HomeMy WebLinkAbout09-03-14 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF L(�iM�j�IC��Ci1 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 Information (� �(/�(�
Name: l�.C�l►'1��1 R.S�"IOWG��'�'� File No• �I - �! � UOS /
a/k/a: (Assigned by Register)
a/k/a:
al�a� Social Security No:
Date of Death: O S/=�G1�?Ol�{ Age at death: ,S C�
Decedent was domiciled at death in l ' County, p � l G;Srure)with his/her last
principal residence at l 7O�3 i C:��cn b
Street address,Post Office a Zip Code City,Township or Boraugh County
Decedent died at 13U P���Sb�C'c� 20�� 1�70!3 C,CL(' liS�2 C����'lc.slc� (�C�-
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
Ifdon:iciled in Pennsylvania............................ All personal properry $ �L�tD�UO
If not domiciled in Pennsylvania. ....................... Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $
Va[ue of rea[estate in Pennsy[vania......................................... ................ $
TOTAL ESTIMATED VALUE. ... $ $061s e���
Real estate in Pennsylvania situated at:
(Attach ndditionnl sheets,ifnecessary.) Street address,Post Office and Zip Code City,Township or Borough � County,
O "
� � � � �'
❑ 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 tlie Decedent,dated � :k7 � �t(i'�t�icil(s)
thereto dated —C t�'! �"
� r
State relevant circumstances(e.g.renuncintion,deat6 of executor,etc.) �„ � � C� ;� C$7 �
� �* .�.' q C�'f+
Except as follows: after tl�e execution of the instrument(s)offered for probate Decedent did not marry,was no�ivErDce�was�y parf�"lo ending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§332$(Sg)�hd'L�d nat4�1'ave�i�orn or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. t� �"
• 33 1-�+ P,``" � ,.
�NO EXCEPTIONS ❑EXCEPTIONS -ip����
0
�B. Petition for Grant of Letters of Administration (If applicable)
c.t.u.,d.b.n.,d.b.n.c.t.u.,pendente lite,durante absentia,durunte minoritute
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 pevding divorce proceeding wherein tl�e 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.
�JNO EXCEPTIONS �EXCEPTIONS
Petitioner(s),after a proper search has/have ascertained that Decedent left no W ill and was survived by the following spouse(if any)and heirs(attach
uclditionul sheets,if'necessury):
Name Relationshi Address
P�e I� (, � e P�1 170
'-�e� � i� ta C.�e� S �� ucPct.��c' GA3�
/'
f
Fo�-��,�wnz iev.10/l1/20!l Page 1 of �
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
-t } SS:
COUNTY OF r'_�M�;X�C-1G�('�U }
Petitioner(s)Printed Name Petitioner(s)Printed Address
ak� + v c�e�essb�- �. C�c'l�sle. PF� - I��3
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 Petitiouer(s)and that,as Personal Representative(s)of the Decedent,the Petitioner(s)will well and truly administer the estate according to law.
Sworu to or ffirmed a su scri ed befor �� Date�3-/y
me thi da o e���� Date
Y� Date
t e Re ister Date
BOND Required:Q YES �NO To the Register of Wi!!s: `�,
FEES: Please enter my appearance �ignatu�elo��
(�� "�7 ..
Letters. . . . . . . . . . . . . . . . . . . . . . $ (�.�7 Attorney Signature: ,� � �.��.. rn (� j
( 'r�' )Sliort Certificate(s). . . . . . . �7 � � W � � i
( � ) Reuunciation(s).. . . . . . . . 5 , y„� y
�
� )Codicil(s). . . . . . . . . . .. . 6'? . "O � �'1
( )Affidavit(s).. . . . . . . . . . . ��" � '�i ' �
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name: » �7 F—+ '~' ..,.
Commission. . . . . . . . . . . Supreme Court � ' r'
Other ID Number: �'' � �
. . . .. . �
. . . . . . . . Firm Name:
. . . . . . . . Address: ,;
. . . .. . . . Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . •. Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $
DECREE OF THE REGISTER
Estate of �P(1(��� 1�. S I-�owc�Ke(� File No: � f_ ���' V�7
a/k/a:
r
AND NOW, ,�:a,�, ,--, in considerati n of the f ego' g Petition,
satisfactory proof having be presented before me,IT IS CREE that Lett rs
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 Codicil(s))of Decedent.
gister o Wills ^_
��° � �I +
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RENUNCIAT���P 3 � 1 5�
CL��:�t �F
REGISTER OF WILLS����A��� �d��T
(�`�,u�,►_,.erle�c?I COLTNTY, P ` -����A��., P�
c�
Estate of ����-�-� ��er� ���;���Kpi,r- Deceased
,
I,� nS�a��rC� Mr r� P )2 i Fe r-� , in my capacity/relationship as
(Print Name)
� of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
�M�an� r� ��n�� ,c �� Ko;�
���� a9,���� -m, �
�D4te�
(Signature)
'�US TG.vlor' �re�K �Pur ��
(Street Address)
Lu���,�c�� a C�,(� 3� 31 ls�
(Ciry,State.Zip)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirme r'�'subscribed Before the undersigned personally appeared the
befor e this 7 d party executing this renunciation and certified
�f � � that he or she executed the renunciation for the
purposes stated within on this day
of ,
!�
� eputy for gis W s Notary Public
My Commission Expires:
(Signature and Seai of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
Form RW-06 rev.10.13.06