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HomeMy WebLinkAbout07-13-10PETITION FOR PROBATE AND GI~;ANT OF LETTERS REGISTER 4F WILLS OF 1 u ~,P~~ru1/~ COUNTY, PENNSYLVATTIA Estate of -1'%/l!'~i~$~ ~ ~llLl ~ File Number ~ ~ " ~d ' 01 ~~J alSO known aS ~ f_//j J[~rf.~ / ^-~ ~.,1 ~/ _T- ,Deceased .Social Security Number 1 ~ ~ '~ r [ '~ f~ -<~SO Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COA~IPLETE 'A' or 'B' BELOW.) ~ ~ ~,,, ~e, ~~~ ^ A. Probate aad Grant of Letters Testamentary and aver that Petitioncr(s) is /are the _ tuned iie"'~ last Wilt of the Deccdent dated and codicil(s) dated ~~. ~ '"" ~;;g ~~~ (State relevant circumstances, e.g., renunciation, death of executor, ete.J Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution o~te far probate, was not the victim of a killing and was never adjudicated an incapacitated person: B. Grant of Letters of Administration ~ S ~' If ap liiicable, enter: c.t..; d.b..c.t/.a.; ~wt~nte Cte; durance absentia; durante minoritate) Petitioners after a ro cr search has /have ascertat a tha~ D edent le n ~' 1 /~ d ~ (~ e b the followin ouse if an and heirs: I e~ o tl an w sur6iv d ) P P as Y g sP ( Y) (f Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) (COMPLETE IN ALL CASES:) Attach additional s/ieets if necessary. was domiciled at death in (List street address, towidcity, township,~count)! state, zip code} County, Pennsylvania with his /her last principal residence at sd.~`! i^ Decedent, then _ Z ~ years of age, died on~~,( at j ~ rh ~ ~~ecX15~'~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property S (If not domiciled in PA) Personal property in Pennsylvania S (If not domiciled in PA) Personal property in County $ Value of real estate in Pennsylvania ~ situated as follows: Forne RW-0~ r~N.10.13.06 Page 1 of 2 --fit' f ~~~ r-~ offerr~d~ Wherefore, Petitioner{s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Pietition and the grant of Letters in the appropriate form to the undersigned: Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~'/.4it/~ 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 i' 4~ ' ~ V~f.~_ b/D ,F a Register Signature ojPersona/Representative t Signature of Pers al Representative Signature of Personal Representative G. r cia- ~d~ "t! ~~ ~ ~k . t '."`~ ~~ .,. . -:.$F ._~- 'f~ ~ ~ . ~. ,.~ File Number: ~•~ ` Lt~J "' ~~~ ~ /~ .----- Estate of ir~,~'!Lt ~,., ~ /!` ~~~~~ ,Deceased Social Security Number ~ 7,,`~ ` 7~'~~ ~~Y" Date of Deathi:~ ~ ~_ AND NOW, _,~„ f1`J ~ "[ , ~~, in consideration of the. foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters __~d(X.t1~~.~ ~f~t~CM 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 a ~ ~ ~~ .. $ Register ofWiltr ~( w,. `~,. t- LCttCCS ............... ~••~~~~ _ S J - _ .w Short Certificate(s) ........ $ Attorney Signature: _ = ` ~ ,- ~.~ Renunciation(s) .......... $~• ~~ $ a~ ~ Attorney Name: ~ Y" ~.~ ~ ~ ~~-- S ... ~ , ., ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ ~~ • SQ Furor RW-q1 rrv. l q.13Ab Supreme Court LD. No.: ~ , Address: Telephone: ~ ~... Page 2 of 2 ~:•"~ '' Ii!l~S.~S REV (01)07) LOCAL REGISTRAR'S CERTIFICATION Off' DEATH WARNIN[~• ft is itl~ai to duelicatp this ceev by ehetnst9t er ehetnnrgeh_ ... .. ......~.. .. .~ _~_.. __ _.~'------ ----- --rte -~ -r---------- -- r-----~---r--- Fee for-this certificate, $6.00 This is to certify' that the information here given is correctly copied from an original Certificate of Death duly filed with. me 'as Local Registrar. The original certificatewill be forwarded o the'' State Vital Records Office for permanent filing. Certification Number al Registrar Date Issued ~; ~ ~ ~ ~ , ~ ~. ~ Q ~; ~, i ,,"~ ~~~ ~~ t~ I c-3~j~ ~ { ~ ~ ~ ~. " ~rP~iw'em0w°° CoYA1t~NwEAL.7H dF PEDM~YLVAtilA • a~lurl'YEMr oR I~ALJH • vR~u. REC~ao6 b ,~• ~~.~ CC'S .ER'~'!F'itC1R'~E OF t~EATti -.1 fl4A_4g~ ~~~~` > STA7EFN.~NlJAA9EA i N W .,~ a ~ 0 v' er i 1. IIMM dfMoliAp3M, nYr/R Irl, w~ ' Michael A Clifford, Jr. _ _ ~~:@ _ _ i BoeiM ~e.~ ~ 74 _ 0456. 4. qY al O~Mh ~~ ot,~ wA January 19,> 2010 a ~a a.r eia~- u~ r uer , 0. 4M d t r ~.. dc..w 21 ~ """` oe.: -.~.. ~.. Oct. , 31, 198$ York,.. PA Q ..C7 p+r a a~ p rao. [] AorNpa • ~var ~a. aoooAr a ooooor- e~, ale ~ ~ wr a nor roooeM ou.,~r w nor+~rf ~: wn aaaooo~a Awy.orro oo~ro-- '~ ~. ~o. Arearr~a rioarn. ~rdt'M-oM., ra 1~~.+e~hocwrn, "Cusbsrland Hatrepden 5236 East Tr1.udle Road wows, rnob Abo.~, +ra W~e UrM of iwAt d am t6. 0 ~w (M ~ OM ~^ "~- it Ml~a o.a~d~r wrr w 1M ii osa~ '~' ~ ~ yj ~ • ~ 10MdNtodc IOndef .' Laborer DenMa, oi`~`~`i ~{ yy ( t7M ei U.9RMWRa~rst r ~ (~a-~1 ~„~ ~,~ ~ Never Married '. ~s.aoM.otliwpwrow(ar.r,a~rr,r,n;ror~,~ooe.) 3 2 6 AO~JCa t Rd . omarA~l onaneoon tTPl~er; p`r8tnk~ord ~ AMwoo~ na arr +~X l Y.~ ~ ,t~.~] wa, o.oooer ww w . ~. ~a N+awville, PA 17241 ~n~.coorr Cuatb®r]~and' 17d.^ ~~~ _ ~ eoA r a. r~.rrr. N.~.nn ~ w: >,owo- 1f. wrr"a ~ ~ortdm R~o Mia~ Michael Clifford a y foR tnha~nn Nrr ('i~pr trdnq 104. Nlornun!'i wrq (~, eMr1+~- EMIR LV aod~l Michael Clifford ~ 326 Bob+~at Rd. N~wville PA 17241 tta wnata n p o,,.r,n ~s ow d aparon prbw- ~ p.A ' eta PYo. d w4ewen 1+r~ dawwr~t aMrery ar arw 6wl zu. taoowoo (Cy r bwn, rrr, ~p ooop 170'6 5 ~°ir1i1 ~ """°""'°'"811 ~ Hollinger Crematory Mt PA Holly Springs ~~~ , . sa: d/ar.aa~r4 t~a~~o+•«1M ~.uon+~wMea zrc.lam+w~.a~ ~~ Ir ~..-• o~ * 011589E 'Rollin ~erFHaCrs~ator Mt. 0.11: S rin s PA17.065 ~al~r.ill~ilbrooo~wr~ao~jiq ati w rr.wr a Door YooM~, oYM amn~e r~ wr. dry ~eayYea mold I~Owno.d wW 2se. Lkriw wry xx. rrr. ~~ yowp Ob~oMnkMMIfA1~11N11iMil d1~1o ~Alrao. dam: i4w~ ~ a aid ~r v«~ ~. ~•• d ooo.n p x . ps. or. pa~o.e o..d prods, dea rwt 2s. rwr c... Arouwd a waver ExrdnK r coiar~ for. Amon Olhr nro Q.nwb~ a Daria~4 ~~"~~ 1:00 A. M. January 19, 2010 ~~+» t]~ C4rl~! OF 11MA1t1 ~ ilwlnioltoa• M11 ~/IN) ~ APpoiiiW~ YM~eNk Pr! M: $rrr aYw 9~. OIr 1bWeoo 1M Corr~M It1~M1 . M iW ~ wQi r arpe rNM ~ra21 M t br M dYMI NdT •r b In gM i u M d rd M ~ Lu 1 ll D D Y kPrl L ~ ~ (~ ~~ ' . , w ~ owM O r s u y pa ~wp, ~. « i . n r na aw u0 O~w1 b M r ~ f~rled~ - ! w~,Yrory ~ a vMiiair ~ilYon Mlial MpnYp Y1 M1ob~ UM aNy an. ~ on ~ iN. ~ ~ ~ ~ , 2i. N frna4: ~~~~--s ,. .Head Injuries ~ O ~~~ O Pr.~nr r ran. or pure wolirWon~,iloon~, b. ~Motor~ V hiCle Cxasfi ~ ~ ~ jj p p O r~atpq~nt,eavnvowrwn~Rey. 6~WMO~~~Awe a ou. b ~t a ~ ~ aA: , o1dwA .+' ~ °' b . i ~ pnpWr,b~rpigwilp~ i~r Our b (or ~ a m~wgrna i ~ d t ^ uornow.rPNlW~~wvMwr soavwsan~ao~.r '' 1 n e aan.ww.krop.yAoo~o " " ' a~.M.e„.raoow uaor.a+o~oonp~n,arw~l e-.w~aowM}rp0oarwe ma~~~ BnM,f~aoffr. i oi j '""'~'' '°"°~ '"°" a coo^ a oorov ,,~,,, p ~ Jan. 19, 2010 Pedestrian, struck 'bq mini-van Read ^ ~ ~ ~ (] ~ ~ ~ ~llaeirnM ©R1ndn0 InM~Ipren ffir.1Y~r d M~p~ ~ !Ia Mjr/ M Mbkt ~d. M'~wporlMMn Airy (SOre>y! 98F 1odMM-okY~ry t~Il cMl l laws, Mw1 Q sWm. p oowa++da o.wnroaa ~, ~~ ~~->~ [7~ E. 7~rindle Ad. , Mechaniceburg,PA .1:00 A. a orK•. _. • cwr~~Nrwwn:~~dr-tau.aarnwn.n.no~n.-pyrerr-oorpwaor~o.ea^ro.naooooopw.e~2~ ~tMrrasw~-..rr~o,+~o«sAw~.~wo...~.1w.r..w._.-------- [7 ----~-------- --- - `` Coroner ~ '_""_-~. - - . w~y~b4Mr~+inwew~eawaao.ww+w~+oworajOrp a~r,- woaaaad ~ d + ~ ~oalorr~ Ox or.~+M~-egt9iw) t rtM w wirs+~+~,r..wiwrr~.+i.n.+r..wow.,.wrrrrr.•wNgw..r....ura.----------------- J atluary 19 , 2010 • o~inA~i e~iirlo~Min auutt r.r w..4wn in.yr awrar w rr a w.w~W rw nu~nr a rrK_ ~, rrr~ eoerowl r w Mew aw w wa , , , , ~. wo C ~~ t a~ °"'L~E° r aa. Done ~1 ~ 0 { ~ x n.r garo, ~ rwt ' ~ 78 , ~~ - .~ 1 1 { ~ o t d Mechanicabur Pa. 17050 _~ ~ orpwlboo ~.omr rro. ~ ~_ R ~NUNCIATI(l~N i.~ ~ ~ "~ ~' -: . ~~ -- w ~ S~ REGISTER OF WILLS COUNTY PENNSYLVANIA ~ -- ~ 3c ~ ~~;, ~.~ ~~ ~*~ , ~, ' ~•.r Estate of _____~-1, (~~.{r~} ~(.~.. ~(., ~ ~~c i>~ ~- ,Deceased I~ ~~t`~~~- ~+ ~ ~ ~ ~~ ~~b ~ in my capacity/relationship as (Print Name) - - ~ T ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to o .~~.. ~ ~--' .~ lJl.lit ~~,~ b I p . roams) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (S~Snature) ~~ (Street Address) C'~~c ~_ ~,~ ~ ~I 70~ (City, State, Zip) Executed out of Register's Offce Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation or the u ose stated within on this - da of ____, U.,1~.~ ~ ~ t b y Notary Public My Commission Expires: S ~ ~ ~ ~ (Signature and Seat of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NdtARiAL SEAL' 804 G~ (+ S ~ ©f~l'~ E.ltlfM 21, 2!414 ~ N ~_ e~ a (,_ 1 ` ''`' " ~~ ~~ t"I 1 .s:,~. U7 ~ ,,,,, C~3 ~ '~ ~7 ~~ ~ ~~-~ rY~~ "" . RENUNCIATION ~ ~~ ~ r ~, ~,. ~.~ ~ = ~ . ~ ~ y~. . y...~ P .,..,. 4 ~ ~ ~ ' ~ ~ 4. } t GI TER C?F WILLS .~.' . OUNTY FENNSYLVANIA ~- ~ ~- t. U -- "2,~. '~~ Estate of i'Y~ [ C.I~1a CI~~~Or6 ~r I, S ~ c~p tnt Name) Deceased in my capacity/relationship as `~ t S ~e--r ~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and. respectfully request that Letters be issued to (Y1 ~cS~QP~ ~ C l ~ ~~ S,~ - f~- CCU ~a~) r gnatsae) C~ ~ C~,-~ (Strtet Address) ~s~e~ 1 CQ ~~ t~~ ~ ~1l ~cfey, stare, gip) Executed in ~tegister's Of, f ice Sworn to or affumed and subscribed before a this ,,,,,,,~,.,,~ day of , 3r, Deputy for Register of Wills NOl'Ap1AL BEAL DAFiG'IE A. NEIL, NOtary PubgC ®01~D o~ X16, CNIIYtIiflMl'f0 C01111ty My Car~nNtlNon Fxpira- Nov. ~4, ~01a Executed out of Register's OffYCe Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renuncia i or the purpos stated within on this day ,. \. ,1 -. ... ,~~.. Notary Pu-blic My Commission Expires: 11` Z~I " ~3 (Signature and Seat of Notary or other offecial qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. !0.13.06