HomeMy WebLinkAbout03-19-09R
LVANIA
al- 09- oa7D
Estate of~jz ~lU~ / t ~ J~ fjR/S p.yl File Number fj
also known as
,Deceased Social Security Number I 1 ~~ ` y Z '.Z 3 9'~__
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
^ A. Probate and Crant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of [he Decedent dated named in [he
and codicil(s) dated n a
(State re(evmrf circumstances, e.g., renunciation, death of executor, etc.) `:7 ~_, r-- ~ __ -C7
. ~, rm _
Except as follows, Decedent did no[ marry, was not divorced, and did not have a child born or ado tad after axe [bYi' e~Rhe ms ~I. ~
P Fbt ~men[(s}oFfe~d
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: --;~j `:~ has t- ~.?
Lr[f B. Grant of Letters of Administration
i>
(/fnpplicable, erzter' u(. n.; d. b. n.eta.: pendente lite;dw-ante absentia; dw~mne nrina,~MC1e)
Petitioner(s) after a proper search has /have ascetYained [hat Decedent left no Will and was survived by [he following spouse j if any) and heirs (!f
Adrrrinistratiou,e.t.a.ord.b.n.c.f.a.,enter date of Will in SecfionAabove and complete /isf ofheirs)
PETITION FOR PR11O~B~A~TE AND GRANT OF LETTERS
EGISTER OF WILLS OF l.(A ~~~ COUNTY PENNSY
(COMPLETE LtV ALL CASES:) Atrac~hladditiana[ shete~ts if reecessary.
Decedent was domiciled at death in L U M ~P~47 /1 C(( County, Pennsylvania with his /her last principal residence atl
/ ~ At~t y _ _
(Lis[ sn'ee[ nddras4 [own/city, township, county, slate, zip code)
` ~~ occy s r, .
Decedent, then ,'~-'~i__ years of age, died on 3 )t a[ SE 1 t("T S ~EC a ~ LT~I'~os}l +g (,1 e Ppda ~i I I.
Decedent at death owned property with estimated values as follows: n Y
(If domiciled in PA) All personal property g d 7 /, ~~
([f no[ domiciled in PA) Personal property in Pennsylvania g
(If no[ domiciled in PA) Personal property in County S
Value oP real estate in Penosylvania „
situated as
Fm-rn RVV-02 rev. 10.13.06
Page 1 of 2
Wheretbie, Peti tionei(s) respectfully request(s) the probate of tl[e last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
.~~~
Oti -ago
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF (A.(.I1L(J[,ti,(2,(~t
The Petitioner(s) above-named swear(s) or affin
the knowledge and belief of Petitioner(s) and that, a:
administer the estate according to law.
Sworn to or affirme~d -a~ndj subscribed
before me the ~ day of
~~
Signature of Personn(Represenralive
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'LyrtheRe islet
g S~gnahre of Persona(Representative
Fi]eNr/u er: OL~" OGCAlJ p?~V
Estate of--__~:5/fir/// L~j~/Q/~~/~ Deceased
SocialSecuri Number._/_L/-r~'dy7J~j`~~,j, Date ofDeath:~~~~ ~~ p~OU/
AND NOW, ~~ IXW / in nsidemtion of th~e oregoing Petition, satisfactory proof
having been presented before me, IT IS DEC ED that Letters ~n"~
are hereby granted to /~ S~yJ
jjj~'~~~` in [he above estate
and that the instrument(s) dated
described in [he Petition be admitted to probate and filed of record as [ e a t Wi~(and Cod' il(s)) of De nt.
FEES
Letters ............... i ~ Register of 4
Short Certificate(s) ........ $ r ~ Attomey Signature: ~
Renunciation(s) ...... $
$ ; ~ Attomey Name: -
~' ' $ s Supreme Court LD. No.:
.. $
$ ~ Address:
.. $
.. $
.. $
.$
$ Te]ephone:
TOTAL .............. $
Form RW-02 rev. /0.!3.06 Page 2 of 2 ~
~ , ,.
P 152167_..
Cel7ifiadum Number
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for Ihic cel7ificala $6.00
,Ilmu, HEV rvrzaz
ttPE: pHnrt IN
PFHAIANEHI
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This is to rerrily that the inlbnnation here given is
correctly copied Rum an orieinal Ceai'l~icate of Death
duly lilcd wish nlc a,q Loral Rcgist ral. Thc• original
celTilieam will be f~:>rn~arded to th'~ Sulte Vrtal
Records OlTice for permanent filing.
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Local RegislrH Dare Issued
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL flE00flOS
CERTIFICATE OF DEATH
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