Loading...
HomeMy WebLinkAbout0479 ~ • ~E~~i062 nu~ 738 1 :;ARNING: It is ille~al to du~licate this copy by ph~o~ostat or photograph. " • ~ ~ $EP. 3 ~ :~u~ ' /.j ~ , ~ D3~~ Z~rK ~ Pnu~ ~i0• • vvJ~ - This is to'csrtify- tr-.~ ~::is is a trae eo;~ of Lhe record ~:~ich is on file ~ in tr~~ ?e:.:z ~;;~lvar:ia .u-t:.:ant of :ieaith, i:~ acco: danca :~;:.n ;~ct EE, P. i.. 30k, 4a~rovea oy ti~a G~r~ar~i Asse~tuy, ,Jur.e 29, 1953. , . ^ ' . ~ (~(~~i E 1-i ~ . (rea ror tt~.:a ..artiPit.ate, ~1.00) t~~~ ~ r..~ - tho;nas ~~T. Georges, • r., D. Secretary of Health ~ Harriaburg, Pennsylvania • " j'- - ' ~MVS-2G.:: 2EV. ~'6~ 2~ OO~ut37+MCAL7K OF PENVSnlVAN1A ~ ; LOCAL RC::_ IIC. ~ ~EIARTk .h: OP HEAITH ~ VITAL sTA: t5T ~S ' ~ ~ ~ PRI1:~1RY ~ ' .~uT. no_ t-~~ CORCtr~R'S CER?f~ICATE OF DEATH G~wT•. Cw~cs w c:.r « i«..sa ~2. ^ECEw;EO'S . Scutcal4~ss. R..., w Bes ~~~?~r i ~YC::a.,:EO . ?UIUVG . ~ Allenhen Pittsbur~r ~~'~EU ~ > y . i~~ Resaca Place j-c-it ..-.:a aid ~e: ~ee.r ia ciry ~~u Otllee, Zwie, ud wce r f x~ -~j?, =i~e a+ne of w~nDfp n. ~ . : ~s~ R.L « a~~ .~e~.~ . Pit'- s~-- Pa 152LZ ~ i:209 esaca Place Y~-,~,_~j :r~ ~ . ~ . . ~ ~s • ~ .-.+tiM R~ co. : 1~piu1. ~i~e ttr. . ..:l.~c ~ s) i sa~~~ e,~ : ~w . ~t •:AU~; L~ (Fi~u1 _ 4 Wi.idt~) e. (L~sa ~ a: ~ ::wt?) (D~f) Qf~ar) } Jci EAi20 . ' ~ - { . r,va ~7ean C =_r,o ~ ~ : >:br,_?ry 4,1968 ~~i1 ~ - . t :~ii deetasc.: .~~t a~ ? .o~aaSi~! ;._C ,~~:J - ; ~ . so... Penna. ~ 7t~.lecnsed l:~ed ie _ . ._~ii~.. I 4Y f"Y k~ ~i~Cg~ ~ ~eascd ii~t3 v:cL'u actul ti~iu - P~ 'f f S iSZ17`,=.1- eiq ~t ~orwjL i _ ,_i,. 7. SEx . 0. GOLOR GR RACf 9. MARRIEO .a NEVEA 1fARR1E0 ~ 1 t0_ OA: E OF BIRTN 1. AGE (1~ ~esi II .edet t.cu If ~nJe~ 2i loats * :C~:iiB ~~~nite ~ x~oo~~ ~ DNORCED 9~1.~1931 : lloui?s 'u,.• Ilovr• f4~. ~ ~ 12 S;SL'Ai. OC.GUPAT~ON (s~t~ 11 ntirs~ 1~. SOCIAt. SECIiF~.TY NO. i4. etRTNPLJIGE (Sr~te ~r fu~cisn coa~oq) pT12EK OF wNAT COUNTAYf A ~ ; " - -0 p Fairbanks Pcnna: U. S. A. ~ ~ ++6. r'uLL. .~t[ OF SPOUSE ;17• MOTMEft'S WIO£N r.~wE ' sc.st;~' r ~ ~ ~ - i,cna Shaw - . - ~'D. iA7.iEA'S NJ?Yc' f!. tlIFOAFtANT'S NAM£ AHD ADDRESS Pgh~ ~ Pa~. ~ =.ar~ Shea ~ Filson C 1~J 11' arrs ~ , ~ • ; ' . • MEDtCA~ CEATIFiCAl'IO:1 u~T°~~~ s~n"'E~ ' ' ' MSET AMO OEATM ~ . : ~0. CAU=£ ilF DE!1TH: Fatv Mly wt eaue ~er W~ fx (4. ~ i (e)• . _ , . • . . ~ ?.~T L De+ri ~as e~~ueJ ~c ' ' . , ~yp~pu~~~g~~~Cllf:_P_ Co~bined peisnnirrr c.~.e~~,. a.ar, .s:~~ • wre ru ca~C~t~ i t A 1 ar~ c~ Dnr i A Pn . ~ - t j...,.,e..b~.•ee...e - . . S ~ ~ w4a~ tL~ c cid~i~j DIJE 1~D (d ( eM~e t+st. ' . i ~ ~ { \ PAR: Q. G'fIiEirSit'.MFiGNT OOh'MTiJ\S: cwvib~i~~ r l~~d i~t ~ reLteJ t~ i4 tet~i~l ~isew ~i~~~ i~ ?.r~ - Zt. MAS AUTOPSY + p~ppw~EDf . • Y~s K~ O - ' ?2 ? ACCICENT 0 ?2. f. OFSGAIBE NC~ INJWitl OCGVRAEO TIME 'ltocr llo~d~ Da~ Y~~t : S4I.GiR . ~ OF ! ~ : D~t,~.:.~~ ~ In estion of Dru s M,~Y E_S.T_ F ?2. t ~HJURY Oi.CURREO 72. t. VI.ACE OF INJURY (t.~.. ~wt. [a~. ?2. t• CiTY, BOAOUGN, TQ~NSHlP COUNTY TATE ~ ~6;Ic ~c Noi ~L~e lac sae«. ea.) i ~ .o~ D....~ C~ Re9i~ience Pittsburgh Allegheny Penna. ~ ~ 2~. 1?eaneb~v~ rtJ~ ma,t i~~~stijuiw d it ~tu? ~t ~Ye ~6q~Fer d/c~ct~se~ ~ sdud i,~d~ (i~.fi~~s ~ete ~aJ, ~ ttiu ti~ 1leu~ i~ titi~,aiaJ a}~_ ~u~y r ~iC11~~ ES.T.. w t!s ~~~e ~uad ~iw~. ~ I I Mt~i ~`f~r L~t' ` ~ _ R.ACI'H J ST'ILTEr2t D - U - ~ l St~9~llYt~I~RMR . u <<. ol.;~.aFeb. 16,1968 ~ ,tt. s JURIAL ~ i1. OA:[ 24. s. NAME 0I CE11~'f~RY'~~~CR~CRE~ :7.~A~fOra~.~7. Tv~.~ L C.w~q) ISuid ~ ' `~E''"'r'" ~ 2-9-19b8 Calvary Ce¢cterq ~ Pittsbu:~;:_ Alle~hcny Pa. 'S..?~OVAL ~ ,:3 :w:.:R"'O YAE6.2~ EfittTRAR'SSIGNA7~~:<E 27-31GMATWlEAM0400RESiOFiW:s~A_G•+~ECTOR ~ ~ ~ ~ rli ~neral Home i; P~t:. , Alleg. Co. P ~ - ' - - - - _ _ - - - ~ jQ~~J,y ~,p ~ 800K 1~0 PAGE 47J Ls~ibilf ~jr o! nri;int~ typin~ or ' ~ printi~ ,~,..ti.t,~tor~ in tlti• ~ + doc~;~ent !or ~icratilait~. ~ T ~ ~ _ . ~ . _