HomeMy WebLinkAbout06-22-12PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~s~f~ / ~ L~_ 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: R^ i~~~~~ ~v~-~13~~', File No: ~ ~ ` ~ ~ "IJ~V~
a/k/a: (Assigned by Register)
a/k/a:
~~a' Social Security No: l s?~' ~ ~ S~f S f
Date of Death: v !'"~- Age at death: ~{
Decedent was domiciled at death in C, ' f~j"`Q County,
T~ ~~ (Stare) with his/her last
principal residence at S2~ 2~.L ~ ~rf N
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at ~ o,+,,,,, Gee ~ of ~ ~ ~~ ~ ~ ~~ ~ ~ ~~ A ~~
Street address, Post ffice and Ztp Code Ctty, Townshtp or Borough Count/y State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property $ vv~~
I/'not domiciled in Pennsy!vania ........................ Personal property in Pennsylvania $
If not 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, if necessary.) Street address, Post Office and Zip Code City, Township or Borough Count
Y
^ 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 and Codicil(s)
thereto dated
'rr..,
State relevant circmnstances (eg. renunciation, death of execrrtor, etc.) r.~ ~..~,~
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not ma C
ny, was not divorced,~s~~a partyt~g;pendttsg- ~_u
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and r~i~ve a c
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. _ Nborn p~ ~r',
^ NO EXCEPTIONS ^ EXCEPTIONS
(~B. Petition for Grant of Letters of Administration
.~
(If applicable) = ~~ N i-- rn
c. t. a., d. b. n., d.b.n.c.t.a., pendente lite, durunte a tia, durante*rertoritute
If Administration, c.t.a. or d.b.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 P . C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
~1 7~0 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, i~'necessury):
Name Relationshi Address
.~ ~ ~ ~. a ~- ,..,. S Z 3 2~- S r 7
s,..-,..r a-
~~
~~
Fo,-nt aw-nz ,~~~. lnirtnnll Page I of 2 ~
Oath of Personal Representative
COMiV40NWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF /11_~_~ , ` }
Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
z. ~s N~2 S~ 3 2~. S~ a-~- a v 3
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) ofthe Decedent, the Petitioner ill well and truly administer the estate according to law.
Swo~rn~to or a_f~rmed d subscribed before ~ Date ~22 ~
1ne=--t' ~ "~'~ay of ~ Date
B ~ Date
For the Register _ Date
Letters ...................... $ 'V
( v) Short Certificate(s)...... ~
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........
........
_ ,. .,
Automation Fee ............... ~, (,'(,~
JCS Fee . .................... 3, `jC,,
TOTAL ..................... $
Attorney Signature:
C7
C~
~~-' ,•-...
~~
~
~
,
r:~ ~
-
~ N
Printed Name: U
- `~
_
Supreme Court ~
.. a
nC;~ -C1
~ -
_: i ~
ID Number: ~~ N .
-~ ',
r
'O `" ~-
Firm Name: ~' ~
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estate of ~~ ~ ~ (~ C ~~ ~ ~-~ ~~1~~~~ File No: ~' ~ ~ ~ - (% ~ ,;
a/k/a:
AND NOW, ~ ,~
,~~~., in consideration of the f regoing Petition,
satisfactory proof having been pt ented before me, IT IS DECREED that Letter ~~ f l (1 /`~
are hereby granted to ~s~,r~ ~, ~ ®~ , t`T ~~- (~ ~ ~-
U in the above estate and (if applicable) that
the instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
f1 p~
C. ~ 1. C~ ~ i ~r
Register of Wi Is n n/yv1
For,» nw-nz rw. ioiivznll 1 ~ ~' J l ' Page 2 of 2
BOND Required: Q YES 10 To the Register of Wi!!s:
FEES: Please enter my appearance by my signature below: