PETITION FOR PROBATE AND GRANT OF LETTERS Register of Wills of Erie County, Pennsylvania Kenneth J. Gamble, Clerk of Records 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 requests the grant of Letters in the appropriate form: Decedent's Information Name: _______________________________________________ A/K/A: _______________________________________________ A/K/A: _______________________________________________ A/K/A: _______________________________________________ Date of Death: ________________________________________ File No:________________________ Social Security # ________________ Age at Death: ___________________ Decedent was domiciled at death in ______________County, Pennsylvania, with his/her last family or principal residence at_____________________________________________________________________ ________________________ Street address, Post Office and Zip Code Municipality: Twp, Borough, City Decedent died at___________________________________________________________________________________ Street address, Post Office and Zip Code City, Township or Borough State Estimated value of decedent's property at death: If domiciled in PA All personal property If not domiciled in PA If not domiciled in PA Value of Real Estate in Pennsylvania Personal Property in PA Personal Property in county $ _______________________ $ _______________________ $ _______________________ $ _______________________ Total Estimated Value $ _______________________ Real Estate in Pennsylvania Situated as follows: (Attach additional sheets, if necessary.) _____________________________________________________________________________________________ Street address, Post Office and Zip Code City, Township or Borough County A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated_________________ and Codicil(s) thereto dated_______________________________________________________________________________________________________ __________________________________________________________________________________________________________________ State relevant circumstances (e.g. renunciation, death of executor, etc.) Except as follows: after the execution of the instrument(s) offered for probate Decedent did not marry, was not divorced, was not a party to a pending divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. NO EXCEPTIONS EXCEPTIONS __________________________________________________ B. 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, c.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 party to 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 ever adjudicated an incapacitated person. Name NO EXCEPTIONS EXCEPTIONS ____________________________________ Relationship to Decedent Address 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): Form RW-02 Rev. 10-11-2011 NOTE: This form must be printed double-sided. American LegalNet, Inc. www.FormsWorkFlow.com Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF __________________________ } Petitioner(s) Printed Address Official Use Only Petitioner(s) Printed Name 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 their knowledge and belief 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 Before me this ____________day of ______________________20_____ _____________________________ Acting Deputy For the Register BOND Required: Yes FEES: Letters....................... Short Certificates ( )... JCP fee..................... Automation fee............ Commission ............... ................................ ................................ Total.......................... $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ $ ____________ _________________________________________ Date___________ _________________________________________ Date___________ _________________________________________ Date___________ No To the Register of Wills: Please enter my appearance by my signature blow: Attorney Signature: ________________________________________ Printed Name: _______________________ Superior Court ID:_____________________ Firm Name: Address: _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ _______________________ Phone: Fax: Email: DECREE OF THE REGISTER Estate of : ___________________________________ File No. ________________Will No. __________________ A/K/A: _____________________________________________________________________________________________ AND NOW, this _________day of _______________________, __________, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters _________________________________ are hereby granted to ________________________________________________________________________________ in the above estate and (if applicable) that the instrument(s) dated _____________________________________________ that is/are described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of the Decedent. ______________________________________________ Clerk of Records Form RW-02 Rev. 10-11-2011 NOTE: This form must be printed double-sided. 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