HomeMy WebLinkAbout01-09-08
PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF Cumberland
COUNTY, PENNSYLVANIA
Estate of Anne D. Seletos
also known as
File Number
rl.' a~ D~~
, Deceased
Social Security Number 198-18-9283
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE ~' or 'B' BELOW:)
lZl A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is / are the Executrix
last Will of the Decedent dated January 29, 2007 and codicil(s) dated
("")
~g
u"
_,Ie)
j ::~: ~
:~~.
r-..:>
=
g named inthe
c...... . - )
"7:'D
d::
I
1..0
'-j
,
(State relevant circumstances, e_g, renunciation. death of executor, etc) . , :; ~3 (,,~ ~ ___,
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution :orilie instrum~s) offered)
~--i ..'
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: 1~~ : .; - ,
en
o B. Grant of Letters of Administration
(If applicable, enter_- c.t.a.,' d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate)
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: (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.)
Name
Relationship
Residence
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland
Manor Care. 1700 Market Street. Camp Hill. P A 17011
(List street address, town/city, township, county, state, zip code)
County, Pennsylvania with his / her last principal residence at
Decedent, then 84
years of age, died on December 22, 2007
at Manor Care, 1700 Market Street, Camp Hill, P A 17011
Decedent at death owned property with estimated values as follows:
(If domiciled in P A) 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
250,000.00
$
$
$
$
situated as follows:
Wherefore. Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of Letters in the appropriate fonn to
the undersigned:
Nancy M. Pcsolyar
T
799 Winterberry Drive, Fredericksburg, VA 22405
Form RW-02 rev. 10.13.06
Page 1 of2
Oath of Personal Representative
COMMONWEAL TH OF PENNSYLVANIA
SS
COUNTY OF Cumberland
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 ofPetitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
before me the
~
to }\~ m.1'1',.14lVL-
Signature of Pers al Representative
C)
C;o
. :::0
~J: =? ()
~ :~ q~\
. ,'- ..-, :::.~-
,....;)
<==>
C:~
<::0
<-
~
Z
I
I.D
'c I ~' '.-)
j ;'
Sworn to or affirmed and subscribed
day of
Signature of Personal Representative
Signature of Personal Representative
,.,..---, ,..--,
.; ';2 '~-~r,
j~
.- ::,D
--,
.,]
:r:>
-0
3:
'="
( -.,
.--.\
0'"
File Number:
:1\
O~ Cf33/
.
Estate of Anne D. Seletos
, Deceased
Social Security Number: 198-18-9283
Date of Death: December 22, 2007
and that the instrument(s) dated '- \cuu.(~rU ~C1 ~
\
described in the Petition be admitted to probate and filed of record as the last Wil (and Codicil(s ) of Decedent.
, in consideration of the foregoing Petition, satisfactory proof
AND NOW,
having been presented befo
are hereby granted to
in the above estate
FEES
Letters . ,~, ace. . . . $
Short Certificate(s) . .~. . . .. $
Renunciation(s) .......... $
0='\'\ ... $
~L~ ... $
~~ ... $
.. . $
.. . $
. .. $
...$
...$
...$
TOTAL . . . . . . . . . . . . . . $
o~D
\~
Attorney Signature:
\'S
\0
S
Attorney Name:
Supreme Court I.D. No.: 6351
Address:
Market Square Building
Mechanicsburg, P A 17055
Telephone:
717-766-3172
"-tolo ~
Form RW-02 rev. 10.13.06
Page 2 of2
H105.805 REV ,Ol/07}
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 14124708
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Local Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~~ lf~~u:t;/~/~b/ ()2
ocal Registrar I r Date Issued
o
r-O
'~);g
::co
-",,>,
. :2: [IJ
.-~ .-....~;
\......Jx
Qc
~...i ~Tl
C
JJ
--i
j1
"->
-=
=
=
L.
:;:...
;;Z
J
\"Q
\J
::!'.:
W
Hl05144 REV 1112006
TYPE I PRINT IN
PERMANENT
BLACK INK
f/31-166
,. Nameci_IFirsI.midde.1asI. _)
Anne
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions snd examples on reverse)
, J
Seletos
.. Dale ci _ lMonth. 00 . )
March 18, 1923
5 A"If IUl~ Bmhda,)
84
12. Was Decedent ever i'l the
u.s. Armed Fon;:ea?
DYes
- 9283
Sa. Place of Death (Check one
Hospi&al: Other:
Shenandoah, Pennsylvania Olnpalienl OERI~ 01lOA ....qHome 0-...
9~~g::-0rigin1 ~Ne DYes
_. PuoI1o Rican. ole.)
13. Ool:odanl',E_(SpooilyonlyNgheslg<ada~ 14._Sl&IuJ _.__
EIomenIary I Socandaly (ll-12) College 11-4 or 5+) _.1lNOR:Od (Spec:i)l
12 Widowed
y"
Sb. Coon!)' of Death
Cumberland
!d, Facility Name (If not insl*Jtion,!jve street and numbef)
Manor Care
11. Oecedenl'sUtual lion Kn::IofWOfkdoot
Kind 01 Wen
Interviewer
most of lift Donotllaterelir
KlndofBuslneslll1OOusUy
US Government
. ,._.llailngAddr...I.......clIy/_._."'coda)
1700 Market Street
Camp Hill, PA 17011
Decodont'.
Actual Residence 17a. State
17b CoonIy
PA
Cumberland
Oou... Spooily:
10. Race; American hlian, 8Iac:k, WhiIe,-=
(Spec:i)l White
T""
w_
live.u
T","""",1
He. 0 Yes, Deced9nl1.Mld in
17d.l&No. _lMld......
Ac:tuIIL.iTilsol
Camp Hill
COy/Bolo
18. Faaher's Name (Fll'st, middle, last. suftix)
19. Mother's Name (FtrSI, middle, maiden surname)
201. tnIormanI.'s Name (Type f Print)
Steven Dubansky
Mary Lou Herr
Mary Hudock
2Qb. Intormant's Mailing Mi8ss (Street, city I town, sIaIe, zip code)
25 Colgate Drive Camp Hill, PA 17011
2fc. Ptace 01 0isp0siIi0n (Name of cemetery, crematory or 0Iher place) 21d, locaIion (CiIy floWn, Mate, zip code)
a
w
'"
"
~
:;/
Gate of Heaven Cemetery
Mechanicsburg, Pa. 17055
22<:. Name and __ ci F....,
Myers Funeral Home, Inc. 37 East Main Street Mechanlc.burg, PA 17055
2:lb. lic:eflso ........ 230. Oal& Signed lllonlh. day. ,..~
26. Was Case Referred to MedIcal Examiner I Coroner lor a Reason ClIhlN than erehwion Of 00nI00n?
)4Yes ONe
ApproAimaIe inletval: Part II: Enler other lianilicanl mndiIions mntributina to deaII, 28. lAd Tobacco Use ConIritMt 10 DeaIh?
Onsel 10 Ilea" buI""'resoJling.....~'.".'lr.,n..P"'1. 0 Yos OP~
ONe 0-
29.' Female:
0"'11'_-1*"''''
o "-"l1moci_
o "'_.,,"__42days
ci_
o "'_. ""'11'_43 days 10 '....
..... -
0-._-...1*"....
32<:. P1a<:a ci"": _. Fann. _ F-,.
0lIic:e........ 00:. (Spad/y)
25. Dale PtOllOUll<Od Dead lMonIh. day. ,...)
December 22, 2007
CAUSE OF DEATH (See Instructions and examples)
ttem 27. PlW1I: En\et!he ~ - diseases, ilpies, or ~tioos -thai directly caused !he death. 00 NOT enter terminal events such is can:iac arrest,
fespiraay arrest, Of ventriculat librilation wiIhot.C showing the et&ology. lis! only one cause on each line
=~~~)~
Occlusive COrOnary Arterv Disease
Due 10 (or as a consequeoce 01)'
=istcondilions,ifany,
10 cause isaedon linea
Fnter . UNDERLYING CAUSE
=~~1'l'rtf'"
b.
Due to (Of as a COflsequenc:e 01):
,.
Due to (or as a consequence 0#):
.lOa. Was an AWlpsy
Portonnod1
d.
3lIl __Frdngs
Available Prior 10 CoqlIetion
01 Cause 01 0eaIl?
OYos ONe
32\1. Tlme ot Injury
31. Manner of 0eaIh
ANa,",al D-
O- OPanclngInVO.llgalion
o s..;Qdo 0 CookI NoI be Dele_
M.
321.' T'_"", InjuIy (SpedIy)
o Driver I Ope<alor 0 Passongo< OPedasIrian
OIt\er.SpedIy'
330. S<gnalu<a and T'" ci
OYos ~Ne
!
t;l
~
I
33a.. Certifier (check only one)
:.=.. "::::"...:::. ==.::.. "'.:"Iho"':.;~= ': :::"~_ ~~ _":' ~ ~':' ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ~
:=~:~=-iln~:::.~~~.::1oto=~~-:marnr....... _ _ _ _ _ _ _ _____ _........ 0
= ~an::':'~= tnd / 01 kMIItgIdon, In MY opIrWon, duIh octunwd at thllime. dIM, end p&ace, and eM to the ~..1I\d mIMIr...a.Itd.. .ad
I all I I atl I I,)J
_"",P"mitNe .-:. D '1 g 1 3 'if
Coroner
330. -_1-. day.",,)
December 26, 2007
34t-'t'rc'FI~'folt:""'lro~:-~oor'O~~ Typo/P"'"
6375 Basehore Roadl Suite #1
Mechanicsbur , PA 7050
LAST WILL AND TESTAMENT
OF
ANNED .SELETOS
I, ANNE D. SELETOS, of Silver Spring Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby
make, publish and declare this my Last Will and Testament, hereby revoking and making
void any and all prior Wills by me at any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my
decease as the same can conveniently be done.
2.
I direct that there shall be paid out of my residuary estate all estate, inheritance and
like taxes together with any interest or penalty thereon imposed by the Government of the
United States, or any state or territory thereof, or by any foreign government or political
subdivision thereof, in respect to all property required to be included in my gross estate
for estate, inheritance or like tax purposes by any of such governments, whether the
property passes under this will or otherwise.
3.
I give and bequeath the sum of Five Hundred ($500.00) Dollars to my nephew,
SAM SELETOS.
4. 'lid '.;1., IU,-}'JnJ
I give and bequeath the sum of One Thousand ($l,OOO.OO)~Q~ji~~;~ood
friend, MARY LOU HERR. 9 i :8 \~d 6- ['~vr GaOl
- 1 -
_....._.,_,:'.-1_
5.
All the rest, residue and remainder of my estate, real, personal and mixed,
whatsoever and wheresoever situate, I give, devise and bequeath as follows:
a.) One-fourth to my brother, GEORGE DUBIANSKY
b.) One-fourth to my niece, NANCY PCYSOLAR
c.) One -fourth to my nephew, ROBERT BUTCHKO
d.) One-fourth to my niece, DEBRA BELL
6.
In the event any of the above named legatees predecease me his or her share shall
lapse and fall into the residue of my estate to be equally divided between residuary
legatees who survive me.
7.
Lastly, I nominate, constitute and appoint my niece, NANCY PCYSOLAR, to be
the Executrix of this my Last Will and Testament and I direct that she be excused from
posting bond or other security for the faithful performance of her duties, in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this vatay of
January, 2007.
~~J,JO~SEAL)
-2 -
COMMONWEALTH OF PENNSYL VANIA)
: SS
COUNTY OF CUMBERLAND)
I, ANNE D. SELETOS, the testatrix, whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the same instrument as my Last Will and
Testament; that I signed it willingly, and that I signed it as my free and voluntary act and
deed, for the purposes therein expressed.
~ 1- JJ..a-~ (SEAL)
Anne D. Seletos ~
- COMMONWEALTH OF PlNNIYLVAN/A
NOTARIAl. SEAl.
M H~jdl M. Nelson. Notary Public
echanicsburg Borough, Cumberland C
My CommlNlon Exp/r81 June 27.;:;
COMMONWEALTH OF PENNSYL VANIA)
: SS
COUNTY OF CUMBERLAND)
We, the undersigned, J. Robert Stauffer and John M. Eakin, the witnesses whose
names are signed to the attached or foregoing instrument, bein~ duly qualified according
to law, depose and say that we were present and saw the testatrix, ANNE D. SELETOS,
sign and execute the Instrument as her Last Will and Testament; that the said testatrix
executed it as her free and voluntary act for the purposes therein expressed; that each of
us, in the hearing and sight of the testatrix, signed the Will as witnesses; and that, to the
best of our knowledge, the testatrix was, at the time, eighteen ~18 r more years of age,
of sound mind, and under no constraint, duress or d e influ ,.... / ,
m, ~
Sworn and s\lbscribed to before
me this .:291h day of January, 2007.
~(- cftt ~11
Notary Public
COMMONWEALTH OF I'ENNlYLVANIA
NOTARtAL SEAL
Heidi M Nelson, Notary Public
Mechanicsburg Borough. Cumberland County
My Com million Expires June 27. 2007
-3-