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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:
Decedent's Information �I
Name: David A Bartlett File No: I �f
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: 04/16/2013 Age at death: 64
Decedent was domiciled at death in Cumberland County, Pennsylvania (State)with his/her last
principal residence at 480 Nursery Drive North Mechanicsburg Cumberland
Street address,Post Office and Zip Code City,Township or Borough County
Decedent died at Harrisburg Hospital 111 S Front St Harrisburg Dauphin Pennsylvania
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 $ 32,910.00
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ................... .... Personal property in County $
Value of real estate in Pennsyl vania........................ ................................. $
TOTAL ESTIMATED VALUE. .. . $ 31910.00
Real estate in Pennsylvania situated at:
(Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County
M 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,eta)
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not man&as not divorce wasa3t arty to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C §CA23(g),and did rtfitlh a child bom or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated pdMn o — O
0 NO EXCEPTIONS ()EXCEPTIONS r-- ---1 C:3
c lTi (it
z� z rn rl
B. Petition for Grant of Letters of Administration (If applicable) z (/?
c.t.a.,d.b.n.,d.b.n.c.t.a.,pen en(e-lite dura !ee absentia;durante minoritate
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A abovi 3t4 complpjd list-6f�;,eirs.
rn
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grouts rf r divorce tLad beEi�-eeblished as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person. p) -ty
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
Helen S Bartlett Spouse 480 Nursery Dr North Mechanicsburg Pa 17055
Sarah M.E.Bartlett Daughter 480 Nursery Dr North Mechanicsburg Pa 17055
Michael S Bartlett Son 480 Nursery Dr North Mechanicsburg Pa 17055
Debra A Thomas Sister 211 Commander Cove Stafford Va 22554
Form RW-02 rev.10/11/2011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s)Printed Name Petitioner(s)Printed Address
Helen S Bartlett 480 Nursery Dr North Mechanicsburg PA 17055
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 Petitioner(s)will well and truly administer the estate according to law.
Sworn to r affirmed and subscribed before -8� ��c�� Date a /
me th' d Date
By: .. ! Date
For the Regis er Date
BOND Required: Q YES NO To the Register of Wills:
FEES: (� Please enter my appearance by my signature below:
OC)
Letters . . . . . . . . . . . . . . . . . . . . . . $ 10. Attorney Signature:
(�� ) Short Certificate(s). . . . . . D
(� )Renunciation(s):. . . . . . . .
( )Codicil(s). . . . . . . . . . . . .
( . )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . . .. . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . ID Number:
. . . . . . . Firm Name: C,
. . . . . . . . Address:
r
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-_
r- rT
Phone: '� C Cl1 j
n
Automation Fee. . . . . . . . . . . . . . . Fax: p ca
JCS Fee. . . . . . . . . . . . . . . . . . . . . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 0
DECREE OF THE REGISTER CD
Estate of David A Bartlett File No:
aWa:
AND NOW, �Vern in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS D1�CREED that Letters,(I�(' Adrn i n,S`VC, C'
are hereby granted to P:L1kn S ntt`le,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 t e last Will an Codicil(s))of Decedent.
Register of Wills Al
p�t
FormRW-02 rev.10/I!/2011 Page 2 Of 2
RECORDED CFPICE OF
REGISTER OF MLLS
"NUNCIATiWIOU 5 Fn 2 96
CLERK OF
REGISTER OF WILLSO R a H A N S' CO U R T
Ci/A26V-(Ay. -COLJNTY,PE=9ffVARDkC0., PA
Estate of D/eV 0 !T LEP) Deceased
I, C`S`I'£L Y 13R27-C.F 7"T in my capacityhelationship as
(Print Name)
of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date)
) (Signature)
49,4 l/.
(StreetAddress)
(City,State.Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes aated within on this - 2 `. day
of Gh bwLl Z-v 13
Deputy for Register of Wills Notary Public
My Commission Expires: "
(Signature and Seat of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Michael CheBook Cumberland County
Woy Commission 127, 2017
Form RW-06 rev.10.13.06 My Commission Expires April
MEMBER.PENNSYLVA141A ASSOaAnON OF NOTARIES +
Ol
LS
RCGIS�ER OF
m, '��3 5 Z
RENUNCIAfi-6 ,�
GI- q
RPWA��' COUP
REGISTER OF WILLSG S�R�A�11j CO., P �
CUB COUNTY,POSYLVANIA
Estate of_ Dll vllj F ✓�i'2%L� ,Deceased
I, �2'�-/�f-1 /y► �/��%C F in my capacity/relationship as
(Print Name)
D'�u C 17 YM of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
(Date) (Signature)
0�4 /j
(StreetAddress)
(City.State,zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes stated within on this z day
of_ 6 6kejl Zv 13
Deputy for Register of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to "
administer oaths. Show date of expiration of NoWs Commission.)
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Michael Cherewka, Notary Public
wormleysburg Boro, Cumberland County
Form RW-06 rev.10.13.06 My Commission Expires April 27,2017
MEMBER,PENNSYLVANIA ASSOCIATION OF NOTARIES