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HomeMy WebLinkAbout11-21-11(_ rreisec a L PETITION F4R GRANT OF LETTERS REGISTER OF WILLS OF ~ m b e r 1 anc~ COUNTY, PENNSYLVANIA Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the following and respectfully requests} the grant of Letters in the appropriate form: Decedent's Information Name:_ 1`'~~bzr-1` ~. Kennv ___. alkJa: a/k/a: a/k/a: Date of Death• D o br ~ 1~ ~, 2 y I I Decedent was domiciled at death in C u m h e r L n c~ County, principal residence at .52 o g' Terrace v a r.~ lYlPCh /7 Street address, Post Office and Zip Code Decedent died at ~ 61 y ,~,~ y ~ : {- {~ ~ s p ~ ~- a ~ ~'a m Street ad teas, Post Office a d Zin p Code City, Town File No: ~,L'~ t ' I "[ ~G (Assigned by Register) Social Secarity No: O 81- i 2 - ~D 8 ~ Age at death; ~ ~ ~erl ~ Sv / ya n i ci (state) with his/her last ~ / 05U ~„n-~o-~-P~-n~ Cu n1 ~J t'r ~cc ~/ City, Township or orouB gh County hlp or Borough County State r Estimate of value of decedent's property at death: If domiciled in Pennsylvania .............................All personal property $ ,3 gr,.C70U If not domiciled in Pennsylvania ........................Personal property in Pennsylvania $ If not domiciled in Pennsylvania ................. . ......Personal property in County $ Value of teat estate in Pennsylvania ......................................................... $ TOTAL ESTIMATED VALUE.... $ ~ 8r O to 6 0 Real estate in Pennsylvania situated at: (Attach additional sheets, if necessary.) Street address, Post Office and Zip Code City, Township or Borough ^ A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) helshelthey is/are the Executor(s) named in the last Will of the Decedent, dated thereto dated ___ State relevant circumstances (eg. renunciation, death of executor, etrnl Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorce divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated. person. © NO EXCEPTIONS ©EXCEPTIONS ® B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente lit<r, durante c:~ If Administration, ~i~a. or db.n.c.a^a., enter date of Will in Section A above and complete list of heirs' Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8} and was neither the victim of a killing nor ever ad}udicated an incapacitated petscm. ® NO EXCEPTIONS ©EXCEPTIONS Petitioner(s), after a proper search hasf have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationsht Address er- S s~ s2o Terrace ~>ud ~t'C~. Pfd 17osb ~ +t /-~- r 17u~ V~~2r' .52lU trace ~04~~ t~lr~' A~ / USD o ~ ~ I,t), e~~ Sdn u ~riv U~/'o~,'a >~ FormRyT'-02 rev.IOlll/2011 County and Codicil(s) r-a ~ ~~ _ _C7 `~, ~~ot a party~t3~apen, i~t~ve a odd bori,Ar_- 7 .ri cry -~~? ---- ,_ _. GC :x7 ,--. ..;.. Pagc 1 of 2 h'~..) ;>~ Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } J } SS: COUNTY OF C4 ~ ~1 ~''"1"`~ ~ } Offici~Tse Unly - ~ ~. .... ".wry ~1 .~ ~(~ ~ vfT..~ ~,~~ j1 ~~ _ r^ - - - ~ S.__ ~... -. r'l -.=i .. --Y Petitioner(s) Prirted Name Petitioner(s) Printed Address --~ n ~.l o ~er~race f2o~ ~ree~- ~-~i'7d.~1~- ~. The Petitioner(s) above-named swear(s) or affirm(s) 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 Representatives} of the Decedent, the Petitioners} will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before Date ~~ me this day of 1~'~( Date By: ')'1 Date For the Register Date BOND Required: ©XES ~NO To the Register of Wills: FEES' Please enter my appearance by my signature below: Letters ...................... $~ ( { )Short Certificate(s)...... ~{- .V~-' ( a )Renunciation(s)......... _~ ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ,~~ L' S ........ ~~~ c,-. ~ ~; cs,r, ...... . . Automation Fee .............. . JCS Fee . ................... . TOTAL ..................... $1?> a . SO r~ o. Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of a/kJa: AND NO'W, ~~c'~L'>`~2~~~L1e~~ ~ ~ 1 , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ ~~:~~ ~ ~ '~~ ~ are hereby granted to ~.t ~ r t ~-- e above estate and (if applicable) that the instrtunent(s) dated ~ described in the Petition be File No: -Q! -- (~ _ 1 ~ `~ to probate and filed of record as the last Will {and Codiicil(s)) of Decedent. Form Rw-02 rev. 10/11/2011 , Page 2 of 2 H105.905 REV.I8711) This is to certify that this is a true copy of the record which is on file in the Pennsylvania ]department of Health, in accordance with the Vital Statistics Law of 1953, as amended. WARNING: It is illegal to duplicate this copy by photostat or photograph. 6449477 No. Marina O'Reilly Matthew State Registrar NOV 4 7 2011 Date C") r-~ --; ~ ~'? r' ~7 -,- ~_ ; , _ ~ ' N,OS,p REV nrmre COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH .VITAL RECORDS .X1 ~ ~ C ~_ `' i ~~ CERTIFICATE OF DEATH ~ ~ -xj N - ~~ 7 I$M Instruetlons end examples 001 roVlroO) CTATE FlLE NtOA9ER~ ~+~ ~ -' - ac +_ s~ 1. Nrrb a ~.a.arl lFbr. ~raiU, Ma. rdltrl 2 8r 3. Bair 8raw117 IAanbr ~. ~ (M~. dJ. - _ '. ` / ' 23 1 _~ .. ' Robert E, . Male 089 - 12 -8087 s Ap. (ur ena.r, ,Afar, 1 e. or. a BMai 7. rr rnr « e. vYr a Orm w Yar. n.y. r,s.. rwr tAipi«I: t)tltr: "--.. ~..- ;-S 't 1923 Brooklyn NY Feb 21 88 ^ 3• ^ b ^ ~ , , . ( E,r-saq~ Tn, RWr,o. o ooA imrwt ^ER/ou,r.a Eb. Caury d o..E, ec ar. eoo, TAp. a O.rh Ed Fri? wr In aRm,0lNan, 9N..O.N.rd «ntrl B. Wr O.o.lrM a RAOrie dIONi No yr ,a. R~ .t ~ Clnlberlarrl t Perulsboro Twp. Holy Spirit Hospital liw .~"ww R`~«~,'..Y.) 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R.a~.~~ n ~ }- S/ ~ lI1M~ ~ j ~o f'~rc~o chive -,u ~.t .~~ u A DupaYtlm pa,,,* ~, (1599679 n .~_ RENUNCIATION 9 O ~. ~ ~. _ 'xz x; ~ F ; ~--= ' C~> r . ~ ~'t' C7 N ~-. r-' - -~ ~ ~ . _Z _ --_-rn ~~ ~~ ~' 47 i - - , GISTER OF WILLS ~~:~ ~ - ~.r~~'~ la.~ ~ COUNTY, PENNSYLV"ANIA t-- ~;~~-?`-n ~`~ --rJ; Estate of ~ ~ ~ ~' ~ ~ ` - ~~~'~~ Deceased I, ~;,2 L ./ ~~ ~, ~ ~ , in my capacity/relationship as (Print Nume) l,,i ; ~-e of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ~,y,~,~ ~~,~c r-,~~ r ~ ~r (tee) Executed in Register's Office Sworn to or affumed and subscribed before me this ~, day of ,_.._~, ,. `~~ i (f~ putt' for Register of Wills pie) (Street Address) S ~ ~~ ~~~~~~~5~~~~ ~~ (City, State, Zip) j ~J 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 purposes stated within on this day of 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. ]0.73.06 ~J ~ ~~~• -x, -*, RENUNCIATION ~~ ~" c, I~~= ~°t --r REGISTER OF WILLS ~, c ~3 ~ ~~ ~~-, t.~ ~. t _. ~ " ~„ F z cum, L.9~~ COUNTY, PENNSYLVANIA ~ ` p -~ t ---i is ;J 'r -- : `T'1 ~ -ri i Estate of ,IZof3~~T Gr/~ld1~Tl~ tC~.wwy .Deceased I, l~~~" ~.4~?~2 tt'E'•~~y , in my capacity/relationship as (Print tYame) seK/ of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to L .ye~/aa-~tl3~- 16. Zo l/ (Date) Executed in Register's Dice Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills Form RW-06 rev. 10.13.06 ~~ (signature) (Street Adtbess) (City, State, Zip'7- 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 purposes stated within on this ___,__ day of ~ 119 y '~ 1 i Notary~ublics~ My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) PADMA BAJRACHARYA NVotary Public Montganery County Maryland My Comm~sion Expi~ Auk. 21, 2014