HomeMy WebLinkAbout04-03-06
CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner ofTrindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
TELEPHONE (717) 766-0209
FAX (717) 795-7473
March 31, 2006
Register of Wills Office
Cumberland County Court House
One Courthouse Square
Carlisle, PA17013
Re: Estate of Fayetta Detter
Dear Register of Wills:
Pursuant to my conversation with Colleen this morning, please find enclosed Check No.
1599 in the amount of $15.00. Please issue a docket number for the Estate of Fayetta Detter and
advise me of same. Additionally, I am enclosing a death certificate for your records.
Thank you for your kind attention to this matter.
Very truly yours,
t!d~ (?~4 ~
Charles E. Shields, III
Attorney-At-Law
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Enclosure
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This is to certify that the information here given is correctly copied from an original certificate of death d~~r filed with me as
Local Registf.ar~ The original certificate will he forwarded to the State Vital Records Office for permanent fIlIng.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Fee for this certificate. $6.00
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COMMONWEALTH Of PENNSYLVANIA 0 DEPARTMENT Of HEALTH 0 VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
TYPE..iPHINT
IN
PERMANENT
BLACK 'Nt(
,.
2
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&J
a
15
w
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N
Detter
SEX
2. Female
STAfE fILE NUMBER
SOCiAl SECURITy NUMBER
3. 170 - 30 - 3291
DATE OF OEAfH lMolllh. Day. 'mal)
L June 27, 200S
PLACE OF DEATH (GhockOlllY(}(!El -- saeins(fUCllOnsonothel SIde)
tiO-SPlTAL
Inpalltlllt [J
...
FACILITY NAME (II Illll in~'lution gIve sheel a.nd nun,htH)
BIRTHPLACE (e.1y and
SIdle 01 ft>ft,iGn C..::o...rrlryj
1. Dover, PA
g::.,) 0
RACE - AmEtllcan Ind&an, Black, White, e\(;
(Spocily)
Whi te
MARItAL STATUS. Wlauied
He.....r Uatried, Widowed,
"""'"""'IS"""oIyl
Married ..Ned E.
Monroe
suRVtvlNG SPOUSE
(II wife, Qtve f'Tlatden nama)
Detter
rop
17b.Goun'Y__ ~rland 17d.D :hi=:::OI
MOTHER'S NAME (First. Middle. M3IOOri SUlname)
I. Sarah Rudisill
INFORMANT'S MAILING ADDRESS (Street CityfTo'iWn. S1<lle. Zip Cudtl)
... 1246 Hillside Drive Mechanicsburg, PA 17055
PLACE Of DISPOSITION - Name of Cemetery, CrernatOf';' lOCRtoN - CityllOwn, State, Zip Code
or Other Place
citylboro
fil
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3
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PA 1705 5
R\ 17055
LICENSE NUMBER
DATt: PRONOUNCED DEAD !Monm, Day, Yeal)
23b. 23e.
~S CASE REfERRED TO ME~Jl EXAMlNEAICOAONER1
...pI(. ,.,0
21.
: ~oxirnal.
llOCervaI betweeh
! onset and death
~,--~-------~~-
!
P"RTM;
Other 56gnt1k:anl conditions COOlribUbl"lQ 10 dee.th. bul:
not r.ding in the ~iOg ceuse g;v.n in PAin I
2'. 3:36 P" 21 June 27,2005
27. PAIn I: Enter lhe dis&ases, UljUrie6 or COf1'lpl~lions which c.aUMd lilt cfQa(h, 00 not enter the tnOd6otdy'ing, slICh BS cardiac 01 fsspUaJOf)' a"~, shock or heart failur.
Ust ()n~ one cause on each Iin&
o_~~~~_ Myocard:!,al-1!lfarction
DUE TO (OR AS A CONSEQUENCt: OF)
b'~_----OUE TO (OR AS AC-ONSlOij(NCEOf::)-----~-~
d
WERi'it.UfOPSvFltmllms
AVAIlAllLt PHIGR TO
COMPI EllON OF C~.U<jf~
OF OEAn-I?
'MANNER OF DEATH
1: No'u..' ~
[ J .""",,,. []
Nu.. Su>C>de []
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I
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TIME OF INJURY
INJURY AT WORK1
DESCRIBE HOW INJURY OCCURRED
C---~--Ol;'E ro-irJAASACOOSf.(lliENCEQj:)--- -
DATE OF INJUflY
(Month. Uay Yeui)
CoUld f'll h& dltl6fmined
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[] ~:;~~~Nlj,:~I-~)A.I-hOrTla~rm. sh8lK. tactory, attic.
300.
Yo. CJ No n
HOmlCKIe
Yo. []
Pendlrl91nveSlIfIEdion
M. 301::.
Coroner
2" 21b.
CF-RTlAER {ChOCI<. ;)f)ly ,)l'el
"CERTifYING PHYStclAN (p1'151l,k:l,'\ l, ;~lor:t"("J l -it, * 0; d~}'lrt, Wh~ll don,,{h')f j.1t,y,;,(.ldll t. "'"I--"(;ffi,'I.lir;u..I(}'Mlt, iJll<JcuUlplauJ(! IU!f!1 :oJJ)
To "'el..t o' 1ftV' lu<,wled~, death oceurr..::t j"8 lr U\e Gaul4{a, af1d manMr.. shdeO. _ .
SIGNATURE AND Till
'UEDICA.L EX....,""RlCQRONEfI
On the IN". ol..amlnaUon anti/or Inve..tig.bcll, In nr,..oPlfljI')P. death U{;culTlIlId.t the U01it, date, and plac., .nd du. to the c.u..ta,.and
mlllo".t .. alated.. . . .. ...... .. ,_ ..... .....,.. ..... ....... . ......... . . . . . . . . . . . . . . . . _ . . . , . . . . . . . . . . . . . . .
:u..
-REG'ST~GNATURE':NONU"HER-' -7 ....--.--..-----...- "-' .
":.-k:':.L-1-!::u,u~~.4~-~"-1.j '.:.&:f.&/...!j---
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[J 310.
UCENSE MBER DATE SIGNED (Monlh.I~~ '1aar)
o 310. 3.d. June 28, 2005
NAME AND ADORESS OF PERSON WHO COMPLETED CAUSE OF DEMH -
(II"m 21jT,pe DrP,inl Michael L. Norris, Coroner
~ 6375 Basehore Road, Suite #1
~ 32. Mechanicsburg, Pa. 17050
DATE FILED (Montt:. Oay. 'Ib3r)
'f>AONOUtU::INQ AND CERTiF'tlfotG 9'H'fSICIAN W'1i>ll.;l<lll t",AIl Llf<.4.oUI.,in<J <k);_l/'.II ~J L'-lIUy,r<(i 10 (,l'l~ ,4 (j(;;.,th)
To the bRtor mv Ir.nowt~, at.1h O(:cuned at the t!me, d..e. and pbk.:., and dlJe t.) tn. c.ua.{a) aod ",.nMI.. atated.. .
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