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HomeMy WebLinkAbout12-27-10IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVA}~I REGISTER OF WILLS ~ I -l~ - ~a-~~ PETITION FOR PROBATE AND GRANT OF LETTERS ,~ ~ Estate of ~~ ~ M (~ T ~ ~ L D ~ I`'I ~ ,Deceased ESTATE NO: 21- ~ C7 ss ~"_ , a1k/a: .- SS NO• Z ~`~ - 374 a a~ ~~ Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or ` AND "C~,as applicable: ^ A. Probate and Grant of Letters Testamentary or ^ Administration c.t.a., or d.b.n.c.t.a. (complete 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 person, and was not a party to a pending divorce pro eedin at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(g): ~ !~ ~ ~ ~B. Grant of Letters of Administration (If applicalie, enter d.b.n., pendent life, durante absentia, durante minoritate) C. 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 (If Administration c.t.a. or d.b.n.c.t.a., enter date of Will in Section A and complete list of heirs); was not the victim of a killing; was never adjudicated an incapacitated person; and was not a party to a pending divorce proceeding wherein grounds for divorce had been established as provided in 23 Pa. C.S.A. § 3323(g), except as follows: ~U~ Name Address Relationship to Decedent S° v S ~ tU $ ~ C9 G ~ ~ .SO ~ 1 R ca: [. ~ d~ vU P l~ I L ~~ - Wl ~ R - iv d t /~ r-a P 1 ~ ~ - ~'' USE ADDITIONAL SHEETS IF NECESSARY T i-~` ~ i r i~~-R THIS SECTION MUST BE COMPLETED: Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal residence At S © S~~ C LE R 1 V'C?. Ct ~A M P 1a t L t, (~ /-~ 1 ~ ~) I (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) Decedent, then 3 3 years of age, died ~ '~-- .,~'"- I U at Sul D Q, G A !1~''T-tf W A/. ~ '1/~ l/~ (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA All personal property $ ~ y d moo If not domiciled in PA Personal property in Pennsylvania $ If not domiciled in PA Personal property in County $ Value of Real Estate in Pennsylvania $ h Total Estimated Value $ ,~1r~~L(~~~ Location of Real Estate in Pennsylvania: (Provide full address if possible.) V~ f Signature(s) Name(s) & Mailing Address(es) V - ^i G e ~ - p IR. l-~ ~ c. Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 1 of 2 lq. ~~~ OATH OF PERSONAL REPRESENTATIVE r.,y ~' ~ x Commonwealth of Pennsylvania ~ SS '~' >~ . v ~ _~ County of Cumberland 7D rv , n-* n / d ~ m ) herein named swear or affirm that the statements in the fore oin Petitihti e true titi ( Th P g g ~ ga oner s e e correct to the best of the knowledge and belief of Petitioner(s) and that, as personal repre~ntative(skpf then; Decedent, Petitioner(s) will well and truly administer the estate according to law. ~ `-' Sworn to or affirmed and subscribed before me this .~ ~ day of 1~1'F ~ ,'11- , ~ ~y For ~.~. e._ ~ -~ DECREE OF PROBATE AND GRANT OF LETTERS Estate of 11 ~ ~ L ,Deceased File Number: 21-~~-~J~ AND NOW, this ~~ay of ~{~~ m ~ r , in consideration of the Petition on the reverse side hereof satisfactory proof having been presented before me, IT IS DECREED that Letters -Testamentary _/ of Administration are hereby granted to: I (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) ~~ L~~ ~.1~ ~ ~ L~~ in the above estate and that i~4st'ruments(s) dated described in the petition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. ~~~ ~~ , Glenda Farner Strasbaug r ~? ~h~~'~-- Register of Wills FEES: Letters ....................$ ~,Q-Q~ Will ........................ `-' Codicil(s) ................. ( )Short Certificates (/) Renunciations....... 5 •C~O Bond . ..... .......... ........ .... . Other ..~hOrf............ ~ ~ . tab Automation FEE......... 5.00 JCS FEE ................... 23.50 TOTAL ................ $ C___~_D ~~ Signature of Counsel Required to Enter Appearance Atty's Signature PRINTED Name: Supreme Court ID No.: Address: Phone: Fax: Interim Form RW-02 revised 12.26.10 by Cumberland County pending action by the Court Page 2 of 2 WEST V{RC~IN{A DEPARTMENT a~ HEALTH & HUMAN RESOURCES au~~au I+o~ Pue~.~c I~ALTIi - vRac. t~E41iISTRAT3(?N PH'rS1CIA1iIS /MEDICAL gXAIu~NER'S CERT~tCATE OF DEATH' - ~- ~,~ ROOM 185, 35U CAPITOL STREE?', CHARLESTQN, WV 253U1 ~ ~ ~ ~ t J ~'f ~~~"~ SLCiE F1Lf NtM1BEA aErw•:~ v~ , 6[ttDE+ri~5 er.. ~. lar[) i sF` j DE~TT+r4ta!n on >tin~ yLK'w. na !~~~ ~~ ^~ 4 r~ ~~ Ra pond I..a an ale i ~. - .~; _,.,~`,.~~. ^_ e w,'fX]IIL. SE Y .RM9EF fe bF1iy 67+Oei $` kfAEA : YEM &. - 1i t DAi E Ottf OE TM t1b+!'+. 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I•~tl Our I? eM10 Ca...eli ••6+~1M+r+1+ •f E Cif Cf R rc Der SK3Nffl r W+n Gw »ri - ~-~y ~ ~ ~RSO1r, vl.+o c~_ErfD ;.iu~ cx nEni~ InrtN 211 vcn.+w,lJ _ L • fr U 1 ~ r'~~[. '['i~~"E ~~, ~',, j~Qa~~ L~1~ 1ni u Oit7E `r `G ~b ~>~!• 2V lL r,~ ~ ~ v ~ n ~ RENUNCIATION ~~;, °~'~ ~~; ~~ rn REGISTER OF WILLS ~ a? ~ Ci N/l (j ~ ~ L, ~/IJ ~ COUNTY, PENNSYLVANIA ~ ca ~ Estate of ~~ ~ ~1 (~J ~ T H ~ ~ ~ G 1~ N ,Deceased I, R ~ ~' m o N `~ ~ L. d C ~ ~ , in my capacity/relationship as (Print Name) ~- I~`T^}-EF.I? of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to V S ~k dV B . L C~ G cA N -- lM d T- ~ ~ (Date) Executed in Register's Office Sworn to or affi ed and subscribed before me this ~ ~ day of ~10 ('Q.YI(1,fG3~ ~~( ~ . ~~~~ Vt/~'~ Deputy for Register of is (S' a e) sd ~ (RCL~" ~ R. (Street Address) C~~l ~ F~1 LL ~~ ~7(~~ ) (City, State, Zip) -~~ Executed out of Register's Office purposes stated within on this day of , Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) Form RW-06 rev. 10.13.06