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HomeMy WebLinkAbout09-06-12PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF ei.~ l}'I B1t~L/(•/uD COUNTY, PENNSYLVANIA Petitioner(s) named below, who is-are 18 years of age or older, apply(iesj for Letters as support thereof aver(s) the following and respectfully regt:est(s) the grant of Letters in the appr~ Name: ~~ a/Wa: ~ a/k/a: -~ a/k/a: Date of Death: Decedent was domiciled at death in principal residence at 1 Z DI1 File No• .`~"/~ (Assigned by Rei 'on Social Security No: S~ Age at death• ,S'S~`- ~(q~._County, ~e»nsyl/tkus. (s Street address, Post Onke aad Zip Code City, Decedent died at (p/S I~~tA>~e ~•s'%G., ~?/$ yi•r~iditf Street address, Post (Mice and Zip Code Estimate of value of decedent's property at death: Ifdomieiled in Pennsylvania ............ . /jnot domiciled in Pennsylvania........ . Ijnot domicUed in Pennsylvania........ . Value ojrea/ estate !n Pennsylvania...... . Real estate in Pennsylvania situated at: NONF (Attach additional s6eeu, ijaeceasary.) Street adds County Township orBoroogh County State ............... A11 personal property $ ~ ~• ~ ............... Personal property in Pennsylvania $ ............... Pctsonal property in County $ .................................................. $ NOty~ TOTAL ESTIMATED VALUE.... S,e DOD xn, Post Otttce and Zip Code C1ry, Township or Boroagh County ^ A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) helshe/they islare the Executor(s) named in the last Will of the Decedent, dated thereto dated State relevant dreumstanca leg. enunciation, death ojexecutor, etc.) Except as follows: after the execution of the insttumeat(s) offered for probate Decedent did not marry, was not divorced, was not a patty to a pending 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 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 (Ifapplicable) e.t.a., d.b.n., d.b.n.c.t.a., pendente life, durunte absentia, duranteminoritate If Administration, e.t.a. or d.b.n.c.t.a., enter date of Witl 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(8) and was neither the victim of~a~k1ill~in~gynor ever adjudicated an incapacitated p/e~rson. ^NOEXCEPTIONS ®EXCEPT[ONS W.CCq~IL 661ts 1//11 CR ~ InI'~t~C~ Ld~ttll~- Petitioner(s), aftera proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (ifany) and heirs (attach additional sheets, if necessary): Name Relationshi Address Tsnnr~ar' H1. O~,Son ~ouy,~ Iz k N%l/S C:n/e ~ 17©70 1t'iK Of~sor- See -~6'~7- $sf~ y K P pG-1icK ~ son ~n ~ 7 20 Shado/~ P: na 'D1-i v~ Form RW-02 rav. tnnuznll Page 1 of 2 and Codicil(s) rv below,~d in ~ n: cn ~c~"~ ~., `O ~ r, rn ~' n =09~, -- , ~.~ t-7 ~. -'~ C:r _ ~~.~ -~ rn ~- n with hiss last k Oath of Personal Representative COMMONWEALTH OF PENNSYLVANL4 } } SS: COUNTY OF CllM13ERLAl1D } Official Use Only Petitioner(s) Printed Name Petitioner(sj Printed.4ddress Tenn;~er I't'). o~sorl fzDr>ry~- Wills C; rcle•,nrwt".ccntbtrld..Id, -7o7»N c ~ - r-, , I ~~: rn ~> C7~: ~ r;; ,; ~; •-3 ~-t ~ ~ ~i The Petitioner(s) above-named swear(s) or affirm(s) the statements in the foregoing Petition are true and correct to the bes~e knowled~nd be~ief of Petitioner(s) and that, as Personal Representative(s) of the Decedent, t)te Petitioner(s) will wel I and truly administer th rate accordirt6•to law.~n Sworn tq o~ffitmed an subscr' ed before VI"~~ ,q Date R - (0~" f 2 me th' l.e da , ~t~ ~ _u~~~~ Date By: Date For the Regi ier Date BONDRequired:QYES dN0 FEES: o~ Letters ....................... $ 3d~ ( 5) Short Certificate(s)...... ~.oo (a )Renunciation(s)......... / ~• 0° ( )Codicil(s) .:.......... . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ,,,,,,,, Automation Fee ............... ~C~ JCS Fee . .................... TOTAL ..................... $ 425, °" To she Register of Wiiis: Please enter my appearance by my signature below: Attorney Signature: Printed Name• '(,~,a~,$ ~, e~l7sG~4/S ~[' Supreme Court ~~QQ~~.--.. ID Number: ..aD~s3 Firm Name: N/f} Address: pr m A~•lnrsiAa{~LIt^J I70S'S Phone: 7 /7- 76 6 - O~Oq Fax: 7/"T- '79S _ 7/s/7.3 Email: C_,e s ~'~ , /+e~..,n~~ .,~ DECREE OF THE REGISTER Estate of F1'LgCJ'IGK !'/YfA'11~ D/IESoN File No: 2. ~ -/Z - Q+I~P~ a/k/a: ~rJC F. ~'Fl~atnn . n llw a~..•Ir a.. /l* c. .. _ _ r__ ~. r. .. AND NOW, _ ~~+Q~Q,~~-jam' ~ ~~-~ ~a , in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECRE D that Letters Of f~ddl,a,ts1S^al~Da are hereby granted to __s1'El1Aii~ /~• O~.Spvl in the above estate and (if applicable) that the instrument(s) dated ,y~/¢ described in the Petition be admitted to probate and filed of~-~cord as the last Will (and Codicil(s)) of Decedent. Form R6R07 rev. !n/l1/2nl~ of Wills ~ ~Q ~i~l, of 2 Io ~~aa3((~ 3 ~y~ i fln Ji p ~• k=333 ~~ 0 i~ n Ni COMMONWEALTH OF VIRGINIA CERTIFIED COPY OF DEATH RECORD M N A 7 O V I'IA-(; ~EPARTYFAIT TIC MFAI TM _ flwl¢Inr ne vlrwl nrnnen~• r.w••Arw.... FOR DMSION OF AREA MUMMER NUMBER TF MEDICALEXAMINER'S N LE VITAL RECORDS - 2 ~ 6 ~ CERTIFICATE UMBER OE~1T 1. FULL NAPE (IIM) (m1001e) OF DECEDENT hap 2. SE% male IemaN ^ a DATE OF hr.l. 10W1 (»ul 1. AGE _ IF VNDER i YFAR IF UNDER 1 DAY 5. DATE OF (mo.l (OaY) (Yw) 9. D C DENT - - T E~R N (E yn ~ r says- - - nourk -r minutse BIRTH ~ 3 ~ )2 ~'~ CC months F ARMED FORCES7 I I 1 I q / O ~~L ~ n JU rre 1 7A ~]7 KALE OF 7. NAME OF hgBPITAL OR INBTI7UTgN OF DEATH (K none, r slate) Oln Pat. 9. CWNTV OF DEATH (II Inaepenaenl chy. Nave Mrp DEATN i! ~ i DOA Emer Rm Inpa9wit O ~` ,r I ^ o ^ /. CffY ~ T ,~ ~ DEATN Imlr city a IaYm Ilmilei 10. STREET ADDRESS OR RT. NO. OF PUCE OF DEATN ~i iNi/d~ ff~P./~- "' o /t ~Tcei/y~t, AvE ~ 7~s IMUAL 1lE 11. STATE FOREKTN COUNTItYI OF DECEDENT'S RESIDENCE t2. COUNTY OF DECEDENT'S RESIDENCE (It IndrnWam city. New oMnNl OF D!ClDENT 1~~]a /8. Cf(Y OR TOWN OF RESIDENCE msi0e city or lawn limit•T t/. STREET ADDRESS OR RT. NO. OF RESIDENCE I ZIP CODE Yb rw I ' - ^ I PBrONAL 15. NAME DECEDENr& FATHER 19. MAIDEN NAME OF DECE(7ENT'B MOTHER DATA Of oECI~T ~ B. ~.i>'~1 I'Qe D~k7B62 17. RACE OF DECEDENT 19. OF HISPANIC ORILiINi 11 yr, tprlty Cuban. Mnkr, 19. EDUCATgN (SPecly onty hlpheM Areas tanplNrl Puwb Rkan. ac. ~-I m ^ r EJ Y Elementary/SecaMry (612J Cdlpe (11 ar 5 ~ I 20. CIT IZEN OF WHAT COUNTRY 21. BIRTHPLACE p4b a count7) 22. NEVER MARRIED ^ DIVORCED ^ 23. ~ ~ ~ ppWED. NAME OF SPOUSE ~~ T~ l.Q'S (~lfr7'TT7.A MARRIED WIDOWED ^ ( eh~ k e Nk 21. 80CIAL 8ECURT' NUMBER 20. USUAL OR LAST OCCUPATION 28. KIND OF BU8INESS OR INDUSTRY 27. INFORMANT • OR SOURCE OF INFORMATION • REUTIONSHIP ... .'y . ,.A,, Imo. ` i ~7BI11~ M. ~.~l~l - cALIeE OF DEATN 10. -ARf L Enlr Mle W Wee, In)utMe. aF Gaeed tha tleMh. Do nd ntx tM matle al Gyitq, each u wdioc a nsplrelay uroeL aMCk, a heN Ieilun. INTERVAL BETWEEN Up aYy one CHIN r each Nle. TD 6 ONSET ANO DEATN MIE0UITE CAIaE (Flne1 ewr. a ~ N /Air L (!(//fY y ( IImICA eoIl/Blon welatllq m arN'1 DVE TO (DR AS A CONSEOU E OFl: [YAYIIILIt M alry~ Iee~n~ (9) bkmw e~ ~'1 1 e9W I F6lvIND DUE TO (OR AS A CONSEQUENCE OFl: CHINE IDleeen a hWIrY INeI M1Nalea CrtPleb 1IM elol eWAr reNAhp In deelhl utrr Irsor owlr.lr c ENIB B1A r/ ~ ti ~ PART N• Older ~ OorleMane conhAwlinp b MMh brn not rnuhinp In tM anaerlyfnp uun 91wn In Put I 3 ae9iu b AeteFY ahealar r ran r . 2M. AUTOPSVT yn no gUTHORIZED 8Y: (7( ^ 9aeeele etr he>~y. Ley ~I . t 718. IF FEMALE, WA9 THERE A PREDNANCV 21c. IF E RNAL CAUSE. IT WAS 2r. DESCRIBE NOW INJURY RELATING TO DEATH OCCURRED Ni PART 7 MONTNBT PNrAAR a CONiWBUIINO Yr ^ r ^ unhnoem ^ TD pEATN ~V ~' fl~c~ ~/~ r~i~' ~ /Q 1i7~ ~ NOTE: M ••~~p•, ~~ ~ ~ y q 2N. TNIE OF INJURY (mo.) IoW) (Yea) NI, INJURY OCCURRED 21p. PLACE OF INJURY (1bm~ term, 2M. Iciry a town) (counlYl letatsl taata7 nre M WIICe ala Nc l I tM al BnY~deri~kn . ~ . 9~~ / 1~ vN~C-. AM. Z (~ f~- whlM 1101 wllr J f~ ,~a~~/ " ~i r ~ „~tl~ ^ .I waM ~Q~/cr L/ ; ' ' iI/,~1 ~aN ~ r ran r ParlMe. _ N Y 7N. 1 CERTIFY 11M I pwk cMrpe of IM remelne oeaerlMe abrna H swe01M badY• mWe irpuiry ana In my apnbn Math rata%b a a aoout (A 1 (PHI ham . F~ { _ _ NATINiAL CAUSES Q _ ACCIDENT ^_ _ SUICIDE C1 HOMICIDE ^ VNOETERMINED ^ PENDING ^ 8~Ni71NTI1RE - - ~ _ --~ D~~~+~~_~a _a~~~ _ NAME ~ ° I -' 1 OF EDIC XAMINFR 1 ~. FIII~IAL OMECTOII r. BURW. REMOVAL MA 3D. PLACE (name of camel OF BURUIL, M a cremalwy) (coy w county) ptnp ^ _. _. REMOVAL. ETC. yn;,y,•._,y__ _ 114.GY1GLJ:7. ~{ r ~•~.~9 .m• c.~.r••cm•/' NAME OF FUNEML ~7 ~`~, tl d~ '~D.?BSD H. D. ULL . ~ ~. ~~,„ s.IYw. ~~ s t 1a. a nprar) ~/f / 1501 'aa"l~lcn TS~$71L - 1 .~Y'1/~ I 1 /~~n DATE RECORD ^ ~ FILED' ~.J ,_.,_ I .1 Q~ n._ T-I -T T TH13 IS TO CERTIFY THAT THIS IS A TRUE AND CORRECT REPRODUCTION OF THE IGINAL RECD FILED W TI7E VIRGII~jy~ BEs,..~- 'T'T DEPARTMENT OF PUBLIC HEALTH, VIRGINIA BEACH, VIRGINIA J~ 'T~'~~j DATE ISSUED: nE~ 1 4 70~~ ,L'+ ~ "~`+ ,SEAL' EPUTY REGI3 R ANY REPRODUCTION OF THi3 DOCUMENT IS PROHIBITED BY STATUTE. DO NOT ACCEPT UNLESS IT BEARS THE IMPRESSED SEAL OF THE VIRGINIA BEACH HEALTH DISTRICT CLEARLY AFFIXED. Ssdlon 32.1.272, Code of Vlrglnia, as Amended RENUNCIATION REGISTER OF WILLS CU~'1/3F72GA-tt?~ COUNTY, PENNSYLVANIA ~r- OC",, --, r,~ Q ti ~ ~ ~ ~~ ~~ car I r~r7f C ~ t--~r ~ C .3 Z~:J ~ - '~ i W ~'z .~ ~ ~~ u'+ Estate of ~'reder; ~/~ ~ Offesnn g,(fa ~d~r. ~.~ Fr~r~ k Dl7~eson Deceased I, ~r% ~ Of~'eson in my capacity/relationship as (Print Name) a ~cn .and heir of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ,TGnnl~r In. ~.Svn (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , x ~~ (Signature) ~r;,K O~+SOn (Street Address) (City, State, Zip) C'4~~ ~ Ybk / P8 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 ated withi onthis~~ day of ~ ~~ Deputy for Register of Wills Ivly C-o ~ si~Expires: F'EFiMANENT att~Seal of Notary or other official qualified to oaths. Show date of expiration of Notary's Commission.) Fornr RN! 06 rex 10.13.06 J:~CQUELI\E D.KI\SE1 Notary Public #201 • 4430 HALIFAX 5T. BURNA®Y, O.C. VSC 5R4 TEL: (004) 2fl0.1 220 A Notary Publlo In end for the Province of &Itiah CdumbW, A Commissioner for taking Affldavlts for &itish Columbia. rN ~ m ~~ ~ ~~ - RENUNCIATION ~ ~? ~, ! r c, ~:~ _ -~ -„ -„ REGISTER OF WILLS 8~ ~ '~ . - Cun1~~Qt~IJD COUNTY, PENNSYLVANIA __ ~ r- `'~'~, Estate of~reder+~k ~ ol~eson , fXa >rrel~E/'i~ck ~ranK Off~san ,Deceased I, DGrGK P/f'P.SOrI in my capacity/relationship as I(Print Name) q Soh ~,l //ei/` of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to f nn~~rr' /~'1. D~e.Son ~-~©- ~Z r~ate~ Executed in Register's Office Swom to or affirmed and subscribed before me this day of , a Tao ~h~datJ ~.%n~ l7r; v~ (Scree! Address) l~~swe//f G~ 3007 (City, State, Zip) 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 ofrposes ated within op this ~ /7 day Deputy for Register of Wills WIC Public t~,SP NUT ~ fission Expires: ~ ~ r ~~ _ ~j ~~ ~~ EXPt GEO ~gn ure Seal of Notary or other official qualified to NOVEM~~n ter ® .Show date of expiration ofNo[ary's Commission.) 20~q ~ p~tlC FarmRW-06 reo. 10.13.06 ~H C~~