HomeMy WebLinkAbout07-26-06
BUTLER LAW FIRM
500 North Third Street
Twelfth Floot
Harrisbutg, PA 17101
Tel: 717.236.1485
Fax: 717.236.7777
lawyers@butletlawHrm.com
Mailing Address:
Post Office Box 1004
Harrisbutg, PA 17108.1004
Ronald D. Butler
July 24. 2006
]ana Butler Toole
Benjamin]. Butler
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle.PA 17013
Rc: Estate- of I~asalYi1 Gerber ti/k/(l Rcz Y. Gerber
File No. 2006-00632
Dear Sir or Madam:
I represent Ronald E. Gerber, Administrator of the Estate of Rosalyn Gerber a/kla Roz Y.
Gerber who died on July 3,2006. As per your request I have enclosed a corrected death
ccrtificate indicating that the decedent was divorced and unmarried at the time of her death.
Your cooperation in this matter is appreciated.
Very truly yours.
7 /'\
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Benjamm J. Butler
BJB/mot
Enclosure
cc: Ronald E. Gerber
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PRINT IN
IANENT
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Name of Decedent (First mlcdle, Jasti
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH STATE 'ILE NUMBER
5 AQe (Lasl birthday)
74 y"
8b CounlyolOeath
7, DaleolBir1h Month, da ear
3, Socia: Security Number <1 8a"te 01 Death (Month, day, year)
Roz
Y.
Gerber
-187 - 24
March
Cumberland
Lemoyne
Market st.
Residence 0 Other- 5 ci
10. Race: American :ndian, Black, White, ete
(Specify)
White
11 Decedent's Usual Occu alKJfl Kind of work done durin mosl o~ workin life; do rlol stale retired
ma?r~ge'ment GerbK;;d~BUF.'~tb~llcs
16 Oecederlt's Mailing Address (Street city~own. stale. zip code)
1004B Market st.
Lemoyne, PA 17043
13. Decedent's Education S eci
ElementaryISecondary{O-12)
16
PA
hihest radeco leted
College (1-4 or5+)
17b Couo~ Cumberland
Did Decedent
Live ina 17c. 0 Yes, Decedent Lived in ~_~____...~.____ Twp
Township?
17d.XJ ~l'U~~~~i~;~7iv~__~~em~rn~_ _ .__..___Ci~iBoro
18 Father's Name (First, middle, lasl)
1 9 Molher's Name (First. middle. maiden surname)
Isadore
Yudacufski
Estelle Terlinsky
20b Inlofmant's Mailing Address (Street, dyltown, slate, zip code)
20a, Informant's Name (Type/print)
Ronald E. Gerber
1004B Market st. Lemoyne,PA 17043
Method of Disposition
o Burial ~ Clemalion 0 RemovalITom St<ltl~
o Other - Specify
.. 22w:ir'~' ~'~<e % 10:'''$0 "Ii",
Complete Items 23a-c only when certifying
physician is not available al time of dealh 10
certitv cause of death
~erns24-26mustbecompleted by person
. whoplonouncesdeath
21b, DateofOisposrtion (Monlh, day. year)
21C, Place 01 Dispositkln (Name of cemelery. cremalory or other plaCe)
22c. Name and Address 01 Facili1y
Musselman FH&CS Inc
21d. Localion (Cityt1own.Slale. ziPCOde)PA
ount Holly S rin s
1 Ave.
o Donalion
2006
23c Dale Signed (Mo~lh,day,year;
0.130
foI.M
25. Date Pronounced Dead (\-Ionlh, day, year)
T...I'I :3 I .l..Oof,
26 Was C.~se Relerred to a Medical Examiner/Coroner?
24 Time of Dealh
II Yos 0 No U1.-P
: Approximate inlerval Part II: Enter other sianificant conditions contributina 10 death, 2B Did Tobacco Use Contribule to Death?
: onset 10 death but not resulting inlhe underlying cause given in Part I 0 Yes 0 Probably
"Il. No 0 Unknown
Sequentially list conditions. if any,
leading to the cause listect on Line a
- Enter the UNDERLYING CAUSE
(dlsease or injury thai inrtiated the
evenls resu~ing in death) LAST
pv.)IV\MIA",/ d,'S'tD\sQ..
Y<<... K,'^Scln.s
N()I1- 1-fo.I, k,"J ~ j "Y\ph 0",,"1
OS.kllyoro~f_5 . ~
29 II Female
Jr: Not pregnant wrthin pasl year
o Pregnantallimeofdealh
o Notpregnant,butpregnanlwithin42days
of death
o Nolpregnant. bul pregnant 43 days 10 1 yeal
beloredealh
o Unknown if pregnant within lhe past year
32c Place of InJUry: Home, Farm, Slleet. Faclory, Office
BuHding, etc. (Specify)
o Yes "t-NO
'" Natural
o Accklent
o Suicide
o Homicide
o Pendinglnvesligation
o Could Nol Be Determined
32d Timeoflnjury
321
3~ ~oC~~~~ci(~~te)S~~
6ir-Q 1.10'\.( L. IN. \
4f)'oOl.\^" \ 'PA Iro ~.3
30a. WasanAutopsy
Performed?
32a.Dateollnjury{Month,day,year)
32b. Describe how InjUry Occurred
33a CertlfJer (check only one)
Certifying physician (Physician certifying cause of death when another physician has pronounced death and completed !lem 23)
To the best of my knOWledge, death occurred due 10 the cause{s} and manner as stated ....
Pronouncing and certifying physician (Physician bolh pronolJl'ICingdealh and certifying to cause ofdealhl
To the best of my knowledge, death occurred at the lime, date, and place, and due to the cause(s) and manner as stated...
Medical er.aminerlcoroner
On the basis of examination and/or investigation, in my opinion, death occurred at the lime. date, and place, and due to the cause(s) and manner as slated
.... ........0
33d Date Signed (Monlh,day year)
Jv..1 3, )..00 b
M.
. ............0
Regislrar's Signature and Dislrict Number
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/ < /:., .{1.~ <'/~~
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34. Name and Address of Person Who Completed Cause of Death (Item 27) Type/Print
:5o.n~ l<;. Cc"yo-i '\)0 \ I PA L1
So J'{.,.-.Il 12..j.~ S{'JU+ u;.-O..".l ~~ U>MO'f^f \ 11-0r3
~
........0
(See instructions and examples on reverse)
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