HomeMy WebLinkAbout08-11-15 PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBER�AND 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 \ � I_ '�-p���
Name•��\� Q.� �-1( \C.'�`M�1 File No:
a/k/a: (Assigned by Register)
a/k/a: `�'\
a/k/a: Social Security No:
Date of Death• `�j - - ��`> Age at death: (��j
Decedent was domiciled at death in ' ��(�U.S�1� C_o,unty, � 'nS ��CS:�\�CNsr\e) with his/her last���I
principal residence a ' ` `! � �
Street address,Post Office and Zip Code City,To nship or Burough County
Decedent died at
_I�� 1 � ����1. \7�� �-�JC\�� 'tll�\ \1���,�V1 � ��7 ,�`\� vJIJ�Vv\.JV ,��
Street address,Post Of and Zip Code City,Township or Borough� County State
Estimate of value of decedent's property at death: ' `�,
Ifdomici/ed i�i Pennsylvania... .. . . . . . . . ..... .... . . . . ... A(1 personal property $ �8.�1�
. ... .. . .. ... . Personal ro e in Penns lvania �--`�
If not domiciled in Pennsylvania. . . . . . . . .. . p p �Y Y
If not domici[ed in Pennsylvania. . . .. .. .... .. . . . . . . . . . . . Personal property in County �
Value of real estate in Pennsylvania.. . . .. . . .. .... .. . . . . . . .... .. . . . . . . . . .. ... . ... . .. . . . ... . .. $
TOTAL ESTIMATED VALUE. . . . $ �G� �+ C��C�
Real estate in Pennsylvania situated at:
(AttAch additional sFreets,if necessary.) Street ad ress,Post Offiee and Zip Code City,Township or Borough County
<� A. Petition for Probate and Grant of Letters Testamentary
� �� Petitioner(s)aver(s)he/she/they islare the Executor(s)named in the last Will of the Decedent,dated and Codicil(s)
� thereto datcd
State relevant circumstances(e.g.renunciation,death of'executor,etc.) �,.� � �
� � � !'zT,
Except as follows: after the execution of the instrument(s)offered for probate Decedent did not marry,was not d�rc�l,was not�art� nding
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S. § 3323(�atRb did not�e a�hil�orn or
adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. :�._4 ;`„ � � • ; �
�._ _ ';.h �-ra
' r'' F—+
�� �NO EXCEPTIONS ❑EXCEPTTONS - �' `"�
, �::�
'n , -,�
�B. Petition for Grant of Letters of Administration (ifappi�cabie) �; � , -��
c.t.a.,d.b.�i.,d.b.n.c.t.Ei.,peradente lite,dur•ante absenticr,durant�rr�yorita�te
rV r___ �
If Administration,c.t.a. or d.b.n.c.t.a.,enter date of Will in Section A above and eo��let�list o�k�irs;.;, a
�
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds for divorce had been es�iablished as defined
in 23 Pa.C.S. � 3323(g)and was neither the victim of a killing nor ever adjudicated an incapacitated person.
�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 skeets, if'necessary,):
Name Relationshi Address
_�� � -^ ` . ���� � C-,a. � �.
�b� �
F�,�,n rzw oz ��e�. roitt�2ntt Page 1 of 2
Oath of Personal Representative offt��al us�oniy
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF CUtllbe('1811d }
Petitioner(s)Printed Name Petitioner(s)Printed Address
m � '�C�rc��C�� � �c�\e.
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 Personai Representative(s)of the Decedent,the Petitioner(s)will well and truly adinini �e estafs according to law.
�
Sworn t ��firnied an subscribed before � Date "� � �--�C�
me th s y,of Date
By' Date
or rhe egre�rer• Date
BOND Required:Q YES �NO To the Regisler of Wills:
FEES: Please enter my appearance by my signature below:
Letters . . . . . . . . . . . . . . . . . . . . . . $ 'Ud Attorney Signature:
( 2 } Short Certificate(s). . . . . . ,�C?
{ )Renunciation(s).. . . . . . . .
( ) Codicil(s). . . . . . . . . . . . .
( )Affidavit(s).. . . . . . . . . . .
Bond.. . . . . . . . . . . . . . . . . . . . . . . Printed Name:
Commission. . . . . . . . . . . . . . . . . . Supreme Court
Other . . . . . . . . ID Number:
� GZX v � i'►'.• • • • • . • • 6 '��'p Firm Name:
• • • • • � • • Address:
� � • • • • • • Phone:
Automation Fee. . . . . . . . . . . . . . . `�o� Fax:
JCS Fee. . . . . . . . . . . . . . . . . . . . . �5�: ,SQ Email:
TOTaL. . . . . . . . . . . . . . . . . . . . . � n. n
DECREE OF THE REGISTER
Estate of �l' K Q�Q/ �1 'd m l) File No: �r - �� - o��q
a/k/a:
AND NOW, , , in consideration of the foregoing Petition,
satisfactory proof having been presented before me, IT IS CREED that Letters p� ���p��i 5{�Q�j ��
are hereby granted to���n �--/` /y�r�n
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
Foim RW-O2 rev. lOfl l/?011 page 2 Of 2
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