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1840
W!s-3t.N1I+FC:: it ia tlltjal to dL~• ~ at •:>:-s ~~'rY eY Ph~:cs:at or ~.ha:~rra~L, k/ , ~ ~ O ~ Dat~ I~f~. ~ . ..,..r• - T:~ia i• to csrtifr that ti?f.i is s trur caty of the record whic~ is oa tite ia ; the PenasYtrss~ta Dep~p~,~t ot Hc:Itlt. in secore3~ntc witn Act 66, P. L. ; 30~, a~prdrad `Y tlt4 t~exsral As;~e~r.hdr, J~ne 29, 1953. n~,Ep ANOII[pq,~~~ ' t 1. `11CIE COUMTr /lA, ° ~ ROQEA t01TM= ~ ~ ~ - r,- . - C ~ ~ ~~iL~i~'~/~i ~ ~ ~ Fte tor chi• certifi~it~. SI• 00) ' CO~VERf 0~~~ 3 ; C. L. 1~ilba:, Jr. . x e~~~~' ~ 21'7696 3sc r~tsrr ot Hsaltb L0 ~ Ha:ri~~s=. Ps~wYi~aaia : ~o~cw'~iii ~wo ~ ~ O 7 ea~n~o+rwwra ot hwasn.nx~w iC ~!~9s _ . . w+~?e~rwrt w w~rM ~ ~xu a•r~ ~~~•o .Z a" d//- C~T~lC'.~ATE Of D~TH ' ~ ear.~ c...~? c~. ~«~...n o~ci+~~o~t . sw..~ .w.., ~ e, w. ~+..r.. ~ - ~ - - ~i! ~r~---------, 13S S. 38th 9t. B1od. c. N~+~M A~/ rf w~ Y G~r ? hA O~n, l~w~, ~ 1Mb i~~- - w l~ew~. Mw w~~ ~1 N?+w~.' : ~ : ia r~ ~ 0. • M~ M~ri ~'1~ i - ~ r. H. *:r t~rpltal ~i~ Pa.- - - - .s+~u?M ~ ~o ~ - ~ .r ~.dM~/~.. cM h ?...+w. ~w.d a ~a+r w~ ~~l s. ~«+d M. ~.r~.~. _ s - - - - ' • - _ : - s ? ~ a. (P4d1 (iM~i.~~ c. (L~wl ' ~ iAf! IM) R~r) ' ~ ~ ' 1~rr~• « r~.?1 4~ot'p , c[,~tN ~bTq1,t'7 ~L _146,2_ _ 1 ~ 1t1~ - - - - - - ' ~ wrwa ao M, ~ o.. :...r`r.. a.-f...+~.t - : wcaA/s • SH.. r.~ r.wM.t M..~t i~ +tiCtM11L?T ~ , lfRt ~ C~~ 1~ ~wN Ihwf ~t~M tAaf ll~h d . _ _ sMf rr rww~ . - - - - - - - ! ~ . M ~~r ~I Mws 3 1~ t COtOR O~ 4.C~ t. ~1A~iii a MN! YA2tli ~ i N Dalf Oi ~7fTN ' 11 AM ta }w~ M~r - Mal~ l~th lt~ w+~vw~ p ~rrwca p! 7-29-% ~ 6 ww•`•, ~j ~ w;• ~ w..:: -!.M: - _ ~t u{~iw~ oOCU~~i~or~ 1«r x~.awwl ti fO~CIAC fiO~Tr ~e0. ~ N f1~tr?+ruGi •r f...y. ~.w~q; : M. Cm2w Of wNwr touNtetil ~ Tl~~is~l -2R~~L~ _ _ _ _-~_32-~'1-- - _ - - 1~uu ~u?w os t1ouM ; s~ wart~i~s iu?NM ~j~+~ ~ _ .~91-- - ~L~i~ .isas:~r• b ~a N?t~~s M~w - n r~FOSwxr~ .Mw ~Na ~~oo~s~ar~~~.~17t1~! H i: n~ s ~ L3 S '36Lb f t Hl~,d ,~1i,_~_ IriEDiC.AI c~RnHCATF ~K... s.r..~. p~.. ti.+~+a+. .~A~ wi,wr~~ .w'~ _ » ewuu os oa•n+ ~r.. ..ti ~..n. w n.. !~s oMSn NM eMm - .nn ~ o..w M Iatwratlaa of qoa~rdiu~, acuta 2 bota• ~Wa~Oi~tE GwtrSt (~i c...»~.... M... ..K. w,c ~o i.: ~rt~riosol~rotic coraa~ thraahosi~ 3~.ar• H ~ . (~i tMe~y 1M ! ca~ 4rf DN! t0 (ct - _ _ - - _ _ - - - - - r,r! o?Ne~ sia++~r~GwMt Co+~a~,o~tf o..r.~~e~ ~..w ?w .w ~.ia•.t i?. r...rca. c.w I. ?«e t 1~1 i?i ww1 wvtw~flr ?frOR~Irt ° - - - - - - - _ _ _ _ - - - - - - Q - ~ i~ II • ACG1Df1'11 21 ~ D[Sl.i+~l NO~M AOCIOfN! OOCVi~~ - - ~ tt.~ ltNf i4M~ Y~wN p~ ' TM I-~ Mi `J . ~ i AOC~~if~ tS.T , - - - - - - ~ 71 ~ ACG'JEM~ OOCvRliD T'i e~U1C! 0/ AG:. OiN~ 1 11 1 CfTT. ~(NiOWN. 70'1UliSH1/ CO~MIT? t?Al1 - ~ wf+. a+ ?rM ~At~. r~.w~. M~~w. ~s.) rw~ M wrt f l y . n ~..f.+. ~.I~~%~~ ~ - ~w.~ wti w<..... w w. .~w.~ w.. 9135 a... t ~.r • Syetrrr. Ri • • y 11 H 1 h' 3~ 2 6~ -~j u Or~1'i ' K~ MA~i Of Cl1~/Rtl7 O~ C~iAt~O~'f r~OM IGHf Mr. 1.~ cwdt! t~wr utu..n ~..~o~*~~ ~ L~~6,'6E ~ Girara ~ Girsrd~ Fsie Cc. Pa. ~ - - - - - - - - - ~ owr~ ~ic~~. ~tc t. ~Ea~sru~~s s~s++~rv t~ `?~urw~ ~ os wNCtu auc~?o_aL/ ~ - - _ - . ~ . - - ~ ii =`M-- ~_._-.-_-~'iru-r..~s ,`....t,._ Y f~.. t~Rx 1~6 F:,tE1839 _ ~