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Home My WebLink About0213 ~tx1543 ; j 'I5 OCT 3 PM 3: 4 0 . - ~ 1~'~~f ~ pOIKREC. ~ 6 6 O PAGE 9 3 ~ ~1':1R\I~G: It ia i12eRal to duplicate thia n..p~• b~ photostat ur photosraph. HIO~. t12- !~~`S ~3 ::3 Cer:_ yrr book~ (:1?\t~tfl\~1'E.\1.'(N UP f'F.\\1l'1.1'.1\L1 ~Fe~ t~r tAb I~EI':1lt"i'\tF \T 11F }!1? 11.T3f ~.n:~,~,.. ,Z..o~ . N° 3 6? 4 2 4 I,OCAI. REGISTRAR'~ CF.EtTIF1C:~T[OV OF DE~T}i ~ Rey;i- emt3 \n. F ull \ame af Deceased _ . _ . . . . . . . . _ First ' ,dale . . . . t.sst ~ . ~aaiess . /.j. L . _ . . ~amAe .l'tr'et f~t1 or ts.n t'o~ett ~ ,tate . Plxce n2' ~ /f~ . Death . . _ C:Jl... . . Pennsylrania . _ A r Tuwa.hip Cooab • - 1)ate of Deat V~/~// N S~K•ixl truri X~f~Q ~Q ~(Y~~!_ Ksc~y!-'~~`~r~~G/ ~4 ~/~Q ~larital Statu~ tiex ir~w nf Rlrt . --<--_--7 _ i Occupati~~n . _ _ ` Ri::hpi:irr ~'H~ ~`';~"T„r ' i . ~ 1` ~'e.eran. N•hich «'ar ~ _ . l'~trrat:'= Srris! to. . ~ - i ~1FDICAL CERTIFICATE Inten.a! Bet~~~een f Fart I. LleaLh wag caas (?r.:et ;tnd ~eaih ~ Immediate Cau;e 1a1 ~ ~ + / IJUE~ Ta ibl ~ ? ; ~ Due To I c ) - _ . . _ . _ . . . _ j Part it. OTHt:k ~ll~\IFIt':1\T !'~l\]11'flCi\ti: i-uri.rih~:tin~~ t~i de:ith t:ut nut +~•±:~t.•:i t~~ .t,e imme~t~:.te c:i:s;e Fi~en ~ ~ ir, E'art 1~ a f t . _ 6 - . t :~ccider,t. Suicide ur Homi~ide fi~~~t di.f ~r.;~:r~: r~~~:;r ~ tian~e and Title of ?c•r:on ~ (tT~c~/,~~~ ~ s «'ho Certificd ('auae ~~f I)rath (~i i~.. i~~ti~' i - ~ .~ddress . ~ - ~ Grrvf Cit> ~ This i; to ceriify tha; the ~r.furmati~ n hrr<• Kicen is c•:~rre-tt!}• ~•u{,ied fruni an oriKirtiai certi;:r:~Fk •1` ~~eat.h dule filr~l ; j«~ith mc as Lnal HeK~~trar. 1~he ~~t~K~r.ai iv~rti:icxte w;il l+e i~ ~~r;,r~Ied :n Stat~• ~"ita! ita;tsti,•s. fiarri~burk, Yenm}•iti•ani:, g ~ for pPrmanent :ilink. • ; ~ ~ I "~N _ ~'~`'939~~ ~ ,4~ • e nr o \lui ~~iU.~: Ui.trici Ko. ~ ~ ~ ~ _ ( . ~/a a ~ ~ _ . . . _ - q + . - ~treet A~dreu (y~, 1 r . i+~i11~ ! . i ~ ~ ~ m ~i:+ ' f t1 e R~ee~ 1 A. (_..c~l Reshtr~r ~ ; ' _ _ . . . . . .~r ts ,tir.E~ : ,t;;.~~ aED { ate sl •ve of ihGr Certif~utwn ~ ST f u;.~t ..:;;~yT. flA~ ~ CLEF~. CiR :U~ 3 3 . . acc:a~o v~.. ~<~o - - -~-f.ft~ R~coROEO arv~ ~ N~~ l0 3.0 ~1'1 J REC0:7,. ? E ~~CfiIFJc ~ D. •~i;,, , ~O ~ ' ~ pp ~ C~r, fr ` i ~ Mr. R. yPhilip Haddock ~ l~~0~ ~~.;t~n., F[~ ~ ~ Attorne at La~, _ ~ ~ P. O. Box 1839, ~a~c~~~y Fla. ~,$Q~ ~ ~ IOOK `!1~ PAGE ~13 ~ ~ _ ~ ` ~ _ _ - '~u,•-.~.: k - t"'J ~=E. * . r?~ 3 ~-~-~~~~w~~~.~,. . .