HomeMy WebLinkAbout12-01-09 (2)
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF
Estate of ~ ~ r I~~~.,.Rlivr ~ I ,~ `~ ~~
also known as P'i'~M - ~~ ~s
Deceased Social Security Number 1U
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
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) -D <_ _; ,,,.,~
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Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of the insttument{a}toffered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
L1a B. Grant of Letters of Ad
(lfapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire;
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: (!f
Adn:irtistration, c. t. a. ord.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name ~ Relationship Residence I
COUNTY, PENNSYLVANIA
(COMPLETE INALL CASES:) Att ch additional sheets if necessary.
Decedent was domiciled at death i ~ 1 n County, Pennsylvania with his /her
(List street address, towrr/ci~ty]township, count), state, zip code) q
Decedent, then 1 years of age, died on ~ /at ~ _ ~~
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 fo
Fm~m R6V-02 rev. !0.13.06
E~=-
Page 1 of 2
Wherefore, Petitioner(s) respectfully request(s) the probate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersiened:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
n /'~ SS
COUNTY OF ~ ~ ~' 4~1~.~
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
before me the ~_ day of
For Register
ojPersonal Representative
Signature ojPersonal Representative
Signature ojPersonal Representative
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File Number:
Estate of
Social Security Number:,
Deceased
Date of Death:
AND NOW, , in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters
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
Letters ............... $
Short Certificate(s) ........ $
Renunciation(s) .......... $
... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $
Register ojWills
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Page 2 of 2
Farm RW-0' rev. 10.(3.06
105.805 REV (01107
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 15980733
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~orwarded to the State Vital
/A Records Offyce,for rmanent filing.
t nral Registrar =~~ ~ I~aEeCtssued
Certification Number
-~_~_07 ~ ~~aa~~
N/05.IM RHI 11x2006
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COMMONWEALTH OF PENNSYLVANIA • DEPARTAAENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH ._„~•„~,,,,,,~,
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