HomeMy WebLinkAbout02-13-07
HIOo.800 REV ]100
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.
No.
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Fee for this certificate, $6.00
Local Registrar
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13105998
FEB 0 2 2007
Date
ITEM # 3 -I- C,
SHOULD READ AS FOLLOWS:
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PRINT IN
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1/30-440
,. Name 01 Oooodonl (AnI, _, Iasl, SIJ1lixI
Ruth
5."'" (last Birlhlay)
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CORONER'S CERTIFICATE OF DEATH
(See Instructions end examples on reverse)
3.~SecultIy_
Irvin
6. Dale Of Birth (Month, da , ~
80
Vrl.
Nov. 23, 1926
STATE ~ILE NUMBER
4. 0'1e 01 Oealh (Monlh, d.y, year)
January 22, 2007
J
6b. Coun1y 01 Death
Cumberland
l1._.Uouol
Kind Of Work
19 Andes Drive
_ oOlher-Specify:
10. Rice: American lndln, Black, White, e1c.
(Specif)1
white
12. Was Oecedent ever in the
U.s. Armed FoIooa?
oVes ~
13. Decedont'. EclJcalloo (Specify Wi hlpot grsda compIeIed)
EIemenOuy I Secondary (0.12) Collage ('-< or 5+)
12 1
, PA 17055
Ilecedanl'.
ActuoJReOdanc:eI7.._ ]Jpnnl'lylvrlnirl
17b.Coun1y Cumber land
17Ca v.., Oooodonl u.ed . U "p E! r A 11 en
17d. 0 No, Oecedanl u.ed """"
AcI1JaIUmllsOl
Twp.
CilyIBoro
Peter C. Musselman
19. Molher'. Name (RrsI, _, moJdan ournamel
R ler
2Qb._rsMailk1g_(~cMyl_,_,1'4>_)
24 Conway Dr.,Mechanicsburg,PA17055
21,. PIllcoolDispositioo (N.me 01 cemetery, ~orolherplace) 21d. Locollon ICiryl_,_, 1'4>-'
Evans Cremation Service Leola,PAI7540
Hummel Ave.,Lemoyne,PA17043
23b, IJalnse Numl>er 230. Dale Signed (Monlh, day, yea~
24. Time 01 Death 25. _ __ Doad(_, day, yoo~
4:00 P. ~ January 23, 2007
CAUSE OF OEATH (See lnatruclIona and a_pleo)
"",,27. Part I: Enterlhe~ -,"IUrie.,or_-lhat<hclJyco_lhedoolh.DONOT_I___"cardioco_
respiratory arrest, or ventricular fibrillation wtthoU IhorMng the etiology, list only one cause on eadl fine.
=~~=-= a. Gastrointestinal Hemorrhage
Due 10 (or as a consequence of):
300. Was "''''-
-
d.
3CIl.w...~F'_
A_ PIIor 10 Complotion
01 Cau8& of D8olh?
ov" ONo
3Ulanner 0( 0eaIh
~ral D-
0- 0 Pondngl~
o &icfde 0 ColId Not be lloIe.-
I ApproxinIte interval:
I 0nsI11o Death
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2&, Was Case Aslerred 10 MecficaJ Examiner I Coroner fOf a Reason Other than Cremation or Donation?
~V.. oNo
Pan U: Enter other sicdicant cmdlinnR avlITbIlWl to dMth, 28. DId Tobacco Use Contribute to Death?
bul no! r88lAlIng In lh. unde~ng COU80 given . Pan 1. 0 v.. 0 ProboI;y
oNo oUnIcno'/In
29. II FomeJo:
o Nolpregnon1wllhi1paotyeer
o Pregnon1a1limaOldoolh
o NOI lI<_nt, bul pregnonl ,"lh. '2 days
ol_
D No! prognant, bul_'43 days 10 1 yea,
......-
o UnknownllplOglOnt_lheP8S1Y"ar
32c. ~=:""~ _ Fodory
~1lst_,llilll'f, b.
=1:~v::rc:~ a. Due to (or 85 a consequence 01):
~ryllu:.~ c.
Due 10 (or as a consequence 00:
0'" ~
321:l.TlrTl801lr'fJry
M,
330. CIolifiorIcl1oCl<Wione)
. CortIIylngp/lyllcllll,IPhysjOanCO<1l1yingc:auoeoldaolh.....anolher'*'-*_doalhond."..edllem23) Coroner
rolho_otmy"-ledgo, __ "'lolheCllUll(a) Ind mo...... "otaIoll..u__ _ _ __ __ _ _ __ ___ _ _ _ _ __ __ u _ _ _ _ _ 0
. ==:=~ ..':.=:'~~.::tlo== .........___ _ _u__ _ _ __ __ m __ 0 33d Dole Signed IMonlh,day, year)
_E'.......IC- January 24, 2007
On ""'_01._ Indlor ~on, In my opinion, - _"""'_,da\o, ond ploco, ond....lo IheCluoo(a)ond me""""IIIIerL)it 34. ~rc~'f"'r'.~oI ~J!P'IP"I
r.Sig1aIu"ond7'~~ . I ..41 /1"<'1/ 1/ 1 ~08Ie~!7;f" ~~~~a~i~~g~~~, R~id17~~~te 1/1
Dlspo.1tion Po"'" No t:f / .7. {" It /J c:-
CERTIFICATION OF NOTICE UNDER Pa. O.C. Rule 5.6(a)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYL Vf\NIA
i
File Number: 21-07 fo 1 04
Name of Decedent: Ruth Jean Irvin
Date of Death: 1/22/2007
Date Letters Granted: 2/2/2007
To the Register:
I certify that Notice of Estate Administration required by Pa. O.C. Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
February 9 2007
Name:
Address:
Bonnie Trusch 24 Conway Drive, Mechanicsbut~, P A 17055
Matthew C. Trusch 24 Conway Drive, Mechanicsbuf~' P A 17055
Michael Trusch 24 Conwa Drive Mechanicsb P A 17055
Christine (Thomas) AlbriJilit 3331 Davidsbur Road Dover A 17315
Michelle L. (Thomas) Kochenow 9331 West Central Avenue #8 ichita KS 67212
John R. Thomas, Jr. 2439 Camino Corso Rio, San CI mente, CA 92673
Adam L. Thomas 630 Humphrey Court, Apt. 203, farrisburg, FA 17109
(If more space is needed, attach separate sheet.) ~
!
Notice has now been given to all persons entitled thereto under Pa. O.C. Rul~ 5.6(a) except:
I
N~ I
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Date 2/9/2007
~~
Signature of Person Filing this Form
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Capacity: DPersonal Repr+entative .counsel
R. Mark Thomas Es uir
Name of Person Filing this Form
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181 JO~) S,NVHd80
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88 : I Jid 81 93J iDOl
101 South Market Street I
Address
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Mechanicsburg, FA 170~5
717-796-2100
Telephone
Form RW-08 rev. 10.13.06
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