Loading...
HomeMy WebLinkAbout1873 ; A . 'fi~ ~ WARNING: k is itipal to dt~pliuM lhls topr b~i photastN or phqto~r~ph. ; Hioe.~u eooM 2,n - ' - ' pOQ C~n, ar book? COMMO~IWEALTH G!~ PENN~YLVANIA . t]~~f~~ ' p[PARTMt1~iT~OF. H~ALTH. V ~~a~ ~ f (h~ !x dd~ - ! C~ifload~ i~.pp) _ . ~ VITAL_ lTATI~TlR~ N~ 12 ~ S~ S - ~ LOCAL RSGLSTRAR'S CERTIFiCATION OF DEATH , . - . _ ~ _ - _ _ ° - . R~ rtnmber_ 116 ~ Fuu Name T~lilliama Lo~ Helder- 3 of Daeasod . ~ _ , wwat. - - - ~ ~ ~ t~ ~-~~-1309 t~ilmingtoa Avenue, Hew Castle, T~s~xrence, Pe~sylvania ~ ~ . tiv~br : sw.t ~ - CtM « rowe , , ' . - cowMr ~ , ~ ; J~meson Memorial- Iiospital, New ~astle; Laxrenae_ - - Pronsyivsaii ; - - thr, ia.vol? e? terw~f~iM ~ ~"v"t~' ~ t Feb~ $ 1973 1 2"09~ ~ Date of Doath .a .t Saiat Secnrity . xo. C auC as i e]~1 i _ _ , ` ~ a~arwi ~ Married ~ j ..._..so:. Male ~ s~ ~ Jari.. _ 21, 1911 ~ ; ~ . . - ~ : - - : ; _ Ne~ Caetle Pen~na lvania ~ ~ ~ Auto Saleeman A;~~ , - - Y ~ ~ ` - ~rta ~ ~ i u vetuan, ..~h war _ . vaeran•: suiat = ~ . ~ Inierval Be~rae ' ~ MEDICAL. CERTIf7GATTs - : f A. 0 RECO E = I Part I< DaW was caused by: i~C1~C 0 i it~T~~ O,~set snd Dead, ~ i t~rocardi.al ?n~aratio~ ~ocf~•~qtiRASr ~ daYH; ; ~ Lnmediate cause ti) ~ . ! RECQRD Y£H4F1~6...~......~ ~ . Coronar~ Oaulusion _ _ ~,._~~s : ~ Due To (b) _ P ~ ~ ~ j Due -'To (c) ~ ~ Part II. O?HFR SIONIFICANT CONbrIIONS: contributio~ to death lwt not nlated w. thc immediate ca,use aivw in ~ f ~ Part I (a) . i ~ t ~ Accident, S~deide or Honucide~ _ _ _--How did injurY ooeur i j Name and T'itle of Person ll~ L~.8I1T39 ~~6~~~~ ~ ; Who Cectifiad Caux of Death (M.D., ' ' s ; ~ ~ ~ Address _.~L~~~Z'~LL~~'c`. e W aAi~'~. e s-~-e~~l y r~ ~ sf ~ ~ , ' su.n ~ ~ 'li~is is to artify that the ia[ormatioa here given is corcectly copsed.fmai sa original certi&cate of death duly fikd ~rith ex ~ as Loca1 Registr3t. The oneiaal certificate will be forwarded to 5tate Vua! St;tistia, Harrisbur~. Penasylvania for ptrmamcdt i f~8- - a~c,,,.~ 3?-352 - « ~ ' ~ t«~ R.ss.~r s~.w~. wa.re r+.. : ~ R. D, ~7. &ii.nburg,~'ennsylveaia 16116 ; ; ~ s~a wae.a~ cnr, ~...~i. Tow++~r . x ~ Feb, io, 1973 3 ~ _ y~ ~g ~ ` • Feb . 10, 19 T 3 a~. e«a.~.e t«e+ ast.~o. + - - 19_.. dQQ~~~ /Rl - ~ Ca» ot I:sw of Thb Grtifioeeloe ~ , ~ I x ~ , _ _ _ : - . - _ -