HomeMy WebLinkAbout10-25-07
Oath of Personal Representative
COMMONWEAL TH OF PENNSYLVANIA
: SS
COUNTY OF Cumberland
The Petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing Petition are true and correct to the best of
the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly
administer the estate according to law.
Sworn to or affirmed and subscribed
before me the ::)~ day of
C tdohu- . ~I
~i""
Signa/Ure 'if Personal Representative
File Number:
d \ 0'1. Oq\o'1
Estate of Damen Rager
. Deceased
Social Security Number: 160-82-2086 Date of Death: July 30, 2006
AND NOW, ()C-/?JAv. ;JS- ,;;;:2t;b ') . in consideration of the foregoing Petition, satisfactory proof
having been presented before me, IT IS DECREED that Letters of Administration
are hereby granted to Tammy Ra~er and Randy E, Railer
in the above estate
and that the instrument(s) dated
described in the Petition be admir.\.d to probate and filed of record as the last Will (a d Codici1(s)) of Deceden .
\C;,
S
Attorney Signature:
FEES
Letters """"""'" $
Short Certificate(s). .~.. ,. $
Renunciation(s) .......',. $
~C~ .. . $
~,--\r") ... $
... $
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TOT AL .,.,...".,.., $
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Attorney Name:
~'" \ ~ \ UQ \ ~M,))'~r
(\S"'?
Supreme Court J.D. No.: ~
Address:
-l1l4~ '.\'lIlmlt Etr,e! ro uQ ? e 1'\ \t i ~CI...i. \.uJl\.f
1"h;I.}jell'hia, IV. 191o.l Sk ~ 00
'~\J..e 'S~\\?A \q(.t~
(rrS) 567 E~ l..f. 1 0 <6L.r~ & ~~B
Telephone:
'-hoD ....
Form RW-02 reI', 10,13,06
RECORDED
REGISTER OFFICE OF
2007 OF WILLs
OCT 25 PM
CLERK 3:31
ORp. OF
CUI\fBE~~~;;OURT
CO., PA.
Page 2 of2
RAGER
LIST OF RELATIVES
Name Relationship Address
Tammy Rager Mother 195 Beagle Club Rd.
Carlisle, PA
Randy Rager Father
Kailyn Rager Sister 195 Beagle Club Rd.
Carlisle, PA
Joshua Taormina Brother 195 Beagle Club Rd.
Carlisle, PA
RECORDED
REGISTER gFFICE OF
2007 OCT 25 F WILLs
CLED v- PM 3:31
ORP . ''l'\..OF
CUMBE~~~: COURT
" "'1D CO., PA
H 105.X05 REV 1/05
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~ c\. ~~..&.~.~
Local Registrar
Fee for this certificate, $6.00
p
12726587
AUG
Date
2 2006
RECORDE
REGISTERD OOFFICE OF
2 F WILLS
007 OCT 25 PM
CLERK OF 3:31
ORPHANS' COU
CUMBERLAND RT
CO.,PA
\ .
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH (CORONER)
-/105.144 REV. 02f2006
TYPE I PRINT IN
PERMANENT
EUCKINK
1.N
A
Rager
6. Date d Bir1h Monlh,
7.BirtI
STATE FILE NUlABER a \ () \ Dq (o~
.. OallIoIOealh (MonIh,day,.....1
July 30, 2006
-I
. andstalelX
2
y~,
September .6,2003 Hershey, PA
&I. Facility Ncne (W not inslilUlion. give snet and runber)
Sb. CoontyofDealh
Cumberland
Carlisle Regional Medical
White
11. Decedent'sUsualOccu
Kind of Work
Never Worked
. 16. Decedenl's MalIng Address (Street city f kMn, state, ~ code)
195 Beagle Club Rd.
Carlisle, Pa 17013
18. Father's Nlme (Fnt. middle, 18s1:, suffix)
Randy Eugene Rager
most of Ife. Do noI slate retired.
KildofBusiMlssllrdJslry
12. Was Decedent MIl' in the
U.S. Armed Forces?
oy" I1!INo
Decedent's
AcluaIResIdence 17a.SIate
14. Marital Statui: Married,NeverMarried,
W_,llM><todr_i
l1b.C<m~
PA
Cumber land
DidOe<:odenl
l.iYeina
Township?
l7c. K1 Yes,Oecedenl:lNedln
17d 0 ~=oIlNed-
M; nrn ~Q~Y
Twp,
Clyl_
19. Molher's Name (firs!, mddle, maiden sumane)
24. Time of Death 25. Dale Pronounced Dead (Month. day, year)
11:22 P ~ July 30, 2006
CAUSE OF DEATH (See instructions and .XIImpln)
tIem'B. PART': EnlerIhe~_dlseases,irjlries,orcomplicalionl_lt1aIdirecnycausedlhedeaf1.00NOTenterl8rminaleYllfllssud1ascardiacarrest.
respiralory;wrest, or venlricUar liriIatioo wiIhoulShowiIg lheeOOlogy. Usl only one cause on each n.
~1_23o<""'_ce_
pI'IySic8lisnolawalableallmeofdeallil
cerlifycauseddealh
1lems2"'26roo11becompletedbypeBOl'l
whopronour<lll_
T Ann Orosz
2Ob. lnlormanl's Mailing Mtess (Street, city I town, slate, zip code)
195 Bea le Club Rd., Carlisle,
21b. Date of Disposilion (Monlh,day, yelW') 2k Place of Disposilion (Name ofcemelery,C18ITI8tOryorolher place)
Cumberland Valley Memorial
22c N.....,n,,,,,,,....oIFacllly Hoffman-Roth Funeral Home
Hanover S. rli 1 P
23b. li::8nse Number
Pa 17013
21d. location (aty flOwn, state, zip code)
208. InIonnant'sNlrne (Type/Prill)
Iil
IS
~
<I
Carlisle, Pa 17013
Zlc. DaleSig""'I"""'.,day,.....1
: Approximaleillerval:
: OnselloDeal1
26. Was Case Refen'ed 10 Medical Examerl Coroner lor a Reason Other lha'1 Cremation or Donation?
~y" 0 No
Pa111: Enter other lliYlilicanll'D'ldilms mnIritlulina to deaIh
bulnotresul~inlheundertyWlgcausegiYeninP<WtL
28. Did Tobacco Use Contribute kl 0eaIh?
oy"o_
o No 0 """'own
29. If Female:
o Notpregnanlwi\hinpaslyear
o P!egnantaltimeofde""
o ~de~bulpregnantwilhin42days
o NoI_""_..,,.3days"",.,.
ol-
D Unknown if pregnant wilhin!he past 'fU'
32&. Place ci Injlly: Home, Farm, Street. FadoI'y,
OlficeBudng,olc,r_
Home
==~=di&ease~
5" tistanilions,ifiiJIY,
tocauMllilMdoninea.
Enter UNDERL YJNG CAUSE
Icbeaseor~lhaliriMMedlhe
eventsr8SUlingfldealh)LAST.
Smoke Inhalation
Due to (or.. a consequence of):
House Fire
Due 10 (or as a conuquenc:e of)
0u.1O lor.. a~nceof)'
'"
i:l
~
o
I
3Oa~~Y ~;=CE?'- 3'~:':::- 0........ 32bo..arn1fr:~nh~ie~moke during
9- o_'.-Igalon 32ll, r"",oIl",.., 321. WT_I",..,rS_ 32g, ~oflnj<.ryIS_,dIyl_'''''1
Os.- oCouldNolbeOe""""'" ~g~~5 pM oo;::opassenger 0-'" Beagle Club Road, Carlisle,
33a. CattIfter(ched.oolyone) 33b. SignalureandTilleof Chi f D
. CtrtIIyIngphyold.nl_certilying""""oIde..._"""",_haspronouncedde...1d"""""tedllem231 ~ ~ e eputy
TottltbettofmyknowleOge.dNthocculftdduttothecauH(.I.ndmlnn......tatlSl__ ___ __ ___... __ ____ ..._____ __ __............... _..0 e; Coroner
Ptonouncino Ind certifytno phyM:1an (Ptlysidan boIh pronouncing death nJ certifying 10 cause of death) ..D 33c Lk:8ose Number 33d. Dale SIgned (Monlh. day, yell')
lothtbntofmyllnowtedge.duttl~rNdll:ttMtlme,dII.,1f'KI pIKe,.nd due to the c.use(11 and manner...tltt;d.. ---.................. - --... -- -- A 1 2006
MedIcII Eumintr I Coroner . ugus t ,
On the bats 01 euminltlon and I Of lnvntigdofl, ill my opinion, death occurrtd at th,tlme, dllle. and piece, and due to the C.use(I' and mant'ttf II mt!t ....a 34. Name and AgdrJss of Person Whq Completed ~ of ~ (11I;m 27] TI!R!' I Prill
3S ..",,"". . 36 DaleF""I"""'.,doy,,..,1 Todd C. Eckenrode, Ch1.e! lJeputy Coroner
.~ tt.,)..r~ 1:111 Iri,J \ I D I 6375 Basehore Road, Suite It1
oy" Iil1No
oy" oNo
PA
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