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Docket No. Commonwealti?df Mi acHuSetts' AM
VOLUNTARY ADMINISTRATION The Trial Court mber
STATEMENT Probate and Family Court
PURSUANT
TO G. L. c. 190B, § 3-1201
Estate of: Middlesex Division
Cynthia Podlesney
First Name A an Name ast
Date of Death 12/19/2023
The Petitioner(s) (hereafter "Petitioner"), an interested person, makes the following statements:
1 Information about the Decedent
Name: Cynthia Podlesney
First Name Middle Name Cast Name
Also known as: Cynthia Podlesny
Name
Domicile at death: 7 Longmeadow Road Chelmsford MA 01824
FeS3) Apt Unit, No. etc.) (Ciy/Towny ‘State) ip)
Information about the Petitioner:
Name: John Apostolos
First Name MT Last Name
7 Longmeadow Road Chelmsford MA 01824
TAdaress) Apt, Unit, No. ety (CityrTowny (State) Tip)
Mailing Address, if different:
aes REO No ee. ——errewny—— tatey~ apy
Primary Phone #: (978) 256-4249
The Petitioner's interest in the estate is as follows (e.g., Personal Representative named in a will, surviving spouse, heir,
devisee, etc. See G. L. c. 190B, §§ 3-1201, 1-201(24)): Personal Representative Named in a Will
At least 30 days have elapsed since the death of Decedent.
A death certificate issued by a public officer is in the possession of the court or accompanies this statement.
CO The Petitioner is unaware of any unrevoked will relating to property in Massachusetts.
OR
[X] The original will and codicil(s) are in the possession of the court or accompanies this statement. The Petitioner is
unaware of any instrument revoking the will and believes that the will filed with this court is the decedent's last will
[X] Copies of this statement and the death certificate have been sent by certified mail to the Division of Medical Assistance,
Estate Recovery Unit, P.O. Box 15205, Worcester, MA 01615-0205.
The probate estate consists entirely of personal property and the total value of all personal property owned by the
Decedent and subject to disposition by will or intestate succession at the time of the Decedent's death does not exceed
$25,000.00, exclusive of one motor vehicle.
MPC 170 (4/15/16) page 1 of 3
adi DéokehNe: rt
Ja 249 AM
Estate of: Cynthia A Podlesney
First Name riddle Name Last Name ng
8. Aschedule of every asset of the probate estate and the estimated value of each is as follows:
Description of Property Estimated Value
lotor vehicle make, model, VIN: nla
Refund check from D'Youville Saab Residences 7,000.00
Total: 7,000.00
9. The following are the names and addresses of all persons who, with the deceased, were joint owners of property. Also
listed are the names and addresses of those who would take in the case of intestacy and the names and addresses of
those persons and/or charities who would take as devisees under the provisions of any will.
Name Address Interest
Carl H. Podlesny D'Youville Saab Residences [KX] Heir
981 Varnum Avenue
Lowell, MA 01854 OO Devisee
Joint Owner
The Cynthia Podlesny Revocable 7 Longmeadow Road OO Heir
Living Trust u/d/t dated Nov. 24, 2003 Chelmsford, MA 01824
John Apostolos, Trustee [K] Devisee
Joint Owner
OO Heir
C0 Devisee
2 Joint Owner
O Heir
OD Devisee
CO Joint Owner
0 Heir
OD Devisee
CO Joint Owner
10. No petition is pending or has been granted in any jurisdiction. The undersigned understands that I/we are answerable
and accountable to any subsequently appointed Personal Representative of the estate or any other person having a
superior right to the estate.
11. The undersigned will act as a Voluntary Personal Representative of the probate estate of the deceased and will
administer the same according to law, and apply assets of the probate estate to those persons entitled as creditors, heirs,
devisees under any will, and otherwise in accordance with G. L. c. 190B, § 3-1201.
MPC 170 (4/15/16) page 2 of 3
de Ourt
AM
jocket No. mber
Estate of: Cynthia Podlesny
First Name waiaais Name Tast Name
10. No petition is pending or has been granted in any jurisdiction. The undersigned understands that I/we are answerable
and accountable to any subsequently appointed Personal Representative of the estate or any other person having a
superior right to the estate.
11. The undersigned will act as a Voluntary Personal Representative of the probate estate of the deceased and will
administer the same according to law, and apply assets of the probate estate to those persons entitled as creditors, heirs,
devisees under any will, and otherwise in accordance with G. L. c. 190B, § 3-1201.
SIGNED UNDER THE PENALTIES OF PERJURY
| certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief.
Date: 3/18/24
Signélure of Petitidner
Information on Attorney for Petitioner, if any a 2 ———
oe fare @f Attorney
games P. Haroutunian, Esq.
(Print ame)
790 Boston Road
TAdaressy (Apt, Unit, No. ety
Billerica MA 01821
Teayrrowny WSiatey Zipy
Primary Phone #: 978-671-0711
BB.O.# 644577
Email: —James@hlawoffice.com
(Bo Not Write Betow This Line-For Court Use Only)
v4 ut
CERTIFICATION
As Register of Probate having the care and custody of the records pertaining to this court, | certify that the preceding document is
a true, exact, complete and unaltered copy of the Statement of Voluntary Administration filed with this court.
Date:
Register of Probate
MPC 170 (4/15/16) page 3 of 3
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ax Pra! Ourt Docket No. Commonwealti?df Mi acHuSetts' AM VOLUNTARY ADMINISTRATION The Trial Court mber STATEMENT Probate and Family Court PURSUANT TO G. L. c. 190B, § 3-1201 Estate of: Middlesex Division Cynthia Podlesney First Name A an Name ast Date of Death 12/19/2023 The Petitioner(s) (hereafter "Petitioner"), an interested person, makes the following statements: 1 Information about the Decedent Name: Cynthia Podlesney First Name Middle Name Cast Name Also known as: Cynthia Podlesny Name Domicile at death: 7 Longmeadow Road Chelmsford MA 01824 FeS3) Apt Unit, No. etc.) (Ciy/Towny ‘State) ip) Information about the Petitioner: Name: John Apostolos First Name MT Last Name 7 Longmeadow Road Chelmsford MA 01824 TAdaress) Apt, Unit, No. ety (CityrTowny (State) Tip) Mailing Address, if different: aes REO No ee. ——errewny—— tatey~ apy Primary Phone #: (978) 256-4249 The Petitioner's interest in the estate is as follows (e.g., Personal Representative named in a will, surviving spouse, heir, devisee, etc. See G. L. c. 190B, §§ 3-1201, 1-201(24)): Personal Representative Named in a Will At least 30 days have elapsed since the death of Decedent. A death certificate issued by a public officer is in the possession of the court or accompanies this statement. CO The Petitioner is unaware of any unrevoked will relating to property in Massachusetts. OR [X] The original will and codicil(s) are in the possession of the court or accompanies this statement. The Petitioner is unaware of any instrument revoking the will and believes that the will filed with this court is the decedent's last will [X] Copies of this statement and the death certificate have been sent by certified mail to the Division of Medical Assistance, Estate Recovery Unit, P.O. Box 15205, Worcester, MA 01615-0205. The probate estate consists entirely of personal property and the total value of all personal property owned by the Decedent and subject to disposition by will or intestate succession at the time of the Decedent's death does not exceed $25,000.00, exclusive of one motor vehicle. MPC 170 (4/15/16) page 1 of 3 adi DéokehNe: rt Ja 249 AM Estate of: Cynthia A Podlesney First Name riddle Name Last Name ng 8. Aschedule of every asset of the probate estate and the estimated value of each is as follows: Description of Property Estimated Value lotor vehicle make, model, VIN: nla Refund check from D'Youville Saab Residences 7,000.00 Total: 7,000.00 9. The following are the names and addresses of all persons who, with the deceased, were joint owners of property. Also listed are the names and addresses of those who would take in the case of intestacy and the names and addresses of those persons and/or charities who would take as devisees under the provisions of any will. Name Address Interest Carl H. Podlesny D'Youville Saab Residences [KX] Heir 981 Varnum Avenue Lowell, MA 01854 OO Devisee Joint Owner The Cynthia Podlesny Revocable 7 Longmeadow Road OO Heir Living Trust u/d/t dated Nov. 24, 2003 Chelmsford, MA 01824 John Apostolos, Trustee [K] Devisee Joint Owner OO Heir C0 Devisee 2 Joint Owner O Heir OD Devisee CO Joint Owner 0 Heir OD Devisee CO Joint Owner 10. No petition is pending or has been granted in any jurisdiction. The undersigned understands that I/we are answerable and accountable to any subsequently appointed Personal Representative of the estate or any other person having a superior right to the estate. 11. The undersigned will act as a Voluntary Personal Representative of the probate estate of the deceased and will administer the same according to law, and apply assets of the probate estate to those persons entitled as creditors, heirs, devisees under any will, and otherwise in accordance with G. L. c. 190B, § 3-1201. MPC 170 (4/15/16) page 2 of 3 de Ourt AM jocket No. mber Estate of: Cynthia Podlesny First Name waiaais Name Tast Name 10. No petition is pending or has been granted in any jurisdiction. The undersigned understands that I/we are answerable and accountable to any subsequently appointed Personal Representative of the estate or any other person having a superior right to the estate. 11. The undersigned will act as a Voluntary Personal Representative of the probate estate of the deceased and will administer the same according to law, and apply assets of the probate estate to those persons entitled as creditors, heirs, devisees under any will, and otherwise in accordance with G. L. c. 190B, § 3-1201. SIGNED UNDER THE PENALTIES OF PERJURY | certify under the penalties of perjury that the foregoing statements are true to the best of my knowledge and belief. Date: 3/18/24 Signélure of Petitidner Information on Attorney for Petitioner, if any a 2 ——— oe fare @f Attorney games P. Haroutunian, Esq. (Print ame) 790 Boston Road TAdaressy (Apt, Unit, No. ety Billerica MA 01821 Teayrrowny WSiatey Zipy Primary Phone #: 978-671-0711 BB.O.# 644577 Email: —James@hlawoffice.com (Bo Not Write Betow This Line-For Court Use Only) v4 ut CERTIFICATION As Register of Probate having the care and custody of the records pertaining to this court, | certify that the preceding document is a true, exact, complete and unaltered copy of the Statement of Voluntary Administration filed with this court. Date: Register of Probate MPC 170 (4/15/16) page 3 of 3