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Home My WebLink About02-28-07 H IOS.80S REV 1/05 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. P 13106817 No. ...-:-:jjliiff;;;;7;;,- /(~\.'." OF.jE~~-----_..._ l' $:Y ~4'~"-. 4~:; . ~~- \~\ $::ei ',. '.".~ ~ Qi c.". .., ',' \~~ ~'-"\_ ::/r /::!:.~ (\~~ .1;/ \~~ /~,,\ -"';___191MENf\\\~~" """""'O~"HIJlJJ~/'~' a~I?~~.. Local Registrar Fee for this certificate, $6.00 FEB 1 9 2007 Date ;' t '"-'-..1 1'.) C0 -u REV 11/2006 I PRINT IN ..,(ANENT CK INK COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER c.Jl Q} \ 01 0\88 .,.., 8b County 01 Death . 9242 4. Dale of Death (Month, day, year) 2-12-2007 5. Age (Last Birthday) 6. Dale of Birth (Month, day, year} 8a. Place of Death (Check only one) Hospital: o Inpatient 0 ER I Outpatient 0 DOA 9. Was Decedent of HispaniC Otig;n? (If yes, specify Cuban. Mexican, Puerto Rican, ele,) 14. Marital Status: Married, Never Married, Widowed, Divorced (Specify) widowed. 10, Race: American Indian, Black, White, el~ {S"",,ifyl white el9 y",. _ 16. Decedent's MaIling Address (Street, cily I town, state, zip code) 100 Mt. Allen Drive Mechanicsburg, PA 17055 Ha.Slale Pennsylvania Cumberland 17b. County 17c. E1 Yes.llece<laol LNed;o Uppe r Allen Twp 17d. 0 No, Decedent Uved within Actual Limilsol Twp City { Boro 18. Father's Name (Arst, middle, last, suffilc) Oswell 208. lnformanfs Name (Type I Print) David A. Long M.D. Bri s 19. Mother's Name (Arst, middle, maiden sumame) Lula Mae Pattison 20b. Informant's Mailing Address (Street, city I town, slate, zip code) 4 Holly Drive, New Cumberland, PA 17070 21c. Place of Disposition (Name of cemetery, cremalOlY or other place) Evans Crematory 21d. location (City {town, state, zip code) cheafferstown, PA - ~ 22c. Name and Address of Facility Parthemore FH&CS,Inc. PO Box 431, New Cumberland, PA 17070 23b. License Number 23c. Date Signed (Month. day, year) Items 24.26 must be compleled by person ~ who pronounces death. 25. Date Pronounced Dead (Month, day, year) d""/ d " 0 / CAUSE OF DEATH (See Instructions and examples) llem 27. Part I: Enler the ~ - diseases, injuries, or comprlCations - that directly caused the death. 00 NOT enter terminal evenls such as cardiac arrest, respiratory arrest, or ventricular fibrinaliOfl without showing the ellology. list only one cause on each line 24. Ttnle of Death dd/C M. 20. Was Case Referred to Medical Examiner { Coroner for a Reason Other than Cremation or Donation? [3'/es 0 No ~~ 4=) Approximate inteNat Part II: Enter other skmiftcant conditions contributino 10 death, 28. Did Tobacco Use Contribute to Death? Onset to Death but no! resulting in the undertying cause given in Part 1 0 Yes 0 Probably D No 0 Uokoown :-:J:J~&:~S~ ~~~\ disea..::. a. &' /? () 'un "'-12 ..s; "..J Due to (Of' as a consequence on. - /~< .;.. .j)/7) 29. If Female: o Not pregnant within past year o Pregnant at time of death o Not pregnanl, but pregnant within 42 days of death o Not pregnant, but pregnant 43 days to 1 year before death D Unknown ij pregnant within the past year 32c. Place of In~ry: Home, Farm, Street, Factory. Office Building, etc. (Specify) Sequentially list conditions, If any, leading to the cause listed 00 Une a. Enter !he UNDERLYING CAUSE (disease or injury that initiated the events resulting In death) LAST. Due 10 (or as a consequence of): Due to (or as a consequence on: d. Dves riNo DYes DNa 31. Manner 01 Dealh ~alural 0 Homicide D Accident 0 Pending Investigation o Suicide 0 Could Not be Determined 32d. Time of Injury 32g. Location of lnjUlY (Street, city {town, Slale) 3Oa. Was an Autopsy Perlormed? 3Ob. Were Autopsy Flf'ldings Available Prior \0 Completion of Cause of Dealh? M. 33a. Certifier (check only one) =::a ~:~=:n~~~~r: ~~ ~I~ W:u:::n~=:: ~::..~~_ ~a~h _~ ~:"~~~ ~:n ~~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~ ... ~=:~f~ :w~~~~~~a:c(::=: :lhu~::::;~~~~~rt~~1oto:=~~)a~~ manner as stated- _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 0 ~::~m~~::~=:, and I or Investigation, In my opinion, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated- D /T?.J) 018;J 1'/ C 33d. Date Signed (Month, day, year) ..2-./.7.~? Disposition Permit No 34. Name and Address2~rs;dWho ~~~~aus~~th (Item 27) Type I Print ~j~..J'<,,~ b- i?4 /7&,) ~}- '"' 35. Registrar's Sign ~ fh118,/,/1 d.. \ 0 \ Q l <08 OATH OF SUBSCRIBING WITNESS(ES) REGISTER OF WILLS C-u 1J118~.D COUNTY, PENNSYL V ANlA Estate of Y E1)A i. Lp/J6 H~~ j/ ~/I X/2ENF LL>N6 , Deceased V/,4,/(LES E. >11/ GZ05 71L , ~ a subscribing witness to (Print Name/s) the ~Will 8 CuJiL.a(~) presented herewith, Eeaefltbeing duly qualified according to law, depose(s) and say(s) that -eM / he / ~ was /~ present and saw the above ..:r.cst.nOl! Testatrix sign the same and that -she~ they signed the same and that ~(l;) ~ signed as a witness at the request of the Tcstato17 Testatrix in her ~ presence and in the presence of each other. ~MMlut~~ (Signature) (! I( /9 ~L ES e: .5h"/CZA> ':Or (;, CLf)U see ~A':tJ (Signa/ure) (Street Address) (Street Address) 1'0 L:,l IJIEMIJAI/~Sfattl((;.) /U- /7055 (Cily, State, Zip) (City, State, Zip) ,....1 --i c; Executed in Register's Office Swom to or affirmed and subscribed Executed out of Register's Office Swom to or affirmed and subscribed before me this ~ 6 of Pebn.tQ"Lf day , d.()6l-. before me this day of \..- Notary Public My Commission Expires: (Signature and Seal of Notary or other official qualified to administer oaths. Show date of expiration of Notary's Commission.) NOTE: To be taken by Officer authorized to administer oaths. Please have present the original or copy of instrument(s) at time of notarization. Form RW-03 rev 10.13.06 a\ Dl o\B~ ~~ =====" ~_b__.~~ LAST WILL AND TESTAMENT OF VEDA I. LONG I, VEDA I. LONG, of the Borough of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will 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 my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to be divided as follows: a.) One-half (1/2) to my daughter, RUTH ANN RIESE, per stirpes. b.) One-half (1/2) to my son, DAVID A. LONG, per stirpes. 3. I nominate, constitute and appoint my son, DAVID A. LONG, to be the Executor of this my Last Will and Testament. In the event that he should predecease me or for any reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, RUTH ANN RIESE, to be Executrix in his place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /2. f1:l day of ~ , A.D. 1995. 7J~ -dI. L-X ~O VEDA I. LONG (SEAL) Signed, sealed, published and declared by the above-named VEDA I. LONG as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses. ~ ~ ~du :LifA~ 6>AG--( . f\trr -,..., , \ ~~~,.'/ r,) co -::-" . <.1 "j ---j en