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~ ~ OOUNl~Y,17.~IDA
IN RR: 88TATB RO~~
~~i~ G~~~ ~OB~ATS DiVI~ON ~ .
, . ~CLERK 84- / C,D
~lAAV~3Y T: BASSBTP - l~W Aiua~b~e .
' . Dhr~io~
. Deaa~d
tP.T1TION P'OR, ADMINL4TRATION
~ (Florida Reddeitt With Wiil - Sin~ Petitione~r) -
` DEBORAH PIt~TATY
~t10Mt~ ~
1. Petitione~ Iw~ an iuterest in tbe above e~te a~ be~neficiary and named A~
personal representative in decedent~c 7ACt A~a
Petitioner'a name a»d iddreas ate ~ PI~TY~ $005 Sauth It~dian River Drive _
~ Fort Pierce, Florida 33450
and t6e oame and addre~s of petitioner's attosney ara set forth at the end oi thv petition. ~
~ Z. Ikcedeat, HARVEY T. SASS~T ~ ~
whwe la~ k~rown addras w~ Easton Manor Nursing Haae, Fort Pierce. Florida ,
: md, ii known, whoee aQe vras ~ xnd whosr soci~l security numb~r is 386-16-1915 ~
died on ~?ef1~eT 25 ,19 -$3._ at F.~ctnr Maru~r N~~-,,,'~_~.jpp~,_ ~
md at the time of da~tb decedent w~ domiciled in St. Lucis
3. So fu as is known, t6e names of t6e bene~ciaries of tf~i~ e~te and of tlr~ deeedent's
~ surininS apouae, it u?y, their addns~ea and r~atiomhips to decedent, and tbe a~es of any who are.
minors, ue:
NAME ADDRESS RELATIONSHIP . AGE .
8005 S. Indian River Dr. - (BIItTH DATB IF ~INOA)
I}E~ORAN PIOWATY Fort "Pierce, Fla. Daut~hter ~ Leg~7
SUIJ BAMC OF ST. LiJCiE P.O.Boac 8 None
~ - Fort Pierce, Fla.
4. Venue oi t6i~ prooeedin~ is ia this county because ~~~t died a resir~r~,r
of this countv -
,
5. DF.BORAH PIOWATY
.
wbose ad~ is ~~5 I~~ ~ver Drive, Fort Pierce. Flor~~ 3~50
/ ~ ~
Form No. P
21 ~ ~
0 Th. Flo:id~ B~e 1~7~