HomeMy WebLinkAbout11-21-13 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OFCJI M �e V l a 11 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 Jnformation
Name: , �l �D(��1QV �6�1 f1 SGY► File No: _
a/k/a: (Assigned by Register)
a/k/a:
Date of Death: Age�aitdeath: I's a
Decedent was domiciled at death in County, �tt) C �� (State)with his/bier last
principal residence at a 0 I$ M i l l-nWh E d CaM V HI1 I 1'l 611 LVMheV jail d
Street address,Post Office ands /Zip Code City,Township or Borough County
Decedent died at TiroUo 0 VeMos `i� tN 1, —M �M t Q-Y F)yd m yblO Mt�lie
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 $ ► �� t QUV 60
If not domiciled in Pennsy lvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $
Value of real estate in Pennsylvania......................................................... $
q 11
TOTAL ESTIMATED VALUE. ...�i$
Real estate in Pennsylvania situated at: (��0 I l ��h \ �m (� t1! rp 11 U t C(i
(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,datedd Codicil(s)
thereto dated
b
State relevant circumstances(e.g.renunciation,death of executor, .) t7 e
M Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,w3as rgdWrced was nog7part to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. 323(glrand did not haveq child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated persoCn�. (D
❑NO EXCEPTIONS ❑EXCEPTIONS
tv rl
B. Petition for Grant of Letters of Administration (If applicable) F-0
c.t.a.,d.b.n.,d.b.n.c•.t.a.,pendente lite,durante a sentia,dumte minoritate
If Administration,ca.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
i?NO .C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
XCEPTIONS ❑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,ifnecessary):
Name Relationship Address
m A loo nw day flqv LIL106600 fte PfffSbooh Pif j5a11
�v�c C'. �04�c�Sc� Scm �.o�� � i l ��s1 K'd Ca�n r11 �� 1?4I►
Fora,aw n2 rev.1011112011 Page I of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
$$:
COUNTY OF C U kYj Q�d }
}
Petitioner(s)Printed Name Petitioner(s)Printed Address
urn r ol�h s� Lt40 &&&s he 4 H Pt4 Asa
The Petitioner(s)above-named swear(s)or affirm(s)the statements 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 Dec it the Petitio% r(s)w'1 well and truly administer the estate according to law.
Sworn to rme a ubscrib d be o l� AAM Date
me thi ay o U Date
B Date
e esi Date
BOND Required:[—]YES NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Legs . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( ) Short Certificate(s). . .. . .
( )Renunciation(s).. . . . . . . . [L n o
( )Codicil(s). . . . . . . . . . . . . Q w M
( )Affidavit(s).. . . . . . . . . . . C]J
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: trtl —4 �
Commission. . . . . . . . . . . . . . . . . . Supreme Court F rn
Other
. . . . . . . ID Number: = (f)
C-)
. . . . . . . . Firm Name: C3 —n rI
. . . . . . . . Address: C7 Ca
—n
Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $
DECREE OF THE REGISTER
Estate of AoZdr File No:
a/lda:
AND NOW, Q V &3 , in cons d ation of the orego' g Petition,
satisfactory proof having been presented before me,IT IS ECREED th t Lette 17) 1
are hereby granted to
in the above estate and(if applicable) that
the instrument(s) dated
described in the Petition be admitted to probate and file)or ord a the I t Will(an dicil(s))of Decede
ster of Wt Is
Form RPY-02 rev. 10/1112011 Page 2 of 2
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Reset Form .
RECORDED OFFICE, OF
RENUNCIATION REGISTER OF WILLS
.'Ol3 NOV 21 PM 12 20
J GISTER OF WILLS CLERK OF
COUNTY,PENNS?fp-J?AW COURT
CUMBERLAND CO., PA
Estate of C. Nq Deceased
I, C r"L C . a,,�nsr,h , in illy capacity/relationship as
so (Print Name)
oof the above Decedent,hereby rerioixwe the 1j.4A.to
adllimister the Estate of the Decedent and respectfilly request tl-mt.Letter: be issued to
La m n , I h osi
I I -y -13
(Date) (Signature)
(areet Address) i
Camo
(City,State, ')
Executed iit Register's Office Executed out of Register's Of
Sworn to or affulned and subscribed Before the-undersigned personally appeared the
before me this day party executira this rel imicia tion and certified
of that he or she execll#.ed the renunciation for the
ptnposes stated within on this day
o /12 AA , l3
OF PENNSYLVANIA NOTARIALSEAL
Deputy for Register of Wild Notaiv Public DEBRA A.PARSON,Notary Public
My Colnullissioll R bersburg Boro,Franklin County
My mmissl(yi Expires November 21,2018
(Signature and SealofNotaryor other ofcialquali6edto
administer oaths. Show date of expiration of Notary's Commission.)