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HomeMy WebLinkAbout02-28-12I-ETlTIUN FUR G~AI'~ OF E,ETTEAS RE~'il$Z'BR aF WILD f3F GfLf~ COUNT', FSNI+ISYLVAMA Fatitiorus(g} Hamad below, who iatata I8 . o€ ~ a~ alder, RFpJyfies) far Let~ors as spoci5ed below, and ;a s~ t~ntwf a+~s) Yha folY~~~fug at~l` reatfWlX retgt~t~s) IUe ~I of I.etnlrs;gn tha aFpr~apiia~ fiotm: lYs~s AI~Ie'A ~-°St1MMY a~a:. alWa a~1 1'l+deeilka~s ~/~l~I2 RdioauaoCvatwe of~i~anpa~ty u de^th: FiteNer o2I- I~pp-~~a ~ 9ecial 5ecaiity N~: 2z2-2~.aas~ Abe at dew: 9~, ~3'~ ;~ (s'errey with hiaR~ct last 1f`~t+wt+~. ... arFAa~' s SO. o0 ~'a~r~irwiimedr6 ~:. ........ . Pe~sonat AMY is ~, s TtYI'AL,BSTFMATeD VALi)& . 5~1 0:~ 1ClH mate ill Paodsylv~fc eidq-ted at: 1+INixii~'efieMU.{/`wY~1 BM~1ta~tlnM1,[aNt#I~tesaiW'?1gG~ Cily'.texa61~r9pw~lt Couahr A. ~. ~. e.,a -v bnt, ~t1ed "mod rG~';: . gj"sa+eaar, erc) tjj pp ; rr, aan~ anu t+aaenau waa n a~ vw~m qia kiuimg aor avd~ atgudiamd au froeepaatalad Pexsca, -p: y W i~ r`*-'i 4 & Feidtlan for ai rara~ .i •'~ Rr~ eta„'d.b.a., dbac:t~t„~uEeyae~ dnra~tea4seaNo, dw+onesalaar(iafe IfitTon, ~Ra os dbr.a.Gta., eater die biVY9t la 3ectlen ~1, aba~ne and ca~nhte ~t of 4drs. B~soept a+ FdHavra: 1 vv~q not e m a Qm~lon P wtu~ain the Bu dlv~uuue Bvd boea eda6[iehad ai defined to ~3 Pa. G.S. ¢ 3i23~} apd arse aeilbsr t6o vietim ofa klUtug nor eVU ad~ud an l+exeon. Q AN7E FJG~''!'lONB Q EXC>eF[7tH4S R4~lZpp~{t~~eeapcop~ahaeilrveaaap~adt?mtleaEkllno~Yiltirdwaseurviredby~he6gitowiaBapouw(i€eaty)mpd1 fateaak adr~watsbaea, ilra-y!js Hama tae tiaarh A. ~Y aare S'1 CEatEi Drtvo, ~ Full, AA 1'9t~ 1 Btepiiea 0. SurOmy am 9S3S Alter t's[vilta, PA 17t~t8 li am 4015 Soaea Avem~t, €lamg Fit"5,1-A 13Qi 1 Pmm k8'.03 m. !Q?I1! Iof2 Doak died at ~'f6! Rm~ar l~tu~ Hand. G'~,F~L P~di ~.'~tfll i Haxt lieuosbnty Ctitl~twt.nd PA apeetraiwel,.lwtopkanra:mp~le G~S,Towrii4~~ Bate: OIL of ~ersoaat Bepreseul~ve Ctl~MM(1NVYi:ALTHOFFEAiNSYLVANIA } } SSa GUtJNTY OF , } Diu `noon RF~1~1'~,',+~FI~~ ~C~j(t;+i. i j:i ~'~~~!'l ~ e) '... Pinlai a~: s7 , n i CLERK. Rt ~aereit.3..id ae~~ddea,>~Pet Sir©n- 60 or a~m~ aart 'HQI'IH Rewired: Q YES Q NQ Letters ... ..... ...... r ,~~~~~~~ ( o~ l 9-Yost Ca~ifi~+~e(*) - --~1..L+stY- (~) ICesuncietioo(s) .... . Affidavits), .......... . Sond .. ................... Cotwmisdee . ............... (?titer ..... . /-utasastion Fee ................ ~~s ~ ~`-' IC9 Fea .. ........... TOTAL. ..... ...... D,ro Dau~ Pleaee eater mr Mppernwee by aty :!<oatwre ~ebwt to Attoroay Signafura: Panted xeme::Jetses H. Tuitla`, BeQUii'e $sp~rema Cent m Namberz :39428 Fiem Aismd: Ttartieregd,0!COOaell ndd~s: 47111 i~anr ce.~+t .gatzxi>~i~na :Tin. Fhone: 719/a3~4S5i P.meiL ,~ DECREE QF THE RE`G~BTER ~Iiar~ of ,~sY N~: ~2l - /o? - (~a~y ~nrt~w, ~(UAru a~ ~a ~-- . itz l:l,~n~~e ~$ P~t~, aatis~ta~y 111'AO$~8Y[t1B hefare 1ne. ~ I~ l]i fat I:tst~ers +~) pct ~+d Ilri dl~ ~etiNol PanwAN~-4? rsv. td7`l~l! .rage ~ c1r ~ H705,g09 RF_V (0 V07) log -~~ d LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARN~,~(~~~tiplicate this copy by photostat or photograph. ~~•~?~fr ,-,<'' s ~~1.~ti 1 G.f.r ~+~ i'1~~a,l.S Fee for this certificate, $6.00 This is to certify that the information here given is ~~' { 7 ~~6 2~ a~ 9' 3 G' correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original ~~ 0~ certificate will be forwarded to the State Vital Records Office for permanent filing. OF~1AN'S COURT P 18 0 3 415 4 CtERi-avc~ Co. ~t --~r,,.,~,(,~,GLG~ Certification Number Type/PMM In wrtraan•ne • In Z ro (/to /2a/z Local Registrar Date Issued CAMMONWEALTH OF PENNSYLVANUI • DEPARTMENT OF NEALTN • VRAL RlfAllpS ~FRTI FIrATF L'lF EIFATY 1. o•Ne•nt \ t4P1 Nbm• RG , L•K, u . Eoe I S•curRy NYm 4. r Sp•11 MOI aural 272-24-4766 Jan 7 2072 b\. N•-l)K NRRdN vr. a. D.t. K Irth (MO D\Y •K) t3p•R Mentnj T...IRRw\LP cRY .A E<ab er FOr•1{A YYnlry) pn• Mlnut•• 9 4 a b 2 3, 1 9 7 7 ab. olehww tceuMY)- rnw fitr•K end NYm . - In ua• Ape o. N. Id D•e •M Wv In • ewnEMP 770 Poplar Church Rd_ •••b•°e•"t'h'•°'" E_ Pannaboro twp. N. R•si0•hN (21p COd•) O No, d•c•d•rrt IN•d wltMn Ilmlbof tRy/born. lwr In W! O14M 10. M•rkEl M•tY• K TIM. OI.D••[h M•M•d 1. EurvNlni Speu•bS N4m• llf , ihr• Mm• PH\r le Rnat maMM•1 Q YN ](~to Q Unknown Q ONOrc•d Q NNK M\RI•d Q Unknown 1 . P•tb• • m• M, M •, L\at, b 13. Moth • Nam• h to FMK M aN r\4 MI , L•K Charles Rumbau h xrane Cooh 14\. InIORnan • N•m• 14b. Mbd\nMIP t0 D•NOMt iN. IMOrlra•M • MN Iry rNa (SMNt a1M NumMr, l:lly, ibt•. 2lP COb• Son Charles Summ 9055 Seneca Ave= Cam Hill, PA 77077 . 1 GKh Orcurrrl In \ HoapMl: ~• Inp•tl•n[ ...... ..... ... ..... ..... .... .. I•• G•aM OccYrrbd to •wMr• OeMr TMn • Nwpidl:~~~ ~,t° ~lla~Pit• F~cI11N ~ C\t•tlwlt'~ NOm• •~• RaOm/Out KI•M ONd On ArrN•1 Nord Hone LO -Term Gr• F•cll ON•r S 1 iib. F4e1Nty Nbmb netln•btullen, •N• KN•! arMnumbbr, iSe. LItY er TOwn, Mato, and 1'Ip Catl• 13d. my th i{•. D NHN Cr•mKbn 1 . D•tb on 1 . P u sptpklen. N•m• c•m•tbrv,. cr•Inbtery, «otMr w.t• p R•meYN aem se.e• poen•eala Jan 13 207 H6rshey C6metery OeMr , iid. Lotaden n CRY br TOwn, {bb, and P 1T•. ft o FYn•N b•rY~l~e °~~ M In C ri• O InbrmbM ~ 1Tb. Lb•nN Number Hershey, PA 77033 /~{J OT2206L iTe. Naa.a..nd Celatpbb Addma a FYry.N FNIIiay ~ Ii. s Eduu' tNM • but • ant spank CMI{M - C • . D•N t • Raw • ChK N! ORMOR! raNa to Indkat• WkK hlill•K d•iN• « INN M Nhool temw•t•d n Na Um• M tlNth. bee tMt bM d•NNbN wMtlaK [h• datad•m tM d•NC•ne mMW«•d WmNlf or Mra•k to M. Q Kh pW«I•aa Is Sp•nbh/Nlap•nkJladno. Check<M •Ne• WhR• Q Koran Q Ne dlpbnu, e!h - 13th {nd• bN If d•Nd•M b loaf SpanlahMbp•nic/L411no. Mack Or AMNn AmKbn t7 VIKNmN• ](~Nyk Nkool{ndYab or GEDwmplONd - ~NO, nptswnlM/NUwnldLatlnP ^Aln•NNnIrld1•n Or A1NW N\UW QOiMf Atl•n a Eo^N reR•ib erdk, bK no dYr•• Y•L M•xk•n, Muic•n Am•rlc•n, Chicano O NI\n Indl•n Q NKIY• N•w•11•n Q Aflxl•b d•Rb• (•/< AA, AS) Q Y•A PuaRe Rhin Q CYa111•aa Q Ouam•N\n pr CMmerre Q NCMI«'a d•{rw (a.{. f>N A{, {b) Q Vaa, Cuban [] FIIIwM Q b•me•n Q MaKK'• d•ir\• l•.i. MA, Mb, MEnL MEd, IILSW. MW) Q YN. KM1« $panlah/HI•p•nWt\Hno Q Jap•n•N Q Other F•cMC 1.1•nd« Q Doctorate (•.{. PhO, LdD) « Fre1•aabn•I dyr•• (bp•cHy) 0 OM•r (bp•cky) • . MD LL{ l 21. nt a {I R\c• 1{Mtbn - ONLY ONE [o Indlcaf• w of the w M COMIWr•d blmNl Or •rNK to 11\. Dec•OMt { W WN Ottup•DOn - Inwc•t• tYp\ e/ Work ® WhM Q l•p•ryN O Nm0•n dory durlry moK Of wOrldni 111•. 00 NOT V{E R{rIRED. Kdr••n Q Other PKNIC IFI•ndar Q MNk or African Amwlun C 1®r l< ~ Q AM•riun Indbn er AIatY Natal VI•M•nt•N Q DOA't Knew/Net SuN Q NI•n Indbn OtMr Klan O R•h.Nd 21b. KIrM uslnN In uurv Q LTIn•N Q NKW N\Wall•n Q OIMr lbP•cIN) Stat6 0£ PA O FRlwno OOU\m\nbn «Ch\morto N /ilt{DI•iMNO /{ONDUNQE OR •. rOnOY • o Y r acute rLPn roneuM ni P •n \P ,( nN um r • N M y r 14.Tm• \eh 16. WN M•dlNl Ex\minN Or COlgn•r COntKt\dT Q YN NO CAWSE OF DEATH Approallm•te 26. P•R 1. Enbr tM cMln of avant:.-dINN•a, Inlurl•., or mmPllutionr-Mat dM•c<M uuud the d•Kh. DO NOT •nMr Hrminal •Nnta ouch ar urdbc •n•K IM•rv01: M{RCVUITE. lMar enN en• NYN en • Iln•. Add •ddklen•t lln•• k nuuNry rKPirbry •INrt, er wntHeul•r ROHIIKien wlMeYt \hOYHni tM KIOIe{y. DO N O T Ona•t b D•Kh a ~ ( IMMEDIATE GUb! ---> ~/~~ !// LVfJ Gd r' ~l f~ ~H~ ~~0"y~ (Final d1aoN «cOndklon DW t0 lOr N \ N Y•nN Ofl: e. ` /-~ // S•gwnH•I(y IIK conditlon•, Du• to (or N • wnwgwnN of): N •M. N•dlry b the e•YN Ibt•d an Raw s. Enter the UND[ItLY1NO GUS! Dw t0 (er u • eenapu•IaN ef): (dl•uN «Inlury thK InRI•t•d Da• •wnb r••umni d. y In dpthl LA{T. Du• b let •s • eenNewnN ef): 26. /\R il. Enbr etMr but nM nsuRlni In <M undMYkai [auN i1Y•n In aR I iT. WN \n •YtepaY p• Y N 3A Wt\butopay A{• \Y\ labh a b•wn tM NUN SI M•MT $ YN No y 2!. If famN•: 30. Oid Tebaae UN CeMnbue\ tp D•Kh 31. Manner D•Kh g NK pr•{Mnt wlMin P\K War Q Y•s Q Prwa•bM ~ Natural Q Homicide 5 PriMnt at tlM•Kd•ath O NO Unknown McIE•M O P•Mlry lnwKl{•tlon ,' Not pr•i^an4 bui prgn•M WRNn 42 days of duih ('] bulcldb ~ Could nK b• d•brmiraad Net Pr•{n•M, bVt er•{n•nt 4E O•ys b 1 yNr MbN dNth E3. K• INury MO/Day r ibp•N MORth7 Q Unknewn H pr•{Mn<wltbin <M paK year 3E. • NYry 34. /1•c• Inlury •.i. hems; mn•trVetbn aM; rm; aclaeel) !S. Lecatbn Inlury btr•K aM umMr, Chy, StK•, Zip Gd•) 96. InluN \i WO ). TNnNOrbtion YNury. bpu 3i. O•NHM How Inlury OoeuR•d: p YN O oHwr/oP.r.eer p -adwtrbn p NO [] P••a•ni•r O O•Mr Isp•Nfy) )~ •r (G pnlY On• brNlylni phNWan • Te tM MK M mY knoWk•dp, death omrr•d dw <o the oase(s) atM manra•r abtw 0 PIOMYMIA{ ~ GRIfYIn{ PhyalCl\n - TO tM b•{L Ot mY klaOWl•d{•, death ONYII•d •t tM tlm•, date, end PI•N, •Ad dY• t0 flee C•YN(f) and m\An•f Ft•t•d Q M•dlcal ENmin•r/COrora« - the MW d ••\min•tbn, and/or InvNNMtlOR In my ePinlen, death oc[VrrW •t tM tlm•, date, •rW pbc•, and dw to tM wuN(s) end manner K\tW 31p1aNr•of drtMbr: - TRI•of c•rtm•r. Uc•nN NUmb•r:m77 63?;4$3 E SSb. N• • p • raga ry VN ,~~ G v~+'F•'7 sre n~ 0 2r~ J JJw .o'~'S ~iS~Y/ S1c. DaH MO ay r o i - 0 9 -' z.o s s-- .er. F um • a w.. f~ ~ ~i Q. I~' / /•_a \/ate ~'~•/~ p Nl~t~'afCG~Z~ 4!. Amen m•nb U697UY3 Dbposhlen Mrmk Ne. -_ __... NIDS-U9 REV OT/1011 l~ -o~(Q 6 >v ~, N ~'t 1"r7 ~ ~ RENUNCIATION ~~ ~ N °D ~ ~; _~ ' ~= ~~ ~ c-: ~ REGISTER OF WII.LS $~-+ v? ~ CUMBERLAND COUNTY, PENNSYLVANIA c'°~ Estate of ANNA W SUMMY ~ I, STEPHEN O SUMMY , in my capacity/relationship as (Print Name) SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to j20GER A SUMMY Q2-Og--l~ ~~ Executed in Register's O, fjFice Sworn to or affirmed and subscribed before me this day of Deputy for Register of Wills FarmRW-06 rev. l0.13.d6 (s; ~ X35 ALLENTOWN BLVD. (sneer Addresy GRANTIlILLE PA 17028 (City, Slate, Zia) Executed out of Register's Office Before the undersigned personalty appeared the party executing this renunciation and certified that he or she executed the renuncia~on for the purposes stated within on this ~_ day of FEBRUARY 02 12 Notary Public _C%~ My Commission Expires: ,3 ~ 9//,~ (Signature and Seal ofNotey a other ofrwial qualified W administer oaths. Show date of expiretioo oFNota7s Commission) cbMrtoHw~iu~rl of Pew~snviwv- noaw ser nrmetoe c Myers. Hoary Public MEMBBt. P911bYLVNW A9EOLTA OF ~~~ n r~ ri rn~' =, . ~ aD ..~ " RENUNCIATION ~ ~~ N ~. ,^, A £: REGISTER OF WILLS ~~~ ~ CUMBERLAND COUNTY, PENNSYLVANIA $ ~ 0 Estate of ANNA W SUMMY ~ Deceased I, CHARLES E SUMMY , in my capacity/relationship as (Prt„r iWmnej SON of the above Decedent, hereby renounce the right to administer the Estate of the Decedent and respectfully request that Letters be issued to ROGER A SUMMY Qz-GS- /Z r~1eJ Executed in Register's O,,Q`ice Sworn to or at~rmed and subscribed before me this day of Deputy for Register of Wills Form RW-06 rev. 10.13.06 (SlgnatumJ 4055 SENECA AVENUE (Street Ra'dreuJ CAMP HILL PA 17011 (City, State. Zip) Executed out of Register's Off ce Before the undersigned personally appeared the party executing this renunciation and certified that he or she executed the renuncia for the p~ ses stated within on this day of-rtBRUARY , 2092 , ~~, ~. Y Yl f/L.t~ Notary Public (f My Commission Expires: ~/g/~~ (Signature end Seel of Notary ~ other ofieid quali5ed ro administer oaths. Show date of expiration ofPlotory's Conanissioa.) r+onweaLrH of Pe~NSnvaNra Notarial sael w ~a~, ca.'t~` oxrartlwl0n MNdt 91015 PB141'W