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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 Letters as specified below, and in
support thereof aver(s)the following and respectfully request(s)the grant of Letters in the appropriate form:
DecedenNs InformaHon �i I 1 I - i a �c�
Name: Robert A.Nichols File No:
�a; (Assigned by Register)
a/k/a:
a/k/a: Socisl Security
Date oT Death: 9/15/2011 Age at death: 71
Decedent was domiciled at death in Cumberland County,pp (Srare)with his/her last
principal residence at 423 Hillside Road 17070 New Cumberland Cumberland PA
Strcet addresa,Post Office and Zip Code City,Township or Borough County
Decedent died at 423 Hillside Road 17070 New Cumbedand Cumberland PA
Street address,Post Office and Zip Code City,Townahip or Borough County State
Estimate of value of decedenPs property at death: _
/jdomiciled in Pennsy[vania.......... ...... .. .... . ..... All personal property $
ljnot domiciled in Pennsy[vania. . . ....... . ..... .. .... .. Personal property in Pennsylvania $ --
!f not domiciled in Pennsylvania. .. ...... . .... . ..... . . .. Personal property in County $
Value of rea[estnte in Pennsy[vaniu.... . . ... . .. .... . . .... ... . .. .. .. ... . .. ...... . ..... . .. . ... $ �
TOTAL ESTTMATED VALUE. ... $ 0.00
Real estate in Pennsylvania situated at: .
(Atmch additional sheets,if necessary.) Street address,Post Office and Zip Code City,Townchip or Borough County
� A. Petition for Probate and Grant of Letters Testamentarv
Petitioner(s)aver(s)he/she/they is/aze the Executor(s)named in the last Will of the Decedent,dated 1/03/2011 and Codicil(s)
thereto dated
Sbte rdevant circum�fances(ug.renunciation,deoth ojexecutor,efc)
Except as follows:after the execution ofthe 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 bom or
adopted;end Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
Q NO EXCEPTIONS Q EXCEPTIONS �
� B. Petition for Grant of Letters of Administration (If applicable) d.b.n.c.t.a
c.t.a.,d.b.n.,d.b.n.c.l.a.,pendente liie,durante absentia,durante minoritate
IF Administration,c.Ga or db.n.c.ta.,enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to e pending divoroe 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. c5 � ���- �
Q NO EXCEPTIONS Q EXCEPTIONS C � rn K'> � � � ��-�
O
Petitioner(s),after a proper seazch hasPoave ascertained that Decedent left no Will and was survived by the fd�ww�g s�ouse�ny)�Q 10ts(attach
additianal sheets,if neressary): , rn -`- ""t �
� y r � m
Name Relationahi A r�" µ O
Mark Nichols Surviving Son � 1218 Georgia Avenue,Roan6lk Rapy�6,N 27870 ._„
c5 c' — _
Please See Attached List „ :a G r m
—i
�y � 'YI
Form RW-01 rev.!0/1//101/ Page 1 of 2 .
�.`J
�
Stephen Nichols, Surviving Son, 322 Braddock L7rive, Etters, PA 17319
Nicole I,athrop, Surviving Daughter, 236 Grean Lane Drive, Camp Hill, PA 17011
Michele Jumper, Surviving Daughter, 121 East Water Street, Middletown,PA 17057
Kathy Worthing, Surviving Daughter, 17 Kramm Avenua, Hahndorf, SA 5245, Australia
Qath of Personal Representative Ofl�cial Use Only
COM4fONWEALTHpFPENNSYLVAN3A } �
} SS:
COUNTY U1= �umberland } ��
� Petitioner(s}Printed Name Patitioner(s)Printed Address
t 1218 Geor ia Avenue Roanpke R ids NC 27870
ftl `�.. 7V �GYiti4$ . .
The Petitioner(s)above-namnd swear(s)ar affilm(s)the statements in the foregoing PeCition are true and correot to the best oPthe knowladge and belief
aPPefitianer{s)and that,as Personal Representative{s}of the i7eoedent,the Petitioner(s)wiit wylt and truty adminisSer tha estate according ro taw.
Swom to or affirmed an subscribed fore �Qh.41. C. I�Lc.�a Date �'�— �3
mC day of Date
y: _.,,_ Date
F t eRegLrter pate
BOND Reqnired: (} YES . � N6 Ta the Register af FYitts:
FE�S: Please enter my appearance 6y my signature below:
Letters. . . . . . . . .. . . . . . . . . .. . . $__5��� Attorney Signature: . �
{ �� }Short Certificate(s}.. . .. .
( )Ranunciation(s).. . . . . . , .
( ) Codieil(s). . .. . . . . . . . . . �
{ )Affidavit{s}.. .. .. ._ ... . �
Bond.. . . . . . . . . . . . . . . . . _ .. . . Printed ame: Am�H. Backenstosa
Commission. . . . . . . . . . . . . . . . . . Supreme Court
4ther ID Number: 87008
Firm Name: Law Offices of Petar G.Angelos,P.C.
. . . . . . . . Address: Govemor'c Pla�a So rt Bnildinp,#3 Ririte 930
. . . . . .. . 24ta� N rth Frnp�Stre.et.
. . . . . Harrisburg_PA 17102
Phane: 717-232-1886
Automation Fee. . . . . . . . . . . .. . . Fax: 717-232-4184 +=% �
JCS Fee. . . . . . . .. . . . . .. . . . . . . Emait: afihR(t�y�pga�� `"' rn �
T4TAL. . . . . . . . . . . . . . . . . . . . . $��_��� �' "7.7 -� r'� Cy
2 � tSl � G: � -1 A;s
�l �7 y' iJ—TF ,-i"E C'1
D �` z" —"] �
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F�.,„nw-oz r�v. innin_n>> Page 2 of2
4ath of Personat Representative a�r"�'U�°"t�
COMMONWEAGTHOFPENNSYLVANIA }
} SS:
COUNTY OF }
Petitianer(s}PrintadName Petitiontr(sj Pri d Address
The Petitioner{s}above-named swtar(s}or affirm(s}the statements in the fore ing Petition are true aod comect to the best of the knawladge and belief
of Petitioner(s)and that,as Personal Represantative(s)of the Decedenq th etitionar(s)will well and truly adminisrer thc estace according ro law.
Sworn to or affirmed and subscribed before Dace
me this_day of ,^ Date
gy; Date
For tHe ftegiver Date
BOND Requirad:QYES �NO To the Register ajWills:
FEE$: Please enter my appeurance by my aignature below:
Letters . . . . .. . . . .. . . . . . . . . . . . Attomey Signature:
( ) Short Certificate(s). ...
{ )ReuunctariQn(s}... ..
( }Codicil{s}. . ._.. . ....
( )Affidavit(s)..... . . .... .
Bond.. . . . .. . . . . . . .. . . . ..... Printed IVame:
Commissioo. . ... . ............ Supreme Cuurt
6ther ... . .... SD Number.
. ..... Pirm Nzme:
........ Address:
.,.... Plrone:
Au[omation Fee. . . . . .. . . . . ... . Faz:
TOTAL. . ... . . ...... . ....... $
DECREE OF THE REGISTER
Estate of�(�� `�°'("" � - �.` t���� � File Na:i( �' � � _ �GX > CJ
1
a/k/a:
AND NOW,—y�' �`i�. �_ ��� .in cons� eration oEthe foregoing Pekition,
satisfactory proof having een resented before me,IT IS DECREE that Lette s /.k ��in i 4�v�r �'.�;. �h,.r'��.._..
are hereby granted to�m/,(i^� � �1 �C,� o��
in ttte above estate and{if apptica6le)that
the instrument(s)dated `?
described in tha Petition be admitted to probate and filed o e rd as he st Will(and C d' il(s))of ecadent.
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