HomeMy WebLinkAbout2433 WARNING: It is iUeg~l to daplieste tbis eopy by photostat oe photoarap6. ~~83
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iYS Cert. yer boolc~ COl~!liO~WE.?I.TH OF PBNNSYLYA\IA
~pK t~r t~s DEPAHT]lE\T OF HEALTH ~~1 7 9 9 S 3
=~•N~ V1TAL 3TATISTiCS " t
I.OCAL REGISTRAR'S CERTIFICATION OF DEATH
Registered Aio.
Full Iv'ame . ~C ~ ~
of Decesaed .......................~~r~._...._~~~~_z'L~"
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Addtess . . .,---•-•~V . . . _ - -
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~18CE Of
Death . . Pe ma
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Date of Death . . _ .~~.,~,~T.~...... Social Security No. .l f~ _.Q_~o~ Asce ~~~!~7~~.._._.
11Sarital Stutus .<I.. . . Se . . - - - --•--Date of B~~h -_-lo--- ---f9~.t
Occupation . . . Birthplace •
If Veteran, which War Yeteran's Serial No.
MEDICAL CERTIFICATE Interval Between
Part 1. Death was caused by: Onset and Death
Jmmediate Cause f a)
Due To (b) .................LX~LC'"G2%~L.~l~._Q•~vJ-----~ . . . •
Dae To (c)
Part II. OTHER SIGNIFICANT CONDITIONS: contributing to death but not related to the immediate cause given
In Part I(s) E~~Ep Ayp RECORQEO
. _ .....5?. WCtE COIfNTY rU. .
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ai < <0~ RdCER~t@?fA~-S•-•-----•-
Accident, Suicide or Homicide ........................•--•-••--How did injury occur
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Name and Title of Peraon ~ 6~1~ f~~
1~ho Certified Cause of Death (M.D., ..H~6-;-6~~ener ,p~~i__,~.2 , tl
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Address ~t~
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street ~ J .
- Cify .
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This is to certify that t6e info aticn here given ia correcUy copied from an original rtificate of death duir €itel _
with me aa I.ocal Registrar. The otiginal ceriti~cate will De iorKaraed Lo ~raTS'viiai Siaiisiicx, riarrisuurg, iC7i?mjivaTii.i
for permaneat iiling. .
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ef Yi Statist;es Ubtriet 1~~.
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D~te Recei~ed b~ RerLtr~r
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Date ~t lrsre • b CertlNqsw~
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