FORMS
| PETITION FOR PROBATE and GRANT OF LETTERS | |||
| Estate of . . . . . . . . . . . . . . . . . . .
. also known as . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Deceased. Social Security No. . . . . . . . . . . . . . |
No. . . . . . . . . . . . . . . . . . . .
. . . . . . To: Register of Wills for the County of . . . . . . . . . . . . . . in the Commonwealth of Pennsylvania |
||
| The petition of the undersigned respectfully represents that: Your petitioner(s) is/are 18 years of age or older and the execut. . named in the last will of the above decedent, dated . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. . and codicil(s) dated . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in . . . . . . . . . . .County, Pennsylvania, with Decedent, then . . . . . . . . years of age, died . . . . . . . . l9 . . , at . . . . . . . . . . Except as follows, decedent did not marry, was not divorced and did not
have Decedent at death owned property with estimated values as follows: |
|||
| (If domiciled in Pa.) (If not domiciled in Pa.) (If not domiciled in Pa.) |
All personal property Personal property in Pennsylvania Personal property in County |
$ . . . . . . . . . . $ . . . . . . . . . . $ . . . . . . . . . . |
|
| Value of real estate in Pennsylvania | $ . . . . . . . . . . | ||
|
situated as follows: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WHEREFORE, petitioner(s) respectfully request(s) the probate of the last
will Signature(s) and Residence(s) of Petitioner(s) |
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|
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||
_____________________________________________________________
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
of
petitioner(s) and that as personal representative(s) of the above decedent peti-
tioner(s) will well and truly administer the estate according to law.
Signature(s)
Sworn to or affirmed and subscribed ) . . . .
. . . . . . . . . . . . . .
before me this. . . . . . . . . . day of .
. ) . . . . . . . . . . . . . . . . . .
19.
.
)
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. ) . . . . . . . . . . . . . . . . . .
For the Register ) . . . . . . . . . . . . . . . . . .
No. . . . . . . . . . . . . . . . . . .
Estate of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW, . . . . . . . . . 19. ., in consideration of the
petition on the reverse
side hereof, satisfactory proof having been presented before me, IT IS DE-
CREED that the instrument(s), dated . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . ,
described therein be admitted to probate and filed of record as the last will of
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
and Letters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
are hereby granted to . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Register of Wills
FEES
Probate, Letters, Etc. . . $ . . .
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Short Certificates( ) . . $ . . .
.
ATTORNEY (Sup. Ct. I.D. No.)
Renunciation . . . . . . . . $ . . .
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . $ . . .
.
ADDRESS
TOTAL . . $ . . .
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Filed . . . . . . . . . . . . . . . . . . .
.
PHONE
____________________________________________________________
REGISTER OF WILLS OF . . . . . . . . . . COUNTY
OATH OF SUBSCRIBING WITNESS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . ,
(each) a subscribing witness to the codicil/will presented herewith, (each)
being
duly qualified according to law, depose(s) and say(s) that . . . . . . . . . .
.present
and saw . . . . . . . . . the testat. . ., sign the same and that . . . . . . .
. . . . .signed
as a witness at the request of testat. . . . . in h. . . . . . presence and (in
the pres-
ence of each other) (in the presence of the other subscribing witness(es)).
Sworn to or affirmed and
subscribed
. . . . . . . . . . . . . . . . . . . . . . . . . .
before me this . . . . . . . . . . day
of
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . 19.
. . . . . . . . . . . . . . . .
. . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
(Address)
For the Register . . . . . . . . . .
. . . . . . . . . . . . . . . .
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
REGISTER OF WILLS OF . . . . . . . . . . COUNTY
OATH OF NON-SUBSCRIBING WITNESS
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . ,
(each) a subscriber hereto, (each) being duly qualified according to law,
depose(s)
and say(s) that . . . . . . . . . . . . familiar with the signature
of . . . . . . . . . . . . . . .,
testat . . . . . . . . of (one of the subscribing witnesses to) the codicil/will
presented
herewith and that . . . . . . . . . . . . . . . believes the signature on the
codicil/will is in
the handwriting of . . . . . . . . . . . . . to the best of . . . . . . . .
knowledge and belief.
Sworn to or affirmed and
subscribed
. . . . . . . . . . . . . . . . . . . . . . . . . .
before me this . . . . . . . . . . day
of
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . 19.
. . . . . . . . . . . . . . . .
. . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
(Address)
For the Register . . . . . . . . . .
. . . . . . . . . . . . . . . .
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
_______________________________________________________________
REGISTER OF WILLS OF . . . . . . . . . . COUNTY
OATH OF WITNESS TO BE EXECUTED
BY MARK
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . ,
(each) a subscribing witness to the codicil/will presented herewith, (each)
being
duly qualified according to law, depose(s) and say(s) that: testat. . . .was
unable
to sign h. . . . . . name thereto; testat. . . . . . 's name was
subscribed thereto in
testat. . . . .'s presence; testat. . . . . made h. . . . mark
thereon; testat. . . . and
deponent(s) was (were) present when testat. . . . .'s name was
subscribed and
when testat. . . . . . made h. . . . . . mark; and testat. . . . .
was present when the
undersigned signed the codicil/will as a witness(es).
Sworn to or affirmed and
subscribed
. . . . . . . . . . . . . . . . . . . . . . . . . .
before me this . . . . . . . . . . day
of
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . 19.
. . . . . . . . . . . . . . . .
. . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
.
(Address)
For the Register . . . . . . . . . .
. . . . . . . . . . . . . . . .
(Name)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
RENUNCIATION
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . ,
In Re Estate of . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . deceased.
To the Register of Wills
of
County, Pennsylvania
The undersigned . . . . . . . . . of the above
decedent, hereby renounce(s) the
right to administer the estate and respectfully ask(s) that Letters
. . . . . . . . . .be
issued to . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
WITNESS . . . . . . . . . hand this . . . .
. . . . . . . . day of . . . . . . . . . , 19. . .
. . . . . . . . . .
. . . . . . . . . . . . . . . .
(Signature)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
. . . . . . . . . .
. . . . . . . . . . . . . . . .
(Signature)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
. . . . . . . . . .
. . . . . . . . . . . . . . . .
(Signature)
. . . . . . . . . . . . . . . . . . . . . . . . . .
(Address)
____________________________________________________________
WILL
REGISTER OF WILLS
CERTIFICATE OF GRANT LETTERS
No. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . .
ESTATE OF . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
Seal
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . .
Social Security No. . . . . . . . . . . . . . . . . . . . . . . . .
. .
WHEREAS, on the . . . . . . . . . . day of . .
. . . . . . .19. . .instrument(s) dated
. . . . . . . . . . . . . . . . . . . . . . . was (were) admitted to
probate as the last will of
. . . . . . . . . . . . . . . . . . . . . . . late of . . . . . . .
. . . . . . . . . . . . , who died on the
. . . . . . . . . . day of . . . . . . . . . . . 19. . ,
and
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, . . . . . . . . . . . . ,
Register of Wills in and for the County of
. . . . . . . . . . , in the Commonwealth of Pennsylvania, hereby
certify that I have
this day granted Letters . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
who ha. . . . . duly qualified as . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
and ha. . . . . .agreed to administer the estate according to law,
all of which fully
appears of record in my Office at . . . . . . . . . , Pennsylvania.
IN TESTIMONY WHEREOF, I have hereto set my
hand and affixed the
seal of my Office the . . . . . . . . . . day of . . . . . . . . 19.
. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Register of Wills
SHORT CERTIFICATE -- LETTERS OF ADMINISTRATION
COMMONWEALTH OF PENNSYLVANIA )
)
SS
COUNTY OF
)
I, . . . . . . . . . . . . . . . . . . . . . .
. , Register of Wills in and for the County of
. . . . . . . . . . . in the Commonwealth of Pennsylvania, DO HEREBY
CERTIFY
that on the . . . . . . . . . .day of . . . . . . . . .19. . ,
LETTERS OF ADMINISTRA-
TION on the Estate of . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . deceased, were granted to . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
having first been qualified well and truly to administer the
same. And I further
certify that no revocation of said Letters appears of record in my
office.
Date of Death . . . . . . . . . . . . . . . .
. Given under my hand and seal of
office
Social Security No. . . . . . . . . . . . .
. this . . . . . . . . . . day of . .
. . . . . . . . .,
19. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deputy Register
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
______________________________________________________________
SHORT CERTIFICATE -- LETTERS TESTAMENTARY
COMMONWEALTH OF PENNSYLVANIA )
)
SS
COUNTY OF
)
I, . . . . . . . . . . . . . . . . . . . . . . . . . ., Register of
Wills in and for the County of
. . . . . . . . . . ., in the Commonwealth of Pennsylvania, DO HEREBY CERTIFY
that on the . . . .. . . . . . day of . . . . . . . . ., 19. ., LETTERS
TESTAMENTARY
on the Estate of . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . deceased, were granted to . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
having first been qualified well and truly to administer the same. And I
further
certify that no revocation of said Letters appears of record in my office.
Date of Death . . . . . . . . . . . . . . . . . Given
under my hand and seal of office
Social Security No. . . . . . . . . . . . . . this . . .
. . . . . . day of . . . . . . . . . . .,
19. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Deputy Register
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of . . . . . . . . . . . . . . . . . . .
. No. . . . . . . . . . . . . . . . . . . . . . . . . .
. .
also known as . . . . . . . . . . . . . .
. To:
. . . . . . . . . . . . . . . . . . . . . . . . . . .
. Register of Wills for the
. . . . . . . . . . . . . . . . . . . .Deceased.
County of . . . . . . . . . . . . . . . . in the
Social Security No. . . . . . . . . . . .
. Commonwealth of
Pennsylvania
The petition of the undersigned respectfully
represents that:
Your petitioner(s), who is/are 18 years of age or
older, appl. . . . . . . . . . .for
letters of administration . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . .
(d.b.n.; pendente lite; durante absentia; durante
minoritate)
on the estate of the above decedent.
Decedent was domiciled at death in . . .
. . . . . . County, Pennsylvania, with
h . . . last family or principal residence at . . . . . . . . . . .
. . . . . . . . . . . . . . . . .
(list street, number and municipality)
Decedent, then . . . . years of age, died . . . . . . . . . . . . .19. ., at . . . . . . . . .
Decedent at death owned property with estimated values as follows:
(If domiciled in
Pa.)
All personal
property
$ . . . . . . . .
(If not domiciled in Pa.)
Personal property in Pennsylvania $ .
. . . . . . .
(If not domiciled in Pa.)
Personal property in
County
$ . . . . . . . .
Value of real estate in
Pennsylvania
$ . . . . . . . .
situated as follows: . . . . . . . . . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . . . . . . . .
Petitioner . . . . . . . . after a proper
search ha. . . . . . . ascertained that dece-
dent left no will and was survived by the following spouse (if any)
and heirs:
Name
Relationship
Residence
. . . . . . . . . . . . . . . . . . . .| . . . . . . . . . . . . . .
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. . . . . . . . . . . . . . . . . . . .| . . . . . . . . . . . . . .
. . . . . . | . . . . . . . . . . . . . . . . . .
THEREFORE, petitioner(s) respectfully
request(s) the grant of letters of ad-
ministration in the appropriate form to the undersigned.
Signature(s) and Residence(s) of Petitioner(s)
. . . . . . . . . . . . . . . . . . . . . . . . . . .
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______________________________________________________________
______________________________________________________________
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 of
petitioner(s) and that as personal representative(s) of the above
decedent peti-
tioner(s) will well and truly administer the estate according to
law.
Sworn to or affirmed and subscribed )
Signature(s)
before me this . . . . . . . . . . . . . day
of ) . . . . . .
. . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . 19.
. )
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. ) . . . . . .
. . . . . . . . . . . . . . . . . . . . .
For the Register )
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)
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____________________________________________________________
No. . . . . . . . . . .
Estate of . . . . . . . . . . . . . . . . . . . . . ., Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW . . . . . . . . 19. ., in consideration of the
petition on the reverse
side hereof, satisfactory proof having been presented before me, IT IS DE-
CREED that . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . .
is/are entitled to Letters of Administration, and in accord with such finding,
Let-
ters of Administration . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . .
are hereby granted to . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
in the estate of . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
Register of Wills
FEES
Letters of Administration $ . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . . . . .
Short Certificates( ). . . . . . $ . . . .
. ATTORNEY (Sup. Ct. I.D. No.)
Renunciation . . . . . . . . . . . . $ . . . .
. . . . . . . . . . . . . . . . . . . . . .
. . . . . .
. . . . . . . . . . . . $ . . . .
.
ADDRESS
TOTAL . . . . . $ . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . .
Filed . . . . . . . . . . . . . . . . . A.D. 19.
.
PHONE
REGISTER OF WILLS
CERTIFICATE OF GRANT OF LETTERS
No. . . . . . . . .
ESTATE OF . . . . . . . . . . . . . . . . . . . . . . . . . .
. .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . .
Seal
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . .
Social Security No. . . . . . . . . . . . . . . . . . . . . . . . .
WHEREAS, . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . .
died on the . . . . day of . . . . . . . . .19. ., and
WHEREAS, the grant of letters is required for
the administration of the es-
tate.
THEREFORE, I, . . . . . . . . . ., Register of
Wills in and for the County of
. . . . . . . ., in the Commonwealth of Pennsylvania, have
this day granted Let-
ters of Administration . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . .
to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . .
who ha. . . . duly qualified as administrator . . . . . . . . . . .
of the estate of the
above named decedent and ha. . . agreed to administer the estate
according to
law, all of which fully appears of record in my Office at . . . . .
. . .., Pennsylva-
nia.
IN TESTIMONY WHEREOF, I have hereunto set my
hand and affixed the
seal of my Office on the . . . . . . .day of . . . . . . . . . 19. .
.
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
Register of Wills
____________________________________________________________
REGISTER OF WILLS OF . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . COUNTY
BOND AND SURETY FOR
PERSONAL REPRESENTATIVE
KNOW ALL BY THESE PRESENTS, That . . . . . . .
. . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . as
principal(s) and . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
as surety (sureties) are held and firmly bound unto the Commonwealth
of Penn-
sylvania in the sum of . . . . . . . . . . dollars
($ ) to be paid to
the Common-
wealth, for which payment we do bind ourselves, jointly and
severally, our heirs,
executors, administrators and successors, the condition of this
obligation being
that if . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . as (state fiduciary
capacity). . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . .
of the estate of . . . . . . . . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . , deceased,
or any of them, shall well and truly administer the estate according
to law, then
this obligation shall be void as to the personal representative or
representatives
who shall so administer the estate and his or their surety or
sureties; but other-
wise it shall remain in full force.
Signed and sealed this . . . . . . . . . day
of . . . . . . . . . 19. ., each intending
to be legally bound hereby.
. . . . . . . . . . . . . . . . . . . . . . . . . . (Seal)
. . . . . . . . . . . . . . . . . . . . . . . . . . (Seal)
. . . . . . . . . . . . . . . . . . . . . . . . . . (Seal)
. . . . . . . . . . . . . . . . . . . . . . . . . . (Seal)
. . . . . . . . . . . . . . . . . . . . . . . . . . (Seal)