HomeMy WebLinkAbout04-24-13 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)the grant of Letters in the appropriate form:
Decedent's Information 2,1- I�Name• File No: (p
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security `NQ: --
Date of Death: A e at death:
��ppo
Decedent was domiciled at death in �i ouhty, (stare)wit` iher last
principal residence at 5 �ric&s CA,�M�be�bn�
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at a ° I aA��&Ca
Street addr ,Post Office and Zip Code City,Township r Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania............................ All personal property $
If not domiciled in Pennsy lvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsy lvania. ....................... Personal property in County $
Value of real estate in Pennsyl vania......................................................... $ _
TOTAL ESTIMATED VALUE. ... $
Real estate in Pennsylvania situated at:
(Attach additional sheets,ifnecessary.) Street address,Post Office and Zip Code City,Township or Borough County
❑ A. Petition for Probate and Grant of Letters Testamentary p
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated and JSdM(s)
thereto dated , c11)
State relevant circumstances(e.g.renunciation,death of executor,etc.)
• Zrn —�
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not diperd;s, s not a party tR pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(R?a1A d8not hayf a clbpf or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. C- C
NO EXCEPTIONS
F E]EXCEPTIONS �.
. Petition for Grant of Letters of Administration (If applicable) ''
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante 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(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
ER40 EXCEPTIONS ❑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,if necessary):
Name Relationship Address
c3 ' C3
Form RW-02 rev.10/11/2011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)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 Representative(s)of the Decedent,the Petitioner s)will well and truly administer the estate according to law.
Sworn to r ed n subscr' ed be re DateL�'3
me fl s ay �� Date
By: Date
F the Register Date
BOND Required: Q YES Q NO To the Register of Wills: KJ `�_'
FEES: Please enter my appearance by>� nature ow:
00 cr) ;a
Letters $ y.! Attorney Signature: �" fi' t�� °-
( Short Certificate(s).. . . . . O
( )Renunciation(s).. . . . . . . . ,
( )Codicil(s). . . . . . . . . . . . .
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . .. . . . . . . . . . . . . .. . . Printed Name: p
Commission. . . . . . . . . . . . . . .. . . Supreme Court "
Other . . . . . ID Number: `Q
. . . . . . . Firm Name:
. . . . . . Address:
I I'd �/I 7 . . . . . D yo
. . . . . . Phone:
Automation Fee. . . . . . . . . . . .. . . Fax:
JCS Fee. . . . .. . . . . . . . . . . . . . . . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ r---A-S9---
�a��a
DECREE OF THE REGISTER
Estate of File No: ✓� � 'J
a/k/a:
AND NOW �� ,in consid atio of the forego' g Pe 'tion,
satisfactory proof having keen presented before me,IT IS D CR ED that Letters T-7T 0(40 L 5'fm tz
are hereby granted to Cf a
in the ove estate and(if applicable)that
the instrument(s)dated
described in the Petition be admitted to probate and filed of record as the last Will nd Codicil(s))of ecedent.
f
Register of Wills `
age RW-02 rev. 10/11/2011 of
H105.805 REV(9/11)