HomeMy WebLinkAbout03-17-14 PETITION FOR GRA�1T OF LETTERS
REGISTER OF WILLS OF��x!����COLINTY,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 respectfiilly request(s)the grant of Letters in the appropriate form:
Decedent's Information ( r � ( '/�
Name• -�-y�� C3'✓�Zci�w File No• �1 "� �`I � ���'I'�
a/k/a: (Assigned by Register)
a/k/a: - �
a/k/a: Social Security No:
Date of Death: /:� / % � Age at death: 1.r%�� - ��
Decedent was domiciled at de th in County, � Stc:re)w,ith his/ er last
principal residence at .3��� � � �
Street address,Post Of ce and Zip Code � City,To ns�Borough Cou�
Decedent died at �'f Yf�G'� � '
Street addre ost ftice and Zip Code City,Township r Borough County State
Estimate of value of decedent's property at death: � � �
If domiciled i�:Pennsyfvania..................... ....... All personal properry $
If not domiciled in Pennsylvania. ....................... Personal property in Pemisy(vania $--r
If not domiciled in Pennsyh�ania. ....................... Personal property in County $
Value af rea!estate in Pennsy[vania......................................................... $
�` � T��ES I�VALUE. ... $ f Q
Real estate in Pennsylvania situated at: J �`� �Ii��'�'[�'t/i'�`l.G7�—'
(Attnch udditionn!sheets,i(necessary.J Street address,Post Offi e and Zip Code City,Township or orough County
�A. Petition for Probate and Grant of Letters Testamentarv �/a�f g!
Petitioner(s)aver(s)h /she/t ey i are the Executor(s)named in dle last Will of tl�e Decedent,dated and Codicil(s)
tl�ereto dated
State relevant circut ces(e.g.re�u� cialion,death ojexecutor,etc.)
Except as follows: after the execution of the ii�strument(s)offered for probate Decedent did not marry,was not divorced,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 did not have a cl�ild born or
adopte and Decedent was uei[her the victim of a killing nor ever adjudicated an incapacitated person.
NO EXCEPTIONS ❑EXCEPTIONS
^� ❑ B. Petition for Grant of Letters of Administration (If applicable)
�" c.t.u.,d.b.n.,d.b.n.c.t.u.,pendentelite,cfurunteubsentiu,duruntemina•itute
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 parry 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.
❑NO EXCEPTIONS �EXCEPTIONS
Petitioner(s),afrera proper search has/have ascertained that Decedent left no Will and was siirvivedby the following spouse(ifany)and heirs(attuch
udditionul sheets,if necessury): ;:;`":
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—rt � ����. �..`.
Name Relationshi Address �;y1' f-:�
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Fo„�,aw-nz ,��v.�oiiuznir Page 1 of 2
Oath of Personal Representative off�;a�us�o�lY
COMMONWEALTH OF PENNSYLVANIA }
��� �,,,� �,� } SS:
COUNTY OF �y�'l.. } �
Petitioner(s)Printed Name Petitioner(s)Printed Address
�� � �� �� � � � C� � ��
� � -
The Petr.tioner(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 tliat,as Personal Representative(s)of the Dece nt,tl�e Petitioner(s)wil ell and truly administer the estate according to aw.
y� �
S�,vorn to or affirmed and subscribed before Dace j /7 �
me this � �j�•-y ef ,��� Date
BY� ��r��1�� �.Q � Date
For the Re,;isrer Date
BOND Required:�YES �NO To the Register of Wills:
FEES: Piease enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( )Short Certificate(s). . . . . .
( ) Renunciation(s).. . . . . . . . ^;w
:.�.�
( ) Codicit(s). . . . . . . . . . . . . �
�r 7
Aftidavit s .. . . . . . . . . . . � - '
� ) � ) `�-j T g,�ti. �-T-��-1
Bond.. . . . . . . . . . . . . . . . . . . . . . . PrintedName: n�i_;: �7 . --
, �y _ ,.
,,
Conunission. . . . . . . . . . . . . . .. . . Supreme Court ,� .' — ..•
Other . . . . . . . . [D Number: �E P . � . �� ;
. . . . . . . �f^; . ..� ,
. ,,
. . . . .. . . Firm Name: �C; � ,- �
. . . . . . . Address: � --� tV ��--,'
. . . . . . . �:�
. . . . . . . . Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . E�*�ail:
TOTAL. . . . . . . . . . . . . . . . . . . . . $
DECREE OF THE REGISTER
Estate of Fi:v No:
a/k/a:
AND NOW, , , in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to
in the above estate and(if applicable)that
lhe instrument(s) dated
described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s))of Decedent.
Register of Wills
F��,,,nw-n� ,��v. initraoii Page 2 of 2
..+
Oath of Personal Representative Official Use only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioncr(s)Printed Address
2 S , LCA4 D 1' Vi CA 9 4 74-
a
The Petitioner(%)above-named swears)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 Dece nt,the Pctitioner(s)wil ell and tnfly administer the estate according toya/w,./
Scutum to or affirmed an subscribed before[ Datc_� !/ 7
me this yof ��7 L /��%?^// Datc
By: Date
For the Register - Date
BOND Required:AYES E—]NO To the Register of Wills:
FEES- Please enter my appearance by my signature below:
Letters . . . . .. . . . . . .. . . . . . . . . . $ Attorney Signature:
( ) Short Ccrtificatc(s). . .. . .
( )Renunciation(s).. . . . . . . . A o
( )Codicil(s). . . . . . . . . . . . . .rte
( ) Affidavit(s).. . . . . . . .. . . m� A n� -
Bond.. . . . . . . . . . . . . . . . . . . . .. . Printed Name:
Commission. . . . . . . . . . .. . . . .. . Supreme Court `_'. r
Other . . . . .. . . ID Number: U'>'
L
C i
,
. . . . . . Firm Name:
. . . . . . . . Address: —+ N
<�
. . .. . . Phone:
Automation Fee. . . . . . . . . . . .. . . Fax:
JCS Fee. . . . . . . . . . . . . . .. . .. . . Email:
TOTAL. . . .. . . . . . . . . . . . . . . . . S
DECREE OF THE REGISTER
Estate of Sm i h File No:
a/k/a:
AND NOW, 9a(q in consideration of the foregoing Petition,
n�satisfactory proof having beenloesentcd before me,IT IS DECREED that Letters
r N Il l l In��'1YC��Y Yl C ?A- arc hereby granted to O n£a C�j LM A d-()
in the above estate and(if applicable) that
the instrumcm(s) dated
described in the Petition Q admitted to probate and filed of record as the lasf•Will (and Codici'I(s))of Decedent.
cgister of Wills,
Fnnn RW-01 rep. 10/112011 Page 2 of 2
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