HomeMy WebLinkAbout08-25-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGI/S'T/ER OF WILL5 OF C t~/vl,~ Y'~~~~PCOUNTY, PENNJSY~LVANIA
Estate of ~ Ci.,T {'~~ ~ (/~J ~~ File Number ~' -`~' ' ~ O~~
also known as ) /~ / / /^~ ~T/ ~ G
.Deceased Social Security Number / - I / r TO(r 0 tAJ 4
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
^ A. Probate and Grant of Letters Testam n ry and aver that Petitioner(s) is /are the named in the
last Will of the Decedent dated h J W and codicil(s) dated
C7 cs
~_T-
(Stale relevant circumsmnces, e.g., renunciation, deatlr of executor, etc.J ~ ~ C U ~ _i
Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted aRer execution bafit~'umenf(~s} offet`?$ -;
m rvv r~ r r i
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -?~~'-~ ut _;: a ~.__~
~~,[( ~C7 <"~ 7
\. ~I B. Crant of Letters of Administration r QCs=- ~ ~
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(/fapp(icable, enter ct.n.: d. b. n. c. t. a.; peadente tile; durnnte absentia; duranr~nirtDrimreJ
y ~- . ~i.
Petitioner(s) after a proper seazch has /have ascertained [hat Decedent left no Will and was survived by the following spouse (if any) atrtt•Meirs: (!f
Administration, c.[.a, or d.b.n.c.[.a., enter date of Wil(in Section A above and complete fist of heirs.)
Name Relationshi ~ Residence ~/~'
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Fonn R!V-0? rep-. ro.ls.oa Page 1 of 2
at death
with his /her
at
t street aaarest, towrvcrrygtownslap, caunry, smte, np coaeJ ~ /~ / ,,
~ r t~~ (
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Decedent, then S I years of age, died on Col XIO`1 at ~-
w/ j,R(Sby20 TTVS1'JI ITLf ~~YJU2~t
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letter in the appropriate form to
the undersigned:
~,
(COMPLETE IN ALL CASES:) A[tach addiriorraf s/~eets if necessary.
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
I/~,r~ SS
COUNTY OF ~.~ ~~ flAt l~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct 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 affirmed and subscribed
before me thea.~~~ day of
Fo he Register
N
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,~/~ /~ ~ i
File Number: t~I - t.M' ~~'7 ~O ~~ ~ ~D
/~,, I, ~ //~~ -o ~
Deceasd v
Es[ateof F~nneu l._.LL(YLL./ f-t_•. _. ~
Social Security Number: I / I " x{-02 ~ b ~ ~b Date of Death
1:. ~
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C.: Lam?
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AND NOW, C11' ' ~ ~ \ ~ ~ 1 _Yl~ , ~~ . in consideration of the foregoing Petition, satisfactory proof
having been presented~bg1fore e, IT S DECREED that Letters o~ Rd m •I n ~ ~fratz aln
are hereby granted to S ~~~ I lrl P `~ ~8'(Yl ~/1
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed e
t Will (and Codicil(s)) of
D
e
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dent.
of rec
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Letters ............... $ Q. ~ Register of Wills `~
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Short Certificate(s) ........ $ / (o. OD Attorney Signature:
Renunciation(s) ....... , .. $
$ ~~ ~~ Attorney Name:
• • $ tJ,~ Supreme Court I.D. No.:
.. $
$ Address:
.. $
.. $
• $ Telephone:
.. $
TOTAL .............. $ .~~ ~ ~ "L~
Signature ofPersonnl Representative o
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Signature ofPersanal Representative
Form RW.03 rev. to ls.oh Page 2 of 2
I05.805 R2v Ip~/OT) ~ ~ ~ ~~~~
LOCAL REGISTRAR'S CERTIFICATION OF DEATNI
WARNING: It is Illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 1565509
Certification Number
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ol~n"~'~~~.,._, This is ro certify that the infomtation here given is
p~TNllFpfyyf`- dul etiled wtth meta,aLo agltRe'istrar. The oriDinal
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._ as certificate will be -orwarded to the State Vital
~i Records O~fiGe frv pl rmanent filing.
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CAMNONWEALTH OF PENNSVLVAN{A•tNiPAfITNENT OF HEALTN•VRAL RECORDS
CORONER'S CERTIFICATE OF DEATH ~6°~'~
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CERTIFICATIOid OF NOTICE UNDER Pa. O.C. Rule j.5(a)
Name of DecedE
Date of Death:_
Date Letters Grp
To the Register:
REGISTE~F WILLS
uM b•e-Y' ~ cxlL 1 TY, PE;vNSYLVA`IIA
File Number: tY ~ ' LJ-i ' ~~~
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the abova•captioned estate on
Name:
Address:
(Ijmore space is needed, attach separate sheet.)
Notice has now been given to all persons entitled thereto under Pa. O.C. Rule 5.6(a) except:
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S ramre aJPenon Filing this Farm
Capacity: Personal Re resentative ~ Counsel
NnmzNamc oJ'r~ Form
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Ad u~~~ 1 !" Ct ~G! ~ I
Tzlephane
Farm RW-08 rev. JO.(3.06
1 REV-346 EX (OS-04) 34600041042
J ESTATE INFORMATION
SHEET FOR REGISTER'S OFFICE USE ONLY
PA Department of Revenue
County Code Year File Number
DECEDENT INFORMATION: Enter data as it will appear on an ^a~' ) , Q<Q /'`~ ~~ (~ 4
documents submitted to the Department. ~ +11,.
Decedent's Social Security Number Date of Death Date of Birth
Last NamefAVi Su~~ff//I{i~x First Name j/}q~//" MI
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t [4es- e
TYPE FILING: Fill in oval to indicate the nature of the return to be filed with the Pgpartment
~ Probate Return O Joint Assets Only O Estate Tax Only ~ Litigation Purposes (NO Other Assets)
LETTERS GRANTED: Fill in oval to indicate the nature of the proceedings at the Register of Wills Office.
(Attach additional sheets if explanation is necessary.)
O Testamentary ~ Administration ~ No Letters O Other (Please Explain)
ATTORNEY/CORRESPONDENT INFORMATIO :Enter all data concerning the attorney or other individual to receive all tax
information and corcespondence.
Last Name Sutix First Name MI
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s a-mail adtlress:
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PERSONAL REPRESENTATIVE INFORMATION: Enter all data concerning the personal representative(s) of th~ fate
authorized by the Register of Wills.
ExecutorlAdmi n istrator
Social Security Number Telephone Number
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o plete general estate information questions and indicate additional personal representatives on reverse side.
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 3460D041042 346DDD41042
MI
Sit as ~
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REV-346 EX
Decedent's Name:
34600042043
Co-Executor/Administrator
Social Security Number Telephone Number
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Second line of address
Decedent's Social Security Number
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Social Security Number Telephone Number
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GENERAL ESTATE INFORMATION: Enter all applicable data.
Did the decedent own real property in PA?
If yes, List the location(s) and an estimate of the value(s) for each parcel.
Location
What is the approximate value of the decedent's personal properly?
Was a bond required in order to obtain Letters Testamentary
or Letters of Administration?
Was the decedent survived by a spouse?
If yes, what is the Surviving spouse's full name?
O Yes O• No
Value
Value
O Yes ® No
O Yes O No
Was the decedent survived by other heirs? O Yes O No
If yes, lis/t th7eir name(s) and their relationship to the //d~e~ce__dent below. __(__
Namel "c~rto ~~ rsP ~, ~01MVJSV nl Relationship S~ 5~ J T
The Department is authorized by law, 42 U.S.C. §405 (c)(2)( )(i), to require disclosure of Social Security numbers in connection with administering state taz laws. The
Depanmenl uses the Social Security numher to identify the decedeni and personal representatives of the estate. The Commonwealth may also use the information
in exchange of tax information agreements with Federal and local taxing authorities. The state law prohibits the Commonwealth's personnel from disclosing confidential
tax information except for offcial purposes.
Side 2
L, 34600042043 34600042043