HomeMy WebLinkAbout01-05-07
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF ("c,., rn ~~ 1c:J, t! COUNTY, PENNSYLVANIA
Estate of
also known as
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LevI'"
File Number
d..\
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2/0 SR (,008
, Deceased
Social Security Number
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
G A. Probate and Grant of Letters T!tamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated (0/ il. q 4 and codicil(s) dated
EKf( (i/t'+c r
named in the
(State relevant 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 instmment(s) offered
for probate, was not the victim of a ki\1ing and was never adjudicated an incapacitated person:
o B. Grant of Letters of Administration
(If applicable, enter: c. t. a... d. b. n. c.t.a.; pendente lite; durante absentia; durante minoritate)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following s~se (if any) a@eirs: (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.) ::~~ s:5 <-
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Name
Relationshi
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(COMPLETE IN ALL CASES:) Attach additiollal sheets ifllecessary.
, Pennsylvania with his / her last principal residence at
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Decedent, then 4 ~
years of age, died on
J!J!U'q..
at
Hu Iv 1" P" .-;' + ,1-Jw.P1= 1 ~+
I ,
(a ;rs f'h
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Decedent at death owned property with estimated values as follows:
(If domiciled in P A) All personal property
(If not domiciled in PA) Personal property in Pennsylvania
(If not domiciled in P A) Personal property in County
Value ofreal estate in Pennsylvania
$
$
$
$
o
situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate form to
the undersigned:
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Gr~.5 }II, V<Vil\
Form RW.02 rev. [0.13.06
Page 1 of2
Oath of Personal Representative
COMMONWE^I\TH OF PENN2V ANIA
COUNTYOF t\~\~
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
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administer the estate according to law.
Sworn to or affirmed and subscribed
before me the b
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ture o/f'ersonal Representative
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Signature of Personal Representative
Signature of Personal Representative
AND NOW,
having been presented be
are hereby granted to
Estate of
~
, Deceased g
, 0 -..l
JA(j/^& (:::'0 <-
VJ \.y Date of Death: :~~:Jb 0 :;
,i7-ct>1 , in '~n=an:~rnregOing P'ti.J,.~;.ijjf"t"!"P<OOf;
ECREED that Letters \P3.:~..:f)j-:; -<;:;!-.'
"--' 'y <:."} '::-n :$. .. ..
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~n the abo1Te estate'
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and that the instrument( s) dated
described in the Petition be admitted to probate and filed ofrec
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FEES
Letters .......... Ii ~ $~ .to
Short Certificate(s) . ~Q.). $-SO'oO
Renunciation(s) .......... $
=I ... $ (v,OD
.. . $ /0 .(j)
:Jo ... $ S.oO
. .. $
... $
.. . $
. .. $
. .. $
.. . $
TOTAL .............. $ <::to . c()
Attorney Signature:
Attorney Name:
Supreme Court LD. No.:
Address:
Telephone:
Form RW-02 rev. 10.13.06
Page 2 of2
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IIOo.BO) REV I/O)
This is to certify that the information here given is correctly copied fron~ an original ce~ificate of death du~~. filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent fIhng.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Fee for this certificate. $6.00
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COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH . VITAL RECORDS
CERTIFICATE OF DEATH
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26. w.. Case ReferreO lD WedicaI Exarrm I Coroner fa' a Reason Oller Iha"I Cremation Q( Donation 1
OVes ONe .
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: ApproQnale i'Ilerval
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28_ Did Tobacco U. Contrtbuillo 0eaIh?
o Ves 0 Probabl,
o No ~now"
29. , Female:
(2]...I6pregnnWlthinpastyear
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o Not pregnant. 001 pregnant Wlthin.42 daY'
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o Nolprugnaol.,bIApregnant43dayaIo1~_
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D Ul'IIlnr:Jwn if ptegflan\ IIfl!hln the past 1fJif
32c._ P1aaldlrf,J'Y: Home. Farm. Stt8f,t,Facby
0lI00 BuddIng.~ (Sp<dyJ
PartII:EnlerollefsiUOOrai.oondilms~kldP.alh
blI'noff85litinQillh9undeJt;~calIS8gMnisJPil1.l.
$1-"'-'''''
kl~iNlldmlnea
En. UNOERl.. YItG CAUSE
(~iJlff.JrY\hdtl1ib.dad1he
lMlI'll:s A:l$I..IIlr1g Wl death J LAST.
OcIBID{otati.llt::OrWeqLlel"lC8o1).
d.
12 I I I.). I I I ~ I
32g lD<3oooll"i"YI_.cily/k>wn._J
308 Will an Auqls,
Portofmod?
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AvalitilPlhlD~
01 Cause of Death?
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CMtjying phpic;iAn (PhYSlCldIl (~C<lI.lS6 d dealh when aootlar phyliic&1 tIiII ~ de... W1d c:acnpltllIld Ittlm 23)
Tou..hMtrAlJl)'~, deIih occ.&In.dduellDthllcauu('1 MdmanlMlr........____ _ __ __... _ ___ __ _ __ ___ _ _ __ _ _ _ ____
. ~:=::,.:::=:h~tan~:::~~~~~.:u~:=~~~lMnneru.tatN. _ _ _ _ __ _ _____ _ __ _.. JJ
. =' =:~= aMI or klwMtiQatioA, In mJopir\6on, dNlh oc.currMi at the UmI, datil, and p4ac;., and due to the c;auee(11 tnd mannIf.. ~.. n
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LAST WILL AND TEST AMENrr
I, Jeffrey Scott Levin, of Cumberland County, Pennsylvania,> being of sound and disposing mind,
memory and understanding, declare the following to be my last will and testament, hereby revoking
any and all wills heretofore made by me.
Item I. I direct my executor hereinafter named to pay all my debts and funeral expenses.
Item II. I give, devise and bequeath all my property, both real and personal, to my two
children Brian Scott and Latka Marie, in equal shares, providing they survive me. If either should
die without issue, I leave my entire estate to my remaining living child.
Item III. I appoint Greg Levin, as trustee of said child or children under age 21 at the time
of my death. I give my trustee the right to invest as it sees fit and expend principal as it sees fit.
especially for educational and/or health reasons on behalf of my children. The trust will terminate
when each of my children reaches age 21, at which time the balance of his or her share of the trust
will be turned over to him or her.
Item IV. I nominate, constitute and appoint Greg Levin, as my executor, and direct that he
shall serve without bond. If he should be unable to serve, I appoint Todd Levin, as substitute,
executor, and I direct that he should serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
twelveth day of June, 1999
~i-- Seal
Signed, sealed, published and declared by the above named testator, as and for this last will and
testament, who at his requ~n his pr, esence, in our presence, and in the presence of each other have
here~~o sub"i~r ~1~;t a~~ing witnesses:
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COMMONWEAL TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I, Jeffrey Scott Levin, whose name is signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my last will, that I signed it willingly; and that I signed it as my free and voluntary
act for the purposes therein expressed.
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Sworn to and subscribed before me this
twelveth day of June, 1999
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COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We,~(U 0...(\ ~cc.r{~ Y'...an;?~~ ~~~hose names are signed to
the attached or foregoing instrument, being duly qualified according to law, do depose and say
that we were present and saw testator sign and execute the instrument as his last will, and that he
signed willingly and that he executed it as his free and voluntary act for the purposes therein
contained, that each of us in the hearing and sight of the testator signed the will as witnesses; and
that to the best of our knowledge, the testator was at that time 18 Q ore years of age, of sound
mind and under no constraint or undue influence ~
~~.~
Sworn to and subscribed before me this
twelveth day of June, 1999
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