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HomeMy WebLinkAbout08-08-08PETITION FOR PROBATE AND GRANT OF LETTERS REGISTER OF WILLS OF CUMBERLAND Estate of CLINTON E. KAUFFMAN also known as COUNTY, PENNSYLVANIA File Number C7~ ~ (7 ~ U ~~ Deceased Social Security Number Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE 'A' or 'B' BELOW:) A. Probate and Grant of Letters Test mentary and aver that Petitioner(s) is /are the EXECUTOR last Will of the Decedent dated % ~- / .'Z~~'3 and codicil(s) dated (State relevant circumstances, e.g., renunciation, death of executor, etc.) 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 (COtY1~PLETE INALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania with his /her last principal residence at 48 LI1viEKILN ROAD, WEST PENNSBORO TOWNSHIP, (CARLISLE MAILING). PA 17015 (List street address, town/city, township, county, state, zip code) Decedent, then 49 years of age, died on JULY 30, 2008 at CARLISLE REGIONAL MEDICAL CENTER, SOUTH MIDDLETON TOWNSHIP CUMBERLAND COUNTY PA Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property $ ~ Q©d,`c' (If not domiciled in PA) Personal property in Pennsylvania $ (If not domiciled in PA) Persona] property in County $ Value of real estate in Pennsylvania $ 180,000.00 situated as follows: 48 LIMEKILN ROAD, WEST PENNSBORO TOWNSHIP, CUMBERLAND COUNTY, 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: C Si nature a.-~~ T ed or rimed name and residence _ ~ ~ ~ ~ CDY~ ~ '2 ~/~ C L i S ~~ i `" Form RW-02 rev. 10.13.06 Page I of 2 for probate, was not the victim of a killing and was never adjudicated an incapacitated person: C7 ~.-a; ~~ B. Grant of Letters of Administration 4 ~~t ~ (Ifapplicable, enter: c.t.a.; d.b.n.c.t.a.; pendente liter durante absentia; durante mtr~rtjtate) ~- '_. ; G ~ i Petitioner(s) after a proper search has /have ascertained that Decedent left no Will and was survived by the following spotis~ ~i~iany) ~ heirs, {If Administrntinn r t n nr d h n r t n antar dnty nfWi// in .Cartinn A nhnvo and rmm~lo~o list nfFoir~ 1 ~ ` Oath of Personal Representative COM]VIONWEALTH OF PENNSYLVANIA : SS COUNTY OF CUMBERLAND . The Petitioner(s) above-named swear(s) or affirni(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. C7 c,a Sworn to or affirmed and subscribed /~ r-- c lure of Personal Representative 1 i ~. before. me ?i-ie ~ day of _-~ .~~ a~ _ _ , Signature of Persona! Representative , , „h C ~ .t ~ ~ -. r G"Or the Register Signature of Personal Representative -~ __' ~; .. G~ File Number: ~ ~ O ~ U ~ a~ „ Estate of CL[NTON E, KAUFFMAN ,Deceased Social Security Number: ,^~''``~~ Date of Death: JULY 30, 2008 ?.ND NOW, ~ ~IJ~C.l , in consideration of the foregoing Petition, satisfactory proof having been presented before me, T IS DECREED that Letters TESTAMENTARY are hereby granted to STEVE A. KAUFFMAN in the above estate and that the instrument(s) dated !~ l !Q ~ r?~n.3 described in the Petition be admitted to probate and filed of record as the last Will (end Codicil(s)) of Decedent. FEES 1(1~, ~-.d ~) j (J~r- ,lil() Letters ... G.tJ W $ ~~ v Register of Wills ~ Short Certificate(s) ...~ . .. $ 3~ Attorney Signature: 1l~.~~`~ ~~'~'~"--~ Remznciation(s) ........ .. $ ~1 1 ] • • . $ ~ ~ Attorney Name: THOMAS E. FLOWER - '~ L ~ • • • $ ~ ~ Supreme Court LD. No.: 83993 . .. $ Address: 2109 MARKET STREET - • • • $ CAMP HILL, PA 1701 1 - . .. $ . .. $ - ' ' ' $ Telephone: 717-737-3405 - . .. $ TOTAL ............ .. $ ~ ~ -9.98-- Forn1 RW-02 rev. 10.13.06 Page 2 of 2 105,805 REV (01/07) LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 P 14649567 Certification Number This is to certify that the information here given is correctly copied fi-om an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ae ~C~..>,s~. d~~~ >_~ Au,~ i /zoos Local Registrar Date Issued c7 ~'~ y , -- l . t- ~ _ ~ ~ l ter, _. -~ _- ..~ ,-_ . _~i >r ;. ~> ~ COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CORONER'S CERTIFICATE OF DEATH "~ ` /~(~ /~ ^~ (See instructions and examples on reverse) CTATF FlI F NI IMRLG ~/ 1 L /C~`l t )~..-1 ~ w +,os.ta REV n/28gs TYPE / PRINT IN PERMpNENi BUCK INK ~k31- 32'i ~i 0 1. Name d Deca,enl (Frs( middle, lea, sWnx) 2. Saz 3. Saga) Security Number 4. Dais of Death (Manor, day, year) Clinton E Kauffman Male 176 - 44 - 1014 July 30, 2008 5. Age (feel Bidldey) Under 1 year UMa 1 da fi. Ode of &rm (MOnM, day, year) 7. BiMplece (C' end state a ) ea Plea d Death (Check Dory one) 49 N°""' °a" """ ~`""" June 21, 1959 San Angelo, TX ~p~L t °tl1ef' t~, Yrs. ^Irge,ied JCiER /Oulpelient ^DOA ^Nswsing Mane ^Residana ^LMrer-Spectty: !>b. Caunry d deem &. CXy, Death 8d. Fadliy Name III nd iretllutpn, give sheet aM number) 9. Was Decedent d Hlspenk Origin? ®No [] Yes 10. Race: American (Man, &ack, Whpe, ex. Cu~eberland South Middleton (N Yes.spedyCMen, (SDes'IM Whlte Carlisle Regional Medical Center Madcan,PuedoRicen,etc.) 17. DeadaiCS Usual Icon Knd d Moth done most d Ipe. Oo not slate retlred 12. Was Decedent ever in die 13. DecedanYs Edurapan (Spedfy Doty highest grade mmpleled) 10. Merifal Stelae: Married, Neva Married, 15. SuMNmg Spouse (It Mite, give maiden name) Kind d Business I Indwtry P l'~'d i`~IE h U.S. Armed Fonds? Elementary / Seandary (O-12) Copega (,J or ul Wes, Divorced (Spedlyj syc o puplic School ^Yea Lei r~ 5+ Married Kimber2 Overby h 1 . Cs M cpy/tam, sM1e, zip code) lore n DecedenYS Did DBCedanl PA ~ ~ W Rawl Residence na. sere . Pennsboro e ,7a$] Vee. Decedent INad m Twp. Carlisle, PA 17015 „~~, Cumberland T°"""''"P? na.^ Iiwdwpnm cpy ~ 78, Famefs Nana (First, midrib, lest, sulfiz) Gideon Kauffman 19. Mother's Name (First, middle, maiden surname) Evelyn Ruth 20a. InformanYS Neme (Tyye /Prim) Kimberly Kauffman 20h. Infamiant's Meiling Address (Sweet, dry /tam, stare, zip aria) 48 Limekiln Rd., Carlisle, PA 17015 21a. Memod d Diapospion ~ [~Cremafnn ^ Daueon 2,h. Date of Disposidm (Halm, day, yearl 1~t nl 1q~d ~et?ry aerre or ~e t~omaD n AOkCYo'a "R L'Uiiera~ f'S r~ e) & z,d. Uocapa, (cpv /tam. aorta. cep code) ^ Burial ^ Removal fromSrete crem.da,aDasmaA ^ Dora-spady: MadicaExamwwyCaoner? ea^Na lang. 2, 2008 L Crematory Carlisle, PA 17013 zza. " '' aalig as auc") zza. I.x;ena Number 22c. Nara any Address d Fatllity Hof fman-Roth Funeral Home & Crematory, Inc . ~ _ 138504 219. N. Hanover St., Carlisle, PA 17013 Conrotde nom 23e<onty wn ~ 'ng 23e. Tome host d my knowledge, seam oaurre0 at ma sore, sate aid plax, dared. (si~eaae end tNal 2x. Ihensa N"mbar zaa. Data signed (MOmh, sax yea) phyakien'e nd evaleble d deem ro cemq ease d deem. Item, 21-2fi must a mrtplelaa M person 24. Time of Deam 2s. Date Pnzzwrxzd Deed (Honor, day, veal 26. Was Case Referted to Metlial Examiner / Corarer for a Reason Omer than Cremation or Donation? wlro pmxxax;ea deem. 11:17 P. M. July 30, 2ooa ~dY~ ^~ CAUSE OF DEATH (Sae InsNruetlona and examples) Approximate interval: Pan II: Enter other ' 28. Did iabaao Use cam'drte b Deam7 dam 27. Pen C Emer me chain d evens -diseases, irpudes, a compfwaasns -mat drectly caused me deem. W NOT erxer terminal evems such es aNiec wrest, Onset ro Deem but not resulting ro me underlying ease given in Pad I. ~ Vey ^ Probably respiretary artesL a veniricWa Nxplatbn winwul shoain9 rite etidog/. Ust sty are cause a each Imo. ~ ^ ~ ^ lMknoxn Ntl1EgATE CRUSE Final cheese a rndpa reading im ~eam) --~ a. Occlusive Coronary Artery Disease zs.nFemale: ^ Dee ro (a as a anaegaa~e d1: Na pregnant wdhin pear year BepuerNapy Wt mrgpions, n any, b, ' m Igt Ne3 m tla d m p a r ^ Piegnenl et rime d deem ng a e ne . ENSr Ilte UNDERLYING CAUSE dry ro (a es a cwnsequence of): ^ Nd Pregnem, der pragnem wimin a2 days (aaeas. a Ytw, uy met inmates me c, evems g n deaM) LAST' d dam Due Io (or es a aasegwrroe d): ^ Nd pregned, bM pregbm d3 days b 1 year A. ~ balsa deem ^ Lmkrwwn N prepred wpNn me pea Yea 30e. Wes r Aabpey 3CO. WereAUmpey Fmdsrgs 3f. Manner d Dean 32a. Date d InWry l• daY, year) 32b. Deecdbe Flaw Inju70mrred 32c. P4ce d injury: Hans. Farm. Srea, Fedory, PedemtaY7 Aveilads Prior b Completlon ~ Nataal ^ Haniride Office BulWktg, etc, /Spetlry) arne d Deelh7 d C Yea ^ No .~ a l iy Yes ^ No ~ ^ Acddent ^ Pendng Imrestigatlan 32d. rime d IniaY 32e. kry"ry at Work? 321. n Trarwpatagon In)urY /SPedN) 329. t.onlion d InN7 (S1resI, dty I town, smte) 7 ^ Saatle ^ Caultl Nd oe Determined ^ Vas ^ No ^ ~ / Kerala ^ Passenger ^Petleatdan M Omer - Speoly: 33a. Cerpfia (aNc only one) 33b. 3lgnatae and T • Canilyhp plryakNn (PMsidan aNhyng reuse d deem when aroma phyecien has pronounced deem and anplaed perm 23) ~ Cor one r To Che lxaaldmy knowredge, rlaM scarred Owkthe awga)end marmeru slated--------------------------------- ^ • Pranoundng eM arUh'h0 phv+klen (Pnysitien wan praaurcng deem altl amMng ro cause d deem) l tth d d l th N N M ^ 33c. fierce NuMer 33d. Data signed IMonm, day, yea) - -- -- - a occurtetla e ate,en plea,e r ueb me, ecausgs)erdmerubrsa9Utetl------------ 'r All uSt 1 2DD8 • pktNWEUmewlCaaier g , On IM We4 0, ezanirotlen erd / a Inreetigsebn, In my opidorz deem oawred N rite Hme, dsre, end plea, and dw [o the auee(e) sM mermx se sMMtl.. 34. teas P Cause of (rem TI) 7 /Pmt c ere L: o rre~s ox~one~°e 'ask,nan,reat~D~t ~ ~ la I ( I ~J \ 16 I Daaaed Maaamr-rte) ~ , 6375 Basehore Road Suite 4F1 ~ Yi Mechanicsburg, PA 7050 DispoaiUon Pemnn No. ~ ~, y~~~ /f ~{ LAST WILL AND TESTAMENT OF ~- .~ -_~ .a >~ CLINTON E. KA UFFMAN ~ =`' ~' -` ~~~~ r.~ - 1 3 _:_ ~.. _ l~ ~ 7 -i I, CLINTON E. IrCAUFFMAN, of R. R. #2 Box~~=?62, N.ew =-- -, .. .. ~ Bloomfield, Cumberland County, Pennsylvania, 17068 being of sound ~'Id disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all former Wills, Codicils, or writings in the nature thereof, by me at any time heretofore made. FIRST: I hereby order and direct my Executor, hereinafter named, STEVE A. KAUFFMAN to pay all my just debts, funeral and administrative expenses out of my estate, as soon as practicable after my death. SECOND: I hereby direct that all taxes which may be assessed SAIDIS SHUFF, FLOWER & LINDSAY ATT°RNEYS•AT•I.AW 2G W. High Str<~et Carlisle, PA in consequence of my death of whatever nature and by whatever jurisdiction imposed shall be paid out of my estate as a part of the administration of my estate. THIRD: I hereby give, devise and bequeath ten (10) percent (%) of my residuary estate, excluding life insurance, to Grace United Methodist Church of Carlisle, Pennsylvania. FOURTH: All the rest, residue and remainder of my estate I hereby give, devise and bequeath, be it real, personal or mixed, of whatsoever kind and wheresoever situate, to STEVE A. KAUFFMAN, of Carlisle, Pennsylvania, IN TRUST NEVERTHELESS for the benefit of my children, ANTHONY W. KAUFFMAN and DREW B. KAUFFMAN in equal shares. A. The trustee shall invest the Trust corpus in good and safe securities legal for trust funds in the Commonwealth of Pennsylvania. In the event one of the beneficiaries has not attained eighteen (18) years of age and graduated from high school at the time of my death, I hereby instruct the trustee to pay to the child's guardian $750.00 per month from the child's share of the trust for his health, education and welfare. B. I hereby instruct the trustee to pay to each SAIDIS SHUFF, FLOWER & LINDSAY_ ATTORNEYS•AT•[.AW 2G W. High Street Carlisle, PA beneficiary up to $10,000.00 per year for his post-secondary education, including tuition, room and board and books for a period not to exceed six (6) years provided the beneficiary has exhausted all other funds available to him including the United States Savings Bonds held by the beneficiary's mother on his behalf and any grants for which the beneficiary is eligible. In addition, so long as he is enrolled as a full time student in an institution of higher education, each child shall draw from his share of the trust up to $750.00 per month, indexed annually for inflation, for his support, to provide for his additional needs. C. Upon attaining the age of twenty-five (25) years each beneficiary shall received one-half (1/2) of the then remaining 2 balance of his share, including any accumulated interest and principle. Upon attaining thirty years (30) of age each beneficiary shall receive from the trustee the balance of his share including accumulated interest and principle. FIFTH: In the event that at the time of my death any child of mine has not attained eighteen (18) years of age, I hereby nominate, constitute and appoint STEVE A. KAUFFMAN, of Carlisle, Cumberland County, Pennsylvania as Guardian of the person. In the event that STEVE A. KAUFFMAN is unwilling or unable to serve I hereby nominate, constitute and appoint GIDEON AND EVELYN KAUFFMAN of Carlisle, Cumberland County, Pennsylvania as alternate Guardians. In the event that GIDEON AND EVELYN KAUFFMAN are unwilling or unable to serve I hereby nominate, constitute and appoint SUE ELLEN DAVIS of Fayetteville, Pennsylvania as the Guardian of my child. LASTLY: I hereby nominate, constitute and appoint STEVE A. KAUFFMAN of Carlisle, Cumberland County, Pennsylvania to be the Executor of this my Last Will and Testament. In the event that STEVE A. KAUFFMAN shall be unable or SAIDIS SHUFF, FL01~~ER ~ r.iNncAv 2G W. High Street Carlisle, PA unwilling to serve as Trustee for any reason, I hereby appoint, SUE ELLEN DAVIS of Fayetteville, Pennsylvania as an Alternate Trustee. No Executor or Executrix shall be required to file bond in this or any other jurisdiction. 3 IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ I day of ~- , 2003 . ,,t~ {i r_ CLINTON E. KAUFFMAN SAIDIS SHUFF, FLOWER & LINDSAY_ ATTORNEYS•AT•LP~W 26 W. High Street Carlisle, PA 4 SIGNED, SEALED, PUBLISHED and COMMONWEALTH OF PENNSYLVANIA SAIDIS SHUFF, FLOWER & LINDSAY_ ATTORNEYS•AT•t.AW 26 W. High Street Carlisle, PA COUNTY OF CUMBERLAND ss I, CLINTON E. KAUFFMAN, Testator, 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 instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledge before me, by CLINTON E. KAUFFMAN, the Testator, this ~ day of ~'c~~^~- 2003 . NOTARIAL SEAL KANDI L LENKER, NOTARY PUBLIC CARLISLE BORO, CUMBERLAND COUNTY MYCOMMISSION EXPIRES FEBRUARY 20, 2005 ~~ Clinton E. Kauffman, T ator ,. Notary P is 5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss //~~ j We, t ~~ ~ - L. ~ S ~ rr '~ and ,the witnesses whose names are si ed to the attac d or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes 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 18 or more years of age, of sound mind and under no constraint or undue influence. to a subscribed to befgr~a,5 me by 1T ~--~~-' this T day of 2003. ;; r~,a t itnes~ Notary Publi SAIDIS SHUFF, FLOVWER & LINDSAY ATTORNEYS•AT•4AW 26 W. Nigh Street Carlisle, PA 6