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Home My WebLink About0089 - _ ; ; - . s~ WARNINGc It ia illeRal to duplic~te thia oopr br photwtat oc p6otoRcaph. . I . JUL 9 - -g~~' ~ - ~ . . D+lt~,~ `u~ ~ ~ ~ . No. , _ ~r ~ ;~~lR~' 17,j,~? ~ ~y, ~ • • ' 'IUis ia w ceKifr that ~ts;u'~ " :g~-~t e record whic6 ia on file ia the Pennaylvaaia , , ~ Deputmeat of Health. ia L. 30M1, ap~roved by the Genecal Assemblr. : .r , June 29~ 1~. ~~i rk ~ : ~ _ ~c ~ii . : r~ ~ z I~~ i - ' ~ . * • - ' I'7 I ~ ~ Y - ~ ~ , ~ ~ ~ . . . + (Fee foe this ca~tificat¢s ~:00) • ~ . ' ~ ~ ~~t , _ ~ < - ~ Ellsworth R. $rowneller, M.D. , ; t:,' i_ ~z~ r~ ~ Secretary of Health ' "i - ~~3H ~ ~ . • Harrisburg, Pennsylvania - 'I ~ - ' • CpMON1rE/1~.TN OF PENN51/LVANIA ~ } ~j~ ' • . ~ E- u'~ ~ . , OEPARTMEI/T OF HEAITM ~ ~ . _ . ' • VITAL tTAT1fTIC: . FIL[ NO. vnpu~r asTS~cT No. ~0 x • ~ MEOlCAL EX/1YINER'S CERTiFIG1TE OF OEA?H • eee~sr~e~ ~p. D~ ~~Q ~ nvvui~r pt~?cE ~ o~?rn . • - ' ~ . ~ uaw~ n~oeMCe . - . - t INT~FsNATION ~IRPORT - - ~ s~,;. YIRGINIA c... ARI,II~G'1'0~T - t ~~rsia~ vaoNOa+e~ea oEwTM 2. OAT! ANO TWE OF e c~r. e«..~.. ....?y DR WHALE'~l ~ ~ . • . 1 23=68 ' ~ ~ ~ AAZ,IIiGTa[~i - . e. vucE os wea~ouweo+eNr . ~ ~ II~T~L AIRPONT DISP. ~«u?onrNU? 4=55p. ~c.s.T. ' - . . . ~ i - 2001 N. ADAMS STREF~' s. MALE OF OECEASEO e. w { • . • . • - - E . Ct ' _ K~ II.~ocr - i. SEX - i` RACE . . TE OI 61RTM AGE MARITAL STATYf VETERIIN MALg ~IHITS 8- -1 ' 65 MaRRIED T" ~ ~ . unzENSw ~ • ~ ~ ' ' - -66 N~t JEASET ~ . ~s suu w?r~ oF sPaus . rorM~e ~o ~ . . - - ALIB~ WAKEFIA.D . - v. i /L FATNEII MItME - INFqtMANT S . , George Washington MaIlveen GEO~E M.- McII.VS~t JR. - r . . . ~o. ~tac~~ cERn~c~?~na~c: ~ ?p.y ~.~;y d.... a. w~..r d. ~..«aP4w ~a ~s.wr~s~.. • . ! + . ' n.~.~». ~..~.K...~» a...~'?~1~'1xf~l}~CC~ROED. ~ - g ~ ~ ~ ' ~ ' - ~ ST. •LUCFF CQUNT7. FLA.° ~ ' ~ • - ~ ' ~ • . '~`';C~1!?T~;V£RirlE-D ' ~ ~ _ • . I R - • ' . - . . . • ' • ' ' ~ . ~ - ~ _ ~ . - . ~ ~ - - " - . . . ' • ' • • • - . . . . . - . . . . _ , . . - • : . . . , -.~~A~ u P . .,r.. .K.............. . - , - . ~ n~~~ ~p NOITR:,S - . . - •2/. pRCUMSTANCES OF i1W11FICA!/T INJtNtY., li MONE, STAT NONE ~e~s 1~t /~cY ~11?i~ ~ta~ ~ M • • r rq~eatd irr i~ ~fGte ~1 t1e PLiWel~i~ Ms~icd ~~iMr,~: . ~ ' ~ , . _ INlURY . : ~ ~ . ' ' ~ ~ , . ~ NNa1S • . ~ . • ' ' • . _ : ~ ' 2f. c. wMLE AT wOiRK f~; ' . ~ ~ . ~ • ~ Yes 0 !i~ ~ ! 21. •PLACE OF ~NJtMtY - - . a CITr, GOYNTI/. YATE • _ . •w •f . ~,F.~~ ~ ~ ~ , } il. YAtiNER Oi OEATII ' ?A. S!G? r Tt~ ~ N• w r~ i t OFFIGE Oi YEOICAL EXAYINEA . DATE SIGNEO { ~ PRESUI~J~LY t7ATURAL . • I~TM A/O w000 STREETS la2~g f r, M.o. ~u., o~. ZHE ~INiORMATIOM AW11E iMALI NOT ~E Al EO EXCEPT ~ iME YITAI STATItTI~t WYif1011 Ot TME MEOIGII EXAMp1ER M~. BURIAL M`. OAT< 2i~ A NAYS CEMETERY 011 CREYATORY LOCATION (G11r. GOYNTr, STATi II CNEMAT Q _g~Ei ~ REI~10VA1 y~•~G ' Fort Thamas Cem. Foi-~ Thomaa~ Keatuclq ~ ~c w•o w wewsr~ w[s ~w's sw T 2!. EIGNATYRE Qi i oa?t, aR[cra~ w~ i,~ G ' ~f . , : ~s V . . . . . _ . ~ ~ -e-~ ~ : - -