HomeMy WebLinkAbout12-28-10IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~f I k~-- 1'Ir ~~tR.~d ,Deceased ESTATE NO: 21-1~ Zfo~e
a/kla• ~ ~ -a o6, n 17r~ J~
alkia: SS NO: `~d 3 ^ ~ '~ -- 7 X72
Petitioner(s) who islare 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' ar ~)~' AND "C" as
applicable:
^ A. Probate and Grant of Letters Testamentary or ^ Administration e.t.a., or d.b.n.c.t.a. Qco~igplete Part C also)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters under
the last Will of the above-named Decedent, dated 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
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated petis~n, and was not a
psrty to a pending divorce proceeding at the time of death whenin grounds for divorce had been est~lgtbhed as defined in
23 Pa. C.S.A. ~ 33?3(g):
i.
li
~. Grant of Letters of Administration
(If applicable, enter d.b.o., pendent life, durante absentia, durantb m n4rltate)
C. Petitioner(s), after a proper search, has/have ascertained that Decedent left no Will and was survived by e
following spouse (if any) and heirs (If Administration e.t.a. or d.b.n.c.t.a., enter date of Will in Section A an complete list of
heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a pariy ja pending divorce
proceeding whenia grounds for divorce had bcen established as provided in 23 Pa. C.S.A. ~ 33?3(g), ~x~ept as follows:~~
N~m~
Address
to Decedent
[35E ADDPTIONAL SHEETS IF NECESSARY ~ C7
N
THIS SECTION MUST BE COMPLETED: ~ ~ ~
Decedent was,~}o~iled at de th in Cu rland Co~y~' Pennsylvani with his/her 1 family 'pal ~i
At ~~ _ (~9b ~ ~ ~ ~ s~ ' Y~ I f .O
_
---~
(Street address with Post Office and Zip Code, Municipality: Township, Borough, City) 7'1'1 :: #:::". r''r
f
Decedent, then ~ Q _ years of age, died ~o / ~ 8~ 02 D ~._at Yl o m e; ~ rc"''~t
(Month, Day, Year of death) (City and State where death occurre~
Estimated value of decedent's property at death: ' _
_If domiciled in PA All personal property $ ~ y ~ OE?T
If not domiciled in PA Personal property in Pennsylvania $
_If not domiciled in PA Personal property in County $
_Value of Reai Estate in Pennsylvania $ _;
Total Estimated Value $
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signatnre(s)„ Name(s) & Mailing Address(es)
IMetim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court rage 1 or
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named sweaz or affirm that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief of Petitioners} and that, as personal r~piteSentative(s) of the
Decedent, Petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed
re me this day of
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DECREE OF PROBATE AND GRANT OF LETTEJ + :~
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.[ter ,Deceased File Number: 21- Zp I ~ Z(ofo
Estate of ~______~~ - ~ ~" -_~
~~~.
AND NOW, this ~ day of > , in considerataolp of the Petition on
the reverse side hereq~ satisfactory proof having been presented before me, IT IS DECR~JED that Letters
~ . Testamentary ~7~ of Administration aze hereby ~Iral~ted to:
~~ _ ~ (If apptigble, enter cta„ db.n„ d.b.ac.t.e., ete.)
.~C~A.c/iYl .At Lf:~//~ lIl
the above estate and that instruments(s) dated described ilt the petition be
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. ',
nda Farner Strasba gh,
Register of Wills
!~~`~
FEES:
Letters ....................$ O,ao
Will ........................
Codicil{s) ............... r
(1) Short Certificates - ° ~
( )Renunciations....... -
Bond ............................
Other ............................
Signature of Counsel Required to lJn~er Appearance
Atty's Signature
PRINTED Name:
Supreme Court ID No.:
Address:
Automation FEE......... 5.00
JCS FEE ................... 23.50 Phone:
Fax:
TOTAL ................$ Sa
Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court
Page 2 of 2
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H105.805 REV (Ol!(YI? ~i_/O /~Y~
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is igegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 16855468
Certification Number
This is to certify that the information here given it
correctly copied f om an original Certificate of Dead`
duly filed with e as Local Registrar. The original
certificate will e' forwarded to the State Vital
Records Office f ~ennanent filing.
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Local Registra
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