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i m n f ersonal re resentalrve (2) Appointment of adminrstrator ~j
e Appo nt e l o p p
(1) Appointment of executor, or administrator with ; Pet~troner rs a nominee;See atlachmenl3e(2)). j
will annexed ! PelrUoner is related to the decedent as_
i. [X~ Pebhoner rs named as executor m the will
ri. NO executor is named in the w?11
ur. PeUtiOner is a nominee (See attachment (3) Appointment of special admintstrator requesl-
ge) ed (See attachment 3e(3) for grounds and re-
iv. [X~ Other named executors will not act be- quested powers).
_ cause of ;death~CX decltnalton t. PeUtronor is a !X$?estdent of Calttornta ;
[ other reasons as set forth rn attach- ( !nonresident of California.
meet 3e (rv
FACTS CONCERNING HEIRS
(Complofo m all r:asos) (Curnhltrle only rl nr? sl?ouso or issue survived the dece-
4. ~ The decedent rs surwvrt{ by dor?I l l,Prub C 22H, ?79)
(1) ~X_ spouse ' no spouse c. The decedent
(2) [ X-( child ( ) no child. (t) ( (had no predeceased spouse
(3) ( + issue ul {rre- j X) no rstiue of pm- ( ' had a predeceased spnusu whose heuS ere
tlece:r.:ed child der.e;c.ed child nanrt~d ur tl?t! list of hems
(0) L! parent (X~ no parent. (Complete only d no parent or rssue 5urwved the dece-
b. No Surviving chilrt or issue M a {rredr•cea~ert child d~nl )
hati been unnllr~d hrrm pie Its1 of hens rl lha det.erlenl e: survived by i
(1) ( (a bruthru or sister of rssue ut a predeceasett
brother or sister and none has been omitted
lrom the fist of heirs.
(2) (no brother or sister or rssue of a predeceased i
hrolht:r or sister. i
S. The names, addresses, relationships and ages of heirs, devisees and legatees so far as known to petitrone~ are:
(List additional names, ardresses, relahunshq?s, and ages of heirs, devrseus, and legatees in attachment 5.)
N:uoc and A~!dress Rclabonship Aye
Terrence Meredith (Karyer) Melton, Uauyhter Over 18
3027 Carotr, Newport, Calif.
Anna Kar~cr ~1ot=1~~~r Dccczsed 1975 ~
Eiennet Short, 18654 liattcras St. , Apt. ~
207, Tarzana, Calif. 9135G Nephew Over 18
Ann Salvin, 1609 Arbor Dr., Glendale,
Calif. 91202 Piece •Over 18
F
Elizabeth H. Karger, 2186 Mandeville
Canyon, Los Angeles, Calif. 90049 Spouse Over 18
. t ~
~i ADDITIONAL FACTS CONCERNING THE INDEPENDENT ADMINISTRATION OF ESTATE
6. a. Decedent's wrU does not prer.lude independent adrmnistratron of this estate under Prob C 591 et seq.
b. Decedent died Intestate
Dated. Septemtx~r .
f 1979 ) ~ L'
, G
GEOR(;i: ?•iERC:AUER ~ ~ r~~ ~
! (TYps or pram name) • (S~yrc~t~we ur Petd~~iw•r+ }
i
1 certify (or declarel unde1 pen:+lty of perjury that the foregoing rs true and correct and that this declaration rs executed t
on (Date).~'ht=ci~ix~r- / 197 ;r{(Placej Los Anc)eles/-.'~ California.
•
GEORGE MERCADER - //`~~-~-'Z~%',r. ~ ~ - -
ITYD~ r Pant name) (5 gr+atur~ at peHMunn• ~ M
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