HomeMy WebLinkAbout09-08-08 (2)In the Court of Common Pleas of Cumberland County, Pennsylvania
Orphans' Court Division
File No. 21-08-0655
Estate of Dorothy J. Woland, Deceased
Hampden Township, Cumberland County
INVENTORY
Fiduciary
Acquisition
Value
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06/17/2008 Sovereign- CD #1995542527 5,406.65 -=
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06/17/2008 Integrity- CD #0000000001015922, 83,253.16 - a
CD #0000000001015914, '~ ;-~ ~-;
CD #0000000001015906 ''~° ''
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06/17/2008 Sovereign- Account #0571131425 15,093.07 _~~
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06/17/2008 Sovereign- Account #0021084300 94,106.23
06/23/2008 Citizens- Account #6219890381 140,561.90
06/23/2008 Citizens- Account #6219890373 101.26
07/10/2008 Freedom Blue- refund 67.20
07/24/2008 Retirement check 668.39
09/04/2008 Loyalton of Creekview- refund 1.628.00
Total Cash 340.885.86
Total Inventory 340,885.86
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Total Receipts of Principal 340.885.86
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certitiatte. $(..00
P 1~33~8~8
Certification Number
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.
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Local Registrar Date Issued
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I REV nlzoos COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
i PRIM IN
MANENr CERTIFICATE OF DEATH
IcK INK (See instructions and examples on reverse)
STATE FILE NUMBER
1. Name of Decedent (First, mitldk, last, sudix) 2. Sex 3. Serial Secunry Number 4. Date of Death (Month. day, year]
Dorothy J. Woland female 174 - 20 - 7104 June 9, 2008
5. Aga (Last Birthday) Under 1 year UMer 1 day 6. Date of Birm (Month, day, year) 7. Birthplace (CNy and state a foreign country) 6a. Place of Deam (Check only one)
Months DeyS Hours Minutes Hospital: Other
82 vre. February 23,1926 Carlisle, PA ^Inpafiem ^ER/ompauem ^DOA ®Nursing Home ^Residence ^Omer Spaclry
6b. County of Death 8c. Clry, Soro, Twp. of Death Bd. Facility Name (It not institution, gNe strael and number) 9. Was Decetlent of Hispanic Origin? ®No ^ Yes 10. Roca. American Indan, Black. While, etc.
Cumberland
Hampden ZfATp,
Loyalton of Creekview pl yes, speciry Cuban,
Mexican,PUenoRlcan.etc.) (Specify)
white
11. Decedents Usual tan Katl of work tl one d un most of worts INe. Do not slate retired 12. Was Decedent ever in Ina 13. Decedenrs Educatan (Specify onty highest gratle comp letetl) 14. Marital Status: Married, Never Married, 15. Surviving Spo use (II wife, give maiden name)
Kits MWOrk Kind of Business I Intluslry U.S. Armed Forces? Elementary /Secondary (0-12) College (t-4 or 5+) Widowed, Divorcetl (Specr/y~
Bookkee er A ric{i2ture ^yea ®Np 12 Widowed
16. Decedent's Mailing Address (:treat city /town. state, zp cotle) Decedent's
AdualReaaence 17a
SWte Did Decedent
Pennsylvania Uveina 17c
®Yes
DecedenlLivetlin Hampden
1100 Crandon Way, Apt. 228 . .
,
Township? Twp'
PA 17050
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18. Famer's Name (First, mitldle, last sudix) 19. Momer's Name (First middle, maiden surname)
Henry Wilson Ickes Elsie Susan Wenger
20a. InfonnanYS Name (Type I Piing 206. Informant's Mailing Adtlress (Street, city /town, state, zp code)
Cheryl S. Stroud 2629 Butler Street, Harrisburg, PA 17103
21a. Method of Disposition ^ Cremation ^ Donalan 21 b. Date of Disposition (Month, day, year) 21c. Place of Disposition (Name of cemetery, crematory or omer place) 21 tl. Location (City /town, stale. zip cotlei
® o~ r Bspaciryn n t oin men t y~ie ari ei e~m r ~/ c`aor~~?h0`l~d
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June 12, 2008
Rollin Green Cemeter
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Lower Allen
Trap . , PA 17 011
22a. Signature d Funeral Se ~ L e (a pe acting as such) 22b. License Number 72c. Name antl Address of Facility
- FS 012 849 L Parthemore FH & CS, Inc., P.O. Box 431, New Cumberland, PA 17070
Complete Items 23at ony when r. ~
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i 23a. To the ggst of my kn edge, deem occur at the tale, dale end place stated. (Sgn
~ ature and t///id111e) 23b. ~~~ccoeeense Number 23c. Date Signed (Mpnlh, day, year)
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Items 24-26 must he completed by person 24. Time of Deam
~~ 25. Dai Pronounced Oeatl (MOmm tlay, year). 26. Was Case Referred to Medial Examiner I Coroner fa a Reason Omer than Cremation or Donation?
who Prorwunces deem. ~ M. O ~ ^ Yes [s}N"
CAUSE OF DEATH (See Inatructlona and exemplea) t Approximate interval: Pan IL Enter other slgnificenl conditions contnbutinq to deem, 28. Did Tobacco Use Contdbuee eo Death?
Item 27. Part I: Enter the chain Mevents -diseases, injunes, or complaations -that directty roused me tleath. DO NOT enter terminal evems such as cardiac artest Onset a Death but not resulting in me undenying cause given In Pan L ^ Yes ^ Probably
respiratory anent, or ventricular libnllalion without showing me etiology. List only one cause on each line.
^ No ^ Unknown
IMMEDIATE CAUSE IRnal disea<.e or //~^//~~ ~/~ ~~..,~,,
contlition resulting in death) _,~ a. ~~/~ I C (/TYL,AJI (•~ /» ~ /~ r
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~ 29. II Female.
Due to (or a
s a
consequence on: ~ ^ Not Pregnant within past year
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Sequemialty dal conditions, g ant. b. t f~,('~) ~ I"~~-! L7 L(~ s/'~~~ SJ S ~ ~0 ~ ~ S ^ Pregnant al time of death
leading to the rouse Gated on line a.
Emer the UNDERLYING CAUSE Due to (or as a consequerce op: r
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Not pregnant bm pregnant within 42 tlays
(disease a injury that initiated the c,
events resultin
in death) LAST t
e ~ ~~A„~j• q„t_ of death
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Due to (or as a consequence op: ^ Nol pregnant but pregnant 43 days to 1 year
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r belie deem
^ Unknown if pregnant wihin the past year
30a. Was an ANOpsy 30b. Wore Autopsy Findings 31. Manner of Death 32a. Date of Injury (Month, day, year) 32b. Descnhe How Injury Occurted 32c. Place of Injury: Herne, Fartn, Slreel, Fadory,
Performed? Available Pnor 1o Completion
atural ^ Hankide Oche Bulldog, etc. (Spedly)
of Cause of Deam'+
Y
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No ^ Acdtlent ^ Pending Investigalian 32d. Timer of Injury 32e. Injury at Work? 32f. If Transportation Injury (Specify) 32q. Loceean of Injury (Serest city I town, state)
^
es es ^ Sualde ^ Could Not be Deleiminatl ^ Yes ^ No ^ Driver /Operator ^ Passenger ^Petlestnan
M ^ Other ~ Spenry;
33a. CeAilier (check onty one) 336. Sgnal Tnle of CertGier
• Certifying physician (Physinan cenitying cause of death when arather physician has pronounced death and completed Item 23)
To the best of my krrorAedge, deem occurred due to the rouse(s) and manner es atated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• Pronouncing arts cerlYylnq physician IPhysaian both prorwundng tleam and ceniryag to cause of Beam)
d
^ r 33tl. Date Signed (Month, day. year)
To the best of my knovAedge, death occunetl at the time, date, and plane, and due to me cause(s) and manner as state
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• Medical Examlrcerl Cororrer _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ //~~'{ ~~ // s
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On the heals of ezamlr~atlon antl / or investigallon, in my opinion, death eccurred at the time, date, antl place, and due !o the cause(s) and manner as stated_ ^ ..
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M Name antl Atltlress ~of Pe"rson W"ho Canpleted Cause of D
fat (Item 27) Type / Pnnl
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35. Reg r Signature an
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36. Date F
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Disposition Peemil No. ~}L(,[J .~L.I\i