HomeMy WebLinkAbout12-05-06
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REGISTER OF WILLS O~
I
COUNTY, PENNSYL VANIA
Estate of
-:r: IN1 l} ~
7:
cP.
File Number
also known as
, Deceased
Social Security Number I 77 7' 6'"
7;;l.~ J
Petitioner(s}, who is/are 18 years of age or older, a ly(ies} for:
(COMPLETE 'A' or 'B' BELOW:)
I
D A. Probate and Grant of Letters Testamenfry and aver that Petitioner(s} is / are the
last Will of the Decedent dated and codicil(s} dated
named in the
(State rete ant circumstances. e.g.. renunciation. death of executor, etc.)
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s} offered
for probate, was not the victim of a killing and was ever adjudicated an incapacitated person:
~ B. Grant of Letters of Administration
(, applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
Petitioner(s) after a proper search has / have ascerta ned that Decedent left no Will and was survived by the following spouse (if any) and heirs: (If
Administration. c.t.a. or d.b.n.c.t.a.. enter date of 'Il in Section A above and complete list of heirs.)
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(COMPLETE IN ALL CASES:) Attach additiona sheets if necessary.
Decedent, then
ode)
'11 years of age, died 001//;21) ~~
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at JLJ.-rr (5 /, rI:J
PA-
,
$ 2~ ~dt)
,
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~3~ ~ ,-=f!R
:1 :c (') ", (7) 0
situated as follows: ::9 3! ~ ("") q ::0
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Wherefore., Petitioner(s) respectfully request(s) the probatelofthe last Will and Codicil(s) prese~ted with this Petition and the grant of ~ff.j:~rrme appro<pflate fO~ 2::3
the undersigned: ,--.., 0 0 :bo S:~ 0
,,-' -n ,,':71
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Decedent at death owned property with estimate
(If domiciled in PA)
(If not domiciled in PA)
(If not domiciled in PA)
Value of real estate in Pennsylv nia
values as follows:
All personal property
Personal property in Pennsylvania
Personal property in County
~16
~~~
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Form RW-02 rev, 10.13.06
Page 1 of2
O~th of Personal Representative
COMMONWEALTH OF PENNSYLVANIA I
ss
COUNTY OF (1 l.XY'\ ~O_l('H~
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 beliefofPetitioner(s) and ~at, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
day of
re of Personal Representative
y OJ /1/1 ~ i !/4/JA< A~.(./
'Signature of Personal Representative
~~.Qu..\- ~ister
File Number:_
Signature of Personal Representative ()
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Date of Death: \\..21- (")t n
Estate of
and that the instrument(s) dated
described in the Petition be admitted to probate: and filed of reco
FEES
Letters ............... $ qo -CO :
Short Certificate( s) . . . . . . .. $ 'LD . (')C:) i
Renunciation(s) .......... $
~~ ... $lD .()D
~\~~..~ '" $ .t::;'.(:C)
.. . $
.. . $
... $
...$
... $
.. . $
... $
TOTAL .............. $/c.J,J, (J'f)
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in the above estate
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Attorney Signature:
Attorney Name:
Supreme Court 1.0. No.:
Address:
Telephone:
[91117 2 ~J~~<~ ?
Form RW-02 rev. 10.13.06
Page 2 of2
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This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~08703
No.
Fee for this certificate, $6.00
Il-))~o&
Date
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BUILDER
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155 SAWK CHURCH RD.
MECHANICSBURG,PA 17050
........
HUBERT GARRISON SR.
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JAMIE E.GARRISON
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w! ......u..i..... ME. CHANICSBURG
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THELMA TAYLOR
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301 N.PROGRESS AVE. APT.A-9 HARRISBURG.PA 17109
012165L
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MATtNCHEK& DAUGHTERP.H.
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1271 South 28th Street
Harrisburg, PA 17111 ;