HomeMy WebLinkAbout03-11-05
Jan M. Wiley
David J. Lenox
Timothy j. Colgan
Christopher J. Marzzacco
I
David E. Hershey
Bradley A. Winnick
Thomas M. Clark
Ari D. Weitzman
THE WILEY GROUP
Attorneys at La'\V
Wiley, Lenox, Colgan & Marzzacco, P.c.
March II, 2005
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Cleo Ruby Truscott
Number: 21-05-0174
Dear Register:
~.J
It has come to my attention that the death certificate which was originally issued for Ms.
Truscott, listed the wrong social security number. Therefore, I would appreciate if you would
issue 10 new short certificates, and the original Certificate of Grant of Letters.
I am enclosing the Grant of Letters originally issued, as well as the short certificates I
have in my possession. I am also enclosing a new death certificate and a check in the amount of
$40.00 to cover the cost of the new short certificates.
Finally, I give my permission for your office to correct the social security number as
listed on the Petition for Grant of Letters and Estate Information Sheet.
Thank you for your cooperation. Should you have any questions, please contact me. I am
enclosing a self-addressed, stamped envelope for your use.
130 W. Church Street, Suite 100. Oillsburg, PA 17019. Phone: (717) 432-9666. (800) 682-4250 . Fax: (717) 432-0426
Offices in Harrisburg. York. Carbondale
www.wileygrouplaw.com
Hill' SIl" RI-\' I/Il'; . .
This is to certify that the information here given is correctly copIed from an original certificate of death duly flied wIth
Local Registrar. Thc original certificate will be forwarded to the Statc Vital Records Office for permanent fihng.
me as
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
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Local Registrar
Fee I,,, this certificate. $6.00
P 11334575
MAR 0 1 2005
Date
~J~utt READ AS FOLLOWS:
/9t-/,-'7<'19
t2wn.- /Jp ~M~
JS,143Rev.2J87
COMMONWEALTH OF PENNSYLVANIA 0 DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
DECEDENT'S USUAL OCCUPATION
(~~~4~~u~~r':j1
11.':Iwsf. 11b.
DECEDENT'S MAILING ADDRESS (Street. CRylTown, Shlle. Zip Code)
304 Deanhurst Ave.
j(amp Hill, PA
FATHER'S NAME (First, Middle, L.st)
11. Lester L. Bosserman
INFORMANT'S NAME (Type/Print)
20.. Ms. Jean T. Eberly
METHOD OF DISPOSITION
Burial DlCremation ~emovlllfromSlIIte D
OU-(~)
fUNERA
KIND OF BUSINESS I INDUSTRY
AS DECEDENT EVER IN
U.S. ARMED FORCES?
YesD NolX1
12.
17.. Sl!Ite PA
ST.-.rEFllEI'lUMBER
SOCIAL SECURITY NUMBER
,176 -18 -6799
DATE OF DEATH (Month. Day. Yellr)
yeb.16, 2005
NAME OF DECEDENT (first. Middle, Last)
,Cleo R. Truscott
AGE (Lest Birtilday)
SEX
~male
BIRTHPLACE (Clly lNld P f T
SIII11I or Foreign Country) HOSPITAL:
7.York, PA ;:bOfllD
FACILITY NAME (If not institution, give slreet and numbs/)
304 Deanhurst Ave.
...
h k I "
ERIOulplllMlD
;,
5.79 Yrs.
COUNTY OF DEATH
. Cumberland
lb.
OOAD
R"~ :':'cIlylD
RACE. Americlln Indian, Bleck, WhIle, II
'Spodfy\.ihite
10.
MARITAL STATUS - Man1ed,
Never Mtinied, Widowed.
Dlvoo::ed(SpecllY)
,;,dowed
SURVIVING SPOUSE
(lfwifoo. gl...",.os.n no"",'
n.
DECEDENT'S
ACTUAL
RESIDENCE
(SeelllStruclioos
onotherskle)
l1b. Countv Cumberland
0<,
deced8fl1
live ifl II
township?
11c. 0 YIIS. dllcedent lived In
..,
l1d.[J ~~i=~~\I~I~~Of Camp Hill
",-..
DonatlonD
.21..
. SIGNA RE
_22a.
Coolpletelteme238--<:onlyllAlllncertilying
physicillOlanolav.kblelit time ofdllllthto
certilycauieofd&lillh.
o
MOTHER'S NAME (First, Middle, MaidllR Surnllme)
1I.0rpha Ruby
INFQ.RJM!Ilrs MAll.lti"G ADOIiE~S..(Streel....CIb'lTown, SJ.II't, Zip C~V
20b.lUU Wel.l.SVll.l.e rl.d.WeJ..lSV1J.le,PA17365
PLACE OF DISPOSITION_ Nllme of Cemetery, Crelmltory LOCATION _ CIlylTown. State. ZIp Code
or Olhllr Piece
~ring Hill Cemetery
NAME AND ADDRESS Of FACILITY
...
:~proKimate
.lntllIVlllblltween
:o~.ndd81i11h
DUE TO (OR
~
Sequentlllllybtcondilions b.
If eny. !eliding to lmmadilllll
cause. Enter UNDERL YINO {
CAUSE {Dille..e or injury c.
lt1etlnitletedevenb
~ondellth)L.AST d.
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
DUETO(ORASACOI'lSEQUEI'lCEOF}
DUE o (OR liS A COI'lSEQUEI'lCE OF)
Yes 0
MANNER OF DEATH
~
o
o
DATE OF INJURY
(t.Ionll>.O.y.'I'....)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
Nlltural
Homicide
o
o
o
308. 30b. M
PLACE Of INJURY - Al homll. farm. street, 'i1ctory. office
OO'd..g.Olo_jS","oll)')
30e.
YesD NoD
30c.
."
Pendinlllnvesligalion
Couidnolbe delemlined
No
Suicide
2h. 28b.
CERTIFIER (Check only one)
'~:-m"J.l~tGorn~\~.Y'u7.s~~hC:=~"J: t: f~:~a~:~(:r.~3~~x~~a~ h:t~g.~~~~~.~.~.~~.~~~.~?~~~~~.~.i.l~.~~).
21.
SIGNATURE
'PRONOUNCING AND CERnFYlNG PHYSICIAN (Physician both p.-onouncing death and ceriifying \0 clluse of death)
To the beet 01 my knowladg., de.th o<:cu".d.1 lhellme. d.... .nd place, Ind due to the c.lU"I(I) .nd mann.r.. ltated,
'MEDICAL EXAMINERlCORONER
Onth.b..l.ofex....lnltlonandJorlnv..tlll..llon,In my opinion, deilthoccurllldIII Ihe tlma, d.le, end pllcl,lnddue to Iha clul..{.j and
mann.re..lIIted .................. ...............,...................... ..........................
31e.
REGIS"'SSlGNAT~.1~BER
33. t..t/Jvn.... /?,. 7a.
o
b<!/WI/Y I
34