HomeMy WebLinkAbout11-21-08Estate of Nancy L. Kauffman, a/k/a Nancy S. Kauffman
Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Nancy L. Kauffman No. ~~ 0~ 1~1~0
also known as Nancy S. Kauffman
Deceased Social Security No.168267420
Farmers and Merchants Trust Company of Chambersburg
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 and aver that Petitioner(s) is/are the execut or
Decedent, dated 3/1/2007 and codicil(s) dated
no exceptions
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapacitated:
B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente life, durante absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
r.,
Name Relationship idence ~
~~n
/~
t- , -~- N -
_ -.~- c -
`.-
-~ -+ ..
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
named in the Last Will of the
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at 206 East Burd Street, Borough of Shippensburg, Cumberland County, Pennsylvania
(list street, number and municipality)
Decedent, then 75 years of age, died November 9 , 2008 , at Episcopal Home, Shippensburg, Pennsylvania
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property ......................................... $ 20,000.00
(if not domiciled in PA)
(If not domiciled in PA)
Personal property in Pennsylvania ...................
Personal property in County .............................
Value of real estate in Pennsylvania ........................................................................................
Total ..................................................................................................................
Real Estate situated as follows:
none
$ 0.00
$ 20, 000.00
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:
Signature Typed or printed name and residence
Farmers and Merchants Trust Com an of Chambersbur
P.O. Box 6010 Chambersbur PA 17201
RW-7
Oath of Personal Representative
Commonwealth of Pennsylvania
COUnty Of Cumberland
The Petitioner(s) above-named swear(s) and 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(;) will well and truly administer the estate accgrding to law. ; _; ~
Sworn to and affirmed and subscribed
before me this _.~ day of
Nov ber 2 8
Farmers and Merchants Trust CorY~pany of Charrd~ ersburg, by Heather
C. Hershey, Estate Administtration Of~icer
DECREE OF REGISTER CUMBERLAND COUNTY
Estate of Nancy L. Kauffman Deceased No. ~ ~ ~~ ~ ~~
also known as Nancy S. Kauffman
Social Security No: 168267420
AND NOW, November ,~ ( 2008 , in consideration of the Petitic~~
on the reverse side hereon, satisfactory proof having been presented before me, ~~
K~ ~
IT IS DECREED that Letters ~] Testamentary ^ of Administration = -° ~ -
(c.t.a., d.b.n.c.t.; pendente life; durante ~ tia; durant~minoritateJ
?~ N
s T~
are hereby granted to Farmers and Merchants Trust Company of Chambersburq - -=~ `
. - ~-
in the above estate and that the instrument(s), if any, dated March 1, 2007 ~ ~ tv
described in the Petition be admitted to probate and filed of record as the last Will of Decedent
FEES
Letters .................................... $ 60.00
Will 15.00
Short Certificate(s) ............... $ 8.00
Renunciation .......................... $
Affidavit ( ) ....................... $
Extra Pages ( ) .............. $
Codicil ................................. $
JCP Fee .................................
$ 10.00
Inventory & Tax Forms ............. $
Other ...Automat ion ............. $ 5.00
98.00
TOTAL ............................ .$
Attorney
Attorney: Joel R. Zullinger, Esq.
I.D. No: 17516
Address: 14 North Main Street, Suite 200
Chambersburq PA 17201
Telephone: 717-264-6029
DATE FILED:
Date of Death: 11/9/2008
RW-7A
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal t0 duplir_ate this cl~py' by photostat or photograph.
~ce (~,~~ this ~~rt)~icate ~'~_~)~)
P _140.2670
C'erdtiri:i(~1~ ?`vin,~hcr
S°~ y;~ ~~`fG
;~ ' ~
U : ~
v ~ ,`~ a
w ' ~ ~ ek
'. , .
_~~iC qP`~~`
4~r~r~T ~~;?~,,,l
This i to cea~;ily t~~~at the iniornrftjen here eiiv~en i~
~~c~nectl~ copieLi li'(.n} an original (~r(U~Iv<;tr nt~ Death
duly filed ~~ith me a~ Local Re~~~Str(Ir. The e~ri~~ina1
certificate will br for~~arded to ti7e State 4'ital
Rea~rds C)tfiict~ iix p ~ ~rr ant [~ilirl~.
o'~ Regi>trar ~~ Uate Issued
f"7 r^
C O c'
c~:,
~
`
. ~^° -
~
~~ G~
_.{,~ N
r1:.-.
~~ ~ 0 11 ~ ~ ~1
.~3 t.__ ..~_i
~
H705-143 REV 112006 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS - ~ u,. N _.
PERMANENTIN CERTIFICATE OF DEATH ~ -
6LACK mK (See instructions and examples on reverse)
CTATF FII
F NIIMRFR C.1
~n
0
1. Name d Decedent (First, aNdNe, lag, aMa) 2. Sex 3. Social Security Number 4. Dale d Death (Monts, my Year)
Nancy S. Kauffman Female 168 - 26 - 7420 November 9, 2008
5 Aga (Lag Sklhtlay) UMer 1 year Under 1 day 6. Date of Sidh {Month, day, ar) 7. BidhpWce City and gale a foreign countM !)a. PIaCe d Death (Check only one)
O
N
ier
xlornra wys Ilaurs Mirwles HospNal:
,,
,yy
,
75 yrs 8-26-33 Shippensburg, PA ^Inpatient ^ER/Oulpalient ^DOA L7 Nurgrg Home ^Resitlence ^Other-Spedry
County d Death &. City, Soro, Twp. d Death
Bb fid. Facility Name (K rid hstkukon, tAve greet sntl rwmber) 9. Was Decadent d Hislmnk Origin? No ^Ves 10. Race: Ameliran lotion. Rleck, While. etc.
. (n Yea, svacgr cacao. (SVeGM
Cumberland Shippensburg Episcopal Home Mexirsn,PUedoRkan,etc.) White
11. Decadam'a Usual Occu tbn Kind d work done tlud rtwg d wakin life. Do cot state reti 12. Was Decedent ever in dre 13. Decedent's Education (Specify oMy hghest grade completed) 14. Madlal Status: Marred, Never Mernetl, 15. Surviving Spouse (If wife, give maiden name)
~~ (SpeclM
Wed
Kill of Work ~ Kind of Sugrless / Indugry U.S. Armed Faces? Elementary /Secondary (1}121 College (1-4 or 5+}
'
waitress Post Restaurant ^ves (~No 12 years widowed
16. Decedem's Meign Address (Brest, c4Y /town, state, zip I»de)
g llacadant's Did Decedem
pA Live in a 17c
^ Yes
Decedent Uvetl in Twp.
206 East Burd Street .
,
Aduel Residence 17a. Slate
Township?
Lweawdmn
~{
n
Cumberland nd
Shippensburg, PA 17257 .
~
~
1,~.GF,,,,ty
Shippensburg G4r/~
1 S. Father's Name (FNsI, mitltlle, lest, sugix) 1g. homer's Name (Fkg, mitltlle, maiden surname}
Unknown Hazel Martin
20a. trdormad's Neme (Type t PdM) 20b. MformaM's Maiymg Address (Skae4 gty /town. gate, rip code)
Greqg E. Kauffman 413 Sunset Lane, Shippensburg, PA 17257
21a. Method d Disposition i ^ Cremation ^ Dare6on 21 b. Date d Diaposilbn (Month, day, year) 21c. Place d Disposition (Name d cemetery, aemelory a other place) 21 d. Location (CNy /town, gate, zip code)
® Burial ^ Removal Irom Bate Was GemMion or Damtbn Aumodutl
/
? ^
^
11-12-08
Spring Hill Cemetery
Shippensburg, PA 17257
^ ref-~~,. ~ byMr!OIglExammer
Caorxv
NO
ves
~ 22a. tore o dal Service Licari a rson acN as such) 22b. Lkense Hunter 22c. Name arld Atltlress d FArikry
~~ ~
' FD-012 4-L Fogelsanger-Bricker Funeral Home Inc., Shippensburg, PA 17257
. ~
j
Carrglete Hems 23ac amy when oMilpng 23a. To dle beg d , death ocamed g me 6me, date and place sated. {Sgr~ature and title) 23b. Lcense Number
~~ 2&. Dale Signetl (Momh, daY, Year)
physidan re rot evaNable el tMw d death to .~ , '1 r r
~ H / „
I'~1V i I I ~ O(1 !\
'1
cenNy cause ddeam. IZ.}J W V
Time d DaeM
24 25. Dale Pronounced Dead (Month, day, year) 26. Was Gale Rderretl to Metlical Examiner /Coroner for a Reason Other Man Cremalpn or Donation?
Hems 2426 must be cortgAeletl by person . ~ ^Ves ~] No
who gonaxtces death. A roX. (1~ Q~ I ~ i ~7 ~. ~y L/
'
CAUSE OF DEATH (See Instructions sntl examples) I Approximate nterval: Pad IC EMa dha simi Irant canMbns cadridaina to death, 26, Did Tobacco Use Cuntdbule to Death?
Item 27. Pad 1: Eller the dtei d events -diseases, inrynies, a canplkatian -that directy reused the deem. DO NOT enter lemunel events such as cardiac arreg, r Orset to Oeelh but not resullmg M the Inxkdying cause gWen m Pan I. ^ Yes ^ Probably
raspirelory erreg, a veMrkWar flbrilletion wdhad showing the etiology Lill only one cause an each 6ne, r
t
^ Nc [] Unknown
.^`
cMIceM~ ~ ~~~ 6E I tgl) drsease or 1 I
//n I
g m des h
e
V ~ 29. If Femek:
r
1
ahi
g
^ N
_~
. `_(
I
Due to la as a rice otl'. ~ I
r
N any, b
SequeMiagyy gg contlilions pregraM w
n pe
yea
o
^ Pregnant et time al ceath
,
,
leatling b dte cause fisted a Gne a. ,
EMa the UNDERLYING CAUSE Due b (w as a consequence o1)~. r ^ Not pregnant, but pregnant wdhin 42 days
of death
disease a injury that inNialed the c
I
.
e
vents resulting m tlemh) IASL
~
' ^ Not pegnenl, WI pregnant 43 days l0 1 year
p~ b (a as a consequence d)
. before death
r
d ^ UnkAOVm N precsxa+l wNldn the past year
,
30a. Waz an AMOpsy 306. Were ANopsy Firstlings 31. Manner of Death 32e. Dale d Inryry (Month, tlay, yearl 326. Describe ylow hyury Ocarted 32c. Place d Injury: Home, Farm, Brest, Factory,
Ogice Buiklirg, etc. (SFeciry)
Pedom~ed? Available Prior to Completion
e M Death
of Ca `1~4a\ural ^ Homicide
us ^ Accident ^ Perxfng Investigedon 32tl. Time d Injury 32e. Inlury al Work? 321. IL Trarspodalion Injury (Specify) 32g. Loralion al Injury (Breel, oily /town, stale)
^ Yes '~o ^ Yes ~lo ^ Yes ^ No ^ Driver I Operaar ^ Passenger ^Petlesldan
^ Suiade ^ Codd Not ce Delermirled M pher - Spedty:
33a. Ceddxe Icheck only one) 336. Bgnatue ant Titie d Ce "
• CMitying physician (Physician cedNyilg cause d tlealh when ermther physlden ties pronouncetl tleath and completed Item 23)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
_
_ _
deem accuaetl due to the cause(s) and manner es stetetl
e
wkd
b
t
f
k
T `
_ _ _ _ _
_ _ _
_
,
g
o the
es
my
rro
o
. Prorwuncing end ceditylry physkien (Physican both pronaxlcing death and cedifyin9lo cause of death)
^ 33c. License NIxM>er 33d. - ned (Monet, day, year]
_ -- - - --
To the best d my knowledge, tleam occurted m the time, dale, erM place, and due to the cause(s) and memmr n tdaled_ _ _ _ _ _ _ _ _ _ _
• Medical FY9lnllier /Coroner ~ /
G~~ { I
1
deaM occurtetl g the time, sate, erM place, sntl due tome cause(s) arts manner as sleted_ ^
In 'nion
On Me basis of examinellon arld / a Investigation ath Qlom 27) T / Prin
l
eled a 1 De
W
la
Co
lry
blame ant Adtlress d on
,
, -
.
11
~~
(
v
~
~
~ ~
35. Registr ignetue strict Nu ~ i 1 i i / I ~ i
~ ,~ z 36. Date Fled (Month, tlay, year) `
K W "
~`
~
~i~
- ~. z
d Disposkion Permit No. ~11 ~ 1
JRZ - 5.1 kauffman.2 January lh, 2007
LAST WILL AND TESTAMENT
I, Nancy L. Kauffman, of 19 Hollar Avenue, Shippensburg,
Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, do hereby declare this to be my will,
hereby revoking any and all former wills and codicils thereto by me
P. t
r-i
heretofore made. `- ~ z-~
~,.,
~-~
,' ~ ~?
'_i:.,
.ry +-r-z ~
I . ~' ~`~
`; ~
~ ~ ~..;
', ~~-
-n "-~'~'
I direct that all my just debts and funeral exper~es, a
including all expenses of my last illness, shall be paid from my
estate as soon as practicable after my decease as a part of the
expense of the administration of my estate.
II.
/ 3
I give, devise and bequeath the residue of my estate of every
~ nature and wherever situate to my grandson, Ron N. Kauffman,
providing he shall survive me by thirty days.
III.
Should my grandson, Ron N. Kauffman, predecease me or die on
or before the thirtieth day following my death I give, devise and
bequeath the residue of my estate of every nature and wherever
situate to my son, Gregg E. Kauffman.
IV.
Any fiduciary under this will shall have the following powers
in addition to those vested in them by law and by other provisions
of my will applicable to all property whether principal or income,
including property held for minors, exercisable without Court
approval, and effective until actual distribution of all property:
A. To retain any and all of the assets of my estate, real or
personal, without regard to any principle of
diversification of risk.
B. To invest in all forms of property including stock,
common trust funds and mortgage investment funds without
restriction to investments authorized for Pennsylvania
-,~ fiduciaries as they deem proper, without regard to any
~ principle of diversification of risk.
C. To sell at public or private sale, to exchange or to
lease for any period of time any real or personal
property and to give options for sales, exchanges or
leases, for such prices and upon such terms or conditions
as they deem proper.
",, ~ D. To allocate receipts and expenses to principal or income
or partly to each as they from time to time think proper.
E. To compromise any claim or controversy.
Page 2
F. To distribute in cash or in kind or partly in each.
G. To hold property in their names without designation of
any fiduciary capacity or in the name of a nominee or
unregistered.
V.
I direct that all taxes that may be assessed in consequence of
my death of whatever nature and by whatever jurisdiction imposed,
shall be paid from my residuary estate as a part of the expense of
the administration of my estate.
VI.
I appoint the Farmers and Merchants Trust Company of
Chambersburg, Chambersburg, Pennsylvania, as executor of this my
will.
/ VII.
No bond shall be required of any fiduciary hereunder in any
~ jurisdiction.
c'~.\,
1~
IN WITNESS WHEREOF, I hereunto set my hand and seal to this my
last will and testament, consisting of five typewritten pages, the
first three of which bear my signature in the margin for the
Page 3
purpo~spe of identification this _j='~` day of
~~~~~ti 2 C~ ~
~~ ( SEAL )
Signed, sealed, published and declared by the above-named
testatrix as and for her last will and testament in our presence,
who in her presence, at her request and in the presence of each
other have hereunto set our hands as attesting witnesses.
-, ,
~~
~ ~- ~~-~, ~- X53 ~~/~~ ~~~ C~g.~-6t~J6~r~~. ~~
We , Nancy L . Kauffman, wL' ~ ~~ ~~l ~~,i/ anc~
/ v
~~ lJ~ Yl~ the testatrix and the witnesses
respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the
undersigned authority that the testatrix signed and executed the
instrument as her last will and testament 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
said testatrix, signed the will as witnesses and to the best of
their knowledge, said signer was at that time eighteen years of age
Page 4
or older, of sound mind and under no constraint or undue influence.
T tatrix r
Witness - 0"
ya ~ a• ti..~,~
Witne
Subscribed, sworn to and acknowledged
before me by the above-named signer and
subscribed and sworn to before me by the
abov -named witnesses this /~ day of
otary Public
COMMONWERi_ ; ;.~ ,_:~ I'ENNSYLi/AN1A
Nichde J ~ Seai
Kellen, Nota
ShiPPensburg Bor„ r^,~.~~ d~County
My Cor-tmissiar, ~ ~iFes Sept 3
Msrnbsr, Pennsylvania gssoc)stlon ~~ries
Page 5