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HomeMy WebLinkAbout01-03-12 ~ f-, ~ -r~ ~. r ,:. s~ PETITION FOR GRANT OF LETTERS ~ ~ c;,a ~.' ' '-` REGISTER OF WILLS OF COUNTY, PENNSYL~ '~ . _ ;~ Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters. as sp~fied below and it» support thereof aver(s) the following and respectfully request(s) the grant of Letters in the approprtate form: ~, Decedent's Information Name: ~,(~~~ ~' ~~ '~'~eXtA2.{/ a/k/a: a/k/a: a/k/a: Date of Death• ~ I Decedent was domicile at death in County, principal residence at 3) ~ `J toil t y~.~~ ~"'. f~-IQ.L File No: ~% ~~ ~OQ~ ` (Assigned by Register) Social Security No: _1 cf.7 Sa 'SS3 Age at death• S•~ Street address, Poat Oftice~nd Zip Code __ - Cfty, T`opwnship or Borough Decedent died at 5'f Pa~rt~g ~e~.s ~l~`•l IU, ~'1~qL~" Street address, Post Orifice and Zip Code City, Tow ship or Borough (Stare) with his/her last M, (3E12C.i4/~~ Count COanty State Estimate of value of decedent's property at death: 7jdotnicUed in Pennsylvania ............................ All personal property $ ~ ~t t~ 0 y Ijnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ •--- Ifnot domiciled in Pennsy!vania ........................ Personal property in County $ --- Value of real estate in Pennsylvania ......................................................... $ -.-.© - ~ , TOTAL ESTIMATED VALUE.... $ Real estate in Pennsylvania situated at: (Attach additional sheets, ijnecessary.) Street address, Poat Orttce Zip Code City, Township or Borough ^ A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Wilt of the Decedent, dated thereto dated State relevant circumstances (eg. renunciation, death ojezerumr eta) Coanty and Codicil(s) Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not many, was not divorced, was not a parry to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child bom or 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 life, durance absentia, durante minoritate If Administration, c.t.a. or d.b.n.c.ta., enter date of Will in Section A above and comalete list of heirs. Except as follows: Decedent was not a parry 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 adjudicated an incapacitated person. ~10 EXCEPTIONS ^ EXCEPTIONS 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 (attach additional sheets, irneeessury): Na Relationshi Addr ss ~ /~ y1 l ~..u. VC.- ~U Form RW-p2 reg. tnitlianll Page ~ of 2 -.. ~3 t:.p Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA COliNTY OF ~~ t } ~ cry ~ w "~_~ C 3 ~,,,~ } SS: :~C.7-~ y ~; - } : `:« r _, ~ Petitioner(s) Printed Name ~ Petitioner(s) Printed Address ~; '"{"' The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing etition are true and correct to the best of the lmowledge and belief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Petitio r(s) ill . ell and truly administer the estate according to law. Sworo to a rmed an bscribed b ~7 A Date me .da f ~ `. _e~ Date Bx' f ~ Date i he Rgi~ter._ Date BOND Required;~Y~~ ~NO FEES: '- 0 a Letters ...................... S ( ~) Short Certificate(s)...... . OD ( ~`-} Renunciation(s)..... , .. . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . her ........ Automation Fee .............. . JCS Fee ..................... . 00 TOTAL ..................... $ To the Register of Wills: Please enter my appearance by my afgnature below: Attorney Signature: Printed Name: Supreme Court ID Number: Firm Name: Address: Phone: Fax: Email: DECREE OF THE REGISTER Estate of ~lf !// ~ ~/ ~e /7 9 ~ ~ File No• ~~~ / ~ - ~ ~ a/k/a: AND NOW, Q GlGf /' ~ ~D~~ ; in consideration f the foregoin Petiti n, , satisfactory proof having been p sented before me, IT IS DE REED at Letters ~ ~m~%7~. Q 02 are hereby granted to iSStt ~ Pn4G~ a, '_~-; in the above estate and (i~~ticable)=that the instrument(s) dated described in the Petition be admitted to probate and filed of record as the last ill (and Codicilts) o€1)ecedent. Form RW-(11 rev. !0/!!/1011 Register of Wills ` -Page 2 of 2