HomeMy WebLinkAbout09-16-10r
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF COUNTY, PENNSYLVANIA
Estate of ~ fl~ File Number ~~'~ ~U `~~~~
also known as l~
,Deceased Social Security Number ~ ~ V ~ a ~ySCO
Petitioner(s), who is/are l8 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 named in the
last Will of the Decedent dated and codicil(s) dated
~~ ~'
5
(State relevant circumstances, e.g., renunciation, death ojesecutor, etc.) ~ f'*'1 ~', '=.,.
~ ~ G . ~z 7
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after exec a inst~tent(sfs~real
C%7 TTT~~~
for probate, was not the victim of a killing and was never adjudicated an incapacitated person:
~~ 3 „ ~t
K! B. Grant of Letters of Administration -r}"" ~ ~ ~ ;
r~u~R
r~
ASS
(COMPLETEINALL CASES:J Attach additional sheets if necessary.
was dolrticiied at dety~lt in
(List street address, tows+/city, township, county, state, zip
Pennsylvania with his /her last principal residence at
t ` ~M
Decedent, then ~_ years of age, died ons at ~ ~ I 1 it ~
Decedent at death owned property with estimated values as follows: c~~
(If domiciled in PA) All personal property $~3y + t 4 ~..7"
(If not domiciled in PA) Personal property in Pennsylvania S
(If not domiciled in PA) Personal property in County a'
Value of real estate in Pennsylvania $'
situated as follows:
~ 1S
(n.n50>d'~
PA.11~5~
Forn+ RW-t7? reg. 10.13.06 Page 1 of 2
(lfapplicabie, enter: c.t.a.; d.b.n.c.t.a.; pendentetite; duranteabserttia?4lurante~i:inoritt~j- ` ~ `+~j
Petitioner(s) after a proper search has J have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: (lf
Administration, c.t.a, or d.b.n.c.t.a., enter date of Will in Section A nbove and complete list of heirs.}
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with tltiis petition and the grant of Letters in the appropriate form to
the undersigned:
Oath of Personal Representative
COMWONWEALTH OF PENNSY~LVA)NIA SS ~ ~~ '~41 ~ (J ~S~
COUNTY OF ~~ b2~ ~a~d
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are hfue ~nd 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 a the 1 Uc~ day of
av
For the Register
Signature ojPerson/a0(~R resentntive ' ~_
Persona! Representative
Signature ojPersonaf Representative
~~ = C~
-~-~
File Number: ~' _
Estate of ~ , Deceased
Social Security Number: 21 CJ -J~ 2' ~~ Date of Death: ~ ~--r~ ~-
AND NOW, ~" 20If~ , in consideration of the foregoing Petition, satisfactory proof
having been presented bef me, I S EC ED that Let rs
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 fast Will (and Codicil(s)) of~trce~enl.
FEES
Letters ............... $ °°
Short Certificate(s) ........ S f 2 ~°
R-e~nulnciation(s) .......... $
V 1..5 .. $ Z~ ~
u~Cama bin .. $ s~~
.. $
... $
... $
... $
... $
TOTAL .............. $_ /J~O, SO
Furor RW-(1? rrv. tU.13.Ub
~/" RegisterlfjWiUs i ~, ~ ~~f,-__,.-
Attorney Signature: ~1.57~~
Attorney Name: ~
Supreme Court LD. No.:
Address:
Telephone:
Page 2 of 2
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Htossos aev ~olro~> _ _ ~/ ~~i " ~/ ~S f
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to dupNcate this copy by photostat or photograph.
Fee for this certificate, $6.00 This is to certify th ~t '' he information here given is
correctly copied fto~ an original Certificate of Death
duly filed with me ~s ~ Local Registrar. The original
certificate will ttie I'forwarded to the State Vital
.Records Office for ~etmanent filing.
P 15 4 3 4 65 2 ~'_ ~h ~,~~~® ,~~1 ~ ~, ._.~.~tt ru w i
Certification Number
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CORONER'S CERTIFICATE OF DEATH _',.__1
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Date Issued
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