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HomeMy WebLinkAbout01-08-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF -COUNTY, PENNSYT.vat~Ila Estate of I / "\t.) `j, C o also known as Deceased File Number _ ~' ' 1~ y Dales/ Social Security Number ~ [~, / -, l 7' ~ ~ ~ ~ V 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 named in the 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 not have a child born or adopted after execution of the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: m B. Grant of Letters of Administration (Ifapplicable, enter: c.t.a.; d.b.n.c.t.a; pendente liter durante absentia; durante minoritate) 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.) LISA HARBILAS CHRISTOS HARBILAS WIFE SON (COMPLETE INALL CASES.) Attach adtfitiona! streets if necessary. Decedent was domiciled at death in CUMBERLAND County, 468 RUPLEY ROAD CAMP HILL PA 17011 Q (List street address, town/city, township, county, state, zip code) Decedent, then 61 yeazs of age, died on DECEMBER 30, 2009 468 RUPLEY ROAD, CAMP HILL, PA 17011 4tits KUPLEY ROAD, CAMP HILL, PA 17011 with his /her last principal residence at at HOLY SPIRIT HOSPITAL, CAMP HILL, PA w ,~ c H a V ~" OO~O~Q Q~~~~~ ~~ti~xw Oc7° ~;r~N O~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) Ali 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 ~ ~o ; 0 of $ OCR- ©O t~ / t 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: Form RW-02 rev. ]0.13.06 Page 1 of 2 „~ ,. :-~~ ~s~~_«~'~~~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND 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. A Sworn to or affirmed and subscribed before me the 1~ day-of .. ~Q) V For Register ~~~` , Signature of Pe aortal Representative Signature of Personal Representative Signature of Personal Representative w ~, O oo ~, F; ~~., ~ O fi CL ~ ~ 0 U 00 UQ File Number: ! -~I I V f v O (~l aC ~ v~ W t O cW7 Estate of -~ , y`1 ~ /l ' ~ ''R ~ ~ ~'/~ S Deceased c~ c~ N O Social Security Number: ~~' ~ ~ ~"~ ~ Date of Death: ~ 3 ~ C` C~ AND NOW, ~ in copsider_ation of the.foregoing Petition, satisfactory proof having been presented before me, IT IS D D that Le ers are hereby granted to ~ ~'j ~ ~(,~ and that the instrument(s) dated described in the Petition be admitted to probate and filed of FEES Letters ...... ...... Short Certificate(s) ....... . Renu~ ion(s) ......... . ... $ ... $ ... $ ... $ ... $ ... $ ... $ _ TOTAL .............. . 8- in the above estate the last Will (and Codicil(s)) of " Register of Wills 100/ ~n ~ Attorney Signature: Q"" `-(~~(~ Attorney Name: Supreme Court LD. No.: Address: Telephone: Form RW-02 rev. 10.13.06 Page 2 of 2 105.805 REV (01/071 ~ //h/~ //~~~'M// ~~ t~`~ ~~ "~ ~~ LOCAL REGISTRAR'S CERTIFICATION OF DEATH v WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P x16030476 Certification Number ttto5-tq ttEV ttrzooe n~ /w elAGC wK 1.ltli.s dDwar.IFiq niddo, btl T%MOTH 5. Ape N.tl 1 U 6 ~' 1 Yn. m. cony d D«n ` u m • t o oe oenr.uwr ~e Knd a w«k E nfT EuA 18 DaoeawN'sMaYgAaanw.isbw, y68 ~NpLEy CArYIP H/LL This is to certify that the information here given i correctly copied from an original Certificate of Deat duly filed with me as Local Registraz. The origin certificate will be forwazded to the State Vita Records Office for permanent filing. .~ ~ ~ ocal Registrar Date Issued n ~~ oG~O tii n ~" v, z~Z~d -~~ doo~oo o~ -c~~ . ~ ,~ ~ ~ to COUIMONWEALTM OF PENNSYLVANIA w DEPARTMENT OF HEALTH .VITAL RECORDS ~ CERTIFICATE OF DEATH ~ d Q A (Ses 6atrMeUons and azemplaa on nverae) . nlfiq~ N// ~ p i L- /- s Y. S« 3 S~ ~ ~~ STATE HlE NUMBE Ods d D«p Mr~~ 187 -'f5' -8`f96 ~e~. 30~ aoa art ~, d Dtl. d aMb 7. .ndtlW a 9 Dya Koss W Ws !.. Ren d p1.~ MAIMlt oMr ar, eG ay, ttadro~a DYW KlnadpueYU«/YOYuhy ESTANRAA!' ron, mr, ~ mal R D. PA. 170/ IARB/LAS ~/ ~9f°8 GREFCE " olw: °° ~r-raly wn n ntl trruo,,, ww w.tlna nsM,q ewrtll ^ ~ 1 p,pele,N ^ DaA ^ wrep ttomo ^ ne.wrt. ^ alr - S. WY Deosatll d lfgrlc QipN1 ®eb ^ Y« 10. aeo.: Awnyl bd.n. Byyl MNb, M 1-~oL SPiRir FlosPiT-A~~ +~ ~..bl ~s~ 1Z. wr O.natlo.sos b M t3 De«daWe Eaunfo. ISF«b ony Nyrd f+.Y mlpleNdl 11. MNIY Sttlue: Msnba. llnw u.8. Amra Fonsn9 ^ Y« ~ 1b ~ Wlzl ~ (N a NI D«.aar, PA . 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IYnrW dPtlson Who ~ 35 ~ Ys~Syuva .id Disoid Hnibar ~ j dDoYb(Mu271 Typ1PM 98.Ostl Fibs plsnR M'.Mtl) NO~ 5 ~S~ r~~/~/L,~t///I~ Disposiuan Parini No.~ s'7 ~ -S .~ /ia' .~ RENUNCIATION REGISTER OF WILLS CUMBERLAND CO~'y~ pENNSYLVANIA ~~~~ Estate of TIMOTHY CHRISTOS HARBILAS ~o ~,~,~ ~b o~0 r~~6~ z~~~r~ ~~~~~d C70~~ OO 0 OH ~ ~tn ~ ~O Deceased I, ~~~I~ e) !~~ t,ry capactryiretat><onship as ~ ~ ` ~ of the above Decedent, hereb renounce th ' Y e nght to administe1r the Estate of the Decedent and respectfully request that Letters be issued to h "~ C X12 Q j ~-/-~ .S - . f=_ D (D e) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills . I ~ '1 ICU '`~ J~ (Street A ess) a ~~~ ~l .~ ~~U~- (City, State, Zip) Executed out of Register's Office Before the undersigned personally appeared the parry executing this renunciation and certified that he or she executed the renunciation for the purposes stated within on this '~~? day of ~ l~r ~----~, ~C~ 1 C~ Notary Public ` ~ ' My Commission Expires: ~~~,~~~. ~ a~ a p /,3 (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 coMMONw~TH ~ ~ v Nobrlel seal Berbera L Tome. N4pry PubNc Camp Hill Born, Cumberj~nd County i'~Y Camml~lon 6rpkes Npv. i2, 2013 Member, PennslAvanla AfiOC,~ on of Notaries RENUNCIATION REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA Estate of TIMOTHY CHRISTOS HARBILAS Deceased I, ~~~ ~ ~~ S ~~ ~ ~~~ in my capacity/relationshi as P S (Print Name) of the above Decedent, hereby renounce the right to a inister the Estate of the Decedent and respectfully request that Letters be issued to ~ ~f~ (Date Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills ~2~ (Signature) (Street Address) ~~ o~o m n ~., N ~z~;dd ~e 7. -T~00 d~o~~~ ~ ~ ~ ~ ~ ~ ~~ ao~o y (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 ~1`~` day of ~~uur4n 2-0 ! O , My Commission Expires: ,//j~-e.-xlu.-- lam, o2O /3 (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) ~~c~~- ~ Notary Public ~IMONWEALTH OF PENNSYLVANIA Form RW-06 rev. 10.13.06 Notarial Seal Barbara L Tome, Notary Public Camp HAI Boro, Cumberland County My Comrr~fon 6cplnes Nov. 12, 2013 Member, Pennsylvania Asstxiation c>f Notaries