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HomeMy WebLinkAbout0306 i; ~ 14`7929 y~a i1 WARNING: fr is Hwsal te ~uoNua ~kis cooy br Platost,t or ohorosraPb. 3 ~ r,vs ~oi~z•aaow-~-es ~3 COMMONWEALTH OF PENNSYLYANIA r~ x c~:. o., i.ot~ F,~ E~- r~;~ DEPARTMENT OF HEALTH N 0 2 5 9 2 2 2 ~ :~.,.f <e~~. si.ao) VITAL 8TATISTICS lf LOCAL REGISTRAA'S CERTIFICATION OF DEATH ~ Rcyisterrd No. _ ~ ~ E~ ull Name (~iLAYT~N F` • BAHKS ! ~t l~ceased _..._._._.---__._..._.._.__w.__._.---..._......_.__.---...N_......_._.... _ iint Middl~ lsi! u`ua' jj~ Moro WRoad, Villanovat-- L....Merion ~Montg._Co. Pa. il t~.~.,~ffSS ~~O 1~1~/ • X.' ..__~_.___._...M._~.~...._" ' 1 Nr~Mr SY»I db ~r INr~ UwM SION P.~~h °f Lower Merion_~~_ MQnt ome __....._._____..__..._8__-- ~ ~~yi~~ ~ 1 aryr, e«o..? « ?e..~lt' Gs..nr v~<< of ~ac~ ._J17tt1e 11~1Q66 _--____s«~ s~~~y No. __.__1~2-_10-62_QO ...,__~~._____White f i; ,z~:t,.z~ sc~n~ Never _married__.~s~:_._.~ ~~e----------._na~e oE sr~.__ Jan.---25-~.._191Q.-----_.._---~ ' o:cupation Ket. Broker _.s~~hPw~e .-------Phila._:___Pa. - (r Veteran. which War l,l ----•-•--•----_....-~----•Veteran's Saia1 No. - 'f '~:F;DICt1L CERTIFICATE Interval Betarcen f'3rt I. Death aas caused by: ~ Onset and Death ii ~ 'I ~ ~ ~i l::~med~ateCause ~a?--StB~~.~~`_~.~~$xt.__.~~.~d~~!~~1~-----••---...--•---•-----°------f~R~;_~_.____~ i: ~'o m~"nri if Due To (b)--~IIL'HY'~.8~._.~BZ'.CY.~QII-----------------~..._.-----•------------------X~ oC nr s - " Due To ( c ) ~ ~ ~ ~ Z ------~----------•----•-•y_ . _ - ---Q i~ P~rt II. O'I'HER SIGNIPICANT CONDITIONS: contributiog to death but not related ~ ; Part I (a) ~ ~2~ _ ~ ' O ~ ~ - - - ~_...__.~C- ~ O~ ' ~j - r1~ c~dent. Suicide ot Homicide _---_How did injuty oecur -C - - • , _ ,I - ;c and 7'itie of Person ~ - , '`.~'i:o Cectified Cau~e of Death (M.D.. 130"~Riner) .--•----•~32:1?1~---8D~'2~.118QA_---_--_~.__....---__.------•--•••---___.__~---••-•- .;.i~?ress. ~ -_.-------=-'tJ-:== •--~.1---Pa~----° . ...._.~44__.Cou~n~y~ ~~~---Ro~~_.----_...__ ~ _ i'i1~s is to cer~ify that the informatioa here ghrn is correctly copied from an original certiflcate of death duly filed with me I_vcal Registrar. '1'he original tettificate will be fo~arded to State Vital Statistics, Harrisburg, Peansylvania for permaneot ~ .:r!9. l*~~_ M ' ~A ~ . -4b_-429 ' , ! ~loc.~ RNts+ror .i vHo~ SM:.?ks ~ w ile. i ~ 1131 Waverly Road, aladwyne, Penna. ~ ~ • SiwM Addr•n Qh. /en~. Torrasuv ; ' ~ June 14, ,~'i6 . ~ _..o - ....-.--..............-.-.---....._..~._~un.~._~}-.---__~9_.~ oo~3J~~ DaN o/ I»w o/ iAis Cirfilicotie~ i~ ,~~,r~ , - ~-~i..:~' -r~~s . - - ' ~ I. 1`'• ~4~„~,Y. ~ o ~ ~ ~ ~ _