HomeMy WebLinkAbout11-22-10PETITION FOR PROBATE Ap ND GRANT OF LETTERS
REGISTER OF WILLS OF ww1,~e~IG.nO` COUNTY, PENNSYLVANIA
Estate of 1 V!Q/1r1(n~j C.= ~S7CZC~I ~C~LJS~/ File Number ~ V ~ / / ~~,,,
also known as
,Deceased Social Security Number ~S~O '~~- ~ 7a;
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
r.a
^ A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the C
~~
last Will of the Decedent dated name~ri:~iF
and codicil(s) dated ~°~ . .
r.... , _.
.C L„ _.~~
fTl tV ~- ~,==ri
(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 bom or adopted after executio(`i~shumEi(s) offe#:zd ~!_:-
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: - 7J ~j -= ~-,
7;b '
'T i
B. Crant of Letters of Administration
(If applicable, enter.• c.t.a.; d.b.n.c.t.a.; pendente life; durante absentin; durnnte minoritate)
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: (!f
Adntinistratiat, c. t. a. ord.b.n.c.t.a., enter da.u of Will in Section A above and complete list of heirs.)
a(o~
Decedent was domiciled at death in ~~~av,~~ County, Pennsylvania with his /her last principal residence at
_~ / _`-; -TL, r v Stn G-l- - ,t2.; l=j._~ ~_Q.~ ~ 7 (~S J
(List street address, town/city, township, county, state, zip code) ~
Decedent, then ~ years of age, died on / / !D a? D/!~ at
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ / (,~~ ~ OCR
(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: Y~~G~e /+,wr.,o ~~ :'
Wheretbre, 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:
or~rlnted name and residence
Form RW-02 rev. 10.13.06
~~
Page 1 of 2
(COtY1PLETE IN ALL CASES:) Attach additiotta! s/teets if necessary.
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA .
SS
COUNTY OF Cvyvl~j p~-~~h~
The Petitioner(s) above-named swear(s) or affirm(s) that the statements+in the foregoing Petition are UUe and con•ect 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 sybscribed
b`e~ore me the O~ ~ day of
V f~
. _ . _ ao
the Register
~;'?
Signature ojPersona! Representative
N ~.~
N .-, -
Signature ojPersaial Representative y.
O `,'' 3
~ C:~
k~ileNumber: ~~' IV' /i{J~
Estate of ~ py-~~rj ~, PS ZG~ p~~pws~l
Deceased
Social Security Number: 15~0'~jg -Q7a ~ Date ofDeath:~!_~/D~jQ
AND NOW ~-a of ~~,,~~,, ~.~,, o
_ =;
~~~
~'", 47
having been presented before me, IT IS DECREED that Letters ' in consideration of the Foregoing Petition, satisfactory proof
• spa fZ pv~_._
are hereby granted to _reu~ ~ ~•~, (}~ ~dl ASSN o
and that the instrument(s) dated in the above estate
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of De edent.
FEES
Letters ....... $ Re istero Wil
Short Certificate(s) ........ $ o .
Attorney Signature:
Renunciation(s) .......... $_
$~~ Attorney Name:
$~" ~- Supreme Court LD. No.:
... $
g Address:
... $
... $
... $
... $
$ Telephone:
TOTAL .............. $
FormRWq' rev. lU.l3.U6
Page 2 of 2
105.805 REV 101 /07,
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 16810156
Certification Number
This is to certify that the information here given
correctly copied from an original Certificate of De duly filed with me as Local Registrar. The orig
certificate will be forwarded to the State Vi
Records Office for permanent filing.
Local Registrar Date Issued
f'7 ev
°
_
_ ~
Y
~~ ~~
~
~
~Cn ~ ~
~)
~
.
-~ --~ ~ ~~....: Tl
~+ .. C,~ ~
N,OS.,M fiEV 11110p"
nPE
auac w"
;~32-385
,. Name a Daadrt (Pi'et mldre, br, satd
Thomas C
s Ay (trt Bidpb,( LMdr t Ua
wr. trp Muw.
1 ra
m.ca."yaorn ~c.r. n
Cumberland game
n.Dead.rawr aarhdar mma,
ribawok tar
C~ii1P..r ~'iVer TTa1
i6.Oandrp'e MaigAdtYay Janet aY~ ban, wle, +o adel
615 Thrush Cart
Poe epoimr~fs Wtr RYq ~ Pdnq
Andrew P3zCZc
z,.lbdm a dgoeipm
^ t7~ r ~ artbeat ban 9w
zza.SgWna srr,atxrrebr
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CORONER'S CERTIFICATE OF DEATtI
(~ Inatructfons and exampbs on Tevema)
STATE FILE NUMBER
2 Sae d Sour Seas"p Nuaoer a. Dab a Darn
Pszczolkowski Male 156 - 38 - 0721 ~'~
s'orawampbrr,• ~ ~. .wmb« ~Praaoern(ord,~ November 10, 2010
Moppet odrr
Au ust 17 194 Bayonne, NJ ^, ^ewna,~.p.p ^~ ^
~ Ao. Faoiry Nrns q m arMrat pwa m.r rr nnbr) & waa D.udrp a ~" Mom. ' ^pMr - Spau1Y:
n ru.+D.ar ae~` °r~T L7CND ^ rK ,o. ~ breA aw, wNr, rn
615 Thrush Court
b m rr ,2 Was M+~L F+Nb wan, rc.l
, bdWey u.s. ~ r~«?n e• ,3 Dawa~rs eacra, (sir «+r ~n.r v+da mnow.al u. Mwr sw White
EMnbntry ~ sxagary (o-12) Co1sYa (1i «5.) . Diwead~j~S1 NrnW. ts. 9srbA4 Svaw ~1 wis, gw naia,n mmy
'tatlCn ^Tee ®NO 2 D1VOrCed
Daosdrp's
ACAW Berrme ,ra sbr PPS1ilSylyaLlia Die D.oeden T,T~..~~~~
t1Yr n a 17G (~ Tae. Daadup liM b •~eKar11
,m. c«.,y Ctanberland T0M'""O~ nd. ^ NA owdrp titwd Win r'°
a+r tint a
tS. Mrtw'e Nrna (Fast midr,, nridrt ewrrtrl CpY ~ Boo
Mat].1C1a Matted
za. npannrp'a r.ttq Aa6ar (sr..c ar ban, aab ay are(
1883 Aster Road 'e PA 18062
~~ 2,E.orea DfePOeim lroir4 ax feM 21e Pro.aDiportlen lNsmeaaaapey, ~aY aohrPba) 2la laoatlm
rr.n r«^rb NOV. 16, 2010 ~'~a"'''b`.~°o00e1
~4an Cx'enatory ShiPPensburcl, PA
2ZO. Barre Harr 72c Name and A6Yes r Prary
F'D-138630 Mal z• 8 Market Plaza Way
py~.is naaasEYrY~mea ~p zs.. ro na eeaamr b~s.~bay.. aonn.erhrna.aream pc. wra. ISVwn.r weJ 1 F1]I1eL31 flplt~ 1C PA 17 55
orgy Dore r aern. zn l+rrre Mettler
23c Dab Sipbd (tbMr, aw, yp0
Dent 2t-ze mr w oarobrd M Drag
~~~"~` 2e. ter. a D.ed, a. Ow Na+arad Deed Mart ay, yr~
A rx. 1:00 A. M. November 10 2010 26 ~
~~bE"~'"~D°"b `~""`ortOtl'""'"a"""b^«ao~«,T
CAUSE OF DEATN (Sr IrWngroro ana e"angbo)
M«Z/. Pbtt FnlsrM}~~~~_dbasas.~¢ras.«mipirrirp_py gbsk aired hdeM
DO NOT er
ne
ir
M
i r
^No
~ nbnr: PN Ih 6MralMr
.
r
m
p
W Swnk suu~u aid.O rnr.
ayanaet«vrNNr McYOn WrutrbwiphsYOEYp.lit «YP «r aaemaWfns.
1TE WmE IFvwdYaM « t
~^9bdtlh)
O 2". OItl TsOan:o Ur
~ Qw1b DaM but natnMlYpbhuMed~i9awpka~bPrtt ^ria ^p~ bDwtli7
i r
cclusive Coronary Arte Disease ^
"° ^~"""°""
""'"(«d°~reorrwnary ~ Exo¢enous Obesity '~"~ ~-
~oeuwlredmMa. b' ;
O ^ Nr prapbr Win paryw
_
NOERYNB~ Dua b (« r s oorraqurp a); ~
~rY' osrere.!Wpfin desU o~ t ^ pgr+r wr a Bern
Dueb(«ra aaarpuras of4 - ^ ~ hPnprH wYAb a2 days
1
^ Nr prapnrp, oul paprrpU b1
days Yev
akMrenAUbpy
Prtanbd7 3oeNYnAVbpyF^yiP
Araiere Orbrb Canprion
a c 31.rwraOrN
Nr
3?a. Ored M7aY (~ap~.4Y•Yeri ~
77D. Deeab, MOw Eelaadwb
.
rb
n
Y PnPtrs WnhDer Wr
eMaT OaearM ^ t"
L
^ re. IEI No are a or,T
^ Yee ^ N ~
«r ^ Mauuee
A«iprp ^ ParAr
b
tl
am o ~n
.v
yy
ad
~ O~W euriY eb ~J ~'"' Fipo1y.
7~ o p
wr
paWn
^ SubVb ^ and Nr ne Derrnrrd ne a bia9
r a.
bj«y r wan a
^ Yw ^ No
pt. "rrrrpalWa nyni ~Pl
^ Odw/ oprra ^ Parrpr ^Pedroten
azp taerm a ejuy lstrr, ab / ben, arle(
37a Cretr kntl ay yi,l gher- y~Y
~M°IDNPetrrr(pde'snwrpyepowrdbriwhnarWrpnyroirrnuprorrraarddbrand
TD Yrleeta n/bbwbdOA ace"tomcod Arb,M
~~Mem z" 33n.BpupaerrTpbd _
/
1~
e+Mpand nrtrrrrrad---_--
• a°rutd"".naarNPMDMrewtlPMrertnon aeenw °'-"--'-'-"-'--'--"-'--
To Maleataary-trw4a.aeruoa«ndrurur~dr apeDe
b
~aa"~ /
/
- ~ ~i[~
^ =G
Cor` o-ne -
•
h
MtloalE~Mter/COtarr SIN err memrrswed------------------
O 2c.~b.a.Nam.,
^ 33a Dab Stprd lrartdry
rr)
n Mahrlaafr®Yt~tbnrr/«bwny.xD,t,tnmrwi+a~drnooa.t.arhu.e.der.end
weee
.nd arbnb , r
~ ,
awe(N rr atraw.rr,d_
a. ~ November 12 2010
3e. Nenr mdAd/nes a Peres Wb Canpred Crs d D
b
- a 3aoerA.nlrars~r~.rJ
L I ~ I a ee
Dbr 2n rype~ Pdn
Todd C. Eckenrode, Coroner
i I .( I ~J
V K' ~z l 6375 Basehore Rd. , Suite #1
c ade,.a.--~--~ - ----
Drweren ~,,,,„, r,. 0497909
RENUNCIATION C7
~ °
~-- :='
~
x~ r- ° ~ ,
t- -
REGISTER OF WILLS
-- ~. U m~ G~.f ~u.~f1c) COUNTY
PENNSYLVANIA ~ O ~ a•
~ ~ _~
-` -
.
, r~ ~ O _
~-.
:~~:.-, ~ 1
~'T'f
a .r : ~~
.; ,
Estate of I h ~ • ~S ZC.ZO `~~O W S `~ 1
Deceased
I, ~ ~
~~" Zo ~~~' ws ~~ ` in my capacity/relationship as
o t1 (P,ntNaae)
of the above Decedent, hereby renounce the right to
adm/ilnister the Estate of the Decedent and respectfully request that Letters be issued to
Andrew ~ , PS c zS~`k0 S~t 1
.-
o ve.v~nber ~ Co ~ O ~O
(pare)
/'
~ 3~ h¢!s G D~
~,
~0~~1~.~~ n/Y ~~ ~~
~~~~~
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Executed out ofRegister's ~e
Before the undersigned personally appeared the
P~h' executing this renunciation and certified
that he or she executed the rerrunciati~r for the
Purposes stated within on this / b'- day
of No~~nar~Z ~,E„ o
Pubic
My Commission Expires:
(Signap~ce and Seal of Notary or owes off~ial qualified to
administer oaths. Show date of expiradion of Notary's C.ommiaaion.)
Form RW-06 rev. ]0.13.06
NOTARY UB/C, StaNe of New York
No.OiKN5087883
Qualified in Cortla Co rtty
Commission Expires ___.ll /o Z.p~~~