HomeMy WebLinkAbout01-28-14 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF C v"`'' ��`"(�-' 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: File No: I al � `4 r wQ I
l��ti �r or,� icPVSPr
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Daie of Death: Age at death: 77
Decedent was domiciled at death in�° ��,i p lG„�. County, �2�hsv Il� ,`cl (State)with Sher last
principal residence at 17d0 &,,ke7- ST. l-» 1 I Cam,og H 11
Street address,Post Office and Zip Code ��City,Township or Borough County
Decedent died at 176o 1'1ae,lef .St,', 17a)1 ('a h,to 17 i l( 61 R" Aar 1A6 &
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 $ 5" Ll o 9 0c,
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. .................... Personal property in County . $
Valueof real estate in Pennsyl vania......................................................... $
TOTAL ESTIMATED VALUE. ... $ o V
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,eta)
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not.marry,was not divorced,was not a party to apending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),and did not have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑ NO EXCEPTIONS ❑ EXCEPTIONS
4K B. Petition for Grant of Letters of Administration (If-applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante minoritate
L Administration,at a. or d b.n.at: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
in 2233 Pa.C.S.§3323(g)and was neither the victim of a lcilling nor ever adjudicated an incapacitated person.
M'NO EXCEPTIONS ❑ EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will andwas survivedbythe following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name Relationship Address
Form RW-01 rev.1011112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF
Petitioner(s)Printed Name Petitioner(s)Printed Address
�u w,A Kev le r- 2 o7 0,t AII*Jd a4owvr , M l 7 n5" 7
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 thlxaa edent,th Petitioner(r(�s))will well and truly administer the estate according to law.
Sworn to-or-affirmed nd subscribed befor 4 / L_ee1.l�-P�L� Date
me this o "'day of Date
By: Date
For the Register Date
BOND Required:Q YES ENO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
ok?
Letters . . . . . . . . . . . . . . . . . . . . . . $ 45. Attorney Signature:
( 1 ) Short Certificate(s). . .. . . V1,
( 1 ) Renunciation(s).. . . . . . . .
( )Codicil(s). . . . . . . . . . . .
( ) Affidavit(s).. . . . . . . .. . .
'Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commissign. . . . . . . . . . . . . . . . . . Supreme Court
Other ID Number:
pJ
. . . . Firm Name:
. . . . . . . . Address:
. . . . . . . . Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . 9-350 Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 1 13 5D
f�DECREE OF THE REGISTER �I
Estate of lJ�i' I L, 1��i�cSU File No:
AND NOW, 0P I in con ide ation of th fore Petition,
satisfactory proof ing been pres ted before tne,IT IS DECREED that Letters (n S
are hereby granted to e 5
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 the last Will (and Codicil(s)) of Decedent.
Ats a
Re 's r of Will/--
Fo,•m nw-nz rev. 10/11/20/l Page 2 of 2
RENUNCIATION
r
REGISTER OF WILLS
COUNTY, PENNSYLVANIA
Estate of a "! i2'p.v Q-- E 4cal ,Deceased
��12/cil-i2 It) , in my capacity/relationship as
(Print Name)
C� 71'01 Gj �`o 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) /
�y 2� � �Lsj'SrP`" c�2GGLJ
(Street Address)
(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 2 day
of
L 1,
Deputy for Register of Wills Notary lUblic
My Commission Expires: i
(Signature and Seal of Notary or other official qualified to
administer oa ion)
F. Wlq PU�('� D WALSH
Notary Public•State of Florida Form RW-06 rev. 10.13.06 RW-06 : 'e My Comm.Expires Aug 12,2014 Commission#EE 16919
Bonded Through National Notary Assn.
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