HomeMy WebLinkAbout02-04-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WII~LS
PETITION FOR PROBATE AND GRANT OF LETTERS
Estate of ~c~°~c' ~ ~ r ~~e~--t ,Deceased ESTATE NO: 21- I ,~ - ~7 J'-~ R~ _
a1k/a:
a/kla:
a/k/a: SS NO: I 1 ~ - ~ ~ Cog 7~
r.
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A' or !`B# AND "C" as
applicable:
^ A. Probate and Grant of Letters Testamentary or .Administration c.t.a., or d.b.n.c.t.a. (coyn~;lette Part C also)
and aver that Petitioner(s) is/are entitled to the aforementioned Letters I 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 ,
instruments offered for probate; was not the victim of a killing, was never adjudicated an incapacitated
party to a ptncbag divorce procerding at the time of datth wherein groundr for divorce bad been
23 Pa. C.S.A.. § 33230:
art of the
war not a
as deflaed in
^ B. Grant of Letters of Administration
(If applieabk, enter d.b.n., pendent life, dannte absentia, dnrante ino~rihte)
'C. Petitioners}, after a proper search, has/have ascertained that Decedent left no Will and was survived by
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 at
heirs}; was not the victim of a killing; was never adjudicated an incapacitated person; aad war not a party
prooeediag wherein grounds for divorce had been estttblished as provided is Z3 Pa. C.S.A. ~ 3323(=),
ilete list of w a
oiling dfvorc~ ~ d,
as follows: w ~ ~ ~
O~ O~c~
N:me Address Re do t to Deco
USE ADDITIONAL SHEETS IF NECESSARY
THIS SECTION MUST BE COMPLETED:
Decedent was domiciled at death in Cumberland ~ounty, Pennsylvania, with his/her last
At r-7r~2Q-~^_ ~.s~ y ~~~SR. ~'`uy-c` Vie, - - -'f~ - - WQs
1 (Strut address with Post Office an~Zip Code, Municipality: Township, Borough, City)
Decedent, then ~_ years of age, died Via"`- Z~ zat~a iat ~~v'~ ~ ~
(Month, Day, Year of td6a h) (City and State where death occu
Estimated value of decedent's property at death:
_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 $
Total Estimated Value S -
Location of Real Estate in Pennsylvania: (Provide full address if possible.) ~ ~
Si~sutorefsl
Name(s) & Msilia¢ Address(es)
f
l a - ~-- ~ ~ '~ Q~ ~ ~''
Interim Fonn RW-02 revised 12.26.10 by Cumberland County pending action by the Court ~ Page 1 of 2
~1~~
~~
I ~~
dent A ~ ~ `~ ~ Q
W
O v
~O N pawa
u~
v
residence
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
j/~~~ n SS
COUNTY OF ~/Y~, '',
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are tn~e ~nd correct to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioners) will well and truly
administer the estate according to law.
i
Sworn to or affiicned and subscribed ~(
Signature ojPersona! Representative
before mc~the ,~ day of ',
~Z Q ~ Signature ojPersona! Representative it
- -
For the Register Signature ojPersona! Representative
I
I
I
File Number: ~(~`~ Q~~~ ~'
Estate of~/1,f~1}ii1J ~~~~GCP~c.~' , De~cea~ed
Social Security Number: l 11- Zd - ~P ~ 7 6 Date of Death:
AND NOW ~"
Zol in consideration of the foregoing Peltiti n; satisfactory proof
having been presented bef a me, ITS C~iED at Letters
are hereby granted to (~ ~ ~ ._ .
in the above estate:
and that the instrument(s) dated R tc. -
described in the Petition. be admitted to probate and filed of record as the last Will (and Codicil(s)) f Dece~ieft ,
-
FEES
Letters ............... $ ZD , OG Regis er of ~11s j
Short Certificate(s) :-3...... $ ~2 -na Attorney Signature:
Renunciation(s) r......... $ S = ~ ' C~`~ _ ~~(t ei~
Jll s ... $ ~v~,~'o Attorney Name:
LAN ~ • • • $ 8". °' Supreme Court I.D. No.: Z~~~
... $
... $ Address: ~ ~ Lt~'s~ U~ S°~
... $
... $ IT
$ Telephone: _ ~ 1 "l ~!~1 ~i ~o ~ ~ 3
... $ .~~`
TOTAL .............. $ O
I
Furu~ RW-OZ rev. to. r3.o6 !~ Page 2 of 2
REGISTER OF WILLS
~ ~~~--~Z COUNTY, PENNSYLVANIA
~,I-II-~~~f~
Estate of
II
O a
FF
W d. ~ ~
~o~o°°
°~~i~zQ
~~
~~~ ~W
OC7N CG°
~~ U
Deceased
I, ~~~ ~a~ ` in my t~apaGity/relationship as
(Print Nmime)
~a-~ ~'~-~' of the above Decedent, hereby ~enounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to ',
~~
Executed in Register's Office
Sworn to or affnme ~nd subscribed
before a this day
of Zd~~
u~iltice~ (~L %~~d,~
epury for Register of Wills
Executed out of Register's ~f,~ute
Before the undersigned person ly appeared the
parry executing this renunci~ti n and certified
that he or she executed the rt~n ciation for the
purposes stated within on this '~ day
of
•'.
Notary Public ~i
My Commission Expires: ~
(Signature and Seal of Notary or other offi~ial~u$lified to
administer oaths. Show date of expiration ~f ot8ry's Commission)
I
Form RW-06 rev. 10.13.06
~p5 enc 9PV IO'/Q7)
,_,
1-fl-D 1~~~
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 1724269
Certification Number
NIOi W 1!V 1111
Tr
~~
.This is to certify that the information here given is
correctly copied frq'm an original Certificate of Death
duly filed with mei as Local Registrar. The original
certificate will ' b~ forwarded to the State Vital
Records Office for' rmanent filing.
Local Registrar Date Issued
IkECORDED OFFICE OF
REGISTRER OF WILLS
2011 FEB 4
CLERK OF
ORPIIANS COURT
CiJ~IBERLAND COURT, PA
COMMOMIMIEAE.TM GF' PENNSYLVAlMA • DSPARTYENT OF HEALTH . VITAL f1EC0. ~ -
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