HomeMy WebLinkAbout09-04-09PETITION FOR PROBATE AND GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND
Estate of STEPHEN D. TESLAR
also known as
Deceased
Petitioner(s), who is/are 18 years of age or older, apply(ies) for:
(COMPLETE 'A' or 'B' BELOW:)
COUNTY, PENNSYLVANIA
File Number
~l -CSI - U ~3~
Social Security Number 193-36-4451
A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is /are the EXECUTRIX named in the
last Will of the Decedent dated I 1-20-2008 and codicil(s) dated N
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(State relevant circumstances, e.g., renunciation, death of executor, etc.) "fl ~~ r ` ~
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Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of ~ZLt;tnent s('~j offered-` ' `iJ j
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for probate, was not the victim of a killing and was never adjudicated an incapacitated person: ~ "D - . - -
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® B. Grant of Letters of Administration ~ ~'
(If applicable, enter: c.t.a.; d.b.n.c.t.a.: pendente lire; durante absentia; durante mmoritate) ....
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: (/f
Administration, c. t. a. or d. b. n. c. t. a., enter date of Will in Section A above and complete list of heirs.)
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her I;tst principal residence at
MANORCARE HEALTH SERVICE 940 WALNUT BOTTOM ROAD, CARLISLE, PA 17015-6926
(List street address, town city, township, county, state, zip code)
Decedent, then 62 years of age, died on 08-27-09 at MANORCARE HEALTH SERVICE
940 WALNUT BOTTOM ROAD CARLISLE PA 17015-6926
Decedent at death owned property with estimated values as follows:
(If domiciled in PA) All personal property $ 17,000.00
(If not domiciled in PA) Personal property in Pennsylvania $
(If not domiciled in PA) Personal property in County $
Value of real estate in Pennsylvania $ 17,000.00
situated as fo
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:
GLENDA CLEMENCE 300 ADAMS ROAD, CARLISLE, PA 17015
FormRW-01 rev. to.is.n6
Page I of 2
Oath of Personal Representative
COMMONWEALTH 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 of Petitioner(s1 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 n subscribed
bef//QQQ//~~~e m •he %~~~ day of
Signature of Personal Representative
• the Register
Signature of Personal Representative ~o
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File Number: -- ~_'
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Estate of STEPHEN D. TESLAR , Dece
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Social Securi umbe :193-36-4451 Date of Death: 08/27/2009
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AND NOW, ~ ~~~
, ~, in consideration of the forego
ing Petition, satisfactory proof
IT IS DECREED t
resented before me
been
i
h hat Letters TESTAMENTARY
,
p
av
ng
granted to GLENDA CLEMENCE
are hereb
y
in the above estate
and that the instrument(s) dated 1 1/20/2008
described in the Petition be admitted to probate and filed of record as t 1Eist W~ 1(and odicil(s)) of e 'dent.
FEES
G 1
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~~ Register of Will
~
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Letters ............... $ /
~
Short Certificate(s) ........ $ ~~ ~ Attorney Signature:
Renunciation(s) $
•~ ~ g ~~ ~ ~l .I.. $~
JV l
~
Attorney Name: STEPHANIE E. CHERTOK
$ ,,
~v Supreme Court I.D. No.: 52651
$ `~ ,
Address:
6l WEST LOUTHER STREET
... $
.. $ CARLISLE, PA 17013
... $
... $
••• $ Telephone: 717-249-t 177
... $
TOTAL .............. $ 0.00
of Personal Representative
Form RW-02 rev. 10.13.06 Page 2 Of 2.
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate. $6.0O ~"'°-"~- Thi,~ i~ to ccrtil~~~ th;lt the inf(lnnati<m here ;~i~-en i~
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I~,o~~,p.~--~fiy~;-._ correctly r(~~ic~l ir,~rn .u~ original Certilirate of Death
~rro~~ ~~1=_ duly filed ~~•ith me ~(~ Loral Re~~ititrar. 'The ~~riginal
r~~~ z; ~elti(i~,Lte ~~~ill h~ for~~arded to the Statr Vital
?~I, ;s;- ~a~ Record; OITirr f~rlr ~9crnru~ent lilin~~.
°`'°9~ Py?`' ~~e ~~~ ~ ccK~~~~a~~ ~~ 1 ~ 2009
P 15729814 ._,. _-- _,~~,,r
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,MENT OF , ------__-- -- ---
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Certifirition Number ~ ~"""""-`'~"~ Local Rcszi~trar Date Issued
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H10S143 REV tlnoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
aeafftnelErTir" CERTIFICATE OF DEATH
aucK INK ISee instructions and examples on reverse)
CTATF FI
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t. Name d Decetlenl (FfM, mkdb, last, sumx) 2. Sex 3. Sodef Security Number 4. Date of Death (Month, day, year)
193 - 36 - 44 ~ u.si- ~"T aeo9
5. Age (Last Blrmday) Under 1 year U r 1 da 6. Dale of Birm (Mnnm, day, year) 7. Bklhplece (City and stale or krsign country) M. Place of Death (Check only one)
MoerM nay¢ Iburs Mnmee Hospital: Omer
62 Yrs. Oct. 4 1 946 Harrisbur Pa. ^Inpatknt ^ER/OutpeMM ^DOA Nursing Home ^Reskence ^omar-Speciyr
County of Death Bc. City, Bo Twp. Deem
M ed. Facility Name (If not kwfilulion, give slmel and dumber) 9. Wes Decedent d Hispanic Origin? [~NO ^ Yes 10. Race: Amedcen Indian, Black, Wnite, etc.
. gr yes, spetay cwlan, ISPedM
Cumberland So. Middleton Manor Care of Carlisle Mexian,PuenoRicen,alcJ White
11. DeceOaM's Usual Oa flan Kind of woA dare tlud moll of world Ilk. Do not srble refired 12. Was Decedent ever k the 13. Decedent's Education (Speciy any highest grads cartlpktea) 14. Medkl Status: Mamed, Never Martied. 15. Surviving Spouse (If wile, give maiden name)
Widorreq DNOmad (Specify)
KirW d Won Kira of Business I Intlustry US. Armed Fumes? Elementary / Secantlery (0-12) College (1-4 or Si)
Teacher Seconder Edu. [Yea ^Nt 12 rs. 4 r D:Lvorced
tfi. Decedents MaNing Address (SlreeL dry f town, slate, zip code) Decedent's Ditl Decetlenl
Decedent cued in S o . M i dd 1 e t o n Two .~1
Live in a , 7t
®vea
Pa
Manor Care of Carlisle .
.
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Anuel Residence 17a. Slak
TtwnahiP?
DeatlenuNed wimk
t 7d
^ No
Walnut Bottom Rd. Carlisl ,
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7b cpany Cumberland
AcluelLimiBtl ciryrBnm
t6. Father's Name (First, middle, last, sWlix) 19. Homer's Neme (First, mitltlk, meitlen surname)
Geor e Tesl r 1 rover
20e. InformenYS Name (Type /Print) 20b. Inlom~enl's Mailing Address (Street, tilyl town, sklB, zip Coda)
Glenda L. Clemence 300 Adams Road Carlisle Pa. 17015
21 e. Method of Dispositlon ^ Cmmelien ^ Wrlalkn 21 b. Dek of Oisposi0on (Mmth, day, year) 21c. Plea of Dispositon (Name of cemetery, aemarory a other place) 21 d. Location (C'Iry I Town, skis, tip cotle)
® Burial ^ Removaltrom5tete ~ WeaCrarrrsOOnorDOrWIonAWhaWd
- Woodlawn Memorial Gardens Harrisburg, Pa.
^omar spervy: ; br al.alral Examin« / caran.n ^ vaz ^ Na S e t . 3 2
22a. signature d Funarel Sella lianaee or person acting a5 Such) 220. L'~cenee Numher 22t. Name antl Adtlress al Fadliy 5 01 N . B a 1 t i mo r e Ave . -
- - ~i~r*-^c~ ~' FO-011 589-L Hollin er FH/Cremator Inc. Mt.Holl S rin s Pa. 1 7065
Cortpkk Items 23ec any when adiyirg
phy~'an k not aveik0k al lime W death to .Tome best of my krawletlge, death oaurree et me lime, dale arM plea ktetl (Signature and tltle)
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G 23b. License Numner
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Carl' ease of tleaM. ~
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- Items 24-26 mu51 M Compleletl by person 24. Time tl Death 25. Data Pronounced Dead (kbnlh
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day, year) 2fi. Was Case Rekrred to Medical Examiner I Coroner for a Reason Other Than Cremelpn or Donation?
,• who Dro,axrces death. ~ ~ (`~ p ~' M. r
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~ ll,S } ;~ r ~ ~ ~ ~ ^ Vas ^ No
CAUSE OF DEATH (Sae lnatruetlona and axamplea) , Approximate interval Pen II: Enter omar: m ~ t md'1' s lnh .t m m deem, 28. Did Tobacco Use Contribute Io lMalh?
I,em 27. Pan 1: Enter the chain of events -diseases. irNUdes, or complications -mat tlkeclly eased Iha deem. 00 NOT enter terminal events such es amiac anesl. Onset IC Death but not resulting in me undertying cause given In Pan ~. ^ Vas ~raUaby
respiratory artest, or vantrkular fibrilletkn w4houl showing me elrology. List alty one reuse on each line. ~,~ ^ Unkn~
IMMEDIATE CAUSE IFlnal tlisease ar !' ~,( ~(}~ ~~ v ~
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~ 29. II Female.
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aMnion resuninq In amt _~ a ~~ +-E.`y\ r ,'~~ '"s"`r ~
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Dore ro (or as a nsapuana op:
Segtrenlieey lest tontlilbrls, it any, G. I
n pal
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Pregnan
w
Year
^ Pregnant al lime of tlaam
kedmg b me ease Ikled on lino a. Due to (or es 8 ton
UNDERLYING CAUSE sequene on:
E
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m ^ Not pregnant, but pregnant wimin 42 days
n
er
e
(asmse or iryury met Initkletl me
a al death
events resulting In deem) LAST
Due to (or as a ronsequena op'.
^ Nat pregnant, bN pragnen143 days 10 1 year
tl. before deem
^ Unkrown if pregneM wAhk ale past year
30a. Was an Autopsy 300. Were ANOpsy Findings 31. Manor elh 32a. Date al Injury (Monm. tlay, year) 32b. Describe How Injury Occuned 32c. PI ca 1 Inlury: Home, Farm, areal, Fedary,
etc (5peciM
Office Buikkg
Penamed? Aveikble Pror Io Completion
of Cause of Death? Natural ^ Manicitle ,
^ Y85 ^ Yes ^ No ^ Accident ^ Pending Invazligetion 32d. Time of Inlury 32e. Inlury al Work? 32f. If Treneptdetien Inlury (Spacilyf 32g. Location of Inlury (Street, cdy I town, skla)
^ $ukke ^ Cadtl Not M Delertnked ^ Yes ^ No ^ DMrer I Opemkr Pazsenger ^Padestdan
M ^ Other -Specify'
33e. Cerrifier (dteck onty onel 33b. agr,a ~ Itle Gartman ~ rr \\
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• Cerlllying phyekkn (Physldan ceNMng aura of deem when anolMr physkian has praqunatl death and amplelad earn 23) ,
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To mre Mat of mY knowlW9a, deem aaumetl tlw loth au9a(6)antl manMrs afeted_________________________________
• Pramuncln9 and urdtying phyalclen (RrysirJan born Pmruurldn9 death and cerhtydng to cause of Math)
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manner ea s
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_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
To tM Mel of mY krrowledga. death occumd el mre Dma, tla[s, ell plea, ell tlus [o the cauaNq en
• Matlkal Examiner/Coroner ~O (l, ~ li ~ `
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On mre Male of saaminNkn arM / or Inveetigetbn, in my opinion, desth atcurted N the time, dab, ell pkcs, end due to IM uuee(e) and manner e• abled_ ^ 34 Name arltl Atltlrass of Parson WAO Complaletl Cause G Deem (Item 27) Typo / Pnnl
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(Monm, tlay, Year
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Disposition Permk No. 4) Y-{'( ~oe''~y~ `
LAST WILL AND TESTAMENT
C;:~~
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STEPHEN D. TESLAR ~ r- ;z
I, STEPHEN D. TESLAR, of Lemoyne, Cumberland County, Pennsylvania, •~ing of sod ~;-, ,~
_~
and disposing mind, hereby declare this instrument to be my Last Will and Testament, revoking
... ~j .. +i:."+ii :'i'ii: u3 :v i~Cr%tvfvi ~; :uwuC:.
ITEM I. I direct my hereinafter-named Executor to pay all my just debts, my funeral and
burial expenses, and inheritance taxes, as soon as may be convenient after my decease. My
Executor shall have my remains buried in the plot which I purchased in Woodlawn Memorial
Gardens at 4855 Londonderry Road in Harrisburg, Pennsylvania; my Executor shall direct that
my casket be placed in the cement block which I have also already purchased.
ITEM II. I bequeath the sum of one thousand dollars ($1000.00) to GLENDA
CLEMENCE, if she is living at the time of my death.
ITEM III. I bequeath to my daughter STEPHANIE TESLAR, unless she predeceases me,
any vehicle(s) in my possession at the time of my death under the following conditions: if I have
completed the loan payments on the vehicle(s), said vehicle(s) may be immediately transferred to
my daughter; if the loan has not been completely paid at the time of my death, my A-laughta~r shall
not be given the vehicle(s) unless she agrees to pay the outstanding balance due. If my daughter
refuses to accept the vehicle(s) under these terms and conditions, I hereby direct my Executor to
sell the vehicle(s) at the fair market price, pay off the outstanding balance if any be owed, and to
put any net proceeds from said sale into my estate.
ITEM IV. I hereby direct that all of the rest, residue and remainder of my estate, real
Page One of Four
personal or mixed, wheresoever situate and of every kind and description, whether now owned by
me or hereafter acquired, be placed in a trust until my daughter STEPHANIE TESLAR reaches
the age of thirty years, whereupon it shall be given to her or her issue per stirpes. Should my
executor find that the residue may be too small to make it feasible to establish a trust, she is hereby
given sole discretionary authority to forego the establishment of the trust and to distribute the
residue of my estate to my daughter immediately.
ITEM V. If my daughter predeceases me without issue, I bequeath the residue of my
estate to Ed Hartman of Wappinger Fars, New York; and if both my daughter and Ed Hartmann
predecease me, I bequeath the residue of my estate to his son, Stephen Hartmann, of Wappinger
Falls, New York.
ITEM VI. I hereby nominate, constitute and appoint GLENDA CLEMENCE as Executor
and Trustee of this my Last Will and Testament.
ITEM VII. My Executor is hereby authorized and empowered to liquidate all of the
personal and real property of which I may die seised and to likewise sell all real estate of which I
may die seised and to convey the same by fee simple deed or deeds to the same effect that I could
personally do, if living.
ITEM VIII. I direct that my Executor shall not be required to give bond for the faithful
performance of her duties in any jurisdiction.
IN WITNESS WHEREOF, I hereunto set hand and seal to this my Last Will and
Testament, this ~ day of ~J ~ , A.D. 2008.
~ (r n
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Stephen D. Teslar
Page Two of Four
Signed, sealed, published and declared by the above-named Testator STEPHEN D.
TESLAR, as and for his Last Will and Testament, in the presence of us, who, at his request, in his
presence and in the presence of each other have hereunto subscribed our names as witnesses.
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Address
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Witness
Page Three of Four
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
SS
We, W(U.lAd1 I". t'UL7~/y 8~IT1UE`f rif}/QTEl~. ,and
FAIL G" SDUD~S ,the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say that we are present and saw
the Testator sign and execute the instrument as his Last Will and Testament; that STEPHEN D.
TESLAR signed willingly and that STEPHEN D. TESLAR executed it as her free and voluntary
act for the purpose therein expressed; that each of us in the hearing and sight of the Testator
signed the Will as witnesses; and that to the best of our knowledge, the Testator was at that time
eighteen (18) or more years of age, of sound mind and under no constraint of undue influence.
Sworn or affirmed to and subscribed to before me by W«-(~1/~N t % ~U~/U ,
~17'NE`f tt~-i2r~r2.. ,and -All. G. ~UDE~-c5 _, the witnesses, this~~
day of N~~~~e~ 2008.
.....~.
NQTARIAL i~Al
~m mac
+rotan- h+bMe
NOTARY PUBL C MA~lIINIIlo Clfl~ OWN Cam'
MM Co~tnNiNOn ixplr~ Oct 11, ZOt0
Page Four of Four