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HomeMy WebLinkAbout04-02-15 PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND 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 requests the grant of Letters in the appropriate form: David L.Semuta Decedent's Information Name: Brian D Semuta File No: 'IS " a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: 03/21/2015 Age at Death: 33 Decedent was domiciled at death in Cumberland County, PA (State) with his/her last principal residence at 504 Third Street,New Cumberland 17070 New Cumberland Cumberland Street address,Post Office and Zip Code City,Township or Borough County Decedent died at Harrisburg Hospital,Harrisburg,PA 17101 Harrisburg Dauphin PA 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 $ 30,000.00 If not domiciled in Pennsylvania.................Personal property in Pennsylvania $ If not domiciled in Pennsylvania.................Personal property in County $ Value of real estate in Pennsylvania........... $ 75,000.00 TOTAL ESTIMATED VALUE$ 105,000.00 Real estate in Pennsylvania situated at 504 Third Street, New Cumberland,PA 17070 New Cumberland Borough Cumberland (Attach additional sheets,if necessary.) CJ CS Street address,Post Office and Zip Code City,Township or BoroughCou . u C__ 'Q .' 7< 70 ❑A. Petition for Probate and Grant of Letters Testamentary �''y° �a Petitioner(s)aver(s)that he/she/they is/are the Executor(s)named in the Last Will of the Decedent,dated Ia i fihdr8dicil(s) thereto dated (State relevant circumstances,e.g.,renunciation,death of executor,etc.) tw] r-- Except as follows:after the execution of the instruments)offered for probate,Decedent did not marry,was not divorced,was not to a pending 'r- divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. 3323(g),and did not have a rid rn or h--' C!1 Q; adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. F1 NO EXCEPTIONS F� EXCEPTIONS QX B. Petition for Grant of Letters of Administration (If applicable) ata.: . .n.; . .n.c.t.a.;pedente rte;durante absentia;durante 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 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. QX NO 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 Delaney David Semuta minor son 3836 Cloverfield Road Harrisburg,PA 17109 David L.Semuta father 14 Carriage Road New Cumberland,PA 17070 Karen M.Semuta mother 14 Carriage Road New Cumberland,PA 17070 Form RW-02 rev.10-11-2011 Copyright(c)2011 form software only The Lackner Group,Inc. Page 1 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF Cumberland } Petitioner(s)Printed Name Petitioner(s)Printed Address David L.Semuta 14 Carriage Road New Cumberland,PA 17070 The Petitioner(s)above-named swear(s)or affirm(s)the statement a for go' etitio ar rue d corr the t of the knowledge and belief of Petitioner(s)and that,as Personal Representative(s)of a Deced ioner well d tr nr the estate accoi in t aw` Sworn tg oraffirmed and subscribed before Date / methijm day of G Date By: Date For the Register Date BOND Required? Yes No To the Register of IMlls: FEESPlease enter my appearance by my signature below: L tters............................................$ �� Attorney Si (E )Short Certificate(s).......... l ( I )Renunciation(s)............... S J ( )Codicil(s)......................... ( )Affidavit(s)....................... Printed Name: Robert P Kline Bond....................I......................... Supreme Court Commission................................... ID Number: 58798 Other 1W,iriV (� - rtx-r�Cla�- I�� Firm Name: Kline Law Office Address: 714 Bridge Street P.O.Box 461 New Cumberland,PA 17070 Phone: 717/770-2540 Automation Fee............................. S(-,) E-mail: 717/770-2553 JCS Fee......................................... E-mail: TOTAL............................. $ 3 �� DECREE OF THE REGISTER Date of Death: 03/21/2015 Social Security No: Estate of Brian D Semuta File No: a/k/a: AND NOW, rt (� �� rj in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters of Administration are hereby granted to David L.Semuta in the above estate and(if applicable)that the instrument(s)dated Q described in the Petition be admitted to probate and filed of record as the last Will(and Co icil(s))of Decedent. Reg't9t4 of Wills Copyright(c)2011 form software only The Lackner roup,Inc. Page 2 of 2 RENUNCIATION REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Estate of Brian D Semuta Deceased I. Karen M. Semuta in my capacity/relationship as (Print Name) mother of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to David L. Semuta, my husband and the Decedent's father r- , M ~. ra,P (Date) (Signatuib) Karen M. S mutzt:x s 14 Carriage Road (Street Address) New Cumberland, PA 17070 (City,state,Zip) Executed in Register's Office Executed out of Register's Office Sworn to or affirmed and subscribed Before the undersigned personally appeared the party executing this renunciation and certified before me this day that he or she executed the renunciati?n for the of purposes stated within on this A3D day of iTIA-24 H a015 . Deputy for Register of WillsNotary Public My Commission Expires: 15— (Signature and seal of Notary or other official qualified to administer oaths. Show date C©�yoonoUVE�IIsc GF PENNSYLVANIA NOTARIAL SEAL SHARON R.FEISTER, Notary Public New Cumberland Boro.,Cumberland Co. My Commission Expires April 15, 2015 Form RW-OB Rev.10-13-2006 Copyright(c)2006 form software only The Lackner Group,Inc.