HomeMy WebLinkAbout04-09-04
PETITION FoARANT OF LETTERS OF A!INISTRATION
Estate of
also known as
(J I/- \}I d Cv >^--u <;; )"
No.
To:
d----' -0 ~ ~)(l ~ ,)
Social Security No.
9 !; Deceased.
! ~ - ~ - '"7~ 'I k-
Register of lills fo] th~ 17
County of lJ lA-,-lJ.:L,r-( 0. ~"o.IL in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitiorwr(s), who is/are 18 years of age or older, appl t 12- ")
b. is , lU.
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
Decendent was domiciled at death in t!VY"l--o.. 6..~1;/Cr, "" 4- ~ ~o}}1lt~ennSYlv~i?rw)f:Ih
h i "5 last family or principal residence at ~?>I # <e..1!.- f'- dL, ~ r' I. f'J1-j
(list street, number and municipality)
/l 1'.-, '~60 S'
HvV U $ -r ,./ ,1'9---,
for letters of administration
on the estate of
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property $
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
Value of real estate in Pennsylvania $
situated as follows:
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
~ Na~,q"^-~ 5" iJY't~
Oy1..; 5'
;..:,,\.
.
~
~
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administi'ation in the
appropriate form to the undersigned. ! c;
~
'"
'tr
u
<=
'"
~~
"'~
"'...
P::'"
<=
-00
S:::'':::
c..s';::
~'"
~~
"''-
50
~
<=
00
i:ii
8~~~
c/
M.
/7..3~.s-
l',-J
\0
c/2.7L/ (!c/d ~.//(~(
1U.a/7(!hs ii..A.. ,f/i.
5. 6
12/22/2003 10:43 FAX 2155579557
12/UD/U~ ~Rl 11:34 FAX 92552749
LBM&Y
REGISTER OF WILLS
141 001
III 001
, -
.' 'r.
r,~
~
~:f.~
;'
~~
~
E$tata of
Register of Wills of Dauphin County, Pennsylvania
PETITION FOR GRANT OF LETTERS
f.r.' 91
-J-l~ ~ No.
also known as
, DeceaS8d
Social Security NJ!' 9-.1:l 7t2 7 ;L.
Pllteu...... .... .111,. t.. v--- DI agl 01 ..... ANI,...., 'nl:
ICOMPLe't1: -A~ OR -B" BELOW:I
a
A. Probate and Gromt of Letters and aver that Petitionerlsl is/are the eXElcut......- named in the Last Will of the
Decedent, dated and codiciJ(s) dated
..- {l:=",-"",:-_ _~_ ___"__ ._.'_;.-._.~
-----=--
.'
'."
!mw NI......... ~IIIAI. t1..go. ~i.... ........, D' ....I;iUWF~ <<C,
-<l:
"
;;'i Excllpt as follow., DIIClldllnt did nat merry, WIlE not divoroed, and dld not have e ehild born ar IIdoPIUd lifter IIxecution of the docl.tmcnts offered
tor probate; was: net tho victim of a killing .....d WBIII tlevor adjudloa~"d incompetllnt:
a
B. Grant of Letters of AdminiStration
lIi.t.... ........e..1.L! JII::nll'lll"ll_ lIu; .....ur ~ &lLlo."". ~~
Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and \Nas survived by the following spouse
(if any) and heirs:
"
~~~
~ lanl
~;
,.,
, '
'"
:: ~
Decedent, then ~ years of age, died
Decedent at death owned property witt! eS.timated Vallles E1s101low&:
(If domiciled in PAl All personlll propllrly . _ . . . . . . . . . . . . . . _ . . _ . . _ . _ . . . . . S
IIf not domiciled in PAl Pet9a...al property in POhtlsylvania . . . . . . . . . . . . . . . . . . . . _ . $
(If not domiciled j" PAl PefSOt'lal property in County. . . . . . . . _ . . . . . . . . . . . . . . . . . $
VlIluc of reel estate 11'1 t:'annllylvanie _ _ . . . . . . . . . . _ _ _ . . . . . . . . . . . . . _ _ . . . . . . . . . . . . . . . . _ $
iotal . . . . . . _ _ . . . . . . . . . . . . . . . . . _ . . . . _ . . . . . . . . . . _ . . . _ _ _ _ . . . . . . . . . . . . . $
Real Eslate sitl.lillltd liS follows:
Wt>ercfore. Petitionerl$) rsspoctfully requestls) tho ~robBte of ~~elli$t Will and Codicil(s) prllssnted with this Petition llnd the grant of 'otters in thll
appropriate form to tho ul1der,lgnlld; .
~
1'3
R:.
1"7/6/
.'
,..
1N_7
OATli OF PERSONAL REPRESEN1ATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF ~'v..'<'n~r\c.r.c\
} ss
The petitioner(s) above-named swear(s) or affirm(s) that 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 above decedent petitioner(s) will well and
truly administer the estate according to law.
EZrt"ni! ,&~
..-,
'"
'-'
Q)
...
~
.....
(l:l
I::
be
Uj
No. ~1-O~-INoS
Est1tte of
~o~ ~eJs<;
, Deceased
~=
'7
P
G~NT OF LETTERS OF ADMINISTRATION
~'~ :..~~
AND NOW ~~ cJ. 0 ~;}oo+, in consideration of the petition on
the reverse side hereof, satIsfa 0 pr...oof having been ented before me,
IT IS DECREED that L '~
is/are entitled to Letters of Administra lon, and in accord with such finding, Letters of Administration
are hereby granted to ~ '~~~ ~ ~r-\:.\r......
in the estate o~b-. C~SS
$~~' 00
$ .00
$
$
TOTAL _ $'2*.00
Filed.. Y.-:-~C.-:-.Cti.... A.D. 19_
FEES
Letters of Administration
Short Certificates( )..........
Renunciation ................
E'~~,,"~::2w~~~
R<gi""JfW~ ~
C;;;;v'Y] -R -; Cl M____ ~N ;7f Z;Ce~ ) '/
ATTORNEYt;:Ct. l.D. NO'~i>
d--rf I / IV' r'~ru-r- -r
r ) 'i'DDRESS
~~, "6vr~ fJ/J J ?1'~
PHO E
.J-'? J- 9 9G 6'
12/22/2003 10:45 FAX 2155579557
J.~' 'I"" '10> l'.ll:l .il.: "4 I"A.\. llIl I\) 1\)", 'f 49
LBM&Y
REGISTER OF WILLS
.~
I4J 002
~002
.
Oath of Personal Representative
;.: Commonwealth of Pennsylvania
County of Dauphin
The Petitioner(s) above-named swearls) and affirm(s) that the statements in the foregoing Petition are true and
correct to the best of the knowledge and belief at Petitionerls) and that, as personal representative(s) of the Decedent,
Petitioner(sl will. well B.nd truly admini.ter the estate ~ccording to law.
:j 11 fYrM-&:71~
IO~~
" ~
_....-...-..
Sworn to and ~ffi~~d ";f1E{ sub$cribed
.... "..- ~ -.'
before me th~; ~-(i;t ~:::. day of
Ob~1>~' .' ~ 2003
'. ~1I;~b~~~' . -;~ <> .. -.
. _~-h_-~"";:- ..' . 'tiJ
- ....._.......- . I
'....,..... r ';"'~'"
''''-. -
- . '.0' _.. _
, DECREE OF REGISTER
Estate of
Deceased
No.
also known OIS
SoCial Security No:
~_ Date of Death:
AND NOW. , 20 ~ in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT IS DECREED that Letters D Testamentary 0 of Administration
fEtA.....: f.h......',; ..........Iltl: dur.. .dr.."~.. 1Iu..... ~,nN!I
are hereby granted to
in the above estate and that the instrument(s) I if any, dated ,
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters.... ...... ................. $
R_gistor 01 Will..
Short Certificate (s)..........
Renunciation. ...... ...........
Affidavit ( ).................
Extra Pages ( )............
Codicil................ .._.......
JCP Fee........ u........ u....
Inventory & Tax Forms___
Othpa:.(;.~............
TOTAL."..... ..___"...
$
$
$
$
$
$
$-
$
~ IrS'- 00
$
Attorney:
LD_ No:
Address:
Telephone:
DATE FILED:
"
RW-7i!1
111~~)~~(~J/2003 10: 45 FAX 2155579557 LBM&Y III 004
. This 1'.;; to ccrtifjr that the information here given is correctly copied from an original certificate of death duly flIed with me as
Loca1 Rcgi.sttar. The original certificate will be forward.c:d to the State Vital Records Office for permanent filing.
WARNING: It is iIlepl to duplicate this copy by photO$tat or photographi'\~
No.
Fee fur this certificate, $2.00
P
I
9572090
,I~;JP -/) :?
Date:
"1QS '..3.... 211'-
COMMONWE~TW OF PENNSYLVANIA' OEPARTlIENTOF HEALTll' VITAL RECORDS
CERTIFICATE OF DEATH
STAn: IIU.....x
,~
1ft
~M"II\:IOT
.ACJ( _
....
. '.
&Ocw. SECUlVT'I' NIIMotll
3.18<1 -5).
DAti; OF B1RlH
1-. DIy, y.",
~..~..~-:"
foI",.iS&IolAIi, Pit.
.ok
.-
~UHYM"CllII'OUlE
.......... ........-..,
...
-
11111
17, "
'""......"'... _ b.
UWlt.IdoInQ..__
......., ~..r UNO!.RL YtNO t '
CAuse (D1St.aSd or ~ury
..... -'w. ....1b
-1I'l on 110m, LASt ..
WA!1 AN AUTOPSY we,,&. AUTOIIST ~INOINca
PERFOIIMEOI AVAIlJ\BLE "RIOH to
CO""'LETIllN OF CAllU
OFDt!A~H"
:-
.-
:..... ..-
. ,
Ub, ~iL
WOS c..&E IlEFE_O A lIEOICN.. ElWolINEIt ,r;:oAONEI\?
2L ""'0 ""li!11
PARYI; OIb_......ICMI~~ID~....
- ----........ uNIf:GJinII AUIIJ.... .P,.MX.....
~(),I-oc!w-~t~
h-.;k"
1
~~
1
OATE P~I\IDUNCED DEIID 1_. Oa,. Y.""
14. f M. 25. lM. ,. '7 .,:J..C .;!,,)
17.'.flTI: 1li........................~...ICRMI.......~........ ..,..~.tUwo""','lIp... 1I6K1Wr..,1t IIt)'M~......W........
--""tI.,.....,.._crr......l'I'la~....-
. .
tgftAIACOfIaImu~ I
Yo. 0 Noill
Y..D
_E~OFDEI\'l>1
"fill 18 toblil!lJ~
- 0 P"'lNnIIl...IIlg-'
Sl.lltiIQ 0 c;~_ "9\ IN ......."."UJ
'nMEQIo lItJuft,.,
IffJUf\Y Af WOU.K? DESCRIBE HOW lNJU"", CJCCURAEO.
NDO
w~ jl-.t:J
J<I