The URL can be used to link to this page

Home My WebLink About04-01-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA REGISTER OF WILLS PETITION FOR PROBATE AND GRANT OF LETTERS Estate of William G. Baksa, ]r. a!k/a: alk/a: a/k/a: Deceased ESTATE NO: 21- ~ ~7 ~i~ ~ SS NO: 171-38-3;796 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. (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 proceeding at the time of death wherein grounds for divorce had been established as defined in 23 Pa. C.S.A. § 3323(8): ~_ D B. Grant of Letters of Administration (If applicable, enter d.b.n., pendent lite, 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(8), except as follows: Name Address Relationship to Decedent Jaclyn S. Baksa 78 Katie Circle, Royersford, PA 19468 Daughter .-- ~._ ~ `a' '~- -~ r~~ ~,: _ _.•.R: ~~ ~.. ~:t ~ ~ -~~:. i_, r :3 ~7 `~ LJSE ADDITIONAL, SHEETS IF NECESSARY ` =a f"'~"i 1 _ ~' i , .d__ _.~ , :i THIS SECTION MUST BE COMPLETED: ~ ~•,•~ ~ .,~ Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or ~ra~~t resi~ICe At 1102 Yverdon Dr, Apt A8, Camp Hill, PA 17011 =~~ ~,, _- ~- ~ (Street address with Post Office and Zip Code, Municipality: Township, Borough, City) ~ ~~ ~,,~. Q Decedent, then 57 years of age, died 3J7j2011 at 1102 Yverdon Dr, Apt A8, Camp Hill, PA 1011 ~ (Month, Day, Year of death) (City and State where death occurred) Estimated value of decedent's property at death: If domiciled in PA If not domiciled in PA _If not domiciled in PA _Value of Real Estate in Pennsylvania All personal property Personal property in Pennsylvania Personal properly in County Total Estimated Value Location of Real Estate in Pennsylvania: (Provide full address if possible.) $ 2,100.00 $ _0_.00 $ 0.00 $ 0.00 $ 2,100.00 Signature(s) Name(s) & Mailing Address(es) Jaclyn S. Baksa 978 Katie Circle, Royersford, P,A 1,9468 Interim Fonn RW-02 revised ] 2.26.10 by Cumberland County pending action by the Court Page 1 of 2 F`"_` =~~` OATH OF PERSONAL REPRESENTATIVE {/~~1 ~`~~ \~r ~ ~ _// .~.~ "T/ ~ ~.,., n Commonwealth of Pennsylvania SS ;~; --~ ~ ..~ r': ' '3 County of Cumberland ~~ ~ ~ ~ . . /~ ~; ., ;~ C:_.. The Petitioner(s) herein named swear or affirm that the statements in the foregoing Petition;ar~rue anc .=~- ~', correct to the best of the knowledge and belief of Petitioner(s) and that, as personal represen~tive(s) of.the ti~•~ Decedent, Petitioner(s) will well and truly administer the estate according to law. `~ Sworn to or affirmed and subscribed bef me this / ~ ~- day of _____~~ ~..d ~~ --- ; - _~... the Register DE~'R~r.E OF PROBATE AND GRANT OF LETTERS Deceased File Number: 21- ~ ~ -~~ Estate of William G. Baksa, Jr. AND NOW, this ~ Sl day of 1~G~. ~~ , in consideration of the Petition on the reverse side hereon, satisfactory proof h ving been presented before me, IT IS DECREED that Letters Testamentary x _ of Administration are hereby granted to: (If applicable, enter c.t.a., d.b.n., d.b.n.c.t.a., etc.) Jaclyn S. Baksa _ _ in the above estate and that instruments(s) dated described in the l;~eiition be admitted to probate and filed of record as the last Will and Codicil(s) of Decedent. f G enda Farner St augh, ,, ~~~~;~~ Register of Wills FEES: Letters ....................$ `~. n~ Will ....................... Codicil(s) .............. . ( ~, Short Certificates ~ ~~~ ( )Renunciations....... Bond ............................ Other ............................. Automation FEE......... 5.00 JCS FEE .................. 23.50 TOTAL ................$ `~~ 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 Cu berlai~County pending action by the Court Page 2 of 2