HomeMy WebLinkAbout05-3302
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY,
PENNSYLVANIA
INRE: IYIPlt. ~- (otrL'i.-
File No. 0.5 - :J 36^-
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NOTICE TO RESUME PRIOR SURNAME
(PLEASE PRINT OR TYPE)
Notice
IS
hereby
given
that
the
above
named
Petitioner,
residing at,
,being a
, hereby intends
name of
Mitt. :\. COlSL(..
/60. LH. ftN/J (6u~T E-IJOLIr
surviving spouse as of fhfr'f
PA
200 \
to
resume
and
hereafter
use the
prevIOus
IlIfrL. T. Wlt~F{'L
and gives this
written notice avowing his I her intention pursuant to the provisions of 54 Pa.C.S. ~
704.1. A Certified copy of the Certificate of Death for the decedent is attached.
Date: 6/2..'1 /0 fi ~ Q. Clr-t-G.-
, I Signature ofPethioner
Si~~~bein?t~
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
On the 21lh day of < \v..~~ ,2005, before me, the Prothonotary or the
notary public, personally appeared the above affiant known to me to be the person whose
name is subscribed to the within document and acknowledged that he I she executed the
foregoing for the purpose therein contained.
In Witness Whereof, I have hereunto set my han and official seal.
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h f h d h h ~l the Pennsylvania DI'vI'sian of Vital Records In accordance
Tnis is to certify t at this is a true copy 0 t e reeor w ic is on n e in
wirh Act 66, P.L. ,04, appwved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
~)/~
Charles Hardester
State Registrar
~.kSJ5.~/~.
Robert S.<Zi.oJnerman, Jr., MPH
Secretary of Health
1645972
SEP 042001
Date
f"~.lot:lf\ew.2Jll7
COMMONWEALTH OF PENNSVLVANIA." OEPAR"TMfNl OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
050358
TY'€fPA,"T
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NA~~DECfDE'lTlfK".M_,l,",,)
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Richard M, Coble
Male
3. 204
03 -
0952
O.ol'E Of OEAH,M<:nI1,e.-,. '_I
l. May 11,2001
76 v~
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1453 Cockleys Meadow Drive
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OIECEOl:NT.S.ll......IIIIGAOCIRESSlSl>...~._.t;peoa..) Of:CEtlENT'S
1453 Cockleys Meadow Drive ~=NC(
Boiling Springs, Pennsylvania 17007 ""~
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