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HomeMy WebLinkAbout12-16-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~'u,~,~-Lr~~~d COUNTY, PENNSYLVANIA Estate of ~~~~~~ ~~a~~J' File Number ~ I - U `'l - ~ ~ 1~,~ also known as Deceased Social Security Number ~~--/a ~&~~ Petitioner(s), who is/are l8 years of age or older, apply(ies) for: (COtYiPLETE A' or 'B' BELOW.) ^ A. Probate and Crant of Letters Testamentary and aver that Petitioner(s) is /are the last Witl of the Decedent dated and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) Except as follows, Decedent did not marry, was not divorced, and did no[ have a child born or adopted after for probate, was not the victim of a killing and was never adjudicated an incapacitated named in the insUumem(s) offered r , © max: .~ h, .. - ~. (COMPLETE IN ALL CASES:) Attae/t additiot:al s/ieets if necessary. ecedent wa domiciled at death in Cou ty, Pennsy vania with.l~is•/ her last principal resndence at (List sheet a -ess, town/ ty, Io nship, county, state, zip code) Q Decedent, then ~I` years of age, died on f0 ~' ~ at ~ ` !i~ (j ~ 1 { ~ Decedent at death owned property with estimated values as follows: ,y (If domiciled in PA) All personal property $ (If not domiciled in PA) Personal property in Pennsylvania $ ~~(~'j~ (~ (If not domiciled in PA) Personal property in Counry $ Value of real estate iLn Pennsylvania $ situated as follows:~rt~'7 ~Q~/1 /Z ,~-~'r~e~ ~ t~mD/r~e Gli7'1 rlQn~ ~a ~n~ ~/r ~~ ~~~~~ Wherefore, Petitioner(s) respectfully reque~,!(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: or printed name and residence Forst RW-03 ,~e~-. !0.13.06 Page 1 of 2 B. Crant o[ Letters of Administration C.7 ~~ ~ i`~ ~,i- •j (Ijapplicable, enter: at.n.; d.b.n.c.t.a.: pendente lire; durnnte nbsentia; oritat!!~ C..:'~ ~'=~, Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the followi~sp tx3e (if stand h~es:~' Adntittistration, c. t. a, or d.b.n.c.t.a.. enter date of Will in Section A above and rmm~lete Ii.rt nfheirc l ~" ~ r1't Oath of Personal Representative COiV1~10NWEALTH OF PENNSYLVANIA Q SS COUNTY OF ~~~f„t~c~P~(~~ ~ , 'The Petitioner above-named s~.vear(s) or affirm(s) that the statements in the foregoing Petition are Uve and cen•ect to the best of the knowledge and belief of Petitioner(s) and that, as persona] representative(s) of the Decedent, Petiti r(s) will well and truly Sworn to or affirmed and subscribed Xf Signat oJPersonal Repres ntntive before me the i ep~ day of ~. , administer the estate according to taw Signature ojPersonal Representative For the Register Signature of Personal Representative File Number: ~' ~ v`-1 ~ ~ ~Q Estate of~Q~'~~Q~_~, ~~~p/' ,Deceased Social Security Number: /IJi~-f~ -~ ~c~© Date of Death: ~~/~ /~ AND NOW, ,inconsideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters are hereby granted to 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 Letters .............. . $ Short Certificate(s) ..''f.. ... $ Renunciation(s) ....... ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL ........... ... $ Attorney Signature: Attorney Name: in the above estate Z, ~ b Supreme Court I.D. No.: Lo ~L~ Address: G-k (~ ~ S~- ~~J Y~~l~ 9z :E as ~ ~ a~a boon oJ!'Pills Form R4P-U; rev. IU.13Afi '"~; ~r`f ~ r 4 Pale 2 of 2 v ..~ J. '.1 ~ _ _ ... ° LOCAL REGISTRAR'S CERTIFICATION OF DEAT'li WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 15922999 Certification Number This is to certify that the'infolma(ion 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 tiling. I~~01a~ a Local R istrar Date Issued NtostAS PE11 ttlmw TrPE ~ IrANT w COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFlCATE OF DEATH f"? C ~'~ ~~ ~~~ ~Q ~~ D (See instructlons and examples on roverse) QT•TF Fn F,e wNFR _© _-y © ''' '~ n ~ ~ ~ ±. * '7 ~ ~~,- ;~- ;=~ c,'-; ~" Oy t. New a o.o,a.+1~. •+aa.. ru. eaW a s.. x som s.cunr wron ~. a awe lw+h a.r. rr) Marian C. Elder Female 183 •- 12 -2830 Ocitober 18, 2009 tL Ape M1+r adat^YI IMiAer t 1NiAer t a Ow a awn T. ~ nr rw « Ba. PYw a D,etlr Gwck ane seat, here lw,w ra,er HaePAr: Otlw: 87 y,a Jan. 24, 1922 Ha rrisburg, Pa. ^yn,b, ^ENrQAprWA ^txwL ®Nm,wp ^neraew ^lMr•Sp•rYr b. Can1Y d paR &. Cb. Sao, T•p. d DaaN ad FaoWy NBnr Ir nol irYYAOn, rN•,tmr ant maMer) 9. Yrw Oec•ArA d WePrYc OApbT No ^ Yp 10, Necr Amrfran warn, &ork, YYlda, ab IA Yae, ePealr c~M ISpaM Cumberland Camp Hill Manor Care p'„e~ ~) White n.OawarA's LMW a wamw morel e.. 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