HomeMy WebLinkAbout09-09-13 Deceased � G�[ r'r'� � Docket No. ��3 — �� �
B�IT REMEMBERED,that as of the day of ,A.D.20
Tliere has been NO ESTATE PROCEEDING RAISED FOR THIS DECEDENT AND NO LETTERS HAVE
BEEN ISSUED BY THIS COURT.
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Glenda Farner Strasbaugh
� Register of Wills&Clerk of Orphans'Court
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REGISTER OF WILLS
CUMBERLAND COUNTY PENNSYLVANIA _
SMALL ESTATES AFFIDAVIT `� -_: `�-� �
For Insurance Proceeds �- -=
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. _ : ;
NOT to be used for Settlement of Small Estates under 20 Pa.C.S.�4. �3102 ��-- .
(Original Death Certificate Must Accompany this Form) : _ -�_-
�/ Case No. 1�I
Deceased �G��,�.........�... /���f�._��._�.�........... ............ .. Z..........� ��� F
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also known as S`.g/yI F Social Securit No. � ' � � � �
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Before the Register of Wills of said County personally came `�/g tsJ who resides
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� � bein dul sworn
at t�� ..�.���...•����.v..�............�..-........._./"±..�-���t!�.._Vl�..L.._�'.....�..../y�..�......_�Z..j.=z...3..�:..-....��.�...%Z...�............................ g Y �
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deposes and says that ............ /`'��.�.ri1_.....��`:`....6'�.��..�...�-'.�..v,-........................... ................................................ �a e .Z..... �a resident of
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C�n�I�S�2L�9�%.�.....C�l�...........�.�.5r=��V_G:.��.D�.�_........."_......CL,�_/�2....E'/rl...�_rJ..�.........................................................................................
ST............................................. �
in said County,departed this life,at �;�/��' on the �.—. day of
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/�,�,iQc)� A.D.20 )3 /,Z.2�fl►'!'lo clock � M.,possessed of personal
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property estimated to be of the value of$ � ���, 3c`� ,and possessed of real estate,the estimated value
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and the location of which is as follows:
Except as follows, Decedent did not marry,was not divorced,and did not have a child born or adopted after
execution of any testamentary writings whether or not offered for probate; was not the victim of a killing,
was never adjudicated an incapacitated person,and was not a party to a pending divorce proceeding at the
time of death wh rein grounds for divorce had been established as defined in 23 PA C.S. section
3323(g): � � T
The total amount of insurance proceeds payable by /`� does not exceed$11,000
and 60 days have elapsed since the death of the insured. The undersigned agrees payment cannot be made
under this Affidavit if a written claim for same has been made by a Personal Representative of the estate and
no other heir(s)having preference exist or have released their benefits to th undersigned.
That said decedent left a s ouse—whose name and residence is /u��'
P ............................................................................................................................................................
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and the following as next of kin:
NAMES RELATIONSHIP RESIDENCE
�`�1�s /�d,eao�,c1 ��►� �z�.3 S�r�c�. RJ. �QK��u.�. �1,�.
1�GiU"A� �1�2�. w �Su!� .�C3 5� "tJ:, T CA,�.L/5�- E A�.
�l��.L /Yl� IQ f�G � �L r'1� %Q �R J�/�H :� I��LU 1��LL� ��.
�L�n� ��ti -� ;r ��u���TE� �35c�1- �c�%rv 5�. ca�et�s�E �'A ,
That the above named are the spouse&and all the known next of kin of said decedent,to the best of my
knowledge and belief.
Your Petitioner avers there are NO KNOWN PROBATABLE ASSETS that would require an estate
proceeding. Therefore,NO ESTATE WILL BE RAISED A111D LETTERS ARE NOT NECESSARY.
Signed
By. 7 :z 3 !,3
Swor�and subs ibed o before me this
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���day of � 20 � � Register of Wills:
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Kindly ente ppea�-ance in the above case this
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