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HomeMy WebLinkAbout09-14-10PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF Estate of l~~ 7 ~~/~,~ also known as Deceased COUNT'iT, PENNSYLVANIA File Number Z ff ~' ~~ ~-~Q ~7.3 Social Security Number ~ 9~~ ~~ Z,~ ~,j~ Petitioner(s), who islare 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 named in the last Will of the Decedent dated and codicil(s) dated (State relevant circmnstances, eg., renunciation, dead, ojezeeutor, etc.} Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution df the instrument(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person; B. Grant of Letters of Administration ^`a (ljapplicabfe, enter: c.r.a.; d.b.n.c.t.a.; pendente fire; durante absentia; minoritat~ t/! Petitioner(s) after a proper search has !have ascertained that Decedent left no Will and was survived by the follow' (if arj~nd h~ , Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete lfst of hefts.) ~~ x Name Relationship r'^: ~-~ • ~ ~ • ,., (COMPLETE INALL CASES:) Attach additional sheets if necessary. Decede was do cited at death in eu~ ~ Count Pen s lvania with his / he last princt~,1 r~el idence at ,~ d ~~( ioa ~'~ P~~r~~~c1t9 P~---! 1~~i~ {Lst street address, tow,,/city. township, county, state, zip code) ~' Decedent, then ~~ years of age, died on _~' /.CG4Gtt ~~.~Q/~~ /i1~ C.Of ~=~ !IVLG~ 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) Persona] property in County $,~,_T Value of real estate in Pennsylvania ' $ ' 1000 Fora, RW-0? rev. 10. f 3.06 Pabe I of 2 l ~ situated as follows: fQQ ~/~ ,Aj~~~~ Gd~td~~ /~~' Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the giant of Uetteks in the appropriate form to the undersigned: Oath of Personal Representative COM~tONWEALTH OF PENNSYLVANIA SS COUNTY OF _ ~d~'~j1~~~C ~ . The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition arel tlv~ and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(&) will well and truly administer the estate according to law. Sworn to or affirmed a~ subscribed before me the ~~ day of Zv1 r~ For the Register Signature ajPersonal Representative Signature ojPersonnl Representative ev 0 o -r; ~. File Number: 2l ~~rr I ~~ `~9`l3 ~ Z .~-_~ © ~ ' *~ ~ ' M =~~ii Estate of ~ , Dt;ce~sed N Social Security Number: ~ ~ Date of Deai:h: 9 ~ 1 ~ AND NOW, ~ 7010 ,inconsideration of the foregoing Petiti'pn, satisfactory proof having been presented befo me,~T IS DECREED that Letters are hereby granted to '~ in the above estate and that the instruments} dated - described in the Petition be admitted to probate and filed of reco d as the last Will (and Codicil(s)) of DeceGiet~. ~ FEES /,I~to•-vii Letters ............... $ 2(o. QD Re ter of wills Short Certificates} ........ $ rrp.°O Attorney Signature: Renu n ciation(s) .......... $ nn ~~ ~W • , . $ Z3.5-~ Attorney Name: ~~ • • • $ 'S-QO Supreme Court LD. No.: ... $ $ Address: .. $ ..$ $ Telephone: ... $ TOTAL .............. $ Z~`r'. So Porn, Rw-n? reg. ro.li.uh Page 2 of 2 i 105.805 REV f011(Y7) ~ ~ ~~ ,2l -~D-. LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photagr~ph. Fee for this certificate, $6.00 P 16854257 Certification Number This is to certify I,that the information here given i correctly copied f om an original Certificate of Dean duly filed with tr~e as Local Registrar. The original certificate will be forwarded to the State Vital Records Offic~l fo permanent filing. ~P t 1 :0'10 L al Registrat~ Date Issued ,v 0 .~ ~-, j 7 ~ r~ is ~„ ~ ":.`7 ~? Z C '~ N• ~~~ ~ ~ Nfoafq f~v+faoor COMAMONWEAITH OF PENNSY4YANiA • DEPARTMF-NT OF HEALTH • VITAL RSCflpDB '~ R ' ~ f CORONER S CERTIFICATE OF DEATH '~'~~ - ;-~ FIAIAL (~ InstruetiorK And ssAmpMs on ltivsnel a t.flw-dD.ran+/int. riaY.irt rit ~ Lif. aeafrMr.R,oErE.r - -- - - - ~. al0..r~lrwLdM,.YrA Judy Earley Female 176-58-4738 September o7, 2010 -sAp.lkrrwp IEdrf UEifr+ :aura r, rrwa r ~ ra.PMEEd 4s rR rr ~ rr. duly os, assl Carlialer PA "°'~ t>s ^~a~~.~.M. ^~+ ^ ~ ^M~r. ^4... r.0atltltlOrlh. ra Cfy, OEEe 1tl. FE~rbrptlbrRx rE•arr rrEUEErI r:wrlMErrrHgrie opyfl 1fE ~ '!n to aEESAYrrw r,REa rrec lfeME. ra Montour County Mahoning __ f3attMlQer Medical Center - DenvlBs krt ~nrq qor, ry I I~ ~~ h- 7Yr1 rrr4 rrd 11b.f1•rrdW IL NEr Waatr awbM 1Sa.rdrrE froAn t1.WAi Ante fa fEEMigllprrE plrb, prE.d~Ya.rw) lsrrwaE wrarwiw/ueEry U.d Air.d raiarl ~pn/flrrdry®fA Cdlgrpialh) MrbEwt CUErd ~'" "° 1 Merri er Sari Ea r.Erwr,llrurreR~la.r, te.E,~rfE.r4•oe~- po tfox 211 o.e.+rn aro...rrr AaErIfEWra7 1hAfY Pennsylvania u.b, vepr wf~DErrEr fl t LOWerFrankford no. Pleinfifrld, PA 17081 r•++v 1nca.fy Cumberland +~a^ aq/arE rn•.nrrbfrc.+++..r,••oFtarlin L. Hoover faYorelrEr.fEd,ruRf,adlrwrbq Reba J. Y m~-«..t-f..»cry,.iA+.o Rodger L. Barley roE.f~..rr.«r.~.~asrrrotiwa,,a.~.rb,rv«+.I i P.O. Box 211, Plainfield, PA 7 1 tfa EMr7d0YfprRr ^tEOfron QDrren - 2fa 4YdAgorAE}Irr~,M.wrl sln rbrr(aro.uE Nrrdarrllq,grrayaEUrplfr) arrr py/fer~rrE; rp ai!) 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