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HomeMy WebLinkAbout12-30-09PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~u..m~ e,~rl G,,r1C~„ COUNTY, PENNSYLVANIA Estate of __ ~O (1 ~~ ~ tr File Number ~ l also known as Deceased Social Security Number ~ C~ ~ ' ~ ~ ' c~ ~ 5 } 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 named in the na (State relevant circumstances, e.g., renunciation, death of executor, etc.) C-- Q ~ ~ , ~,. ~ Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executiorf-~ trumeiMt~s) '.i ~ ~: ', off~ed for probate, was not the victim of a killing and was never adjudicated an incapacitated person: t=~ .. ._._. ._., _.. . , . , _ _ . _ ... ~::~.~ r,...... B. Grant of Letters of Administration r.. ~ ~~~ ~ Z7 c_ . , ~^,--~ (If applicable, enter: c. t. a.; d. b. n. c. t. a.; pendente liter durante absentia; Clu1•hnti~inoritate)r ~ „~1 ~ -:_, -~~--~ ~ M~ Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following~pouse (if any~d heirs`.'~'(ffi Ad trti~tlstration, c.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) ~ -- ~a ~ 0 Decedent, then ~ _ years of age, died on ~ c~ " `j~ C~j at ~n~ VQ~~~ ~ ~ ~ -~~-~}~,t ~ ~pn~+~,~1 ~~ f' 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:_~~ ,~~ ~'I ,S 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: Si nature T ed or tinted name and residence ¢,1~ i rnrn ~ l V2rlen0.n5 ~i - ~ ~~~bu.r~ PiA ~ ~ o ~ ~ Form R6V-0? re,-. lal3.o6 Page 1 of 2 (COMPLETE IN ALL CASES:) Attacl: additional s/teets if ~:ecessary. L,tlm179..t'~ ~e~ Decedent w s domiciled at death in County, Pennsylvania with his /her last principal residence at (List street address, town/city, township, county, state, zip code) Oath of Personal Representative COMIVIONWEALT OF PENNSYLVANIA SS COUNTY OF 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 belio me the _~~ day of -ti~ / ~ , For the Register Personal Representative Signature of Personal Representative Signature of Personal Representative r_~ File Number: ~~ - Q lZ ~ a ~;~ O ~~'-, y. >, =~ Estate of D~ ~~S~,t-~f°P-- , Dece~u ~ ~ ~ Hv -rte ~ ~ _~ ..J Social Security Number: /' ~' ' ~ ~ "-' ' -~' Q ~• `~"'~ 7J ~ Date of Death: f Z~S ~p `f ?`'fir--*~ 4 -.. ,: AND NOW, • ~ ^' C.7 ~~ ~ , :F ~~'~ ~C)~ , in consideration of the foregoing Pet~t~atisfactory proof~_= having been presented before me, I DEC D that Lett s ~ ~ -~ ---' ,. ~ :-~~~Y i are hereby granted to ~ ~ __. fV v in the ab~•re estate and that the instrument(s) dated _° described in the Petition be admitted to probate and filed of recor as the last Will (and Codicil(s)) of Decedent. FEES " t~lZ Register of Wiils Letters ............... $~E3 Short Certificate(s) ........ $ r2 ~ ~ Attorney Signature: R unciation(s) .......... $ `-" . ~ . $ 23 STJ Attorney Name: ~ ~ ' • • • $ ~ < `'`-~ Supreme Court LD. No.: ... $ $ Address: ... $ ... $ ... $ ' ' ' $ Telephone: ... $ TOTAL .............. $ For»- RW-0' rev. lU.l3.U( Page 2 of 2 RENUNCIATION n ~'° N ~ ~: `. `° ~~~~~ - ~ -' ~ ~~ REGISTER OF WILLS ~ ` . -' ~ y r, . ~ ; . COUNTY, PENNSYLVANIA :~~-~ :~ =-t-~ ~' - '-~ ,. Estate of ~U~~~~'' Deceased I, _ J ~2~..~n ~~e~J~~ in my capacity/relationship as (Pant Name) of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ___-, ~ ~~ m - V~ ~~ ~~-~ (Dare) Executed in X,egist`er'~ Office Sworn to or affi d subscribed bef e me this ~~~ da Y of ~ ~ :;~ p epu for egister of Wills ( afore) ~:7UV~~ (Street Address) -~---~~~ (City, State, 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 to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 ,,,,r~~~~~~~~~~---. This is to certify that the information here given is ,,tll' p~tH OF pf ~- ~~,pa~~. ~~s = correctly copied from an original Certificate of Death ``~~~~~ ~ duly filed with me as Local Registrar. The original e o = ~,,,; ~ z~ certificate will be forwarded to the State Vital ~ , .~~~: ~! a~ ~„~ Records Office for p~exmanent filing. 3 "~'='"~ Local Re Istrar g~ Date Issued C7 na ~ . ~ __ _ ~ :-~..~ ----~t~ ---- . _.__. Li ~7 ~+~ Q t r._yr ~ .~ r __. _ _..___ C,r~ ~ © ~. ~~ ~ ..i ~-~ ~~ . r~ <_.,~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS ~ "s;•:~ ; "'•~- CERTIFICATE OF DEATH `~) ----i •• r ~--` ' (See Instructions and examples on reversal -~=" .. c •r'-' r"" t _ .... _ ..__ .._.•__.. -- ..r _ t Natme d Deceoerr (First. mrdale. yel. sultisl 2. Ses 3. social Sewmy Number 1. Day d Oean (Yaw,. day, '' 11 ~:.:J Male O ~ - ~'1 - 'J}S j ~E~Kq~ S 2-00 5 rpy. Mast l3rmroayt ta,a.r t war Unaer t aay 6. oaa a Ginn IHOrrn. as . ul 7 B•rpyu tc tiro soy a for ca.av) ea. Plat. a Dean 1Cneck orgy aryl ywrw Hoye Nows wv,w M«pty~. Oryr: • S 5 ya. Ma, 19 , 19 5 4 Ha r r i s bu r , PA inpalyrN ^ ER r owwtym ^ t30A ^ ldursaq Nom. ^ Retiaerbe ^ortr • soar: eb c«rnry a Dean 6c. coy, 8oro, rwp. a Dean ea. Far,Wy Nam. Ih na rtstibrno, ywe strew ono rkrnDer) 9. w« Deredad a Ftispaac oryn? ®No ^ r« to. Race: Anyurarp trot,, Eyct tMay. ape • Allegheny Pittsburgh ~,~~, of P, 3~ MtlP,CAc.~ lh y«. weay Cuwn. +.~~.«~.1 IsP~-1 White I1. Deuaerr's Usual Occ Krla d wok n one mosl d ye. Dona stay tale 12. W« Oscsoant ewr n ry 13. Oeoedxr's Education (Speedy tidy tugn«t grade atrrlp latedl t4 Martial Syn : Ho d N Y d KrW d Work Kind a eutrysa, Ylduwy U.S rvmea fans? ENrtlenaary ! ,10.121 CoMego 11.4 a 5+) . rne ever n . arry . Widowed. DivapOlSpeayl 15. Surviving Spouse Ir wde. yrve maden nrnel Cut Saw 0 orator Steel-Manufactur ^r« ®hb 10 Never Married ~ t6. DecedeKS YrYp Address (9treN. pry! poem. shy, >:p code) Deudea's pq pk~r Pennsvlvania ~~ 27 Evendale Court •~• ,7a.Sar l.iwna „~.®v«.oe~durran North Midd1_eton r,,,p, Carlisle, PA 17013 rownanrp? 17d. ^ No. Deoederd Lned wren t7b.colaur Cumberland r,~~a aryre~e td. Faryr's prarry IFiret, rnOde, yq, suhul 19. tdotlw's plarty (First. made, nyiden sumrryl Raymond Donald Stouffer Elizabeth D. McGurk 20e. hramarr's Name hype !Purl 20D. kdarmartt's Yaeng Address ISUee4 ary ! towel, state. Lp rbde) Mrs. Jackie Kimmel 2563 Veterans Wa Elliottsbur PA 17024 ~ 2ta. Marlow a Oypoarnon ®CrenWiont ^ oay«n ^ l~.w ^ R.awrr~ t~ stay 2tb Day d Otspantiort IMatn. my, y«rl 21c. Ptaa d orpos•an INany a an»t«y. pertytay a onr ptaal 21d. tawon ICay ~ town, stay. LP codel tilh. crennMlen « oarron AWbrf«d ^ oryr~spepy: ; byY.dtatEaaatitynrcowtten ®y«^,ro Dec. 14, 2009 Cremation Society of PA Harrisburg, PA 17109 ' ~ F Serena Lrcentsee la prsan agn9 as stcnl zzb. l.icans. tattbr 22c. Name and Aadess a Faary Zimmerman-Auer Funeral Home , I ne . - ~ ~ Q ~ --~ FD-010694 L ~ - 4100 Jonestown Road Harr spur PA 1710 Carpyy hems 23at ody aAten cerMyrg 23a To tM Dest oaunea a ry trry. day orb pace stwd. ISignaare tiro wel 23b. lrcerl« NtrMr 23c Dar Sgpw (Yawn. aay. yar) pltysoan y na avNiby at ome a aeon b / `/ ^G- arty can« a oar,. L M 4 Mrl qo 2.. } ~ trams 2426 mua w atmpyyd br penan • 21. rme a 25. Day Prabtrtce0 0«d IYarh, der, Y~1 26. was case RaNrted b MertiW Eaatrvryr! canner par a Reeaon Ottw tyre Crrttaron ar Dataeon? wlb pnortaub« aeon. ~-~. H. S Ze ~!" ^ No CAUSE OF DEATH f~ IMVlaetlortr atppot ea+mvwel n Approsrryy inlenral: hem 27. Pan l: Error rN tlraio a evaYe - areas«, rtjWya, a oprpicaran - ttW descry caned try tlean. 00 NOT enter terrtwtal sverre such as raraisc art«t Pan IL EnW over 2B. Did Tabeao U« Canh+ew b Oean7 , n OryN b Dan netpealory ama, a vendriprar tibteatian aAltout fltoerg the etiobgy. 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