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Home My WebLink About1981 WARNING: It is We=+~l to dapUeate ti,~. eepT b~r p6ot~stat a~ ptiotoRrap6. 30fi2s6 ~ H105.t14--$OY !-tl . . tta cee:. ~ sookl COAIMONWBALTH OF I~BNNS1'1~`1ANIA _ ~ . ~ lPee i~c tLb bEPARTllEI1T OF HEALTH 1~1 ~ 4 a`; O 7 . c.~sn~ i~N~ ~V1TAL STATIST[CS LOCAL RF7GISTRAR'S CI£RTIFIGATION OF DBATH Be~iatered Na - ~uD oea~aed ....._..__~~~.~G~d.~f.~r.Z/ ~ . .......~~%i-~ . . no~t 1lM~e ~ 1~.~1 . na~ l Q..4~ . ~~~~..cr~r.~..~.......... ~ ..r_._._~.....--.. x¦:i.t se.r.e cni w:a a+.is . d etak Place a~f , _ / De~th .~r ..~J..-~~~~~~~.......--•----•- f.cf! . ~''~~'._.''M'!»_... Pent~ytvsnis ~ ctv. e.e~::... 1+.~...a4 . D~?te of Death ..w2:=C~,N ~_..~..~r1. Social 3eeurity No. ..~-~~_"_03_ ~~..z~~8ace ~ , . i i~ . M~rital Status -•-...Date oi Bitt6 . . ~.i._.~~.:~...__..__..-- Sez i ; _ : { / ' I.s ~ . _ - . ~ - ' Occupation .i~-~:22 p - .T- . ~ ~cP~~?~t.~:~w Birtfi b?ce . . - ~ ~ _ . ~ Yeteran's seriii No. ::3 .._..70 ~ u vec~~,, wu _.Z~-------------___._..._------____..___._.__...__.---......_. ~ 7 ~ ~ MEDICAL CERTIFICATE . ~ " I~?tcrvsl Bet~en ~ Part I. Death ww caused hy: _ Onset and DeaW ~ Immediate Cauae (a) ,~p • , ^ ( ) . ~ Due To b ~ ~ ' Due To (e) Part II. OTHER SIGNIFICANT CONDITIONS: eontributing to deat}~ but_not teLted to the immediate cause given : - . ~ ~ /f ~ ...i~-.I (~~'Y.!:~r~r~~.s..._4~'_.~?-..._._...lX~..~'.~'~.__.~• ~ Accident. Suicide or Homicide ..............•-._........_..•--.•......._._._...How did injury oeeur ~ Name and Title af Persoa L ~ ; . , Who Certified Cause of Death (M.D., D.O., Coroner) - %e ~ U ~ . ~.,tf ~ ~....:•$t~ ----~-~t.?~::2~.'..-••-••-..i~.••••-/...'~.:.---•-- • - 7 A ress • ~ ~ This is to certifp that the information here givcn is correcdy copied from an originsl eertificate of death dnly filed ~ with me as Local ~tegistrar. 1'he original certificate will De. forwarded to 3tate Vital3tatistica. Hanisburg, Pennaylvania ~ for permanent iiling. _ ~ a f LEtS ~ti[ 1t~C~vE~ ~ y~ ~ y_ ~ s, . . ST. . ~ -:::!tT" F: ..-r~-sl~LL~.cz`_~. ~o-itQA~.POi~'?qc lwcal RKi~tnr ~I ft~I81sW4es D4t~fet N~. ~ ~ cLL`RK C`lGCae?' [~yy~ ~ ~;l =y, ~ ~OaI~tZ'Y~ ..:1"~ L~S~~~~~'~a~<:~~ ~+t ~ ~ ~ 8t?~rt Ai~nr ptl. H~+~slti T~weab~ r- ~ `~a ~ ~_~'R 21 1 : ~~4 f-. . - : .:...R 19 7~r-•...._.. » - . D~b d~Isa~ ~f Ttii~ C~stllk~tsw ~ „>~~„~,ds'w"-r ,~,x..~" G, ~k.43 ~r` :l . . . ' _ S ~ . ~ ~3}.~ ~e~"~~ ' I ~ ~ r _ _ lii y ~ ~ - . t~-c. .