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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF ~' Q, ~~ 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: So ~ ~ $to ~.~ File No: ZO / Z. 'G~ 5•'p 9
Ewa' (Assigned by Register)
a/k/a:
~~a' Social Security No: ZO6 'OS - Z 73 Z
Date of Death: i4~r; ( 'ZZ t -Lo t 'Z. Age at death• __ ~~
Decedent was domiciled at death in _~~d,. ~yr ~~~. ~ County, _ }~~ (stare) with his/her la t
principal residence at ~Z y (,e ~,~,~ ~ _ ,~~. z/ ~, a ~ ~~ a
~~~~ ~
Street address, Post Office and Zip Code ~~ City, Township or Borough Coun
Decedent died at _~Z ~/ L. s(~,~ ~ _ _~ .4~(~ ~, .~ ~~' ~ ~
Street address, Post Office and Zip Code +C,~ty,1 ownsh~p or Borough Coun
ty State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania ............................ All personal property
If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania
If not domiciled in Pennsylvania ........................ 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
$ / 00, pO,p
$ --
$- /ooe 00000
City, Township or Borough County
A. Petition for Probate and Grant of Letters Testamentar
Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated
and Cc
State relevant circumstances (e.g, renunciation, death of executor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a :V ~ ~
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, 3
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ~ V W
Q NO EXCEPTIONS Q EXCEPTIONS ..,
~x~
N
B. Petition for Grant of Letters of Administration (If applicable) 0~~~ C ~, _~ ~' `'•''
-- - ~ o
c. t. a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante m;V ~ N
If Administration, c.t.a. or d.b.n.c.t.a., enter date of Will in Section A above and com lete 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
in 23 Pa. C.S. § 3323(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS Q 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, ifnecessary):
Name Relationshi A dress
Q J // 'ISyr ~-
f3 T ,~,~ ~ ~ tt Gee: l ~ a.tit. s /-
_ ~ ~S6o
fo n ~~4 ~ /SSe~, i
N N
.~ s ;,
~~z
`'-. l
~N~
..
Form RW-02 rev. l0/11/2011
Page 1 of 2
~'~v -
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
Official Use Only
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) of the Decedent, th~ titi~r(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before ljyl/~ Date 9 /4 / 1
me this 4th day of a tembez 2012
sy:
F the Re ist
Date
Date
Date
or g
BOND Required: Q YES ~ NO
FEES:
Letters ...................... a
( )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission ................. .
Other ••••••~•
Automation Fee .............. .
JCS Fee .....................
TOTAL ..................... $ 0.00
To the Register of Wills:
Please enter my appearance by my signature below:
Attorney Signature:
Printed Name: l~(1 i ~~tQ «n, ~ . ~F~f ~~
Supreme Court
ID Number: 3q~ ~ Y
Firm Name: ,
Address: K ~ ~
1 O
Phone: 7l "~ SQO 56.50
Fax:
Email: ~~'~' ~- +~ Q. ~~ A l~l' G..v~/l
s
M
~ ~
~- W~~ fn
~=v~~zz
'^N-1 r-' ~ ~ ~ ^'
_ O ^
x N ~, x
Ya~c ~ vi ~.
Form RW-02 rev. 10/ll/201 /
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
}
} SS:
}
Otricial Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
Emil Beck 46 Martha Street, Uniontown, PA 15401
"~'- i 724-550-4347
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) of the Decedent, the Petitio (s) will well and truly administer the estate according to law.
Sworn to or,pffirmed anti subscribed before C-+ Date ~- ~
me this GG.• da of ,-2$12 Date
By: Date
For the Register Date
BOND Required: OYES L`~' NO
FEES: To the Register of Wills:
Please enter my appearance by my signature below:
/~
'
~~~
Letters ....................... $ c
~ Attorney Signature:
( '~7 )Short Certificates(s) ...... f ~ • ~(,~
( )Renunciation(s) ......... .
( )Codicil(s) ............. .
( )Affidavit(s) ............ .
Bond Printed Name:
Commission .................... Supreme Court
ID Number:
Other ... , . , ,
~~mrY~isSic„ ~
~~k~
~~~.~[' ~ s
~ ~ ~
.
. Firm Name: ~ ~ r"~ w ~ ~
......... Address: J _V W C
~ s
^,xcl~~~,zz
.........
......... ~ s ~ ~ i
.........
Phone: O %~ -
;: `~ N
.........
Fax: _ x
-~
~'
Automation Fee ................. Email:
JCS Fee ....................... ~
TOTAL ......................$ ~ -~L~
DECREE_OF THE REGISTER
Estate of -s~~hn ~~~ ~ File No: c~~ -~ ~ ~-- ~~~-
a/k/a:
AND NOW, L ~ { l~ ~ f S-en~e m be ~ , 9~Lo~-- , in co ideration oft foregoi Petition,
satisfactory proof having been presented before me, IT IS DECREED that Letters ~~ -~l ~ ~ ~ ~~~'~ ~ ~'?
are hereby granted to `~;~.~ tYl Ct Pjc'C li; ~h rr`(1QJ.S ~. ~.IYII ~ I~c'C-~
in the above estate and (if applicable) that
the instrument(s) dated -
described in the Petition be
Form RW-01 rev. l0/!1/10/1
to probate and filed of record as the last Will (and Codicil(s)) of Decedent.
i
Register of Wills (~ C/~ns~~~~l
Page 2 0>~ 2