HomeMy WebLinkAbout07-10-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF COUi~tTY, PEA"SYLVANI
Estate of `-~~aa ~ m ~ ~t~c1~.16~. File Number ~ ~ L' C~ C'h`f
also known as nn ~~ // ( /
,Deceased Social Security Number o~.yl=~~~ 6:. 2--3 ~ 7"
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COrtiIPLETE 'A' or 'B' BELOW:) ~
-,
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the c Y ~~named to the-.
last Will of the Decedent dated and codicil(s) dated _ ~ • }
__~~ ,-v
_. ~ _?
(State reievmU circumstances, e.g., renunciation, death of executor, etc.) _ r ~ ~ -; y
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the~istl~tment(-s~`offetefl ~ i .,
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ ~
-~ N
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B. Grant of Letters of Administration
(lJappiicnble, enter: c.Ca.; d.b.n.c.t.a.; pendente liter durante absentia; durmite ntinoritnte)
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(COMPLETE IN ALL CASES:) Attach additional sheets(i~f necessary.
Decedent was domicti~led at death in ~u rv.~-tn.~-Pn, 2~ County, Pennsylvania with his her last principal residence at
ZZC: t- E ~cVP'z- Q~w~,- Dee. ~Rr~P N~t_.L; ~~ 1~6 ~ 1
(List street address, torva/city, township, county, state, zip code)
_ ~2-GC.7 ~'1
Decedent, then i ~ years of age, died on ~~ -~ ~^~~t at '~Y~~ ~ , 5 ~ ~ ,
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ Z y, C> O ~
(If not domiciled in PA) Personal property in Pennsylvania $ c~ ~; <>
(If not domiciled in PA) Personal property in County $- o c~ c
Value of real estate in Pennsylvania $~; ~ c• J
situated as follows:
~~I
7~
~-}oi
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/'
Form RW-01 rev. 10.13.06
Page 1 of 2
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Petitioner(s) after 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. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
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 undersigned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tine 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 to law.
Sworn to or affirme/d~and subscribed
before me the /'•~ day of
.._- ~ 2~~
/C
For the Register
of Personal epres(:~ewtive.~ ~ ~~?
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ojPersona! Re~reset'tative t ~ tr.
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File Number: a t` ~ ~, ~ ~ ~~ ~~-' ~-,7 ~ ,':- ~; ~ .
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Estate of ~ t~Q t~' C~
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,Deceased N
Social Security Number:~~~ ta? ~ ?- •...~~~ ~ Date of Death: ~L~~ '~
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AND NOW
onsideratio
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of the foregoing Petition, satisfactory proof
,
at Letters
t
RE
IT IS DEC
re me
ted bef
se
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are hereby granted to ~ `~ --
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in the above estate
and that the instruments dated
described in the Petition be admitted to probate and filed of record as the last Will ( d Codicil(s)~j o Decedent.
'~ ~ ~ _ _ 1,~ .. ~C ., _ ,-. ~ ~ _... ~~ ~i . ~1. ,
FEES ~ /`tc L~ ir,,,,9~t ~v_
Letters .... ~.~ 1 ~~ ... $ CP Q
Short Certificate(s) ... ~. .. $ Attorney Signature:
Renw~ciation(s) ........
~•~ ~~, .. $
~ ~
Attorney Name:
$
~ . .. $ ~ Supreme Court LD. No.:
. .. $
Address:
$
. .. $
. .. $
. .. $
• • • $ Telephone:
. .. $
TOTAL ...........
... $ n
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Register of Wills
F~,„~ aw-o? rev. lo.lj.or Page 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF CEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.. ,
Fee lin this rertii~i~.,tc. 56.!1(1
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Certili.~atiLYr~ Number
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS {V
CORONER'S CERTIFICATE OF DEATH yy {~ / I ~s j
(See Instructions and examples on reverse) STATE FILE NUMBER J \ / ! ~ L l ``y({ `~
1. Name a Decatlam IFtrst. mtlae. lass. saga) 2. Sea 3. Sow! Securlry NaMer a. Dab d Dean (Homo. hY. Ywl _
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5. Age (Last &MhVI Under 1 year INIGer 1 Gay 8. Data d BiM IMOnm, hY. Year) 1 BumDlace ICIry arM wb a la coanryl 9a. Place d Deam (CMnx Dory anal
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Items 242fi mua h conlplela0 oy person
,' waapanarceaaeam 5:00 A. M. July 3, 2009 ~YB3 ^"°
CAUSE OF DEATH (SN ImaruetbM And AaampNS) , Appoasnab axone: Pan II: Enter oma =^^c^•a^• mndnor~ cas•~±=~ena m Ee~m„
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respeawry arrest. a verurcJar Mrxlallon wNlod snowing ab aaoWgy. lW aaY one cause an ucn kw. ~ ^ No ^ UNrcwn
WNEDIATE CAUSE Foal d5easa a ~
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m 29.11 Femur.
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^ Yes ^ NA ^ purer, Cperatar ^ Passanga ^PeCestnan
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Cenllyirg physician.PnysKwl calAYn9 cause d ham wtwn a1Wwr pnysKbn Has paalalcetl ham and cmgleleG Ilan 231
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3a. `aanw and Atlbess d Person
Michael L. Norris, Coroner
3fi Regava~ssgnatae arW ~ 'aF ' 'ay year'
' 6375 Basehore Road Suite 111
X7050
~ ~ Mechanicsbur PA
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