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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 request(s) the grant of Letters in the appropriate form:
Decedent's Information
Name: Robert Maurice Kauffman
a/k/a:
a/k/a:
a/k/a:
Date of Death: January 15, 2013
11 ? a)
File No: X / ;'~S //
(Assigned by Register)
Social Security No: 168-24-2768
Age at death: 88
Decedent was domiciled at death in Cumberland County, pA (stare) with his/her last
principal residence at 249 Rich Valley Road Mechanicsburg. PA 17050 Silver Burins=. Two.. Cumberland County
Street address, Post Onice and Zip Code City, Township or Borough County
Decedent died at Holv Spirit I losnital. 503 N. 21 s4 Street, Camp Hill. PA Cumberland Cotmt
Street address, Post Office and 'Lip Code City,'I'ownship or Borough County State
Estimate of value of decedent's property at death:
/f domiciled in Pennsylvania ............................ All personal property $
/f not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $
/f not domiciled in Pennsylvania ........................ Personal property in County $
Value ofrea[estatein Pennsylvania ......................................................... $
TO'T'AL ESTIMATED VALUE.... $ o7S~p 0 0.00
Real estate in Pennsylvania situated at 249 Rich Valley Road, Mechanicsburg, PA 17050 Siber Spring Township, Cumberland County
(Attach additional sheets, if necessary) Street address, Post O[ce and Zip Code City, Township or Borough County
/^ A. Petition for Probate and Grant of Letters Testamentary
Petitioner(s) avers} helshelthey 'ss/are the Executar(s) named in the last W ill of the Decedent, dated April 21, 1994 and Codicil(s)
thereto dated rila
State relevant circumstances (e.g. renunciation, death of executor, 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 htid been established as defined in 23 Pa. C.S. § 3323(g), and did not have a child bom or
adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person.
O. NO EXCEPTIONS Q EXCEPTIONS
^ B. Petition for Grant of Letters of Administration (If applicable)
e.t.a., d.b.n., d.b.n.c.t.a., pendentghjte, durance antia,~iltt~te minoritate
w -
If Administration, c.Ga. or db.n.c.~a.,
Except as follows: Decedent was not a party to a pending divorce proceeding wherein the grounds fpdi~err~had lS~n established as defined
in 23 Pa. C.S. § 3323(g) and was neither the victim of a killing nor ever adjudicated an incapacitated ~ r-+ rrtr~t
Q NO EXCEPTIONS Q EXCEPTIONS ~ LJ? :.~ C, ~>
~-
Petitioncrs),afteraproper search has/have ascertained[ha[DecedentleftnoWiilandwassurvivedbythe'~ol spotts~e ifar;y}ahYttheirs(attach
n Vii' "
ruirittiona! sheeKr, ifnecessary): ~ ~ ~ ~ i
,,
Name Relationshi ddress -~ ~ ~
rt~nnaw-n? ,~~~.la~llizolr Page 1 oft
Oath of Personal Representative
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
}
} SS:
}
Official Use Only
Petitioner(s) Printed Name Petitioner(s) Printed Address h
CL
/~O ~~U
The Petitioner(s) above-named swear(s) or affirm(s) 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 dent, the Petitioner(s) will well and tmly administer the estate according to law.
Sworn to irmed~3 ubscribed before ~ z__._ Date / / ,~i~ ~ ~~
' "~ ~ Date
me this ay o
13 Date
Y~
For rh .Re icier ~ yf ~ >~ Date
BOND Required: Q YES
FEES:
i
To the Register of Wills:
Please enter my appearance by my signature below:
Letters ..................... .
( ~~) Short Certificate(s)..... .
( )Renunciation(s)........ .
( )Codicil(s) ............ .
( )Affidavit(s)........... .
Bond ........................
Commission .. . .............. .
Other {{ -)1~
r!.-r)J ......
$a,.
........
Automation Fee .............. .
JCS Fee . .................... ~ ~~ ~ , .
TOTAL ..................... $e~.OQ
Attorney Signature:
~_~
C p `-' ~ C7
Printed Name: 3
~ ~-
_~ ~~ t~
-
Suprcmc Court r-t ~ e7 J e-±
IDNurober: ~ ~" ~ F~~ 9'1 r_°i
~ ~ ~~~
'
Firm Namc: :x' r•C
--~ _
"O 3
C% L
`a `„t
Address: .- t ,, .:-' ~ : ~~ . ~-
~.~
- F--• a -. ~,.t
s"
_;
~~ C3 ~ '*t
Phone:
Fax:
Email:
llECREE OF THE REGISTER
File No: '1/~ ~' ~~ ~ ~ ~~
Estate of Robert Maurice Kauffman
a/k/a:
' ~'~
AND NOW, ~ , ~ ~~ , in consideration o~the foregoing Petition,
satisfactory proof hav~ been pre a ted before me, IT IS C~ED that/.Let s ~ ~` ~"~u ~>>~- c a -z
ereby granted to ` -,~ r f„~ >t-7 ~ ~i { j~?~•'~
in the above estate and (if applicable) that
the instrument(s) dated ~` ~/'~_ ~ ~
described in the Petition be admitted to robate a{td filed of record as the la t Will and Co ipil(s)) of Deced t.
P
-~G~;~,4 ~Z :L
egister of Wills ~ ~~ ~~ ~~ ~~ J~~ ,
_r ~ Pa a ~~
F~rmaw ~~ rev-in~il~zoii g
/~ i -
_J
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
1 c: ;13r !hr. I_e1'titi~aie. kC,.111}
P 19179452
(~1:'rtific~nlun NunlhcF
m/vnm In
This is [I> ceriif) that the inlilnnation hrre gi~rn i<
axrecU~~ copied from an orikinal Certificate ot~ Dcalh
dull tiled kith me as Ll,lcal Registrar. The original
certilicate mill be foniLarded to the State Vitul
Rccuril, Otlicc fiu pcnn!ulcnt filing,
Lrlcal he~3lsu:fr Date Is,ued
COMMONW fALTX Of PENNSYLVANIA • DEPAgiMfNi Di NFALTN . VITgL gECORDS
fC[ITI[I/'IaTC /YC nv~wraa
1. pe[Menfs legal Name If Nit MMele, Lasl, SuMv Slate Flle Number:
1 Z
Sea 3
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ecUNry NUmper d. pah of OKlh (MO/Day/Yr115p<II MO
Robert Maurice itauffman
Male 168 - 29 - 2768 Jan
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a.
fe lasa Blrthdry Yrs Sb. UnelrlYUr $[. UnaerlDa 6.Date of Birth IMO/pay/Yearl (Spell MOn[F la 99yytthpNVaCC ICIN On 5fdf<or is [[ Coun[ryl
~
MoMn3 Days (lours Minulea M[_CE1a)41CS~llTgp ~
A
88 Ma 27 1924 m. elrtnpN«ICpunryr Rmlberland
W germ<nu aaae Or Fnreyn coumryl en. Resbace kneel ane Niamxr. bdeee pvl Xe.i e<. Dm De[edmmye inamwnsMp)
PPN15 1 Vdllla
ffi yea, eemnmumed.n
W. RKm<n[<ICn.nlrl 249 Rich Valley Road - ~~~ Sgr ~ 4 lwv_
Cumberland Be. R.neeibe (np Eedel ^NO. dK<dKllived wemn llmiea Ol
m
/b
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em.
Y
9 Ever In US grmltl for[K) 10 MarNll Status at ilme of OeatF Mauled ^ Wedowee 3a. SurvIVIM Swum Name Nl wile. Else name prior to Oral manly{el
!$res ^ N
^
^
.
vnmewn
Divorcee ^ NevK M,mee ^ wmewn Gertrude H. V
13. fa[M1<Ia Hame (Elul, MHele, Lasl, Sulllr 13. Mo[heli Nam! PrlOr b Xn\ Mdnia{e (ilrst, Mltlele, Lasll
Morris Xauffman
Anna Rider
Ida. Informant's Name tab
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p to De<eaenl 1<c. IMormanks MalgnB pae[ess(sveK ane NUmpeE Clry, state, ilp CUael
Gertrude H
Hauffman W
o .
ife 299 Rich Valle Road Mechanics pp 17
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n 1Ba. Meahr,e MDiawnBo~ ®{uNRI ^ u<maabn Ssb. DalMOiswamen SK. pkce pr Diswnnen (Namer,lametery, <r.mamry
or pme pm<el
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^ Removal lydm slate ^ Donation
^ Dtno lswnryl _ _19 2013 Trindle 5 rin Cemeter
2 36d. wanpn pr Diswsmpn (ory nr mwn, salt, any xlpl va. x [e uam.e ar Penen mcnarde Pnmamem vb. Ikense NVmmr
? Mechanicsburg, PA 17055
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FIBM1esl de{ne or kvel pl aCnapl [pmpktee al tM time o(dea1M1. boa ahat M[t ees[rlhes wheNer an
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^ No dlOloma, 9th-1Z[M1 Enae MxI1dK[tlen1151wI5panhn/Hlspmit/Iwtina. ^ Bll[k Of Alrl[dn Amerlun ^ Vletnarriese
~HI{n uhool Eraeua[e er GFptpmpl<[etl No, no[$panlsn/NlipanN/latlno ^pmeri<an lndlan or Alaa4 Halnx ^gnerAlkn
^Seme colleve credia, but rw depee ^YU. Mexican, MexkanAmeri<an, CM1lcarw ^Allan lnelan ^Natlva Nawallan
^Aisoclate eeerve le.I. M. 0.5) ^Yei, puenO Rl[an ^[hlneu ^GUamanirn or Cbamono
^0acnebiseryrte 4.B~BA,AB, BSI ^Ver, Cuban ^flliplno ^Samwn
^MasteiFdeEreee.t.M0.M5,Mfng MF4,MSW,MBg ^Yes, panty SpdMSn/Ilispank/labno ^laparcse ^0lner pa<Ilk lalandpr
^ Do[tarate leg. PM1p, EeOl or praleubnal tlegrce Sp<[Ilyl
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Il pecetllna's sm{le Pate Self-DeslAwabn' Chec40NlY ONF to mtlkate wnat [M deutlena [onslaered himsell or henell la be. 32x. pe[edent's Usue10<cupatlon ~ Inekate type of worF
Flt Whlb
^ lepdnefe ^ Samoan
^B4[FerAMCan Amen[an ^ROrcan ^gher patlNr ldaneer dyne duanB moo olwerFlnR llle. 00 NOT U5(flETIREO.
^Amen<an lnelan prglatka Naarve ^Vletwmese ^Ddn'a Nnpw/Npl Sure l`~intenan(-'e WQ1dHT
^gslan lnelan ^O[nlr Allan ^Refuud 22b. Nlnd of BUSlness/Industry
^ cnlnese Nrzwe Nawallan 1 p<[lryl
^ ^ acne, s
^ Nnpiw ^ w. aM.~„r cram -... Welding
REMSf3a. i3 MUST BE COMpIETFO 23x. pate PronaurNetl Deaa IMO DaY .) 336.SIBnaturc of Penen Pronoun[inl DeatF lOnly when appll[abkl 13f. L1[ense Number
RY PERSON WNO pRONOVNCF50R
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/Y). ZS WasMNICaI Examiner or Carener COnaa[aea? ^ Vn No
CAUSE OF DEATH
m. part 1. finertne man eyen s..eizfa... ka m<e gpproxlmam
mbr mullwnpns-Thal eeealy nosed me aeon. no NDT emenermina eventz oven as rndiac amen. n Imerval:
reapirrtoryarrest, or vennkuld<albnllaNOn witnput ahO
wl
M lne enplagy OO NOT gBBREVIAif. Enter Only on[<iufe anallne 1M additional lines lln«e~ I Onset to peatM1
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IMMf 01AT[CPUSE --. > a I ~N[ l>Mr.A./~ ~ iO
ffinel tllaa.a<n, <e~mue^ pvemle, a,a <o, zew.^m erl. 1~7
rcwmM in eeatM1l
sKmmlaiv pn <oomapw, Dve le loran to aepuence oq. ~ 1~-
u anr, leaalr,{md,aavae I~ r
nsmtl on Ime a. mtu me _ ru r
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uraDearwc uusE or,e to lons<mneepumceoN: i~ r..
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lelseueorlnlurytnat ~ i~ -~J
m¢inee the evems reawbn{ a. ~~'?', ~_
' Dee ~e ter as ace aeNU! <e pm. -- ~=J ~C7
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36, pan II. Enter erne, Hvn Ncan[ canaMen bU - d n but nay resulNM In the uneedNM [auu Eiven In pan I. ]]. Was an Wt sy Mm I
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acco USe COnMbute to 0eetni 3L Ma olpwtn
^ Ne[prednanl xilM1ln put Year
s ^ p
nFnown Natural ^ Homl<I~f
^ pregnan[at lime el tl<aln
^ No
e
~ ent ^ PeMlnB lmesMBatbn
Xol pre{nen[, but ^ q<[l
^ prttn<nt wltM1ln d3 Gya al deatM1
^ Sul[Itle ^ CouW not Ee determined
^NOa preBnanC Wl preBwnta3 day to lYparbelore death 3Z. Ddae o11n1ury Mp/pay/Vr15p<II MOnIM1
^ Unkrown/I.e{nani whnln the wit ywr
33. Time of lnlury
3 d. place of lnlury e.{. nomei [onsnu[tlpn stte: Mrm; unool 35. Loudon 0I lnlury ISar¢et and Numhr, CIry, Coun1Y. Stan, Zlp Cotlel
3 6, lnlury at WOM1 3)IlTranswrtatlan lnN[Y. SpeClty: 3R. Describe Naw lnlury Ot[urretl:
^ rn ^ Dnvn/operator ^ peeexda^
^ Na ^ pauenBer ^ Otner lSpe[IIYI
l 9eC er~phyldan. urtifletl nuru pntthbn<r <tlkal udmlwr/[owner ([Feck only Duel:
Clmh'IM Onty-iO tM1<blsa al my knowlld aIn ODUnetl tlul to [w uus<(s irM manMrsutee.
^pronouncinB&CprtitylM'TO [nl Clsa of pwlee(e,deatM1OC[urred al the time, dau and plate, ane due l0lhe [ousels and manner slated
.
^ Metlkalfwminer/Cmm~pr~pn lhp minaabn and/pr lnVea[Ifaalpn, in my opinbn,deaah
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[urred al[he tlme.tlatl,aM Pia[a anddw to the cause(a and manner a[atee.
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3 90 Name. Adercu and Zip Code olperwn COmplealn{Cause of peaMllum 3G1
g4Y /Pt'[ga fla-c, I•-1 'oad7 Ivan is nl Oza l~[I~
n. Ca7cn Cti /N-utlnl 39<. Date Signed IMO/Day/yrl
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nlaeeaubn P<,mn no 0819537 `3D5-Sd3
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LAST GIILL AND 7.'ESTAP'ZENT OF ROBERT I~1• i~AUFFT~IAN
I, ROB~tT NI. KAUF'FT'IAN, of the Township of Silver Spring,
County of Cumberland and State of Pennsylvania, being of sound
and disposing mind, memory and understanding, do make, publish
and declare this my Last ldill and Testament, hereby revoking and
making void any and all prior Wills by me at any time heretofore
made.
1.
-~
I direct the payment of all m ~~'
y just debts ado unex~l ~
ca
expenses as soon after my decease as the same cam ~rcot~ena~s~ly
~ n. t'- ~ ....¢
done . ~ ,;• ~,~~~ w ~~~ ~:~
J'J .-i1 :.:5 C;7
r„~ r'~ ,- ...,0 wy -fry
_., t
--f
I give, devise and bequeath all the rest, residue and ~
remainder of my estate, real, personal and mixed, whatsoever and
wheresoever the same may be situate, to my wife, GERTRUDE H.
Y~tTF'Fi~IAid, absolutely and unconditionally.
3.
In the event that my wife, GERTRUDE H. hAUFFItiIA.N, should
predecease me, or should she die within thirty (30) days from
the date of my death, then in either of such events, I give,
devise and bequeath my entire estate, of whatsoever nature and
wheresoever the same may be situate, to my two (2) children, to
gait, ROBERT B. KAUFF~~IAN a.nd BARBARA E. KAUFFMAN, share and share
-1-
alike, per stirpes.
LASTLY, I nominate, constitute and appoint my wife,
G~?TRUDE H. Y~AUFr~7UTAN, Executrix of this my Last Wi11 and
Testament, and in the event that my said wife should predecease
me, or should she be unable or unwilling to serve in such
capacit~* for any reason, then in such event, i nominate, constitute
and appoint my son, ROBERT B. KAUFFT~~A.N, Executor of this my Last
U7ill and Testament, in her place and stead, and in either instance,
I direct that my said personal representatives be excused from
posting bond or other security for the faithful perforz~iance of
their duties in any jurisdiction.
IA,T b^1ITP3ESS `vdFIE~REOF, I have hereunto set my hand and seal
this ~ ~ r aay of April, A. D., 1991.}.
(SEAL)
-2-
Signed, sealed, published and declared by the above
.named, ROBERT I~~T. k~1UF~:+'NiAIv7, as and for his Last Will and Testament,
in the presence of us, who have subscribed our names hereto as
witnesses, at the request of said testator, in his presence and
in the presence of each other.
i'
-3-
COMMONWEALTH OF PENNSYLVANIA )
SS.
COUN'LY OF CUMBERLAND )
I> ROBr'~~T Psi. KAUFFT~ZAN the testat or
whose name is signed to the attached or foregoing instrument, having
been duly qualifled according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will and Testament;
that I signed it willingly; and thaC I signed it as my free and volun-
tary act and deed, far the purposes therein contained.
Sworn and affirmed to and acknowledged before me by
ROBERT P7. Kr`:UFFPT.4T~T the testator this ~.:,'
day of April A• D• ~ 199th.
.
~4,y vii. fJ, . C::"i i~~LV~rlr~~l. G~ 1~J~~
COMMONWEALTH OF PENNSYLVANIA ) «,_.,"
f'~Yh~ n
SS.
COUNTY OF CUMBERLAND )
We, the undersigned, J. POB ~' T STAUF?~r~
and FRTKa L. L:f?,'VLT'~TAGLTd , the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the
testator , ROBERT T4 n 9TTIi~FP~`fAN > sign and exe-
cute the instrument as his/, Last Will and Testament; that the
said testat pr ROBERT T~f Y,AU~T,T• AP~i , executed it as
his~}tCaG: 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
testat or was, at the time, eighteen (18) or more years of age,
of sound mind, and under no constraint, duress or undue influence.
,~,~
Man~yr r ~ ` i 3ry °ubiiC
Mfeah ~ Y t t : ~ rt eraro C:~mty
MyCo~nr,~;,so.,L>.Li~est~nv.5, 1997
,PermsyivaruaRSSOaalionof {~_, ~- i
Sworn and subscribed to before (~_ ~\ ~=~~ ~-
me this ~ day of
April , 199-. f"
Ne±~tl Ss3, ___
1. '~ `~ ~,~~,~.~,,sy,~;;,'
~*,-~ !3oro Guar ~ r r
- / ~ ` j ~mrzrssipnF~resPlo
(i,..,w,.,,i'EX1rAssodationof~... _..,