HomeMy WebLinkAbout01-28-15 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF Cc,wv)6aAo,i:� 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: S t u�tc.S E� I t File No:
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: CcA d 2 t,l Age at death: SO
Decedent was domiciled at death in C , County, �" (state)with his/ er last
principal residence at as 4e d pial- �j�l�,,
Street address,Post Office and Zip Code ity,Township or Borough County
Decedent died at
Street address,Post Office and Zip Code City,Township or Borough County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania............................ All personal property $_/DQp --
If not domiciled in Pennsylvania. Personal property in Pennsylvania $
If not domiciled in Pennsylvania. ....................... Personal property in County $ —
Value of real estate in Pennsylvania.... ............................... ... ... ... ............. $
TOTAL ESTIMATED VALUE. ... $ U
Real estate in Pennsylvania situated at:
(Attach additional sheets,ifnecessary) Street address,Post Office and Zip Code City,Township or Borough County \
❑ 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 the Decedent,dated and Codicil(s)
thereto dated
State relevant circumstances(e.g.renunciation,death of executor,etc.)
G 7z rTJ
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not diVyLte as not a(arty to e>ong
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. §3323(g)'am_ id not ha chihdf'-b4 or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. �w
NO EXCEPTIONS ❑EXCEPTIONS ;;'= r r� cap --- .�
c.n
B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durantg`'ubsAtia,du-?ante MlInof ate
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and complet4ist of hbVs. - rn
d
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divord'e had been estabbshed as de-ni ied
in 23 Pa.C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
eNO EXCEPTIONS ❑EXCEPTIONS
Petitioner(s),after a proper 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 YK 01f Kms[ S) �A
Farm RW-02 rev.10/1112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
�� } SS:
COUNTY OF u�Y nry-u��rtnd }
Petitioner(s)Printed Name Petitioner(s)Printed Address
U. 3o�t �f► Eerre�� it 11/V.�,sv/�
lA2a� -70-E 6allimefie S r 70S
The Petitioner(s)above-named swear(s)or affirm(s)the statements int foregoing Petition are true and correct to the best of the knowledge and belief
of Petitioner(s)and that,as Personal Representative(s)of the Deced t,the Petitioner(s)will wel and truly administer the estate according to-law.
Sworn to cr affirmed acid subscribed'before Date
Inc -t 1) ��..—day o. k Date
Date/Z 2-UI5
For the Register Date
BOND Required:Q YES E]NO To the Register of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( J ) Short Certificate(s). . . . . .
( ) Renunciation(s).. . . . . . m
( )Codicil(s). . .. . . . . . . . . . = (17)
( )Affidavit(s).. . . . . . . . . . . r71 72' �:7
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
C'J
Commission. . . . . . . . . . . . . . . . . . Supreme Court co ;,+� V
w Cry -
Other . . . . . . . . ID Number: r «
. . . . . . Firm Name:
. . . . . . Address: ry rn
. . . . . . . . 1 h, (� Q
CL1 T
. . . . . . . . Phone:
Automation Fee. . . . . . . . . . . . . . . Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . J Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 11G.50
DECREE OF THE REGISTER !�
Estate of File No: �_��—
a/k/a:
AND NOW, J ('. f\Q CA 2 2n�, in consideration of the foregoing Petition,
satisfactory proof having been pres nted before me,IT IS DECREED that Letters
are hereby granted to N
� C1 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 rszl��
Form RW-n? rev. 10!1120// ti'' 6P9e
2 of 2
IN THE COURT OF COMMON PLEAS OF THE NINTH JUDICIAL DISTRICT
CUMBERLAND COUNTY, PENNSYLVANIA
I ORPHANS' COURT DIVISION
IN RE:
DECEASED I ,
o
I
I NO. 21- cQO Imo_- at__—
I
AFFIDAVIT
I swear or affirm that4_CL�
� C m P LgD2IA
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R
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C, T
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Sworn to or affirmed and subscribed
ign ture
Before me this '�day
Name
` U. a� f
Deputy fur theegis e"r of i?rills � ��� .
Address