HomeMy WebLinkAbout10-15-09PETITION FOR PROOBATE JAND/~ GRANT OF LETTERS
REGISTER OF WILLS OF rr ~-"- er I~Y+O° COLTITY, PENNSYLVANIA
Estate of rIST-~-1 /~/~ Q /`~(~ Q /~'-}
I i" 1 ~Q ~/~- ~ r/C • Jd W'~~File Number ~ ~ ~ V I ~ ~ ! (O /
also known as 1 H M • O bJ,s~r` / 7 /~
Deceased Social Security Number ~~ ~ ' b G ~ /~b
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(CONtPLETE 'A' or 'B' BELO {i!
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Will of the Decedent dated and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.J ~
n C=? :w.7
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution insttumr~s) off
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: i =~- n -"'t C,`"~ r J
v t ~~ ~ t' ~ t'"3
r ~, w `
B. Grant of Letters of Administration C~ -~ , r `,- t
(lfapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendentelite; duranteabsentia; durcnii,toritate) -. ='=.~
Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following ~ sue (if any) ri hetrs¢ off
Administration, c. t. a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ '
(List street address, [owrr/city, township, county, state, zip code) A A QQ I
Decedent, then 2 ~ years of age, died on ~ C'~• at MAC ~-~ Sf-: (J P`! p y~ /~grYY Sam/ r f
P~ , ~
Decedent at death owned property with estimated values as follows: ~ L~ ~0~ 0~ C~
(If domiciled in PA) All personal property 5 fi~'~~sa~-•~4s T
(If not domiciled in PA) Personal property in Pennsylvania $
(lf not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $
situated as fol
S~
/ 70//
named in the
Fo,-n. Rw o? rev. !0.13.06 Page 1 of 2
(COMPLETE INALL CASES:) Attach additior:al s/tee cessar . d
Dece e~w s d ici~ed t eath in ~ ty, Pe Ivania wit>,t~~ er ast principal residence at
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
f ^f SS
COUNTY OF ~o~n~ ~ 1Qn (~ ,.,
n `~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tivjcorrect to`~e besE-p~' ; r`~~s
~) O i~ ~-_t * J
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s)?'wa~' ~'§p an taf~ly r„ _y '~--~
- ~.1
administer the estate according to law. ~ ~ ~ n s
,,:;
Sworn to or affirmed and subscribed k ~ ~ ~ ~~ %~p= ~
/ before}-m~e the ~~ dagy of
l _Jl.~ ~~h'-' ~ 1
Q.Q~
For the Register
Signature ojPersonal Represefhative ;~ -- _" ~"'r'i
'r~ ~ ,. ,...,y
W -
Signature ojPersonal Representntive
Signature ojPersona(Representative
File Number: ~~`-(J /~ ~ 7~I~
Estate of ~ISrt S~t n m tC~~ ~ ~ t~l-'l _, ~ W~1~ ,Deceased
Socia] Security Number. ~, ~ -(oZ- l Ilo~o Date of Death: ICJ - 3 - U°I
AND NOW, ~1~~. ~5 , ~_, inconsideration of the foregoing Petition, satisfactory proof
having been presented /before me, IT IS DECREED that Letters 7~,M1,n16'~Mb~.\ 1llr.+
are hereby granted to \ ~++~~,~~•- e,~ ~ ~•y. ~o
and that the instrument(s) dated
in the above estate
described in the Petition be admitted to probate and filed of record as the la t ill (and Codicil(s)) of Decedent.
FEES
Register ajWi!!s
Letters ............... $~
Short Certificate(s) ........ $ ~}~ ,(~ Attorney Signature:
Renunciation(s) .......... $ . , (~
~P ... $ 10. o0
... $
... $
... $
... $
... $
.. $
... $
TOTAL .............. $ Q~ •~
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Forut RW-Il' ,•ev. tu.~3.v~ Page 2 of 2
+ns 4n5 ec~.~ rn+m~~ _ _ ~ _
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 15832495
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me, as Local Registrar. The original
certificate will be forwarded to the State Vital
ecords Office for pe anent filing.
0
Local Registrar Date Issued
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N,~r~iuNOS COMMONWEALTH OF PENNSYLVANIA• DEPARTMENT OF HEALTH • VITAL RECORDS ~
^E~+"r+e+T CORONER'S CERTIFICATE OF DEATH ry
BIACK ""~ tSee Instructions and a><amolea on revereel STATE FILE ralwaEir
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1271 South 28th Street
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RENUNCIATION
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REG STER OF WILLS
h COUNTY, PENNSYLVANIA =?
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Estate of /'(S7//J /~ ~.Q~.~r'! c/• ~du~SQ~
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Deceased
• /.~.~ /Llf in my capacity/relationship as
(Print Name)
- ~rer~~s of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~~
(Date)
Executed in Register's Office
Sworn to or affirmed bpd subscribed
before me this ~~~~'` day
of .sue ~~.~
~-
e uty r Reg ter of Wills
~,
~~IZ-. ~U~ fie, ,~4,8~ 92.
(Sireel ilddrecs)
~~! 5, ~- /S~d ~
(City, Stare, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other ofTicial qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06