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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland COUNTY, PENNSYLVANIA
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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: Kristopher A. Smith File No: ~~2 ~
- j- - G ~{Cq
a/k/a: (Assigned by Register)
aJk/a:
a/k/a: Social Security No:
Date of Death: December 31, 2011 Age at death: 25
Decedent was domiciled at death in Cumberland County, pennsylvania (state) with his/her last
principal residence at 1295 Ouster Mill Road Came Hill PA 17011 East Pennsboro Township Cumberland
Street address, Post Office and Zip Code City, Townahlp or Borough County
Decedent died at 333 O'Farrell Street. San Francisco. CA San Francisco San Francisco California
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 $ 0.00
If not doatiiciled in Pennsylvania ........................ Personal property in Pennsylvania $
If not domiciled in Pennsylvania ........................ Personal property in County $
Value of real estate in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ 0.00
Real estate in Pennsylvania situated at:
(Attach additional sheets, ijnecessary.)
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
and Codicil(s)
Street address, Post Office and Zip Code City, Township or Borough
State relevant circumstances (eg. renunclatlon, death of executor, 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 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.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate
If Administration, c.t.a. or db.n.c.~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(g) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
® NO EXCEPTIONS ~ EXCEPTIONS Decedent's cause of death is pending investigation by Medica~xaminer in~alifornia ~~
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Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survivedby the following spa~e~¢any) anc~irs (a ~ -t
....-
additional sheets, if necessary): ~ ~ ~ _, . ~~
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Name Reiationshi Address '~~ a_ ~ W '
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Alice Jacobs Mother 1295 Oyster Mill Road --- ~ % ~7 --3 -
Cam Hill PA 17011 ~ ? =~ --r, -,° _
Frank B. Smith Father 106 North Enola Drive
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Fvrrn Rw oz rev. to/Il/2011 Page 1 of 2
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF Cumberland
Petitioner(s) Printed Name Petitioner(s) Printed Address
Alice Jacobs 1295 O ster Mill Road Cam Hill PA 17011
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Official Use Only
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 Representative(s) of the Decedent, the Petitioner(s) will w//ell__and truly administer the estate according to law.
Sworn to or affirmed acid subscribed before ~ ~' l~d~J Date ~~3~ ~Z
me this "~~ ~'<< d of ~' P ' ~, ~~_ Date
$y. ~ ` __' Date
For the Regi Date
To t/te Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed N~(y~! Nathan C. Wolf, Esquire
Supreme Court
ID Number: 87380
Firm Name: Wolf & Wolf, Attorneys at Law
Address: 10 West High Street
Carlisle, PA 17013-2922
717-241-4436
717-241-4437
~atha_ n~wnlf~ me har Imail ~nm
Phone
Fax:
Email
DECREE OF THE REGISTER
Estate of KristonherA. Smith File No: 7I I ~ ~ L~-((~~
a/k/a:
AND NOW, t~'C->~ l 1 ~~ , ,~C ~ ~ , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Alice Jacobs
in the above estate and (if applicable) that
the instrtunent(s) dated n/a
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Deceden+.
Register of Wills
_ ~ ~'
Form RW-02 rev. 10/11/2011 Page(~2-~f 2
BOND Required: ®YES ~ NO
FEES:
Letters ...................... $ 20.00
( 4) Short Certificate(s)...... 16.00
( 1) Renunciation(s)......... 5.00
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other .....,.,
Automation Fee ............... 5.00
JCS Fee ..................... 23.50
TOTAL ..................... $ 69.50
RENUNCIATION
Cumberland
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
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Estate of Kristopher A. Smith
Deceased
I, Frank B. Smith , in my capacity/relationship as
(Print Name)
father of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Alice Jacobs
03/29/2012
(Date)
.. ~,~,~~ ~ L•
(St afore)
106 North Enola Drive
(Street Address)
Enola, PA 17025
(City, State, Zip)
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
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 ,~.`1 day
of r~ c~, rc. ~ ao i ~-.
otary Public
My Commission Expires: n o ~ + s ~~' S
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEgi,TH OF PENNSYLVgNLq
NOtarlal seal
Tina M. R
East Pennsboro~m~nd Coun
~ CAmmisslon Nov. 15, 2015ry
MEMBER, PENNSI'LVANIA ASSOCIATION OF NOTARIES
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