HomeMy WebLinkAbout0737 ww~r+~NG: If. r i~b~al 1e ~lie.t. tAf. wrr ~f? r~•tosht K~ot.a.~•
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I~oo un• o« e«U ~3 OOMMONWt/?LTN OF P[NNSYLVANIA
st« e« ~W; DErARTMENT O!~ HEALTH
~R~. ~~T~~~ N~ 5 9 9 3 21
LOCAL RSGISTAAR'3 CERTIFICATION OF D~ATH
Repi~tend No.
' Fun Namc Joseph Hers~n Beck Sr.
oE Deeeased - -
ws~ ~'iii+iw ~?~r
; 5512 _~Iolfe I~ive Pitt~bursh 1~236 Alleohc~r Penna.
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i ~lace ot g~ldrrin $orvu~h llle,~iner~? p~~..
~ a1f. M~+~~ M T~ ~ CMMy
f Date of Death Janur2'y 16~ 1964 SOdal Secmity Na ~72-~1-9/`+~~ '__._...R~oe__._ ~t6
~ -•-•---•-------_..._._~_.....__M_r. -
' Mantal Statiu __~r?~ed___-_~ Se=. ~le ._____Da6t of Birth.._ 1~2 _
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= o«u~c~ ~ineer -~e~~a« Ger~az~
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~ If Vetcran. w6ich War •-----•--••--------Vettrao's Serial No. .
~ tIdFDICA[. CF~iTIFICATE F f L~0 A N" ~ F C 0 R 0 E D toeervat Bec..eea
~ Part I. Deatb w?a~s caused by: Oa~et aod De~
~ ST. LUCIE "'~U':TY F~.~.
I~me~~ac~ C~~e ~a~_ 2~yoeQrdiil In~crction ~.~i~h Rr_~~~~
~ _ _
~x
~ Doe To (b) co~.~licct~or~s of '~be ~es
~ ~ , .
`j Due To (c)~ ~r
Past II. O~
THFR SIGNIFICANT OONDI'I'iONS: convibidaq to de~t6 b~ ~ tmmedlate cau~e pivta m
~ Part I(a) CLrRK CIRCfMT COURT
~ Accident, Su3dde or Homidde How dW lajury aceur
Namc and Title oE Person Jo.. n. Dob~s,Coroner per J.Kieren Jennir~;s~Dep.
~ ~Ybo Certified Cause of Death (MD.. D.O.. C.orooer) ~
Adar~i.~-----------__.___...__ _ ~2-~th Avenue,Pitt~hur~h,Pa.
se~.d ah
Thlt ts to certif~tbat t6e informatlon bere pivea 1s aornecdy ooDied from ra otiptaal «rtiflcate of death duly fi1M wleh me
- at Local Rep;strar. TGe oriqiaal artlHcate wil! be forwarded b~ State Vital StatlWa. Hatri~butp, Pennsylvada for pe~saoe~
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- ~ Brotn~vi2le Ro~d,s Pitt~bur~h,Pe.. 1 22~,M_
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Jenu~ry 18 19 6~i ~
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: ~ ------_~9__6~' e00K 1~70 PACE
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