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HomeMy WebLinkAbout10-09-12Reset PETITION FOR GRAN/T OF LETTERS REGISTER OF WII,LS OF G ~++~~ 2 y ~~ h d 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 requests} the grant of Letters in the appropriate form: Decedent's Information Name• Kehh~ ~- ~~~,t.s ~:., e a/k/a: a/k/a: a/k/a: Date of Death: S 31 oZ yl a Decedent was domiciled at death in C. u rn b e y ~a ti principal residence at Clare.h.o~f ~ar::~ (ooo CCcr Street addreaa, Poat Office and Zip Code Decedent died at N•~ S »;t s'a 3 tVoY t[ ?, Street Post Office and Zip Code Estimate of vahie of decedent's property at death: File No• ~` ~ I ~) ~ `~' (Assigned by Register) Social Security No: I ~ ~~- N ~ - 6 `~'6 7 Age atpdeath• S" 7 Countyn/, 1 ~ (State) with his/her>last ~N.orf ~r~ CRv~;r~c Cal.t:er Ind City, Towaa>tip or Boroag>, Couty City, Towdlship or Boroegh Ce'aty State If dont~Aed in Pennsylvania ............................ All personal property $ /~ 8 3. ~d If not ~otniciled in Pennsylvania ........................Personal property in Pennsylvania $ If not doariciled in Pidtnsylvania ........................ Personal property in County $ Yalne of real estate in Pennsylmnia ......................................................... $ TOTAL ESTIMATED VALUE.... $ 0.00 Real estate iu Pennsylvania situated at: u (Attach addtttonal sheets, if necessary.) Street address, Post Office aed Zip Code City, TowosLip or Boroag<t Cosaty A. petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/she/they is/aze the Executor(s) named in the last Will of the Decedent, dated thereto dated State relevant eireaaasta®ces (eg. renrnciatioa, death of execwtor, etc.) ~s ~ ~-' i Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divo ~ ~' -not a to a P~ divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(8), ~ not hav ~ hild T~xn adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. ...~ ® NO EXCEPTIONS ®EXCEPTIONS ~ GJ!i B. Petition for Grant of Letters of Administration (If applicable) c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durante absentia, durante minoritate If Administration, c.~a. or db.n.c.ta., enter date of Will 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 killing nor ever adjudicated an incapacitated person. ~NO EXCEPTIONS ®EXCEPTIONS Petitioner(s), after apropersearch has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach additional sheets, if necessary): Name Relationahi Address ~~ a ~,~ ~, ~~- P.o, o~ ~~l G~ abr. /.~ ~ ~sd v h ~ v~ ~y (ad y ~ e.- c ~ k ~y e e~ r I ` 1 7° Form RW-63 rev. 10/11/2011 Sa Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF } Official Use Only P titioner(s) Printed Narne e Pe titione r(s) Printed Address ~ , Q l/a-~ d~r //u 4s n / / 1:~. oX~~~ BGthPvrJ t ~ I7.$~o l St~~~, ~ u l ~~ < rov y ev «% v ~!«L<~,'cf ~+ r£ /7oi D 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 n will well an Sworn t affirmed bscribed be or ~ ~'~ me 's day of By or she egister ister the estate accordin to 1 Date f ~ / Date o 9 Date Date ~ t~ BOND Required: Q YES To the Register of Wills: n ~ FEES: Please enter my appearanc e by my signatu ~iei: ~--1 G^ Letters ...................... $ ~~/, uV Attorney Signature: Cr'y'-=` ~ ~~~~ ~'~ (5 )Short Certificate(s)...... ~ i i a ~ ~:" ~,. 4- 7 3 ~'" ( )Renunc at on(s)......... v = ~ O -"i ( )Codicil(s) ............. ( )Affidavit(s)............ Ut i ~, Bond ........................ Printed Name: Commission .................. Supreme Court Other ........ ID Number: ........ Firm Name: ........ Address: ........ Automation Fee ............... Phone: Fax: JCS Fee . .................... Email: TOTAL ..................... $ DECREE OF THE REGISTER Estate of 1 1 ~- File No: ~ ~ ~~ ~ `~' ~ (~ a/k/a: AND NOW, - I ~ ~ ~~ ~ ~a, in conside alien of the for going Petition, satisfactory proof having been presented before me, IT I S DECREED at Letters _ are hereby granted to V in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of r cord as the last Will (and Codicil(s)) of Decedent. Register of Wills~,,~ }~' - Foy Rw-oz rev. ]0/Il/2011 /J~' Page ~ of 2 HIOS.lAS REV (9111) LOCA - 1 'S CERTIFICATION OF DEATH WAR plicate this copy by photostat or photograph. ~~ i ~.t~ i.i) ,~,.:..~ Fee for this certificate, $6.00 P 18571211 ?~~2 OCT -9 AM Ia~ Sb OI~W~i'S COt1Rj This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registraz. The original certificate will be forwazded to the State Vital Records Office for permanent filing. Certification Number O Typ•/PrMtln P•m/ln•nt _ ~ Local Re istraz Date Issued COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH 1 . D•esdarK ^ IaIN Name (Rust, M ,last, ) 2. Sex NYmMr _ _ _ _ M Kannath Au atlna mala 174-4t3-6967 Ma 31 2012 S •. Ale-fait M n 1 s. Dm liRh M wr 7a. n PI•o• CItY and ar retry MenMi. D.Y. -1eur. Minugs May 31 s 1955 5 7 7b. lurenpl.c. tcourreN) or . R•,idane Iltr••t and Number - Include Apt N•. k. D art thr• n . Tewrq PA 1000 Claremonr Rd. ••, aautNnt llyd in Middias~~ twp. t rdyY JM. RMWnd (ZIP Cede) _ Q No, d•<•d•nt IN•d wlthln Ilmin of <RY ! . [wf 111 10. Ma 1 K Time 01 M Marrld 11. nl SPOU>• s N•ma tN wlfa, /lY• reams r q Q VM N• Q Unknown ~Dlwrc•d Q Nw•r MarrNd Q Unknown - •~~ Earl FC Auguatiaa L. M • IJarn• Prbr q FlrR Marty Flrst, M , Lat Tharasa Aare Calami . t m s Harm 14b: M bnihlp q D•e•d•nt i.e. InlermanYS MaRlro and N .CRY, Strq, Os•M QearrredM ~NCSORNi. M H D•aMOPEUn•d m ere OMa Than H•ppital• C7 iw.Pte. FadIRY y ~+d•ni's Nem• 1~~~ D•W on Arr1YN N Nem• Tenn CN+ R Other y net -. . EM R/e~t Me n~mNr, Hol S irit Tina ital ale. Clq. er Tewn, itbq. art Ztp COdO 1 Ceunty D!•th Cam Hill PA Cumbarla)ad urla Crmadon 1 . D•t• DfiposRlen lk. of - - en •Jarn• oam•esry. orsnttery. er etiY•r Q R.rrtoyaltrornstq Q DO^suO^ June 4, 2012 Hoover FH !i: Crematory Inc. Dense ,end Zlp a own i. S n • ~ r in rp of lnt•ml•rlt 1 u , Harrisburg PA 17112 012534-L 1>m'wm• snd Cmrlplsq Addrw o1 Rulr•ral iscRFry FH & Craaator Ia¢, P.O. Box 475 Harsha PA 17033 Ho sr , • bait tM i/. M Hhpantc In - t 20. Raea - ONE OR MORE raw q IrlWeab whet i°- hl{lrit d•Er•• er 1•yal 01 aehool ce'npl•t•d at t!1• tlma e1 dsaM. box treat best dwcrib•s wh•M•r tM d•ad•M tree d•ad•nt eonald•r•d hlrrHNf or hsrs•M q b•. Q ~~ ~~ pr yp Is Spanbh/Nt•panlc/LKlnp. CMCk the ^NO^ Whlt• Q K•r•M Q N• y~ - i~ry crepe box N decedent R rwt SpanlM/FRSP•nle/latlrw. Q 61•ck er AMC•n Am•rlon Q VNtnam••• Q HI[FI seneel paduat• a 6ED completed No, net Sp•nbh/Flbpanlc/Latlno Q Amerlean Indian er Alaska lNtlw Q OtMr A•IM M•Itlun Am•rlcan, Chluno Q ANan Indian Q Nat1Ye Hawalbn M•xlCan YM , , Q Some <aRy <r'•dlt. but n0 d•p•• ~ Ai.out. a.l... (•.l. AA, AS) Q Yp, Pu•no RI<an Q oxn... Q Ouam.nbn er wmorw Q l•Glalor's d•{r.e 1•.s• M Al, lS) Q Ytl, Cuban Q RlNpir,p sarnean Q MYgt's d~'N (•.{. MA, MS, MEro, MEd, MSW, MlA) Q Y•s, other Spanish/Hbp•n14Utino Q Japan•w OthK PaeMe b1aelWr Q Doctoraq (•.{. MD. EdD) or hotassionN dalr•• (SpaeNy) Q OtMr (Sp•cNy) s Rea - Cl+aek ONLY ONE q Indluq what the decedent eonsida himw or horse to M. 31a. 'i Uswl O«upation - Indiaat• type work 1 . yyb,te Q JaP•n•sa Q Samoan done duMn/ most ol.workinE /H•. DO NOT USE RHTtR[D. •an QOtlNr P•NfIC lsbndar QICe $ r WCIcaAfrlean Amarlun aCCOUniint Q AmaACan IrNRan or Alaak• NatN• Q VNtn•mase Q DonY Know/Not Sur• Q RHU•W 2 . Kmd uNntl n usery l A f an Q Asian Indan Q Other Q O)dMaa Q NatM Nawa{lan Q Other (Specify) on processing cou p Q RRIWne Q Eiu•manlanorCMmorro n o W - aturs anon ronouncro n eani• u.n hf,P[IMON tI11ND P710atOf,R1C'A OR r) . Tlm• ~ 2S. Wa 1 w Comaet•d7 Yq No CAUSE OF DEA'Tli APPreximaq 2•. lmdr tM ShEi6J>f~"db•wi• INurMS, or compllc•tbna-thN directly c.uwd tM d NOT enter t•rminsl w•nn suM ai ePrdl•c .rriS Int•rwk r•iWratery •rrai4 a yamrlcular RbH11Wen wMwut showirll ~•tte~loi~Yt•~DO NOT ANREVIAT~E~Ent~ ~r~N-e~M~ cauN on • Iln•. Add •ddRlen•I 1M•i H nK••Yry OnMt q Dwth ~~~©I~'~•~s//i/i jr~-TL.•tG(/T/ IMMEDUTE GUSE -> .• ~ a on (er as • <oni•quen D u e q / ~~ . (Real dbwe er mndRten y~~ ,,. ~ ~ ~ ~ ~ ~/~ { / J ~ rauRlroM Wath) ~JJ~i~i~~~"Y„~ ~ ~G(/f/!'.•~~' ~~ Q~s j b. SaquMtlNly Nst. eenditlony Du q (or as a eonapu•nee of): ~ y ~ !! M any. laadlla q tM dauq ~n`-ssiA-.'\.~ ~ / / ~~ ~ ~ ~ / Ibtd erl ilia a. Enter tM c. , r 3._~I /L IJI.O/R1YINi G//tHlR Due t0 (or .i • cons•4u•n<e oft: ldi••sss or Iw),Iry tltat mlelab.d ale .Y•nb r.,~Riro d• Due to (ar a: • <ona•quena on: In d..m) tAtT. but not rMURIrK in the und• nE uus• lMn In Part I 27. Wu M autopsy nb. r othH 6. /~~~y, / / /y`'~,/ ~ / ere autep•y hT Z q compNt• the a d•at Y Id obacce UN Convlbuq to Daath7 31. nn•r D•atn PNna Q Noe pr~ant wRhm wst war st tlm• of death lt P n Q Probabh ~ No Q unknown NasurN Q li•rNl<Id• Q Amk!•nt Q P•ndirrs lnwrtlpebn 1 d ~ ~! ! . Q r•RUx Net Pr•pl.rlt, but prynant within 41 days of death nant ai dew q 1 yqr bfw• death Mrt r• rM ~ 32. Date of In)ury (Me D•y r) ( 1 M n• Q Suicide Q Could net W det•rr11 t p S , Net pr•p Q Unknown R pr•Pant wlddn ens Pau war S!. Tlrrl• of In)ury /Nary •.[. : oDnRltn:den •Ra: farm; school) 35. Lo<aLOn M INury titra•t and NumWr, City. SUq, 21p ) In Hat raniporbtbn INury. W Now Inlury Oeeurra Q v« Q DrIY•NOVSrater [] Q No O R••••nl•r Q Otn•r (SpaeMy) ens tnMYmE PIYrHWn - To tM MK of my krwwl•d{e. death oeeumd due q eh• ousel,) and manner st•g0 Q PrononrMrl/ i crd-Ylro phYSi6lan - To the best of my knowl•dl•, death oocurr•d n the Hm•, dK•, antl place, and dw to Hl• owe(s) and manMr stated _ Q NI•dlol Exsminw/ the baw o x Inaelon, an or Imr Ration, in my opinion, death oqur+W~t tM Nm•, daq. and Place. and dw q iM cPU••(s~d~ ~ / V Y 7 /7 M '• •'{ ~ 1 , ' / Lioms Numb•rl i' 57tnatuq o1 pnlfl•n TMe d certifier: , , 1•tirl[ Cause Da Jt•m 2i _ Sfb. r i r .. stn s natur! ~ ~ - - .'x 3 Y Aln•odm.ne. 1 . ~,~ 0762194 N1O5-"" DliposRlon P•rmR No. REV 07/2013 r.s N ~ RENUNCIATION ~~~, _ .~ . ~,; ,~ ~~ ~ __ ~ } _x , ~-- REGISTER OF WILLS C c ~~r I~ ~ COUNTY PENNSYLVANIA C'7 G) a ~ ~ -,-, ~ c»,, , ~ ~ ~ ~ ~n cr Estate of 1~ P. h n e ~~t ~k c, o(s l t h e ,Deceased I, ~/t e Y ~S R ( / u a ~S ~~ h -e-- , in my capacity/relationship as // (Print Name) yh y fh e;Y of the above Decedent, hereby renounce the right to administeer the Estate of the Decedent and respectfully request that Letters be issued to ~~ ,1 h ~ u °~ Cl S~t ~ 2 a N ~ ~~ PiU.e, j't ~ (mot ~i LlS ~ 11. ~. /~ (Date) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of , Deputy for Register of Wills G~ r \.SCJi9All~. ! J.~LA i (Signature) ~77 ~/es~ Chec~/~~~ ~uf_ (Street Address) jj Ners/~ey ~~ ~ 70 33 (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 renunciatio for the purposes stated within on this _~ day of , _ d~~p /~~. ~J ~ r Notary Public My Commission Expires: D~~p ~~ O~~ (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COiYMONWEALTM.O€ PCNNSYLUANIA Form RW-06 rev. 10.13.06 NOTARlA~, SEAL SUSAN C. CIRANNI, Notary Public Derry Township, Osuphin County My Commission Explrea AprN ~ 2f113 tv RENUNCIATION ~° o ~ REGISTER OF WILLS cr-~ ~ ~ -~ Cumberland COUNTY, PENNSYLVANIA Q s ~;~~ ~ ~' cn cx~ Estate of Kenneth Augustine, ,Deceased I, Amanda K. Augustine , in my capacity/relationship as (Print Nmne) child of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to John Augustine and Steven Augustine (fie) Executed in Register's Office Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 C7f~ G~,n~l~~ (Signatrve) 3050B Linden Street (Street Address) Bethlehem, PA 18017 (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 purpos sta wi hin on this ~ day Expires: V~ ' /~~/~ (Signature and Seal of Notary or other official qualifred to administer oaths. Show date of expiration of Notary's Commission.) M AL ~~P ~N ~f VAN NOTARIALSEAL ROSEMARY A. TUKE1pt, Nt>~My Public City of AgKMawn, trtlfl~ My comminioe Expars~r ~a, pans O _~ ^' ~i ~ , ~~ c ~ ' "T' " ' RENUNCIATION F. ~ ~ ° `° ( F f r l ' ": ~=; o ~ . ~~ 3 _ r-• _~~ :~-y ~ C~ REGISTER OF WILLS -' ~ °• ~ n CUMBERLAND COUNTY, PENNSYLVANIA Estate of ~~TH AUGUSTINE i, JEREMY AUGUSTINE in my capacity/relationship as (Print Nmne) CHILD of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to JOHN AUGUSTINE AND STEVEN AUGUSTINE (~) F receded in Register's O,J~rce Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills For-nRR'-06 rev. ]0.13.06 3284 SEQUOIA DR (5meerAd~+tsr) MACUNGIE, PA 18062 ~~: s~ ~~ Executed out of Register's OJ~rce Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renunciation for the p ses within on this _(.? day of ~~~~~ ~' ,!J 2Q t 2 ~~tary Public ' y Commission Expires; ~I~E~1~ (Signature and Seal of Notary or other official ~HQ~f1~f W ~ ~ • administer oaths. Stow date of expiration of Notary's Commission.) John P. L.Inny OSJA, V Corps WITH THE US ARMED FORCES Heidelberg, GE 47 HEIDELBERG, GERMANYS ~ s1,p0 AE 0810? -