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(too can. w. ~ COMMONWEALTH OF PENNSYLVANIA ~
- DEPARTMENT OF HEALTH N O g ~ 4 g 8 ?
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G.r~tKO:.. st.ooi VITAI.. STATISTtCS
LOCAL ftEGISTBAR'S CEItTIFICATION OF DEATH
Registercd No.
Full Name =
of Deceased •••-_..._._.._._.._.~~11II~____.._____._.-.__._..____BAj10.---------._..__.___.._.._~...-_•---~~~___..._..__.._._.______...._... ;
Usuat ..~~~.~nfmann A nue ._~~tt~~~-Sh-~SZ~Z---------~-~~enX __~.g~• _ ' `
Address ~ Gy or a.~ ~,4 ~ .
Placc of Brentw~od Boroug,~,h ._.__~leg~~Y Pennsylwa~a `
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Dcath te..a
Gh. M~ a Tews4io =
! . ril 4 _--1966 168•09-3119 ' --_-____Race.----- ~ite
Date oE Death . _Social Security Na y
~
I' Maie Nov. 2, 1896 ~
f Married ----.nau of s~rth___-------------------
Marital Status ----_Se:~___~_-•---•-------._ .
~ :
~ Pitteburgh y
Occupation Ss1eSOISA _ _Birthplace _
_._..W_.---------~__---- ~_~..._..y.~____ s
~
li Vcteran. which War -Veteraa's Serial No. ;
MEDICAL CERTIFICATE ~ ~~Q RE Interval Bcta~een t
Part 1. Death was cauxd by: ~T.~j1C1E CQ(t11~~~ Onset and Death ~
. OCE~+ P'ITRA ~
N ocardial ~nfarc~ion ~«R~ ~~Y.iJll~py~.T
Immcdiate Cause (a1-•.._._._..Y-------.-.---._--•----_•__-_---•--•--------•------•~--- !tE'4~lid
Y R?FIEO...,~,~~~ ~
Due To (bl._.....-•--•-------._ ~
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Part ll. OTHER SIGNIFICANT CONDITIONS: cantributing to deaih but not related to the immediate cause givcn in f
Part I (a)
Accident. Suicide or Hoanicide -•---•---•----•------•--------------•-------•------.How did injury occur
- I`ame and Title of Pcrson C~D.Mertin M.O.
~'}w Ccrtified Cause of Death ( M.D.. D.O.. Coroner)
Address --------•----..._.__~~QZ_.~1CQ~18Y~.~~.~..BQ~~~-PitC~tb~x~P~.---•--------_.._..._-------------
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. 7'his is to certify that the information hcre given is corrcctly copied from an original certificatt of deat6 duly filed v?dth me ~
as Local Registrar. The uriginal certificate wril! be forwarded to State Vital Statistics, Harnsburg. Pennsylvania for permanent _
E~ling. ~ ~
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