HomeMy WebLinkAbout01-05-07
PETITION FOR PROBATE AND GRANT OF LETTERS
. Deceased
. COUNTY, PENNSYL VANIA
File Number iJ 1- ~ - J 8'
Social Security Number lab -d8-7V77
REGISTER OF WILLS OF
Estate of ~~ue: I (~ ~tuJL
also known as
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the
last Will of the Decedent dated and codicil(s) dated
named in the
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of~~enav offer~~~ ,~~ J
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: -~f en ~ U1 ' (-:-:-1
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B. Grant of Letters of Administration~--:-) ~
(If applicable. enter: c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; duran'14minoritate)
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Petitioner(s) after a proper search has / have ascertained that Decedent left no Will and was survived by the following spouse (if any) an'lfteirs: (If
Administration, c.t.a. or d.b.n.c.t.a.. enter date of Will in Section A above and complete /ist of heirs.)
(State relevant circumstances. e.g., renunciation. death of executor, etc.)
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Decedent, then
years of age, died on IJ. - ;) ~-()(,
at3~c1\lr\') 30fJ LleMJOC)< R2. n1~h. p(.).
} J, 1 /0'55'
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 of real estate in Pennsylvania
$ .1 OGfrO 6
$
$
$
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:
T ed or rinted name and residence
f) '1 t J./ner Jti3 Reel ~1a\lZn Rd.
e-w CumbM~d,
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Form R WoOl rev. /0.13. 06
Page 1 of2
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF
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
administer the estate according to law.
Sworn to or affirmed and subscribed
B~
before me the
day of
Signature of Personal Representative
Signature of Personal Representative
File Number: ,Q 1-01- I&'
Estate of l "5u rc I { ~ f3tcn-f?L9-
Social Security Number:j 8b '"d8-'7l1 77 .
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Date of Death:
, Deceased
J~ -J 9-00
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AND NOW, --.J6-I'.'-"- n ,\. ~ ~ S , lJM'1 . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, I S DECREED that Letters -M~\ ~\ 'S..+rrd-'~
are hereby granted to ~ (\ -"'---"- ~~ OA
in the above estate
and 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.
FEES \ W.pYlriaJiaA.I'J.P1 ( j-;h~~
$ Y)JO. () r-.. Register o~
Letters ............... Q!Q _ ~
Short Certificate(s) . . . . . . . . $ L.J{) ./JC Attorney Signature:
Renunciation(s) .......... $ 5.00
- \(t P .. . $ to. 00
O.a ~~--.. ... $ 5~;'Jm
...$
...$
... $
...$
...$
...$
. .. $
TOTAL .............. $ f)1?O .OD
Attorney Name:
Supreme Court I.D. No.:
Address:
Telephone:
Form RW-02 rev. /0./3.06
Page 2 of2
{105.R05 REV 1105
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.
No.
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Fee for this certificate, $6.00
Local Registrar
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December 29. 2006
34 ~cm~aft:"l'o~c:_e8"tdm TlllIIlPrint
6375 Be.sehore RQad1 Suite 111
MechanicsDurg. PA 7050
RENUNCIA TION
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REGISTER OF WILLS
COUNTY, PENNSYL VANIA
Estate of ,5tt f./h &n fze I
I, YV()'lne tv~ '1 ttJ/, ;fz.e./
(print Name)
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, Deceased
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
/Ild~ A~"
Ii'ffhe+-
fI~~-'~.f
9;0 7 /1 ~rn I~c/L U
(Street Address)
111 evh frJ- /70Ss
(City, State, Zip)
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renunciation for the
purposes stated within on this day
of
/- S~tJ(,.
(Date)
Notary Public
My Commission Expires:
(Signature and Seal of Notary or other official qualified to
administer oaths. Show date of expiration of Notary's Commission.)
FormRW-06 rev. 10.13.06