HomeMy WebLinkAbout05-01-15 PETITION FOR GRANT F LETTERS
REGISTER OF WILLS OF COUNTY,PENNSYLVANI.A
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: A ✓—V File No: a`.- 15 `—t""/
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No:
Date of Death: Age at death:
Decedent was domiciled at deatil in County, (state)with his/her lasrn
principal residence at &y,
Street address,P06 Of ace and Zip Code I^, a+R1s� orough County
Decedent died at L `^'�
Street address,Ast Ofricc and tip Code City,Tokshil or Borough 9County State
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania............................ All personal property
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. ...
Real estate in Pennsylvania situated at: �b^/E
(Attach additional sheets,if necessary.) 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.)
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not divorced,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 did not have a child born or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑NO EXCEPTIONS ❑EXCEPTIONS
B. Petition for Grant of Letters of Administration (If applicable)
a a.,d.b.n.,d.b.n.c.i.a.,pendente lite,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 a pending divorce proceeding wherein the grounds for divorce had been established as defined
irNO .C.S.§3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
E
XCEPTIONSS ❑EXCEPTIONS
Petitiont:r(s),after a proper search has/have ascertained that Decedent left no Will and wa<•t- ived by the following spouse(if any)and heirs(attach
additional sheets,if necessary):
Name }Relationship `` Address
tl: Otl) S r�oc�Tln el� �e I'73 5--
f> t Lam', -E 1700
Form,Rill-02 rev.1011112011 Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF }
Petitioner(s)Printed Name Petitioner(s)Printed Address
bqs PA t 33
The Petitioners)above-named sv e1u'(sa or cffirm(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 Persondi Represcntet ve(s)of tl e1Decedent,th Pe itioner(s)will well and truly administer the estate according to law.
Sworn t or affirmed and subscribcd bofore Date
me this day of Date
BY Date
For the Register 7 1 Date
BOND Required:Q YES ONO To the Register o'f Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ Attorney Signature:
( 3 ) Short Certificate(s). . . . . . S
( � )Renunciation(s).. . . . . . . . Q
( )Codicil(s). . . . . . . . . . . . .
( ) Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . . . . . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . ID Number:
h . . . . . . . . l5
Is Firm Name:
. . . . . . . . Address:
. . . . . . . Phone:
Automation Fee. . . . . . . . . . . . . . . S Fax:
]CS FCC. . . . . . . . . . . . . . . . . . . . . 35.5d Email:
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 15.50
DECREE OF THE REGISTER
Estate of File No:
a/k/a:
AND NOW, in consideration of the foregoing Petition,
satisfactory proof having been presented before me,IT IS DECREED t1;at 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
Forin Rcv-o2 rev. 101112011 Page 2 of 2
RENUNCIATION
REGISTER OF WILLS
lr- VJ COUNTY, PENNSYLVANIA
Estate of
Deceased
I, 72UQ 6)CAOS in my capacity/relationship as
oN (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
-D
Ujpvv,
(Signature)
(Street Address)
pf
(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
before me this day party executing this renunciation and certified
of that he or she executed the renunciation for the
purposes stated,within orithis day
I
of— ARC1. Adi's
Deputy for Register of Wills 7otary Public
My Commission Expires:AD C/,+ j'),
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
—COMbQr—E--ALTHOFPE—NN§X�VANIA
NOTARIAL SEAL
JONATHAN DALE GERSERICH,Notary Public
Swatara Up.,Dauphin
Forin RTY-06 rev, 10.13.06 County2018
My Commission Expires August 22,
118
RENUiCIATION
REGISTER OF WILLS
occY1an COUNTY, PENNSYLVANIA
Estate of— IcLr jo ► e— Deceased
r
I, M �F_ if'`tfY1tFN , 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
e-W_A 4
ei 1
35 'MI*S.
(Dat) (Sign ture)
ad �s� r
(Street Address)
�� O V
(City, tate.Z7p)
Executed in Register's Office Executed out of Register's Office
Sworn to or affirmed and subscribed Before the undersigned personally appeared the
before me this day party executing this renunciation and certified
of7Yi 1 ,2C1 J that lie or she executed the renunciation for the
purposes stated within on this 2_j day
of.-.._ 2015
c
f
Deputy for Register of Wills NoOr Public l t
My Commission Expires: �l 1(4l( EJ
COMMONWEALTH OF PENNSYL'i WWAture and Seat of Notary orotherofficial qualified to
NOTARIAL SEAL ster oaths. Show date of expiration of Notary's Commission.)
Elizabeth L.Messner,Notary Public
Lower Alien Twp..Cumberland County
My Commission Expires July ib,2018
Mukt6ER, N to .1 tam N$TARiES
Form RlY-06 rev. 10.13,06