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HomeMy WebLinkAbout03-09-11PETITION FOR PRO~B~/A~ `TE AND GRANT OF LETTERS REGISTER OF WILLS OF ~,~,~1,;' 1 ~~4~~~~~/"(~ COUNTY, PENNSYLVANIA Estate of O ~ n~~Cb ~ • ~ ~.~ '~ f File Number ~~ ~ ` 11 - (is ~ ~~ also known as :=,~11Ct~ _ , ~~~~~,(` , Deceased Social Security Number ~ `"~ " 3 ~~~ 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 ~ Q ~~, named-itt;~ last Will of the Decedent dated and codicil(s) dated c~-~ ' '~ ,. __ ~„ rrt t (State relevant circumstances, e.g., renunciation, death of executor, etc.) "y'- :~ Except as follows, Decedent did not marry, was not divorced, and did not have a child bom or adopted after executio,~ie `i~tstrum'Edt(s) offered for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ -~~-t ~ `- `~`: / ~' C,,~ `''~ CQ -r3 4 :, ® B. Grant of Letters of Administration (Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente life; durance absentia; durance neinoritate) 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 Adntittistratiott, c. t. a, or d.b.n.c.t.a., enter date of Will in Section A above and complete list of heirs.) 1 Decedent was dom~ ile/dt a~t~eath in 'I-• t-~ ~"l~~Yil^~ a, Count , Pe nsylvania with his /her last rincipal residence at (List tree[ address, town/city, township, county, state, zip code) Decedent, then _~ years of age, died on ~' "~'7~I ~ at \...~(`'~ :'~1 ~ ~`+~-' `Or1~C ~~ ~L°T~ Decedent at death owned property with estimated values as follows: +~,~~.~~£~f 1' (If domiciled in PA) All personal property $_ ~~~l,~Y°'esi ~ dt~~ (If not domiciled in PA) Personal property in Pennsylvania $ ~~L tn~ D(~ (If not domiciled in PA) Personal property in County $ !L(~ .~- Value of real estate in Pennsylvania $ ~.Q ; . p~~ situated as follows: ~r~ Wherefore, 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: Si nature T ed or rioted name and residence Form RW-0? rev. 10.13.06 Page 1 of 2 - - - - v (COMPLETE IN ALL CASES:) Attack additional s/:eels if necessary. ~,~/ W t~t~ Ccpa ~ ne.f l ~~w o ~,•, ~~, ~ ~~ ~ _.. s __ .. C31 Q ~._ - ~ [~ - Oc . - © `~ ~ t.i C11 ~ RENUNCIATION t ] "~ /L . C__> !_t_J ~,~ ~_ O ~ v REGISTER OF WILLS ~~ d COUNTY, PENNSYLVANIA Estate of Q I, f, Deceased __ - in my capacity/relationship as ~~intName) of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to 3v ~~ 2~i v (Date) (Stgnature) (Street Address) /La,t- ,'~ /n (city, stare, zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Form RW-06 rev. 10.13.06 ~Z ~ Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation fo~~ the purposes stated within on this 3 o day of . l~P_.C~in ~iGt ~1 , s 1 ~r 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.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Candice Lynn Walter, Notary Public Liberty Twp., Adams County My Commission Expires Jan. 12, 2013 ~pp.,~r Pennsylvania Association of Notaries WvJ~,J , c~-~a.. ~L~- ~vJ o ~.~ ~~ Q :_~ -;~ c~ ,_ - .vim ~ c ~,~~> ~, ~' ~"'~ RENUNCIATION _ . ~~ c~ -- O~ REGISTER OF WILLS ' v COUNTY, PENNSYLVANIA Estate of Y~~C~ ~ ~_ .. ~~ z Deceased r (Print Name) -" , in my capacity/relationship as - ~~ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~, (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this of day Deputy for Register of Wills Form RW-06 rev. 10.13.06 afore) ~~~- ~ (Street Address) ~Fy~l~~ i~ 3~,~~7 (city, state, Zip) Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the purpo s stated within on this t'~ ~'~`~ day of .ZO !/ ~~ Notary Public `~~ `~~~T t tu~~~~~' My Commission Expires: gyp( ~~`~~U"f ~ ~~~: F .. STq ~'' :'pcp (Signature and Seal of Notary or other official qua]ifiecj~ ~F administer oaths. Show date of expiration of No]~s 1rd~~EE :~ NOTgRY = ~ <, ~E COv` ~~,.~ • `r~ tt ttt,tt~~t t~ v~ `~ a , `^ ~ LC i'% ~~~ i - ~, ~ ~j'~' w ~.; . - - ~ ~ ~ L~, rti;.~~ , a~ ~~, `., j ~ ~ -~ k © J : -- ;._-:. v RENUNCI ~TION REGISTER OF WILLS COUNTY, PENNSYLVANIA Estate of ~Jt~Ctt`\.~~ . ~~ Z ~.~- . I, A~ ~~ l~~ nP,CP?..SP(j in my capacity/relationship as ~~ t ,~ 'Jame ',~~3n' of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to a ~ r~ ~,1.c ~Z_ 1~eb I ~ ~o ~ 1 (Date) (Signature) j ~ 0 5 ~ 6'~u-,,~- ~~--, i~j (Street Address) ~~~~ , ~~- I ~ o 13 (city, state, Zip) Executed in Register's Office Sworn to or affirmed and subscribed before me this ~_ day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 Executed out of Register's Office Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation fur the purpose atgd^within on this day of ~~„1~ .? ~- , i~oiary runiic My Commission Expires: ~, ~~ f (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) C MMON'UsIENLi i-9 Ui,~,,, r~,_,,,~~.,~1~•+~ a ova-,~vrr, NOTARIAL 5~>f_ DARGI~ A. i~~iL, Nnia~ry 1'~:b;ic BSaro ~f ~~rli~ta, Cumbnr3~igc~ Cputyty leRk~ ~;`~~r*~;r~~:;4?':r, k~xpires Nov. 24, 2;a19 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA ,~r~~ f ,~/~ SS COUNTY OF(~~ ~1 1 I~~~tC~1 ~" - The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and 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. Sworn to oi• affirm~ed/~and~„subscribed before me the __L~~J -day of /, r9 ~1 ~ A'~ ~ ~ ~. Signature of Personal Represenrntive -r-ry Signature of Personal Representative `~ ro '~'"' "' " ` '_j ~ n .%~J ~.~ :n rn ~ ~~ ,-,. ~-. ..~~r~~~ For the Register SiSnatw•e of Personal Representative 7 ~•~ ~ ~•~ ~ = r, ~, _ : ~-~ _~ -~ - "cn ~ _ --~ -Y-, File Number.1 ~{ ~) ~. Estate of ~~Y~~l t l.~ ~ - f~(-~ -~ ~- ll~ ~ • ,Deceased I `I Q ~ r Social Security Number ! ~.P L~ ` ~ ~f -- ° ~ ~~ Date of Death: ) I ~ I ` ~~~ AND NOW, ~ `~y1 ~ ~~l.l~ ~~~ , d~a L1-, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ `~Yl l~~l ~ (~~ t ~~~~-- are hereby granted to in the above estate and that the instrument(s) dated described in the Petition be admitted to probate and filed of recor as the last Will (and Codicil(s)) of De dent. ~ t ~ r FEES i'~ ~ Register of Wi s Letters ............... $ ,~~' Short Certificate(s) ........ $, Renunciation(s) .......... $ ~W - - ... $ ... $ ... $ ... $ ... $ ... $ ... $ TOTAL .............. $ Attorney Signature: Attorney Name: Supreme Court I.D. No.: Address: Telephone: Form RW-U' rev. lU.l3.U6 Page 2 of 2 105.805 REV i01l07) ~ ~-~~ ~-~f 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 16855611 Certification Number This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. L~•~. ~~~~r'FX' Nf~V 3 4~ 2010 Local Registrar Date Issued n `` ~ ~ ~ r-rt n ~'°' m < ~~ ~ ~ I - ~ _~ : t? _ ~z~ t , '~, `='7 r vi x cD , -~ ~ ~..I . _ 1 1 3y' '--I ~Y 3 GAD Q "i"1 C>r m N a 0 U s i ~7~rP~EI~M~ a~iac ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS CERTIFlCATE OF DEATH rc.ee inedneCtbna and examoNs on rovarse) l3TA7d? FxF bUMeER 2 Sae a Sedel Seaenl' Nuax e. Dre d DeYr Oiaw. aY~ Wfl 1. tlrrn d Deteder (Rr. nitlae, MR rihd Male - - nald E utz Jr o h er a ~ M1+r a~'1 Urber 1 Undr / a oer d Bhb T. rte rr.« ee. 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