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NO, 21.80
PETITION FOR LETTERS OF ADMINISTRATION eTA
IN THE ESTATE OF ........AmY....I?.....W~.r.4,................................. DECEASED,
410
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IteKi~tel' Ilf Will" fill' the Cllunty of Cumberland, in the Commonwealth of Penn"yivania,
The Petition of DEl.upbJ,J:\.J)!;l.P.Qf,l.tt...!?~n\t. .?nQ,..,<rr..\.!!?.t...!:;9ffiPJHlY... ....,.,. .....,.,....,........,...
Amy B. Ward
""",...,.....................................,.....,... re~ pec t full y s howe l h th at.......... ,.. ,..............,..,.,..,.,.,....,..............".......,. ..",
Wll~ II re~ident of ....G!,!.I))p....H.nJ....................,..........'li::~l'lX , Cumbel'land County, State of Pennsyl-
vllnia, and II Citizen of United Stllte~, and departed this life intestate in the County of ,........................,..
,~,\.\ m )?,~ r.1,~mt.....,.,... IInd S tllte of .........,.,...,.. .P.~X~~? .":1.1 ~.a.~. ~ ~.. ,...........,........,.,......,....................". ..,..."......
011 ..,W~dne,ap.al1......,..'" the ,..............,~8,tJ:\............ day of ................1:11\.1.........,..,......,....'" A, D" 19..?9....,
lit the liKe of ..,..,8)...... yellrs.
Thllt the ~Ilid ....,..AmY...!.1..,..X!1!.r.g.....,......,....,..,..................,.., decea~ed, left surviving the following
named widow or flusbllnd, heir~ and next to kin, to wit:
Name
RelationHhip
Residence
,................".,,,,,..,,................................... ............................................ ................................................................
UnkTlo~rn
,............"................................................. ............................................ ................................................................
,,,.................,,......,,.................................. ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ ................................................................
................................................................ ............................................ .............................,,,................................
..."........................................................... ............................................ ........................................................,.......
...",.......................................................,.. ...,........................."............. ....................................,...........................
."............................................................. ............................................ ................................................................
That those above named include all of the next of kin, so far as known,
The sllid decedent was possessed of personal property to the estimated value of $..,15..9,Q,9....Q.9.....,;.
and of Real Estate, less incumbrance, to the e8timated value of $.....gS...Q,Q.Q,.,Q.Q"'''' as near as can be
ascertained,
, ' ' ' ,22 South 30th Street
Thllt the said Real E8tllte III so far as IS known IS located 10 ..,..................,................,.........................
.Camp..,Hl11..........,..,..,..,..,........,....................,..,............ ..............,............,..........,..,......,............,......,..,....,........,......
Therefore, your petitioner(s) respectfully apply (ies) for Letters of Administration in the above
named estate,
Dated ,..,.......~~~~....~~....................... A. D., nl8.9....,
Signature nnel Addre"r
of Petitioner(s)
Dauphin Deposit Bank & Trust Co.
....f1Z"4:,~~(.t.;~lli.tt.&'",........,......
3rd & Market Stree~'.
........................................................................................
Lemoyne, Penna.
........................................................................................
...,.....,...,.....,....................................................................
COMMONWEALTH OF PENNSYLVANIA 1
COUNTY OF CUMBERLAND t ss:
.W. ,...,.~.~... .~,~.!1:f..~ !:',?,... ~,r.~?~...<?.f. I~,c:~, r.... !??,~Jl,~.~.::... .D.~.p..~~. ~.t.. .B.~.~.~.. ,?-,~~.. .T.r.,~.s. ~....c.C?~......, named
, th c I" b' 1 I sworn I' I
III e lIuove app lcal10n ClOg (u Y ,......,..,..................................... accO\'( Illg to IIW, .a)' that the facts set
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before me, .... ..,........... .....,........,. .....,.. ......... ......,...... :.............,....,....
,.,.............,...~!':':~~...~,~.,.......,........... A, D., 19,~~,.... .. ..,............ ................... .....,.....,......,.,............... ................
1;/ ,....;;
,....,.,~:l..i..(..?u.~....e.:.,..;;.~,.................
v' 'l....... Register
Filed: ....i!.~n~..,.,.~l,. .....J~!'!.g......,. ...... ...............
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LAs'r 'tlILL ArID TES'rM'IENT OF
A!1Y B. WARD
I, Amy B. Ward, of the Boro~gh of Camp Hill, Cumberland
eounty, Pennsylvania, do hereby make my last Will and Testament,
revoking all Wills by me a t any time heretofore made.
FIRST: I direct all my j~st debts, funeral expenses and
inheritance taxes to be paid by my executor as soon as conveniently
may be after my decease.
SECOND: I give, devise and bequeath to my sister,
Dorothy Zook, of Camp Hill, Pennsylvania, an undivided half interest
in and to my real estate known as No. 22 South 30th Street, Camp
Hill, Pennsylvania. I make this bequest and devise with the con-
sent and understanding and at the request of my husband, eharles
E. 'tlard.
THIRD: I give, devise and bequeath to my said husband,
Charles E. Ward, the remaining undivide half interest in my said
real estate known as No. 22 South 30th Street, Camp Hill, Penn-
sylvania, and in addition, I give, devise and bequeath to my said
husband, Charles E. Ward, all the rest, residue and remainder of
my estate, real and personal, whatsoever and wheresoever the same
may be.
FOURTH: In the event that my husband, eharles E. Ward,
should predecease me, then I give, devise and bequeath all the
rest, residue and remainder of my estate to my said sister,
Dorothy Zook.
LASTLY, I do hereby nominate, constitute and appoint my
husband, Charles E. Ward, to be Executor of this my last Will and
Testa~ent. In the event of his death prior to my decease, I ap-
point my sister, said Dorothy Zook, to be Executrix of this, my
last Will and Testament.
seal this
IN WI TNES~ \VlIEREOF,
~
I have hereunto se t my hand and
da;r of ~
~ cfJ. ~~
A. D. 1957.
(SEAL)
OATH OF PERSONAL REPRESENTATIVE
ss:
e Probate of Wills and granting of Lellers of Admi '
Cumberland, personally came
who, being duly
, do
of the last Will and Testament of
deceased
the provisions of the law relating to Transfer Inheritances.
nd subscribed before me,
,0.,19_
Register
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Be it remembered that on the
17th day of
DECREE
June
80
,A.D.,19_, there was probated and
recorded the last Will and Testamenl of
Amy B. Ward
late of
camp Hill
Deceased, Lellers of Administration,cfl~e~anted to
Witness my hand and oflkial seal the day and year aforesaid.
, Cumberland County, Pennsylvania,
Dauphin Depmsit Bank & Trust Co.
0~~(l
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V Register .
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I. Apl'il, IQ71 to Apl'il. I'l7(;:
A. 1'('I'iotlk visHs to ['Ill' IVHI'd hUll"! HS tlt'st'l'i!Jetl in
1'1I1'ugPI-1pll :} (nvP-t:'ilge - ~1 lit'S. p(~ll \\leel<)
I, Apl'il. 1971 - 1l(""'llllJ(!I' 1971\
1% \~ks. x 3 In's, = 5H5 In's. [II $2,OIl
2. ,January, 1975 - n('"em!Jel' 1975
52 wl<s. x 3 In's. = 155 hI'S. rc>> $2.10
3. January, 197G - April, I97G
13 wl<s. x :, hI'S. = 39 hrs. ,,1 $2.30
II. April 1, 1975 to April 9, lQ78:
A. periotl:ie visits to the Ward home tiS desel'ibed in
Paragraph 5 (tlverage 3 hI's. per week)
1.. AprH 1, 1975 - Deeemher', 1977
91 wks. x 3 hI'S, = 273 111's. (ii $2.30
2. January, 1978 - April 9, 1978
111 \~ks. x 3 hrs. = li2 hrs, @ $2, GS
B. Preparation and delivery of meals as tles(,I"ibed
in Paragraph 8 (average 3 hrs. pep \~eek)
1. Apdl I, 1975 - Det'ember 1977-
91 wks. x 3 hrs, = 273 hI's. (,J) $2.30
2. Januury, 1978 - April 9, 1978
11[ wks, x 3 hI'S, = li2 hrs. (il $2.GS
III. April 9, 1978 to November 23, 1978:
A. I'eriodie visist to Ivur'tl home HS tlesel'ibed in
Paragraph 5 (avel~age S hrs. pm' weel<)
32 wks x 5 hrs. = IGIJ hrs. t\' $2.65
B. Preparation and del.ivery of meals as deseribed
in Paragraph 9 (average 9 hI'S. per \~eek)
32 wks. x 9 hi's. = 288 hrs @ $2.65
IV. November 2li, 1978 to Odober 1, 1979:
A. Daily visits to l10sp:ital and nursing home
as described in Paragraph 11 (average J. hr per day)
1. November 2'1 - Deeember 3J., 1978
38 days x J. hr = 38 hrs @ $2.liS
2. .January J. - October 1, 1979
273 days x J. hr. = 273 hrs. @ $2.90
B. Periodic, visits to the Ward house as described
'in Paragraph 12
1. Spl'ing and Sllllullt'r (A pr il - September)
25 \~ks, x 5 hrs = 130 hrs @ $2.90
2. Fall and Winter
J.978: 5 wl<s x 3 l11's = 15 hrs (i $ 2.li5
J.979: 13 \~l<s x 3 hrs = 39 hrs @ $2.90
V. December J.5, 1979 to ~lay n, 1980:
A. Daily visits to hospital and nursing home as
descr ibcd in Paragraph J.J.
1. J.979: Hi days x J. hr. = J.5 hrs f' $2.90
2. 1980: 1'18 days x J. hI' = J.118 1l1's (:~ $3.10
LAW OFFICES
SNEl.BAKER.
McCALED a ELICKER
J:xhibit "A"
1,170.00
327,60
89.70
627.90
111. 30
627.90
lll.30
~,2li.00
763.20
100.70
791.. 70
377 . 00
39.75
113.10
1\6.liO
IjS8.80
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
I_
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,_-..- .Su,,,._M<lJ.l~,Y.., .Assis tal).t__Tr.ust"Of (ice .DC OJl\,ptJin.J2.e_poslUJlnkJo-Tl:.JJS_L.C-Ql1lpilnY_---,-
being duly sworn_,__._ according to law, deposes and says that he. it is Administra_~Qr,__~J.L
_._,_._._,___.._____._ of the Estate of . Amv M Ward
late of __-- _..,._ Camp ,Hill _ ___________, Cumberland County, Pa" deceased and that the
within is an inventory made by _J:l1:l'!l'hin...Q!,;pQ.'iH Bank &.'.l'r1J.!'.l~ompanL-" the said Administrator, CTA
of the entire estate of said decedent, consisting of all the personal properly and real eslate, except real estate outside
the Commonwealth of Pennsylvania, and that the ligures opposite each item of the Inventory represent it's fair value
as 01 the date of decedent's death, Dauphin Deposit Bank & Trust Company,
Administrator CTA of the Estate of Amy B,
by: AI (') /J"~)c'-U{/,u~
Assistant Trust Off~cer
Executor" Administrator
Sworn to
_..d "b.,,".d bol... m., \.
213 Market Street
January 29 19 81
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() ~ Elizabetb j, Benko, N,tary Pubfil
My (ommiuion h,ircs April 16. 1984
Hml:bur, P. 0 h'
.. au;! In County
Harrisburg, PA
17101
Addr."
Date of Death
28
Day
May
Month
1980
Year
INSTRUCTIONS
I, An inventory must be filed within three months alter appointment 01 personal representative,
2. A supplement inventory must be filed within thirty days 01 discovery of additional assets.
3, Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act 011949.
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Inventory of the real and personal estate of
Amv B, Ward
deceased
CASH & CASH ITEMS
1, Received from Dauphin Deposit Bank & Trust Company Atty-in-Fact for
Amy B, Ward-
Principal cash
Income cash
Accured income
2, Received from Prudential Insurance Co, - cash proceeds on
Policy # M01984146
Policy # M03830156
3, Cash ,found lock box
4, Refund from UGI Co,
5, Refund from Riverton Consolidated Water Co,
6, Received from Donald L. & Edna R. Shaw
Pro-rate city taxes
Pro-rate school taxes
7, Dauphin Deposit Bank & Trust Company 5~ Golden Passbook Account
#14-108453
Accured interest
8, Residence located at 22 South 30th Street, Camp Hill, PA more fully
described in Cumberland County Recorder of Deeds Book Q Volume 17
Page 254
$8,186, 76
811, 89
78,:. '13
1,264, 46
1,179, 03
137, 02
190, 73
24, 80
22. 18
221. 09
5,635, 92
52. 25
sales value 36,000, 00
9,
Various coins - sales value
1,278, 25
TOTAL 55,082, 68
R';:V.449 EX~ (3.80)
COMMONWE~~ TH OF PENNSYl.VANIA
DEPARTMEHT OF REVENUE
TR~NSFER IHHERITANCE TAX
RESIOENT DECEDENT
AFFIDAVIT OF
FIDUCIARY
(Instructions on Rev.... Side)
.*
~
Estote of _ Amv_~-,... WaI.d.......______
Last Address 22 South 30th Street
~p Hi~. PA
(ctTYI (STATEI
Date of Death Mav 28. 1980
Sacial Security No, 173-50-4824
17011 Bureau File No,
(ZIP)
County File No, 21-80-410
I. Decedent died:
( ) Intestate (without a will)
( X) Testate (leaving a last will--copy attached)
2, Is the filing of a Federal Estate Tax Return required for this estate? Yes_ No X
3,
Executor/Executrix
(X ) Administrator/Administratrix
Name Dauphin Deposit Bank and Trust Company
Address 213 Market Street
4, All correspondence should be mai led to (
Attorney
(X ) Fiduciary,
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Harrisburg
(CITYI
PA
17101
(ZIP)
(STATE:
5, If an attorney is representing the estate, indicate:
Nome William A, Yocum. Esquire 16/-S7J'fJ
Address 1525 Ceder Cliff Drive
Camp Hill
(CITY)
PA
17011
(ZIPI
(STATE)
List 0\1 safe deposit boxes registered in the decedent's individual nomel or jointly with, or as an agent or deputy
of another, or in decedent's individual name with right of access by another as agent or deputy, Include the nome
and address of the bonk or other institution where the safe deposit box is located, the name (s) in which the box
is registered and the relationship of the joint holders to the decedent,
NAME AND ADDRESS OF SANK OR OTHER INSTITUTION
IN WHICH OECEOENT MAINTAINED A SAFE DEPOSIT sox
Dauphin Deposit Bank and Trust Company
3045 Market Street Cam Hill PA
NAME OR NAMES IN WHICH
SAFE DEPOSIT SOX IS REGISTERED
Charles E, Ward or
Amy B. IVard
RE~ATIDNSHIP DF JOINT
HD~DERS TO DECEDENT
husband (deceased July
12. 1978)
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and
statements, and to the best of my knowledge and belief it is true, correct and complete,
Dauphin DepDsit Bank and Trust Company Administrator CTA
of the Estl'te of Amy B, l~ard
by: '.':/U 1';' /) ;.t~'.~" ,.,'( . / /;j,r/J' /
SIGNATURE OF F1DUCIA~Y Assistant Trust DATE
Ott:icer
PENNSYLVANIA INH_EI1ITANCE TAX GENERAL INFOHMAI!ON
1. PERSONS RESPONSIBLE FOR RETURN
Section 701 of the Inheritance and Estate Tax Act of 1961 provides IIIi1t the 101 IrJ\vi ng IJClsons siwll prepnre and file
a return:
a, The personal representative of the estate of Ihe decedent as to properly of Ihe decedenl administered by him
and such additional property which is or may be subject to Inheritance Tilx of which he/she slwll hilve or
acquire knowledge;
b, The transferee of property upon the transfer of which Inheritance Tax is or may be imposed by the 1961 Statute,
including a trustee of property transferred in trust, provided thai no separate return need be made by Ihe transferee
of property included in the return of a personill representative,
2, PLACE FOR FILING
The return is to be filed in duplicate with the Register of Wills of the county wherein the decedent resided,
3, TIME FOR FILING
The return is due nine months after the decedent's death, unless an extension for filing has been applied for and
granted by the Secretary of Revenue within IIle nine.month period,
4. FAILURE TO FILE RETURN
Section 791 of the 1961 Statute provides that", . ,any person who willfully fails to file a return or other report
required of him. , .shall be personally liable, . ,to a penalty of 25% of the lax ultimately found to be due or $1,000
whichever is the lesser to be recovered by the Department of Revenue as debts of like amount are recoverable by
law,"
5. TAX RATES
Inheritance Tax is payable at the rate of 6%on transfers to line81 descendants, such as father, mother, husband, wife,
son, daughter, grandchildren, grandparent, son-in.taw and daugf1ter-in-law and at the rate of 15% as to all others,
6, PAYMENTOFTAX
The tax assessed on the transfer of property reported in the return is rlue 9 months after the decedent's death. Interest
at the rate of 6% per annum accrues thereafter until payment is made. All payments received are first applied to any
interest which may be due with any remainder applied to the tax. IF TAX IS PAID WITHIN 3 MONTHS AFTER THE
DECEDENT'S DEATH, A DISCOUNT OF 5% OF THE TAX PAYMENT IS ALLOWED,
All checks should be made payable to the Register of Wills of the county wherein the decedent resided and are
received subject to the final determination of the Department of Revenue,
7, FAILURE TO PAY
The taxes imposed, together with any interest thereon, are a lien upon real property, which lien remains in effect until
the taxes and interest have been paid in full. The taxes may be sued for against any real property in the decedent's
estate or against any property belonging to a transferee liable for the tax,
B. FILING OF FALSE RETURN
Any person who willfully makes a false return or report required of him shall, in accordance with Section 793 of the
1961 Statute, be guilty of a misdemeanor and, on conviction thereof, shall be scnlenced to pay a fine not exceeding
$1,000 or undergo imprisonment not exceeding one year or bolll.
~ REV.450 EX+ (3.80)
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "A"
REAL PROPERTY
.
(Instructions on Reverse Side)
ESTATE OF
Amy B, Ward
ESTIMAT ED DEPARTMENT
IlEM DESCRIPTION MARKEl V ALUA TION
NO, VALUE (OFFICIAL USE
ONLYI
1. Residence located at 22 South 30th Street, Camp Hill, PA
more fully described in Cumberland County Recorder of
Deeds Book Q Volume 17 page 254 .&uu-<l.u4'1l'"l),
sales value $36,000,00
TOTAL THIS PAGE $36.000.00 Jt: ~~',oO
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REV-45Z (,-eol
COMMONWEAL TH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIOENT OECEOENT
ESTATE OF _ Amv B, Ward
seHEDULE "e"
TRANSFERS
I INSTRUCTIONS:
11. Answer the questions on reverse side,
I 2, If the answer to any of the questions on the reverse side is "Yes," provide a description of the property transferred per
. Schedules "A," "B," or "E," its estimated market value at date of death, dates of transfer, to whom transferred and
I relationship of transferees to decedent. Attach a copy of any trust deed or instrument relating to the transferred property.
I
I
I ITEM ESTIMATED DEPT. VALUATION
! NO, DESCRIPTION MARKET VALUE (OFFICIAL USE ONL Y)
I
I II None "
,
I
TOTAL THIS PAGE A I. .. ^
Ai?9'f-
QUESTIONS CONCERNING PROPERTY TRANSFERS
1. Did decedent, within two years of death, make any transfer of any material part of his estate without receiving
valuable and adeQuate consideration? (1I,llswer "Yes" or "No".)__
2, Did decedent, within two years of death, transfer property from himself! herself to himself/herself and another party
or parties (including a spouse) in joint ownership? (Answer "Yes" or "No",) -
3, If the answer to one or two above is "Yes" and the transfers are claimed to be nontaxable, provide the following
information:
a, Age of decedent at time of transfer,
b. Copy of death certificate.
c. Affidavit by the attending physician indicating the state of decedent's heallh at lime of transfer.
d, All other information supporting nontaxability of transfer,
4, Did decedent, in his/her lifetime, make any transfer of property without receiving a valuable or adequate consjderation
therefor which was to take effect in possession or enjoyment at or after his/her death? (Answer "Yes" or "No" ,)
a. Was there any possibility that the property transferred might return to transferor or his/her estate or be subject
to his/her power of disposition? (Answer "Yes" or "No",)
b, What was the transferee's age at time of decedent's death?
5, Did decedent in his/her lifetime make any transfer without, receiving a valuable and adequate consideration therefor
under which transferor expressly or impliedly reserves for his/her Ii fe or any period which does in fact end before his/her
death:
a, The possession or enjoyment of or the right to income from the property transferred? (Answer "Yes" or "No" ,) -
b, The right to designate the persons who shall possess or enjoy the property transferred or income therefrom?
(Answer "Yes" or "No".)
6, If the answer to five b. above is "Yes," state whether the right was reserved in decedent alone or others.
,
.'
7, Did decedent in his/her lifetime make a transfer, the consideration for which was transferee's promise to pay income
to or for the benefit or care of transferor? (Answer "Yes" or "No",) --
B, Did decedent, at any time, transfer property, the bmeficial enjoyment of which was subject to change, because of
a reserved power to alter, amend, or revoke, or which could revert to decedent under terms of transfer or by,operation of
law? (Answer "Yes" 0 r "No" ,)
9, If the answer to eight above is "Yes," was the power to alter, amend or revoke the interest of the beneficiary reserved
in the decedent alone or the decedent and others? (Answer "Yes" or "No".)
REV.454 (1-80)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
, TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
Estate of
Amy B, Ward
SCHEDULE "E"
JOINTL Y OWNED PROPERTY
'*
(/nstructicJ/1S on Rr.versfJ Sic/oj
P
TOTAL E VALUE OF DEPARTMENT
ITEM R
NO, DESCRIPTION MARKET C DECEDENT'S VALUATION
VALUE E INTEREST IOfficial Us.OIlIV)
N
T
It None II
, -
TOTAL THIS PAGE M.. b/
..
.'
INSTRueTIONS FOR COMPLETING seHEDULE "E"
Schedule "E" must include all property, real and personal, owned by the decedent jointly with another
party or parties as joint tenants with right of survivorship. Both tangible and intangible property are to be
included, List real estate first.
1, Describe all real property as indicated in the instructions for Schedule" A", Describe ati personal property
as indicated in the instructions for Schedule "B", Include the name, address and relationship to the
decedent of the co.owner (s) and the date the joint ownership was established,
2. Indicate the total market value of the jointly owned property,
3. Indicate the percentage of the decedent's interest,
4. Indicate the market value of the decedent's interest,
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File Number
Estate Name
Date of Death
Social Security Number
INHERITANCE TAX SUMMARY SHEET
(BUREAU USE ONLY)
21-80-0410
Amy B. l,ard
May 28, 1980
173-50-4824
REPORT OF INHERITANCE TAX APPRAISER
[] Original
o Supplemental
o Remainder
I, the undersigned duly appointed Inheritance Tax Appraiser In and for the County of Cumberland
Pennsylvania, do respectfully report that I hove appraised the real and porsonal property as reported In the foregoing
retum at the values set forth opposite each item in the last column to the right In Schedules "A", liB", lie", and HE"
Dated: April 13, 1981
Ah,u;, /1f',i,J {j ,,/)
INHERITANCE TAX APPRAISER
R.al Properly (Schfldulo A)
Personal Property (Schedule B)
Jolnt.Held Property (Schedule E)
Transfers (Schedule C)
$
VALUE AS APPRAISEa
ADJUSTMENTS
CODE (HARRISBURG USE ONLV) REMAINDER APPRAISEMENT CODE
INVENTORY
TOTAL GROSS ASSETS
Less D.bts and Deductions
(SCHEDULE F)
CLEAR VALUE OF ESTATE
o Life Estate
o Annuity
RATE
FOR USE OF REGISTER ONLY
Tax on $
T ox on $
Tax an $
Tax an $
Tax an $
Exomptions
Total Estate
TOTAL TAX
INTEREST FROM
BALANCE
36,000 00 00+
19,082 68 10+
none 2:<lf
none 30+
55,082 68
40-
FACTOR
PRINCIPLE
CODE
6%
15%
TO
Less Credits
DATE OF PAVMENT AMOUNT PAID DISCOUNT INTEREST
S + S S =
+ =
BALANCE S
INTEREST FROM TO __ S
S
92+
93.
VALUE
COOE
\
COMPUTATION OF TAX
$
S
$
$-
$
$
S
$
TAX CREOIT
$
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Rt,;v.4ee EX+ (3.eO)
COMMONWEALTH OF PENNSVLVANIA
OEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "Fo
STATEMENT OF DEBTS
AND DEDUCTIONS
~
.
Estate of Amy B. Ward Date of Death 5/28/80
WHEN CLAIMING THE FAMILY EXEMPTION, eOMPLETE THE FOLLOWING:
File No, 21-80-410
Claimant
Relationship to Decedent
Claimant's Address at time of Decedent's Death
ITEM
NO,
DATE
NAME OF PAVEE
REMARKS
AMOUNT
1980
'.
Cost of advertisin and roof
publication
18,00
2.
Ju1 7 Haar Auction House
Commission of sale of coins
3,
8 Jose h McGraw
A raisal of real e ta
4,
10 Riverton Consolidated
Water service to 5/5/80
5,
10 Director Tax Claim Bureau
1978 Borou h and Count Real Estate
Taxes
6, 11 Joe Hartman
7. 11 Truman E. Horner, Inc.
8. 11 UGI Corporation
9, 11 PP&L Co,
10, 15 Patriot News Co.
Lawn service on 5 25 80
Refuse service to 6/80
Gas service to 4/21/80
Electric service to 5/13/80
Cost of advertisin and roof of
ub1ication
22.50
11. 15 Johnston Laborator Inc, Professional services . 12.0
TOTAL 743,38
I hereby certify that to the best of my knowledge and belief the foregoing is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes,
SIGNATURE OF FIDUCIARY
OFFICIAL USE ONLY
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ ,I'~ / t,I.!, ;, '1 AT
DATE
/,c
,')
% TAX RATE
q;. ? ~' .
1/ r:U7J (:., . /~ /( .(/~
~EGISTER OF ILLS
)j -~*,-n
DATE
Unsatislied liabilities incurred by the decedent prior to his/her death ore deductible ugainst his/her taxable
estate. In addition to debts incurred by the decedent ar estate, other items are claimable including the cost of
administration, attorney fees, liduciary fees, funeral and burial expenses including the cast of a burial lot, tombstone
or grave marker and other related burial expenses,
GENERAL INHERITANCE TAX INFORMATION
,
'.
All debts being claimed against an estate Ole subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed, Evidence ,to support the decedent's or the estate's liobility for the debts being
claimed should be attached to this schedule,
A family exemption may be claimed by a spouse of a decedent who died domiciled in Pennsylvania, If there is
no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of the same
household can claim the exemption. In the event there is no such spouse or child, the exl/t11ptian con be claimed by
a parent or parents who are members of the same household os the decedent. The fomily exemption is allowable only
against assets which pass by a will or by the Pennsylvanio Intestate Laws.
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services
performed in administering an estate is reportable for Pennsylvania Income Tax purposes, This taxable income
item should be reported on form PA.4o.lndividuallncome Tax Return,
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is beirog claimed, indicate the claimant's nome, address and his/her relationship to
the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2, Assign consecutive numbers to each item listed,
3, Enter the date an which each debt was incurred and/or paid,
4, Enter the names of each payee,
5, Provide a brief explanation in the ren,arks column for each debt c1oimed,
6, Enter the amount of each debt being claimed.
7. The form must be signed by the person who has assumed the responsibility far paying the debts,
IF ADDITIONAL SPACE IS NECESSARY USE B%" x 11" SHEETS,
REV.45!l EX+ (3.80)
eOMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
TRANSFER INHERITANCE TAX
RESIDENT DECEDENT
SCHEDULE "F"
STATEMENT OF DEBTS
AND DEDUCTIONS
Estate of Amv B. Ward Date of Death 5/28/80
WHEN CLAIMING THE FAMIL V EXEMPTION, COMPLETE THE FOLLOWING:
File No, 21-80-410
Relationship to Decedent
Claimant
ITEM DATE NAME OF PAYEE REMARKS AMOUNT
NO.
12, Julv 28 Register of Wills Cost of Drobating Will and two short
certificates 37,00
13. ' 28 Professional Pharmacy Ethical drugs 25,91
14, 29 PP&L Co, Electrical service to 6/12/80 10,51
15, 29 UGI Corporation Gas service to 5/20/80 69.96
16, 30 Anne E, Keller, Tax Collector 1980 School Real Estate Tax 323.87
17. 30 Musselman Funeral Home Funeral ey'nenses 2 398.85
18, Sept. 9 Keyst0ne Portable X-Ray, Inc. Professional service::; 55,40
19, 19 Gingrich Memorial In~criptjon on m~rker 64.00
20. 31 Balderston Real Estate Comm1ssion on sale of real estate 2 520,00
-
21. 31 Recorder of Deeds Transfer tax on s.ale of real estate 360,00
22. 31 New-Wa" Peot Contrn1 ('0 ,,"". ;, .M"H, 18,00
TOTAL I 5,5883,50
Claimant's Address at time of Decedent's Death
I hereby certify that to the best of my knowledge and belief the fore90in9 is a just and true statement of debts, funeral
expenses and expenses of administration submitted to the estate as deductions for Inheritance Tax purposes.
SIGNATURE OF FIDUCIARY
DATE
OFFlelAL USE ONL V
DEBTS AND DEDUCTIONS ARE ALLOWED IN THE SUM OF $ 1'/ /t, {;, i.t; AT
, /
)Jj/
% TAX RATE
J~~ 17 ~:,
.. '/U,(..( e:.'. ,/ I'll"';
J'EGISTER OF ILLS
Jj-~':jcJ-t /
DATE
Unsatisfied liabilities incurred by the decedent prior to his/her death are deductible against his/her taxable
estate, In addition to debts incurred by the decedent or estote, other items are claimable Including the cost of
administration, attorney fees, fiduciory fees, funeral and burial expenses including the cast of a burial lot, tombstone
Of grove marker and ather related burial expenses,
GENERAL INHERITANCE TAX INFORMATION
\
\
All debts being claimed against an estate ale subiect to the approval of the Register of Wills with wham the
Inheritance Tax Return is filed, Evidence to support the decedent's or the estate's liability for the debts being
claimed should be attached to this schedule,
A family exemption may be claimed by a spouse of a decedent wha died domiciled in Pennsylvania. If there is
no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of the same
household can claim the exemption, In the event there is no such spouse or child, the exemption can be claimed by
a parent or parents who are members of the same household as the decedent, The fomily exemption is allowable only
against assets which pass by a will or by the Pennsylvanio Intestate Laws,
NOTE: Compensation paid to an estate representative; namely, an executor or odminislrator, for services
performed in administering an estate is reportable for Pennsylvania Income Tax purposes. This taxable income
item should be reported on form PA.4o.lndividuallncome Tax Return,
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1, If the family exemption is being claimed, indicote the claimant's name, address and his/her relationship to
the decedent, Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2, Assign consecutive numbers to each item listed,
3, Enter the date an which each debt was incurred ,and/or paid,
4, Enter the names of each payee,
5, Provide a brief explanation in the ren,arks column for each debt claimed.
6, Enter the amount of each debt being claimed.
7, The form must be signed by the person who has assumed the responsibility for paying the debts,
IF ADDITIONAL SPACE IS NECESSARY USE BIl" x 11" SHEETS,
','
Unsatisfied liabilities incurred by the decedent prior to his/her death ore deductible against his/her toxable
estate, In addition to debts incurred by the decedent or estate, other items are c1aimoble including the cost of
administration, attorney fees, fiduciary fees, funeral and burial expenses including the cost of 0 burial lot, tombstone
or grave marker and ather related burial expenses,
GENERAL INHERITAiKE TAX INFORMATION
....
All debts being claimed against on estate ale subject to the approval of the Register of Wills with whom the
Inheritance Tax Return is filed, Evidence.la support the decedent's or the estote's liability for the debts being
claimed should be ottached to thi s schedule.
A family exemption may be claimed by 0 spouse of 0 decedent who died domiciled in Peonsylvania, If there is
no spouse, or if the spouse has forfeited his/her rights, then any child of the decedent who is a member of the same
household can claim the exemption, In the event there is no such spouse or child, the exl/t11ptian can be claimed by
a parent or parents who ore members of the same household as the decedent. The family exemption is allowable only
against assets which pass by a will or by the Pennsylvania Intestate Lows,
NOTE: Compensation paid to an estate representative; namely, an executor or administrator, for services
performed in administering an estate is reportable for Penr,sylvania Income Tax purposes, This taxable income
item should be reported on form PA.40.lndividuallncome Tax Return.
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INSTRUCTIONS FOR COMPLETING SCHEDULE "F"
1. If the family exemption is being claimed, indicate the claimant's nome, address and his/her relationship to
the decedent. Enter "family exemption" in the remarks column and the amount claimed in the amount column.
2, Assign consecutive numbers to each item listed,
3, Enter the date on which each debt was incurred and/or paid,
4, Enter the names of each payee,
5, Provide 0 brief explanotion in the reo.arks column far each debt claimed,
6, Enter the amount of each debt being claimed,
7, The farm must be signed by the person who has assumed the responsibility far paying the debts,
IF ADDITIONAL SPACE IS NECESSARY USE BYz" x 11" SHEETS,
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,
IN THE ORPHANS' COURT OF CUMBERLAND COUNTY, PENNSYLVANIA
IN THE MATTER OF THE ESTATE OF
AMY B. WARD
LATE OF THE BOROUGH OF CAMP HILL
CUMBERLAND COUNTY, PENNSYLVANIA
DECEASED
PROPOSED SCHEDULE OF DISTRIBUTION
Balance for distribution as per First and Final
Account
Uary L, Ryder - 1/3 share of the residue consisting
of:
Principal $ 10,841.97
Income 3,123,59
Mary Miller - 1/3 share of the residue consisting
of:
Principal $ 10,841.97
Income 3.123,59
Robert R. Ryder
ting of:
Principal
Income
- 1/3 share of the residue cons is-
$ 10,841.96
3,123,60
STATEMENT OF REASONS FOR PROPOSED DISTRIBUTION
,See attached documentation to verify existing heirs,
~CCi: 10;,: Pi,Cf ;~O
$ 41,896,68
$ 13.965,56
13,965,56
13,965,56
$ 41,896,68
,
COUNTY OF DAUPHIN
)
) SS:
)
COMMONWEALTH OF PENNSYLVANIA
I hereby certify that on this I' I; day of
/.1 . ' ,
"'/
in and for
said
1982, before me that subscriber, a Notary Public
Commonwealth and County, personally appeared Sue Mauery, Assistant
Trust Officer of Dauphin Deposit Bank and Trust Company, the above
named accountant, who being duly sworn according to law, deposes and
;
I
I
\
I
I
I
I
t
,
i
,
1
1
says that the foregoing is a true and correct account of all the
rights, goods, chattels and credits which came into the hands or
possession of Dauphin Deposit Bank and Trust Company, Executor as
aforesaid, or into the hands or possessions of any other person or
persons for them.
The affiant further says that all persons claiming to be
interested in said estate, whether as creditors, legatees, next of
kin or otherwise, who gave written notice or such claims to Dauphin
Deposit Bank and Trust Company, Executor as aforesaid, have been
notified of the filing of this account and the time and place where
the same will be presented for confirmation, as required by law and
the rule of the Court prescribed thereunder,
,
/
( .:.1. /
/
Sworp,'to",and subscribed before me
. :",S V,i .......... . ;
t'h~f.\(t~.t""a4Y",Of/l(1;, I , 1982
{~){r'i:~!~:JWY2'::~ .' v~
(l /'/ fS'*',:i,l,t<ttu.: f;./ I / /; :l/ ..._ '),l ,/
"<"'f"::":(':';'~'!lei\tY"'PUbliC"" :,'.':
'''. .( I ';t: l~ '. l . , I' .,.. " !
, , . '.: l:' : ,.; . .' ..(1 t, '.' , ,! ... , : I l",',' ,: ,~.,' i 1:; , .: I."
""",.;;i;"l""'-"" /,', r',l:n;r';'.J" i': :' i~.':'.' ! .("/
. ':.~t';i;! ,,'I, i','::' ',. '," -T. ;:" ,',':","",,",', '
. ~ . ri ,:. ~;...
reCK l~!;~ PLGi:
C"2
'J
1980
July 15
15
28
28
30
Aug, 29
Sept, 9
19
Nov. 7
1981
Jan, 29
June 30
July 2
2
Sept, 11
Dec. 4
Patriot-News Company - cost of advertising and proof
of publication $
Johnstone Laboratory. Inc, - balance due on profes-
sional services
Register of Wills - cost of probating Will and two
short certificates
Professional Pharmacy - ethical drugs
Musselman Funeral Home - funeral expenses
Cumberland County Register of Wills -
Pennsylvania Inheritance Tax $
Less: 5% Discount
5.000,00
250,00
Keystone Portable X-Ray. Inc. - professional ser-
vices
Gingrich Memorial - inscription on marker
Loucas C. Tzanis, M,D,. P,C, - professional services
Register of Wills - cost of filing Inventory and
RCC
Patriot-News Company - cost of advertising and proof
of publication
Public Opinion - publishing legal notice
Cumberland Publishers. Inc. - publishing legal notice
Dr. John A. Fritchey. II - services rendered on Ward
genealogical research project
Register of Wills - balance due on Inheritance Tax
RESERVE TO PAY THE FOLLOWING:
Dauphin Deposit Bank and Trust Company - Administra-
tor's fee
William A. Yocum - Attorney's fee
Cost of filing
- 2 -
P r" '( ''', P' C'
c.", ,_'...;/_ . ,I'
4.2
22,50
12,00
37,00
25,91
2.398,85
4.750,00
55,40
64.00
18.00
9.00
83.91
26,14
29,50
80,00
688.00
2.754.13
2.754,13
100,00
l1!Q
Oc to 31
Nov, 10
Cumberland County Recorder of Deeds - transfer tax
on sale of Real Estate
31
New-Way Pest Control Company - pest inspection
Pennsylvania power and Light Company - electric
service to 10/30/80
TOTAL REALTY PRINCIPAL DISBURSEMENTS
PERSONALTY
INCOME RECEIPTS
Dauphin Deposit Bank and Trust Company,
5,5% Golden Passbook
U. S, Treasury Daily Repurchase Agree-
ment
Dauphin Deposit Bank and Trust Company,
Master Savings Account
U, S, Treasury Daily Repurchase Agree-
ment
Dauphin Deposit Bank and Trust Company,
Master Savings Account
U. S, Treasury Daily Repurchase Agree-
ment
U. S, Treasury Daily Repurchase Agree-
ment
Dauphin Deposit Bank and Trust Company,
Master Savings Account
U. g, Treasury Daily Repurchase Agree-
ment
Dauphin Deposit Bank and Trust Company,
Master Savings Account
- 4 -
r-" 'I ')' i p'r-
t..;.l.I.!1I . JJr_ .....t
'I
:;.'*
$
360.00
35.00
4.94
$ 3,759.51
$ 54,75
21,,36
33.87
85.61
73.26
98.94
351. 71
44.70
560,75
38.94
SUMMARY
PERSONALTY PRINCIPAL RECEIPTS $ 19,375.08
PERSONALTY PRINCIPAL DISBURSEMENTS 19,089.67 $ 285,41
REALTY PRINCIPAL RECEIPTS $ 36,000,00
REALTY PRINCIPAL DISBURSEMENTS 3,759,51 32,240.49
PERSONALTY INCOME RECEIPTS $ 10,502.32
PERSONALTY INCOME DISBURSEMENTS 1,131.54 9,370,78
REALTY INCOME RECEIPTS $ 0.00
REALTY INCOME DISBURSEMENTS 0.00 0.00
BALANCE CONSISTS OF THE FOLLOWING:
CASH:
Principal
$ 32,525.90
Income
9,370.78
- 7 -
n 'C" J"" pi C'
Ll' ;1\ J";r... .... 'l
'*7
$ 32,525,90
9,370,78
$ 41,896,68
$ 41,896.68
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lIFJTII'BBN 'DOROTIIY ZOOK ef the Dorough of Camp IIi \1, County of
Cumberland, State of Pennsylvania, party of the first part,
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..-_---C"---:<' f?Y!AFI<W' 'IYt!.tJ I <t jl /4/JOV'1!,antor
a,ul (AHY B, WAR_~f the Bo;oUgh of Camp II ill , County OfY
f umberlan~'Staf'eor Pennsylvania, (',,1/ /1.'111 /J, ,,f ///.,/
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Grantee
;\.I'J'.......ESSE'l'H, tlla(. in (~lJiil~id('rltti(Hl of the sum of
"ne Dollar and other 'valullble considerations Mtxlmu.
.. il(IIl" }Jaid, tJu' f('ccipt whereof 1'.; hcrelJY aclt'ltowlcr/gl'fl. the snid rrrnntor do e s Ite,.dlll flnt1~t
,'"'' "1I1I11cylo Ow "aid IIranf.cl' ,an undivided one-half (-~) interest in
ALL That certain lot of land situate in the Borough of
C~mp lIill, County of Cumberland, State of Pennsylvania, bounded
and described as follows:
BEGINNING at a point on the western side of Princeton Avenue
at the northern line of a ten feet wide alley, the second alley
south of Market Street; thence in a westerly direction along the
northern lice of said alley two hundr.d twenty-eight and five tenths
(228.5) feet to a pin, the northeast corner of said ten feet wide
alley and a fifteen feet wide alley; thence in a northerly direction
along the eastern line of said fifteen feet wide alley forty-one
and nine tenths (41,9) feet to a pin at lands now or late of Myrtle
S~ul Smith; thence in an easterly direction along lands nOw or late
of Myrtle Saul Smith as follows: First one hundred twenty-nine
lInd five tenths (129.5) feet to a pin, and second, one hundred
feet and eighty-five one-hundredths (100,85) feet to a point on the
yeotern line of Princeton Avenue fifty-five and four tenths (55.4)
feet to a pin, the po~nt of Beginning,
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do h"""by certify that the Jll'ecise ..('sidlellec IIf tlte wil,hi" named ,!I'll"'.., '"
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MADB 7'IJE li'lll III '" nu' 11"1'"
of our l..ord one thowmmlnllw hllJLdn:d "'1 (Old Iwll"l"f1
DAUPIII~ DEPOSIT BANK AND 'l'1{uS'!' l:oMI',\;';Y, Ad,,, III I :.1 ,..., , 1:', " I, 1\, W II!' II"
principal office in the City (If !1dITj~:1)l!':' Clllj,dV 1'1 l),111I1;1I1', P'-''ltl'lvIVo'Ildd
1?:ret:ltt under thf' IA1St Will and 7"::/'1111' lIt I"~ /\t-rl' B. WI\ldl
du~eCl.-:/'fl.1ateor the Boruugh of C.ll:l[' ili;l, ClIll,!!I! III Cllll\lll lid 11,1\ ~itdll' III
Penn:...ylvania,
/ :(~,.I ,\"f'nl1
AND DONALD L. SHAW dnd EDNA H, SIIAII. llis loll I"
of 711 Winding Hill Road, llprwr Allt'll 1\1\Y'I,~;I,lp. Id,ll1h.lldttt! (IHillly,
Pennsylvania,
(;U,lNTI..'I..'H
WHERE.4S, the said AMY 8, WAHIl
was vested in her lifetim.l! with tit1(. to l/r"llliHI'li IIf (I'i""O. r d/'.','f'/'ifll:rI, .>1;1,1111,'
Borough of Camp lIil! ,
in lllC
County of
Cumberland
(.'11'1/1"'011/1'1'111111 of J""",Jil//llllllill" /Inti
WHEREAS, till' said AMY B. WAHIJ
May 28, 1980
and her UI..t Will and 7'r..I<I,,1I111
County of Cumberlano
di,'d lc.'~t,ntr nil
lI'(/": 11111/1
; 1/1/11
Ilff/lwlul ill till' /{"oi..la of Will.. Office ;11 tll..
WHEREAS, the said rClu ""tatr h"rci"ltfl..r dORrdl",d //'I/.< nol, spedfi('o/1y d",,~",'d, a."l the sa,id
DAUPHIN DEPOSIT IlANK AND 1'IHlS1' COfII'ANY
Administrator C, 1', A.
quali{wclll.. r.:l"'MIo- of till' 1.//,"/ 11'11111,,01 7'....1,"'11'<1,..
NOW THEllBFORE,
TRUST CONl'ANY
7'lIi.. ,,,,1,,,1//1'" lI'il<l"",','11I rJ/<I' III,' "<lid IlAIlI'IIIN IJEl'tlSIT IIANK AND
Admillistrotor C, T. A,
. ~..'.u'" a,~ a.forc.',mjrf,
"
for and in (~nn...;idcr(Lti()11 of fill' ,'HI/II flf '1"11 i r t y -tj i ~< 'J hOll~a ncJ -- - - - - - -- -- -- - - -- -- ....--
_____________________________.________________________-($]6,000,00) Dn/1al'~
lawlu11/w'J1C!I rj( t/it' Uni/uJ ,':flltf.':' to /1/ 11Il1i,1 J)/lirlllllll/f' .~'aid t;rlll1lees
1/' (1I1i! 111 '(Il/'l flll~ olsf'ulillfl f/wl ddi.llcry 1I,'n.").',
tltr rl~(;(ilJ/. II'JrlJ"c',f 1.'" lU'J'd},11 ([1'1.-/111/1 I' rI.1/1 ". lill Vll !O'll1If,d, IJlu'!/aiw'd, sold, alienl'd. 'NII'(1.~I'd n'lld
confirmed. aUtll):1 tllI;'I' IJl".""llls. /'!.' idlll of fllf 11.'1/1'('" ,,,,d (ll/thority;lI 1'(,':f('1/ ill! ,,/If!
Probol,;, I..:.'itate.'i IIwl FNIICirl1'jr,': (',HII' I'{ till' G01fl1l1rll/lI"f'llttlt oj Pi'lIllsjll,'(wia, du !I 1'0 lit,
l}aT{Juin, Sill, f1li{f~. 1'1'/';(/.<./.> lInd l'IIIII'i"I/1 11"/0 till' .'wid Cr':lnteeS, tllL'ir
hf'il'.q /Iud I'...,<:iuwt. .-\If t!l,I! 1 (~rti..lill lot of land siluatc in the
Borough nf Camp Hill, COU1llY 1\1 CI1l1;!,,'rl;1111. ~:t.:ttl~ of l'l'll1lSYI v':lni:l, bounded :tnd
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This is to.certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Statistics
in accordance with Act 66, P.L. 304, approved by the General Assembly,June 29, 1953
(Fee for this certificate, S3.00)
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WARNING: It is illegal to duplicate this copy by photostat or photograph.
SEP021981 I I ;17()~j
~f1~
Charles Hardcstcr
I State Registrar
Date
No.
HV8.5P-~50J,[-8.40
br:r'i1o. "J,_'-::.fZZ~.hL-e..
~"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
?_ b tl
I .
Cl08e,0
FII, No. M-n .",,")
....0111..." No. (t) 6_.___
CERTIFICATE OF DEATH
L PLACE OF DEATH: . , '
() C t "'Vn?1?6r-/";r.-'
a ann y __"== _g-U_'!r."'~___._....____.__.__._.._.
(b) City or borough or township ,._C..ii.J_'7/L.dijl.:..".
(c) Name of hospital or Institution:
nr ~~~p~i;;tiLUllon write .tr~t num';;-;'i~li;;)---
(d) Length of stay: III hospltal or Institution ------"-
/ 1 . (Specify wheth(!r
In this commUttlty,._...__.:;2...~. .,-,,,--.,,,,.
,.tara. monllls or dll)'II) t/
3. (a) FULL NAME _".. \[(2_,fJ~.b ..~..2Z>$._e C-
3. (bl It U. S. Veteran, complete I 3 (c) SOcial Security
reverse side of cerUflcate No..___:_-==---.
15. Colot' or 16, (a) Single, widowed, mar-
4. sex11-- raee_1<L_ . rled, dlvorced..&~-'-
6... (b) Namv>t1)usb~nd or w.I!.e 6 (c) Age of husband or wife
m,ns ~/1t!.N7?e-Lf)t!l.y-.)! a1lve__~rs
7. Birth date of deceased S~"/? t /~ /n"
n.(onlh) . (Day) (Y('u)
S. AGE: Years I Months I Days I If less than one day
7,) / ~ _hr.' min.
9. Blrtbplace ~2!.1f1L 7? _ CJLIL?Z..T.v j!A.--
(Clly, tov.'1l, or eOlllll)') (State?';c;;lf;1l COIl\1tr)')
10. Usual occupation __lll".l?2.e;- . -:-----
11. Industry ar bUslnes., -b" m. . .
=j 12. Name -4L:J..s.l2z.a.-~-",...t::-.-,-_..-
S 13. Blrtbplaco ), a :?7 e,8 <;?e r Co .. ,P-A
"" (CilY, t,own, or count)') (6'tale or forel.,.. (!(luntt')')
Ci 14. Malden name CJ,:;;,--hrd W~ 77<; e f- ._
!; 15. Birthplace ..<.;2 ??r .ei.Sn r-u Co I' A
:a: (ell)', 10'o'Il, or count)') te or o~h;n counll}')
16. (a) Informant's own slgnaturo . .
(b) Address~.(J!!::_~"L~ .
17 Ca) /.l_t't,e,<t. (b) Date, thereof "(P-l-..2,,.!I..L~
~;W, cre~o.tton, ot' lemo,'.I) ()Inntti) (DtI),r(Y(!Hr)
(0) Place: burial or cremation ~-."
18. ::: ~::r~~~~:al~::~~= f_---
19 (a) (2.eT ).,,+~Yl '-I, "3..._ (b) .;:L7.2JW~
(Date kccolvcd loea) rf't;ldrar) (lkgillru'. ~1fCJ\alurt)
2. USUAL RESIDENCE OF DECEASED:
'd
(a) Stete _L:.? __ (1)) CoUnty C' (.> .1714.,-
(c) City or town _~~/;> m //. "
(It (lI.It de afr or to'lm limite., 'fI'rit.e RURAL),
. _ .... - u::. c-
(d) street No. ....2..r.." v.~ (/' i -./' .
(If tunt cive locaUon)
(e) If forelgn born, how long In U. S. A.?
Ye8lll.
~~~~~M"M' M
MEDICAL CbR'l'R"ICATION
20. Date of death: Month c!/iJvf't- daY: , .l.t
yearJ.~ hour ,., A1Il1lnute_..:-.-
{21'f::erebY certify tbat I attended the deceased from_
r n e , I~, to !:PCM&~,o<- , 19~:
that I last saw him. alIve on ~Tob~r- /'1 . 19.fi;!,;
and that deatb occurred on the date and hour stated DURAtiON
above. .
=e<!\aJe ~th .. . '.
.__~. . V~A-'"
A~/~-(~~~ -,/.M+-
Dueto~.
:7/
t)(i,.
/ '"-
Due to _
other condltlons
(Include prtgnaM1 within S mOlltha of dt'f.th)
PHVSlelAN
~ UndtrllM
tt:t cause to
""icla IItat..
should be
chlmd It...
tlltlWlt.
2. If death was due to external causes, 1111 In the following:
(a) (Probably) Accident, suicide, or bomlclde (speclIy) -
(b) Date of occurrence
c) Where did Injury occur?
. (Cltr or town) (County) (Sa;)
Old bljUry occur In or about home, on farm, In industrial
place, In public place? .
1.<, .I ;ff ,:.? (S(W'CUI type or pllce)
, While at wor~W:"'- (e) Means ollnjury_n_
23. SI!;1l.tur~.,..;_:".::,<e~",,(/ (M. D. or-c>thcr)::j...,
Address/~~:d~_;z;..0/j Date slgned /O"~>~~
, .'
,Major llndlngs:
Of operations
Of autopsy __
'This is to certify. that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Statistics
tn accordance WIth Act 66, P.L. 304, approved by the General Assembly, June 29, 1953
(Fee for this certificate, 53,00)
WARNING: It is illegal to duplicate this copy by photostat or photograph.
SEP 021981 If!; ii'",
~f1~'
I
Charles Hanlestcr
Stale Registrar
.....
...'"
'.'
Date
No.
-.-.--..":,,
.___4._..,.....- ...-....,...'....~- ..-.........
-.--..-----.-,.,--... .. - ---~-~-
~,-"'...---_._..-
.IIVS.6-600M-U.S6 ' 0
. PrimarY COMMOKWEALTH of PENNSYLVANIA 1\'
. 1. PLACE OF O~. ~ I? ( Ohl. NO..e.t.."".O..I.-e1 OEPARTMENT OF BEALTH '/ 0
Co..'" _AkC~~~'-- BUREAU OF VITAL STATISTICS .l/ .
'Tow"hl. _-.--:.--...".:....--.-,-:..- . . : CERTIFICATE OF DEATH
. BctfOU~l\ ---"-...- -~_...,_...---
.. . N.. ....__._' Be, -".-- Wa".
CBy' . "..,__ (Il ."th OCOU"'. In a HOSI'ITAL or IKSTlTllTION. .... Ita NAlIE 1..1'" .f ".." an' .umbo')
L,noth.1 ,..ld.... In .Ily or lown oro ".lIh _rrad __Y". __mOl. __"'YL H.w 1"0 I. U. s.. II .1 'or.lon birth? ,_yra. _m'L _"'YL
.." tJ/I/f/{ C "Z..t:Jd/r (IF u. S. VETERAN. COMPLETE REVERSE SlOE OF CERTIFICATEl
2..FULL N^ME (type or~llt !111_- . !I..---. ---
, / rrt~ D .
. R..,,,...., N.. __. ._. ____------'-."..,,- SC, -.." Wild. -,,--- .------
(U&Ual place of abode) (If Douruldent, cive plaClt. countll and State)
l'~JRSONAL AND STATISTICA.L l'ARTICULAI18
3. SEX \ 4. COLOR OR RACE \ S. SINGLE. MARRIED. WIDOWEi),"""
OR DIVORCE,O (write tJu~ wurJ.)
M A efllE"{\'_
!ill. I marrl,d. wldow8d, or dl'iOro~ ~-
HUSBAND <I' -t-. J.:
,,'n,(or)WIFEof ~ A Cot3Z0""(' .
6. DATE OF BIRTH (month. dlY. alld YULr) l1k-- /.L I {t ZI-
1f~'i::"""" t'Z \ MonthtJ \ !Y' \, II"tESS thIn 1 Ifa'i.
I 7< _~,~ hra. or. _mInI.
';;. -I&':rrad" prof..'loft, orparllClular I' e'. .
'.'z A~ol"- kind <lr work do"'. I' spinne.r. 1,/_<- .Ie.. ~
70 '~_ pWJel", bookkeeper, etc. _-tiJf2._ . - - ...:...-~
", i= b.9:~indu.trY or bu.lnli" In which
: f .:' work WI' dane, .. sUk mill,
, g !-ttr"r" oWD1lD. bank., ItO. -".."..-.. ~--~
: 8 ,10~_o,ted6Cea"d laltworbdat \ U. Total tlmo h'cara)
. ": f.;.' thla occup,tlon (monlb ,pont In thle
1" !:fI,lol;J.!,""lJ\d yu,r) _._,~__. - ..."..... occupation ---.-
;'i2:;BIRTHPUCE (city or to~) a .
;~.._;'-" eState or Counfn} ". l'::"o_~'.I#'I ,
""'\"1.1. NANE '
~lI! ..UIII,," 1&'" e.." R- /l - 0 .
':z: .. ~ E' tt V k--11-
. ~ ,~" BIRTHP CE (,Ity "lowo) 'nl. .
;,u. 'c".' . (State or Country) ~ AAA .
'. ~ ,
::'Ct\~' MAIDEN NAME. .
.~..:.,;:;..." . .' . .. ifiC,Az,E1=-G'(l.
.l5 l6. BIRTHPLACE "It, or ..w.) . .
:.:E ~~..."(Btat4 or Couolf7). .
l'.'SIONATURE (naml! an dred~ iJ ~ -/
OF INFORMANT ~ .JT~
:;iB: ~'U".'~IAL. CREMATION. OR REMOVAL' .~O,t .- ,"'.. .,~."..... 1937
''''',_~'' t I' (
;-- . Pie .' . County .. ~tale .... ....
-,'U..UN ER ( 0 IDd addrMI)
Fll. No, .._..40.6..60-
Registered No. .c:: st",.,a'
~
)
/.70
.
--
Olhar contributory eaWle& of Importance:
--
~/U
-
,,-
;?;1 ,ptL , ".'
N,m..' .....ll.n ~ :::-~' 0... of - ~
What ted eonfirmod dlaonolla .. ~,. W.. there an Illlop"t____
23. tr dOlth w.. due to ext.;nl' ClaVi" ('riole:ace), fill In' ,1&0 tha followlna:
Aoc'dt~t. ,uloid., or homlolda! __ Dttl of InjUrY 19)
Whirl. did InJury ooour'
(sr<<tfJ db' or tawD, eounty. ..nd Btate)
SpOlllfy whether 'nlury ooourred In tndurtl'7, In home, or In publlc pta.ce:
MlJ\ntro'lnJu1)'-
-----
.'..'" ,
,":--,.,',
24.:.:';::..:: :::::~~ a::w.y ;:::::U"ll -;:.-::;'!&==
.
If 10, IPeclrr
(SIgned) ~___
{Addr..,l _._..H'.'''_~'
~..,
'.
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Statistics
in accordance with Act 66, P.L. 304, approved by the General Assembly,june 29, 1953
(Fcc flll this certificate, S3.00)
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l DEC101981 I I !,.",',j
Date No.
~f1~
Charles HardeSler
State Registrar
A\'S.I0008-UOll-5.52 ~~IO
Primary '} ,
Dhl, N.. ,,~,LiL.c...:;,gLL-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
BUREAU OF VITAL STATISTICS
CERTIFICATE OF DEATH
FII. N.. ,,3.1rK~\7
" /
Real,tlred No. --'~_.-
1. PUCEOF~TH ~
I. COUNTY
..""
b. -en"'I' (1f ouhltl corporato limit&. write RURAL\ c. LENGTH OF
-GR'" .~ e townlhlp) STAY (In tbla
BOROUGH ~a~)
d. FULL NAME OF (I no.t In bMpltal or Inll!tutlen, give .treet ad.
HOSPITAL OR., 0 J,,/.r ""'^-t~ d'lI'~r I"",tl..>
INSTITUTION .....;L '\lo.a 11 .:>U;po-'::'1.
3. NAME OF I. Flnt)
DECEASED
(TJ/Pe or Print)
SEX
2. USUAL RE
.. STATE
(Where dtc'f.lll'd IIv . If Itltutloo: r~tdence
b. COUNTY brfore admllllon).
.
d. STREET
ADDRESS
'i lvRAL ind ;lye to'll1\lhl~)
. It rural, slve loeatlon)
.:J.~' s~tJf/' ~otiJ..!;f;
I 4. DATE
OF
DEATH
9.AO
I
. ARM ORC T
c mplett tfveRe "de
to)
18. CAUSE OF DEAT MEDICAL~TIFICATION . .,. -
Entfl' only 000 ctUU I. DISEASE OR CONDITION . A ," - . / /
per line for la), (b), DIRECTLY LEADINO TO DEATH' (a) (.. 1./"A.A.A - ~Arl..AAA,vt1./'1
Ind (c) 1.,#
'Thb doff net ANTECEDENT CAUSES /:". ~~ '. . '/1 .'
fMlln the mode 01 DUE TO (b) 0. t1./.AAA/?~~
dulnQ. IUch cu hroarl M01'bf4 ~, If AnU. ahllnQ rile
/llUur" IUthmm, to the Above CIllu.&e (A) mtlnQ the
etc. It mtlll'U the undeTlvinQ (U.IIIt l4rt. DUE TQ (0) . I,., '
~~iCa.~tL~hi~ II. OTtiER 81QNlFlCANT CONDITIONS
cuwed. death. Condltlont: ~na to the dtllth but not
relaUd to the cf..LI,eo.sf or conditLon C4tuinq death.
19.. DATE OF OP. 19b. MAJOR FINDINGS OF OPERATION
ERATION
A....C'..:..-(''';'';'';'
;'
211. ACCIDENT IS~lfy)
SUICIDE
HOMICIDE
21d. TIME (Month) (D,y) (Year)
OF
INJURY
22. t h....by eMit.
210. (CITY, TOWN AND TOWNSHIP)
2lf. HOW DID INJURY OCCUR!
.
b.
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,!his is to certify. that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Statistics
In accordance with Act 66, P.L, 304, approved by the General Assembly,junc 29, 1953
(Fee for this certificate, 53.00)
WARNING: It is illegal to duplicate this copy by photostat or photograph.
LSEP 021981 I I :;, "
~f1~
Charles HilrJcstcr
I State llegiSlrar
Date
No.
,',
INS-zona :110321-
COfo\MOMWEA,LTH OF PEWNS'1l.VAHIA
DEPARTMENT Of" HEAl. TH
VITAL STATISTICS SECTION FII.Ho.
PfhnClr, ;!? (l . ? I ~ CORONER'S CERTIFICATE OF DEATH ,~..;4 C;
,~
0101. Ho. lttlll.'....d No.
1. Pl.ACE OF DEATH. OR PLACE WHERE BODY WAS fOUND 'z. USUAL RESIOENCE (....... MCMJH 1I<Nd. tf IMfthrt~1 ,.,.ldolK'l k-
., Co"n'r DIJUP,/;'V '..ood..lulon) fA-- C ()fnl3 CCi
.. 5t.,. b. "-'"
b, CITY, BOROUQH OR TOWNSHIP I c. loE:IIGTH' OF STAY IN c. CUy, Oorl)lJljlh 011' To_ohlp 0<- /FO
J1IH'.ci.s c;;"dC- 1 . IF KNOW" Ct';",Y1P HILI-.
d. STREET ADaMUS OR LOCATION d. Sir..' odd,.... _Iocatloct
7.1.. " 3::)"t1~'S\
--'0
.. MAME OF HOSPITAL OR IHSTITUTION" IF AP'pLICAOLE c7/J ., II R.,ld,,,CI IfMllOe MlIlllelpolUr LhMtd\'. -I1I-J!:..ldellce Ml 0 PQ'_""
i-!llf1l<i",P,tJrCu.- J.iC'!'{)lt~\.-o Y.. &L .. 0 y.,O ..J&).
S. MANE OF DECEASED II. (FIr.t). b. (Mlddl.) e. (L.nl) 14. DI.TE OF (Mot'rth) (Do,) (V.or)
(T}'I"' or PrInt) /)O#C7',l/I/ ?O c: IG DEATH /J/- /5' -S:P
-
5. SEX 1" COLO~ OR :AeE 1".ARRlEO 0 NEVE' .ARRleD ,rv 8. O"TE OF alRTH I. AGE (In ,.-.1 H' .....r ,'''', 11'.1f 24m..
}, [.\(:u.1..... WIDOWED 0 QIVORCED 0 J."'l /.1:-1'1;",'- ....r;.? IalrtW.,) r Momh. I DII", H_lI!Mln.
". FU\.L. NA"E OF SPoUSE 11. BIRTIlPLACE (AI...I"_dm.....-I... rz. - CITIZEN OF WHAT
J->......-;~ ..=-~ ..i:,ou~ry), l '/. ,'. (. ;:{ /OUNTRY? \
. ._,' 'i,.,.,: ..,!.~'" j'. I ..... .' /" tJ '
"" F"TtIER'S,WAME ~ () 12 14, NoTHER'S ',MIDEIC NAME ,0,
(;.c-t~ _ U " Ii::. tL" .. ;KYllO'.'
. '/ ,1'.....-1"': c.,\...--' 1-' \
... U~UAl. OCC~P~TI~ l....n II rlll~J l'" 'OCIAL SECURITY NO, n. IHFORM"~T \: ...!, .,' :. ADDRESS ..~. .J i
~-,......'--' ,- 11t.'", /../.:1 j:~j t(n~;;; -:r~,;rlt sr L)"",'f/.oh i
MEDICAL CFRTIFICATION INTERVAL. 8E"WEEN
., CAUSE OF OEATH [Enter onl}' on. ca",.. plIf 11_ 'M (a), (b). (e)] ONIET AND DEATH
PART 1. DIGlh_.eou..db}'l ~ '7'f.'-::".o ..-?:I'G<.t't:.<- <'$)(z.. t1~.s .
IMMEOI"TE C"USE (l!l c.:. 'V". ~
t.,.II"~" 11 ",. Whldo} --900h
..... .1.. 10 ab.... eel.... DUE TO Ibl
(.) ,t.tlllg tit. ""d...I}'" .., .~
''''' c..... lut. DU E TO '"
P"R'T II. OTHER SIGNIFICANT CONDITlONS[c:lftttIWIIIlI t. dlllllh but not (.~ 'a,tM ......MI dl.....glv'"' lfl pact I (cO 11, WAS AUTOPSY
PI!:RF~EDf
"'.. .0
2OlI. ACCIOENT SUICIDE HO~IC1DI!: 1-2011. OE5C'UIJE HOW INJURY OCCURRED I zo.. TI_ JJ- .~.w Mom' Do, y..
@" 0 0 ;::cT~ l)&iUn ,srC:/H ,..~f ~. 'T-' /.:l-18-S;8
Inw . .
ao... INJURY ,OCCURRED I. ,... PLACE OF '.JURY I'"" h'_'\ ,Of. CITY, BOROUO.., TO"U'NIP COUNTY STATE
"hil.", D "elwhll. 5Y S ......'o'II.'.,.t,..t.II'.) HAI2 . B D.o Pt4' oj \f>A.
wMIl .1 walk ttctr ~IS . 1,,! CG-u I r.
%I. q,,;,.b' ""'" ,h.. Im..II,...".' .... d...'.f .... .b... MMd d"...... ....II.d '" ,... 11""1,,,. .... .,...... "d ,ho' 11- .f "_., I. ....-.... ..
,,-()
. . f}, 1ft. E. $, T.. on tit. dol. .toted .b.w..
2~GNATURE OF C,0HE~ . ._._.__._~-- ~ lZZb. ADDRESS ,a Inc. DATE SIGNED .
- ~ ,.. ~ . /C'I/ A/. ,..."//,,,. /"81, /~-ltJ-S'c5'
--,/~/I,-,tt~.. c.,.- . <~ /It:t:.I~,(..L.__J ~.,,-,,, "".
U.. BURIAl. 0, SREMATlOH 0 ,Ub. O'TE /5- ,r" N..E OF eE"ETERY OR :+,'d' ~OCATlON "10" 'w'. Twp. & C....,' ",,!.)
/1'" / '~i~EMATORY, I .' - " 'I- ....," ,,-- '.. ~ - [. i/. t.. '.
R!MOVAL n .,,11"". ~:;. 5'5 )~":-l'/,' -_I,:,<--.:j I~:';::'-'Z ',,/ rl.f'~""l/iJ.J~;i 1.-1)/' ,t.'--1"1', ;.,.. ,
2~ ~\~;~':;Y<lREG. I" 'EGIST~AR"SlG"TUR~'C'/"~/ d2l. SlGNPTURE Of .UNERAL OIREeT;i;:'; ~;;;,ORESS /,:~
Ii ,.., ./7 7." / ;.:,. .' ,. I'" "
!:J<-/ L I.Cd. ",,.'- / (LA....".!... ~. \....;.{I~lll..l. /\ ',.;//.1..(>.'..)1 :.r::/~,;.71". . .'I:,,!.j'.LJ'!..../'U
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This is to certify th~t' this is a truc copy of the recurd which is on file in the pcnnsylvania Division of Vital Statistics
in accordance with Act 66, P.L. 304, approved by the General Assembly,june 29, 1953 ,
(Fcc for this certificate, S3,00)
WARNING: It i~ illegal to duplicate this copy by photostat or photograph.
I I
~f1~
Charles Hardcstcr
I State Registrar
DEe 101981
;,.
"
Date
No.
R\'So6-200H-8.IG . .
p,'m." ;;f?-n/-<7LL COMMONWEALTH OF PENNSYLVANIA 1.0
L PLACE OF DEATH Plat. Ho...,IG.p--V__'p T DEPARTMENT OF HEALTH, ,fA lP
0,"'1>' ,".,e.:z:r.f1..Lf(./.L...l.t..LV__.., ,"", BUREAU OF VITAL 8TATI8TIC8:" ,,",/. ;', ~.
T.."hl. .,d/f...NJ..b.,T.:I2.LJL.__' ,,' 'CERTIFICATE OF DEATH" ..
Borough _.__.H____"~-.-_-.---- No.' . _~.,. .'.' .... ....~:...,... .,'~ - Sl. ____M_ Ward.
City (U d.th oecul'ffi1 ill & HOSPITAL or lNSTn'DTJON. ctn It. NAllE iutad of ~t and number)
L.nalh of rtlld."u In olty or town 'Nil.,. d_lh oo:lOumd ---fA. _-'"_. ___Ill,., How kmtil In U. 8.. " of fortllJl'l birth' __YrIo __mOL ~d.y..
~ D ~IF U. S. VETERAN, CO~~LETE REVERSE SIDE OF' CERTIFICATE)
.. FULL NAME (,>,p. " .Iin') --LJC '23 7;>'1 /v,? ...s LL-Y---E4 ,._
RMrd.noo: Ho. ___ St.. _ Ward. _' _ _._
(UllIa! p1&.ecl or abode) (If aool'N'ldtDt, rife pllC'e, COUDt1, &lid AtAte)
96889
~
':.FlI.;H.O~_~M_.
,'", :'//
fttglslorod No. ~_w'_t2-.-_
PEItSONAL AND STATIS'l'ICAL PAltTlCULAR8
,. SEX I 4. COLOR OR RACE I 5. SINGLE. MARRIED, WIDOWED,
M . , . OADIVORCED~(tDT'itt'theword)
"fhl-.e" ~/r/:?" jIf#7f'7r/FlP'
s.. Ii marrIed. wldOwod, or dl'fO~6d '7 C-_"
r~~ ....5 ?" iP 1'" /7" 23. ".if" 7".z:> ~>r
6. DATE OF BIRTH (mOJlUl, dl', lad :J'ou) 0 C '
7. AGE V.... I Ilooth. I Day" I If L.ESS th.n 1 'Y.
7' S ~ IS' __ hIS." -",I..
.8. TradO,!rof...lon, or plrllcular
~. ~~~, Wb:kt:e~~~ :f~~~'M_M~....f--B~.EJ7
~ 9. 'ndu.hy or "utl"t.. In Whloh /
:: work 'WIlt doni, It IUk m1U,
:Ii ,a.wmlIl, blUlk, e\o. "'MMM__M__ .
8 10. Od. d.oeuod I.d worbd at Ill. Tobll time (,ean)
ttll. ooouP'lIon (monUl ,pent In thll
Ind Telr) _._...__......_..M.. occupatIon _ _ ____
MEDICAL CEItTll<'lCATE F DEA'fll
ATE OF' DEATH (motlth. d.a1'. I.[\d year) 19'
., _I HEREBY C RTlFY.. Thd I, :1t"m~~O ==--. I!J(.
..t II. ~,1I.. ... ~:) f,?t,-"'::Jil9;{. ".d" I, ..Id
to have oocurrtd on tJI. datt ,ttt.4 .bo... ..II-'-.:::~ "'-
Tho prlnefpal caWle of death and nllted oau,.. of Importanot ...re O.t. of
u follow.: onltt
~~~ d;;z:;;:F ___t
1t, 1/).,& --.-
~ 9 l'.I";" ::;,':'"'--
,"'; .;J ,.1/, ..
"'"'" --z--
-r' ,..
J,;.~,
12. BIRrr.r..~c~ ~~~) tmn>) J-/f'''1N10../N Gq
a: U. NAME ~(J __ _' .
~ r/O..sC/"N /?~.i:::>E"Jf '
~ 14. BIRTHPLACE {city or 14\1'n~ /.. - '. /'_ .~
~ (Ollll or eoun""l r-If"P)/IrLI/l1 l.-lZ ~
a: IS. MAIDEN NANE , ,r .',...
~" " ,C"L1.z:91Z3.1=Tq' '~r;'''~,"r'-l
b: 16. BIRTHPLACE (cfty or town) .,
:5 (State or Oountq) ~ I
~j,l:",
Naill' .f ,"pn,trOll
What ted confirm
D....oI =:...~_
tre."..uloP'!l"~_.'
. Aooldtnl, eulcld.. or homlold.'
Wher. did Inlury coour'
~vtoI8Il~). till In .110 th. following:
Dat. ., InJull'_-== 1"
'.:.'v.
(Bpec1t;r elt)" or ~ llIQunty, ,llnd HLatel
Spoolfy whether InJury eocurred In lndtLltt1, In home, or In pubUc pl&ee:
-
~
'r ~
20. FILEOf{P,y,_ J.?j.___~. m'i Q~'YY',/e."J"II.s,~, ..,." "
( U"O'-1Tor.
Manner of InJlI1'J'
Nature of Injury
24. W.. dll6l" or fnJu
I' to. 'PflCtfy ~. .
(Signed)
{Addr
"
In .nr w.; ,.Iattel .: ooou~lon.f :OOUMCl~M~~~~N~~
-
.
hill .) i"" ,( '/
11/1/ .,~l I ~ .
PETITION
For Grant 01 LETTERS OF ADMINISTRATION in the Estate 01
......................:.........................~~.;:~.I!!..f1,!,..~y.4.~~.:.........................:.........................:.....:...................
La te 01 the... ..., ,::\'.9. Y'f!!.. ~ P.. ~,p"".....:.......,..,............. .01,:......... J!~,J:ll t:j,:Ii .o,n,......"... .:......... ..., Deceased.
--
~
TC? ........ol.9.~!),..W.....~.~;t:,'\;.lJ)1!,~L...........................,.....,....,...., E..q" Register ol'Will~ lor the County ~I
Franklin. in the Commonwealth of Pennsylvania. :_
The petition 01. B." Eli za beth .Ry,dez... J.Y .Ry.der 1 ~a.ryL.Ryder., ,.,8,....G.II1J,...Ryder
'01 ..R~,l!lH:t9.!L.'r.Qxm~,l:1~p.~...:F.;r.an~J ~:!\..P,Q.."...~a. ......... ,............ ..,respectlully represent.:
That .............:..........~'!1.;:~!!l...f1.!...~.Y.4.~~................:.................... lately deceased, was a resident
and citi;en olthe........'r.Q.1.m.E;l.lJ..~lL.......................ol.................,Ham11to1l..........................., in the
County 01 Franklin and Stat~ 01 P~nnsylvania; that..J;l.\t.,:.died on....,Satur,day..... the...,30th......
day'ol......9.~.tgJ?!!;r;.....,..................... A. D. 19 37, at or about l],'c1ock P. M. at......hlB.........
home in Hamil ton TownBh1p-"'-----_. TATE-:-"\i-'- --'d"'d -"d ._--1' f to survive
...m...................................................... ............... lNTES . t at sal eee ent e t
....P.:~!!!....the following.named spouse. heirs and next of kin. to wit:
Sara.h B. ~MJ.I..
B. Elizabeth Rvder
J. Jl. Ryder .
,Ma.ry L. Ryder
S. Gail Ryder
RWh'V.:jON8IlIP
Daughter
Son
Daughter
Daughter
RIiJ8J/)JNG A'l'
Ohambersburg, Pa..,
" . II
" A
II "
" II
R 7
II n
II "
" .
II II
That the said inteslaie died p'ossessed of PERSONAL PROPERTY to the value of $..l?QO.Q~o.O..
and seized of REAL'ESTATE situate in the................t5?Xm!;lW~p....l?J...~U.:tQ.:(>,mm......................
....................................to the value of $..~.7.0.Q~QQ.............. as near as can be ascertained; that your
petitioner is a resident and citizen of.......J~~!!l.~J.j!Q.~..J.9.m.>,!lP.:~P................m..m..m.min the County'
of...r.;t:i~J*-I;!......:..........in the State ~f Pennsylvania. and claims the right to have Lellers of Ad"
ministration on the estate of said decedent issued to....them....by rea;on of the Renlnoia. tion 'and
Request of Sarah B. Ryder, the widow of said deoedent. _.,.. '" _
r~~~" ..~ .., '.' .
".";..,..,.."'~~,._..,._-'-...
.. __.._........__4_
. .-.... ..--~..
Wherefore your petitioner respectfully applies for Letters of Administration upon the goods,
chattel.. rights and credits of which said decedent died posse.ssed.
Dated....~~.9.~mR~.~..~1iP.:............. 1937 ,'. .....;1i1~..~~~~....~.~
............f)k,..C~n.~.u~.Jt::v-<;;..~...
FRANKLIN COU ,55. ...~~~~~........:.......
B.Elizabetir1Yder, J .M.Ryder . ~ ' "
:...M.~;t:y...1,o....)~y.P,~*...~~.\l,...~.....g11-.rL.By.9&f................... the 'above.named petitioner. being duly
affirmed d' I d d h th'l 1 h' 'h 1 . I'"
.............................., aceor 109 to aWl eposes an says t at e acts set ort In t e oregomg pe IlIoD .
are true to Ihe best of deponent's knowledge and belief.
....4.f.fJ~!!l~!!.........~.............and .ubscribed 10 .2......rf.t.jy.aJe.d.......~~
before me thi..............1!A..........................day of ,,/l ". , ..../. _ .
~e~' ~~~:if/:.~A 119' 7 ....... .J..../.I:.I.I........ .... ,.t7~AC.................
.... """~J'
...v.;!. .............. ...................Regi.ter. "V'-~ . , .
I
I'
~
lid. ,J' If)- () --,
PETITION
For Grant of LETTERS OF ADMINISTRATION in the Estate of
....................m...m..............B..._Ell..zabe.th...~.de,~__......................_..............,...._........_..........................._....._._
Late of the _.....................TQ~ws.hi,P.._'..m__..m....m.. of ...........Jl.amilt.ou.._._.......................,. Deceased,
To ..m..'...............,........._..,J..Qhn...P......Resaler......._,....... ............., Esq" Register of Wl11s for the County of
Franklin, In the Commonweallh of Pennsylvanla:-
The petlUon 01 .._..S..,.Ga1.l., .!:y.de r..,.a nd.. :1a~,y..,L.,..,"ydet'.,..........'.m"""'_'''''''''''.._........_m__..
of ...J~o,uj;.e...If4.....Ch"',mbe,l',sbu!'g,._.J:'a .,...( Harnl1ton...THp,. J..,...,......... respectfully represents:
That .......................B .,.,.EIi z"-lb,e,th,..':y,de.!'...".,...." Ago ..71...., lately deceased, was a resident
_~. __~"",,-,,h.___._
ond citizen of the ,..m" ,.T,Qwns,hip,...,.................... ... of ..'......m'.._...Ha,m,llt.on..m..'.....,..,..........n....' In the
County of franklin and Slate of Pennsylvania; that .....she.... dIed on ..,...Jl"ednesday.. the m....!ith....
day of ............Febr.uary...................., AD" 195,9,., at or about.. ....3:.0,0.............. o'clock ....nA..... M" at
_n:: , ..;;-t;h~=.'ffr.l~.!PbersJm.J:'g::.H.Q.spij;.aJ.::~:_::.:. ..,.,:', INTESTATE; that ~~Id decedent left to survive
._...m~.h,~,.......... the following.named spouse, heirs and next of kin. to wit:
NAME RELATIONSHIP RESIDING AT
S. Gail f'ydeI' s1stet' "oute 114, Charnbg. .
Mary f,. ""ydeI' sister Route 1f4, Chambg. .
Joseph M. "yder brother 'Ooute #4. Chambg. .
That the said inteslale died possessed of PERSONAL PROPERTY to the esUmated value of $ 3.o.Q.Q.._
and seized of REAL ESTATE sUuate in the ...........To,w,nahlp....o.LHamilt.on.m__.____._....__m......m..m.'
.........................m....... to the estimated value of $.Z5Q.O..,............, as near as can be ascertained; that your
petilloner Is a resident and dtizen of m..Hamilt.OIl._T.Olmshlp....__._..m._...m..._.............. in the County
of mm....Er.a.n!-!:JJn....... In the State of Pennsylvania, and cloims the right to have LeUers of Admlnis.
tration on the eslate of said decedent Issued to ........t,hem,....... by reason of being heirs at law a
next of kin and renunciation filed herew
Wherefore your peUlloner respectlully applies for Lellers of Administrallon upon the real and per.
sonal estate, except real estate outside of the Comrr.onw~llh,..9f whlch_~ald..decedenL dIed, possessed.
D'ated ...._:...::--=.A~;~1...9..=_...: 195~:-:~~Jt._~d_~._.._...
, ..m.PAjuu!t....,d1r/dJ5u.'.m..~.m_u........
FRANKLIN COUNTY, SS:
......._.._~u,._.Qf'ilJ...z.Y.~t;).r.__a.rHL.!::a.rL.r,....;.::y.der.__.,_.n. the above.named pellUoner, being duly
....._._..!?.f.f.irme,d..,...u." according to law, deposes and'says that the facts set forth In the foregoing
patltlon are true to the besl of deponent's knowledge and'belief.
.Af.f.1.rlI:.ed........._.....u_....u_ and subscribed to
before me this ....._.._..._Sth.___u._u_u._. day of
J;t:..-..A.>'.lL.----. All.. 1""
f- !l~7~ ',,"m
-.g:..~c.L...i'd~~-.--
....{jfj.~u.;t....~~--.!-.-._..-.--..
This is to ccrtify that this is a truc copy of the record which is on file in the Pennsylvania Division of Vital Statistics
in accordancc with Act 66, P.L. 304, approved by the General Assembly;]une 29, ]953
(Fee for thts ccrtificatc, $3.00)
WARNING: It is illegal to duplicate this copy by photostat or photograph.
JAN 211982 I I
~f1~
Charles HardeSler
I State Registrar
Date
No.
,~
.....-..-.r,.--'.
HVI.201", AE.... 1l/~9 J... ~ ~
LOCAt REG, NO......................~....m..n.......n.
~~~~.A~6,......:!:.. .r.p... ~..!.-::n. .g.k..7.. .......
_..~-_._-~'~ .~.;r-----~----
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF HEALTH
VIML STATISTICS 06767 7 67
CERTIFICATE OF DEATH .-
1. DEATH a. County
OCCURRED ~ l'
IN, rrank J.n
c. If dealft did not occur In City
or borough, give nome of 'ownship
(Do not UIO R. D. or Box Number)
".F.IIN,mo C b b 11' 1
of Hospital ham ers urg dOSp~ ta
or lnttltution (if not In hOlpllol, give .trect address)
b. City or borough
2. DECEASED'S a. Street add,e", R. 0., or Box Number
MAILING ,
ADDRESS R.ll.ft-?
b. Post OHice, Zone, and Sial.
Chambersburg Penna. 17201
3. VETERAN V.. 0 NO ro
Chambersburg
a. Which War............:':.......... b. Seriol NOh.......~.......n_
". NAME OF o. (Finl) b. (Middle) c. (Lad) 15. DATE (Month) (Day)
DECEASED J 1 ') OF J 6
(Typ. 0' 1''''') oseph ! . hyder DEATH uly 29th. 19 7
6. WHERE DID P . c:. I.ljd d~(ltQ~d liye in 0 townshipt
DECEASED a. Stole........u~.nn.~~................--.. 4J Yes, deceased Ii'ted In..m.lfamil.to.n...............townlhlp.
ACTUAllY , ~'ranklin
LIVE? b. County..................................... 0 No, deceased liyed within aduollimits of................................city or borough.
7. SEX 18. COLOR OR RACE 19. MAkRIED 0 NEVER MARRIED 0 \10. DATE OF BIRTH 111. AGE pn years Ilf under 1 year Ilf under 24 hours
Hale '\Ihite WIDOWED Xl DIVORCED 0 6/4/1891 7/)"bor'h"o,) M,,'h. I Doy. It,"" 1M;,.
12. USUAL OCCUPATION (eyen if retired) 1136' SOCIAL SECURITY NO. 114. BIRTHPLACE (State or foreign cauntty) I IS. CITI~.EN OF WHAT COUNTRY?
Fa.1'mer. 1 If.,;4-.19'jLf Penna. __ u.S.A.
16, FULt NAME OF SPOUSE Hattie a,Ryder 117. MOT~~;at"IDE1~i1r:r.
18, FATIIER'S NAME 'tb "'( d 11Pj..INFQI!Io\ANT'S,NAME AND MDRESS R.bR. ;r J.
, ram u.l y er larO.Ld Lr . "yaer _vnambers urg l'enna.
MEDICAL CERTIFICATE (II,m. 20 ,h"..h 23 "'.. ba <ompl,..d by "hyoid.. ..I,) INTERVAt 8ETV/EEN
20. CAUSE OF DEATH: Entt't only ono causo per II,.. for (0), (b) & (c). ONSI!T AND DEATH
, , PARI I. D~E~~~I~';:U;t(o) ...~!:'?:'!::?-:....::::L:::.....T................ ....G..~.........
. ~::~i~~~;s;oifab:~; ::~~~ DUE TO (b) ...~.~':-:':...d..41.~................ ....m.m............nm..
~~)u.:tol~~~ Iho underlying DUE TO (c) .........................................2.....................--................__.... ..............................
PART II. aTllER SIGNIfiCANT CONDITIONSl conlributing to doalh but not ,elated 10 the immcdjolo couso giyon In Port I (0)121. WAS AUTOPSY
PERfORMED? _____
Yel 0 No ~
Month Day Yeor .
(Year)
..' .t
22. a. ACCIDENT \22. b. DESCRIBE HOW ACCIDENT OCCURRED 122. ~'F TIME
Ves 0 No 0 ACCIDENT
22. d. ACCIOEl'H OCCURRED 122. e. PlJ.CE OF ACCIDENT (e.g., home. 122. f. CITY, BOROUGH, TOWNSHIP
Whllo 01 Nol while , forni, slroel, etc.)
work r 01 work 0 .
23. I h...b 'Ot1t." ';;;r:::':;;:" 0'" (!-p'h o~v'~~ th~~ "o~b''',ol~3rpm,. E.S.T.
a. Si~nolure '1 D. O. b. Add,ess c. Dote si ned. ? - -6
2A. o. BURIAL ill \24. b. DATE \2". c. NAME OF CEMETERY OR CREMATORYI2A. d. LOCATION (City, 80ro" Twp., Coun y1 (Stale)
~~~~~~~O 8/2/1967 .Lincoln Cemetery Chambersburg-Franklin Co._Fa.
25.-11AlE REC'D/8Y REC. Ifi~GISTR R'S 51 NAtuRE../ /l NATURE ND A DRESS OUUNERAt DIRECTOR
~-1-(.,7 . , ...DJ J!JJ.-.- .4/A<' ,. :.<.J,,-~hambersburg i'o..
,oes.ei.' i;l 5
Hour
m
E,S,T.
COUNTY
STATE
.
Thi . t 'f I h"
in a~~~rda~;~l~i:l:al:t '6sds ~ ~u3eOc40PY of thedrbecor1d which is I on file in the Pennsylvania Division of Vital Statistics
, ' .. ,approve y"eGenera Assembly,june 29,1953
(Fee for this certificate, $3.00)
WARNING: It is illegal to dupliGate this copy by photostat or photograph.
I I
~f1~
I
DEe 101981
Date
f).\:.'; I ',:
Charles Hardcstcr
State Registrar
No.
H'Os,'" REV. '-72 I '1/ COMMONWEALTH OF PENNSYLVANIA
LOCAL REG. NO,_.L_ DEPARTMENT OF HEALTH
PRIMARY ;) 0-' / I <1 VITAL STATISTICS
DI5T. NO, ,""-' () CJ {- ,:} (p / CERTIFICATE OF DEATH
1. DEATH a. County b. City or borough 112. DECEASED'S a. Street address, ,A.D., or Box Number
?N~CURRED Franklin Chambersburg ~~bL~~~S R.R. # 7
c. If death did not occur in City b. Post Office, Stale and Zip Code
or borough. give name or township ChamlJersburg, Pa. 17201
(Do not use R.D. or Box Number)
d. Full Nama . 3, VETERAN Yes 0 No gg
of Hospital Chambers burg HospJ.tal
or institution (if not in hospital, give street address)
4. NAME F a. (First) b, (Middle)
DECEASED
T a or rint) S. GAIL RYDER
6. WHERE DID
DECEASED a. Slale
ACTUALLY
LIVE? b. County Franklin 0 No, deceased lived within actual limits of city or borough.
7. SEX 8. RACE 9,MARRIEDD NEVER MARRIEDl9 10. DATE OF BIRTH 11. AGE(ioyears If un er I ear If under 24 hours
last birthday) Months Days Hours Min.
Female White WIDOWEDD DIVORCEDD DEC. 22, 1898 74
12, USUAL OCCUPATION (even if retired) 13, SOCIAL SECURI1Y NO, 14, BIRTHPIACEIState odoraign country) 15. CITIZEN OF WHAT COUNTRY?
Housekee er 18 _ -b721-A PA. USA.
16, FULL NAME OF SPOUSE 17. MOTHER'S MAIDEN N~*T=
H' SARAH BELLE "J..l..LW"'"
18, FATHER'S NAME ' INFQRJ<!ANT'S NAME, ADDRESS <!IN 0 ZIP_CODE
ABRAM S. RYDER SS. MARY L. RYDER R.R.1t 7 CRA I
MEDICAL CERTI FICATE (Items 20 through 23 must be com plated by physicien only) INTE 'A lWEEN
, ONSET AND DEATH
20. CAUSE OF DEATH: Enleronlyone cause per hne for (a), (b) & (c),
PART 1. Death was caused by: G' \ ^ , . r
IMMEDIATE CAUSE (a) ,-...{"~\-,,",,VN' l.."- (;;" ! ~..Q""- '--
Conditions. if any, ~ \' .
:;~~~e'i.~~~(~)eSI~? DUETO(b) '\~, ,'V\n<:"c\~>' ,-
ing the underlying
causa last. DUE TO (c)
PART II, OTH~CANT CONDITIONS: co 'utinglo deat~ but nol related to lhe immediate cause given in Part I (a)
~V"K\...s-. .~ (U .
22. a, ACCIDENT 22, b, DESCRIBE HOW ACCIDENT OCCURRED 22, c. TIME Hour
fuO No~ ~ ~
'T ACCIDENT E. T.
22. d, ACCIDENTOCCURRED 22. a, PLACE OF ACCIDENT(e,g" home, 22, f, CITY. BOROUGH, TOWNSHIP COUNT
While at Not whilo farm, street, etc.)
work. 0 atworkO
23, I hereby rert~OAd"') the ~bove OS_mad deceased and~;ath occurred from t':: causes and 00 the date stated abow ~t1\" E. S, T.
a,Signature ~~ D~O, b,Address e~,'U6.,.,.b." h,DataSigned '11:.....\, \'\"1)
24, a, BURIAL N! 24, b, DATE r4, c, NAME OF CEMETERY OR CREMATOR 24, d, LOCATION (Cily, Boro" Twp" & County)(Stata)
CREMATION 0
REMOVAL 0 JULY 10, 1973 LINCOLN CEMETERY HAMBERSBURG, FRANKLIN CO. PA.
25, DATE REC'D BY REG, 26"I1EGI TRAR'S SIGNhoTUR~., j!7. SI3"'1j~R NDAD OF FUNERAL DIRECTOR
-1 _It) ._ 7 } ./11<. ,~~.J' ,~",.,<,. ---r~ 297 phila. Ave.
S,S, No, ~ '. -' c , ~ ! Chambersburg, Pa.
G8i23 7~~
a. Which War
c, (Last)
b. Serial No.
(Month) . (Day) (Year)
July 7, 1973
Pa.
5, DATE
OF
DEATH
c. Did deceased live in a township?H 'It
ro Yes, deceased lived in anu on
township.
0",-,<_1/-"
\o-\5~,...._
21. WAS AUTOPSY
PERFORMED
Yas 0 No
Month Day Year
STATE
'.
'.
Ii) 1-/ vi f ")
\\.
PETITION
For Grant of LETTERS TEST AMENT ARY on the Estate 01
___...._.m_____..____......'._..______.._.__..._.___.._~~...~!:i.~._~Y.<l~_r..__...__.______.._..._m_______._._m_______,"_
Late 01 the ____....________!O'~~~P__.-..-m.-mm------.- 01 .________...)la,mH:t.Qn---.----, deceased
To .._____.__.~i_~~~!!__T..___~.::t.:ll~r:.!.__.______._.__._.___.___'._.__m.'__....... Esq., Register of WUls for the County 01
Franklin In the Commonwealth of Pennsylvania:
The petition 01 .._..~!y.._h_~y..~~____._____._____..m___..._.__.._______.--.-----.--
of ...~~y.~.._~..!...~~~~.r..sr:u.!g, Pen:::.!2-:::~::...:7.~<.'.~.___.__m__.__.moo_.._._ respecUully represents:
That .__._._?-'-..~.g.-~y.dez:-_------oo.----.-----m, Age __00.14.____, lalely deceased, was a resident
and - citizen of the _____.!0.!:7!'!!!.)g.P.-.-.-.--- of __..._~~to!.1:___. -- ---:===--u:; the
County of Franklin and State 01 Pennsylvania; that .___..9.\1iL.... died an __mSat!:U'~~.Y:..--.--------.._-~""
J1o..u.S.T.
the m_..7.~!!._m.m day 01 ._____~E1y...____, A. D. 19]L---, at or about ._.__..._e.:.g_~._.____._. o'clock ~_'._~M.,
a! m.._._~~.~E~.~s~.!j;-!10-~-pi.tal..!.5~amb~rs ~rg!__.~~~s.Y 1 ~~ni~~_____..--.-m.--m.---m---
and uroarclfj
That ..._____she____. died possessed of PERSONAL PROPERTY to the estimated value 01 $__~.I_Q__9.!9.QL
and seized 01 REAL ESTATE situate in lf$ ~~~!:~r.:..~!?~.~.~.p.!.. Fr~~::.~ountY.!-!.~~sY1.vani!:.--
up.Hams
to the estimated value 01 $__.2_,-990 ~QQ__.~~j- as near as can be ascertained; that on the ._5.:\:JI,__... day
she
of ...s._\lJ?t~!!!!?'?^__m__..__. 19__.29._m..,l made ._..~_e.!'._.. Last Will and Testament, oUered lor probate herewith,
01 and In which .___m_!?~_.___._.__ appointed your petitioner ..__.___..__J\Lhe.r-.-.--.- Execut ~-.-._.
That since the execution 01 .,._.3~.;:-------. said Last Will and Testament the sold testa! r~____ has
not married nor have any children been born to said tesla! r.i:l-'._._m__ excepting as lollows:
No exceptions.
Wherelore, your petitioner respecUully appJi_e.1;...__oo.m__ for probate of the said Last WUl and Testament
and lor the grant to your petitioner 01 Lellers Testamentary thereon.
:.-> /) /
Dated ._____.__~!!;1,y._?.s______, Ig..tL.2J!.':'<':'!..d.--,.lL 1,t<0.L,L_.__._________
." .1
.~-...--_...------_._------_.-
.,..-..._~"':<."'='=-~-,.....,,...-,,-_.._-
FRANKLIN COUNTY, ss:
__._______.___...____.__--M.:ayl.-..!-~---~~~E----.-..-----..-..--.-...-, the above-named petitioneL..,
being duly ____'._.h€!!C).~...._._.,.....---- according to law, deposes and says that the lacts set lorth In the lore-
going petition are true to the best 01 .__..___.__!1e"-......__....._____h....'..____ knowledge and belle!.
\ ~"=~:":~ i~;C~:~ ==-_==
..
",
7li ?\C!:3t2
~.:-:". ,
This is to certify that this is a true copy of the record which is on filc in thc Pennsylvania Division of Vital Statistics
in accordancc with Act 66, P.L. 304, approved by thc General Assembly,junc 29, 1953 '
(Fee for this certifkate, S3,00)
:~, ..
$;':'
~~:
~ '
f.:{ " '.__'_~ .
300101.120<1)
'l..1.!.?-.
t><
r:::::::::::::
LO...!.
1--
[~~~~
r...........
\..r.......
(..:........
,
I
I
1
i
i
I
I
~~-,
.'>"
WARNING: It is illegal to duplil:ate this copy by photostat or photograph.
I I
~f1~
Charles Hardcs(er
I State Registrar
DEe
3 1981
I' .) ,- i \
0.) , .1.;
Date
No.
HVS.20IU REV. 1I/~' g
LOCAL ~EG. NO.............................................
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF HEALTH
VITAt STATISTICS
CERTIFICATE OF DEATH
4579
PRIMARY ..:<?' '7 /.<~,;1. 7/..
DIST. NO..........'l........................ ..................
1. DEATH a. County b. City or borough
OCCURRED F enkl' I' b
IN, r J.n 'lOrCerS urg
c. If dealh did not occur In City
or borough, 91", nome of lawn~hip
(Do nol ule R. D. or Box Humbel)
d. full Nome
of Hospital
or inlUlutlon (if nat In hospital, give Itreet oddreu)
a. Street oddreu, R. D., or 80x Number
208 S.?a.rk Ave.
2. DECEASED'S
MAILING
ADDRESS
b. Pod Office, Zone, and Stale
Hercorsburg,Pe" 17236
3. VETERAN Y..~ NO 0
a. Which War..vM..X.J:.......... b, S,,,lal Na.2,9.5.l9Z......
\5. DATE (Month) (Do)'} (Year)
DE~:H Jan,16,1967
208 S,Park Ave,
o. (Finl)
JOSEPH
b. (M'''dla)
D.
c. (Lost)
NILmR
4, NAME OF
DECEASED
(Type or print)
6. WHERE DID PaC. Did detlt05ed liye in CI township?
DECEASED o. Stot....u..;....~......................u... 0 Yel, deceased lived In......................................township.
ACTUAllY 'P 1r1 . .' .' "
LIVE? b. County.__.I'.Q..nJ..._ln............... El No. deceased lived within act\lalllmlts of..JI'Ie.r.ce.r..g.bu..r..~...CIIV or borough.
7. SEX 18. COLOR OR RACE 19. MARRIED 0 NEVER MARRIED 0 110. DA~E OF illRTH 111. AGE .(in )'oan Ilf under 1 year Ilf under 24 hours
H'11e \1hite WIDOWED !Xl DIVORCED 0 1/23/1891. 11l2"rth"ay) M,,'h. I Day. Ha"" I Min.
12. USUAl OCCUPATION (even if retiled) 113. SOCIA~ SECJJR TV NO. II". BIRTHPLACE (State or fOleign countryl\15. CITIZEN OF WHAT COUNTRY?
Farmer 1 2-~L,.-1j 6 Hercersbur Pa R 1 1 S '
16. FULL NAME OF SPOUSE 117. MOTHER'S MAIDEN NAME
r...'1h Ryder
lB. FATHER'S NAME 119. INFOR!\.AN.T'~ NAME AND ADDRESS H.JJ.J
David JIIil]er Donald, ~.Hj.ller,'\jercersbur".Pa.
MEDICAL CERTIFICATE (I..m.20 .h.-ugh 23 moot b. .ampl.t.d by phy.ic;an .nly) INTERVAL BETVlEEN
20. CAUSE OF DEATH: Enler only ene caU5e per line for (a), (b), & (c). ~, ONSET AND DEATH
PART 1. Death wa. couled br- 11. CAR' IJ j!JO V U, ' .
IhlMED1ATE CAUSE (0). ..t'.tl!:E...... ."'..."'.......J~.{..........rO..JA.S:J.d)J................u ..............................
~::~I:\:';.ifab:~ ::~ DUE TO (b) ...fh~J:EK(~...l.!:.l"Egp.:n:c,..~.':tRr..;P.l~~tlSJ;. ..............................
(a) Itating the und~rlying
coule lad. DUE TO (e) .......................................u.n.............................................. .............................~
PART II. OTHER SIGNIFICANT COt-lDITIONS: <<Inlributing to deolh but not related to the immediate caUIll given In Port I (0}121. WAS AUTOPSY
PERFORMED?
Yel 0 No 0
\22. b. orSC:UCE HOW ACCIDENT OCCURRED 122. c. TIME Hour Month Day Year
OF m
Y.. 0 No 0 ' ACCIDENT E.S.T.
22. d. ACCIDENT OCCURRED 122.~. PlACE OF ACCIDENT (e.g., home, 122. f. CITY, BOROUGH, TOWNSHIP COUNTY
While at Not while farm, Itleel, ete.)
",,'ork 0 at work 0
23. I hereb)' certify that I o"ended the chon n~d dl'ceoled and ',hat. death occurred f,am the caules and on the dot~ Italed aboye at If 1m., E.5.T.
I 'r,n. C ~ c. ~::.. '/1 I
c. Signature I ,l.t.,\:.u.?vL.L '- ,,1 \;~C'-Ll.(. ....... ~ b. Addreu QAC!') VIA.' . Co Dote si~ned -I
24. o. BURIAL !;a 12.c. b. DATE 124. Co NM,'I Of CEMETERY OR CREMA ORY 24. d. LOCAl' N (CII)', 80ro., Twp., & Count)') (Slale)
CREMATION 0 1/10/ 7 "' . ,. b pn
REMOVAL 0 I _Ia~r 0'4 '1erCerS urg, 0:.0..
/. /TVEC'D BY REG. 126. REG tRAR'S S1GN~URE AND""DDRESS OF FUNERAL DIREcTOR
~ d.t . ( ./71 Hercersburg,Pa.
22. a. ACCIDENT
STATE
1,// ,
I ' .
,
~, ;; J J' y:.
" "
PETITION
For Grant of LETTERS TESTAMENTARY on the Estate of
IEAR MILWl
......__.__._____._._._.__.........._..............._.._...... .... '._._._..... _.....___._...............___._____nn..__..__.___.___.
Late of the _..__.._...._~!!)!~~P..____.._................_..__ of __..._____m__}lontgOOlllry......_..........._........, deceased
To Johp-1...Jt~Jl..!!J,.l!.r..._......._._._... Esq., Register of Wills for the County of Franklln
In the Commonwealth of Pennsylvonla:
The peUllon of .J~Qnl!.J!.,..Mooreoo.lll1cLDa1By:..M...Hamilton___.oo...____._..m.oo________..,.....__...
-:LeoDa B. MOOUt 2505 Swede Road, Norristo\lll, Pa.
of _.P.~!.!l.1_~.~~k.C?!!~_.R.Q11-.~J!._~,..JI.e,r.!J.!!r..!!Mg, ..1'a.,......__,..._....._____.___ respectfully repre3ents;
That ._.._._.___~~._~,J,!!;r;:._oo__m._oo__...___'_..moo____' Age 9J..t...oo, lalely deceased, wos a resident
an citizen"ol the _.~g.'!m.~!!,tlL___m. of _______......___.._____..._...MontgomerY.-.-.----...-..-'.m.--;--.:::::::::::rii the
County of Franklin and State of Pennsylvanlo: that .;ooshe.... died on __...._......,Sunday__'__.....m_____oooo....._._
the _.~~_ day of ._mm~~.lm______' A, D. 19 ...~9._, at or about .oo__m)'I.S.5..__oo.__.____._..____ o'clock ...A_M.,
at _._The We:i.1.le.~9J:g.J1Q!!p.t tl!;!.~..WI!.Yne.sJX)r.p..__,l'ennBYlv:e.nia---.-_.._---....------.-----...-..___._
That .~!!!!__m_ died possessed of PERSONAL PROPERTY to the esllmated value of $..?...Q2Q.!.QQ_
and seized of REAL ESTATE situate in the m..oo.....___...__)l~m!!...._oo____....__.___._.__... to the estlmqted value of
$._.......m...~~.!!~_.... as near os can be oscertained: that on the mm.,6th._._._ day of ---September...-...-
19_~~ made _........~!'.~.___..... _.Last Will and Testament, offered for probate herewith, of and in which
. ,
._..!!g.\L__..._. appointed your pelltioners.~.....______her.. execu\..r.llll!l,!!...__._______.._.
That since the execution of ...mhllI'....__ said Last Will and Testament the said testatr.J~L_. has not
married nor have any children been born to said testat".):'.1x '... m.m..._...______....._. excepting as' follows:
NONE
Wherefore, your petitioner!l"especUully appl y__.mmm_ lor probate of the said Last Will and Testa-
ment and for the grant to your petitioner of Letters Testamentary thereon.
I Dated __~'!!l..!~_.__.___..._, 19. ~.9.___ . UlOta- lltf3H60~-~
f' .--..., .,... - . --.. ~"'--'--' ,.. . ,- '--.211....~
I I 1sy M. HamiltOD
I
I
i
I
FRANKLIN COUNTY, ss:
_.___Yl.Ql'l.o,..B.....Moor.. And Tlaiay...M...-HamiUo.tI___, the above-named petitioneLII
being duly __...!!,,!!-0;'.J:!___.._.._; occording to law, deposes and says that the focts set fOl1h in the foregoing
petlUon are true 10 the best of _1;hdl'_.__m. knowledge and belief.
_..1?1!!PI;'D..----- and subscribed before me this l.--.L~1!.t@.,.-.0--~-
~ ----xeona-l!. floor~{
_J..?_1;l;l_ d f .-___ July__.___. A, D. jg5!> .. n~lIiilll-K~ iiiiilItOii"': ~.._n_._.
, . ..,... ... ., _ Register. _m_._._____. ._.__.___....______
(i d It,)
I
/,
,..,j::> t..,/ ,','/ ~
'-
r--,..",," ;'l
mortgage, hypothecate, exchn.nge, improve, develop, Invest or reinvest any
real, personal, or mixed property belonging to my est,llte at the tIme of my
death or thereafter becoming a part thereof; and I fUl1;hor empower them
to cry~prQmise and settle all claims and differences in favor of, or against
my estate.
IN TESTIMOl!Y WRF.RFOF, I have hereunto set my hand and seal tl11s 9th
day of September, A. D. 1949.
~~
Leu 1 ioli ller
r:'Yn~ (SEAL)
Signed, sealed, published, and declared by Leah loliller, the above
na:l1ed Testatrix, as and for her Las.t 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 thereto.
IL~ 1/ C?~(I
~- ,.-- ~1<A/
-.....-='.-.
,.......-.-
, ,.... .... ._""'_....._~~
,. "~. ,....
,~.~,~
-_.~.
.-:-
"
-~
" .
Ii & R 46 - 1.'73
~ ,
PETITION
For Grant 01 I.EITERS TESTAMENTARY on the Estate of
DAISY M. I~ILTON
Late of the
Township
, deceased
of ..._---'io~9omery
To _~ideo~ T. Hartman
._...__.m____ Esq" Register of Wills for the County of
Franklin in the Commonwealth of Pennsylvania:
The petition of Helen Hamilton LO~S[...of_l-:l_~EfordL-.R~~ Jers~
aIl6l MlLIY. Louise Hamilton Betz .QL_Rock",i;L.;L~.,._!1i1_n'.!i!D.c;L_.._.. respect!ully represents:
That Daisy /:1. Hami~~on .. __ ::.:::...".:.:,.A~_:_~~,.latelY_d,:"eased, was a '.':sid~n~.
and cltlzen of the ~~wn~.__ of ___..__~.~tgomery ____ in the
County of Franklin and State of Pennsylvania; that ._..??e..._ dJed on _.. F r:!:.~~y ,_,,___.
the __J.8tL day of October, A. D. 191.4.__., at or about _...__4.;..~9._..._._ o'clock Y..!.M.,
at _E;;mdolph Hills Nursing: Home, WJ:Ie~~.~.!1_L_~.'!-_JOY.!and _____.__._
That ~~ died possessed of PERSONAL PROPER1"{ to the estimated value of $'~.!...OO~~'~'~dand
upwar s
and seized of REAL ESTATE sltua1a in the _______..-E:~ne
to the estimated value of $ -0- os near as can be ascertained; that on the ...?Jltl!.. day
of _~rch. Ig.Ji.L, made _ her Last Will and Testament, offered for probate herewith,
of and in which she appointed your petitioner s_abo.\le...namad___ ExacutJ::~.~__.
That since the execution of _ her said Last Will and Testament the said leslat ::ix _ has
not married nor have any children been born to said teslat ..J.::.:!:~_.._.. excepting as follows:
No exceptions
Wherefore, your petitionalS respectfully appI.Y__..__ for probate of the said Lost Will and Testament
and for the gront to your petitioner of Letters Teslamenlcrry thereon. ~ I
Dated (er,)1 ~ q ,Ie( , ,lg...1.1....._21<:~~:1i:.~...--Lc. ~..~..r;:.t;) _ ~
~;f . c/ 1/ ~!l.7.v' A"'-r="
,_., , .j/ v, ~ '.,' ~ .,.-j,-,{,.. -. --l
!I
1
I
~ accordinq to law, deposes and says that the facts set forth in the fora-
.. ... ~ . .
going petition are_.~El"I?.~~:besl of ___ thei.1=
....., ,".'
-_. sworn<;"i":;I:~~.;,~ before me thls l -7.t.. t!~ yJ'..,-"':" It::;:., ~~ ~
~-.. ':12- . .
"?'I:"':,.),, .0. ." .; ,'.' ,," '. . . .'. ....,
, . .'il,*'f/:' (/01., '.,'""', A. D. 19 74 7J..L"'.'1 o(~ u 7P!.~......_~ / Lurf
' ,~.,' ~ . ' { " '. -', t.-J. '
. " ,/,1,. . ,
/' (lLl.;[; '.f:..i '7.7 ~0;;:1'7-<'"'7 Register. _.
~.,.:. '\A,"'\ ,):,..
.I. "..., ,
/0 .~! ,1....0, :,,:.
. t" ,.... ....J_ .1....
f':-, ....."-..-~.'.IJ ....,..: :
,', 'J. "0 \,.,L.:._,' ',' '
,. .' "'..
If .., 1". ....... ~.' .,' .
'II' " .....',. ": J~ "
",' ~. '1" ....
.............
FRANKI..IN COUNTY, ss:
HeleILli<lln.Uton Lowry ancLMll_fY. Lou:i,.!?e JI_<gn_U!:_on Betz, the above-named petitioner~,
sworn
being duly
knowledge and belief.
SOOK
78 P:'Gl 60
1
I
,
I
,
,
LAST WILL AND TESTAMENT
I, Daisy M. Hamilton, of Montgomery Township, Franklin
County, Pennsylvania, being of ~ound and disposing mind,
hereby make, publish, and declare the following to be my
last will and testament, revoking all former wills or tes-
tamentary papers of any kind by me heretofore made.
FIRST: I direct that I be buried wearing my diamond
ring, as 'this is my desire.
SECOND: I direct my Executrices, hereinafter named, to
fully pay and satisfy out of my estate all my debts, funeral
expenses, and the costs of administration of my estate as
soon as conveniently may be done after my decease.
______.--'IHIRD: T Eille~..de\lise. and bequeath all of my estate, be
the same real, personal, or mixed property and wheresoever
the same may be situated at the time of my death to my be-
loved husband, Harry D. Hamilton, to have and to hold as his
property absolutely.
,
FOURTH: In the event that my husband, Harry D. Hamilton
should predecease me, or should die in a common disaster
with me so that it was impossible to determine who of us
died first, I give, devise and bequeath all of my estate to
my two (2) daughters, Helen Hamilton Lowry and Mary Louise
Hamilton Betz, to be dividded between them in equal shares.
FIFTH: I nominate, constitute and appoint my two (2)
daughters, Helen Hamilton Lowry and Mary Louise Hamilton
Betz, to serve as Executrices of this my last will and tes-
tament and I request that they be permitted to qualify as
such without giving any official bond.
IN WITNESS WHEREOF, I, Daisy M. Hamilton, have to this
my last will and testament set my hand and seal this 28th
day of March, A.D., nineteen hundred and sixty-seven (1967).
iLa,:"L/'-f ))1, 1-/--z1Y)1.,J..'L1;;,,1. (SEAL)
o
Signed, sealed, published and declared by the above named
Daisy M. Hamilton, the testatrix, as and for her last will
and testament, in the presence of us, who at her request and
in the presence of each other, have hereunto signed our names
as witnesses,. '!:_l1e_~~yan_d_ye~E-}-~Est. set foith_above.
_ ,,' .._._. -'-~.H . .,." ,,'",. u==-;-~___c-=-_=~ ~. -... -, _
0~ . tJ.;/ ~{0-
/':"'-:'//7"'"~/_'7 /~"""'; \"- ,.-"':.c.c-:r,.-:r'
,~ ~ ....,,;...... _ 7
.../: .. ~r.. . . ... .~. ..... >7'" ....
). /;
. . "'{"l(~'~ . (. '.
"
/>7'-
.... "J"
,ODK 78 FAG! 59
,'. .
Rce-,? (12-63)
comlON\\'EAI.TII OF PENNS\'\'l.ANIA
TRANSFER INHERITANCE TAX
RESIDENT DECI::DENT
SCHEDULE "0"
BENEFICIARIES
BENEFICIARIES AND ADDRESSES
(5 tate full .names and addresses of all who
have ~n interest, vested. contingent or other
. wise. in estate)
REl.ATIONSHIP
(l! slep,ehildren or
illegitimate children
are involved, set
lorth this lael.~
SURVIVED
DECEDENT
STATE YES
OR NO
Helen Hamilton Lowr
1101 Eu enia Drive.
The Cedars at Medford
Medford, New Jerse 080 5
Dau hter
Yes
Ma Louise Hamilton Bet
14303 Gaines Avenue
Rockville, Ma land 208
\ - 30 \ - /..\ I. 0 'I S 1lo
Yes
DATE
OF
BIRTH
INTEREST OF
BENEFICIARY
IN ESTATE
1/2 interest
1 2 interest
Deponent rurther says that all the above-named beneficiaries are living at this time except below:
I
NAME
DATE Or' DEATH
RESIDENCE,
\
I
\
;
J
\
x,f) Davi.e F~'l.Jl1kli:l >~i.l1er, ;~pl'J..L i 0, 1 :-~5!j
Leah Hyder :.1i.1 1::: r, :atl. 9, 1 ;';l.?
::lrc:, 1')01.. /, , ((0
,Tll1.y L, 195(). rf:(!r:i" 1;"/ ...J
c,; l~;C:
11
l':'1I'I'ir~':: Dec. ;Yl-, 1 ::(/1 iE
1,i(~l'clJ r~:l)lll'r:, i;Dnnr:;yJ. '!aniu .
llL;SUt})"
lIarr'y Hiller ;jept. 1, 1 ~;9;~ Di(~d. tlov. 30, 1955 Gresnc:J.8tle, Pa. S
" . r':iller I~an. 23, 1 ;:,91, 11 .7un. 16, 1967 l';ercersbuTE, 1'a.
"o~cpn
Daisy !,\j ller \1~M~9.1(,,\ Oct. 6, 1C:,96 II Oct. 1 ~, 1971, Rockville, Vel.
'}\o ;,:ary ;:111or j':'J..r. ;~9, 1 cS'7 Li ving, .rain(~s Cit~., Fla. 33 CU.
David ;.ti..ller .' 19, 1 i~'ig Dioo Au [;,1..1flt 1 C99 Hercersburg, FIl. "
1'..';.11'. ,,'
.:ohn l>:iJ.le r l\.~Jr. ;,7, 1 GS'<;' II ~er-t. ~~O , 197/, Hi1.licton, Fla. ')'"
Leona :/1il1or ~~"'''d':... Dec. I., 1')01 II Dec. 0 19'12,I;orristown, Pa. S
"
Chester Hi.l1"r :an. 6, 1901, II Dec. 1, 1955 Lake 'dales, Flu. -y
::ov8J,b'3I' 17, 1901
'a:nes City, Fla.
Dear Jf.r. Davie:
"de hope the '3!1clo:.:;"c inforTi.:L1.on ",.'ill ::.,rlti:'f';r ~~b~ c,)u)~tr~, :~o\.levC!r, if you
n88d nddi tionul \1'J \.TiJ. attempt t::, (lie 1 t 1:p.
Thank you.
l{.:.:spectfully,
....ohn . .,.fin[:'~r
,\FniJAV IT or' fiEl,/,Tlvr:
,.,"; h;rtH~n ii:ft'k"inC Lhis Ilf'i'lduvif~ tnUGt huvo
\ ".,.;: ~c' YtJUr13 o]J or ol'lct' ut tll1.tJ of, t.hi~ birth.
""""I',J"'~"JI. ty J:1,\"",[11"
:~~,r\I,., d.....~~;.I.;~..,.''(..I..'rt.'UOWl 0 II l("....J......
p.-f,'!"'"' J:I(t...~...l~,.;.'.\~~..r~........n Homry Public
;;, ~,,:, for oui<\ s~~.t,a and CO\U1ty pornonall:r
tq,;t~/ll'<'.ld. I .::.. ;..~:A^I"ll/.~f';'l6,.ftM t..... .... . . . . ... .. .
w~". 'I'~ng mude kJ!I)Wn to mo dOlJpol!oO ,find. says that
:; 1" ,. rolutfJd u' !"ill' nppllcunt ua. i'r9,hx~r. 'otc.
he Wfill..I?..Y,:h/'S 01' 11.(,1) at Lho timo of
'.t. ';~irthj thnL ':1(; n:llidos in :~,ho l1i~Y or town
. , .,. ";', ..".:~. ,', ..:-:.. c.ount:! of... ~ r;:.:'~ ~,:.J.\~.....
~"~.~.l~ (,It'.......~..~..~...~.......(lnd furthor states
'!:cL.....:~~~..:-... ......:.~.....:;.~:..~r......Wl\.B born
',' , n,6,',(' of', 1''' r ~ 9",.,. <J t' i' ',' \1 1 ~ l'
~.l. s~\~:::,,~,,~'t\:'''>i:,:~~ tl fl~' . . t'~,:I:'f. . '1'~~M ~. i',,~'. ..~.
~lfld. '~';'Nt' I' ..,....),;......1.... . . on. .,. rt't':. .'..'..-.,.. J..!i.7...
l'Il~' :t1r'. ' ':::orn..n, ..in:!, yeur
, ' .' " ,," \ \ I j. I '. i ~ \.
;,', ',,1!', \'lIro..".....; ""...,. tu'" .~la ~i""'"
_ r'JIJ:.m 1:IU.\.lnc :uS au. . -:v L:-""
[inr." thin./.~.ttd Y <J..f~.... ~'.l9'Y.?;-
. r_ ~,' C ."'~-
'S 1,' n!i. turB.. .'-r... .:.. . ~ ....... 1lo4~' ...
/." .... ,..::."_' no ~[! ry r.lJ.u 1C
".l'r4- c.;,..) It n J l'.,r."," r'"J~r _ "" v~ ::I~ .J.Z-
AFFJDi,VlT or' nCIl-RE!;. TIVE
lh,to: Person iri!lkinp affi\ltlVi t l'lUst hnvA been 16
:,r.::a.ru old' or oldor El. t ti!lX) of this birth..
sto.te of.... ............ ,Count~,. of. .... ..... ...
Before me...........................u. Hotnry Pub-
lic in fllld for said Stata und Count:" porsonully
"pfourod..,............. ','Llit.n.ia' "t.......'
person lr.aK:l.nL I.. 18 D.J.1. l~\'+
who being made knOi'ol1 to jilO.. dcapcses El.n\1 (lays
that he was ....... .yeurs of a~e ut the tirr.e of
this 'liirth, that _ho ron;oea in tho ci ty cr town
of.. ....... . . .... ., ., .. . county of..............
state of..................and furtb.n' staten
th.t.....Mt'l!.or.rMSM....""s born nt'01t,..et"
t.e~r^...in the sto.te or..............,..........
to. ..... .rdtr.llt......... .o.nd... ...tttothO,........
on....,.. 'r'lOflt!I;.~t1S"$~at.........
Signature... ../.......,.... '1."J'" 'f.ia" iL......
jJ ~r"on nJU~ 1Il[ ~ll :> a J. nv \,
Done "n18......:.. r yo...... .194. . .
SignntUl"r.:... . .......... ~l'."""""
:lot.nr.r pula c ,
AFFlUAVlT OF NOll-HELATIVE
Note. Person 1l1!\kin~ "fJ:idovi't must have boen 16
old or older at tilllfl of this birth,
of... ...... ._..1.' ..._._..IC,ounty_o.i\',I' ... '_'..'..1 1,,1.'_' I
IIlSUHAIlCE POLICY
tate of..... .,., ..... . County 01'...... ,.... ,.,..
This ia to certify that I ro,ve this day examined
Policy Nurnber...............,issued to~.........
. . . . . . , . . . . . by tho..,............... Insurance
Compan:r on"Il1Mth" aA.~" .tO~~"" At the time
of issuonco, the inaul'ed r;ovs placo or birth
to bO....61ty.br.towu.....in the State of.......
........dntc of birth.......1.t....a......t........
monlin.. ay. year
no.nr3 of fB.thor......................and nB.r.v3 of
mother...................... No alterations or
erasures hove be on mado on the application for
thia policy.
Done this..........day of...... 194...
SiGnature.. .fJ.~tdtS".pt\t>llb.............
~h G
Stato of..... .......... . County of.... ..... .....,
I hove this dny o;,:alOinod the rocords of nr;r office
and find that on....~~..~............I delivered
nonon oa:r :rear
a child nawd.............................. to
. -.... ".t.............. .and......'tf'!............
lather r:1O'tmr
at"cif;y' or. ~own""" 'Gtn~e"'.""'_,
Sibnaturc..........k....L~i!..~h!~t.)~..........
per c on ma In(; \.oil 0..1. .l1-Uu.V1-u
Dr;nc -::;~:..:;...... .:.;;.y of... ..... .194....
~iGnu.ture.... .1-..... .of..l!..............
n01;Bry PUU 1.0...
l3 J...;jJ u.;t;
(If po..ible, furnish printad church racord fcrms
When not available, suppl:r statement similor to
that ahOTffi below, containing seal of ehurch or
written on church stationery)
Thi. io to certify that I have thi. duye xomined
+....he records of.........,...<t,...!...................
nnr.J) 01 Cnurcu
looatod .t.cltfor.tMn.....Hnt~... which shoVls
thot.Ml!:e.br.MH~~".."wae baptized on"Mto"
........ .., EUl'ri WtU5..... .. .years of ar;e. The
recordlS shows tro name of the father............
. . .. . .. . . u.nd mother...................; place of
birth....................nnd date of birth......
...............
Done this.......d~ of........194....
Si{;na.ture.". ...... . ... . ...... . . ... .. .
~uGtodial or church records
lll"')..i:: "to 'OI'lJ
~ '.....'l.::.li ~ , ....-.....-
7!.1-rv", /~ I 11 /? ! I
,~
i In]" ~t{l/1- f 1t. J~cvv-'~
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. 71U'^'" I, iL 1, I r 'f 7, 7nofiJV:fl;; Jrl~Ce -U~ \
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Y~'~~~~~da~~;~i~i:~a~~h~~s ~ rU3eOc40~Y of thetrleeor,d which is 011 file ill the Pen"sy"',,"ia Divisioll of Vital Statistics
c ,.. ,,'pprovec 'Y tie Gelleral Assembly, June 29, 1953
(Fee for this certificatc, S3.00)
WARNING: It is illegal to duplicate this copy by photostat or photograph.
DEe 1 0 llllit I I " ' . ,
Date
~JI~
Charles Ilardestc:r
I Stal. Registrar
No.
._.f':.... .,'.,....,._..:I_.~" 1. . ,,)_. ."..' ,,- .....",.,....-~...'t':~----~..
~~rm'~~:::;:~~~:.'::. -'\" ." :'..~.' "J."2~.~I.THOFPE::.:~NIA~:
, ' ".:1"<r'" fi " , " . -, . ,1DEPARTMENT of HEALTH
DD.n~D!d';:'_ ~ .::...._. ~.. . ~ERTl~.I~~~E OF ~EATH,..U.REAUOF.~I~ALST~,.g09.-
Town.h~IP of _._..___--:.....- R.' .1,"ot'Dn DI."'D' No ..i / d. ;;Po :', ,t.. File No.~,.:_.~........___...:............-. '
0..,' _ "I' -'.~ c' , . _,'" ..~. ~ ", .---..........-""....."".."........... "",:- :'d"''''''~:\l''l!J.id'~..,, _,~"""-,,,:,.:
T j.h-~'~ ~........ ~. . 7 ~_ . , 7 z...;:- ~7'~_-=- s.::
Borough of _...~.........__......____. Primary Rogl.traUon Dlstrlot No.....L '" ......_.... ,.- Reolalofod NO."I..:_....._.._...~.._._....:.:.....- '00:.:-:: \. .
O'!-J';~~' :"Il\~' . . .......J1..v.J..,...,.j..,.".
. ".,,, . .... ,.. 7 .' _ ..' :;... IlId""I;~;,," -,
CI a- 5t ~, W.rd}.....,! ""'H tal I tu! ' .
~Qr.-=--_...... . ,_"':':'__"" .... '.._,..' ......... .....__.____.........."............... .............. .-..' " .i~il..N~\1~II1i:lIt~ .
_ ~_ ' _.: n~.I."~; /.' . .' . -.~ Of~Ied..~nWllbcr.1
. Z. FULL-NAME ._..................C:.._.. ._~~,...._..........,..,......."..........."......-... ... '.1\ ';,:'- ,0.:.....";'::.;.',.
'r.:'"' ...........' . ,
. -
.. PERSONAL AND STATISTICAL PARTICULARS.. MEDICAL CERTIFICATE OF nEATH !,:,"..
;.:: ,:~Z22- ~CEI ~ SO(';~:OM"'l:RRIE::::~,D I.. DATE O. OF-ATH .,......~.. ".":"..,,,,,,,,:,,l"::._~_::~, 19M \.
~ ' (Monlh) (D.y) ...~' (YCAr). ~:':'.:.;:
.. DATE OF BIRTH' " ..." ~ ,,' ," " .."" , 11,;.,,, } HEREBY CERTIFY. Th.' I DltDndDd d'O"",d from :""';
'" '.' /M;,~j.:...-_-~...,,(!;,--_..:__-,.l~~~. .,,~..{!:L,~, IO""~""..I.",:"",~ '.. .:;
.. AGE . ~ I. . ",' . I U LESS than I clay 'hot I loot .ow 1~".lI'D on"..4e..,.....:."/.""."..,'OI.",,,,,..,,., '
Ihi (J 2.. () , . on" thot "..th DOD."Dd, on tho dolo .t.l.d ObO'D. ft' ";2...",t:/L..",,.. M.
;:_...._>2_".~.:'"...:~~.......~.:.:.."..".. ~:..~::i..>;..:...""." or Tho CAOSE OF DEATH' woo .. fnllDW" '
. OCCUPATION ....~" :, c\
.. (~~~~.~,..... ............... (Durat1onl...................yro,.................~..I1,o,. .~,......d..
10. NAME OF' . ..- .. .. ,...
11. ;:;;.f~ ,,' (SI.n.d).~..."'"..,' "...."...",,,....,,'t;....M.
. (ScaturCounll)') -. .,.. .., 1 ~ ........g....t9.2i:L (Addresa).
,
"
12. MAIDEN NAME
. OF UOTHER
-.""'~
<":1:
.Slate tho DI,EASR C"'tnlCfO DF_'TlI: arin deaths from VIOI.Y.NT C"Ulm.. al" (1~
J\(EA:iS 01' I~JURY; nnd m whether ACCIIlI!NT,\!., :-lmcIOAI., or HO:'<lICI ..
f;:;
13..BIRTHPLACE ..\-, - '((B .. " ..: .f . ';.:."
OF MOTHER .'.~I ,,,::,: ,...':"" ~ ..., -,
.. Co ) 'i>,.......".n.:," '.',' '.,,','.\.'.
.. ,""taleill' IIDIr1 ,... ' " .. _", .......:-~. :-, . ..
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10. LENCTH OF RESIDENCE (For Ho&pltal~, Instlt~'t1on., Translanb
or Reoent ROBldenb).
Atpl.", ',..,,' ..'.. '
of dealh...........,....yn......._m05._-.....d~.
Where was disease contracted.
If Dot at place of d.eath'
Formerot
u.ual reli(!ellce ..-.-.--.....,........................'........................................:.......-.-
'~?I:;~ ~;Z~..3:~..:,"~~.~
.. 2D.,~>>yrAKER l":A.9PRESS
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;V,) 707').-0
,
PETITION
For Grant of LETTERS OF ADMINISTRATION in the Eslale of
",,' ".""..........nani.e1..R;ll'der.............. ......,...."..... ............. ...'........."...........".........
Late of the"".". B.or.ough... ........' ...."".."",or.....Chambe;z;abur.g......."......,....", Decea.ed.
To,,,..... :a .,..E\'l.c;ar.,.F.e.ul;l,e1." ,,,...,,.. "...".." ....." ....,,,,,, ~'q" Register of Wills for the County 01
Franklin. in Ihe Commonwealth of:Pennsylvania,:-
The pelition of. "" ....' ,.Anna,,].. ,.B., . Ry,d,er"". " ..'" "". ....... ......... "....", .."., """'"
ol..ll).,e"~Q;Z:Qush,,Qf "Ch<llllb,er,a,burg" '''. .... ,." "...." "...... ..., ",,,respeclfully represents:
That".. "...Daniel.. Ry,d.er.. ......... ".. "............ ".." ........., lalely dece..ed, wa. a re.ident
and eilizen 01 Ihe...",:aO.r,O.u./bb.""."....."........,..of..........Ch<llllb,er.sburg."..". .." "......., in Ihe
Counly of F,anklin and Slate of Pcnq.ylvania; Ihal,.. .he..died on.... ".... ,:..._ ~,,,..... ..,Ihe... ..., .1st... ......
day 01 ,.,..,/iP.r.q".."..., .,.",.., ,..., , A. D. 1920 , al or .(,oul2 .aO:c1ock A. M, at...Chamber-sburg
.... lio.sp1:t""ar:;'-::bnamlieis,1:i:Uig::::P a..-:-.~:-::-;I!\1TESTATE;thalsaiddecedentlefllo .urvivehit:l.
,
lhe following-named 'pou.e, heirs and nexl of kin, 10 wil :
NAME
'f{E:.LATIONSH1P
RESIDING AT
Alina L. B. Ryder
Leah Miller
Abram L.Ryder
Anna Z.o.ok
Jaceb R. Ryder
Wi dew
Sister.
Brother
Siater
Brether
37 W. ~ueen, Cha.~bg, Pa.
Mercersburg ,Pa.
Hamilt.on Tevmship
Guilferd Te\mship
Ashland, Ohi.o
That the said inle.tate died possessed 01 PERSONAL PROPERTY 10 the value 01 $.1$00,.0,0...."
and .eized ol~ .iluale in the......None.. ...."...."........................................,."...
.............."" ............to the value of $........ ....................... ,as near as can be ascerlained; that your
pelition<< i. a re.ident and cilizen 01.. .....Chambersbur.g,,, P.a. ....".., ......... ...... ...."."in Ihe County
ol......,f);'.Cj.mclin........."in the Slate 01 Penn.ylvania, and claim. the righl to have Letters 01 Administration
on the e,tale 01 said deeedenl i..ued to...her...,by reason 01 the fact .of Widew and as such
en ti tIed te hi s Esta te ~-:.""..~.:... ...::
-
_u __~ _.==
Wherefore your pelilioner re.pecllully applie. lor Letters 01 Admini.lration upon the goods, chattel.,
righl. and ctedits 01 which .aid decedent died pOS5essed.
Dated..J~aY"ll3.'!............,' 19 20. .~..L.!-&.,..~~...."..
FRANKLIN COUNTY, 55.
......".........AnnF\."L...l\....fu',o.ex... .................., the above-named petitioner, being duly
Swern d' I' d h h I I h' .L I . ..
.................... .............., accor 109 to aWl depo5es an says tat t e acts set ort In Ule oregomg petlllon
ate Irue to the be.t of deponent'. knowledge and belief.
...fl'lH).:r.n..............and .ub.cribed 10 1
' ,
belore me this. .. .........lB.~....... day 01
......J4il:y............ ,A. D. 19 20. )
......h:~..L.1Q...~~.........
........I3,.~.1~........Regi.,er.
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OHIO DEPARTMENT OF HEALTH
R.fll. Oisl. Nll._/O 0 :t_.- OIVISION OF VITAL. STATISTICS Stile Pile No,~-BGgB--'
"'m,,, R.., 0''', No,__,_-.- CERTIFICATE OF DEATH R.".",,', No,--'lP~.-._._--
I A E OF DE TH 1 2. USUAL RESIOENCE (Whtrt ckernel! ll\'cd. If unlllulllm' fll'
o COUNIV IJ. ~ h j a_-yUd---------'--"'y!~".~h.U--.-:...:~.(~~~~ ''Jf't~111.K1'lA
., (IIV, V'/;{O{ 0' LOCATION 1<' lEHOTH O' STAY IN " \ <, ClIT, VlllAO', 0' 10CATlOH ' -
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"'_;:-_I~::~t:E"~; t" INSIDE ~~y t:l~ 17l/J1:~AL,li.-o.s--\'.~IESii~Ci""i~f{-ftv~-!'sf-a--:H.I\2 f.LlSi~~.f:t ON It. PAiii-;-
YES NO YU NO 0 YES 0 NO
J NAM OF FlUl ~ Ml.ldlt ~L1\t j .. DATE Munth Pay ur
DECEASED . _ / \ O'
_~!E O' "INTI P Y ___ .,.a...s..e..~h Jd.E Y _ O'ATH . ..1.J. $-2_
~ me \ .:"CoCoil~O OR .lACE \ 7. """nlED _ NEVER MARl' EO {Ji, 8. ~ 1l1')H 9. AOE (h, YIlt'.! U"der 1 'f:ll.\, "' Ullder 24 KI1.
M L U 1/ J. . .,l.. I I", ""'WI ---.----
uL:.!fA- e. , 'U:J.J,Jd!- _wl~"'.!~_':J__OI~ORg~S)!J.~!:liL)()12 ______,,_~-,.:~"'l f)",__""" I '~'.'.-
10.:.. USUAL OCCUPATION (Gilt ""oJ u/ll'"'~ J,,'If lOb. KIND OF aUSINUS OR INDUSTRYl ", IUTH',li'cf (Sr,," l" l~r',l")J'" CIT,ZEN Of
dlJrln, mod of wOlilfllli/., '''flE''it'd) M . i All:""'''! LA f) / . WHAt cOUNny"
lid; ~"d ..fMt...v ,_;Lt.,;. -/3-./: a_.___._____Vc~JJ.fi J.:..,,_~. -...-- M________._ - --.----
D 'A1HfR'S NAME~. 7"-r ' u. ""OTHU'~""IDEN H...... .J1
~ r. j, f( 'Y. d ~ y . 11--0& L.Ji -.---~-
'5. WAS ~EVE(tN U. S. ARMij!HollCES? I 16. SOCIAl SECUI'T'f NO. 17, INF N 5 5 N
11'".,w. or Ii" "'")'1 tIl7'" <<il't 1l'".n.J./t1 01 Jtrrj(t} I' IlL /
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18. CAUS OF OEATH {E"". 011/7 (I'" fll/llt pt. Itrl' or 14\, ibl. ""d '.1 J
PUT I. DE"TH W"S ",USED ,y, C . / J -t 1 - /h
IMM'O.m CAUSE '0'_ _gfJ-'-7..l.,"",~-1I~""':..--~-...L/Y'"
COrflitirHlI, i/.'" }DUE TO Ibl
"hi(. ..",IIt'O !L:~' Y-U
.ho," (."st {.}, ,,(
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/,1., "... ,,,,, out TO '" ._:_. _________=_ , .J -
'''' II OIMIl '1""IC.II1 CO.OIIIO.' Con'l,u"II" to 0'11" tut NOI UUUII to t". nU'Ul DUUU co..m_ ."'l III PUt 1101
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2'. NA.M.l,Ol Efr...,A\MU ILIC. NO.1
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26. 'UNElAl 111M "ND "DDIUS IsnltT" NO.1
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n:;6"iTE I(C'D n I' n. lEGIS A ~NATURE
.r. L9CAL 1t0,
uIY;'S. /7.171
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04-
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fUNERAL DI~(C1'DI'S SlGN"TUU: " !LIC. NO.1
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ICITYI ,~STATEI .
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i '9. SU.-ItGIS,.....S SIGNATUIE /.
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1170;; 6; 1'}'ff2-
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