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HomeMy WebLinkAbout11-09-12Reset PETITION FOR GRANT/OF LETTERS REGISTER OF WILLS OF Gyct,s ~~4y~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 fallowing and respectfully request(s) the grant of Letters in the appropriate form: Decedent's Information Name: (fate r-v ~T, ./ua~c S a/k/a: a/k/a: a/k/a: Date of Death: %a 3 r Z- Decedent was domiciled at death in ~~.,,. principal residence at L! i) it/. 7 9 ~ Street address, Poet Office and Zip Code Decedent died at ~~ .,.~" ~iAt- . ~{a~-d- Streetaddress, Post Office and Zip Code Estimate of value of decedent's properly at death File No: (~1 ' ~ ~" I ~ ° I (Assigned by Register) Social Security No: 'Zr7 Q - 36 -6 Z 3'Z Age at death: b y un!t~y, P~4 (stare) with his/her last_ / ~Zr%/i p ~twc/a ~+'7r+.r~t City, Township or Borough County Township or Borough Couoty ~ Stah ` /jdomiciled in Pennsy/vania ............................ All personal property $ .Sd r 00 O /f not domicl[ed in Pennsy[vania ........................ Personal property in Pennsylvania $ /jnot domiciled in Pennsylvania ........................ Personal property in County $ n `_ Value of real estate in Pennsy[vania ................................ ...... $~ ^~ - ................... TOTAL ESTIMATED VALUE.... $ -~ oo ate. Real estate in Pennsylvania situated aC (Attach addiaana(aheets, if necessary.) -.c Street address, Poat Omce and Zip Code City, Township or ~ C_ Q A. Petition for Probate and Grant of Letters Testamentary J~_' ~ .,- Petitioner(s) aver(s) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated :n -and C7~. thereto dated _ ... State releveot dreuns,tances (eg. renundadon, death ojexecutar, eta) Except as follows: after the execution of the instmment(s) offered for probate Decedent did not many, was not divorced, was not aparty to apending 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 (Ieapplicabte) c.t.a., d.b.n., d.b.n.c.t.a., pendente life, durance absentia, durance minoritate If Administration, c.t.a. or d.b.n.c.t.a., 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 aproper seamh 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 Relationshi Address Sa wu.. e.~ /vlq~t Soto z a a Pe,,.... (vr~,,,t t .4 ue . ~'~ ~- c ' `Jo K t . . c 5 LZa r~ t z t, ,, I n Ro ~' ~ l ~c S 8r-B'~.v~-- bbb Gam. (terwceu,9oa.." ~~ L~a~f Z6/~ irle(, aver vll•~ "~.~rnS J P~ Form RW-01 rev./0//1/ZOl1 r9 y6~ Page 1 of 2 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Official Use Only The Petitioner(s) above-named swear(s) or affirm(s) the stat the f go ~ Pefitio are true and correct to the best of [he knowledge and belief of Petitioner(s) and that, as Personal Representative(s) of th ec nt, Petiti r( 'll well and truly administer the estate according to law. Sworn to or affirmed anc~ subscribed before Date ~~- q- 20 I ~L H.r n ._,,,. i _ ~., me ' For the Reg'ster ~()I~ Date Date _~ iAufn N _... -r BOND Required: Q YES Q'NO FEES: Letters ...................... $ (~ )Short Certificate(s)...... c ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ Automation Fee .............. . JCS Fee. ...... . TOTAL ..................... $ Estate of a/k/a: File No: ~~'~~~~~~ AND NOW, ~~1 (,$ ~l'~ ~ bl.Q~ ~, in co id ration of tlt fore$otng Petition, satisfactory proof having been presented before me, IT IS1~±EC ED that etters /l~. (. ~ ~ ~ .~(' 9"l'l- are hereby granted to _ -~(1 ~/~~ ~~ ~ in the above estate and (if applicable) that the instrument(s) dated described in the Petition be admitted to probate and filed of as the last Will (and Codicil(s)) of Decedent. of Wills ~7 T .., -~ r-'--~ -' ~ - . To ffie Register of Wills: E- ": ~p _, Please eater my appearance by my signagDge below: _ b,_- s. Attorney Signature: ~, ' = c -1 .. F.- P O i/J( ~/,/ / ^ r Printed Name: CU ~~~ca we L A C~~ Supreme Court ~ Q S Y y ID Number. Z Firm Name: Address: ~Q~I{/Q e~~ouls c..~ ~T2.7'rT 9 c.AV (7r~ T' Phone: Fax: Email: DECREE OF THE REGISTER Form RW-01 rev. IOiiuzon - ~./ Page2 r LOCARF,GI~~R'S CERTIFICATION OF DEATH WAF~1G { eUt'as ill duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 , This Is to certify that the information here given is = U ~ 2. ~ ~'~ -9 P~ ~ ~ ~ 4.~~F.p~~y~~ correUly copied from an original Certificate of Dea[h 1 f'Id h C •IR Th 1 P 18 8 4 9 '~ 4 ~cuM~F~~aly~ co., PA d{t y 1 e wtt me. as oca egistrar. a origma ertificate will be forwarded to the State Vital Records Office for}~rrga~nenffiling. - Cerhhcanon Number ~ ~~+%~~ - Local Registra~ lypp/FMt In COMMONWSALTN OF FCNNSVLVANIA ~ DCPARTMCNT OF NGLTN ~ V ITRL RICORQ$ ^^tl•^•^t CERTIFIGJOTE OF OEJOTM I Date Issued . 1. .nYt t.pl N•m. (flert. Mlaal., taN• a a) 1. Su . Swh13•eunty Num r D <n Me/DPy r 9p Hanr J. Malin Mal 2 2 X19 S•. Aa•-IaK CIRR ry ! VnMr 1 Y«r , pw alnn (M Ory «r (Sp. Men< )e. Elnnplw q •n a at Fonlan Cauntryl r 62 Menq. p.w Neun Mlnumt peril 30. 1950 )b. alnnpl•u (CeunM M.1<••la.nu er e<.Ian Deun<ry) .w« Sp.«•na NUmWt-In<ua. Ap[Ne. fc. Ob MUe.n< • n ownglp- P v i 142 ~ 3 h S T annay an a . 0t t. pv... e.me.nt llweln two. 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Pr come«~n<amea O v« GUSE OF DEATH Approklmem aa.p.Nl. fnHr qe geln uF ev.nr.~l«et«.WuN.a«mmPln«mn.--titer alree<IV UU«ageeeeq. OO NOTewrurmin.l e.'.nt. w<n eeurtl l:e«xtt Iwnel: ratplnfwy..ratp or wngmN. nban«len wru,pW .npwba q•«leleaY. Do NOrAUwevwTe. eMrPNV One tee«Pn.nne. nee aeagenal one. nn«.a«rv on«<m oe.<n IMMEDIATE UVSE a • ~r1L ~ _ IFnnl elteep> mnehlen pus tp 1'or et a mNUVenu oC: ~ r«mana In eee<nj sewwNlally IIE mMgev. Ow to (or «e mM wnm P/1: n env. I«mN m qe r..... ' !~ ~ ( ~ ~ L ~ G-a+L.c_ Ilwa en aN e. aN« qa e. \ ~ <_I e L` bL-3C : L DNwwinlEa <Jt<JaC Dee w (Pr «. <PNehwne. Pn: «erlNUry q•t u„ qe Mw rewnlM tl. mesa e ItAST. pwm(er wn•mu «ef]: et• n 16. pvt t . Enbr w .r bu<,q<rM Ina In tM un ar ba outs Slwn In Pert 1 1 W eutopty p. e uen Y e 1.~ax eumptV ntllrytevellebN eempla. m. wme ma..ga v« Np 1e. r.m.L: aD. pie rewt.>s u con<nbum m De.<nT ai. Ma «ween a p Nw Pxa•• N wools PeN we. s Q vn eebly Q y p~R er.l O nemble. 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