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PETITION FOR RAN OF L TTERS
REGISTER OF WILLS OF AO-�t ll COUNTY,PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ics) 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 Jnformation
Name: C/' df-t e4 IC File No:
a/k/a: Assigned by Register)
a/k/a:
a/k/a: Social Security No: /
Plate of Death: — Age at death: (O
Decedent was domiciled at death in 1,eQ Coum (State)wit 6i er last
principal residence at 3 6k-,
`/St��eat/a dress,Post Of6`f and Zi�Cade / f y_City,Township orJ Borough rY Coin
Decedent died at /z t� S{}�l7 �70�ip1 Wl1i
Street pfdrYsti,Post Office and Zip Code I City,Township Borough County State
Estimate of value of decedent's property o R Y at death:
If domiciled in Pennsylvania............. All personal property $
�
If trot domiciled in Pennsylvania. ........_............. Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....... .. ._.... . . ..... Personal property in County $
Value of real estate in Pennsylvania............. ......... . . . ...... $�00 d
V/ TOTAL ESTIMAT'ED V}A�LUE .7. 7$
Real estate in Pennsylvania situated at3--:0 mAgj1 11.0 !{Jetl rf r 7K
rt-+
(Attach additional sheets,ifnecessary) Street address,Post Office and Zip Code City,Township or Borough County
M A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated and Codicil(s)
thereto dated.
ipw O Jae rn
State relevant circumstances(e g.renunciation,death of executor,d�f n —
S Cs ::ZD i,ry
Except as follows: after the execution ofthe instrument(s)offered for probate Decedent did not marry,v*sr i ced,pusa§not rfyxo apending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. 3 g nd did]tor f*.&t4hild barn or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated pers
7NOEXCEPTIONS ❑EXCEPTIONS
,�s 4
®-16. Petition for Grant of Letters of Administration (Ifapplicable) c
e.t.a.,d.b.n.,dAn.c.t.a.,p;iuh;It lire,duranle4dtrfcenti it ynte minorikae
ca
If Administration,c.t.a. or d.b.n.at.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 bad been established as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
-ONO EXCEPTIONS [-]EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survivedby the following spouse(ifany)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
3� mfdW ,0/ I/ I » 5l/
hLe/lam
Fonn nw.nz rev.In/1112011 Page I of 2
Oath of Personal Representative Official Useoaty
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioners)Printed Address
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 Representatives)of the Deceit t,the Petitioners)wilt welt an truly administer the estate according to law.
Swoon to-or affirmed subs ribeddb
Dace �"taq�
m da Q' _Date
y; Data
For do Lgislar Dale
BOND Required: 0 YES NO To the Register of Wilts.
FEES: ``//�}� Please enter my appearance by my signature below:
Letters . .. . . . . . . .. .. . . . . . . . . . S t5 Attorney ature:
O )Short C",ertificate(s). . . . . .
( )Renunciation(s).. . . . . . ..
( )Codicil(s). . . . . . . . . . . .. )
( )Af.. . .t.. .. . . . . . . . I . . �Ok6C` W J<L.-Ajr
Bond.. . . . . .. . . .. . .. . .. .. .. . . Printed Name:
Commission. . . . . . . . Supreme Court r�
Other . . . . . . . . ID Number:
Cz m
I 4y� . .. . . . . . _ Firm Name: W (Jfi�! , El. 'G-_
r,... . . . . . . . . Address: it f
. . . . . . . . 57f
. . . . . .. . n :ry co
O GJ
. . . .. . . Phone: °r, —'
Automation Fee. . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . .. Email: — R_-
TO'rAL. . . . . . . . . . . . . . . . . . . . . S 3s CJ Ga C3
to -
tt J�DECREE OF THE REGISTER ) (C]
Estateof �i3 t�lC �� ha� t.r File No:
a/k/a:
AND NOW, in consideration of the foregoing Petition,
satisfactory proof avi be presented before me,IT I DECREED t Letters
are hereby granted toy C P9,zerlh6 ,>- ,
m the above estate and(if applicable)that
the instrument(s)dated C�
described in the Petition be admitted to probate and filed o a rd as the I st ill(and Codir 1 )of Decedent.
Re Ater Will
Form RW-01 rev.IW]1,1011 ty Paget oft