HomeMy WebLinkAbout11-24-09PETITIO~~ FOR PROBATE AND GRANT OF LETTERS
• ,
REGISTER OF ~~ILLS OF ~ ~~ ,~'(~~~~ ~ ~ ~.,~OUNTY, PEl~'~iSYLV~NIA
Estate of~- (1 ~~~ ~~...~~~-F•tle Number ~C ~ ~ ~~~~~/ - ~ l~•~ /
also kno~.vn as !! / J ~
~~ ,Deceased Social Security Number ~ j I C~ ~ SG ~ ~J'~1
Petitioner(s), who is/are 13 years of age or oider, apply(ies) for: ~
(CO:LIPLETE A' or 'B' BELOW:) ~ ~ ~
G~ o ~ _ -
_, ~ ~
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the ' '~ _~~-, named in tl~a,
last Will of the Decedent dated and codicil(s) dated -' =:' `-.-, ~~ ;
- - __ --~.~ -~ _. J
(State relevm,t circumstances, e.g ,renunciation, death oJexecutor, etc.) _-_ - ~ , ~
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution=tE~ insttum~i sj offered ' '
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: '~
it ~ _ _ -
B. Grant of Le[ters of Administration v_ h..~ 1 ~~ _ _ ~ 1 t 1 1 !'mil 1 [ 4~ \ tt~ ~ ~ ~ L.- ' ~ ~~ ~_J~~
QJappticnble, enter: c. t. n.; d. b. n. c. t. a.; pendente lite;~rlw-ante nbsentin; dur,^,nte minorita!ej
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 1:
Adrrtiaistratioa, c. t. a. ord.b.n.c.t.a ,enter date of Will in Section A above and complete list of heirs.)
~ Name Relationship Residcn;;e ~
(CO;YIPLETE 1,'V ALL CASES:) Attach additiot:al sheets if necessary. ~j~
Decedent was domiciled at death in-~~~~ C u~y, Pennsylvania with\his~ her l~t~ncipal residence at~, ~ ~ Y
T
(List street address, town/city, Township, cowtq,, state, zip cads) i + ~
Decedent, then ~ ~ years of age, died on _ ~ I y 1 ~ ~V~ at ~ ~ C~
Decedent at death owned property with estimated values as follows: ti
(If domiciled in PA) All personal property $ ~ ~ ~
(If not domiciled in PA) Personal property in Pennsylvania S . ~' , ~'
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ _ ~`~
situated as follows:
Form RW-0? rei, 10.13.06 ~~3~8 i Of
Wherefore, Petitioner(s) respectfully request(s) [he 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
COivI~10NbVEALTH OF PEN~;SY"LVANIA
SS
CGUNTYOF~~,(~~L(x.~/ ~I;ij~L~
The Petitioner(s) above-named swear(s) or affirnl(s) that the statements in the foregoing Petition are true and con~ect to the best of
the kno~,vledge and belief of Petitioner(s) and that, as personal representative(s) of tha Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
/~
before me the t.,,~ day of
For tl Register
Si~iaatw~e of Persaia! Representative ~ ' !"~
._t-a
~ > _. ---i
File Number: ~' r,~ e f ~' ~/ J
Esta±e of ~~~~1~~ (f' Z- ~)o~~ rl ~~ ,Deceased
..~
?~
Social Security umber: (7~~ ".LF~' `;~~ ~ ~i' Date of Death:
--~ 1~1~1'~ nR. ~s' ~, ,..,.,,
AND NOW, ;;~~ ('~`"~'~'`'~ C~ ~-~~~ in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters }~ ~rryl.lr~i ~~n 1 r~'L ~
are hereby granted to ~- ~ S~,l A - ~2ce~r,e~ A ~ ~-
in the above estate
and that the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
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FEES `''~~~C-~"ZC~~ ~.~-'~~`1.~~~ ~..~~tCt. fJC~ ~ L '~/ }
~/~ ~~ t Re ister o Wills ~` ~~ ` ~ -i - ~"~
Letters ............... $ V • ~ ~ j r,
~l
Short Certificate(s) ........ $ .~~ ~ 'L A t ~ S
Renunciation(s) .......... $
~ ~ ~~ ... $ C~ ,~~,
... $
... $
... $
... $
... $
... $
...
TOTAL .............. $ J ~ ~;`
t orney tgna ure.
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form RbY-U? rev. 10-13-OG ~a~f: ? Of 2
;,.~
SiJ~mture ojPersonal Represenrntive ~ ~ r o
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~El~T~Jl~TC~A"I'IO~I -T; t-`
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REGIS ER OF WILL5 ~ x
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y COUNTY, PENNSYLVANIA ~=~ -'
s-
Estate of _ ~ ~1,ry ~~~~T~~~~c.;~,~~ r=~~r=~~r'~ ~~~:~ a'~ ~ ~~~ Z .Deceased
~, t' ;. ~ _
_ , in my capacity/relationship as
iPrii7~ ama)
~~~~„h of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~ ~:
(Date] (S,~nature) ` I?
(S'n~ee1 Adrlrer.r)
Executed in Register's Office
Sworn to or affirm. d and subscribed
before e this ~ ~ V ~ day
of ~~~ 1, ~'~'~- ,c~~I
~, j
Deputy for Register of W'
_~
~ { ~ (r~~
1 ~~~~-~ ~~I~ ~ ~ ~ ~~, ~ l ~7
(City, Sia1e. 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 official qualified ro
administer oaths. Show date of expiration of'vbtary's Commission J
Form R~6`-06 r-ev. 10-13.66
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Tr PE PRWTIN
PERMANENT
BIACK INK
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~~
~~ ~
CORONER'S CERTIFICATE OF DEATH --
(Sew instructions and a:amolea on reversal STATE FILE NUMBER
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A ^DmwyCwrabr ^P~°f1Ya' ^Pe~+^~
^ re: ®Na Interstate 83 South M 42.8, Harrisbur PA
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dxN OaurrM dwroB,a uoWalud m.nnauwra_------- ---------------^
__________
To IN lraamr enorkdpa
- ~ Grahams FieUick. Coroner
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PrwbuMrg and osnMn9 ptyaKin (Prryawn bon pran«av:n9 maN am uMpnq b ww• d marl
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- - - - - - -
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