HomeMy WebLinkAbout09-17-14 I
I PETITION FOR GRANT O�II F LETTERS
S.�
REGISTER OF WILLS OF (JyV��0 /Y"l 0-n d COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ics) 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 s i �
Name: -r h-P T-e Sa K I C)10 File No: z'�'l — g—E 1r
g
a/k/a: (Assigned by Register)
alkta:
a/k/a: Social Security No: >
Date of Death: go/ y r Age at death: 9�
Decedent was domiciled at death in CA M beery l 0,f\d County, _ (state)with his/her last,
principal residence at G{ I -)� S{• tS•e-w � Die yI aA^ � ca- M ►. L- 6tJ
Street address,Post Office�ands�Vflpp Code City,Township or uoogo , 0151- County
Decedent died at 9D to SDIff+ f�A � Dtlf (tF 6yycrxs A tSS�a m rt W t, {�1 - j 7011
Street o s,Post Ofnce and p Code City,Township or Borough' ounty _� State
Estimate of value of decedent's property at death: 6,
If domiciled in Pennsylvania.... .......... ........ All personal property $ It),000 "19,C)00
If not domiciled in Pennsy lvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsy lvania. ....................... Personal property in County $
Value of real estate in Pennsylvania.,,......... ......... ......... ....................... $
TOTAL ESTIMATED VALUE. ...
Real estate in Pennsylvania situated at: irlf3 *,
(Attach additional sheers,ifnecessary.) Street address,Post Office and 71p Code City,Township or o5ough o Comity
rn
o
r-1 A. �
A. Petition for Probate and Grant of Letters Testamentary co rn ci o
Petitioners)aver(s)he/shelthey is/are the Exccutor(s)named in the last Will of the Decedent,dated m ro andfaat ffs)
thereto dated .
I Z fit —.7
State relevant circumstances feg,renunciation,death of extensor,na) T '
O -n� Co p � 'sl "i1
Except as follows:after the execution of the instrument(s)offered for probate Decedent did not marry,was not divordcd,was not;*, to"pi;$ding
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(8),•aE'did not a cI�iIQ�n or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. —f r-
0 NO EXCEPTIONS ❑EXCEPTIONS "" ~' -n
Q� B. Petition for Grant of Letters of Administration (if applicable)
c.t a.,d.b.n.,db.n.c.t.a.,pendente lite.durante absentia,durance minoritate
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complete list of heirs.
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
N NO EXCEPTIONS ❑EXCEPTIONS
Pet:oner(s),aftera propersearch hasfiave ascertained thsaDecedent left no Will and was survivedby the following spouse(ifany)and heirslettach
additional sheets,ifnecessary):
Name Relationship Address
rn 1cha la,I J, f)ntl 4vp Li 1 -7 ewt,urm6Yt sPA 170C
Max 3a Gt t M D Se S' id�mrl� q$ II
�' tt Vo k D �t� C-10, anPf' �J%Ma'�a5g55ci
3, ''h�r�s Pmn o do a lMtl rat ut 47 o3 335
on as4ct:tIt o-,,j skie.fi- .
Form aw-na rte,)011112011 Page I of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA I
SS:
COUNTY OF
Petitioner(s)Printed Name Petitioner(s)Printed Address
�
+�— in
VYl I C'h ck�p_ RL I e l l -7 N St (CLnCj PW I-�-O-�
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 theitioner(s)will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed before I"tle t e
me this Th day o V J t-V I I
By: e
Date
.For theRegister _A
BOND Required:AYES MNO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . $ U10 Attorney Signature:
�O )Short Certificate(s)...... S6
)Renunciation(s).. . . . . . . .
)Codicil(s). . . . . . . . . .
)Affidavit(s).. . . . ...
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . ... .. . .. .. . . . .. . Supreme Court
Other A . . . . . . ID Number:
. .. ... . . Firm Name:
. . . . . . . . Address:
Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . .. . .. .. . Email:
TOTAL. . . . . . . . . . . . . . . . . . . . .
DECREE OF THE REGISTER
Estate of File P70:
a/k/a:
AND NOW, K5 ,in coni eraion of the fore oin et,
satisfactory proof having been presented before me,IT IS DECREED that Letters
are hereby granted to M k don_QA S-_
-M in the above estate Ad(if applicable)that
the instrument(s)dated CZ
described in the Petition be admitted to probate and filed of record as the
Alas d Codicil(s))of Decedent.
WgIster of Wills
0&/ZA2 2
P
Form RW--02 rev.10/1112011 age of
�,
.�
�„
r
�-*�
v
��
. .
k � - D r
rt�
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
r� Petitioner(ss)Printed Name Petitioner(s)Printed Address
VYl i Lh at Cie `��� -7 f" 2u1 L r,c{ j�b9 [`�0 0
The Petitioners)above-named swear(s)or affirm(s)the statements in the foregoing Petition ire true and correct to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of the e. ,the P tltioner(s)will well and truly administer the estate according to law. Li
Sworn t or affirmed and subscribed b�.�e��fo',r'��'e e `
me this ITh day o ,
By: r �3
For the Register Date
BOND Required:AYES F-JNO To the Register of Wills:
FEES: tt Please enter my appearance by my signature below:
Letters.. .. .. ... .. . . . ........ $ L.VIa Attorney Signature:
( 9Cl ) Short Certificate(s).. . . . .
( ) Renunciation(s).. . . . . . . .
{ )Codicil(s). . . .. ........
( )Affidavit(s).. .. . . . .... .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . .. . . . . .. Supreme Court
Ot ID Number:
. . . . . . Firm Name:
.. .. ..... Address:
. .. . .. Phone:
Automation Fee. . . ...... . . . ... _ Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . a Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $
DECREE OF THE REGISTER
Estate of File A?o•
alkla:
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
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.
Register of Wills
Fo,,,,RW--nz rev.101112011 Page 2 of 2
ket s
f0 � � otnul �f
z�. Sos.f V\ C `l b soy, a o �a Ft 33 55
-�, S�sa ,
CC I cy pb ao 4 (eaa-�
-bse 5150
C
Sow (� ��
Joy ydh a � -3
.!te �
`[D c�o. 0��o 159 o � a�� e RTe D
U� j � 9q 8T
CP
`/o ` aolj
(�avt d S - `Deeeased`p
P--c- be600, Vo �
H105.805 REV(9111) .