HomeMy WebLinkAbout03-13-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of HELEN J. TESNO
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW.)
Social Security Number 172-28-9615
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the individual
last Will of the Decedent dated July 22, 1975 and codicil(s) dated
COUNTY, PENNSYLVANIA
File Number ~ ~ ~' i-, ~, ~~
(State relevant circumstances, e.g., renunciation, death of executor, etc.J
named in the
Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the instrument(s) offered
for probate, was not the victim of a killing and was never adjudicated an incapacitated person: n/a
B. Grant of Letters of Administration D.B.N.C.T.A.
(If applicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter 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.)
Decedent, then 73 years of age, died on January 25, 2009 at Manor Care Nursing Home, Camp Hill, PA
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 60,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 75,000.00
situated as follows: 6011 Robert Drive, Hampden Township, Mechanicsburg, PA
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 form to
the undersigned:
Si nature T ed or tinted name and residence
Joann Tesno Miller, 170 Fairway Drive, Etters, PA 17319
Form RW-0? rev. 10.13. D6
Page 1 of 2
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(COrvIPLETE W ALL CASES:) Attach additional sheets if necessary. ~ E"` ~
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Decedent was domiciled at death in Cumberland County, Pennsylvania with his /her last principal resi~tce at ~
6011 Robert Drive Hampden Township Cumberland Counri PA 17050 -
6"
(List street address, town/city, township, county, state, zip code)
Harold Tesno Jr
86 Blue Ridge Drive
Levittown, Pa 19057
Linda Hochtman
8590 New Falls Rd
Apt J 10
Levittown PA 19054
Andrea Clise
1416 Washington Rd
Westminster MD 21157
~-,
William Tesno _~~~~ ~ -- -
31630Trails park ='~ 4, ~ -
Conroe TX 77385 .,
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-
Lorraine Miller ~ ~.-, .
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170 Fairway Drive
Etters Pa 17319
Doris Mc Elhenie
454 Elder Trail
New Cumberland PA 17070
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Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
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 Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the1 ^ 1 ~ day of
Y _ Y \ _
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~ For the Register
of Personal Representative
~~
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Signature of Personal Representative C` 0
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Signature of Personal Representative
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File Number: ~ ~ ~~~ ~ ~~~
Estate of HELEN J. TESNO
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Deceased
Social Security Number: 172-28-9615 Date of Death: JANUARY 25, 2009
AND NOW, ~ ~~~ ' " ~' ~ L h _, 2-~c~r~ , in consideration of the foregoing Petition, satisfactory proof
having been presented before e, IT IS DECREED that Letters Administration d.b.n.c.t.a.
are hereby granted to Joann Tesno Miller
in the above estate
and that the instrument(s) dated July 22, 1975
described in the Petition be admitted to probate and filed of reco~ +~s t~h~e l~as~t Willa Codicil(s)) of De dent.
FEES `"'~ v1 G, .
Re ister o Wills ~ / b
Z~ g f ,~
Letters ............... $ '
Short Certificate(s) ....1:~ .. $ ~~ Attorney Signature: _ '~~--~`~- ~~` ~%t-°
Renunciation(s) .......... $
K M S ott
... $
... $
... $
... $
... $
... $
... $
... $
... $
TOTAL .............. $ 0.00
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Attorney Name: even c
Supreme Court I.D. No.: 70322
Address;
Telephone:
2 North Second Street, 7th Floor
Harrisburg, PA 17101
717.257.7551
Form RW-02 rev. 10.13.06 Page 2 of 2
OCAL REGISTRAR'S CERTlFiCATION OF [SEAT!-!
WARNING; It is illegal to duplicate this copy by photostat or photograph.
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COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH /
(See instructions and examples on reverse) STATE FILE NUMBER ~ I ( ~ ~ ~ j ~~
1. Name of Decedent (First, mitldle, last, sulflx) 2. Sex 3. Serial Secudry Number 4. Dale of Death (Month, day, year)
Helen J. Tesno Female 171 - 2.6 '- 6404 Februar 28 2009
5. Age (Last Bidhday) U~ 1 year lMtler 1 day 6. Date of Bidh (Month, tlay, year) 7. Binhplece (Ci and state or loreign crountry) 8a. Place of Death (Check only one)
MOnIM pays Hours Minule5 Hpapltal: Olh¢I'
atient ^DOA ^NUrsin
Home Residence ^omer. S
ecity
tienl ^ER/Out
15 1930 Mt earmel Pa ^In
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78 Yrs.
8h. County of Death 8c. Cay, 8oro, Two. of Death lid. Facility Name (If not Inslitutwn, give street and number) 9. Was Decedent of Hispanic Origin? ~J No ^ Ves i0. Race American Intlian. Black. While. etc.
(If yes specity Cuban, I specilyl
Cumberland Ham en 6011 Robert Drive Mezican,PuertoRican,etc.) White
Decedent's Usual Occu Lion Kind pl work done tlurin most of workin life. Do not slate retired
11 12. Was Decedent ever in Ina 13. Decedent's Etlucation (Specify only highest grade completed) 14. Marital Status: Married Never Marrietl. 15. Surviving Spouse (If wile, give maiden Hamel
.
Kind of Work Kind of Business I Intlustry 115. Armed Forces? Elementary I Secondary (042) College (1-4 or 5+) Widowed, DNOrced (Specity7
Clerk Matan os Cand ^Yes ~No 9 Sin le
16. Decedent's Mailing Address (Street, city I town, state, zip code) Decedent's Ditl Decedent ~is~T
Pa Live in a 17
ham~~P
Tl T
Y
ced
t Lived
D
6011 Robert Drive _
en
in
wp.
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Actual Residence 17a. Slate
Towrrshlp7 17d. ^ No, Decedent lived within
Cumberland
C
Mechanicsbur , Pa 17050 17b.
ounty
Actual Limits of Coy i Boro
18. Father's Name (First, middle, last, aumx) 19. Mother's Name (First, middle, maitlen surname)
Luther Tesno Fst 11 elk r
20a. Infortnanl's Name (Type /Print) 20b. Informant's Mailing Address (SIrceL coy /town, state, zip code)
Joann Miller 170 Fairway Drive Etters,Pa 17319
21 a. Method of Disposition ^ Cremation ^ Donation 27 b. Date of Disposition (Month, tlay, year) 21 c. Place of Disposition (Name of cemetery. crematory or Omer place) 27d. Location (City t town, state, zip codel
[~ Burial ^ Removal horn State ~i Was Cremation or Donation ANhonzetl
^
^
h 4 2009
M
eter
Citi
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Lavelle Pa
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Yea
^ other-speciy bvMedicalExaminer/cpromer7 arc zens
em
22a. unera ervice Licensee (or person cti s s ) 22b. License Number 22c. Name and Address of Facility
4 17011
1903 M
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t St Cam Hill Pa
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01165 ar
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ome
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M ers-
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Complete Items 3a-c only when certi mg
physican is not available at Gme of death to 2 a. To the best of my kr ath occul~71 a lime, dale and place shat d. (Signature and ti(le)
tlq
y~n
~ 1 23b. Lice se Number
~ ~ ('~ ~-~ ~' ~
ff"-~~ ,,} 23(c~'DatG1Signed (Month, day, year)
L-.f) In.~m , ~ ~/1 py7
1 `KJWx 9r"x' %V(J`I
certity cause of death. ,
Items 24-26 must be completed by person ~
24. Tme of Death
~ 25. D P anted Dead (Month, day, yQear)
• 26. Was Case Referred to Medical Examiner /Coroner for a Reason Other than'6 anon or ovation?
who pronounces death. (.
.
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Zd ~,(}~~ ^Yes ^ No
CAUSE OF DEATH (See instructions antl examples) ~ Approximate interval. Pan II: Enter other sieniFlcant conditions contributing to tlealh, 28. Did Tobacco Use Conlnbule to Death?
Item 27. Pan I: Enter the Chain of events - tliseases, injudes, or complications -That directly caused the death. DO NOT enter terminal events such as cardiac artest, r Onset to Death but not resulting in the underlying cause given in Part I. ^Yes ~] Probably
st onty one cause on each line. i
Li
ogy.
respiratory arrest, or ventricular fibrAtation without showing the ellol ^ No ^ Unknown
///
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IMMEDIATE CAUSE (Foal disease or ~ ~y ~ i
condition resulting in death)
a 29. If Female
^ N
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Due to (or as a consequence of): c pregnan
in pes
year
o
wi
^ Pregnant al ume of death
if any
Sequentially list conditions
b
,
,
.
leading to the cause lisletl on line a.
'
^ Not pregnant. Dul pregnant wmhin 42 days
Due to (or as a consequence ol)
.
Emer the UNDERLYING CAUSE of death
(tlisease or injury that inaiated the c r
events resuaing in death) LAST. r ^ Nat pregnant, but aregnanl 43 days l0 1 year
Due to (or as a consequence oQ:
I before death
d ^ Unkrwwn if pregnem within the past year
30a, Was an Autopsy 30b. Were Autopsy Findings 31. Manner of Death 32a. Dale of Injury (Month, day, year) 326. Describe How Injury Occurtetl 32c. Place of Injury: Home Farm Street. Factory
OAlce Su7dlrq. etc. (Specityl
Pedormed7 Available Prior to Completion
se of Death?
of C ^ Natural ^ FI«nicide
z au ^ A¢idem ^ Pendirg Investigation 32d. Time of Injury 32e. Injury al Work? 32f. If Transportation Injury (Spenty) 32g, Lacalbn of Injury (Street. city /town. state)
_,,
,
^ Yes ~LNO
- ` ^Yes ^ No
^Yes ^ Na ^ Drrver I Operator ^ Passenger ^ PedesMan
/ ^ Suicitle ^ Cald Nat be Delerminetl M ^Other- Specity:
33a, Certifier (check only one) 33b. Signature and n of Cedifier ~„~
• Certltying physician (Physician cenitying cause of tlealh when another physician has pronouncetl deem antl wmpletetl Item 23)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^
th occumetl due to the cause(s) and manner es stated
e
d
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LJ
_ _ _
,
ea
now
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g
To the best o
my
• Pronouncing and certifying physician (Physician both pronouncing death and ceditying to cause of tlealh) - _ _ _ --- _
To ttre best of my knowledge, tlealh occuned at the lime, date, sod place, and due to the cause(s) and manner as stated_ . _ _ _ _ _ _ _ _ ^
• Medical Ezaminer I Cororrer
Onthe bazis of examination antl / or investigation, in my opinion, death occurred at the lime, dale, and place, and due to the cause{sy and manrar as stated_ ^ 33c. Llc se Number 33d. Date Sign (Man ,tlay, year;
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34 Name and Addres Person Who Comp d Cain~?? I Death (Item 271 Type i Print
35. Registrar's Sig re and District Numhe
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I vt I
~ 36. Date Filed (MOnm, day, yeas) , J ~ _ p_ ,
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(f -~ ~ ~Jor ~ ~ mil' l'„n"~~' ~'" ' ` 1 - . - . .
Disposition Permit No