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HomeMy WebLinkAbout07-26-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF ~~ ~ ~~r{~i ~ COUNTY, PENNSYLVANIA Estate of J 1A t•~-~ ~~1~ ~u n~,,,~~ also known as Deceased File Number,/ (O T D /~r Social Security Number C~~~ ' ~`/ ~ ~ ~ ~ 3 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 r.> o .- the (State relevant circumstances, e.g., renunciation, death of executor, etc.) ~ C =• , -t Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after executic ~ e instru{~ttt(s) oft for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -ti ~~ `~ ' G''t B. Grant of Letters of Administration (If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendentelite; duranteabsentia; duranteminoritate) (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in N M3€tZ LAN' County, Pennsylvania with his /her last principal residence at ~'~~ ~ - CN ac o (List street address, town/city, township, county, state, zip code) -~ Decedent, then ~_ years of age, died on 7 ~ )Rt•/ 20 { p at ~~asC~Si~,((u ~ oS P/.7-p t_ (-(,c}2QrS~lQ (~(~ Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ / eo'O ~ 06 (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: 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: ~p nt t Q /.~ . Form RW-01 rev. !0.13.06 Pag2 1 Of 2 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 Ad~uiitistration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) Oath of Personal Representative COevI~[ONbVE_~LTH OF PEiv'tiSY'LVA: (IA SS COL'iVTY' OF GUM~2tA~~ 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 tlu Decedent, Petitioner(s) will well and truly administer thz estate according to law. n Sworn to or affirmed a/nd subscribed before me the ~[Q~' day of For thz Register File Number: - •• r~-t ~ .~ s ~:7 Estate of ~N)~i-tl ~11/.'[~ ~M~~'~9 ,Deceased ~ Social Security Number: /(~ ~ 5 l " 3Q ~~ Date of Death: 7 ~~1 ZOO O AND NOW, ~ , ~/O , iu//~~considzration11of the foregoing Petitior, satisfactory proof having been presented e me, ITS ~E iat Letters r/L U~MVM/~7d~L~bt~ are hereby granted to ~.,rwvri~r/w.,!/ and that the instrument(s) dated described in the Petition be admitted to probate acid filed of FEES r .~ Letters ............... $ Short Certificate(s) ..... ... $ ~ Q° Renunciation(s) ....... ... $ 5. oz, ... $ 5.©0 ... $ ... $ .. $ ... $ ... $ ... $ ... S TOTAL ........... ... $-----f~~= Farm RIKU_' rev. lU.I3.U6 ojPersainl Representative i Hi Signature ojPersann! Rtpresentnrive ° , ._ ~ ~~ r" ~ C Signature ojPersonn! Rzpresenrative ~ r fV _ ~~.~~~ j ` r~ .y. ~ t7~ ~ + ;fir ~:3 r_~ 4"~ ~1--"~ -=Z- --~ -Y'I Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Page 2 oil __ the last Will (,end Codicil(s)) of in the above estate RENUNCIATION REGISTER OF WILLS COUNTY, PENNSYLVANIA Estate of _ ~t~c I '10075/ Q ..... } ~ }:; , ~ ~l~~C? ~ N ~ } . rte'; ; r-~ ~= ~~ ..~ _r._, ~ ~T ., ~' ~ ; _ ~ Deceased I' - ~~~ ~ ~''~" ~~' ~'~ ~ in my capacity/relationship as Q 1 ~ ~~(Prrnt Narne) of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills (Si lure) ~~~~ ~\\4~~~iex~i ~~ (Street Address) N~!~citc~i~- ~ ~~ 1`'1 ~~ (Gty, State, Zrp) ---~ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renuttciatio~r the purposes stated within on this R day _s~----- n` , _ a o I o Notary Public My Commission Expires: ~Qy~o ~~A1o /~ (Signature and Seal of Notary or other official gyalifipd to administer oaths. Show date of expiration of Notary's Commission.) Common Wealth of PA NOTARIAL SEAL Form RW-06 rev. 10.13.06 Parvin M. Mehrtash, Notary. Public Upper Allen Twp., Cumberlangl Cqunty My Commission Expires March 06,' 2012 7ps.80t 2°_V ~m ~n-r~ _ _. _ _ - -_ _.- _ __ - - ~l ~l~ _o ~5-l 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 15935164 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registraz. The original certificate will be forwazd.ed to the State Vital Records Office for percr~anent filing, JAN 9 20 Local Registrar Date Issued N J~ ' ~ . 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