HomeMy WebLinkAbout09-01-10 (2)PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ~~~~`~!/~COUNTY, PENNSYLVANIA
Estate of ./~'~ .~/Li~ J ~ ~' • /-f~ ~> ~ ~ File Number
also known as a~
Deceased Social Security Number oC/~ ~~' ~~~~
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
A. Probate and Grant of I e~.ters Testame tary and aver that Petitioner(s) is / aze the cG~FG /~~~/t S named in the
last Will of the Decedent dated J~/r/-~ ~~~ and codicil(s) dated
(State relevant circumstances, e.g., renunciation, death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the insttvmentt(s3offered
c,
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: n
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^ B. Grant of Letters of Administration -~l ~ ~ '~1 ~ l
(Ijapplicable, enter. c.t.a.; d.b.n.c.t.a.; pendente lire; durance absentia; durance neskQ ' e) _
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Petitioner{s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spatas~>~any) at>~,lieirs: ~If
Adntinistrafion, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) .~'~ ~-- ~'° _ -
-- ~ _t
Name Relationshi Reside • ~ ~o ~ _
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(COMPLETE IN ALL CASES:) Attach additional s/[eels if n/ec'ess~ary.
ecedent was d m~c~led at death in Gv/ri /1f'~W~~' amount , Pennsylvamyg with is (her last princi al residence at
(List street address, town/city, township, coung~, state, zip code)p / ~~,
Decedent, then ~ years of age, died on t1 _~d`/d at ~~1i/f/~ ~~9 ~ Or'v~} /~ /Li9~~'y~ti
_ /~/~~
Decedent at death owned property with estimated values as follows: ; ~ G // O
(If domiciled in PA) All personal property $ ~~%
(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
Form RW-U? rev. tal3.o6 Page I of 2
Wherefore, Petitioner(s) respectfully request(s) the prohate ofthe last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersiKned:
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA .
~~~~ SS
COUNTY OF ~~ ~ ~ ~~~ ~~w'--~`-'-
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.
Signature ojPersonal Representative
U;~_
'r ~"~
~t .7~-:~
File Number: ~ Q
C,:.
Estate of ,Deceased
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~~,
. - `ri
7 c.._:
-~ Date of Death: 15 ' I ~ ~ j o
Social Security Number:
AND NOW, ~~ ~~ ~ e~lC~ , in consideration of the foregoing Petition, satisfactory proof
rated before me "r IS DECREED that Letters
havm~ becn rrese ~ ~ ~ _ ~ ~ ~ , f --~'~ ~ ~~ N '~~ ~,' ~
are hereby granted to
in the above estate
and that the instrument(s) dated ~ 1~/1~A 11.1
described in the Petition be admitted to probate
FEES
Letters ............... $
Short Certificate(s) ........ $
Renw~ciation(s) ...... ,
IA!'~ (~
w~~~
.. $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ ~ ~
of record s the last Will (and Codicil(s)) of Decedent.
i ~ ~
Register of Wi s
Attorney Signature:
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Page 2 of 2
r--~,,n Rw-o' rev. lu.l3.o~
Sworn to or affirmed and subscribed
I(1i805 RI ~ t0;/07;
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. X6.00
_ P 16535545
Certification Number
This is to certify that the information here given is
correctly copied froman original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~~~t-.~~~,~.~~ au,G 1 a/2o~o
Local Registrar Date Issued
H10S113 HEV 11fN09 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TYPE I PRIM Ni
PEHA4WENr CERTIFICATE OF DEATH
BIACIC INK MSee Instructions and examples on reverse) ,a,c F„ c u„eaeaFp
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I, MARGIE M. DAVIS, of Carlisle, Cumberland County, Pennsylvania, being of sound
and disposing mind, memory, and understanding, hereby declare this instrument to be my Last
Will and Testament, revoking any and all Wills by me heretofore made.
ITEM ONE: I direct my hereinafter named Executors to pay all my just debts, funeral
expenses and administration expenses, including inheritance taxes, as soon as may be convenient
after my decease.
ITEM TWO: I give all the rest, residue and remainder of my Estate, real, personal, or
mixed, of whatsoever nature and wheresoever situate, in equal shares, unto my sons, ALAN
GOODYEAR DAVIS, of Carlisle, Pennsylvania, and JEFFREY LYNN DAMS, of Carlisle,
Pennsylvania, or their issue per stirpes.
ITEM THREE: I hereby nominate, constitute, and appoint my sons, ALAN
GOODYEAR DAMS, and JEFFREY LYNN DAMS, as Co-Executors of this, my Last Will and
Testament.
ITEM FOUR: I direct that my Executor or Co-Executrices, shall not be required to give
bond for the faithful performance of their duties in this or any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this this, my Last Will
and Testatment, consisting of ~_ typewritten page(s), bearing my signature,
this , Q day of ~~ f A.D. 2007.
h ~ 1. , -~-ti1.,
Margie M. avis, Testatrix
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ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
BOROUGH OF CARLISLE
`f~--
On this, the L ~ day of ~~v„~;p~1 , 200, before me, a Notary Public, the
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undersigned officer, personally appeared Margie M. Davis, Testator, known or
proven to me to be the person whose name is subscribed to the within Last Will and Testament,
and acknowledged that he executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
BOROUGH OF CARLISLE
Before me, the subscribers personally appeared ~ ~~ ~G~ ~ .S.S~ ,and
~~°~~'y~iS ,who being duly sworn according to law, doth depose and say
that the foregoing will, consisting of ~ typewritten page(s), was, on the ~ ~ day of
~a~ , 20(~, signed, sealed, published and declared by the said testator as and for
his/her Las~l Will and Testament, and it is hereby acknowledged that said testator appeared to be
of lawful age and sound mind and memory -and there was no evidence of undue influence. We, at
his/her request and in her presence, have hereunto subscribed our names as attesting witnesses:
~~ N ~~ ~ ,Affiant
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~~ ~~ ,~/3/I J ,Affiant
Swc~n to and subscribed before me this
day of ~(~yti(~,A.{,~- 200 ~