/
Social Security Number
-/2-3soc~
^ A. Probate and Grant oC Letters Testamentary and aver [ha[ Petitioner(s) is /are the
last Will of the Decedent dated and codicil(s) dated
named in the
(State relevmv circwnsmrtces, e.g., renurzcia(ion, death of eseculor, e1c.J
Except as follows, Decedent did no[ marry, was not divorced, and did not have a child born or adopted after execution of the insntimen[(s) offered
for probate, was not [he victim of a killing and was never adjudicated an incapacitated person:
d. Crant of Letters o[
(lfapplicabfe, erzter.' c.Ca; d.b-n.c.ea., pendente Lte; durmue nbsentia; durmve muroritate)
Petitioner(s) after a proper search has /have ascertained [ha[ Decedent left no Will and was survived by [he following spouse (if any) and heirs: (/f
Adrninistraliort,ct.a.ord.b.n.c1.¢., enter date of Wil(in SectionAabove attd complete lis(ofheirs.)
Decedent was domiciled at death in Ui'r1
~ S, 3lvTN 3T ~~~^ County, Pennsylvania with his /her last principal residence at
!A~lA / /LG p 7a//
sr street nddre~~a'. [orvn/city, township, counh~, state, zip code)
Decedent, then g1 years of age, died on O/ 2¢~oq at /~7Hn/OI? CA2~
/JU,QS/,t/ NLVIIE C L AMO N [.L
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property OU
(If no[ domiciled in PA $_ /~~~ UDU,
) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania ~
sihtated as
Form RVKO? rev. (0.13.06
Page 1 of 2
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Wherefore, Petitioner(s) respec[fiilly request(s) [he probate of the last Will and Codicil(s) presented with this Petition and the giant of Letters in the appropriate form to
the undersigned:
6 %- /7~
Oath of Personal Representative
COMMONWEALTH OF PEiVNSYLVANIA
SS
COUNTY OF .(1~;„~
'rhe Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are Uve and con~ect 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 [o law.
Sworn to or affirmed and subscribed
l~
befo~rte me tl:e / ~ day of
mersnrure aJ Yersonnl Representntive
Signaxve of Persara! Representative
File rN7~um`be1r,_ ~/' (/ ~-/ J/
Estate of ~I`~~ ~
ti ~t'r/lPG' ~E v~ ,Deceased
Social Security
.4ND NOW, ~~'~Q !CJ/tl,/l
having been presented before me, IT
are hereby granted to
- ~ ~ ~ (~- `~'~ Date of Death:,(jI ~ y 2(X.> j
that Letters
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as
last W iIL (and
FEES ~"l / n nnif/l
Letters ...1 ~Qt dt U . $ o(CD ~ _~
6~~
Short Certificate(s) ..~.~. $ Attorney Signature:
Renunciation(s) .......... $
(~7 . , $ ~~ Attorney Name:
-~ ' ' ' $ `
S
- Supreme Court LD. No.:
. , $ Address:
$
Telephone:
TOTAL .............. $ o~'1~I ~-
in the above estate
Register
foregoing Petition, satisfactory proof
of
Form R4K01 riv /0_!3.06
Page 2 of 2
C9_/~%
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ I~ee for Ihia certificate. k6.00
I P 1502818__
Ccrli flcation Number
I TEV 112gOfi
PRINS IN
(ANENT
:N INN
Thi,v is to certify that the inlbrma;ion hem given is
correctly copied Rom an original Certificate o(Dea[h
duly filed with me as Local (tegintrar. ThL, original
cerlifinrte will he forwarded to the Slide Vital
Records OI'lice lirr permanem fling.
p-~ JANNNNN~2009~__
Local Rgith'ar ~ Date IsscLed
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Sea Instruc~lons end examples on reverse) STATE FILE NUMBER
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