HomeMy WebLinkAbout08-25-14 In Re: : IN THE COURT OF COMMON PLEAS OF
: Cumberland COUNTY, PENNSYLVANIA r-.a
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Paula L. Dyba • � o � rn �
Deceased : c� � � � e�
: ORPHANS' COURT DIVISION .'�;; � � � � �
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: FILE NO.: � - =f�� ::� c�
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PETITION FOR SETTLEMENT OF SMALL ESTAT� ;,, � � �
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AND NOW, comes the Petitioner William E. Bray, as a Pro Se Petitioner, and
files the following Petition for Settlement of the Estate of Paula L. Dyba pursuant to 20
Pa. Code § 3102 , and states:
1. Petitioner is an adult individual eighteen years of age or older. Petitioner
presently resides at 817 West Keller St., Mechanicsburg PA 17055;
2. Paula L. Dyba died at the age of
66 on June 6, 2014 ; and at the time of his/her death
resided at: 817 West Keller St. �
City of Mechanicsburg County of Cumberland , State of
Pennsylvania, having a Social Security Number of
�
3. Petitioner's relationship to the decedent is:
Husband
4. Decedent died:
a. � Intestate
b. ❑ Testate
(1) ❑ The Will was Probated on the day of
, 20 and Letters of Administration
were granted on the day of ,
20 . The Personal Representative
, was required to give bond in
the amount of $ and the surety is
❑ A Copy of the Will is attached hereto.
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(2) ❑ The Will has not been probated.
❑ The original Will is attached hereto.
5. The following are beneficiaries of the estate either under the Will or the laws of
intestacy:
Name
, William E Bray
Relationship to
Decedent: Husband
Describe Interest in
Estate: 100%
Beneficiary:
� Has not received or retained any property of the decedent by payment
of wages or other items under Section 3101 of the Probate, Estates, and
Fiduciaries Code, or otherwise.
❑ Has received or retained the following property of the decedent by
payment of wages or other items under Section 3101 of the Probate,
Estates, and Fiduciaries Code, or otherwise:
❑ Is deceased (attach supporting documentation)
❑ Is incompetent (attach supporting documentation) and his/her
fiduciary is
whose address and telephone number is:
❑ Is a minor whose date of birth is and
and his/her fiduciary is
whose address and telephone number is:
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❑ Is deceased (attach supporting documentation)
❑ Is incompetent (attach supporting documentation) and his/her
fiduciary is
whose address and telephone number is:
❑ Is a minor whose date of birth is and
and his/her fiduciary is
whose address and telephone number is:
(If there are additional beneficiaries, attach additional sheets)
6. The following individuals are entitled to the family exemption:
Name William E Bray
Address: 617 West Keller St.
City: Mechanicsburg
State and
Zip: Pennsylvania 17055
Relationship
: Husband
DOB: (minors only)
Name
Address:
City:
State and
Zip:
Relationship
DOB: (minors only)
Name
Address:
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Name
Address:
City:
State and
Zip:
Relationship
DOB: (minors only)
7. Real and Personal Property assets of the estate'and their estimated values:
ASSET DESCRIPTION COMPLETE ASSET ADDRESS DOLLAR VALUE
Pa checks Commonwealth of PA 4100
Annual Leave Commonwealth of PA 1300
8. Debts and Claims against the Estate:
Funeral and burial expenses (attach statement and/or receipts):
Type of
service:
Services by:
Address:
Amount:
Paid/Due: 00.00
Type of
service:
Services by:
Address:
Amount:
Paid/Due:
Type of
service:
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Last illness expenses (attach statement and/or receipts):
Type of
service:
Services by:
Address:
Amount:
Paid/Due: 00.00
Type of
service:
Services by:
Address:
Amount:
Paid/Due:
Type of
service:
Services by:
Address:
Amount:
Paid/Due:
Other claims or expenses that are unpaid:
CLAIMANT ADDRESS TYPE OF AMOUNT
CHARGE
NONE 00.00
9. The following exhibits are attached hereto:
❑ An itemized list of disbursements made prior to the filing of the petition,
indicating the payor and whether the disbursements were in payment of
administration expenses,
preferred or ordinary debts, items of distribution, or the family exemption;NONE
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� A certificate of the Register of Wills or the equivalent thereof, satisfactory to
the Court, showing payment or other status of the inheritance tax, unless the
estate be
valued at less than the family exemption and petitioner be claiming the same as
such;
and
❑ A certification on valuation of assets by one or more appraisers competent to
give an
opinion as to the value thereof, accompanied by a brief statement of the
qualifications
of such appraiser, except for cash or listed securities, for which no certification
of value
is required.
Therefore, Petitioner requests payment or distribution to of the property of the
estate to those entitled and such other a further relief as the Court deems just and
proper.
Respectfully submitted,
Date: Friday, July 11, 2014
a
� �
Signature of Party
William E. Bray
Printed Name
817 West Keller St.
Address
Mechanicsburg, PA 17055
City, State, and Zip
717-458-5407
Telephone Number
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VERIFICATION
A. PETITIONER
STATE OF Pennsylvania
COUNTY Cumberland
I, the undersigned Petitioner, being sworn, state that I have read and understood
the Petition in the above styled case; that the petition was filed at my request and
direction; and that the allegations in the above petition are true and correct, to the best
of my knowledge, information and belief.
Given on this the � day of ��r � 201�____�
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Name Of Petitioner
ACKNOWLEDGED, SWORN TO AN'$ SUBSCRIBED before me on this the � ��
day of �� . 20�.�
y�n ��yl
Notary Public �
My commission expires: ��� �I� �\�
Commomrealm of PA
NOTARIAL SEAL
Kimberly A.Maher,Notary Public
Upper Allen Twp.,Cumberland County
My commission expires Nov.9,2015
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