HomeMy WebLinkAbout04-0248PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of No.
also known as To:
Register of Wills for the
Deceased. County of in the
Social Security No. ) {_o ~ -/o ~ - L~ ~ ~c3_ Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl -~--~ _~- g for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in Q~ L, r~ ~:>~ ~-~ rx ~.-~County, Pennsylvania, with
h~-'~_5~ last family or principal residence at
· -
Decendent, then ~ .~' years ofage, died .~ x-.,.
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not dOmiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows:
Petitioner.__ after a proper search ha
the following spouse (if any) and heirs:
Name ~
ascertained that decedent left no will and was survived by
Relationship
'X2 ~ -?~..~ .,--.
Residence
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA ~ ss
COUNTY OF
The petitioner(s) above-named swear(s) or affirm(s)that 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 above decedent petitioner(s) will well and
truly administer the estate according to law.
Sworn to or affirmed and subscribed
before me this day of
19.__
Register
NO.
Estate of
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW 19 .... in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
in the estate of
Register of Wills
FEES
Letters of Administration ..... $
Short Certificates( ) .......... $.
Renunciation ................ $
$.
TOTAL __ $.
Filed ..................... A.D. 19
ATTORNEY (Sup. Ct. I.D. No.)
ADDRESS
PHONE
REV-346 EX (8-92)
PA DEPARTMENT OF REVENUE
FOR REGISTER'S OFFICE USE ONLY
County Code Year I File Number
ESTATE INFORMATION SHEET
DECEDENT INFORMATION: Enter data as it will appear on all documents submitted to the department.
Name (Last) (First) (Middle)
C..
Decedent's S~'ial Security Number I Date of Death Date of Birth
TYPE FI~.ING: Enter check (~,) mark to indicate the nature of the return to be filed with the department.
Probate Return AsSets Only Estate Tax Only Litigation Purposes (No Assets)
[--'~Ooint
Other
Enter check (~,) mark to indicate the nature of the proceedings at the Register of Wills
LETTERS GRANTED: Office, (Attach additional sheets if explanation is necessary,)
~--lTestamentary E~Administration F-1No Letters F-1Other (Please Explain)
ATTORNEY/CORRESPONDENT Enter all data concerning the attorney or other individual to receive all
INFORMATION: tax information and correspondence.
Name (Last) (First) (Middle) Supreme Court I.D, #
Street Address
City State Zip Code Telephone Number
PERSONAL REPRESENTATIVE Enter all data concerning the personal representative(s) of the estate
INFORMATION: authorized by the Register of Wills
Executor/Administrator
Name (Last) (First)
Street Address
C ty
C~3;E:~ecut;:)r/.~,dm~nistrator-' '
(Middle) Social Security Number
Telephone Number
State Zip Code
Name (Last) (First) (Middle)
Social Security Number
Street Address
City State Zip Code
Telephone Number
Co-Executor/Administrator
Name (Last) (First) (Middle)
Street Address
Social Securityl Number
City State Zip Code ITelephone Number
Date