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Home My WebLink About03-07-13Reset 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: BEVERLY J. KAUFFMAN File No: ~, ~ j ~ `- ~~~ a/k/a: (Assigned by Register) a/k/a: a/k/a: Social Security No: Date of Death: FEBRUARY 15, 2013 Age at death: 65 Decedent was domiciled at death in CUMBERLAND County, pE~ (Stare) with his/her last principal residence at 882 ALEXANDER SPRING RD., CARLISLE 17015 S~. TOWNSHIP CUMBERLAND Street address, Post Office and Zip Code City, Township or Borough County /~ t cKr ./sv ,i Decedent died at 882 ALEXANDER SPRING RD., CARLISLE 17015 S-1y41~B91/£~=9N TOWNSHIP CUMBFRLAND PA Street address, Post OtTice and Zip Code City, Township or Borough County State Estimate of value of decedent's property at death: If domiciled in Pennsylvania ............................ All personal property $ 1,500.00 If not domiciled in Pennsylvania ........................ Personal property in Pennsylvania $ If not domiciled in Pennsy[vania ........................ Personal property in County $ Value of real estate in Pennsylvania ......................................................... $ 1 R7,400 (l~ TOTAL ESTIMATED VALUE.... $ 188.900.00 Real estate in Pennsylvania situated ar 882 ALEXANDER SPRING RD., CARLISLE 17015 S. MIDDLF,TON TWP CUMBERLAND (Attach additional sheers, if necessary.) Street address, Post Office and Zip Code City, Township or Borough County ® A. Petition for Probate and Grant of Letters Testamentary Petitioner(s) aver(s) he/shelthey is/are the Executor(s) named in the last Will of the Decedent, dated MARCH 28, 2003 and Codicil(s) thereto dated 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 had been established as defined in 23 Pa. C.S. § 3323(8), and did not have a child born or adopted; and Decedent was neither the victim of a killing nor ever adjudicated an incapacitated person. Q NO EXCEPTIONS O EXCEPTIONS ^ B. Petition for Grant of Letters of Administration (If applicable) c. t. a., d.b.n., d. b. n. c. t. a., pendente life, durante absentia, durante minoritate 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. Except as follows: Decedent 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(8) and was neither the victim of a killing nor ever adjudicated an incapacitated person. O NO EXCEPTIONS ~ EXCEPTIONS Petitioner(s), after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs (attach ad~ional she@~J if necessary ~ ~ ~" n ~ N Name t~ Relationshi Address ~ Z ~Z t--, '-J tr C7 II,'. C!) c~ Q W w~ °~ ~ FormRw-oz rev.lo~lli~otl Page 1 oft Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA } } SS: COUNTY OF CUMBERLAND Official Use Only Petitioner(s) Printed Name Petitioner(s) Printed Address SHERI SWIGERT HECKMAN 2 BRIAR OAK LANE CARLISLE PA 17015 The Petitioner(s) above-named swear(s) or affirm(s) the statements in the fore oin Petition ar true and correct to the best of the knowledge and belief of Petitioners j and that, as Personal Representative(s) of the D ce'd~nt, t e Petitio er(s) wil we 1 an t y administer the estate according to law. ~._ Sworn to or affirmed and subscr_i/b~ed before - ~- ~ " _ a e o7 r3 me this day of ~ , y~~/,~ Date $y: ~ Date For the Registey' Date BOND Required: Q YES Q NO To the Register of Wills: FEES• Please enter my appearance by my signature below: Letters ..................... . ( 1) Short Certificate(s)..... . ( )Renunciation(s)........ . ( )Codicil(s) ............ . ( )Affidavit(s)........... . Bond ........................ Commission ................. . Other ........ WILL ........ INVENTORY ........ INH TAX RETURN ....... . ~ 260.00 5.00 15.00 15.00 15.00 Automation Fee ............... 5.00 JCS Fee . .................... 23.50 TOTAL ..................... $ 338.50 Attorney Signature Printed Name: ROGE ~ . IRWIN, ESQUIRE Supreme Court ID Number: 6282 Firm Name: IRWIN & McKNIGHT, P.C. Address: F~ WF.4T POMFRF.T STRF.FT r'ARI i4T F„ PA 17013 Phone: (717)249-2353 Fax: 57171249-6354 Email: DECREE OF THE REGISTER Estate of BEVERLY J. KAUFFMAN File No: ~' ` ~~ _ ~ Z~ a/k/a: AND NOW, ~ y~L~ C,h ~ _, in consideration of the foregoing Petition, satisfactory proof having been presented before me, IT IS DECREED that Letters T°ESTAMENTARY are hereby granted to SHERI SWIGERT HECKMAN_ in the above estate and (if applicable) that the instrument(s) dated MARCH 28 2003 described in the Petition be admitted to probate and filed of record as the last Will (and Codicil(s)) of Decede Regtster of Wills ~`L~l~~~ ~~~ r ~ Form RW-02 rev. ioiuiaou ~~'~ 'Page 2 of 2 LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 This i~ to cartifs that the information here given is c<~rrectiy copied~li-o~n gut original Certificate of Death ~ ~ ~ ~ ~ d(.)ly filed with me as Local Registrar. The original certificate (.~~ill he f~:)rwarded to the State Vital ~ ~ N ~ ~ Rccord~, C)t}ire ii n' ncrmanent filing. P ~.9~3~2~8 ' ~ ~ ~ FE Certification~u~er N ~ ~ ~ L)~cal Registrar Date Issued \ LU ~.~r `g Type/Print In ~ ~,-.r ~ .~t~ ~ . t COMMONWEALTH OF PENNSYLVANIA ~ DEPARTMENT OF HEALTH ~ VITAL RECORD!i Permanent C/? ~ ~ Y{~1 CERTIFICATE OF DEATH Black Ink L 0 State Flle Number. 3. Decedent' m¢ ( Middle, L S ) 2. Sex 3. Social Security Number 4. Date of Death (MO/Day/Yr) (Spell Mo) Beve ffma Female 167-40-0849 February 15, 2013 Sa. Age-Last Birth Yrs) Under 1 V¢ar Sc. Under 1 Da 6. Date of Birth (Mo/Day/Vear) (Spell Month) 7a. Birthplace (City and state or For¢Ign Country) ~` 65 ~,. ,•yonths Days Hours Minutes NOV 9, 1947 7b. Birthplace (County) 8a. Residence (state or Foreign Country) Sb. Residence (Street and Number -Include Apt No.) 8c. Did Decedent Live In a TownshipT PA 882 Alexander Spring Rd. QO Yes, d¢teeenc lived in Sou h M~ ddb on t 8d. Residence (County) v/p. Cumberland 8e. Residence (Zip Code) ]-'701 ej Q No, decedent Ilv¢tl within limits of city/born. 9. Ever in US Armed Forces] 10. Marital status at Time of Death Q Married ~ Widowed 11. Surviving Spouse's Name (If wife, give name prior to first marriage) ~ Yes ~ No ~ Unknown ~ Divorced Q Never Married ~ Unknow 12. Father's Name (First, Middle, last, suffix) 13. Mother's Name Prior to First Marriage (First, Middle, Las[) Robert D_ Kauffman M tie F. Solon 14a. Informant's Name 14 b. Relationship to Decedent 14c. Informant's Mailing Address (Street and Number, Gity, State, Zip Code) o Nancy Sweeney sister 455 N_ Co11 a St.r Carlisle, PA 17013 G W .. _...,r,,,,,,_.____a,__ ace o eat ¢~ on one .......................................................... ...Pa........................... ..................... _ If Death Occurr d I H it l [~ ~~~-~~~~~~~- ~~-~~-~ -~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~-~~~~~~~~~~~~~~~~~~""""""""""""" "' '"""""" '"""" """' """ ~ c C - ° ` S e n a os P a : In dent _If Death Occurred Somewh ere Other Than a Hos ital: p Hospice Facility ~ Decedent's Home ~ Emergency Room/Outpatient Q Dead on Arrival 0 Nursing Home/Long-Term Care Facility Other (Specify) ~ e 156. Facility Name (If not Institution, give street and number; lSC. City or Town, State, and Zip Code i5d. County of Death 882 Alexander S rin Road Carlisle PA 17015 16a. Method of Disposition 0 Burial [~ Cremation 166. Date of Disposition 16c. Place of Disposition (Name of cemetery, crematory, o other place) r p Removal frpm state p Dpnation Other (Specify) Feb 19 , 201 Hof fman-Roth Funeral Home & Crematory 16tl. Location of Disposition (City or Town, State, and Zip) Carlisle PA 17013 17a. Sign of Funeral service- a or Person in Charge of Interment 17b. License Number , 138504 E 17c. Name and Complete Address of Funeral Facility 8 Hoffman-Roth Funeral Home & Cre mato 219 North Hanover S e li P m 16. Decedent's Education -Check the box that best describes the 19. Decedent of Hispanic Origin -Check the 20. Decedent's Rac¢ -Check ONE OR MORE races to indicate what ~ highest degree or level of school completed at the time of death. box that best describes whether the decedent the decedent considered himself or herself to be. Q 8th grade or less Is Spanish/Hispanic/Latino. Check the "NO" gj White ~ Korean Q No diploma, 9th - 12th grade box if decedent Is not Spanish/Hispanic/Latino. ~ Black or African American 0 Vietnamese ]Z] High schopl graduate or GED completed ® No, not Spanish/Hispa nlc/Latino ~ American Indian or Alaska Native 0 Other Asian Q Some college credit, but no degree Q Yes, Mexican, Mexican American, Chicano ~ Asian Indian ~ Na[IVe Hawallan Q Associate degree (e.g. AA, AS) Q Yes, Puerto Rican ~ Chinese ~ Guamanian or Chamorro ' ~ Bachelor s degree (e.g. BA, AB, BS) 0 Yes, Cuban ~ Filipino ~ Samoan ' ~ Master s degree (e.g. MA, MS, MEng, MEd, MSW, MBA) ~ Yes, other Spanish/Hispanic/Latino ~ Japanese ~ Other Pacific Islander Doctorate (¢.g. PhD, Ed D) or Professional degree (Specify) ~ Other (Specify) . MD pD5 OVM, LLB, JO 21. Decedent's Single Race Self-Designation -Check ONLY ONE to indicate what the decedent considered himself or herself to be. 22a. Decedent's Vsual Occupation -Indicate type of work White ~ Japanese ~ Samoan done during mast of working Ilfe. DO NOT VSE RETIRED. Black or Afri a A i n mer c can Q Korean ~ Other Paclflc Islander ~ American Indian or Alaska Native ~ Vletna mesa Q Don't Know/Not Sure Bartender ~ Asian Indian ~ Other Asian ~ Refused 22b. Kind of Business/Industry Q Chinese ~ Native Hawallan Q Other (specify) ~ Filipino ~ Guamanian or Cha morro BP17E ITEMS 23a - 23d MUST BE COMPLETED 23a. Date Pronounced Dead (MO Day r 236. Signature of Person Pronouncing Death (Only when applicable) 23c. Cleanse Number BY PERSON WHO PRONOUNCES OR CERTIFIES DEATH '1 ~ - t S - Ot O ~ 3 23d. Date Signed (MO/Day/Yr) 24. Time of Death Q ~ ~ 25. Was Medical Examiner or Coroner Contactetli ~ Yes $ No CAUSE OF DEATH Approximate 26. Part I. Enter the chain of a ants--diseases, injuries, o mplications-that directly caused the death. DO NOT enter terminal a n[s such a ardiac arrest Interval: respiratory arras(, or ventricular fibrillation without showing t et i l o og y . O N O T ABBREVIATE. Enter only one cause on a Iinee Add additional Tines If necessary Onset to Death ~h ]e Q/ ~ . / '~~ ~ / ~ / ~ . / . ~ ~ ~ IMMEDIATE CAUSE --------- -- -> a. - ~' Y Y ~~ T - - -'3-~~ ' (Final disease or condition ~ Due to (or a3.a a of): .conspquenc resulting in death) 1 b • ~ Sequentially list conditions, Due to ( s a sequence of): cp If any leading to the cause 1 ) , NI 3 listed on line a, Enter the - ~~ ~ UNDERLYING CAUSE Due to (or as a consequence of): (disease or Injury that F Initiated the events resulting d. in death) LAST. pue [o (or as a consequence of): S 26. Part 11. Enter other signiFl t ditl t Ib tl t d th but not resulting in the underlying cause given In Part I 27. Was an autopsy performedT ~ D Ves No 28. Were autopsy findings available $ co to plate the cause of death? g o Ves ~ No 29. If Female: 30. Did Tobacco Use Contribute to D¢athT 31. Manner of Death S Not pregnant within past year Q Ves 0 Probably '~ Natural 0 Homicide P e~ Q regnant ai time of death 0 No 0 Unknown ~ Accident ~ Pending Investigation Not re n t b t 0 p g an , u pregnant within 42 days of deatt Q Suicide ~ Could not be determined ti Q Not pregnant, but pregnant 43 days to 1 year before death 32. Date of Injury (MO/Da V/V r) (Spell Month) Q Unknown if pregnant within the pas[ year 33. Time of Injury 34. Place of Injury (e.g. home; construction site; farm; school) 35. Location of injury (Street antl Number, City, State, Zip Code) 36. InJury at Work 37. If Transportation Injury, Specify: 38. Describe How Injury Occu rretl: 0 Yes 0 Driver/Operator ~ Pedestrian Q No ~ Passenger Q Other (Specify) 39a. Certifier (Check only one): Certirying physician - To the best of my kno ledge, de th occurred due to She cause(s) and manner stated ~ Pronpuncing ffi Certifying physl la - T th b y know edge, death occurred at the time, date, and place, antl due to the cause(s) and manner stated ~ Q Medical Examiner/Coroner - O [i~fa d/or investigation, In my opinion, tleath occurred at the time, date, and place, and due to the taus (s) a d ma nn ta t¢tl L ~~ ~/~ ~ y g signature of certifier: Tltie of certifier: license Number: /FYI/V Q ~ ~ O ~ O l~ 39b. Name, Atldress and Zip de of Person Completing Cause of peath (Item 26) A ' 39c. Date Signed (MO/Day/Yr) ~/~. A t ~1 .7 t f ~ w i..-, a- G~: ! e ~S CF. I - - v ~ 40. Registrar's District tuber 41. Registrar's SI ~ 42. Registra FI a Date (MO Day r) t _ O ~ ~ \[ ~~ ~ `-` a~ ~3 43. Amendmen Disposition PermiT No. ~~~~ V R H105-143 REV 07/2011 LAST WILL AND TESTAMENT I, BEVERLY J. KAUFFMAN, of Dickinson Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. 1. I direct my Executrix to pay all of my debts, funeral and administrative expenses as soon as maybe done conveniently after my decease. 2. I authorize and empower my Executrix to sell any realty owned by me at my death and not specifically devised herein at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I give, devise and bequeath all of my estate of every nature and wherever situate as follows: (a) The sum of $4,200.00 to ELEANOR HERTZLER; and (b) All the rest, residue and remainder to SHERI SWIGERT ~ ° ~~ ~=~ rn ~ ~ ~ ~ cy~ HECKMAN, ANN TOLBERT, DARLENE GROVE and A. rn ~ ~ ~' ~ ~- r° r ;~ r~ .~ n ~ ~~~ ~ ; ; a~ CHRISTINE La VALLE, share and share alike, or to the survivor ~ v-' ~ ~ ~ ~ "' _ i ~ ^t if any of these persons have predeceased me. ~ ~ r. ~.w ~, --~ 2 ~ c~- ~ ~ CO ' *1 1 4. I nominate and appoint SHERI SWIGERT HECKMAN to be the Executrix of this my Last Will and Testament; she is to serve as such without bond. Should she die before my death, renounce or refuse to serve for any reason, or die leaving any of my estate unadministered, I nominate and appoint ROGER B. IRWIN, MARCUS A. McKNIGHT, III and JAMES D. HUGHES as substitute Executors, also to serve as such without bond and with the same powers as are given herein to my Executrix. 5. I hereby suggest that my personal representative retain the services of Irwin, McKnight & Hughes as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~>~`"' day of March, 2003. ,T.Y ~~./ (SEAL) BE J. N Signed, sealed, published and declared by BEVERLY J. KAUFFMAN, the Testatrix above-named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other have subscribed our names as witnesses hereto. .~ ry ~~ 2 a ACKNOWLEDGMENT AND AFFIDA VIT WE, BEVERLY J. KAUFFMAN, MARTHA L. NOEL and SHARON L. SCHWALM, the Testatrix and witnesses respectively, whose names aze signed to the foregoing instrument, being first duly sworn, do hereby declaze to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament, that she had signed willingly, that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of their knowledge the Testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. < <. BE J. KAU N l MART A L. N L SHARON L. SCHWALM COMMONWEALTH OF PENNSYLVANIA . SS: COUNTY OF CUMBERLAND Subscribed, sworn to and aclmowledged befere me by BEVERLY J. KAUFFMAN, the Testatrix herein, and subscribed and sworn to before me by MARTHA L. NOEL and SHARON L. SCHWALM, witnesses, this Z~° day of Mazch , 2003. ~: ~ '3 _ ~..._. otary Public ~~ Notarial Seal Roger B. Irwin, Notary Public Carlisle Boro, Cumberland County My Commission Expires Oct. 3, 2004 Member, PerlttsyNania Assooiation of Notaries