HomeMy WebLinkAbout02-05-14 PETIT ON FOR GRANT OF LETTERS
REGISTER OF WILLS OF 9 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 Infor ation
Name: ar File No ��' 0
a/k/a: r (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: A at death: /
Decedent was domiciled at de h1 in Q Co /`�,fJ'(sra e) w' his/her last
principal residence at M o
JL
Street address,Post Office apd Zip Codl ity, wnship or Borough 00,unty
Decedent died at OM 0a CA I.. 1 R�1 CIJI t
Street address,Post Office and Zip Code City,Township or Borough County style
Estimate of value of decedent's property at death:
If domiciled in Pentt sylvania............................ All personal property $ Q ��
If not domiciled in Pennsy lvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $
Vahte of real estate in Pennsyl vania............................. ............................ $
4100V TOTAL ESTIMATED VALUE. ... $
Real estate in Pennsylvania situated at:
(Attach additional sheets,ifnecessary.) 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
PR
rrI
State relevant circumstances(e.g.renunciation,death of executor,etc.)
rn
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not dgr�, not a party to--a,p�ing
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §3323(gj-at�d'lot hug a chu boar or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. T c X C3 Q
NO EXCEPTIONS ❑EXCEPTIONS C-:,
❑ B. Petition for Grant of Letters of Administration (If applicable) ° ~ r-
c.f.a.,d.b.n.,d.b.n.c.t.a.,pendente life,du+rrgnte bsentia,fu anteCpmw1are
If Administration,c.t.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
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
A O EXCEPTIONS ❑EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse(ifany)and heirs(aatach
additional sheets,ifnecessary):
Name Relationship Address
"De. 1 d ` VV
6 JA *v s3 6
F/acv cl
322
For RW-02 rev.1011112011 Page I of 2
Oath of Personal Representative official use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petition am
P ' e Petitioner(s)Printed Address
c N. e 3!420
• 71l
The Petitioner(s)above-named swear(s)-or affirm(s)the statements in the foregoing Petition are t.rueand correct to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of the Deceden a Pe'' well y administer the estate=091ing to law.
Sworn to or affirmed and subscribed before
-r Date
me this % da o ' Gb LL Q ,�_ Date
Date By:For te Re
Date
BOND Regaired: 0 YES O NO To the Register of Wills:
FEES: Please enter my appearance by m atnre be w:
Letters....................... S 90.00 Attorney Signature:
(3 )Short Certificate(s)......
( )Renunciation(s).........
( )Codicil(s). ............
( )Affidavit(s)............
Bond........................ Printed Name:
Commission ............... .. Snpreme Court 3 7G
Other • ...... ID r:
Numbe
...... 15.-0
I 15 Firm Name: �---_
Address: /" &/ �
...... Phone: 117 —23Y—OUL
Automation Fee. ..... ..... .. .5 DO Fax:
JCS Fee. ..... ................ Email:
TOTAL. .................... S 1'73 cep
C> �+ rn n
�. p
M m
f;1 1-n
3i C n :�a C 9
:z
• �] N �" 1-5.1
4 r
C3
> C?7
..Form RW-02 rev.108moll Page 2 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
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 or affirmed and subscribed before Date
the this day of Date
By: Date
For the Register Date
BOND Required:❑YES F-I NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( )Short Certificate(s).. . . . .
( )Renunciation(s).. . . . . .. .
( )Codicil(s). . . . . . . . . . . . .
( ) Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . . . . . . . . . . . . . .. . . Supreme Court
Other . . . . . .. . ID Number:
. . . . . . Firm Name:
. . . . . . . . Address:
Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . .. . . . . . . . . . . . . . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $
DECREE OF THE REGISTER
Estate of 051�& File No: 4 (noy
a/k/a:
AND NOW, -7 _ inconsideration of the fore ping Petition,
satisfactory proof having been presented efore me,IT IS DECREED that Letters
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 filed f ord as the last Wi 1 (and Codicil(s))of Decedent.
R g ster of W lls
f�y
Form RW-n2 rev. 10111201 Page 2 of 2
RECORDED OFFICE OF
RENUNCIATION REGISTER OF VI U S
REGISTER OF WILLS !'-i1tl FEB 5 PN 12 26
PENNSYLVAR K OF
ORPHANS' COURT
CUMBERLAND CO,, PA
Estate of Se Q� <e r ,Deceased
I, �GLN'►Q� �. �l�e� , in my capacity/relationship as
(Print Name)
SOW of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
r e 9f
OF I LA
v
Rig'
(Date) 0ignare)
G?fry /S x/,Wt L.'e,
(Street Address)
32z3e jp,
(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 6M day party executing this renunciation and certified
of E& o 1+ that he or she executed the renunciation for the
purposes stated within on this day
of ,
Deputy for gist r of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission)
Form RW-06 rev. 10.13.06 RW-06
RECORDED OFFICE OF
RENUNCIATION REGISTER OF WILLS
1:114 FEB 5 PCl 12 26
REGISTER OF WILLS
C
CLERK O F
OUNTY, PENNSY
' XAKAS' GOaRT
GUMDERLAND CO., PA
Estate of �roje,04 , Deceased
I, OVIES .. i I �/� , in my capacity/relationship as
(Print Name) �
S'[1yI of the above Decedent,hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
r 0C eW. t
(Date) ( 'gnature)
90.2/ Car r
(Street Address)
X3,2 3
(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 5 m day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes stated within on this day
of ,
0A,6- 0�
Deputy for egj'ster of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission)
Form RW-06 rev. 10.13.06 RW-06