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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY,PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Lettersets specifiedEbelow Md in
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support thereof aver(s)the following and respectfully request(s)the grant of Letters in the a§a riate for1A: M cr
Decedent's Information M, , cn
Name: ALYSON C.ANTONICELLI File No: = — r– W "Tl M
a/k/a: (Assignetb 2ister � �
a/k/a: C-.) ---I -.I ..
a/k/a: Social Security NFul
Date of Death: November 15,2012 Age at death: 49 -M
Decedent was domiciled at death in Cumberland County,Pennsylvania (Stateaith fffs r last
principal residence at 1804 Bridge Street,New Cumberland,PA 17070 New Cumberland Borough Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Community General Hospital,Harrisburg,PA 17105 Lower Paxton TWP Dauphin PA
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania............................ All personal property $ 9,000.00
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $
Value of real estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE. ... $ 9,000.00
Real estate in Pennsylvania situated at: N/A
(Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County
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
State relevant circumstances(e.g.renunciation,death of executor,etc.)
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not divorced,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 did not have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
0 NO EXCEPTIONS 0 EXCEPTIONS
B. 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.m 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.
Q NO EXCEPTIONS 0 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
Frank J.Antonicelli,III Spouse 1804 Bridge Street,New Cumberland,PA 17070
Rebecca Chick Mother 8 Stoney Lane,Auburn,PA 17922
Joseph Chick Father 1 East Lisburn Road,Mechanicsburg,PA 17055
Form RW-02 rev.10/11/2011 Page 1 of 2
Oath of Personal Representative Official Use Only
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COMMONWEALTH OF PENNSYLVANIA } -G� CAJI t'�"#
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COUNTY OF CUMBERLAND } rn _ C
Petitioner(s)Printed Name Petitioner(s)Printe dQl?s
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Frank J.Antonicelli III 1804 Bridge Stret New Cumberland PA 1707&
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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 P titioner(s)will well and truly administer the estate according to law.
Sworn to affirmed su scr ed before Date K j
me this 6%av o Date
By: Date
r e Register Date
BOND Required: Q YES 0 NO To the Register of Wills:
FEES: Please enter my appearance by my signature be":
Letters. .. . ... . . . . .. . . .. . . . . . $ 6 Attorne natur .
( )Short Certificate(s).. . . . .
1
( )Renunciation(s).. . . . . . . . 1
( )Codicil(s). . . . . . . . . . . . .
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . .. . . . . . . . . . . . . . . . . Ont Name: Francis A. ul i,Es uire
Commission. . . . . . . . . . . . . . . . . . me Court
Other . . . . . . . mber: 15613
. . .. . . Firm Name: Wion,WE&Seibert
. . . .. . . Address: 109 Locust Street
. . . . . . . Harrisburg,PA 17101
. . . . . 06'
err
. . . .. . . Phone: (717)232-1488
Automation Fee. . . . . . . . . . . . . . . Fax: (717)236-6100
JCS Fee. . . . . . . .. . . . . . . . . . . . . Q Email: fa7tilli,wzsamindsprina_com
TOTAL. . . . . . . .. . . . . . . . . .. . . $ x.0.09
Form RW-02 rev.1011112011 Page 2 of 2
Oath of Personal Representative Official Use Only
COMMON ALTH }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner Printed Address
The Petitioner(s)above-named swear(s)or affirm(s)the statemen/ie oregoing Pet ition are true and correct to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of the Dee Petitioner(s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before Date
me this day of Date
By: Date
For the Register Date
BOND Required:❑YES O To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters.. . .... ............... $ Attorney Signature:
( )Short Certific (s)...... -
( )Renunciatio (s)... ..... . C._4 M n
( )Codicil(s .. .... ...... G7 p
( )Affida t(s)............ M C-> cJ)
Bond.. .. . ...... .... ...... Printed Name: T► t�
Commissi . . ... ..... .. ..... . Supreme Court ]�► �
Other ...... . ID Number:
. ..... Firm Name: C
eu
Address:
Phone:
Autos Fax:
JCS Fee. ..... ........ ....... Email:
TOTAL. ......... . ... . ...... $
DECREE OF THE REGISTER
11,5 /J /ow � M �Estate of o �' 417 /Ce File No:
a/k/a:
AND NOW, d t , in consideration of h foregoing Petition,
satisfactory proof ha'v*ing een presented before me,IT IS DECREED that Let rs
are hereby granted to /7 D f /
in the above estate and(if applicable)that
the instrument(s)dated
described in the Petition be admitted to probate and filed of record as th last Will(a d Codicil(s))of cedent..
Register of Wills
Form Rw 02 rev.10/1112011 Register
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