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PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CIAVh3C 2I-"+?Q `\ COUNTY,PENNSYLVANIA
I
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 I orma ' n
Name: V Goa M1 � , r�.p_-,1 1, - File No:
a/1 a: J L ! (Assigned by Register)
a/k/a: J Social Security No: -
Date of Death: 2 LJ I Lc) Age at death:
rb
Decedent was domicile at de th in Gf County, (St, wi hi a I St
principal residence at -f70 t�o 4-41
Street ad�jess,Ast Officeed Zip Co a Ci TcNvnship or Borough County
Decedent died at
Street address,Post ffice and Zip Code I City,township or Borough County State
Estimate of value of decedent's property at death: (�
If domiciled in Pennsyl vania............................ All personal property s-332-3, ,
L
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................. ................................. $
TOTAL ESTIMATED VALUE. ... $ t 0.00
Real estate in Pennsylvania situated at:
(Attach additional sheets,ifnecessary.) Street address,Post Office and Zip Code City,Township or Borough County
N
L7 O :0
Q A. Petition for Probate and Grant of Letters TestamentaryC o ° :M m
Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated 37 ems!CoQ(g
—U
thereto dated rn �� T Ejj -p
—491
State relevant circumstances leg.renunciation,death of executor,etc.) ice ' O j- M O rri
T
Exceptasfollows:after the execution of the instmment(s)offered forprobate Decedent did notmany,was not divordeA,tivSsn apatiipaµgdtiq
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),acrd d(BsnUaven�ild born-el
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
rm
0 NO EXCEPTIONS 0 EXCEPTIONS r
S
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durance absentia,durante minoritate
If Administration,eta. or db.n.c f it.,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.
ONO EXCEPTIONS Q EXCEPTIONS
Petitioner(s),after aproper 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
L_ L 3z7 ���
Ie4 113 ow6vvvJc Rck. tbiruw,b . Qa
Form RW-02 rev.1011112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
'�.,
} SS:
COUNTY OF 1��}}4.E AmW 6 }
P itioner(s)Printed ame Petitioners) nted Add ess
L O f G '2-
The Petitioner(s)above-named swear(s)or affirm(s)the statements in the o g Petitio are true and correct to the best of the w) ge and belief
of Petitioners)and that,as Personal Representative(s)of the Deceden th eti' ens "truly administer the estat,to
or mgt law.
Sworn to ooraffirmed and subscribed before Date l LQ(�
l
Byn ad�s. �' Date
Date
For the Register Date
BOND Required: Q YES Gl-KO To the Register of Wills: o :;a
FEES: Please enter my appearance by my s ature below~F :M rn
rn
Letters . . . . .. .. . . . . . . . . . . . . . . $ V Attorney Signature: t q -D UO %p
( )Short Certificate(s). ... . . �
( )Renunciation(s).. . . . . . . . r ^� rn l,— -'�) 0 �'
( )Codicil(s). . . . .. . ... ... '== (A T
( )Affidavit(s)... . . . . .. . . . t7 n CD
Bond.. .. . . . . . .. . . . .. . . . . . . . . Printed Name:
Commission. . . . ... . . . . .. . . . . . Supreme Court O t� r— M
Other . . . . . . ID Number:
rPr vim,
,, , , . . . . Firm Name:
. . . . . . Address:
, , . . . . Phone:
Automation Fee. . . . . . . . . .. �— Fax:
JCS Fee. . . . . . . . . .. . . . . . . ... . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 00
DECREE OF THE REGISTER
Estate of�3,_ �&c File No: 2
AND NOW,�Cl 2� It _,in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED that Letters H(HAJ 11rS fYCJ_ }7dn
are hereby granted to 1 J ud I L. L V{�-f-
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.
egister of Wills � box rnt -P
Form RW-02 rev.101112011 kJ' tiJ'�"�r/ age 2 of 2
ti .
o
RENUNCIATION M
nix n to M.>
.GI TER OF WILLS a .-ma F% M o
l t� COUNTY,PENNSYLVA44n
CD,
o
'o r rn
Estate of `� Crt d -I �b✓�Gov 1 t C Deceased
I, 2G r i L� fI` p f lK X '�fl in my capacity/relationship as
( int ame)
_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)
63 'M<arAow �rx�IC ��
(SYreetAddress)
Kftty Cum (�erlarrl �� f� oS7
(city,Sam,zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
befo a me this day party executing this renunciation and certified
of±M6 that he or she executed the renunciation for the
purposes stated within on this day
of
Detppu for Register of Wills Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
r _ administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 'rev.10.13.06