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HomeMy WebLinkAbout05-26-06 , Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Dorothy 0 Kaufman also known as No. 21-06- YS~ , Deceased Social Security No. 172-01-6744 John E Slike and PNC Bank Petitioner(s), who is/are 18 years of age or older, appl(ies) for: (COMPLETE 'A' or 'B' BELOW) [!] A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the the Decedent, dated 02/28/1997 and codicils dated 11/02/2005 none named in the last Will of 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 incompetent: not applicable o B. Grant of Letters of Administration (c.t.a; d.b.n.c.t.a; pedente lite: durante absentia; durante minoritate) Petitioner(s) after a proper search haslhave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: j......~) Name elationship Residence ;:-) ~:::l (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania with his/her family or principal residence at 100 Mt. Allen Dr. , Upper Allen Townshi ' Cumberland County, PA 1St street, number, and municipality) 0:> Decedent, then .-.!L years of age, died 05/14/2006 at Messiah Village (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in Pennsylvania (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania situated as follows: none 15,000.00 $ $ $ $ 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 appropnate form to the undersigned: ignature yped or printed name and residence John E Slike 2109 Market Street Camp Hill, PA 17011 PNC Bank P.O. Box 308 Camp Hill, PA 1iIM't 17a&r- "3ci' Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc. Form RW-1 (1991) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) or 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(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ~ ;; to ~y of ~. \) \Cf- ,~~"'~~ ~ - t::,b \ ~~gisrer1tf No. ~~ 21-06- 4Srl Dorothy D Kaufman , Deceased Estate of also known as Social Security No: 172-01-6744 Date of Death: 05/14/2006 AND NOW. ~dlo , /J(j{)(P , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 00 Testamentary 0 of Administration (c.t.a.; d.b.n.c.t.a.; pendente lite; durante absentia; durante minoritate) are hereby granted to John E Slike and PNC Bank, in the above estate and that the instrument(s) dated 2/28/1997 11/2/2005 described in the Petition be admitted to probate and filled of record as the last Will of Decedent. lJd{ui1~J1 :7t~ E. Slike, Esq. FEES Letters.......................................... $ 60.00 Renunciation............................... $ Attorney: J Short Certificate(s)...................... $ 8.00 Affidavits ( )...........................$ I.D. No: Said is, Flower & Lindsay Address: 2109 Market Street Extra Pages ( )......................$ Codicil.... ..... .............. ..... .............. $ 15.00 Camp Hill, PA 17011 Telephone: (717) 737-3405 JCP Fee............. ..... .....................$ 10.00 Inventory...... ................................ $ E-Mail: Other...4:-?.!.l\....~...~~~.!F 20.00 TOTAL...... ........ .............. $ 113.00 Prepared by the Pennsylvania Bar Association Copyright (c) 2004 form software only The Lackner Group, Inc. Form ~VV-1(1991) HIOS ~()' REV 1/11' This is to certify that the information here given is correctly copied from 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. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $6.00 p 12411948 No. !) 1- 01; - is r ~/Jp~ Local Registrar MA~ 1 6 2006 Date ~ (;::;) a~ .';--) ['.) 0\ ';c;-J, --.:,p - ( ) :=::: hi - - co COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH .. DaleofDealn(MonI~.day.yoaf) May 14, 2006 Cumberland Upper Allen Twp. 11. Decadent.s u...r O<:c ion ind 01 _ done durin mosl of worki ita; do nol stale rstired Hom~~~r Own H8m~inossllrdustl'j 16. Decedents Mailitg Md'", (SU..1. eityllown. state. zip code) 100 Mt. Allen Dr. Mechanicsburg, PA 17055 17a. Stale 17b.County Cumber land 19. Molher's Name (Flrsl. middle, meiden surname) Kate Deibler 18. Fal~er's Name (Firsl, niddle, last) Charles Daniel 200. Intormants Name (Typelprinl) John Slike STATE FILE NUMBER 3. Seeial Saeurily NurOOer 172 _01 _6744 lXher: o ERIOuI lianl a DOA Nursin Home a Residenee a Ot~ar 9 ~N~~en~: ~~~~=~uban. 10. Rac.: Amerioan Indoan, Black, WMe. ele. Mexican. PueI10 Ricon. ate) (Specify) Whi te h hesl ode co feted College (H or 5+) Twp. 15. SUoViving Spausa (If wife, give maiden name) Did Oecedanl live in a T ownsh\>? 17d. 0 No, Dee",,",'1 lived withil1 Aclual Units 01 Cityllloro 2Ob. Inlormanl's Mailing Mdr... (Sire8\. eilyllown, stole, Zl> code) 2109 Market St., Camp Hill, PA 17011 21c. Place of Disposlion (Name 01 eemelOl'j, cremeloly or olher plaee) or "- CAUSE OF DEATH (See InslrUCllons and... ) aem 27. Pa~ I: Enlerlhe ~.. diseases, InjJries, 01 CO""IClllions -thaI dirlClly eaused 1M d..lh. DO NOT entertemina! evOnlS such as eardiae arrest, respialOly orros!. 01 ventricular fIlriIIalion wlhouI showing the etiology. DO NOT abbreviale. Enter only OIlS cause on a in.. IMMEDIATE CAUSE (FInIl dis.... 01 condition resuling in deathl -,::. o. "! Sequenlialy IsI conditions, ~ any. ; I leading 10 Ihe causa lsIed online o. .. EnI", the UNDERl YIIlG CAUSE 1 (disease or iliul'j thai inilioled lhe :Ievenls resulling in death) LAST. .. .. 300. Was an /oUlDpay _mad? : Approximale inll~rv81: : onset 10 death i ,;<1./ t-,.." ~ dtlA.f ~ UleMiA OUeIO(Orasa~~: . ~ uJ.. tt.-f 1lA<te.. Due 10 (01 as a ~: Due to (or a. a conoequance o~: a Yes d. :lOb. W",e AIJIopsy Flfllllngo A....lable Prior 10 eorr.>letion ~~:eol~ 32d. Time ollnjul'j 31. ~er 01 Dealh <6 Nalural 0 Homicido o Aceident 0 Ponding Investlgalion o Suicide 0 Could Not Be Do_ed 320. Dale ollnjul'j (Month. day, year) 3211. Descrile how Injul'j Occurred: M. 33a. certifier (chod< only one) CertiIytng pIlyaltlan (I'I1ysician certifying cause 01 dealh'When anolher physician has pronounced daoth and cofl1lleled lIem 23) To the best 0' II1\' _go, death oceurred duoa to the cause(s) and manner as stated ............_._......_..._..................................._.........._........................................_0 Pronouncing and certifying physician (Physician both pronouncing dealh end certifying to cause of daath) / To the besl of II1\' _go, ~ occurred allhe llme, dale, and place, and due to 11IIeause(s) and nnno, as Slaled.......................................................................g' MedlealoxarrWlerlc:oraner On the bas" 01 e"""",,lIon andlor Investigallon, In my opinion, duth occurredalthe lime, date, and place, and duoa 10 the caUSe(s)and manner aa slated .........0 35 Regislrar's Signalur istrict Numbe Dale Filed (Month. day. yoar) I~I /I~I /1/1 /(. qo~ 6 (See instructions and examples on reverse) 21d. location (Cilyllown. stote. Zl> code) , PA 2:lc:. Dale Signed (Month, day, year) 26. Was Casa Referred 10 a Medical ExaninerlCofOner'l a Yes >> No Pari II: Enter other skI1ificant condmnlli conlriulIinn In tiM'h, but 001 resuiling in tha underlying causa given in Pa~ I. 28. Did Tobaeco Usa eo_ to Death? a Yes a Probably Q..Md' a Unknown 29. If Femele' a Not plegnanl within posl yoar a PregMnl allime of doath a No! pregnonl, but pregnant wlhif142 days 01 doalh o Not pregnanl, but pregnant 43 days 10 1 yoar before dealh a Unknown ~ pregnant within lhe post year 320. Place 01 Injury: Home. Farm, Slreet, F_ry. 01fIce Building, ele. (~ J'.J-dA N fdi ,I v.c- ,10 fh ri v<e- e~~Y1 tLV'1 tl/le.f'1 d./st..( K. cltl"l-U/<t.i",A I .4--1 ~.I'')1...L./ f '1tK... 321. If Transpol1alion Iniul'j (Spoc;M o DrillerlOpelOtor 0 Pa..enger o Pedeslrian 0 Other - ~ 331>. Signalure and nle of Cartifier ~"M-<.d4../ 33c. License Nurrber )11 tJ 1/,plJ- tI r-~ 32g. localion (SUeet. cilyAown, slale) 3M. Oa'e Signed (Month, day, yoar) 5'"-/6 .~OO(p 34. ~'!'" and Mdress 01 Parson Who Corrl>Ieled Cause of Doath (lIem 27) TypelPrint ~,q.H rVOoe..4~.s#- M!;) /oo/Hr A-l-L.et/IJ 7>J't..."v~ 111~qj./f/YI("' 6,"~ t:" r".19 .I 70,5-.p' SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill. PA LAST WILL AND TESTAMENT OF DOROTHY D. KAUFMAN I, DOROTHY D. KAUFMAN of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testa- ment, hereby revoking any will previously made by me. I - I direct the payment of all my just debts and funeral expenses, if any remain unpaid, out of my estate as soon as may be practical after my death. II - I make the following bequests of my tangible personal property: A. I bequeath my diamond watch and my diamond solitaire ring with basket-setting to my niece, Elaine D. Koppenheffer. B. I bequeath my Grandmother's clock to my niece's husband, Donald Koppenheffer. C. I bequeath my three-diamond ring and my four- diamond wedding band to my niece, Bette Grant. D. I direct that my executors hereinafter named divide my remaining tangible personal property, not including cash and securities, between my nieces, Elaine D. Koppenheffer and Bette Grant, as they shall determine or that said property be sold and the proceeds thereof added to the residue of my estate. III - I devise and bequeath all ther.~st, residue and I' ; remainder of my estate of whatever nature and..lwherever situate in l the following manner: Jtj( ."". ......, ~ :.., "~' .,'~ ~ , ~ 1 .1 i' , t" ~ . f ' , Page 1 '.....' .J A. 25% of said residue shall be divided among the following organizations in the percentages indicated: Zion Lutheran Church, Harrisburg, Pennsylvania - 25% Shriners' Crippled Children's Hospitals - 15% Bethesda Mission, Harrisburg, Pennsylvania - 15% PA Capital Region Chapter of the American Red Cross - 15% Harrisburg Area Salvation Army - 15% Messiah Village, Upper Allen Township, Cumberland County, Pennsylvania - 15% B. 30% of said residue shall be paid to my niece, Elaine D. Koppenheffer, and her husband, Donald Koppenheffer. Should they both be deceased, said amount shall be divided evenly among the organizations indicated in Paragraph III-A. C. 45% of said residue shall be paid to my niece, Bette Grant. Should she fail to survive me, one-half of her share shall be paid to her son, Jeffrey Grant, and the other one-half shall be divided evenly among the organizations listed in Paragraph ITI-A. IV - I appoint John E. Slike, Esquire and Elaine D. Koppenheffer, Executors of this, my Last will and Testament. SAIDIS,GtrnDO, Should either of my executors fail to qualify or cease to act as SHUFF & ~LAND such, then I appoint PNC Bank, N.A. as substitute executor. 2109 Market Street CampHiIl.PA None of my executors shall be required to post bond in this or any jurisdiction. J: 21{ Page 2 3AIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the '$(~15.- dayof ~~ ,1997. I j kLI-;fr~..:rr .~~tU1f.J(SEAL) (/ Dora D . a man t- V Signed, sealed, published and declared by DOROTHY D. KAUFMAN, Testatrix therein named, on this and two (2) other sheets of paper 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 subscribed our names as attesting witnesses. ~ ~~ L~-:!!,A )-tJ ~' , Name ~J~ti~ / Name ~~~f4- Page 3 SAIDIS, GUIDO, SHUFF & MASLAND 2109 Market Street Camp Hill, PA . . COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instru- ment, being first duly sworn, do hereby declare to the under- signed authority that the testatrix signed and executed the instrument as her Last will and Testament and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses 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. lbU~f ); lr:fu~ :/ T tatrJ. \ Subscribed, sworn to and acknowledged before me by the testatrix, and dHlbscribed and "..s.worn to before me by both wit- nesses, this ~o:-tn day of ,\--,. , 1997. NOTARIAL SEAL JO SMITH, Notary Public Camp Hill, Cumberland County My Commission Expires May 6, 2000 t, i~J11 'Z~ / " .~(, ,. .~ ': ")(1 ~ ". .' .I SAlOIS SHUFF, FLOWER & LINDSAY AITORNEYSoAToLAW 2109 Market Street Camp Hill, PA CODICIL OF DOROTHYD.KAUFMAN I, DOROTHY D. KAUFMAN, the within named Testatrix, do hereby make and publish this Codicil of my Last Will and Testament dated February 28, 1997. I. I hereby revoke the provisions of Paragraph II relating to the disposition of my tangible personal property, and provide that all of my tangible personal property shall be given to my deceased niece's husband, DONALD KOPPENHEFFER, now of Camp Hill, Pennsylvania. 110 I amend Paragraph III-C to provide as follows: 45% of said residue shall be divided evenly between my niece, BETTE GRANT, and her son, JEFFREY GRANT. Should either of them fail to survive me, their respective shares shall be divided evenly among the organizations listed in Paragraph III-A. III. I hereby ratify and confirm the remaining provisions of my Last Will and Testament dated February 28, 1997. IV. I appoint PNC Bank, N.A. and John E. Slike, Esquire, as co-executors of my estate. IN WITNESS WHEREOF, I, Dorothy D. Kaufman, have hereunto set my hand and seal to this Codicil to my Last Will and Testament this d f!. day of November, 2005. ~.~... \-,1 J;~y~h~ (SEAL) 8 I ;! I !!~j 07 !' 11 _ ~r,\ . iI i...' ; SAlOIS ;HUFF, FLOWER & LINDSAY AITORNEYSoAToLAW 2109 Market Street Camp Hill, PA .. Signed, sealed, published and declared by the above-named Dorothy D. Kaufman, as and for a Codicil to her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. {I,w.,fJ )1 ~ H. / ' ADDRESS: aLd&nV~ - ( ADDRESS: ~-??fJ J/dP' PI/- COMMONWEALTH OF PENNSYL VANIA : SS. COUNTY OF CUMBERLAND ufman, $ ~ g~ , and , the Testatrix and witnesses, respectively, whose names are signed to the fj egoing attached instrument, being first duly swom, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Codicil and that she signed willingly 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 Testatrix, signed the Codicil as witness and that to the best of their knowledge the Testatrix was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. fJ~.IL~W1A/"/ Dorothy D. Kaufmatf ~ Subscribed, sworn to and acknowledged before me by Dorothy D. Kaufman, the Testatrix, and subscribed to and sworn or affirmed to before me by ~ E&;Jfi and ~. j)f. J&ifl? ,witnesses, thiS~aYOfNOVemb~05. COMMONWEALlH OF PENNSYLVANIA 4. ~ ~ - Notarial Seat / () '-N P bl" SaraJ. Ensinger. Notary Public tar u IC Cartisle Boro. Cumberland County My Commission Expires Oct. 17,2009 Member. Pennsylvania Assooiatlon of Notaries