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HomeMy WebLinkAbout12-03-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~wt8~1~t~>~iD COUNTY, PENNSYLVANIA Estate of ©fLPI•IA ~1 dJot~Dc~ld also known as ,Deceased File Number ~ ~ _ D l / l Social Security Number ~ 9 4' a 8 ' ~ ~ 7 9 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 Testamentary and aver that Petitioner(s) is /are the last Will of the Decedent dated and codicil(s) dated (State relevant circwnstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution for probate, was rat the victim of a killing and was never adjudicated an incapacitated person: in the t r^ W ~['~ ~ offer~e¢~ C ~~ dB. Grant of Letters of Administration (]f applicable, enter: c.t.a.; db.n.c.t.a; pendente life; duranteabsentia; durmrtemirrorttate) Z (COMPLETE WALL CASES:) AttocAr at~irllotral shtets ejnectssary. Decedent was domiciled at death in C B6R1A1~3D _ County, Pennsylvania with his /her last principal residence at ! S'.~'S 3 t M~s~ ` F ~tzy RD r1 Es't~ (List street address, town/city, township, ebtaety, state, zip code) Decedent, then, ~ ~ years of age, died on d~-T r29 . ~~ at NoIT ~ntR1 ~ SOtTdI C'~w-P }}11.L_ ,P~ Decedent at death owned property with estimated values as follows: (if domiciled in PA) All personal property $ ~ ~.~ yn~ (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania ~ f ~' ) l $~j ~ Z~ ~ ~O situated as follows: 1 ~~~ 5 i M ~ S~ ~ 1=t~~y ~~ KQ~ l.~.iati (: e.t 1 ~ (~ I7D 7D Wherefore, Petitiocer(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 undersigr-ed: _ /1~:....e«..,n . ~ Tvned or minted name and residence 2 ..1,9, Form RW-02 rev. 10.13.06 L. I~, •aDfu ll9" /'~1~cf/, ~A l7ar.S~ ~ ?' 9 yob Page 1 of 2 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. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA r SS COUNTY OF Tr.~d h'I~P.Y-ICc Yt ~i 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 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 affirmed and subscribed bef re me the _ dayoo~f B~ I ~ ~.~~ For the Register . File Number: ~ 1 ~ ~ ~- ~1 Z Estate of ~ / ~~ ~ 0 Deceased Social Security Number:~9~-Z ~- 7 Date of Death: ~r[~'l}Ql?] 2~; ~.~U°l AND NOW, 6~- ~~ /~, ~ D(7~' , in consideration of the foregoing Petition, satisfactory proof having been presented or e, I EC ED that Lette are hereby granted to 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 FEES ,~i«r~~L'~'~u Letters ............... $ `2 ~ O. "" Short Certificate(s) ........ $ ~~ 2-"" Attorney Signature: Renunciation(s) .......... $ '- i .___ .. $ ~ ~ ~ Attorney Name: • • • $ s- ° ~ Supreme Court I.D. No.: ... $ $ Address: ... $ ... $ ... $ $ Telephone: ... $ TOTAL .............. $ cg 0 ~ • '~ Form RW-02 rev. 10.13.06 s Page 2 of 2 .3 _ _ _ HIOSBOS REV (01/U7) ~ ~ .~ ~'~/ / f Z LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15839054 Certification Number ~~.a 0 a~ .~, ~z7 ~~,~~ v r,l i-r~ ~. I = =7 ca 1 x ~ ~ ~:~ ~ -~ _ - ,~, == o r 1-•1, c ~,~ ~,; w nlos u3 flEV llnooa COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS nPE . PFert w ~T CERTIFICATE OF DEATH ($B! IFYWuctlons •SIId ei~lllillOt 013 wWMNI STATE FILE HUMBEfl j i` hy I 1. Noma d Dardra (Fir, nidda, Yal udicW 2. Sr 3. Sodr BaarY Y4lOr ~. Dw. d DWI plad4 dM~ Y+•9 - ~ •• -~ ~ alw a. Dw d BYn 7. ar WM a as Pb d a. Aq Pasl BaadaY) Uldr 1 Unda 1 art OMr: ~ ~ 11aa F abnlw 6aYr Ibus aa..w Q -- - 2 7 -37 I v ~ ^ Efl Y DuppMO ^ DOA ^ Hom. ^ wawnn ^ oMr - aPaeh: ? ~ YB. BD. Cw$i d Own ac. O9'• aP~ Earl 90. Faoily Nenla Ia ImlYrloalon, aM Mar and IYa16ar) a. Wr Dardaa d lf.prYc gpn4 yr 10. Ran' Aalamr Ndan, Bmd. Ydila, rc. Cu,Mber•lol-n.l, ~• ~~w tw \ «. 'Y.~,".I°'arM1.ml d or wIW DaadslY's Uwr d wolkdaw mot d M DoM arb 12. Wr DacaMO h M 13. 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Irll. ra Am `a Fa~rq ~Y' ~G C ~(.1 170 ~ ( ~ ~ 2 x3ac aiY Mn ealdyiq 23e. To M , rrl omrtr r M aaM, Oda .lSgr•• anoYaa) x7D. licalna tYar4a ^ 23e. Ora ~ pAnn• rY, Y•r) ~a~~ l ~J~p{, . plysirianslitl awrawrama adsrhb (~ • ~ ` J....~.A~~ earn u~a• a darn. ~~ TYIw a Din 26.Ow Praaawlud Dar (wm, . Yaal ?B. Wr Car Kral- nq/o wart EuiNnar r caa~r mr o wrm Oaw Nn Gwwen a Damli 21 l ~ . aanr 21-Ta mW r axnpbMO M a14011 '1F~ ^ v« ~ ` "•t° wm nalouwa din. +. , a O P M. OU] ~ ~ dawm Ur b 7 CAUSE OF DEATH l6•• qutruoabna and aaampMa)- APPlosbwb iwsnr: Pan aMr wm 27. Pan I: Eaa.M iDiRfdlYNli- areasac, YWain, a mrtpicaiolw -+W el.aaY rbrad M tlcw. DO tar Door bnlirl awr auto r rlawc amt, ~ awl b DWI 4a m nai111V n M urldaryiiq IaY1• ~ b Pr I. ^O rb^fdDdaro.n r+vabn amt, a wwmbar IhaaDm wanes shorq M aaob2y. lr araY ar taut m aadl Yy. 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SyIMa• amt a ~ ~'f i 39a. rlaaa Wurk aNY ar) D•IrYOIa WYSfcWI (PDYeioau urWq Oise d dean wlwn amMr PDYr+•^ me paaalna dean ana empmro Dorn 23) drlDrewrdwbMwrlalwmwwrrarr_________________________________ ^ bmaed a rr • - ~ yaal) ~~~~ 73dDaMSbwdlyadl.rY ~ , p aY T•Mar • PraplamYq aad orWYM MMamr^IPlryaidan 0an ponoaaalY dealnam aidWgaawrabrD) dWla«arodrdr alr,ar.. rw Pmn~ra drrws.walalra nlrwwrrwd_--'--------------^ To dbaaaexY bioraaaa . / y n ~~ ~,{~ ,Q ~7 =7'C. ~~7i L67"1% /W Il 1. ~~ (T'LF (l~il . • weer EarWrrlCaar On tlr WM d aardaaUOn rd I a nwagrbA, m ay oPinbn, dWl aonr.d r ul. wry dw~ rr gw~ rla ar adb crrNalaid ar.la r aamd. 9l Mflu wAmw a Parn wDOCaIpMr Cw~ d ~ (a~°~,?yp l/IS I LG G`'~ 'H '+~ ~ ~ (1, /WrrT .'yyl./rbsn•')l IV•I/ i( • t ~ [ ~ ~ ~ [ ~ ~~ ae - j~ 04 N~"tl ~t ..~ ~j } ~ i~ ~ L N~/ [.n' l`~~~7!%1 1 . a orePoaroalP.mrHo VSO 7 ~Z/ n 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 Records Office for permanent filing. ~~~ R ~ ~~-~- _~! / ~ / eg Local Registrar Date Issued