HomeMy WebLinkAbout05-01-13 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(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 Information
Name: At
7`4 File No:
a/k/a: — (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: Age at death: _ j7
Decedent was domiciled at death in 41141— County, (state),with his/her last
principal residence at .7— &,ni ZIALt�, c4i 1 -6 Al y PY
?A --bi
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at
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 S (51 C. C C,
If not domiciled in Pennsylvania a. ................... Personal property in Pennsylvania S
If not domiciled in Pennsylvania, Personal property in County S
Value of real estate in Pennsylvania........ .................... ........................... S
TOTAL ESTIMATED VALUE.
Real estate in Pennsylvania situated at:
(Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County
E] 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 c
end Ca� K-8)
thereto dated --c
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;wasnot ap, to iFertailng
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g)i,and did not have a child bo*"
Fn-Or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
F-1 NO EXCEPTIONS []EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b,n-db.n.c.r.a.,pendente lite,durante absentia,duranteminoritate
If Administration,cd.a.or dbxx.f.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.
[.ENO EXCEPTIONS ❑EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived bythe following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
17
'7 V L, .14 L
H123J-
Form R W-02 rev. 10/11.2011 Page I of 2
Oath of Personal Representative yy t Y pt 39l c ionly
COMMONWEALTH OF PENNSYLVANIA }
COUNTY OF �i•�'1���u.(+C.i 4 }
Petitioner(s)Printed Name Petitioner k'ti t d 1dres
I
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the foregoing Petition are truce 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 or affirmed and subscribed before Date
me thi day of KALu --i} Date
_
By: i . � r Date
For,l:e Register Date
BOND Required:AYES r\_1NO To the Register of Wills,
FEES: Please enter my appearance by my signature below:
Letters .. . . ... . ... . . . ..... . . . $ `-�F; Attorney Sig ajure:
{ )Short Certificate(s)...... �`) f
( )Renunciation(s).. . . . . .. .
( }Codicil(s). . .. ... .
{ )Affidavit(s).,. . . . . .. .. .
Bona.. . . . . . . . . .. . .. ... . . Printed me: i��yJt y
Commission. Supreme Court
Other ID Number:
Firm Name: _Iz 1U i tc_ T�41'4
Address: U t{ G,c"'-q
1T
i7C,/
.. .. . Phone: l' 7 ai `{ 3 2 t{ 7
Automation Fee. Fax:
]CS Fee. . .. .. . . . . .. .. .... ... L3 ;>i Email: IT, i Z Z fi,, 77-_ 7ni Z.Z,
TOTAL. . . . . . . . . . . . . . . . . . .. . S. i Yc
DECREE OF THE REGISTER.
Estate of i5_tj'-���6,ij �. l�o iK_ File No:
a/k/a:
AND NOW, L > in consideration of the foregoing Petition,
satisfactory proof having b en presented before me,IT IS DECREED that Letters Adlk,
are hereby granted to T,y1-4 E � �?� j-:,,
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 the last Will (and Codicil(s))of Decedent.
Register of Wills
Fo,,r�RGY-rtz rev.tn/tlf?ntt Page 2 of 2