HomeMy WebLinkAbout08-29-05
Hln".~n" Rl:V "I'"
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 permanenPfiling.
WARNING: It is illegal to duplicate this copy by photostat Qr photograph.
Fee for this certificate, $6.00
'...,,;
,\",'(~(1H'OrPE,i----~_
l#'~~~",,-
/~-' ~\
~:JEr .~.---. ~~
~~ _fl(#j:' ),i;"~
~_ . 'hi . .1 ~
>'*~'~~;"'/.'*ff
~a" ~\'
\. ~ /.....~ l
-.".::f,f" _,~\.'r/
~---- ' MENl \)\ """"
"''''''''''//##/#/'''''
t1.. '~1
6v4-~: ';,,; ,&
Local egistrar M
~",-,."
I
." r-- C~
J. :J '"
No.
,-:>
<~
.o....'J
_:,...C\
a/j~~ i Zf' JI:J";
1 . 'Oate
, i,/\
',' .')
;::-{-I
t_'"':J
'.J .I
\"J
,..~-
~'. "
.....-,-.
C)
",' \
--,'"
. c)
i"n
"'~n
'-'..J
:J
(J'
-
H105143 Rav. 2187
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
>-
Z
\JJ
o
W
()
W
o
u.
o
w
:e
0(
z
CERTIFICATE OF DEATH
TYPf/PRlNT
IN
PERMANENT
BLACK INK
twp
city/bow
fa
'"
=>
Ul
<
~
24.
2'
. Approximale
: interval between
: onset and death
~-.r
j i
) sr.,
Othef s.igniflC-Olof\\ conditions contributing to dealh. but
not rasulting in the linderlying cause given tn PART I
27. PART I: Enl., 111. dl.......lnlurMl. or ~ompll~.llon. which u....d th.. d'llll1. Do not .nler the mod. of dyIng, .ueh.. c.rdl.c or r..plralory a....t, .hock or he.rt fallu...
UaConly on. c:aua. on.achUn..
2
'Q..
SequentiaUy .~\ OOf'odlUOf'lS
if any, ~ading to immediate
cause. Enter UNDERLYING
CAUSE (Disea$e or injury
Ih;:a! inihaled events
resufting on death I LAST
WAS AN AUTOPSY WERE AUTOPSY FINDINGS
PERFORMED? AVAILABLE PRIOR TO
COMPLETION OF CAUSE
OF DEATH?
E
",
--.
Natu.al
IXJ
o
o
DATE OF INJURY
IMonlll.Da)'.'illiilr)
TIME OF INJURY
INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED
MANNER OF DEATH
Homicide
o
o -0-0
301l. 30b. M 30c-.
o PLACE OF INJURY - At home, 1arm. street, faclory. office
bUlldl"". ete (Sp-eel'y)
30.
Acciden\
Pendlllg lnvO::'ligillion
Yes. 0 No IR1
v., 0
NOD
Suicide
Could nol be uelml1lined
288 28b.
CERTIFIER (Check only one)
.~~':J:=~~tGor~~f~~~e~hJ.S~~:r..C~g~~i~ia':K.s: t<:: :ea~.~~:~,:r~~3f,g~x~~~a~. h:l~l~~~~~~~~.~. ~.~~~~. ~?~ .~~~~~~~~~?~ .i.(~~ .:~.)...
29.
-PRONOUNCING AND CERTIFYING PHYSICIAN (Physician both Pfonouncing lIeaU-l and certifyIng 10 Cdw;e 01 dt:!illh)
To the be,l of my knowledge, de.th occurred at the lime, date, and pl.ce. and due 10 the cause.(., and manner as .tat.d.....
.0
hO
DATE SIGNED (Month, Day, Year)
31e 31d. 0 'i - 7:-1- W
NAME AND ADDRESS OF PERSON WHO COMPljlED CAUSE OF DEATH
litem 27)Type o,Prinl I-A/I ,-"f<f'rt-t /.5~f""J~
o ?le}I ,v. ~.-/ Jj- .
32. . ~.""'A<l . / ~'/ r z:..
DATE FilED (Month. Day. Year)
34. f),"'c ~C;d~-
*MEDICAl EXAMINER/CORONER
On the baal. of examlnallon and/or lnve.ligalion, In my opinion. death occuHed at Ihe time, data, and pl..ca, and dUll 10 Ihe "..u...{.) and
manner a. .tated
31a.
REGtST~ S SIGNA.TURE A.NO NUMBER
'--
/.
-"7
l-;Ll (\.;lJ II.~
....
WILL OF
JOAN G. QUINN
I, Joan G. Quinn, Camp Hill, 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 five hundred ($500.00) dollars to Mark
Quinn.
B. I leave five thousand ($5000.00) dollars to Claire
Durborow.
C. I leave the rest of the value of my stock portfolio to
be divided equally to Susan J. Durborow and Beth
Morris.
D.
I leave my Heisey Glassware to Susan J.
Durborow. ~)
j~.')
E. I leave my household goods to Gerard Peters.
F. I leave The Cat painting to Beth Morris.
G. I leave my Ahab Hit painting to Susan J.. Ourboro)j.
H. I leave my Red Bible to Susan J. Durborow.
I. 1 leave my Black Bible to Beth Morris.
LAW OFFICES OF
STEPHEN]. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
J.
I leave my Angel sculpture to Susan J. Durborow.
""...')
"';'"'}
./"1
, ..
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
IP'
K. Should Mark Quinn, Claire Durborow or Beth
Morris predecease me, their share shall go to
Susan J. Durborow. Should Susan J. Durborow
predecease me her share shall go to Claire
Durborow.
4. I appoint Susan J. Durborow as Executrix of this my
Will. Should Susan J. Durborow predecease me or
cease to act in such capacity, I then appoint Beth Morris
as my alternate.
5. The Executrix 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 Executrix acting under this Will shall be
required to enter bond in any jurisdiction.
, F, I have hereunto set my hand this JY day
,2003.
ff;'~. ~in(l, ..:~
, '
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
-
ACKNOWLEDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Joan G. Quinn, the testatrix, 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.
CL_~ -j ,41~~*<
/ban G. Quinn
NOTARIAL SEAL
STEPHEN J. HOOG. NOTARY PUBLIC
CARLI8LE BORO. CUMBERLAND CO.. PA
MY CQlfMII8ION EXPIRES SEPTEMBER 3. 2005
Sworn to or affirmepnd acknowl
Quinn, the testatrix, this day of
ore me by Joan G.
,2003.
AFFIDAVIT
State of Pennsylvania
ss
County of Cumberland
..
We, (;frQ Ice, of' Ii f{/f~nd 0~ I( ~'I bc-rt ,the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her last Will; that the testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of
sou ,mind a~d under no constr;el'ntndue in~fl nee.
_ . J,I _~. . . I )
__ l~l" c"- e:i ('
(, I
~orn to or affirme before me by witnesses,
this -{).- day of 2003.
NOTARIAL SEAL
STEPHEN J. HOGG. NOTARY PUBLIC
CARLIsLE BORo. CUMBERlAND co
MY COU~''881ON '. PA
EXPIRES SEPTEIIBER 3, 2005