HomeMy WebLinkAbout01-30-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ,~tn`~,ey ~yl~ 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 request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: C i \/ I -
a/k/a:
a/k/a:
a/k/a:
Date of Death: ~ ~ - ~ ~ - ~ 1 t
[,
Decedent was domiciled at death in _ ~w~ ~~~ ~a n ~~ County,
principal residence at ~ / t~ ~ i q ADD r.,n 7 ., „ ~1
f.
File No: ,~~ - ~_..~~ -~ ~ "~~
(Assigned by Register)
Social Security No: ~ ~S ~~ ~ -- ~7 7~
Age,,~at death: -7 ~
A
Street address, Post ice and Zip Cae1i{ City, Township or
Decedent died at ~_~ G ~ ; `i She; ,-~(, ~~ ~ ~~ V ~
Street address, Post Ottrce anti Grp Code--, City, Township or Borough
Estimate of value of decedent's property at death:
If dottticiled it: Pettnsylvania ............................ All personal property
If not dotnici[ed in Per:nsy!vania ........................ Personal property in Pennsylvania
If trot domiciled in Penttsylrania ........................ Personal property in County
I~altte of real estate in Pettnsylvania ........................................................ .
r _ I TOTAL ESTIMATE jVALUE... .
Real estate in Pennsylvania situated at:~~ C% ~ t'1 (~by~ ~~ 1 ;l :r>-~,~ {"A ri. 1
(Attach addi[ional sheets, ifnecessary.)
Street address, Post Office and Zip Code
(stare) with his/her last
County 1
`~Jiy ~ ca u ~ ~ ~
Count ~ ~,
Y State
$ l /I} DOQ.a a
$ ..
$TA ~ 6
~r~ (~_'
City, Township or Borough County
^ A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated and Codicil(s)
State relevant circmnstances (e.g. renunciation, death ajexecutor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pei
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child be
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., pendettte lice, cturante absentia, durmtte mint ., ~ ti -~, ~
If Administration, e.t.a. ord.b.n.c.t.a., enter date of Will in Section A above and tom lete list of heirs. - - ti - z
t ~
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as dr - :: ~
in ~ Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. _ _ ~ ~_
O EXCEPTIONS ^ EXCEPTIONS -
Petitioner(s), after a proper search has/have ascertained that Decedent lefr no Will and was survived by the following spouse (if any) and heirs
additional sheets, i/necessary):
Name Relationshi
Address
I , i
~V ~O i-~ ~ u v -
n Al ~- ~ ~ ~~- r.~ r ll~.
~~ s ~ ~ ~~~ . tea,, ~ P~~ ~ c~~--'z ~~ ~ I ~~ ~ ~.
Fn,~m R 46'-nz rev. 1 nil !ant t
~~
Page 1 of 2
,`•
-~ ,
,,
Oath of Personal Representative
CO~I~(OV WEALTH OF PENNSYLVANIA }
1 } SS:
COC~TYOF~~ ~A'h~ }
To the Register of Wi!!s:
Please enter my appearance by my signature below:
7a~
Foa• the Register
BOND Requ4red: AYES 'p
FEES:
Letters ..............
( )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ~ ~C
~~t a-t i ~,~r"~Ir, j a r t" 1 ::::::
~~ . ,~~
Automation Fee .............. .
JCS Fee. ...... ~-
..............
TOTAL ................. ~___
.... $ r t,'- ~~
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email
Ofticial Usc Only
Date
Date
-f
O ti~
z
_ ~~,_~z
f eN~l .., l N
... - N r
DECREE OF THE REGISTER
,• I/
Estate of L--~~~_ ~ I ~f ~(• ~~-~~ \I f~ l ~" _
a/k,~a: File No: ~ ~ ' ~-~1. (_ ' ~ .,.%,
~_,
AND NOW, '% C .l ~., , _! _ .~L f !~(. (.Cc. ~. ~ ' .~ ~_ _
sa isf ctor --> ~- ~ ~ ~ ' -" , in consideration of the foregoing Petition,
~ y proof having been r sented before; e, IT IS DECREED that Letters __.. ''
~..~ r ~ 1 ~ t l t ~~ are hereby gran ed to ~ t ~' T~ ~ ~ r ~- `
_~
the instrument(s) dated in the above estate ;i (if applicable) that
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
~.. f ~
f f ~(.l ~,~, ~~ X111%` ~ ` , ~~j,~~,, ~' , , ~ ~.M1
Register of Will '~"-' ~ a~--~--~
~.' !' ~~
For,,, rzW-n? ~ ~ G'/"L hL. Ji!~: t~_.~ - E ~~~,
-w roitr~zo~r ~' ___ ,
Page 2 of 2
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 k:iowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the D edent, the Petitioners will well and truly administer the estate according to law.
Sworn to r affirmed a.nd subscribed before
me tpis .: Y~~ay o f~.:- 5 i; . ~, Date / -- .~/S ~ ~~
' 7 ,
~Y:` ~ ~ ~ i` '`~j ~f Date
LOCAL REGISTRAR'S CERTIFICATION pF ~}EATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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RI~:GIS['1?R (>I/ ~X/11,1.5
2012 JAN 30
):LCxIL ~~).
ORPEI:~IVS COURT'
(:l'~tillil?IZI,;1Nll C(>UR'1', ly.A
H10S743 REV 112006
PERMANENT
TYPE /PRINT IN COMMONWEALTH OF PENNSYLVANIA .DEPARTMENT OF HEALTH • VITAL RECORDS
euclc lNK CERTIFICATE OF DEATH
1.NMroaDerxaaa)Faelmmr ~ Mdla) + (See Instructions end examples on roverse)
I ~ 1 lA . I I e 1 ~ /1~ .. U.. 1 STATE flLE NUMBER
~ a..
s. Aga Ilan eMnmr! antler 1 ar u 1 6. Der a e
MANS pays liaae Masnaa
Yrs. O
~ a Dean &. Cdy, Born, iwj(y'~'~(a~Death c1{•~•w''/'
KkNdwan daN moMa ~ Me. DO na err rthr.
P niMaW /l
16.IMcetlenfs MaiN s • OS
Shell,ah/bwn, e, pwdel
ar~ec.^g~S-prv„-Tq
~v~l~e °~AI ~t7~µl
16 Fa9Nfa tFrtL nlMdrrlaat, wlfia)
~r hip S~ ~,,,.~,~~/
20e I^brmea 3Rer~a (Type / Pme)
_-. T//i1'!`/!`,the%~ /1~ u
~~ r Crarodm ^ Donetlon
Burn ^ Removallmn Star i WY CrMrrtlpn a• DarlaUOn AWpNead
^ mar - ~ pY 1rdkY Examrar/Gassy] [
~~ Sga~sae a Fawel Savka lv„,,... (a Dorton actlrp es aucD)
+ 3. SotlM Saaeny Number
~R!S -,U_
- r,vsp,rec ~.
!a. FadWly NMro (n na iroarnon, ~ ' ^ hpedem ^ ER / Qrpe6anl ^ DDA Nurtap Nome ^ RaeWenca ^ odNi
eheat °"° nunDar) 9. Wu Deceyra d Hlapreac Ddpin7
G ~ r-FN ~ D~ E ~, ~~AG F ~n>~..,~r~.n. Ra ^ Y. ,p.R.~:k
Meaipn, Puerto Rion. ale.) (SPK+M
12. Was DecedMe ever N me 13. DecetlMe's Eduea6on (Speay ayy higMet grade
U.S. Artrotl Forces] mnprM) 14. Medal SraN: Monied, Never Herded, 15. Su~pvsq f
n ,.__ la .. E'°""""'1'; sacaaery (a1z> carve nr a s«1 MnUavea. Divorcra) /speow~ SPOw• m was,
Dacetlenrs
Aclwl Reeldence 179. Srr
17b. Couay
19. MonNf midst
2pp. I . Haaeq Aeaa,
21b. Der d D'apwNm (Mall, day year) x1~o. P+I~eq! a ~
Yaa^ No O O/ J yam.
b. Llpriee Number m wm...,n ....~__ ~ ._ _(.~~
Cargier intro 23ac only when ~ ve-r! / ~ (...
physician r na avalrpr K time d ~ b 23a. To IhemY rpwbdP. tleedi o ~ der entl place arrtl. (Sipnalure W tltls)
w~91y cause d deem. '/c/`I]
Irrre 2446 mull be mrpertl by pertm 24. Time d Death 26. Der PmiarNal Dmd
veto Pronounces tleem. ' IMorlm, dAY~ Y•a~
CAUSE OF DEATH / ~ ~ O /
Irrn 27. Part I: Emsr tM Mein a evens - aseeees ~~, a ~ ~ 6~ Nrshuetlom arM • NN) r Appodmar ineerv
raepirtbry arras, a ventricular tibrMatlon wimad ~ dN ~Y eaueatl dN death. DO NO artrr rmiw avems such u eardec arrest, r OrNSt b Death
etiobgy. UM my one awe m each Me.
~~ ?E~C~U~ (Pave 6eene a ~.
m _~ a. '
r
r
Due (a ae a aessrtwnce ~ ~ ~ .. ~ r
b cMSeRMeO m e~ e. D. C,
Eax UNDERLYpM CAUSE Due b (a as a r
(daeeea a aMaY mat initlasd me ~' r
aveme mumvg m aam) UST. c. ~
Due tc (a as s wroegwnce a):
d. ~
30a. P ae~~ 30b. Wero AurpeY F idmP 31. Mama a Deem 32a. Date a I " i
Avsirbr Prbr r Cangblbn r4u / (Mmm, hy. yey) 32p. pescrlDa Hpv, Iryury, Cmxrotl
a caws a Dwm7 ~ Naaaal ^ Haniatle
^ Yoe ~ No ^ Yea ^ No ^ Attitlenl ^ Pen6ng Investiganpn 32tl. Tors a Inptry 32e. Injay et Wak7 321. n TrorspprrEm e
^ Sukide ^ DOatl Not be DelemlllNd ^ ^ Driver
DItl Decedent
live in a 17c. ~ Yss. Decetlem LMtl r
TowneNpl
t7tl. ^ No, Decedent I-Ned witltr
Acrel Irma a
~ elaname) s _
• • weal GII;~R I (..1 • ~
23b. License Number ~.
1 ,3f!o 9 L S4'm pbrdh. der. nr1
26. Was Case Ketones b MedicM Eaerriisr / Cadsr lore ( Otlsr then Crmeeon
^ Yea • ~ No
Pan II: En ~aMr ' 28. Ditl Tabeow Uaa Conhibule r D
'°gArq ^ me uMerlying ealee phw, n Part I. n v.. n z._..
tn~en~eiee~. WNr, eb
en name)
~y~.~
~-a~Twp.
--_Ci1y/Boo
4•
0 ~~
a Daseon7
~ Ll No Y9 UrJppen
zs. n Female:
Na praplr4 wiriir prW year
^ Pis~syn n time a awm
^ Na preplyd, pal pregsM wimh 42 tlAYs
a seam
^ bebrt ~ pa prapsnl4J aye b 1 year
^ llNOiown M prsprsm verso me pelt year
32c Place d Irytry: Hans, Farm, SeeeL F
Onbe Buadrg, sb. (Spaoy) ~Y.
33e. Certifier (dledc Day one) M, Yee ^ No Oder r U PetlseMan - . __ _,
• C•roMn9 phyakiMi (Phypoan c•ieMn9 ease a deem when anodsr physician has Monounced tleath ell ~~ SSnabrt dr
TomsDauanry bs•'rdYa,rWth aroumdtluabtha uuaa(q ors mamarparsd__--- cmgbrdltem 23) O
Pronounclnyall prtllYlnY PDYMCIan )Physican bah -'--------------- -- ^ ~ -
TomaMMamyFnowrdya, deem oaurred at tls dp drb m~~Mn9r ease adeem) _________ ~
• Maaeal Examiner/Comr place, and tlue tithe awa(a) arM mamsr n roars- _ - - - - ® 33d. Dar Sped (Haan. day. year)
Dn ds balaaazaminMlon ell/alnwallgHrn,rmy aplnbn,eam oecunM NlM rims, das~ana ------------ ~~~ s.J ~ ~•' ~( ~~e v~
piss, and tlua r IM cwaa(a) end murnar n.rpd_ ^ 34. NMro grid a
and ~ wlro convrrd Ca~4 d Death (lrm 22r7~~ Typo /Print l
l~l ~ I.~I Q I<+Li ~' FyW(Mo^m-0er.rearl G•AShrGI ~°'LL1SriLVP+ITiG ~,D
~.
Dlepoemlm Permit No. -[J+~ / / O Q
l;
RENUNCIATION ~ x M -
-'z v
~~~
(~t
REGISTER OF WILLS - `~ ~~' ~
COUNTY, pENNSYLVANIA ~ ~° ~ r`
-~, - _'
~- ~'
Estate of i/ ~ ~ ~~
p, ~ ,Deceased
I, ~ V , ~ -
(Prrnt Name) , in my capacity/relationshi
p as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
It ~ ~ rJ ~ ,fit G~~ -P S ~ u
(Date)
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
(Signature)
a I ~ ~ ~ ~ SPrI,~
(Street Address)
~~`~ l (-~, P~ ~-~ a-~ ~
(Crry Slate Zip)
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 - a` da
of _~A-I~~nf~_ 1 y
< '
b ~- J~e~~
N a Publ c
My ommission Expires: ~ ~ 1 a- n 1 ~
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PEyt~$YLYANIA
NOTARIAL SEAL
JODY L. GiLBERT, Notary Public
Newville Boro., Cumberland County
_~______._. ~,.~___._.._. ~,-2012
~s
RENUNCIATION ~ M
:=~N~,^
~-
REGISTER OF WILLS ~ _ '~ -~
` ~rncC.. COUNTY, PENNSYLVANIA ~ N ~ _ -
' ~ ~
Estate of ~- t,~i ('. {~ ~,
r~
C ice. ~ ~,~ _ ~,~--
T f A
Deceased
~..
(Print Name) , in my capacity/relationshi
~~^ ~ pas
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued
t t0
(Dare)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this d
of
Deputy for Register of Wi sll
Form RW-06 rev. 10.13.06
ay
u~ ~ : ' ~~'~ t ~
(Srgnature)
G
3 ~~d 1-~f ,~ ~ ~'
~~,
(Jtreet Address)
~ :-~``~ 1 D ~a 1 ~
6~
(Cary State Zip) .
Executed out of Register's Offce
Before the undersigned personally appeared the
party executing this renul~nciation and certified
t}tat }gyp (~1^ S~'1? Pa'Pf'~,1}?~ }f1P rP*~un~12~i~n flVr the
purposes stated within on thi r2. day
of --t~~'i ;jn -..
Commission Expi er s:
(Signature and Seal of Notary or other official qualiFed to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
NOTARL4L SEAL
MICHELE D. RUPERT, NOTARY PUBLIC
HUNTINGDON 60R0, HUN"I"iNGDON CO., PA
MY COMMISSION EXP1REiS PCB. 2, 20 it
RENUNCIATION
REGISTER OF WILLS
Cu rn6~~~~''''~ COUNTY, PENNSYL
VANIA
~ ._ ~_,~ - C~i
v
~o
~~'-
~ ti =~ ;
`'-'
Jo~
ti N ~ x
Estate of (,{,C r I l ~ ~ ~~i~
Deceased
I, ~o na i ~ ~, ~w I h ,
c_~ ~
(PrintNameJ , in my capacity/relationship as
O rl
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issue
f i d to
1~ S A r~S ~ ~ Ci, Vr~ ~S'1-~
~.
(Dated ~~ ~/ --z ~~
(Signature)
~D '7`7
~~ ' ~ o~ ~~,~'
(Street Address)
r-'---
~~ 7
(City, Slate, Zip)
Executed in Register's Office
Sworn to or at~rmed and
b Executed out of Register's Office
su
scribed
before me this
day Before the undersigned personally appeared the
of
' -
' party executing this renunciation and certified
--- that he or she executed the renunciation for the
purposes stated within on this ~
da
y
_
of _~~ ~1Z
Deputy for Re ister of
g Wills "°""" ~~~
Notary Public
My Commission Expires: ~,~~~,~~,~
(Signature and Sear of Notary or other official qualified to
administer oaths. Show date ofexpiration of N
'
otary
s Commission.)
~ OFFICIAL SEAL
Form RW-06 rev. 10.13.06 4 ~or~tr aueuc~loliw~u.TM of vlac~a~
S ~R~Ci B. CRONIN
COUNTY
SPOTSYWANIA ,
ID#
?{ Q ~~ y
nsy Commisslort Expires
September 30, 2012
-f -
RENUNCIATION = ~°J . =
.n-+ N ~ N l
t ,REGISTER OF WILLS ~ ~'
C v~ m bar ~~;~~~~ COUNTY, PENN ~ J ~ v
SYLVANIA ~ ° -
N .,
Estate of (~ ~ (' c I I (~. ~ /(/l ~
K~~.-~.
,Deceased
~- (Print Name) , in my capacity/relationship as
C 1~~
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
l ~
(Date)
Executed in Register's Office
awurr ~~ ur ai'irrued and sunscrioed
before me this day
of
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
(Signature)
3~9.~
(Street Address)
1 W ~~
(e;ty, state, ap)
Executed out of Register's Office
Before the undersigned personally appeared fire
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this h
of T~v -~- ~ -__ day
_._.,
~~I otary P
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date ofexpiration ofNotary's Commission.)
BRANDON THOMPSON
Notary PubNc
Frederick County
Maryland
My Commission Expires Sept. 23, 2015