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PETITION FOR GRANT 0 LETTERS
REGISTER OF WILLS OF GLl I,iiL t�% I n 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
Name: a 91-4-FEA2 E U pD YKE File No•
a/k/a: • (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: Age at death:
Decedent was domiciled at death in County, (star With his/her last
principal residence at (7 731 C�vK
Street address,Post Office and Zap Code City,Township or B ough County
Decedent died at %X L_t` %rn QL_ f�p+91 O Civy A 11 .4k- J'ZO � � Ce m cS�C�
Street address,Post Office and Zip Code City,To ship or Borough County State
Estimate of value of decedent's property at death: g
If domiciled in Pennsylvania.. ... All personal property $ 1p t 8
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsy lvania. ....................... Personal property in County $
Value of real estate in Pennsylvania......................................................... $
TOTAL ESTIMATED VALUE.... $ y,@
Real estate in Pennsylvania situated at:
(Attach additional sheets,if necessary.) Street address,Post Office and Zip Code City,Township or Borough County
® 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,etc.) _+ ;D rn
n M C'>
Except as follows:after the execution of the instrument(s)offered for probate Decedent did not marry,was novled,was npart}9 ading
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§332 ) d did no e a�f?id • rn or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. rn —r t 7 r rt rn
O NO EXCEPTIONS O EXCEPTIONS r—
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,oW ntte abnntia urante:rriin�tate
<:> = r rn
If Administration,at.&or db.mata.,enter date of Will in Section A above and co><uPleWlist of heirs. p
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divot had been sen tithed as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
®NO EXCEPTIONS Q 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
r W<Y_ 5 0 K o-J_ evIc-A 173A)
Form Rw--02 rev.10/11/2011 Page l of 2
Oath of Personal Representative Official Use only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
/ (]U
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 Representatives)of the Dec ee t,the Petitioner(s)will well and my administer the estate according to law.
Sworn to ov affirme (d subsc 'be befor /% tom` Date 11 O�/
met ' da Date
Date
t Re ,ter Date
BOND Required:Q YES O To the Register of Wills:
FEES: l ` Please enter my appearance by my signature below:
L rs. ................... .. $ -"�CC.I Attorney Signature:
{ )Short Certificate(s)...... -Jr
( )Renunciation(s)....... .. w I T1
( )Codicil(s). .. . ....... ..
( )Affidavit(s)........... ............ v =-
Bond..... ..... ... Printed Name: M -.r C) C
Commission. ..... . Supreme Court F— D f rl T1
Other ::::: ---���� ID Number: J�► � :�a
... ..... Firm Name:
..... Address:
t°,—
Phone:
Automation Fee. .............. Fax: ,
JCS Fee. ....... ......... ..... Email:
TOTAL. .................... $
DECREE OF THE REGISTER _ n / / Q,
Estate of AA� File No: UUi/S // ��/ /
a/k/a:
AND NOW, C)"'013 ,in conside o of the fore c in Petition,
satisfactory proof having been presented before me,IT IS DECREED that Le rs Q �F
are hereby granted to Vare,
in the above estate and(if applicable)that
the instrument(s)dated
described in the Petition be admitted to probate and filed of cord as the la t Wiil(and dicil(s) of Dec t.
egister of Wills
Form RW-02 rev.10/11/2011 Pa �2f