HomeMy WebLinkAbout06-06-12~Q~
PETIT/nLION FOR GRANT OF LETTERS
REGISTER OF WILLS OF _(~ttm~erlan c~ 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: nC E. Cis rA.atlll File No: ~ I I ~ - ?jq~
a/k/a: Anne Bwch¢nu. rsglztne / (Assigned by Register)
a/k/a:
a/k/a: Social Security
Date of Death: 6 3 ~ y 7 aao f r Age at death: _ ~ 3
Decedent was domiciled at death in CUmU~r"~sCr~ County, P fl• (Stare) with his er last
principal residence at 5.~..2St Wi/San L¢nP., /y)e[/7cor~cburq, pA /7o 5'S C~,>a.larl~,,,J
Street address, Poet Office and Zip Code
City, Township or Borough
County
Decedent died at5.2a$ 1.Jilsuri crane, lytech¢raK:sbfxrg , PR ! zo~S C~Ix~/aaJ ®~
Street address, Poet Omce and Zip Code City, Township or Borough County State
Estimate of value of decedents property at death:
IfdomiciledinPennsylvania ............................ All personal property $ ~~J`~, 000 Od
/foot domiciled in Pennsy!vania ........................ Personal properly in Pennsylvania $
ljnot domiciled in Pennsy!vania ........................ Personal property in County $
Vrtlur oJrea! esfine in Pennsylvania ......................................................... $
TOTAL ESTIMATED VALUE.... $ , O 00 . d
Real estate in Pennsylvania situated at
(Anach oddirional sheets, i(necessary.) Street address, Post Otace and Zip Code Ciry, Township ar Borough County
A. Petition for Probate and Grant of Letters Testaments
Petitioner(s) aver(s) h h the are the Executor(s) named in the last Will of the Decedent, dated /V1QYCh 3/, LEta I and Codicil(s)
thereto dated
State relevant circumstances (e.g. renunciation, death of eaennor, arc.)
Exceptas follows: after the execution ofthe inswment(s)offeredforprobate Decedent did notmatry, was not divorced, was noteparty to spending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
~NOEXCEPTIONS ^EXCEPTIONS o
~~ v rn
^ B. Petition for Grant of Letters of Administration (If applicable) ~ r-
af.a., d.b.n., d. b.n.c.t.a., pendente lite, durance #;durant~minoril6ld~
I
If Administration, c.t.ff. or d.b.n.c.t.a., enter date of Will in Section A above and complete ~stof Iteirs.a` ~~' i
r-,,
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce hadCbg~~stablishe~s definr?d' ~~
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. O
o ~_ m
^NO EXCEPTIONS ^EXCEPTIONS ~~`~' ~A
Petitioner(s), afteraproper search has/have ascertained[hot Decedent left no Will and was survivedbythe following spouse (ifany)andlsllrs (attach ~i
additional sheets, i(necessury):
Form RW-02 rov. f0/11/lpl! Page 1 of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
/~ I } SS:
COUNTY OF eltm ~~la~td }
To the Register of Wifis:
Please enter my appear
Petitioner(s) Printed Name Petitioner(s) Printed Address
{ Ga A r~ro Can o 02$ G SGt ,,, / ,~ {/ . ,-Yet Vf1 Z6l6j
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the best ofthe knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of thenDe'cedent, the Petit~io}ner(s) will well and tmly administer the estate according to law.
Sworn to or affirmed a subscribed before (w oQ,~, /~ - -,rya Date T l y 7, Zo ~ L
me,tgi$ ~vrt day of ,(~V .~(~- n„a
For (he Register
BOND Required:~YES ~NO
FEES:
Letters ...................... $
( ) Shon Certificate(s)..... .
( )Renunciation(s)........
( )Codicil(s) ............ .
( )Affidavit(s)............
Bond ........................
Commission ................. .
Other ........
Official Use Only
by my signature below:
Attorney Signature:
Q o
N
~
-
~~
z c' L r
r
t
C ~.~
t- <„
Printed ame:
Supre a Court
ID umber:
'l: irm Name:
Address:
Automation Fee .............. .
1CS Fee .....................
TOTAL .....................
Fax:
a
s
DECREE OF THE REGISTER
Estate of
a/k/a:
AND NOW,
satisfactory proof
the instrume
described in
No:
inZ
been presented before me, IT IS DECREED that Letters
are hereby granted to
dated
Petition be admitted to probate and
of record as the last Will (and Cod3jl(s)) of Decedent.
Register of Wills
of the foregoing Petition,
in the abch(e estate and (if applicable) that
For~~ Rw-na rev. roinia°Ji Page 2 of 2
wes.PCS eevlen ~~
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Department of Health, in accordance with
the Vital Statistics La of 1953, as amended.
~EC7Rtl~li' ~FI~;E
~~~81Vtt~QSatt~L~gal to duplicate this copy by photostat or photograph.
20f 2 JUL -6 AN 10~ I
0~'~V'S +/OURT
c~aEr~wo co., P,a
6820551
Marina O~Reilly Matthew
State Registrar
MAY ~ ~ ii77_
Date
No.
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March 7, 2012
Cin anelli x'~nal 229-2A-3358
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