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HomeMy WebLinkAbout09-04-15 Reset PETITION FOR GRANT OF LETTERS REGISTER OF WILLS OF C rv-btel" 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: c(A V( ani File No: -f V a/k/a: . (Assigned byRegister a/k/a: � a/k/a: Social Security No: Date of Death: Age at death: 7 Decedent was domiciled at death in int County, rq (state)with his/her last principal residence at © C o St t address,Post Office nd Zip ode Ty,Township or Borough County Decedent died at CaQ Street ad ress,Post Offipt 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 $ 2, QW- 00 If not domiciled in Pennsy!vania. ....................... Personal property in Pennsylvania $ If not domiciled in Pennsylvania. ....................... Personal property in County $ Value of real estate in Pennsylvania......................................................... $ TOTAL ESTIMATED VALUE. ... $ 12 Real estate in Pennsylvania situated at: (Attach additional sheets,ifnecessary.) Street address,Post Office and Zip Code City,Township or Borough © :..Corty rl A. Petition for Probate and Grant of Letters Testamentary ry c� Petitioner(s)aver(s)he/she/they is/are the Executor(s)named in the last Will of the Decedent,dated CO- , and'&4dil(s) thereto dated -y Z'- fn rn State relevant circumstances(e.g.renunciation,death ofexecutor,etc.) t �l Except as follows: after the execution ofthe instruments offered for probate Decedent did not m , `3 P ( ) p arty,was not divorced,was not a party to a_pertd�rg divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa.C.S.§3323(g),and did not haw-0 chibxboffflor adopted;and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. 0 NO EXCEPTIONS 0 EXCEPTIONS co /Petition for Grant of Letters of Administration (If applicable) c.t.a.,d.b.n.,d.b.n.c.t.a.,pendente lite,durante absentia,durante minoritate If Administration,e.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 parry to a 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 e:Z4!644 djudi�cated an inc acitated person. NO EXCEPTIONS EXCEPTIONS Aa ( 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 j Address ) /V LcAA � �.� . lilt' Form RW-02 rev. 1011112011 Page 1 of 2 V Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF } Petitioner(s)Printed Name Petitioner(s)Printed Address vrlS l�lir l7/ 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 Personal Representative(s)of the Decedent,the Petitioner(s)will well and truly administer the estate according to law. Sworn to or affirmed a d subscribed before Date met I day of ,tXV�J Date By: Date For the Register Date BOND Required: Q YES 0 NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters. . .. . . . . . . . . . . . . . . . . .. $ Attorney Signature: ( � )Short Certificate(s). . . . . . ( )Renunciation(s)... . . . . . . ( )Codicil(s). . . . . . . .. . . . . ( )Affidavit(s)... . . .. . . . . . Bond.. . .. . . . .. . . . . . . . . . . . . . . Printed Name: Commission. . .. . . . . . . . . . . . . . . Supreme Court Other . . . . . .. . ID Number: . . . . . . . 5 ti Firm Name: . . . . . . . . Address: . . . . . . . . Phone: Automation Fee. . . . . . . .. . . . . . . Fax: JCS Fee. .. . . . .. . . . . .. . . . . . . . Email: TOTAL. . . . . . . . . . . . . .. . . . . . . $ Form RW-02 rev. 1011112011 Page 2 of 2 Oath of Personal Representative Official Use Only COMMONWEALTH OF PENNSYLVANIA } SS: COUNTY OF } Pentioner(s)Printed Name Petitionerts)Printed Address The Petitioner(s)above-name vvear(s)or affirm{s}the statements in the foregoing Fetitio are true and correct to the best of the knowledge and belief of Petitioner(s)and that,as Persot Representative(s)of the Decedent,the Petitioner( will well and truly administer the estate according to law. Sworn to or affirmed and subscr' ed before Date me this day of Date By: Date For the Register Date BOND Required:DYES F-1 NO To the Register of Wills: FEES: Please enter my appearance by my signature below: Letters . . . . . . . . . . . . . . . . . . . . . . S At ney Signature: { ) Short Certificate(s). . . . . . ( ) Renunciation(s).. . . . . . . . ( ) Codicil(s). . . . . . . . . . . . . ( ) Affidavit(s).. . . . . . . . . . . Bond.. . . . . . . . . . . . . . . . . . . . . Printed Name: Commission. . . . . . . . . . . . Supreme Court Other . . ID Number: . . . . . Firm Name: . . . . . . . . Address: . . . Phone: Automatic, Fee. . . . . . . . . . . . . . . Fax: JCS Fee. Email: TOT . . . . . . . . . . . . . . . . . . . . . S `�~v DECREE OF TIME REGISTER Estate of t A !1 IV 1 File No: �� J a/k/a: AND NOW, {��� �, in consider tion of the foregoinc,Petition, satisfactory proof having b en presented before me,IT IS DECREED that Letters (� are hereby granted to I in the abo estate and(if applicable) that the instrument(s) dated described in the Petition be admittedtop abate and filed of record as the last Will(and Codicil(s))of'Decedent. Rkjs1kr of Will Page 2 of 2 Form RtV-t12 rev. 10/11/2011 ,1(� RECCORDED OFFICE OF' REGISTER OF V/ILLS ?0I5 SEP 4 Pel 1 38 RENUNCIATION CLEki' OF ORPHANS' ^ T REGISTER OF WILLS CUM[3 E R LJ,!, COUNTY,PENNSYLVANIA Estate of CWY) w QMA ,Deceased fR 01 M ei � �'� ,in my capacity/relationship as (Print Name) �QJ:L!QZ of the above Decedent,hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to 1 1,eytS o�, Al 'a fid( 'Q /-2--7 !S' (Date) (SiBnrt—) 1:3 Ulm (Street Address) (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 on this d 7 day of (4,,,As1 u s.4 -2b rte` Deputy for Register of Wills Q4�oPublicrlZ--L My Commission Expires: �7/�aiCo (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) COMMONWEALTH OF PENNSYLVANIA Notarial Seal Form RW-06 rev.10.13.06 RW-06 Jan E,Miller,Notary Public Upper Allen Twp.,Cumberland County M(Commission Expires Aug.7.20t6�_. jqMt§, . v •+ Form D.2 . zA CAUTION:Any person who(1)Falsifies any of the particulars on this certificate or(2)uses a ` falsified certificate as true,knowing it to be false Is RECORDED O F i C E 0 "''�••• liable to Prosecution. REGISTEZ OF WILLSORIGINAL ?p1� ��EP q pill �� A. FEDERAL REPUBLIC OF NIGERIA CLEI-NK OF NATIONALPOPULATION COMMISSION ORPHAf45' CO1 iT , CUMBERLA11D CO., F'" ttifi.We Of 'NIH) No. D09 R 0 � Issued under the 6' its and Deaths Etc. mpulsoryegistration)Decree 69 of 1992. Registration Centre T'E'A TownfVi lac -' L.G.A t 3 t 3 {�. State - 7 Volume. Year Entry No. Thi s to cerci t at the deatp�details of which are recorded here' lasben regi tred on aDayyMonth Yeat this Registration Cent a .�r. � S A1.Full Name ► " Y V I I�__ (Surname first) (in block letters) (�h J 2.Sex: J�L ^ 3.Date of Death: Day Month Year 4.Age of Death: 5.Place of Death: EC . � _ �� ""Town/Villag ��y"�l"� (G.. "ti. `fit 6.Fu!!Address of Usual Place of Residence of Deceased.— �_ �� _('6uwp9 } Place of lssu Date: Si ,�'d elo ;Reg'mat i i