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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF 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) Uie grant of Letters in the appropriate form:
Decedent's IDformation / / ~+
Name• 7~.1<./ ..r+c.9/S V~.~ o ~/~.
a/k/a: ,•
a/k/a:
a/k/a:
Date ofDesth: OS- Z4-- 20iZ
Decedent was domiciled at death in
principal residence at _~'S• .T, P.
Barest addreu, Pbst Oface aed 7jp code
File No: ~i ~ ' 1 J
(Assigned by Register)
Social Security No: /~5 = LG ~- / 7a.Z
Age at death: ~'j
-~
Chy, Township ar
(score) with his/her last
Decedent died at SJr J~ /°d O .~~ ~y e i 7e~9 ,~~.t a~~inr/~!`,!e ~~* >(.eli/~/
Street address, Bost Orrice and 7Jp code City, TowneHp or Borough Coaaty state
Estimate of value of decedent's property at death:
ljdarwiefi~ in Peeasylwnfa ............................ All Personal property $
/f not do+nieiled to Penery!wain ........................ Personal property in Pemnsylvania $
Ijnot daastciled In Pennsylvania ........................ Personal property in County $
Vafae ojrml elate in Penasylwnia ......................................................... $
TOTAL ESTIMATED VALUE.... S ,{"G O p,pp
Real estate in Pennsylvania situated at:
(Attach additional sheets, ifnecessary.J Sfreet address, Poet Offlu sad TJp Cade City, Towaahip or Borough
^ A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) hc/she/they is/are the Executor(s) named in the last Will of the Decedent, dated
thereto dated
Couuty
Codicil(s)
state rdevaat drcudhaen (ea rearaeudon, MaM o/execrbr, en•.)
Except as follows: aftertheexecution oftbe instnrment(s)offered forprobate Decedent did notmarry, was not divorced, was notaparty to spending
divomc 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.
,._,/Q NO EXCEPTIONS Q EXCEPTTONS
Ld B. Petition for Groot of Letters of Administration (If applicable)
c. t.a., d.b.n., d.b.n.c.t.a., pendente tits, durance absentia, durante minoritate
If Administration, eta or di%n.eta, enter date of Will in Section A above sod comolete 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 rwr ever adjudicated an incapacitated person.
i~NO EXCEPTIONS O EXCEPTIONS
Petitioner(s), after aproper search hasthave ascertained that Decedent left no Will and was survived by the following spouse (ifany) and hero; (aaach
additional sheets, if necessary):
Name Relatioashi dress ~;_; 7D '~
tl ~ ~ ~ ~
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Fa„nrtw-oz .er.ionuzou Page 1 oft
County,
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA }
} 3S:
COUNTY OF
Official Ux Only
Petitioner(s) Printed Name Petitioner(s) Printed Address
The Petitioner(s) above-mined swear(s) or a6rrm(s) the statements in the foregoing Petition are tore a~ correct to the best of the Imowledge and belief
of Petitioners) and that, as Personal Representative(s) of the 1~e Pell well and truly administer the estate according to law.
Sworn to r, ~i'irmed subscribed before ->,I/ >.~ .,~ ,/1 Date di .3
me tlt' "'day of 20 /3 Date
By: ~ ~' Date
BOND Required: Q YES
FEES:
~NO
Letters ......................
( )Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)............
Bond ........................
Commission ..................
Other
Y.~'~........
.......
Automation Fee .............. .
1CS Fee .....................
TOTAL .....................
Ste` -
IlJ
S~-
~IO$.~'
ore me, IT
granted to
DECREE OF THE REGISTER ~7 2
Estate of ~~ r ~, (~ ~ ~~ ~. File No: ct' I - I
a/k/a:
AND NOW,
satisfactory proof having been
the instrument(s) dated _
described in the Petition be
Date
To tke Register of Wills:
Please eater my appearmee by my aiguatore below:
Attorney Signature:
Printed Name• n a7 ~
Supreme Court ~ ~
~ ~_ 7 n
ID Number: m " -^' ~- ~
~= ~:.{ t7
Firm Name: ~ n r-
~ ~ ~ F~
r- r,.l rat
.~ ,
Address: ~;,~ U'? ~ ~ ,~
~~ ~ •'Y' ' I't
f'7 ~ ^e~
- GJ
~C7 CXJ - rr7
~
Phone: _'' ~~-
Fax: D ~~ 'Y7
Email:
in consacjgration of tpe foregoing Petition,
in the above estate and (if applicable) that
to probate and filetj~of~cord a$ the~kast~Will (and
7
Form RW-0I ,rr. miirnmi P e 2 of 2
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
I~el~ Ibr this certificate, $6.00
This is to certify that the information here given is
correctly copied fmm an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent tiling.
10113 JFN 1`i R
n,, ~ _,:
~ `..:iii ~~:1
Certification Number
#33-349
pB1ac41nkt
CLERK Oi~
ORPHANS' CO'.i' ~~~~~~-`~'~ DES 1 3/2012
CUMBERLAND CC., ~~ Local Registrar Uate Issued
COMMOrvwEaLTN O. nENNSYLVxNIT ~ OEpkRTMENT OF NEwLTX . Vnxl RECOR05
CERTIFICATE OF UEATM
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RENUNCIATION
REGISTER OF WILLS ~ ~_=< ;v
~(,l /79 G-C !' IC(N ~. COUNTY, PENNSYLVA)~,4~ `•, ~ n
`~ - o~ :~;
~ x n __.,a c.:a
a. r i--' ru, r'a'y
~,~~ ~ ~t~: c5
ar: ~c cs ~;: >
L7 ~ -~ _,.y .,.
~ 7 ~ '"Y
Estate of TO~h To.sc,~h JCC rCfJNf-Q- ~ r~+ c~' ° rDaceased
rt ~_
~.. ~ V `rt
I, ~l'lG~a ~' ~~rC0~7-Q-- , in my capacity/relationship as
(~~~ yNmneJ
VYl D Y~'h.L r of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
\1J GtV i pr SGt ~rarc.e_
/ ~3~j,3
(Date)
Executed in Register's Offue
Sworn to or affirmed and subscribed
before me this day
of
1~~~~~~~
~~ n
~ S .5. >D~ n (~luC /~v~
(Sheer AdrbesaJ ~+ (( ~/
(City, sane. zivl
Executed out of Register's Offtce
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 ~,~:.clu~,~, do l3
Deputy for Register of Wills
Form RW-06 rev. 10.13.06
Nbtary Pdblic
My Commission Expires: Q6 ~ 3 ~~ 1 ~
(SigneWrc end Seal of Notary or other official qualified to
administer oaths. Slrow date of expvation of Notary's Commission.)
t;OMMONWEALTH OF t'ENNSYLVANIH
NOTARIAL SEAL
KATHY A. BURKET7. Notary Public
S. MitldletonTwp., Cumberland County
My Commission Expires May 23, 2076
c ~ ~ rn
m ~_ c'
~
~
m
_~>
= '~
U
yn
RENUNCIATION ~ A' ~
t•~ ?
~; r„
Cn
;.zG
~' C : mro
REGISTER OF WILLS ~ ~ .t
C uM13i` R Lrlrty> COUNTY, PENNSYLVANIPr~ r'
~; (7r <::~
"`r
Estate of ~CNt" ~oSkPH ~~~~t~~ ,Deceased
I, /V\ R~-IC D+\v I> 3~1-i•IZCa w~ , in my capacity/relationship as
(Print Nome)
+3 zc~-(NE2 of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
l~~v I~ S~FKt caCfF
Ja~(UVARy~ :2013
(Date)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this
of
day
Deputy for Register of W ills
Form XW-06 rev. 10.13.06
~~
(Signature)
.1011 MoNIZO~ STItEEt' {~Pf I
(Streel Address)
I~At~1So-n~ wl 53~-
~ary, smte, zwJ
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 3 day
of /lluccaiy do/3
~?1t iLt.[. ~ ~ ~C~.l~c.~E
N~tary blic
My Commission Expires:Qy" d3 d~/6
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
~ MMUNNiFJtCtHUf•r'ENNSYLVANIA
NOTARIALSEAL
KATHY A. BURKETI. Notary Public
S. MlddletonTwp., Cumberland County
My Commission Expires May 23, 2016