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Thi, i~; to certify that the information here given is cOlTectly copieLl from an original cer~ificate of death duly' filed with me as
Joetl Registrar. The original certificate will be forwarded to the State Vital Records Ofhce for permanent hlmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No,
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Local Registrar
Fee for this certificate. $6,00
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COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATI; Fl\.EN\JM8f.Fl
TYPE/f"RINT
,.
PERMANENT
BLACK INK
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COUNT'( OF DEATH
80 .,.~,
SEX
,M
BIRTHPLACE (City and P CE F 0
StilteOl'Fon:lillJ1COuntry) flOSPITAI
pherrnansdale ,PA ~~alJenl 0
FACILITY NAME (If not institution, glvo street Bnd number)
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RACE - ArMrican Indian, 81aclc, White,,,
(Sp.lldfy)
White
SURVNlNG SPOUSE
(If..u,,.,,i,,,,,(t'l&ld.on~ft)
.., Cumber land
1000 Claremont Rd.
",Carlisle, PA 17013
Old
decedenl
Ilvalns
17b. Countv Cuml:erland township? l1d.D :tt.1=~j\I~I:Sof
MOTHER'S NAME (First. Middle. Mlllden Sumame)
19. Frances Bear
~~~~~~38S ~d:ll~~~~ssG~p~~~o;o' ~~~ ric;r~, PA 1 7013
PLACE OF D1SPOS\j\QN. Name of Cemetery, Cfemalory LOCATION - CltyfTowl'l, State. Zip Code
orOlherPllllce
....
citylboro.
~
.
~
co
6-1
26.
: Approlllmale
. interval between
: onset and dealh
Olher significanl conditions conlrlbuUng 10 dealh. bul
nOI resuJling in ll1eunderfying cause given In PART I.
S8quen\\ally liS\: cond~nons
if any, loading 10 Immediate
. caU5e, Enter UNDERLYING
C.a..USE tDlw.~tl or Injur'1
.ltIatinitiElladavenls
mulling on death) LAST
WAS AN AUTOPSY WERE AUTOPSY fiNDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE:
OF DEATH?
E
DUE TO (M AS A (:(lfo(SEQUENCE OF,
Natural
Accident
[SI;?
o
o
Homicide
Pendinglnvestigalion
DATE OF INJURY
{Month.O.y, v....r)
o
o
o ~~E OF INJURY
bullding,"lc_1Sp8dty}
30..
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED.
MANNER OF DEATH
Yeli'D NoqP Yelio
28a. 28b
CERTIFIER (Check only one)
"~;~J~'Ir~~tG J~~\'~~~Jfuhl.s~~:~ ~~~~8~U:: t~ &e:~a~:~(:r~~3r;K~~~a~1I h:t~fe~~~~~~.~.~.~~~~.~~.:;.~~~:~,i,t~~.~;,)"",.
NO-cl
Suicide
COUld natbe d<Iltarmined
YesD NoD
3Gb. M 30e.
At home. farm, slreet, f8.';tory. offica
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"PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both prorloundng death and certifying to cause of death)
To the be,t of my knowledge, de.th occurred at the lime, date, and place, and dl.le 10 the !;IIUlIlf(S) and manner 8S stat.d,.. .
"MEDICAL EXAMINER/CORONER
On the b..IA of examination end/or Inv..tlgatlon,ln my opinion, death occurred at the tillie, dale, 8nd pllee, And due to th.. cau...(.} and
m.nnerasstated.
31...
REGISTRAR'S SIGNATURE AND NUMBE
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1a111ri.1 \ 101
WILL OF
GERALD C. BAUM
I, Gerald C. Baum, of Carlisle, Cumberland County,
Pennsylvania, declare this to be my last Will and hereby revoke all
prior Wills and Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I leave everything to Roy F. Baum. Should Roy F.
Baum predecease me, I leave my estate to Kelly
A. Baum.
4. I appoint Roy F. Baum as Executor of this my last Will. If
he should predecease me or cease to act in such
capacity, I appoint Kelly A. Baum as alternate.
5. The Executor of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
. 'J
IN WIT~WHEREE' I have hereunto set my hand this -2;>S day;'~
of c!7/"&nt ~ ,2004. -..)
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Gerald C. Baum
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LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
:
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Gerald C. Baum, as and for his last Will in the presence of us, who at
his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
Dr' J
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*ESS ~
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LAW OFFICES OF
STEPHEN J. HOGG
19S.HANOVERSTREET
SUITE 101
CARLISLE, PA 17013
~
ACKNOWLEDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Gerald C. Baum, the testator, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
/; JYr-'4.eJ C JJ on .I'.o{.N"\
GERALD C. BAUM
Sworn to or affirmed and ackno~dged befor me by Gerald C.
the testator this 2-';3 day of Vc:J"7A.ep ,2004.
NOTARIAL SEAL
STEPHEN J. HOGG, NOTARY PUBLIC
CARLISLE BORO, CUMBERLAND CO. PA
MY COMMISSION EXPIRES SEPTEMBER 3, 2005
AFFIDAVIT
State of Pennsylvania
ss
County of Cumberland
We, j and :}r;SSH.A Gv...ISI-. ,the
witnesses whose names are si ned to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testator sign and execute the
instrument as his last Will; that the testator signed willingly and
executed it as his free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testator signed the Will as a witness; and that to the best of our
knowledge the testator w~at that time 18 or more years of age, of
s")}nd ,. d and un er n",con t",irl( or undu~ influe~'Ji7 .
//; / .. 1~A-'~ (jlJy;--r (
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Sworn to or affiJ;r1l~ and subs ribed to before me by witnesses,
this "27 day of / I/c~~ ,2004.
LAW OFFICES OF
NOTARIAL SEAL
STEPHEN J. HOGG, NOTARY PUBLIC
CARLISLE BORO, CUMBERLAND co.. PA
. MY COMMISSION EXPIRES SEPTEMBEFl3, 2005
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 10]
CARLISLE, PA ] 7013