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COMMONWEALTH OF PENNSYLVANIA
PE.PARTMENT OF HEALTH VITAL. RECORDS
1..0CALREGISTRAR'S CERTIFICATION OF DEATH
April 2, 20.07
GERT. NO. T 61236'74
Date of Issue of This eerWicatron
Donna
J.
Reigel
Nameof Decedent
Sex
Fema Ie
Middle
Last
- 34 - 4799
Date of Death March 25, :2 007
Social Security No.
sept. 10, 1912
Place of Death
Lewisburg, PA
Cumberland
Hampden Twp.
County
City, ,Borough or Township
ArmecLForces?(Yes or No)
90 Salem Church Rd. Mechanicsburg PA 17055
Marital Status
Stree;t
State
Number
Lisa
Sally A.
Funeral Director
Informant
Name and Address of
Funeral Establishment
David;'1Mye:r~ Funeral Home, Newport, PA 17074
I nterval Between
Onset and Death
probable pulmonary.Emboli
(a)
(b)
(c)
(d)
Other Signtficant Condttions
('~ I
>~Q
, "T=1
-'I
". 'i:~:~")
..:0.._-".. i ~~__
. .: ::~:: r{~~:
r-...... \.,"
r':""~J
25
-...
.:r:~
~,
;;0
C)
Hx DVT
Natural !]IX
Accident 0
o
Describe how injury occurrea?
, ,
-
-
"
o
en
Homicide
Pending Investigation
Could not be Determined
Michael L~ Norris
Coroner
Name and Title of Certifier
(M.D;{O.O. ., Coroner, M.E.)
6375 Basehore Road, suite #1, Mechctnicsbur<J, PA 17u50
This is to certifythaLtheJl1formation here given is correctly copied from an original certificate
of death duly filed. withmeasLocal Registrar. The original certificate wHlbe forwarded to the
State Vital Records Office for permanent filing.
March 29, 2007
District No.
50-455
101 Barnett St., New Bloomfield, PA 17068
Street Address
City, Borough, Township
Date 'f:l"eceived by Local Registrar
RENUNCIATION
REGISTER OF WILLS
C~fY\ber hvJ COUNTY, PENNSYL VANIA
I,
Yo n Yl q JQ ,4fl re.Q.'(3~J
Le.s+e..r- R C I'a p",'
(Print Name) J
Son
, Deceased
Estate of
, in my capacity/relationship as
of the above Decedent, hereby renounce the right to
administer the Estate of the Decedent and respectfully request that Letters be issued to
Lisa Fo Yfley
'-I-4-D7
(Date)
/ J.. ( N, Bed-ford Sf. Api- {AD?;
(Street Address)
t1 r 1/5 Ie. fit. 17l) 13
(City, State, Zip)
Executed in Register's Office
Sworn to or affirmed and subscribed
before me this day
of
Executed out of Register's Office
Before the undersigned personally appeared the
party executing this renunciation and certified
that he or she executed the renuncia~n for the
purposes stated within on this 1./ day
of 11'; d- OfJ7 .
Deputy for R:~i~t,~r~fWi1lS;'1
....:..~,:..J: I. ,'" ,I .~_I ,~.,I !-rO
- ",' , !"_.i'~J
Notary Public
My Commission Expires:
o I :01 IJlJ 0 I tidlJ LOOZ
(Signature and Seal ofNotaIy or other official qualified to
administer oaths. Show date of expiration ofNotaIy's Commission.)
Form RW-06 rev., 1.~;J~;O(, J
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Laura V. Bright-St~~. Notary Pub!'
Carlisle Boro -.......,........ IC
. . . Cumberland County
My CommISSIOn Expires Sept. 18, 2010
Member, Pennsvlvania Association of Notaries