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c.T r` ,4 t~ ji~~11"HE C~RGKIIT COURT FOR
4~,~a~~ ~F 5 t S t. Luc ie CpUNTY. FLORIDA
'18 ~ltr 2~ p''~ '
PROBATE DIV ISlON
QV RE: ESTATE OF . ~ - •
;
CHARLES H. SIMMONS Cl_L~~~ i::': ~ ~~~sit i F~ Number ~'f U
Division ~
. . Deceased
PETITION FOR ADMINISfRATION
. (Florida Resident With Will - Single Petitioner)
The petitioner, Tack Fordham alleges:
l. Petitioner has an interest in the above estate as Personal Representative
nominated in the decedent's Last Will and Testament
Petitioner's name and address are ~ Jack Fordham 451~+ Travois Drive
San Antonio, Texas 78238
and the name and address of petitioner's attorney are as set forth at the end of this petition.
2. Decedent, CHARLES H. SIMMONS , whose last known
address was 768 Airoso Blvd. Pt . St . Lucie , Florida~d~ known, whose age was
78 and whose social security number is 333-18-6743 died on " August
18 19 78 ~ at Martin Memorial Hospital , a~ at the time of death
decedent was domiciled in S t. Luc ie County. Florida.
j 3. So faz as is known, the names of the beneficiaries of this estate, their addre.sses and
` relatioruhips to decedent, and the ages of any who are mittors, are:
P -
~ .
~
f
~ NAME ADDRESS RELATIONSHIP AGE
; (BIRTH DATE
~ - IF ,ViIlYOR)
C. Jack Fordham 4514 Travois Dr. Nephew
~ San Antonio, Texas 78238
C John Fordham Jr 793 Scripps Dr Grandnephew
Claremont California 91711
~
~ Gar~t Fordham % C Jack Fordham Grandnen ew
~ 4514 Travois Dr. San Antonio,Texas
~
w decedent died
4. Venue of this proceeding is in this county because
~ domiciled in St. Lucie County, Florida
~
~
~
C. Jack Fordham 4514 Travois
5. , who9e address i~ _
_
~ Drive S~n AntoniQ, Texas 78238
~
~ -
~
~ Fornt No. P-21 80QK~e PAGE 4~
i~ The Florida Bar 1975. 1976
~ ~
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