HomeMy WebLinkAbout06-26-12PETITION FO$ GRANT OF LETTERS
REGISTER OF WILLS OF ~~~p"t /il+~•c~ COUNTY,1?ENNSYLVANIA
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 i ,
a/k/a:
a/k/a:
a/k/a:
Date of Death: 3 ' ` 2 a tt
Decedent was domiciled at death in ~c'!'n 6;.G f 9Y-~, ~
principal residence at !ll ~?~ "«^~
File No: ~ ~ ~ - -~)
(Assigned by Register)
Sociat Securitq No: !
Agepat death: _ ?_,--: m o ~ ~'~ ~.~
/ ovavS 2'~<+~ (Scare) with his/her last
rvi3 +t...dt( M+BD(<=~.. ~~raddJ~w
Slreel address, PRet Office and Zip Code /~Ity, Towmhip or Borough n County
Decedent died at C/)r@ Its L a K (•G1 C ~fJif ~rJ (-( `ua~~~y+.r~ ~~
Street address, Post Omce and Zip Code City, Towmhip or Borough County Stale
Estimate of value of decedents property at death: Qr~C.
Ijdomiciled in Pennsylvania ............................ All personal property $ ~`°`~
fjnot domiciled in Pennsy[vania ........................ Personal property in Pennsylvania $ ~~. 3 ~,.<
Ijnot domiciled in Pennsy[vania ........................ Personal property in County $ $ b c ~~ ao~
Value ojreal estate in Pennsy/vania ........ ............................................. $ 9~ ~ °~
'/POTAL ESTIMATED VALUE.... $ t~fyu J /
Real estate in Pennsylvaniasimatedat: (IlG~wt.....DRCpp~f({~~t7°+J l~o2flr~+C1VLTra~'u...)p ~r-/tt~t[(!/~r~
(Attach additional sheeu, if necessary.) Street address, Post Omce and Zip Cade Ctty, Township or Borough 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 _ and Codicil(s)
thereto dated
State relevant circumstances (eg. renunciation, death ofexecuPor, eh'.)
r+
p O p try, was not divorced, otaparty togt¢ndin8.,..,
Ezce [ as follows: after the execution of the instrument s offered for robate Decedent did not me o
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § :1323(8), and di ve a chi m o ~ C7
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~p t.. Z ~~'. `~
^ NO EXCEPTIONS ^ EXCEPTIONS ~ ~'_ N n"?
r'? c~
B. Petition for Grant of Letters of Administration (If applicable) ~U- - ", ~~'
' -ri
c.t.u., d. b.n., d.b.ac•.t.a., pendente lire, durunre abs&~ urunte mx`~rimte :_ ~`
If Administration, c.t.a or d.b.n.c.ta, enter date of Will in Section A above and com let IisfvV t its. ~ `~ ~i
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as8slined
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated parson.
~}NO EXCEPTIONS ^ EXCEPTIONS
Petitioner(s), after a proper search hasPoave ascertained that Decedent left no W ill and was survived by the following spouse (if any) and heirs (attach
udditiowl sheers, ifnecessury):
Name Relationshi Address
~ AN l~ B Cgs ~~~~ SPA t,s~ lu Grlr1.. rat.., 0,2; c ~s r J7o/3
Farm RW-02 rev. 10/1 //10!/ Page 1 of 2
Rf,COP~:li ~ i~FICE OF
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Oath of Personal Representative
.,~.i=.'"',
Petitioner(s) Printed Name Petitioner(s) Printe
~~t~ c~N~.~ ru ~~-~ ~w D,e r~,rf~, _ ~- i7~,~
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are we and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the Dec~eyd~ent, a Petitioner(s) will well and tmly administer the estate according to law.
Sworn to or affirmed and subscribed}~efore Qr^ yg~ Date a ~e ~`~-~'G(2
me this day o ~ Date
BY• Date
~~ r
For the Regirter Date
BOND Required: YES I /}NO
FEES: r
Letters ...................... $ IU
(~ )Short Certificate(s)...... $-
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ~ ,,,,.,.,
Automation Fee ............... .5 "~
1CS Fee ............... ... ~.
TOTAL ..................... $ .R4 f . ~-(T
Ta the Register of Wil[s:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name:
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Faz:
Email:
DECREE OF THE REGISTER
Estate ot~=T`~ _ ~ ~~ ,n~ ~~ File No: ~~ - ~ ~ - ~l~ I
a/Wa:
AND NOW, ~
satisfactory proof
presented before me, IT
_ are hereby granted to
the instrument(s) dated 'Y\~!ti_
described in the Petition be admitted to probate and
Fonn RW-01 rev. l0//1Q0/l
that
in con;;ideration of the foregoing Petition,
in the
2Ui2 JUN 26 PM I ~ 42
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