HomeMy WebLinkAbout0333 l
~YARNING: It ia ilkgal to daplfeate tLis cop~ b~ photoetat or photoaraph. ~~~0~
a~os.ic2--eoit x-~i
~28 Cert. yer Daoki Cp»Wp~;H~pLTH OF PE\I~Sti'LVANIA
- -
IFee f~r thts - DEPART~IE.\T OF HB~LTH - 1~1 ~7 ~f
c~~su~,k, s=.N? ~'ITAL STATISTICS 6/ H O!
LOCAL RF~GISTRAK'S CERTIFICATION OF DEATH ~
Registered No.
Full Name -
of Deceased -
~ E -------------------------------------My.~R .s._._....___..--.--.--_.._.....__~N.o.Q.x~-x------...---.----.....---..........
Pint Y~~ y~~
Aaa~3g .~..0..-$.---.PR4.S.P~.~T.---S7
...............N~?D)AIR.Y.----...----........~I~I.A..~.N_I~.I.S~r.?4rt._..........P€,A~~1.i9_-__.._...
N~~Mr St?eet Cit~ ~r b.?w Cw~~t~ Rtata
P18C! O~ prJ - A u C y
Death .ITT.~8u.1~.V.f~.._..._ .............•-•--•••---........._........._.._.._.....---••------•---..l..~.L.~-~.~7..~L.l-~l._....._... Pennsylvania
Cib. B~roo=A ~r Tow~aky ~~y
Date of Ueath ...._V ~Y.__~..~.f.._~..1-~-~•--•-•-••-- Social Security No. 1.~ _Jr..'..y.y..'_..~Q~ y~._..... Race _....Y{l.~--~.7.~..._
:liarita! Stat~s ------YY_1.Q.OW-~.D.•--•-•--•----. Sex ---l.._~.I~A-~aE.---Date of Birth ..---~J.Si.T~_.._1..~.t_.~_.1_.~_.~.._..
Occupatton --..-•--l.1~ u.s ~.W Birthplsce _...._~~,[-F..l\.~.~. ~-y.....1..~.
If Yeteran~ which War Veteran's Serial No.
111EDICAL CERTIFICATE Interval Eetween
Part I. Death was caused by: Onset and Death
:
)mmed'eate Cauae U_Iss.~M~NA1E_~..I!~7.~R_Y..A. s~_u~~4.R.._C~B.G?.~.~.A.tl~ . ..._.l._1..N_.~.E.K....
; ep
~ Due To. (b) .~ll.il.C.~.~ ~_M~.TO.~.~..~ 3._..Il.r ~.~_~S
.
' Due To (c}
£
; Psrt I1. OTHER SIGNIFICANT CONDITIONS: contributing to death but not related to the immediate cause given
F in Part I (a)
; - - • - -
~ _ .
~ Accident, Suicide or Homicide ...........................`._._~...How did injury oecur
~
' :~ame and ltitie of Person ~ p
"s Who Certified Cause of Death (~I.D., D.O., Coroner) ..l.l.~_R.....~A.R_A.DI~..~....!!!I' 4~--------------•--....
i
; Address '~.t~.~?'7.......F~_~=YH...A.~E..N...~.~ ..........-.--..--.....P1.TT.5.~.41.R.GN.
s~~Ke c~~,
This is to certify that the information here given is correctly copied from an original certificate of death duiy filed
! with me as Local Regiatrar. The original certificate will be forwarded to State Vital 3tati~tics, Harri~burR, Pennsylvania
~ for permanent iiling.
s /~T f~~~ ~ ~ ~ F
; FiLEO /?NO RECOR~E~ ~.~l7~~.~ll~:i'~..:~..._ d`~C~ ~..3.. ._.J.'r_b~...........
° ( ET.IUWE COtt1RY FZJ~. ~;,tnr .t v+i.i ~st.ct,i:n ~f • ai,irte. tv..
~ aoc~~ PO~fRAS
= A' ' ' ' CIE.°.K CtnCUtj C UR .
~ RECOROVEf~~FtEO •~-••S••••N~~1~---..z?..T...-~-----------~t~R.~E.TTS.T.O.W.N.
3lreet A~ires~ C1t~, Borou[6, Tewnshi~
€
:
. I~ 29 3 4i P'~3
,
~ ...---~.----.......I.~IOY....d.....-~ - iy .~i .1-~--
...2 .
' n.a Reeet.~a e, t..~.~ R.jbt.:.
4 .1~.oy ~9 7.t.......... 26 60
~2i~
- Dat~ ~t Iawe H'I'hi~ Certi(intwn n I
3
. _ _
r ~
b~* . ...,_~r:~,~^~~ar ~ 1„' i - • ~r ~
-~~.~r-
- _ ~ _ . •