PETITION FOR GRANT OF LETTERS

REGISTER OF WILLS OF   

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 request(s) the grant of  Letters in the appropriate form:

File No:       

        (Assigned by Register)

Social Security No:       
Age at death:       

Decedent's Information
Name:       
a/k/a: 
a/k/a: 
a/k/a: 

Date of Death:       

Decedent was domiciled at death in 
principal residence at       

Decedent died at       

Estimate of value of decedent's property at death:

   Street address, Post Office and Zip Code 

   City, Township or Borough   

 County

  County,        

      (State) with his/her last

  Street address, Post Office and Zip Code 

 City, Township or Borough   

  County 

  State

$  
If domiciled in Pennsylvania.. . . . . . . . . . . . . . . . . . . . . . . . . . . All personal property
$  
If not domiciled in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . Personal property in Pennsylvania
If not domiciled in Pennsylvania. . . . . . . . . . . . . . . . . . . . . . . . Personal property in County
$  
Value of real estate in Pennsylvania.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $  
TOTAL ESTIMATED VALUE. . . . $  

Real estate in Pennsylvania situated at:        
(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) he/she/they is/are the Executor(s) named in the last Will of the Decedent, dated    
thereto dated      

    and Codicil(s)

 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 a 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.

    NO EXCEPTIONS         EXCEPTIONS         
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):

Name

Relationship

Address

Form RW-02   rev. 10/11/2011 

Page 1 of 2

Oath of Personal Representative

Official Use Only

COMMONW EALTH OF PENNSYLVANIA 

COUNTY OF 

 }
 }  SS:

 }

Petitioner(s) Printed Name

Petitioner(s) Printed Address

The Petitioner(s) above-named swear(s) or affirm(s) 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 Decedent, the Petitioner(s) will well and truly administer the estate according to law.

Sworn to or affirmed and subscribed before
me this            day of                        ,      
By:         

For the Register

 Date 
 Date 
 Date 
 Date 

To the Register of Wills:
Please enter my appearance by my signature below:

Attorney Signature:

BOND  Required:       YES         NO 
FEES:

Letters . . . . . . . . . . . . . . . . . . . . . . $ 
 ) Short Certificate(s). . . . . .
( 
 ) Renunciation(s).. . . . . . . .
( 
 ) Codicil(s). . . . . . . . . . . . .
( 
( 
 ) Affidavit(s). . . . . . . . . . . .
Bond. . . . . . . . . . . . . . . . . . . . . . . .
Commission. . . . . . . . . . . . . . . . . .
 . . . . . . . .
Other 
 . . . . . . . .
 . . . . . . . .
 . . . . . . . .
 . . . . . . . .
 . . . . . . . .
 . . . . . . . .
 . . . . . . . .
Automation Fee. . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
JCS Fee.
TOTAL. . . . . . . . . . . . . . . . . . . . . $ 

Printed Name:  
Supreme Court
ID Number:       

Firm Name: 
Address: 

Phone: 
Fax: 
Email: 

Estate of       
a/k/a: 

DECREE OF THE REGISTER

 File No:       

      AND NOW,                                                                            ,      
satisfactory proof having been presented before me, IT IS DECREED that Letters       
     are hereby granted to     

  , in consideration of the foregoing Petition,

        in the above estate and (if applicable) 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.

Form RW-02   rev. 10/11/2011 

Page 2 of 2

Register of Wills