HomeMy WebLinkAbout07-13-12t,~
PETITI N FOR G/RAN/T OF LETTERS ,~, ~
REGISTER OF WILLS OF Lid COUNTY, PENNSYL
~ cn~
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as sp ~ '~rbelow and ~ _
support thereof aver(s) the following and respectfully request(s) the grant of Letters in the appropri ixn: 'v - ~i ~'
Decedent's Informati
Nsme: ~, d
a/k/a:
a/k/a:
a/k/a:
Date of Death: 7 3 X o t'2
Decedent was domiciled at each in I~jt _ i
principal residence at /I ~a /Q.aQv P , S
Decedent died at _/yi4Q kt Sb
Street addreay Poat
Estimate of value of decedent's property at death:
File No ,~ `~ S~
(Assigned by Register) i
Social Security No: / 9,3 ~ Q(y/'S~-
Age at death: U
~~
~..r, IVANi...,. V~ YV. VVaI.
Ijdomkiled in Prnosy[vania ............................ All personal property
Ijnot donrkiled in Pennsylvania ........................ Personal property in Pennsylvania
/jnot dornkiled in Pennsy[vania ........................ Personal property in County
Value ojrea/estateln Pennsylvania .........................................................
TOTAL ESTIMATED VALUE... .
Real estate in Pennsylvania situated at:
(Attach additional sheets, ifnecessary.J
County
$ ~~ DD. -
a
S /.5'00,
stmt addrep, Post Orrice and Zip Code City, Township ar Sorouph 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 cireumatancet (eg, renunciation, death ojarauror, etc)
Except as follows: after the execution ofthe instrument(s) offered for probate Decedent did not many, was not divorced, was not a party to a prnding
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 bom 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, durance absentia, durnnte minoritute
If Administration, c.ta. or d.b.n.c.ta., enter date of Will is Section A above and complete list of heirs.
Except as follows: Decedent was not a parry 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 left no Will and was survived by the following spouse (if any) and heirs (attach
additional sheets, if necessary):
Nome Relstionshi Addreaa
/1% ~+Htc°1~~
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~ce I~E'/L
1?3~ ,
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1,-t~ I.~a~-~eQS ~ACe het 3 ~a RJ Iw Q,z,[1~te ~-~
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Form RW-tl2 rev. 10/t 1/2011 Page I of 2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
} SS:
COUNTY OF ~~d ~ ~~ } 4 ~ se Only ~
~C~~% 1~
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.
Petitioner(s) Printed Name Petitioner(s) Printed Addres
`-y'r ..
~2 ~a~E~o ~ ~ `C 3 /~od e ~
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the forogoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s) and that, as Personal Representative(s) of the De dent, the etitioner( 'll well and truly administer the estate actor tng to law.
Sworn to or firmed su cribed before ~ ~~ Date ~ ~
me th~ o c3 Date
By: Date
'~` rithfRe,¢isrer _ Dale
BOND Required: AYES ~10
FEES: ~
Letts ...................... a___L~
( )Short Certificate(s)..... .
(~ )Renunciation(s)......... /~
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ........
Automation Fee .............. .
!CS Fee .....................
TOTAL ..................... S ~
To the Register ojWi(!s:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name•
Supreme Court
ID Number:
Firm Name:
Address:
Phone:
Fax:
Email:
DECREE OF THE REGISTER
Estateof~~/ ~~brYjr~T~ File No: ~~~ ~~ - J /~
a/k/a: ~t I
AND NOW, ~ { U..-~~.( ~ ~ . ~ (~ , in consideration of the fore ing Petition,
satisfactory proof hav g been resented before me, IT IS DE REED that tiers
are hereby granted to
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 t last Will and Codicil(s)) of Decedent:
egister of Wills '~ W~
Vv
Form RW-DI ,•ev. iauiaon Page 2 of
- ~.
p1p5,c9g wcV 19/1'
~1~~ ~~~
LOCAL REGISTRAR'S CERTIFICATION O~fICE
WARNING: It is illegal to duplicate this copy by photostat or pho~i i~- ~~~.~
Fee for this certificate, $6.00
P 18626862
Certification Number
4
ryM/PNnt In
PermeMnt
d
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1
This is tEi'~~~'tita~thA idfo ~ a~ti<n here given is
correctly copied from an original Certificate of Death
duly filed with ir~~;jli.oyal Registrar. The original
certificate jto the State Vital
Records fig.
l~Q~ rkG.,~,gl..,r .~- 5/2012
Local Registrar.. ~ Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
fYQT1 PI (•ATC AF 1']FATI.1 _.
_~ •'• Y~ (Spell
3. D+caG+nt'a Leg+ Neme (Glut, MIddN, Laa4 Sum%) Z. Sex 3. Secl+l 3ecur Number 4. b o +< fM
~
Batt J_ Romito F 193 24 06'1 U,
S+. Aga'Left Blrt day (Yn) Sb. Un r 1 Year c. Un r 1 M B. D•N of Binh (MO Day a r Spa I Momh) )+. Blrthpl+a CIH+n St Or FeN retry
MdniM1a D+ys Houn Minutes $O i ri
8 Q
~ O/ 1 2/ 1 9 3 7 7b. BlrthPl.u (COUnYy)
untry) Bb.Re•Idanu Street eiW Number-IncIVOl Apt o.) Bc DItl DK•tloit Lew ln+TewnshlpT
3~~{~ rs~
B+Pan
ria]r .(-Va111a
11 9 B. bleat Ridge St. Owa,apaee.x maa h. twP.
cm
Cum 6r 1 aT18 s!, w••la.nu (zip code) ~+uP, aeEPd.nt IIY.d wRhln umw of Car? i s l a Eky/bpro.
9. Ewr In U9 4rm Rvrc+a9 30. MarRal Sfatus et Tim. of Dalth Married 31. SYIYMng Spouv z Neme Rf wNl, iM names prior t° Rnt merHap)
[] Yea N° Q Unknown Q Ohroreed 17 Newr Married D Unknown
12. F+ er t N+m! (Pint, MI die, Lest, Su a) 13. McMer'a Nem+ Pr1orN First Marttary fFlrft, Middle, ust)
Samuel Balcar MARY C1a ar
14a. In maM a N+me 14b. RalKlonahip to paudent 14c. InfOrrrient'a Melling rou (Streit antl Number, City, SNN. 21p Gad!)
Row Dau Yltar
Mar Jane 73 t Rd_ NeR.nrille PA '1724'1
.
......... ...........
........... .... ~...._........
If Death Occurrod~ln i Nospttal: ~~~ Nent ~ (
e. aw ~.l......l..,............. .............................. ... ..... ... ... ... ... ......... ... ..
......................... en one ...
If Death Oecurrod mew ere Other Than + HeapttN: t°1 Moaplce F+cnttv ~Oeutlint'a Hema
Eme en gvOm OYLD+tlant D+ad on ArtNal ( NYMI H°m!/Lore -T+rm Gn FOdIRy Other (SpeciN)
)Sb. F+diRy Neme of Instttutlon, glVa atreK antl numbers lgc. CIH or Tnwn, StsN, en Zip Ggde 13d. GuunH ° aKh
a iabur Hos i 1
. MKhvd Dlappttlen Burls Cr+matlon SBb. Date of Olapealtlvn 1 . Place of Olspoattlen (N+me W cemetery, crom+tory, yr Khlr plea)
~r p R.moy.ifrom u.N o DvnKl°"
OVlar July 1 2, 20 2 Ho111nger Crematory
1 . LOCetlen of plspoalt °n H yr Tewn, S<aee, end Zip
19+: SIgnKYN O FunarN Yarvice ucenaaa rn Person In Charge Interment r
19b. Uunse Num a
Mt. Holly Springs, PA 7706 ~.~.--%aC. O~'15H9L
1TC. Nam+ end ComPiaN AGdrep of Funeul Fecllhy
•~ ig. Daod+n<'s E 4utlOn - CTeck the boa +[ best scribes the 19. Decedent o Hispanic ODgin - C ac Ne 30. Decedent's Rau - Chec NE O0. MORE neaa N Indicate whet
t= M1ighast depee or Ia V•1 °f school e°mplK+tl N the time of da.th. bo% the[ Mrt tlefcrlb.s whatMr [he dle.dem the de[edent conNtleretl hlmslR or herself [o be.
~ gth Intl! er leas la Spanish/HlsPanlULatlnv. Check the ^Nq• t} WRtta Q Koroan
No dlplom+, 9th - 12th treda box If deutlen[ is no[ Spanish/Nlspenic/latlno. O Black or African AmKlun d Natnempe
High school graduate or OED comPllNtl A Ne, reef SPenlfh/HlaPanlc/I.Atino Q Am•rk+n Indl+n or Alaska NKWe 0 O[fiar Asian
~ Same colNge credit, but no tlegrea Q Yp, Maalon, Me%Ipn Amarlun, Ghluno ~ Afien Intlian ~ Naflya Hawaii+n
Q ApecieN dqm (e.g• AA. A57 0 Vls, Puerto Rion Q Ghine» 0 Guemanlan er Chamorro
~ /achelor'a dMroe (a.g. BA, AB, BSI Q Yes, Cuban ~ FIIIPIno Samoan
Q M+•N/a degr+! (•;. MA, MS., MEni• MEd. MSW, MBA) 0 Yas, other SPanlafi/HlsPenlc/LetinO O J+Paneaa Other PaclRC Islander
O Dvctorefe (e.g. PhD, EGO) or Profpaion+l d+groe (SpeclHl 0 OtMr (Specify)
D DS PVM LLB JO
21. O4c ant s Singh Mce SeN-DpignKlon - Ghec ONLY ONE tP IndleeN what the decedent wnslGeud hlmpif or harp f <q b+. 22e. Oeeatlem's Uau+ ccupRlon - IndluN type work
WhiN ~ J+Panpe ~ SemOen done during meff W Werkln/ Ilfe. DO NOT USE RETRED.
~ pl+ck Pr Ahlun Amarlun Q Koro+n O OMar Peclflc Islander HOU 6 E6 W i f a
0 Amarlun Indian ar Alpke Naclw ~ VlKnameae O DonY Know/Not Sure
0 Aflan Indian ~ Other Alan Q R+/u•eG 22 b. Kind Busm Industry
~ Chinp! ~ O NKiw Hawaiian ~ Other (SPaciH) House wife
FIIIPIno Q GuamaMan or Ghamorro
ate rpnepne ey eturo non ronouncln On a app Its a 23E. Elnaa
a
~
/V NR10M WNO PRONOYNCES OR
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~
7
RTIFigg TN ~7 ~/(/VU
Lyyt
7
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38tl. D 91( tl (Me 34. mf e t / C/
/ 25. s 1 ErGmin! rCe rCOntact+dT a Yas NO
CALSE OF DEATH Appro%imaea
16. P+n I. En er [M chain of evenb-disapp, Injuries, or evmplluflons--that dlroctly ceYaetl [ha Ge+ih. DO NOT +nter terminal awnb such as cardiac irne4 In<erv+h
o
uusa on + Ilne. AGG addltirmal lines N necessary
B N! Klolory. DO NOT ABBREVIA
E.
Mr
o
n
ly
ne
rpPlrKOry erroaC, or VMRlcyler Rbrlihtign wlt
T
En Onaat f° DeNh
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IMMEDIATE GUSE ----------a a. Err ^~•~'
(Final Glapp or condition DVe [o (pr as a ronsequwnq~ on:
roaulting In deaU) b , ~ ~ )i+~' /1'„ _ /T~~ .~ I
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ras a cpnea
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0
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Sequentially Ils[ condttlona,
If any, heding tq the comae / M ~ dYS Al.+L2/_ ~
listed on Iln+ a. Enter eha c. ( !/ 4~ 0/C-IC.-' ~ ~ Lam, /~a~G.yJ
LE /=~E
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UNDERLYING CAUSE Due to (Pr as a conaequenca Oft: _
(dlspse or INury chat
Inlthted [h+ events resulting d.
es
In tlplh) LAST. Due to (er a NnsegwnEe of):
ZB. -art 11. Enter other but not rosu ring lb the untlerlYln[ cause glVen In Pert 1 27. Wp an autopsy OeAOPneG9
No
2B. Wero aV<gpry Rn rep awllable
}~ Yo wmpktN the uusa oI d+a<ht
Vas N
39.1 F ale: 30. Did Tobacco Ua+COntrlbirta to Daeth9 3 annar of De+t
NOL Pregnant within Peat War Q Yee Q Probably Npurel [] Homldd+
al pre{nanf at tim+O/dpth
Q Not rnegnen4 but pro{n•nt wthin 43 dew of tlealh ~ No ~ Unknown Accident [] Pending lnyaatlgKlvn
~ SVlcld+ Q Could noY W determined
O Not Prgnany but pregnant 43 Gaw t° 1 year b+Nro dlKh 32. DaN o In)ury (MP/Dey/Yr (Spe 1 Month)
[] Unknown N pre{nen<wtthln the D+i[ year 33. Tme of In)vry
B4. Phu Inlury e.g. Nom.; conrtruC[len •tta; arm, < qo 35. Locatbn Of InIYN (Street and Number, GIH, State, Zlp Coda)
B. InIVrY+t Work 37. NTnnsperta[lon InJVry, SPldfy: 3B. paeEnbe HOw lNury Occurretl:
[] Yea Q DrIV+r/ODaraeor Q Pad.a[rlan
Q No ~ Pauanpr ~ Other (SPadH)
9a. Clrtmar (Gh+ck only ores):
0 frenllying physician - T° th+ t»•t M my knowladg aeatM1 occurr.d tlua to the ceufala) and manner aWted
P nvuncing / Gnlfyln h an • Tp the Ws[ T my knowledge, Geath occurred at LM [Imo, GaN, .red phw, and du! to the cause(s) and manner sta4d
O McGlul Eaaminar/COr +r - [h pis Ot a% In. , and(vr inYa fgKlen, in my opinion, h vauNltl at chd Nma, data, antl place, and Gue t° the oase(s) and manner s[abd
Slgnaturo of certMer; Tltla of certlRer: LlOanae Number:
39 a, A roaaend W P! pl G u D+K N 1 /,~_ n ~ a~
' T to IBnN IMO ay
! f ra er eg Itrar i Nra ~
' a D1Ya a ey r
43. AmendmantaR'y ~ ~`
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( 0172 0/ /1~ N305-343
OlsposlNOn permh Ne. ~ 1~ LQ ~L REV 09/2033
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R~~~~
REFER ~r kVIt1.S
2912 JUL 13 PM ~~ 42
RENUNCIATION
Estate of
I,
u~ciM~~, ,.'y.
G ~~ (~•,TPA
Deceased
in my capacity/relationship as
(Prtnr Name)
. ~',r~ J of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Dau)
Executed in Register's Office
Sworn to or affirm d bscribed
bef re a th' da
of
for
Cam"' REGISTER OF WILLS
COUNTY, PENNSYLVANIA
(Sigmrture)
(SveerAddreaa) ~ '
(Crry, Smu; atp)
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 day
of ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev, )0.13.06
ia- ~ T
A~:{~PtQED OFFICE (lF
i~GIS c.~ Gr; ~~'~,.5
2012 JUL 13 PM 3~ 42
RENUNCIATION
Estate of
RE ISTER OF WILLS
COUNTY, PENNSYLVANIA
Deceased
I, ~ i ~ ~ ~ ~ (..~ a- ~ 7L~rs in my capacity/relationship as
(Print Name)
D rc 1~ r~ h ~' ~-2 of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~(~~~ 1. ~ aD/a.
(Date)
yl ~~~1 8L4~.~
(SignanaeJ
3tlr F.~lr/~e~rJ ~~--
(Street Addrest)
C~-~1 r~ le ~,~- I ~° ~s-
(City, State, Zip)
Executed in Register's Office
Sworn to or affumed ubscribed
be re a tl~s day
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 day
of _
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
LJ~~~~tii 'J~~
QRPFi~4N'S COUNT
(Ef~LAMD CO., PA
Farm RW-06 rev. l0.1i.06
~~- ~ ~.~-
~.
~~
x~, ~ ~~~~~~s
RENUNCIATION
2011 JUL 13 PM 3~ 43
~;.:r=rr~. ~.~
REGISTER OF WILLS pRPHAN'S COURT
COUNTY, PENNSYLV~~~ ~" R4
Estate of
I
Deceased
I, _ ~ l~ ~n.ok S >p a4 ~ h in my capacity/relationship as
l (Print Name)
°`' ~ /I - of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
~~~ ~o ~
(~ e)
~s+g,~t>~
~3 F/~s¢~,cJ Sf'
(Street Addnsr)
~~~~ 1/~ ~~ ~ ~a~~
retry. smote, TAP)
Executed in Register's Office
Sworn to or affirmyd subscribed
befo a is // day
of , ,~~/~
uty fo Wills
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 day
of ,
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev. 10.13.06