HomeMy WebLinkAbout02-26-13
PETITION FOR GRANT OF LETTERS
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
Petitioner(s) named below, who is/are 18 years of age or older, apply(ies) for Letters as specified below, and in support thereof aver(s) the
following and respectfully requests the grant of Letters in the appropriate form:
Decedent's Information
Name: Esther Mann Teunon File No: 21 -13
a/k/a: (Assigned by Register)
a/k/a:
a/k/a: Social Security No: 198-30-5887
Date of Death: 02/14/2013 Age at Death: 100
Decedent was domiciled at death in Cumberland County, PA (State) with his/her last
principal residence at Messiah Village, 100 Mt. Allen Drive, Mechanicsburg 17055 Upper Allen Twp. Cumberland
Street address, Post Office and Zip Code City, Township or Borough County
Decedent died at Messiah Village, 100 Mt. Allen Drive, Mechanicsburg 17055 Upper Allen Twp. Cumberland PA
Street address, Post Office and Zip Code City, Township or Borough County Stale
Estimate of value of decedent's property at death:
If domiciled in Pennsylvania All personal property $ 250,000.00
If not domiciled in Pennsylvania Personal property in Pennsylvania $
If not domiciled in Pennsylvania Personal property in County $
Value of real estate in Pennsylvania........... $
TOTAL ESTIMATED VALUES 250,000.00
Real estate in Pennsylvania situated at NONE
(Attach additional sheets, if necessary.)
Street address, Post Office and Zip Code City, Township or Borough County
❑X A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) aver(s) that he/she/they is/are the Executor(s) named in the Last Will of the Decedent, dated 02/19/2008 and Codicil(s)
thereto dated
(State relevant circumstances, e.g., renunciation, death ofexecutor, etc.)
Except as follows: after the execution of the instrument(s) offered for probate, Decedent did not marry, was not divorced, was not a party to a pending
divorce proceeding wherein the grounds for divorce had been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child born or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
❑X NO EXCEPTIONS ❑ EXCEPTIONS
❑ B. Petition for Grant of Letters of Administration (If applicable)
c.t.a.; . .n.; .n. c. t. a.; pe ente durante a erdlib ura nil"ntate
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. X _,_,T1 O
co rri Except as follows: Decedent was not a party to pending divorce proceeding wherein the grounds for divorce had been establishMa,:FefiaW m CJ~
in 23 Pa. C.S. § 3323 (g) and was neither the victim of a killing nor ever adjudicated an incapacitated person. r--
r~lo A r'V rat rat
❑X NO EXCEPTIONS F1 EXCEPTIONS A r C7-) Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if am) RH heirs (attar -trt `n
additional sheets, if necessary): cJ __4 y t
C7 "T P C')
CJ C' M
Name Relationship Address -0 C7
-3
Form RW-02 rev. 10-11-2011 Copyright (c) 2011 form software only The Lackner Group, Inc. Page 1 of 2
Oath of Personal Representative Official Use Only
COMMONWEALTH OF PENNSYLVANIA }
} SS:
COUNTY OF Cumberland }
Petitioner(s) Printed Name Petitioner(s) Printed Address
Robert T. Mann 723 Sinclair Road
Mechanicsburg, PA 17055
e- w
c rn
C= -Cf)
-t
M
-713
;3C G7 r7
C, fc~ T "t' "tt
on
The Petitioner(s) above-named swear(s) or affirm(s) the statements in the reg n eti ion re true and correct to the best of the knowle ge and
belief of Petitioner(s) and that, as Personal Representative(s) of the Dec ent, a on ill well and truly administer the estate accordin to law. i
%
Sworn to or of ii med an u scribed before Date 3
Date
me & day of 'X/_3
By: /07 Date
i the Register Date
BOND Required? ❑ Yes Ell-do To the Register of Wills:
FEES Please enter my appearance by my signature below:
Letters $ Vo Attorney Signature-
( Short Certificate(s)..........
( ) Renunciation(s) ~ef
( ) IL' /
Codicil(s)
( ) Affidavit(s) Printed Name: Gerald J Brinser
Bond Supreme Court
Commission ID Number: 09655
Other
7i4! h n Firm Name: Brinser, Wagner & Zimmerman
Address: 6 E. Main Street
1AWA P.O. Box 323
Palmyra, PA 17078
_ Phone: 717/838-6348
Automation Fee
Fax: 717/838-6912
JCS Fee
TOTAL $ E-mail: gjbrin@aol.com
DECREE OF THE REGISTER
Date of Death: 02/14/2013
Social Security No: 198-30-5887
Estate of Esther Mann Teunon File No: 21 -13 • -3
a/k/a:
AND NOW, fe1 % in consideration of the foregoing Petition,
satisfactory proof having been prese before me, IT IS DEC ED that Letters Testamentary
are hereby granted to Robert T. Mann
in the above estate and (if applicable) that the instrument(s) dated 02/19/2008
described in the Petition be admitted to probate and filed of record last 11 (and Codicil(s)) of Dece a t.
L~ /
egister of Wills
Form RW 02 rev. 10-11-2011 Copynit (c) 2011 form software only The Lackner PG J0 V/ aqef
1110s Xos RFV ,I,lI u
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
r _
Fee for this certificate, $6.00 RECORDED OFFICE OF - This is to certify that the information here given is
I~ TH 0f p"
REGISTER OF 1LS correctly copied from an original Certificate of Death
duly tiled with me as Local Registrar. The original
1013 FEU certificate will he forwarded to the State Vital
'ke Records Office for permanent filing.
U
52.05326 cLRKo FEB5 013
ORPHANS' COURT ~99rMENT~F,~~P/
o al Regis Date Issued
Certification Number CUMBERLAND CC
PA
Typ./Print din COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF HEALTH VITAL RECORDS
Fermanent CERTIFICATE OF DEATH
Bla k Ink state File Number:
1. D.c~ddent's Legs Name (First, Middle, Last, Suffix) 2. sfL- 3. Social Security Number 4. at. of Death (MO Day/Yr) (Spell Mo)
So. Ag.-Last Birthday (Y,s) Lab. Under 1 Yaar Sc. Untlar 1 Oa 6. Date pf Birth (MO/Day/Vaar) (Spell onth Ta. nd 5tst. or Foreign Count )
00 Months Days Hours MlnuNa
.ce (GOUn )
:;---hp;;
Ba. Itlen- (Sts to or Forol{n Country) eb. Residence (Street and Number- Include Apt is. pm o•e. ant Uv. In • To~`^(nshlpT
Yy Yes, d...dent Ilv.d In ll r 7~/-, P ✓1 twP,
Ed. Id.nc: Cou )l
8e. R•+id•n- (Zip Code) Q No, delsd.n[ lived wlthln limits of city/born.
9. Evar In US Armed Fpr-s7 30. Marh-' Status at Time oT Death Merci. I owe 11. Surviving spo i..'s Name (H X7' {Iva name prior to first marriage) I-I 2. Yas Np O Unknown Q Olv_o d C3 Never Marraed E3 Unk o
12. F that's Name (First, Mi tltlla,Last, SuMx) . w33. M is Name prlorC 1 Marna a (F- 1Yiddl., Last)
I
14a. for + Name 14b. Relatlonship to Decadent 34C. Informant's Iling Atltlrsfa (S of and Number, City, State, Zip God.)
- - - - .<,o .as.< p e - n-
11 OeKF, OCeurrod In • Hospital: Cj Inpatient tlf Osath Otturradtl5omewhere Other Than . Hospital: d Hospice Feclllty ~1 D~c1daP<'+ Home
Q Eme en Room/Out eV-1 Q Dead on AT11.1 Nuraln Noma/LOn -Term Caro Feelll Other S selry)
iSb. acidity Name (H not instl u[lon, g va aSroat and number) 115e. City or Town, Stsu, and Zip Code 13 County Death /
16a. Method o1 ...position Burial Cremation 16b. Data o1 Olsposttlon 16c. Plat. of Is position Nam It cemetery, <rsmato, or other place)
O Remov.l from State r_3 Donation
O Other 5 .11
-d. Lo-Lion of OI.P..-On (City or Town. State, and Zip) _ 1Ta. Sig ur. 5•rvl 1 n+. or Person In Charge of Interment 17b. Lice=ae Nu ber -
37c. Name and Complet A dross o1 Funeral 2-ti.. 18. Decedent's Education - Check the box that be tl.+c Ibea the 9. c dent of HIS. n c OrlEln - heck the 20, p.-tlent'a Race -Check ONE OR MORE r ces to Intlicate ax O/~
hl.hest do,-. or level of school completed at the time of tl.ath. box that beat describes wh.th.r the decedent the dosod•nt considered himself or herself to b..
Q Bth grade pr lass la Spanish/Hispanle/Ladno. Ch.ck the ..No.. Whit. Q Koroan
Q No dlpioma, 9th - 12th I box If d...d,nt Is not Spanish/HlspsnWLatImo. Black or Afrl-n =A"1-n Q Vietnamese
Q Hlgh school {rotluat. or GED compl.t.tl 64 No, not Spa nlaM1/Hl+panlc/Latlno Q American Indian or Alaska Native Q Other Asian
Q Some college -dIt, but no d•.m. Yes, Mexican, Mexican Am•,1-n, ChI-no Q Asian Indian Q Native Ha Wallah
Q[ Associate do&-. (e.g. AA. AS) _ Q Yes, Puerto Rican Chin- Q Bachelor's tl.Eroe (..g. BA, E. BS) Q Vas, CuWn I Filipino Q C3 u
5 mo.n I nor Chamorro
Q Master's degree (e.&. MA, MS. ME.E, MEd, MSW, MBA) 0 Yes, other Spanish/HI,-nle/LstlnO
Q Japers. Q Other Paelne Islander
Q Doctorate PhD, ECD) or Professional tl.gro. (Specify) Q Other (SpeclN)
. MD. O DDS DVM LLB 1D
21. D•..dents Single Race Self-D-ignagon - Check ONLY ONE to Indlcat. whet the dec•tlont considered hlmsaM or herself to ba. 22.. Oa-dent's Vsu.l Oeeupaelon - Indic.te Cype of work
ILWhite Q Japen.s. O Samoan done during most of working life. DO NOT USE RETIRED.
Bl.ek or AMCan Am.H..n M Korean Q Other F-P. Isla.d.r
Q Amen-n Indian or Alaska Native Q Vietnam... Q Don't Know/Not 5ur. ,
Q Asian Indian [3 Other Asl.n Q Refusal 22 b. Kind o slnesa/Industry
Q Chines. Q Native Hawaiian Q Other (Specify)
Q Filipino Q G..m..i.n or Chamorro
1 EMS 23. - 23 MUST E COMPL EO 23a. Dab Pronounce Daa M-.73. y r 23 . Sign.ture of Person Prpnounc na Dea[ On y when app Ica a 231. License Num .r
CERTIFIES DEATH PRONOUNCES OR o7 (J"'t / )
231. Data Signed (M./D.V/Yr) or Death
S J O Q
CAUSE OF DEATH 1Cel .r or corps., coot Y.a Approximate
26. Part 1. Enter the chain Of evenu-dI...s.s, Injuries, or compllcatlona-LM1a<dlrectly caused tha d.ath. DO NOT enNr terminal ev fits such as urdlac erreat, tervel:
raspirstory arrest, or ventri<ul.r fibr.11- on without showing tthe~.tlolory. DO NOT ABBREVIATE. Enter only one -use on • line. Add additional lines H neeassary. Onset to Death
IMMEDIATE CAUSE ~ ~ Z~ ~ ~ C•~ G t- ~ ~ ~ GZ-~j~JG• ~ ~Lf1Lgs.f`S
in do.,
(Final disease or eondttion pus to (or as a conaoqu.nc y~
Sequentially tilt lolditi.n., f)
r env. I..ding to the ..us. '
listed on line Ent., the
UNDERLYING CAUSE r~ Duo to (or as • consequence of): 1
(tllaa,ad or INury that as • eon 1
Initlaatl the aven4 rosulting d.
1
In death) LAST. Due to (or .eq..... of):
26. Part 11- Enter other but not resulting In the underlying taus. alvn In Part I. F-7-t; s an autopsy perforetlT 1-tributina to death No
ro aupsfindings available
tom plots the ca s of death?
Q Y.s No
29. H F ale: 30. Did Tobacco Use Contribute to p•athT 31. Mannar of Oath
Not pregnant wlthln past y.a r O Yes .Q Probably {r Natural Q Homlcld.
Q Pregnant at time of death r3 No _3 Unknown Q Accident Q Pending Invertigatlon
O Not pregnant, but pregnant within 42 days of lesth O Sul.1d. E3 Could not be dstarminel
pregnant, but p%.nant 43 days to 1 year before death 32. Data of INury (MO/Day/Yr) (Spell Month)
,fr[ Q Unknown If pregnant wlthln the past year 33. Irn. of Injury
34. Pia- of Injury (e.g. home; construction site; farm; school) 35. Location of Injury (Street and Number, City, County, Stste, Zip Code)
f~ 36. Injury at Work 31. If Transportation Injury, Specify: 38. Describe Now INury Occu Tad:
Q Yes O Driver/Operator Q Pedestrian
Q No Q Pass. ng.r Q Other (Sp.city)
39a. Certifier- physician, -rtl otl nurse practitioner, medical min.r -roner (Cn.ck only ono).
.rtllying only - To the best o1 my ---led--, death occurred due to the -us.(f) and manse rtat.tl.
O Pronounelna i Q_rt.1In{ - To the best of my knowledge, death oeeurrad at the time, dot ma
e, .n pl and du. to She -user.) and nner stated.
_rl • Q Medic f. ]nation and/or Inv.atlgaVon, In my oplnllpn. di t1+ eccumtl at the time, date, and Fla-, and due to ~the cau-((,) and'm'anner statetl.
V• ~V TIO.Ol License Nuoj:;W~
Ip Cole of n Co pletina Cause of Death rise ) 39c. O.t• 51{n•d (V1 O.y/Yr)
Qv f scS Su i ~~4 s~ IF
• v/i S
40. •{litter s Nu 4 R. r • SI{nature 42. glrtror le • O D.y
43. Amendments
0
Disposition Permit No. REV V~eY O7T/20
/2012
C CJ w M M
W rn G'? O
M =r n OD Gy r1J
WILL , M
~.Cn :~a cT~
OF C~
C>
C-) r fv,
ESTHER MANN TEUNON ; C.0 I, ESTHER MANN TEUNON, currently of Upper Allen Township, Cumberland
County, Pennsylvania, realizing the uncertainty of this life, but with confidence in God
and trust in His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the
cross and rose again to redeem me and give me eternal life, do hereby make, publish and
declare this to be my Last Will and Testament, hereby revoking any and all prior Wills
and Codicils made by me.
L I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
11. I direct that all estate and inheritance taxes that may be assessed in consequence
of my death, shall be paid out of the principal of my general estate to the same effect as if
said taxes were expenses of administration and all property includable in my taxable
estate whether or not passing under this Will shall be free and clear thereof.
III. All the rest, residue and remainder of my estate, of whatever nature and
wherever situate, including property over which I hold a power of appointment, I devise
and bequeath equally unto my two (2) children, Ruth T Zook and Robert T. Mann. If
either of them predeceases me, his or her share shall pass unto his or her issue per stirpes.
IV. I appoint my son, Robert T. Mann, Executor, of this my Will. In the event that
he fails to qualify or ceases to act as Executor, I appoint my daughter, Ruth T. Zook,
Executrix, of this my Will.
V. I direct that no bond be required of my fiduciaries for the faithful performance
of their duties in any jurisdiction.
IN WITNESS WHEREOF, I,ESTHER MANN TEUNON, herewith set my hand
to this my Last Will, typewritten on two (2) sheets of paper including the attestation
clause and signatures of witnesses, this Pq~-hday of , 2008.
(SEAL)
ESTHER MANN TEUNON
-1-
Signed by ESTHER MANN TEUNON, by her declared to be her Will in our
presence, who have hereunto subscribed our names as witnesses in her presence and at
her requ st, this (q" day of lzb 1 , 2008.
residing at
4), residing at Mjx k 6,, ~6 704
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
WE, ESTHER MANN TEUNON, GERALD J. BRINSER and //?0 L,2r+T- ✓ ac _
, the testatrix and the witnesses, respectively, whose names are
signed to the attached or foregoing instrument, being first duly affirmed, do hereby
declare to the undersigned authority that the testatrix signed and executed the instrument
as her Last Will and that she signed willingly (or willingly directed another to sign for
her), and that she executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the testatrix,
signed the Will as witnesses and that to the best of our knowledge the testatrix was at that
time eighteen years of age or older, of sound mind and under no constraint or undue
influence.
ESTHER MANN TEUNON
ITNE S
WITNESS
Subscribed, sworn or affirmed and acknowled To before me by ESTHER MANN
TEUNON, the testatrix, GERALD J. BRINSER and "N-f
witnesses, thisIT-Vay of 2008.
COMMONWEAL;rH OF PF-NNSYLVANIA L)
NOTARIAL SEAL otary Public
WENDY L. CRAWFORD, Notary Public
Palmyra Boro., Lebanon County
M Commission Ex fires Se tember 10, 2009
-3-