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PETITI,/O~1F'OpRn GRANT O LETTERS ~ ~ ~_ ,J '
REGISTER OF WILLS OF 'd.~, 1Il I Yt ~ ~ ~~~~UNTY, PENNS ~ ~ ~A ~ '` ` ~~ =`
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Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as seed Belo , an41~-
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the approp~ale form: '" ~ci
Decedent's Info motion 2J. r~ D ~~ ~ '"`
Name: CJ 0 n Z.Z. W~ ~~'~~ File No•
a/k/a: • (Assigned by Register)
a/k/a:
a/k/a: Social Security No: ~ g ~ - , ~ ~ »~
Date of Death: I o°L - / C5 -- ' IO _ ~ _ _ __~ Age at_ death:. ~` o'~ .~- • ~~
Decedent was domiciled at death in ~ `t ~ ~ ,County, ~_ (state) with his/her last
principal residence at N~ / 6~AZ.aVW !'~A S $G~ ('J+! 1 ~~ s'~ R ~. C° U Ill x3
Street address, Poat Oftice and Zip Code _ ______ _Lit~Tnwnshin of Boroa¢h County r
Decedent died at > `~ UI A 1.IV u7't ~ ~'lM, ISp~~ ~ ~~ ~`~ - ~ ~ ,fit ~, ~ ~/~?'F j~A •
Street address, Post Office and Zip Code City, Township br Borough County State
Estimate of value of decedent's property at death:
Ijdomiciled in Pennsylvania ............................ All personal property $ s d
Ijnot domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not dotniciled in Pennsylmnia ........................ Personal property in Coun $
Valae ojreal estate in Pennsylmnia ........................................... ty ............ $ 1
TOTAL ESTIMATED VALUE.... _$
Real estate in Pennsylvania situated at: i ~:s ~„ S t lr1 / ,
(Attach additional sheets, ijnecessary.) Street address, Poat Otnce and Zip
City, Township or Borongh County
^ 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 Will of the Decedent, dated
thereto dated
State relevant circumstances (eg. renunciation, death ojezecutor, etc.)
and Codicil(s)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not many, was not divorced, 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 did not have a child born or
' adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
^ NO EXCEPTIONS ^ EXCEPTIONS
[7~B. Petition for Grant of Letters of Administration (If applicable)
e.t.a., d.b.n., d.b.n.c.t.a., pendente life, durunte absentia, durante minoritute
If Administration, Gta. or db.n.c.t:a., enter date of Will in Section A above and comalete 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
to 2 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
~1V0 EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survivedby the following spouse (if any) and heirs (attach
additional sheets, iJ'necessary):
Name Relationshi Address
~a~~r~ ~~rx Zu'~~~ ~ a~ s ~ n~a~~Z~ sr,
Form RW-02 rev. t D/l1/2011
Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
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Petitioner(s) Printed Name Petitioner(s) Printed Address "`
;~O 0~ l~2Cl'~ /~ C3 ~ ~ S~ ~ G ~ ~ G, P
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and cottect to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Decedent, the Peti 'oner(s) will well and truly administer the estate according to law.
Sworn to r fumed and subscribed be o Date ,f ~ ~ d _ ~e~
me t s ' da " Date
By' ~ - - Date
~.~ ~ r ~ 7te~s`ter ~- Date
BONDf Rgquiceds~]YES ~NO
FEES: _, - .
~~ ~ 0
Letters .. ... .... $
(~ )Short Certificate(s)...... / ~.'.
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Otl ......
Automation Fee .............. .
JCS Fee ..................... '~0
TOTAL ..................... S
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~p ~/~ ~~-sG[~ /'~"~ !`~~ ~ File No: ~~'~~df,U,~
a/k/a:
AND NOW, ~a /~ u a /" la ~ (~ 2 0 ~z , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS CREED that Letter
are hereby granted to DrQ ' w
in the above state and (if apptic~ble) Qia$-
the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codi(7r/ail(s)) oPDecedeht: "
Fo~~mRW-na ,•N~. imitiznit
of Wills
- 0~
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