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HomeMy WebLinkAbout0335 ~ WARNiNG: It is ill~gal to duplicatc chis copy by E~I,:~toscat c~r E~hotc~,rap}:. 'ti ' ' • ~i ~ J~ " Date No. ~ - This is to certify that this is a true copy af chc rccord N~hich is on filc in thc Pennsylvania Department of Health, in accordance ~vith Act G6, P. L. 304, appruved b}~ the General ' Assembly, June 29, 1953. . ~l _ T ' : . ~r~~.t,,.. i\~Z~ (Fee for this certificate, S2.OOj J, Finton Speller, M.D. _ ~ Secretary of Health - - Hanisburg, Pennsylvania . _ - . - - • -t- - - _ H1~_16~ R~v. 4-71 CO~MONIIEALTX OF PEtiHSYLVANIA ~ ~ M. E- CASE NO. 7~~..7~ OEPMTMEfJT OF MEALTN _ , • NTAL STAT~ST~CS i1LE NO. L - PRIMARY ~ISTRICT NO. 51001 MEOICA~ EXAAINER'S CERTIFICA?E OF OEATH REGISTEREO NO. 1. APPAAENT ~ACE Oi DEATN I~. USUAI fiES10EN~E t ~~uoE~~+~~ ~ s~.~~ FLORDIA ce,~~ PAL~I BEACH 2~. PMYSICIAY PRO!~OU`~CING OEATM 2_ A. DATE AHO T W E CF c. C~t~. BoroadS, or Tor~~Ai~ a.+,! 2~pCodr ~ PRO~tOUNCE~ENT _ ' DR PEDROTTY 1-~-~4 2 c. PU1GE OF ~AG~O~yCEwENT tn~t N• < ' hAZARETH PNII.ADELPMIA 1; OP.y~E.D T. 1220 N. ~~E~' STREET ~ NAME Oi OECEASEO l us 11L6C c• so ~ow~ ~a1 FILI:?ff NA JURGELIS S_ SEX 6. RACE 7. OATE OF B~RTH S. AGE 9. WRITA~ STATUS 1. VETEa~w FEI?1ALE WHITE 5-26-1912 ~ 61 MARRIED Ye~ ; ~ 11. CITIZEMSM~P USWI.OCCUPAT~GH . SOC1 l. E U 1 V N1iM . ~10 f-•~ j.__ U.S.A HOUSEWIFE 14~-0~-~:~A1 UNIO\ TO~v'\~ PA • ~ 1S FULL MAyE OF SPQUSE . YOTHER 5 MAICEN MAN ~u T T nT\ a~To - Senu \o. ' ~ 17. FA MEk'S NAM£ , . INFORYAMT'S hA4E ANDRF.t~ G~RG~\\O - ELEAA'OR L. SAR~VLLO - ~ 20. MEDIC~L CERTIFICITIU\: 1 6ereS~ eert~k eLat oa tSe E~~is o( tAe h.e~:~:a6os u! eias~uat.oe of the 19. REIAT:CtiSH~P ~ SISTER bd~. i~ epiaios. de,el «e.aed ea ~e d¦ee a~d uae .u:ed .bo.~ ud iD~ c.¦.e~ o[ de.rs .cre: - ~ - i. - - NOT DETERI~II\ED - - - - - - ~ ~ ~ k C~ ~s x - e. ~ - Il. Q6cr ~p~ ~c~~i oeo~vo~• _ ~ - - ~ 2~. CIqCl1MSTAhCES OF SIGhi°IUNT INJU+iY. IF hOhE, STATE "MOt`E° llafutra~t~u~ n6~rC~e6 ~'+e f~cb o~ teii dc~th o~ be • c INJURY req~e~ted 6om tSe o(6ce o! e!e PA~1adelplis t!ed~cd ~S~i¦er.l c~i~ ~ t1. c. wMi~E AT wOqK NO\ E ~ ~ ~ ~ . wwSwuTO~Sr PEa~v`..~_J ~ 2f. 1 PIACE OF ~NJUAY 21. e. GTY, COUhTv, STATE ~ ~ Yt• t~ Vo ~ ri~ ~ r 27- WNN~R OF DEATM IGNATJRE / OFFtCE OF Y~Q+GAL Ex~u~~~A II :S. CA:: s•v~c7 ~~T.~ . , ~ 1)TM AND w:C. STR°_~TS ~ T * / ~ / / , C • ~.(/7-~~ M.D Pti1lq . PA i4'^7 1^ J~ I -,t p~si~sar~~_ ~_~_~_R~i.__,_~~-__ - 7ME IHFOR?~ATICN .?9~~E SY.AL~ 6G~T 9E AITER[C E7(CE''? SY i?i: Y:TAL S7ATISTICS CtVIS:CN CR TME YECiCAI FxAM:\FQ - 26 BURUL ~ 26. D. OATE 26. c. ?:+tv~ C= C~~[~~aV CR C'~.vaTOp~ j i: -.t~' • Y. C4 ~ ~ CREMATI7N ~ -'~7 ~ .l L'Ct) l ^ ~ ~ REUOV~I L)O 1-~ 1-7j1 ...TOSP^:l ~ S CC~''.~t~'Tti' j.:e:7`.~Y~'I" ..7. , 27. 6ATE RECC-BY REG~.TFAH FEG ,tRAR'S6.'.VATL~7E ~.a}O )1~ SY '~Tl~ Lt'A1~1n~an J' ?~(~1 y~~ J:-, JAS~g-t:i~ _ ~ ~gi;t1~-- ~ ~ ~ , . ~ ~ - . ~ ~ ~ K. _'`7 ~;,5 . `.7:GEE 8 EJliNG r` - - :EVS AT L:.W . 2 C37M. FLORIDa. ~ , F~::E i 4 `~~4 _ . ~ ,rx` - . . ' - ~ , n ~z~'r'T . s,,,~~ ~ f x~'~~ - . ; '-;r.- ~-xT ti ~ ~ ~ . . ' . • ; :i ~ --'~':_a