HomeMy WebLinkAbout05-04-11IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA
REGISTER OF WILLS
PETITION FOR PROBATE AND GRANT OF LETTERS /firr
Estate of ~ V'vn ~ /~, k S ~ h S ~ V Deceased ESTATE NO: 21- i V JI
a/k/a:
a/k/a:
SS NO: la 9 -1~-
Petitioner(s) who is/are 18 yrs of age or older, apply(ies) for: COMPLETE SECTION `A'
applicable:
^ A. Probate and Grant of Letters Testamentary or ^Administration c.t.a., or d.b.n.c.t.a.
and aver that Petitioner(s) is/are entitled to the aforementioned Letters _
the last Will of the above-named Decedent, dated
and codicil(s)
~ `-„ '`
Part C atsn),
-st under
~~ N ~
(State relevant circumstances, e.g. renunciation, death ofexecutor, 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 bad been established as defined in
23 Pa. C.S.A. § 3323(8):
6YB. Grant of Letters of Administration
(Itapplicable, enter d.b.a., pendent Ilte, ducaate absentia, dunnte minaritate)
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
procteding wherein grounds for divorce had been established as provided in 23 Ps. C.S.A. § 3323(8), except as follows:-
r.uoroas Rela6onsbi to Decedt
5 ~ o z 1 - av~P lpd t~/E~ .Jai, ~ a d ~r
Ahtt: Ka/Q h $/Q(~ t- ~at..a 4c~ `,
IrSF. AnnITIf111tA t. RtIriCTC rc nicncce~nv
THIS SECTION MU5T BE COMPLETED:
Decedent was domiciled at d ath in Cumberland County, Pennsylvania, with his/her 1 t family or principal residence
AtllAQremnntNi/~~`rta't' Pl~ab,l~ >•iaK C'enler ~QOOI'/a~~.t„~nf/~oad CQr/rc/r~°/9'/70/'~
totreet aaatsss wtth Post Office and Zip Code, Municipality: Township, Borough, City) D
Decedent, then g~ years of age, died D.3 -~ ~-a0 l ~ at CQ V f t 5 ~t T
(Month, Day, Year of death) (City and State where death occurted)
Estimated value of decedent's property at death:
~f domiciled in PA
_If oot domiciled in PA
_If not domiciled in PA
-Value of Real Estate in Pennsylvania
All personal property a /,ADO
Personal property in Pennsylvania $
Personal property in County $
a
Total Estimated Value S _ /~' QQ
Location of Real Estate in Pennsylvania: (Provide full address if possible.)
Signature(s)
Nn mwlel A. Mail:.... Ad.t---ei-..~
_.____~_, __ ______._e.___.-,.,.~.,,
/ Lo ~ ~t i1/ow a d P !70 7a
Interim Form RW-a2 revim!A » ~~ tot.., r.....t...t...a r,.,...... ___,,:__ __.:__ ~_.. ~ _ ,... _
., ,..,.~...6..,.....~ ,.~ ...~..~~., Page I oft
OATH OF PERSONAL REPRESENTATIVE
Commonwealth of Pennsylvania ~ SS
County of Cumberland
The Petitioner(s) herein named swear or affirm 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 or affirm~~ subscribed
Signature of Counsel Required to Enter Appearance
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Estate of
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AND NOW, this Y' day of ~"~~, , in consideration of the Petition on
the r rse side hereon atisfactory proof having en presented before me, IT IS DECREED that Letters
testamentary of Administration are hereby granted to:
/'~ ^ rtn , I ~ ~~ , ~ , ~ 0i Iluble, enter c.t.a., d.b.n, d.b.n.at.a., etc.)
described in the petition be
in
admitted to probate and filed of record as the last Will and Codicil(s) of Decedent.
the above estate and that
~~
enda Farner Strasbaug
egister of Wills ~ f
FEES:
Letters...... - - - - - ~ .~~ ~ GLJ
Will ........................
Co lctl(s) .................
( )Short Certificates `t'-~~
(~Renunciations.......~_
Bond .............................
Other .............................
Automation FEE......... 5.00
JCS FEE ................... 2¢3.50
TOTAL ................$ ~ U ,
Interim Forrn RW-02 revised 12.26.10 by Cumberland County pending action by the Court
OF LETTERS ~ °
~~~ ~ ~ )~~ /
~~~~~ased File Number: 21-~- l~/~ N
/ ~ as l
Atty's Signature
PRINTED Name: _
Supreme Court ID No.:
Address:
Phone: _
Fax:
Page 2 of 2
'~ DECREE OF PROBATE AND GRANT
OCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 17298587
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.
G~~2. ~ ~ MAR ~, 51011
Local Registrar Date Issued
~/ ~~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS
a"wac.« CER'TIflCATE OF DEATH
(Ssr Inrauotlorurnd rnmpNr on rrvrrw)
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BT~IE FILE NUMBER
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RENUNCIATION
CLERK OF
ORP~.gN'S COLRT
Cl)MBF.RLAND C0 , PA
//11 I 1 ~REGISTER OF WILLS
C~Urn !7f V' IR h d. COUNTY, PENNSYLVAI~IIA
Estate of
I,
Q
Deceased
in my capacity/relationship as
(g'traName)
~(LL ~ of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
le
P~
~l, :sly/
(Date) ~
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Deputy for Register of Wills
Form R W-06 rev. 10.13.06
(Sigrw
~ ~ s~
(Street A s) / 2
/(O J
(Crty, State, Zip)
Executed out of Register's O, jj~ce
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes states within on this /. S day
of ,~O / ~
No Public
My Commission Expires: 9/.2,3/o?D/ ~/
(Signatun; end Seal of Notary or othor official quatiSed to
administer oaths. Show date of expiretlon of Notary's Commission.)
aana~aarna~ t~~if~t%~~
~3, d~~ y
1. / ~ 5~//
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Rr^ y
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'%tli t M~'~ -~ P~ I : 2 4
RENUNCIATION O~ERK OF
ORPw~A~~ ~ ~ TPA
REGISTER OF WILLS s/llMRF..~
C'y~6er IQ h~ COUNTY, PENNSYLVANIA
Estate of
I,
Ka ~
Deceased
(~~ Name) in my capacity/relationship as
~u ~ ~'f'~rz-- of the above Decedent, hereby renounce the right to
administer the Estate of the/D~ecedent and respectfully request that Letters
liQyYli I ~l° _I~• ~y ~e~
~'~~~ 1 Zj ZDl I
(Dore,
Svc ~
(SJ~anre~
be issued to
(Street Address)
~i ~/`f 3~
(c• . state 2>P1
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 O, ffrce
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes statedc~within on this ~[_ day
of I~1~>7i V ~ 1 I ,
Notary Public '
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths, Show date of expiration of Ndn9JM+GbAi~fi6f~ISON
Notary Public, State of New York
No.O1ST6082771
Qualified in Cueens County , (~
Commission Expires Nov. 4, 20~ lI{/