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PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF 5,x,1 b, ~1.~ti~^ COUNTY, PENNSYLVANIA
rf ~Ae, LA~L~S ..~ ~ tru ~ File Number ___.,ES~L
I
awn as
Deceased Social Security Number ~ Q~ ~~(- ~~q ~
~-- -
ho is/aze l8 years of age or older, apply(ies) for.
'A' or 'B' BELOW.y ~~
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the
last Wil of the Decedent dated and codicil{s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after
for prob te, was not the victim of a killing and was never adjudicated an incapacitated person:
B. rant of Letters of Administration
(Ijapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente lire; durance absentia; dm
after a proper search has /have ascertained that Decedent left no Will and was survived by the following
an, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.)
Name
WALL CASES:) Attach^additionat sheets if necessary.
as domiciled at death in (.}. n~~[~. ~ w..~ ~ County, Pennsylvania with his J her last principal
named in the
~t
:~~
-~`I '~' -- - .r
ti.~7 (~)
(if any) ~ heirs: (If ~ ~
at `~1 ~ ~y .
street ddress, tawnlcity, towirship, county, state, zip code)
)eced nt, them years of age, died on ~ at g
at death owned property with estimated values as follows:
(If domiciled in PA) All personal property
(If not domiciledtn PA) Personal property in Pennsylvania
(If not domiciled in PA) Personal property in County
Value of real estate in Pennsylvania
situated as
Wherefore, ~titivner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters i~t the appropriate form to
the undersie ed:
name and
Fornr RW-02 r~e~. 10.13.06 ', Page 1 of 2
~:
I 1~";
Oath of Personal Representative
COM ONWEALTH OF PENNSYLVANIA
SS
CO TY OF ~~I~aw...~ ~1`)~-~•t.
Th Fetitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true a#d correct to the best of
the kn wledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) v~till well and truly
admini ter the estate according to law.
n
Sworn o or affirmed and subscribed
I -/
/~ Signature ojPersonalR resentative
day of
bef re a the
~`~'~~ t
ti
P
l R
~
ve
epresen
a
ersona
Signature of
/
l I hr1
o the Register Signature ojPersonal Representative ~ I o r?")
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7
File Number: / e - ~ ~ ~ ~
~ ~` ~
~ Dec ~
~
~ --
>
Estate of ` ~- r~ _
w.aC ,
s~ rlt .
` '.~_
,
Social Security Number: Ig$ ~ ti ~ - $ 49$ Date of Death: ~ ~1~. ~ ~ t a
. .~
AN NOW, ~ ii
~ in consideration of the foregoing Petition satisfactory proof
having b en presented before me, iT D C E that Letters i / ~~ ~
are here y granted to ~~Q'Z- ~ ~ ~
in the above estate
and that he instrument(s) dated '-
describe in the Petition be admitted to probate and filed of record ~a~s~,the/l~ayst Will
FEES ~7~,~~~
Letters ............. $ ~~ O°
Short Ce ificate(s) ........ $ .'t" Attorney Signature:
Re ncia ion(s) .......... $ ~~~oo
~• $ ~ Attorney Name:
5 ... $ J~.~~ Supreme Court I.D. No.:
... $
$ Address:
... $
... $
... $
• • • $ Telephone:
... $
TOTA .............. $
Codicil(s)) of Ueceaent.
Form RW03I rev. 10.13.06 Page 2 of 2
71 7?d,'l1 ?7 :'I r..~r n•,^,~n^
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REC3iSTER or W~S.LS I° Q
~ ~ =
~
~.rG~1.4.~..u~_ COUNTY, Yl/NN~Y'LVANiA
':~_'~z~ ,
o'' ~_" ~-~'
~~
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SO ~_~
r~"~~ ~ rr t ~ ~
CR "rJ ~
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~e~ ~.s~+.~ . _. ... .... • tax .x. t .•.•~F,~w~a, ~ ~ wl,rafvawi.i,...v
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zC~ _ _ ~ of the above Decedent, hereby renounce the right to
the Estate of the Decedent and eespectfully request that Letters be issued to
-t~•/o
ti
F.ro. ulvd i„ .1i<a~lsfor~r Cl~ca
Swo to or affirmed and subscribed
befo me this 7'~d day
of ti-v i o
foe Register of Wills
Fo~mJt~Y-06 rcr, 10.!3.06
.Tc.sno~vlt~d oa/ ofr,R~~islor~s ~~:.~
Before the undersigned perso ally appeared the
party executilag this renunciati',oia and certified
that he or she executed the ran ciation for the
purposes stated within on this ~1-~ day
4f /~rwVs / ,d a ~0 ) p
Notary Public
My Commission Expires:
(5i amd Seai of Nola or other oRieisll )~ W
Snatwe ry ~Qus
administer oaths. Show date of a~iration of ota>yls Cac
S.W. Boswell, Notary #5118 ;~
East Baton Rouge Parish ~~;
State of Louisiana t,,~~°
Comtnissiou Issued for Lif ~"''~`" ,
RENUNCIATION
LLS
REGISTER OF WI
COUNTY, PENNSYLVANIA
of
I, c1
(Print Name)
in my
. ~,
a ~:, ~.~~
~-
c ~;
`'`^
V. ~~..} T~~~
~~
I~ceas
~ ~.
`
-+ •• ~
,
~.~ ~
tv/relaticS~hi>, as
of the above Decedent, hereby renounce the right to
t//h~e/Estate of the//D~~ecedent and respectfully request that Letters be issued to
1 ~V/'/1 ~ , (J1.7 P.Iti ~'
(Dore)
Execut d in Register's Office
Sworn t or affirmed nod subscribed
before a this day
of ~/O
~t8~~'e)
~1~ n ~~~
(Street Address) f
(City, Stats, Zip)
Executed out of Register's Offc~
Before the undersigned personall appeared the
party executing this renunciation d certified
that he or she executed the renunc ation for the
purposes stated within on this ~^ day
of ~
~~Deputy i er Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other o~cial quali ed to
administer oaths. Show date of expiration of Notary~s Commission.)
Form RW-06 rev. 10.1.1.06
___ _ _ _
v,ns_Rn~ qty ~m~m~ T... _ ___ _ ~ _~ _... ,
,21-/~ -D~~B'
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00 Phis is to certify thalt the information here given is
correctly copied'fro ' an original Certificate of Death
duly filed with' me s Local Registrar. The original
certificate will be orwazded to the State Vital
Records Office for plrrmanent :filing.
P 16355888 ~.A~~' -,,
~.
Certification Number Local: Registrar Date Issued
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