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HomeMy WebLinkAbout12-14-10PETITION FOR PROBAT/E AND GRANT OF LETTERS REGISTER OF WILLS OF ~~~~A?-~~ COUNTY, PENNSYLVANIA t:state of es~-~/ ~ ~ ~ ~ c--®ielJ Flle Number L t ~ ~ also known as ,Deceased Social Security Number ~~ t ~ ~ .~ ~' '" ~7` " G~~/ 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 i~~j last Will of the Decedent dated and codicil(s) dated ~g named in the r _ ~ ( g., renunciation, death ojezecutor, etc.) State relevant circumstances, e. Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after execution of for probate, was not the victim of a killing and was never adjudicated an incapacitated person: thb instrument(s) offered i ^ B. Crant of Letters of Administration (ljapplicable, erter: c.t.n.; d.b.n.c.t.a.; pendentelire; durance absentia; durant Petitioner(s) after a proper search has / ha•. •°rtained that Decedent left no Will and was survived by the following~I .l Administration, e.t.a. or d.b.n.c.t.a., enter date o,/ if'ill in Section A above and complete list ojheirs.) I I ntinoritateJ ine (if any) ~ heirs: (!f r~a r~r`r ' ,. Name Relationshi R n ~' ..,t -'r, . (COMPLETE IN ALL CASES:) Attac/rAadditionalls/'teets if necessary. Dec ©t was domiciled aydeath in G--~~~~~~~~ County, Penns lvania with his / he ~princip ~ ~ P-- ~ '~'~' si ence at (List street address, towrr/city, township, county, state, zip code) Vr Decedent, then ~~ years of age, died on ~ 01 /O at ~'~/f~ v~~'~~ ~~ ~~ , i I Decedent at death owned property with estimated values as follows: ', (If domiciled in PA) Alt personal property $ ~ (If not domiciled in PA) Personal property in Pennsylvania $ ~, (If not domiciled in PA) Personal property in County $I _ Value of real estate in Pennsylvania $ ~ fo situated as follows: '' ~ Wherefore, Petitioner(s) respectfully request(s) the probate of the last W ill and Codicil(s) presented with this Petition and the grant of Le the undersigned: , kters in the appropriate form to Si nature T ed or tinted name and residence ', ,~~ ~3y~ ~ ~ `~` ~s~ ~ Form RW-0? rev. 10.13.06 Page 1 OP 2 Oath of Personal Representative ~: COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF ~~/'~~~'~~ The Petitioner(s) above-named swear(s) or affirm(s) that the statements~in the foregoing Petition are tlve land 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, _ ~~ II Sworn to or.affirme~d}and subscribed before me the j _ 1 ~ day of . For the Register Signature of Signature ojPerswial Representative Signature ojPersoaalRepresentative File Number. Z ~' ~ U `f' Z Z S ~ Estate of .~T~i' • 1 Social Security Number: /77~ o~~ is li~.~ Date of Death: / O AND NOW,y~` y ,cz..a, L, ~ f 0 , in consideration of the foregoing having been presented before me, T S DECREED that Letters are hereby granted to .r~ta~p ~~~ and that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of FEES Letters ............... $ •~~ Short Certificate(s) ........ $ Renunciation(s) .......... $ - j~- ~~ .. $ tj as ~c.5 .. $ z3 sd -Au-la .. $ s- ~ o .. $ ... $ ... $ ... $ ..$ ... $ TOTAL .............. $ -5a Wills Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: ~. ~_. ,: O ~`i *"3` n ~ x'1 .~ ~:7 S~7 c .t, w ~~' IV `n O~ satisfactory proof in the above estate -r-- ;nk. . ~. a Fw•u~ RW-Oa rev. fu.r3.uh ' Page 2 of 2 __r~ H 105.805 REV (01/07) G I~ I O~ Z LOCAL REGISTRAR'S CERTIFICATION OF D~~I-TH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 16855731 Certification Number the information here given is n original Certificate of Death Local Registrar. The original ~rwarded to the State Vital manent filing. DE/C1~2010 Date Issued This is to certify) correctly copied duly filed with ri certificate will ~ Records Office fq ~ ~rt~ Local Registrar ~~ 0 ~1q ~tt~ et COMMONW~ALiN OF PENNSYLYANIA • ~PARTMEMr OF HEALfH . VRAL RECORDS cEirnwcArs oR ceAn+ (s« M~budlorya ane •rampi.. on nwr..) ...w~ 9 3 :J y it -- ~ p ~i C7 ~" ~7 ~:7 1.brao..rr(w.1,~rrar.t.wp a4w smdas.eagrww a or (-bowaa,vrn Gail R. Me F 177 - 24 - 6623 1 2010 AAA. 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PERSONAL REPRESENTATIVE: ,_ I appoint ~%~~ of ~,~ as Personal Repre ntative of this my Will T `~ Representative is unable unwilling to serve then I appoint ~ ~ ,~ .~ .~ , as alternate Persona Represe shall be thortcarry out all provisions of this. Will and pay mY and funeral expenses. I further provide my Personal Representative shall not be required to pi or any other jurisdiction, and direct that no expert appraisal be made of my estate unless regal II. GUARDIAN: r/ In the event I shall die as the sole parent of minor children, then I appoint N as Guardian of said mina~r children. ff thi~ unable ~ unwilling to serve, then I appoint as alternate Guardian. .~ III. ~ ~``"`"Z~.QC}>~STS: _ - . I, I direct that after payment of all my just debts, my property be bequeathed in tbe ~~ ~~ ~ ~ p ,~ 07 ~ ~ ~~'~ G~~ ~ Execute and attest before a notary. Caption: Louisiana consult an attorney before preparing a will. O F Z t.epa Far~ers. Before yon use Wis form, read it, 511 in all bhmka, and m~e whatevrr ~ haosaelioa. C.oasuk a lawyer if you doubt the farm's 5tneas for yoor po<pose and use. E-Z Ilgal F 3 repreaenhlion ar wemoty, express or implied, with respect to the mr7ity of this fo® far au i O; ~~il/ if this Personal of seen ' e. My bts, obligations bond in this haw. led Guardian is foll~o~win~g~: ~2.'~T/ L~ rv m ~ ~~ `~ ... should ~. ~a~ to your particular retailer make no ar purpose. r __ --- IN WITNESS WHEREOF, I have hereunto set my hand this day of (year), to this my Last Will and Testament. TV. WTI'11TE.SSED: Testator Signature ' ~~ The testator has signed this will at the end and on each other separate page, and hay de~red or signified in our presence-that it is his/her last will and testament, and in the presence of the testator an~i a other we have hereunto subscribed our names this day of (year). ?'il ~h~o~ew ,t~k;~ I 33s?3 C~~ ~ Sa •y ~'~ Witness SignatureF_,~D ~ ~ J"ci~tilll~~ Address c (7c,c~ ~ ~ sS W'l~ss Sign pu~~ //~ ~~ ~~~ w .~ ~/ State of ~ ! ~~ ~ ~-. } County of // s L rt~~ ~ 1 1~ SIC ~'' (~,(il!/i~GCJ Address e ~ !3 ~ 3 Address /~+ .~-+-~ ~ -r+ 'and .r7 c C o .- , the testator and the witnesses, respectively, whose names are signed to the attached and forega~in ihstnunent, were sworn and declared to the undersigned that the testator signed the instrument as his/her Last ~ And that each of the witnesses, j~ the presence of the testator and each other, signed the,.4G'$ as a witness. ~~ _ A ~~~ Testator,,~~~ ~ //!`L.+~t~( Wi .- On before me, , appeared personally known to me (or proved to me on the basis of satisfactory evidence) to be the perspn ) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the sa~i~ in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(sD, ~r'the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my han~t,pnd official seal. Signature of Not< Elaa ehwartz Yi .~ -µo:dry Fie. State of Florida ~yG.tm~mission #GC 87>3625 - ~ ~':_mber 13, 2003 Affiant Knovi~n Produced ID Type of IDs, (Seal) ~, ® E-Z Legal Forms. Before yoe use this form, read it, fdl io all blacks, and make whatever changes aro ceca4sary to your particidar : Coesult a lawyer if you doubt the form's 5toess fa your purpose and use. E~Z Legal l'n[ms and the retailer make oo teptesentatioe or warnmty, express o~r . 'ed, with respect to the merchantability of this form for ae inoended use or pdrpoae. f s ~, L_ I_ I__.--- - _____._