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HomeMy WebLinkAbout2113 . 1 w~NtN~i~~. k i. +ayd ~w a~? N~.~ « r1~r+N~. ; N~os.~t: ~ootr t-re - . • ~ t~0e c«+. a! Md/ GOM.MONYVEALTH OR lENNSYLVANIA ""~1 IO~• ` ~ OQJ1RTMeNT OF HiALTM . _ i o."`'+~`.~ u:o..? ~ v~rwc. srwrisT+cs N°- 9 4 7$ 0 ~ . ` LOCAL R~G~ATRA~B C~BTiFiCATION OF DEATH _ : - . . Rc~d Na ` ~~~a~--- ; ~ ' - ~ .~'d ~ ~ _ ° t.~ t F ~ •ww~awP • 1?~ ; _ l~wF' Gb ~t tMr~ iNM ~ ~a " . , ~ ~ - 4 - _ - . CNb: ~e~~M~r ~w..M~? ~ _ ~°n~ - ~ - s~,, ~ ,~"o a , _ . ; _ : ~ - f ~o ~ ~ ~ s~ s~.._ _ ; ~ ; - /I~ ~ _ _ - - j If Yeieraa ~o6Ecb Wsr _........_.Veterim's Saial No. : i I~DiC~, ~PtC.1~~E - - Imen~al Betweea i i Psrt Dc~tL was,, bp= =t~~~~~ Omet ad Deseb ~ ~ ~ } i ~ ~ ~OC#R POlTI~~ ' ~qsedlaEetC~r~e'(s)_ LsicSs~~i~.t~st~-S.G~ _ ' i , . . : t ' ' . Dae To jb . - r : 3 C`, _ _ ~u~ ~ Part il, O~IER Sk3I~IFICANT OONDtITONSs aaatri~ti~ to~ dwh buut not rclatcd to tbe loa~iabe cauae y~ven t4 ~ ~ : : . _ 20i'782 1i~a~. s~aa~ a t~ - _ ~ a~a mp~? ~ i . • Name an~ llde c~ ~ , ~ Wb Ccrti[~cd C#~se`~~ t6t.D~ DA., C~o oc ) ' 1lddrsa _ . ~ ~ - 'i?~ is to oertfiq tbat_d~e Wvr~attoa bcre~v~ i~ ccac~cdy coDicd Gom an ori~lOal «rt~HcaRt oi drat!? ~nhr dled ~ith me. ~ lteqis6rar.: 7~e cri~lna! oe~eq~Caee ~rlll Le f~nvaMed Is State Vkal S~ Haeritba~ PeooNtva~ jor pe*~~ot _ ...'_':.~.~~,Z ~ ~ - : , _ _ . , . _ ~~~f : . ' i . =~.s: boW..+ b t.o.~ 19~ ~i~..i~~ ._.19..~0 . - - ~ our ~....i . . _ _ ~ _ . _