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This is to; cert,~€jr~a~~~'t11is ~s a'.ttn~opy of the recotd which is on file in the Penns ylvania
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epu tmen~=~~,~'~; ~n. aFeo~ '"~.~wit h Act 6 6, P. L. 3 Q 4, approved by the Genera! ~ s
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Assembly ' t:{~` , 'g~ . ,
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(Fce for chis cett` ~ _ ~'y ,
,_,.~~#f~~..~,:.,~. 1 J. Finton Speller, M.D. '
~ • ."`r:;~ - Secretuy of Health
Harrisburg, Pennsylvania `
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f LEO ~M; RkC~RDED ~ ±
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RGCE ; POiTRAS ' ;
NiOS.t4~ REV. 4-71 GD COMMONNEALTM OF PENNSVLVANI RFCORD VER~F EO CO~'~T ~ i
LOGAL REG. NO. OEPARTNENT OF MEALTH ` i
~f VITAL STAtISTICS " ] £
vaiwuer Q~L001 {~[f 1 (Y ~4 ~fl ~
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DIST.MO (.U~fVI'ICi~~~ LCR/~f ~6.AIC Vf YGA~~~ t
i. DEATH Co~et~ Cit~ wA~iljM~ 2. DECEASEO'S Street ~/dres~, R.D., ar Be: N~~bet
OCGURREO MAl IING
A AD°"~ 3431~ WILLET ROAD . : _
dHll,lA ~pl OCCt Y CN~
~Olt 01f'Kt. Sutt a~/ l.y C.Jf
(Do ~st ~se II.D. ar Dwa N~6e~1
~ ~ ~ PITTSBIIRGH PA . 1 227
F~~ St. Francis Hoepital 3 VETERAN Ye~ ~ !Iu ~ j
d liopinl _ '
s Mstiutle~ (If ~et i~ Ses~ial, ~ine ~aett ~d6eu) ftiic\ ~~r NONFs a s~.~., r~. NONE s ~
l. NAME OF 4(Fintj b. (Yiddle) e. (L~~~1 OATE (Mmt?~ (Da~f IY~~tI ~
DECEASED.t ~~n~ ~ DfA H ~d'
V 111 ~i4,i-~ ~
' 6. wHERE DID ~ . . . c. Did deceased li~e i~ ~ ~o~aiip) ~ ~ . . _ . . .
DECEASED pENNSYLVANIA ~ ;
Sute _ ? Yes. dcce~sed li~ed i~
ACTUAILY j ~e~r~ship. ?
b. C A~,~ig .~Y R
- { INEt ~o, deeeased li~ed ~i~6u ~cerl li~ia e[ ~~a~k ; i
f 7. SEX s. RACE MARRIEO NEVER MARRIEO ~ t0. DATE OF BIHTH 1. AGE (t~ ~e~r• It rwdrr 1~e~r t[ rsder 21 lorts i
' p p 9/26/1915 , w.. ;
~ FIIKALE WHITI~ ~~EO eN«~~Eo
12. USWL OCCUPATION (em if retire~ 13. SOCIAL SECUNITY NO. 1t. BIRTMPLACE (Sute er lari~ cartq) IS. CITtZEN OF NNAT COUNTRYT
1 HOUShti+IIFE CONNEi,LSVILLE, PA. U. S. A. ;
` 16. FULL NAYE OF SPOUSE t7. iqTNER'S MAtDEM N/UtE ~ ~
I WALTER J. RIDLING SR. UNRNOWN ;
1~.FATNER'SNAME 1• IMfOI~WNT~MAYE,ADD11E5l~AMOZI?CODE
~ DH~IETRIS WYTIAZ WALTER J. REDLING SR. - SAME AS #2
! MEDICAL CERTIFICATION INTERVA~ eETwEEN
20. CAUSE OF DEATN: fitcr MI~ ~e nue ~er li~r tar W. (y !(d. ET A11D pEATN ;
~ PART L De~ ~a~ cNSd 6/c i
I IIY~pATE CAIbE W j
r Co~dule~~. il ~f. ~ld DUE TD (!1 ~
~ pn rise a ~bs~e c~ut
~ wtiq t~e ~ded~i~ WE 70 (c) ~
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~ PAIIT IL OTItF.II StGNIRICANT CONOtTtON4: rwerib~N~R m Je~eL .a..d.~~a ~e ~~e u..~..i ~u,.... aj... i. r.n ~ t•>. t~. w~s ~uTOPSr
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. i ACGOCNT U I2. OESCRIDE IIOw INJ1/RY OCCURNED ~ ~22. c. TIYE Ilo~r yoMb Ih~ YtY ~
~ SUICIOE pF ~
f NOMICIDE INJl1NY F. T. i
~ ?2. INJURY OCCURREO t2. e. PUCE OF INJURY (e.~., b~e, fw~, 22. f. CITY, BOROUGN, TOwNSHIP COUMTY STATE F
riile u Nw sAite fuue~. ~tta, ea.)
~ ~k ? u ~ork Q
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~M cmd~ dua i~~eniRnio~ ~f t~e ~ni~ d ~?e a6o~e dcc~ued ~e~~le ~tie s?ere stud. ud ~?~c d~e et de~~\ i~ e~ti~ced {
f ~ E. s T., e~ t?e Lte ~uud ~s~e. Pe ~
~~4.4A.~~p..~. li B. ~leon . u~ l. AYE.. PGH.> Pl~~w~u~ N ~ ~
~ t4. BURIAL ?,t. DATE . c. NAME OF CEMETERY TOqY 1A. d. LOCATION (Ciq, 8sra, T~p., ! Cowc» (Satt) }
~ S/17/1973 CALVARY CBMETERY PITT3BORGH, ALLEGHENY, PA~ F
28. OATE qECO 81/11EG. 26. REGISTRAR'S SIG?/ATURE 27. ATURE AN A OF fUN l OIRECTOR
/ ~i - 73 ~ - 1~H)t ~I. au'[t..~t sot,..
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