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PETITION FOR GRANT OF LET;~~
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REGISTER OF WILLS OF __ C~ rv~.~,E L~~COUNTY, PE;Vt Y A A
Petitioner(sj named below, who is/are 18 years of ale or older, apply(ies)~P ~' ~ rs ified below, and in
support thereof aver(s) the following and respectfully request(s) the grant of IEa~~;,~~~tr ~~~ ~ ti`a form:
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Decedent's Information pp
a/k/a:
a/k/a:
a/k/a:
Date of Death: ~' ~~'
File No• ~ ` - 1 -~ - (~ ~~. (,Q
(Assigned by Register)
Social Security No: ~ Q j -a $ " ~ ,2~ ~j
Age at death: ? O
Decedent was domiciled at death in G~ ~ QE/Z~.q..t~~ County, ~ (scare) with his/her last
principal residence at / ~j / y („ IC7C y~,~~-ry R t~ . (' ~4 ~ ~, • /~-~- ~'ct,M, t3Ft2~A~U~ Co,
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at ~-~ c7C..Y 5 {~ I ~ I r f -~yg rPI f->~ L C,,,l~ Y/t ~° f~ 1 C.L. ('~,r,~yl Q~r-~~~{~ }) f'~J ,
Street address, Post Office and Zip Code City, Township or Borough County State .-
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ ~ ~ ?~
Ijnot domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $ ~
If not domiciled in Pennsylvania ........................ Personal property in County $ d
Value of real estate in Pennsylvania ......................................................... $ ~
TOTAL ESTIMATED VALUE.... $ -tS
Real estate in Pennsylvania situated at:
(Hunch udditionnl sheets, ijnecessary.)
Street address, Post Office and 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 Will of the Decedent, dated
thereto dated
State relevant circumstances (e.g. renunciation, death of executor, etc.)
County
and Codicil(s)
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 pending
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 born 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.u., d.b.n., d.b.n.c•.t.a., pendente lite, durunte absentia, durante minoritate
If Administration, c.t.a. ord.b.n.c.t.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 adjudicated an incapacitated person.
~NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search has/have ascertained that Decedent lefr no W ill and was survived by the following spouse (if any) and heirs (attach
additional sheets, ijnecessary):
Name Relationshi Address
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F~,~,» Rw-na ,~w. tniuiznll Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
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COUNTY OF ~lt~Q[~ILCA-'tlD }
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Petitioner(s) Printed Name Petitioners Printe
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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 Petitioter(s) and that, as P;,rsonal Representative(s) ofthe Decedent, the Peti,~ioner(s will el d truly administer the estate according to I w.
Sworn to or affirmed and subscribed before_~~ ~~1L ~~h Date
me thi day of i
By~ ~' I '
For the Register
Date
Date
Date
BOND Required: Q YES ~NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters ..................... .
( +-~ )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other
$ dV • ~i
l l ~ ~ cY~
Automation Fee ............... '~~ ,~'
JCS Fee . ....................
TOTAL ..................... $
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of C~r~ ~ ~ ~-` ~Y ~Q 1' File No: ~ ~ - ~ ~ - (1 ~~ (,/
a/k/a:
AND NOW, ~ ~(~ ~( )(?~ ~ ~ ~ ,tea ~ a , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters y~L, }~j(`a.-{~ ~m
are hereby granted to ` ~' ~.Q ~'
in the above estate and (if applicable) that
the instrument(s) dated jy {~}
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of pec~aient:
egister of Wil r
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Fonn RW-02 ,-w. roilriznii Page 2 of 2
H)05.905MS REV.(Ol/93)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records in accordance
with Act 66> P.L. 304, approved by the General Assembly, June 29, 1953.
' ~~-,'. ,'~' i~~4fR~tl~IC~J~t is illegal to duplicate this copy by photostat or photograph.
rt~IZF~821 ~t~li.2~
Military CLERK OF
~~'~~~~s~-%OURT
Status Ct1MPF!~,,~~' ~~3 5P~ 2
No. .
(~~acv"G•o ~a.,,e4.Q,~.e„
Charles Hardester
State Registrar
AUG O 1 10Q5~
Date
N,os.la3 Rey.4YB7 REPLACES ORIGINAL CERT. COMMONWEALTH Of PENNSYLVANIA • DEPARTMENT OF HEALTH • VITA4 RECORDS
FUR ITEM(S) :1-34 SIGNED:5-5-05 CERTIFICATE OF DEATH
-YrmNT FILED•5-6-05 7-11-05 bee STATEflIE NUawER
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NAME OF DECEDENT (Far. Middle. Lash 9EX SOCUIL SECURITY NUMBER DATE OF DEAN,MaM.psY.'Aw1
~. Gale H. Arter ~. male ~. 191 - 28 - 1226 •• May 5, 2005
AGE ILar 8inndayl UNDER 1 YEM UNDER 1 DAY GATE OF BIRTH Sltl[T1aPl.ACE iCay and PUCE OF DEAR ICnecF gray nre __ au mamaaona on aMr %dsl
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FATHER'S NAME (Fiw. MidOS, Lash MOTHER'S NAME fFirw. MaIW. Mwtlan Sunrrla)
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Arter 1514 Letchworth Road, Cam Hill, PA 17011
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