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Home My WebLink About0443 1 ~ i ~ ~ , • i?r - • ' . WARNING:_ ICis iflegal to duplicatc this copy by photostat or ph~tograph. 3~1~21 - • ~ ~ r. - , - .~:~;~i-~att~~_ 3 9o Z , _ . . , - > ~ ~ ~ Date ~ No. BJ~! ~.a~t 45~ _ ' . . . This isr~"to.~certi~jc,t~+a~: this is`i true copy of the rccord which is on filc in thc Pcnnsylvania rr': ; ~ _ Departraet~:o~~He~t}~,~ in,~~cordanc,e with Act;66, P. L. 304~ approved by the General 3~ Assembly~3v~'•(.9j~75~`t~ ~~~j~ - _ lif~ . . _ 1 _ , , ,O : i 1 1 I... „ ~ Fce for this~c~• tcate;~32:00~ - ' _ ~ • J. Finton Speller, M.D. ~ ~ 'p = " rn Secretary of Health ~'-n~° - - O , ,,,s , : . = - . Harrisburg, Pennsylvania ; ; , ~ _ , ~ ~ - ~ ~ ~ mw.~~a ~av. J OOMMtOMnIY~iN O/ ~J!?t37lVA)itA ~ = 7D >o ~ LOGI REG~ N0. 0@ RlT~tBdT C! ftfJli7ii ~ M , V[iAL STATtSTICS ~ " p~ ~"""RY _ ~ 2 Q Q~_ c~n~cw~ oF n~?ni ~Q , ~ OIST. NO. ~ 1 M 1. ~EI?rn county b. cfy? « boroupA Z. oECEASEO~s sa..t ,aar.,., R. a„ o. eox wx+,bv : ~ :'7 i~~ED Allegheny Pittsburgh 1508 Daleland Avenue e!f d~ath ~d ewt oonK In Gty ~ b. ?ost OAIu. Stot~ ond 2ip Cod~ ~~~"RQ Pittsburgh, Pa. 15220 ~ ' d ~t~ South Side Hospital l~~+ Y~• +b 0 ' a. u~.~~nn~ cff ~+o* ~~ar.i. Oiw ~troat ~d ~waa) . vv~+~d, w~ WW I I--- s«t,t r+o. U_S~ Navy ~ ' i wwtE oF a. ~ira) b. WuddA G.st) s o~ITE WIon~W ~sr) (lfir) ! ~ ~ A ~ ~'~cEn ~'fa~~e~ ~~-NrL ~ { ~ ~ ~ ~ ' a. w~e ao ~ o~ d.a..~.a w. r~. w~P~ ; D~ASFp u... Pennsylvania p Y„~, d.a.,,.d p„d ~ , b~erNa ~~~'Y Alleghen ^ irv~ e. c~,?_ ~Y ~ r~, a~..~.e ar.a ,~a n~.h. ~_~itLsbur.~d+r a. e«~,,k j ~ sfx w?cE 9~~fc ~~~aiEC p~a a?h of eumt ~ ~c~ a~ yo.n ff~.? ~ Y.u ff~,~+a.. u~ ' ' ~ ~~Y~ l~Aomhs D.ys Flo~rs Mtti ; ~ ttale I White I~~ti++~o ? orvoac~n pI 3/4/1912 I59 I ~ I ; . 12. UStJAI OCCUPATION (svrn ff nti~~ i~. SOClAt SECURfiY NQ. 14. 6lR7HPlACE (St~ o~ fcni~n oountryj 1S. CITtZEN OF WFiAT COUMRV? ~ (~,m~r-Dairv~ueen I 159 12 8135 I FittsburQh,Pa. ~ USA ~ ib. FLLL tdMi1E OF SaOtJSE 1~ MO 'S 10 PtAJV1E ~ ~eo~a~urzynski ' 1L FAiHEIt'S NMAE 1`1FORMANT'S NAME ADDRESS AN Zi C D ' ~tefan Ranr_le ( Mrs. Alma E. ~antle,1588 6a~e~a~ ~Ave. ~ MEDICAL CERTIFIC~ATE qe.nr 2o rhra,ob x~ nwsr b. eompt.t.d sy pl~y~tdan ony) 1 udiEltv/?t sEivvEE~J ; 20. GtJSE Of DEATH, ErttK anly or» uwe p~r (In~ ~a (al ~I s($ . ONSEf /WO DEATH I ~/IJtT i. Marh rr~ nuNd by~ - / T - ~ ~ W{MFDIATE GUSE G~ _ i. i_ ~ ( ~ ~ .t~~~L L `'l~~--t C V € ' ~ ? condi~ion~. :f ,n,,, ,wl,;ch . ~pave r~se to ~bov~ uuse ~ TO ~ ~ ! (a) sta~ing tM u~+d~riying • " ~ uuu I~st. OUE TO (tJ.» I PAitT 11. OTHER SIGNIFICANT CONDITIOl~IS: cnntribvtinp lo d~ath bvt not rd~t~d to th~ Imm~~i~N uus~ piwn it? lart 1(~ ~ Zl. WAS AUiOTSY f ( PERFORMEO ~ Y~s Q No Q ~ t 2~, ACC~pEpJT ~~T. b. DESCRIBE HOW ACGCENT OCCURRED c TlJM.£ Hoar Momh G~y Y~w OF ea ` Y~s ? ~ ? ACCID~iT ES.T. ~ d ACCIDfNT OCCURRfD I Z'2. PtACE OP ACCiGEM harr, I 22. f. GtTY, dOROUGI~, TOWJ~iSHlP COUNiY STA?E F wwa ,r Nw M,t~ti~ i..m, ur..r. .tc.) ~.r. ; _ ~worlc N work t Z3. 1 hM~by artify thal 1~ttendd tM abov~ ni d~aaaed and tlsat dNth ooaxred froen tM uvus and on th~ das~ sr~»d sbovs ~4~ w~. T. i ~ M. p. ~ ~ ~ '~tit`~.; ~~---:t..:- - ~ ~ ~ ~ f ` /L.,c: /l ~ ~ . ' a. S;pnarur~ . : `Z ~ ' i.. f ~ O. O. b. Addrtu ' _ . ! ~ ` t Daf~ styrad 6 'J / ~ 2!. a. BURIAL (j~ 2~. b. DATE u. c NAME OF CEINETERY OR CREMAT02Y 24. d IOC.+~TtO.V (Gty, Eua, Twp„ i County) (St~») ( ' ~o~~~ ~ 6/10/71 ~ Jefferson i~temorial Park Pleasant Hills, Al1eg.Co.,Pa. ! ~ zs ^.T ~a,Ero sY Rca. I~a ~s~~ r~ rua ~~.'•e~fiCi~ ?P~~"~d's`~tt'3R~ °F Fur~ e~~EC?ae.`. ~~u~^.~ c ` ; _ . - - - , ao~r ~t- e~ _ ~ 'i~ ~ - :::...C _ . ' _ _ " . _ L'~'"'~'.i. c~ "~S~zr"~-'~ ~.Y s cs.=i?ia-Ti~~ci__ ~ _*`a:'r~, c. . .