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Home My WebLink About0572 ~ . ~rARNUra - !t ~ +w~t ~e ~Yw. ~w e.r~ b? r~oa.ra~ a .u.t~s..~. Niob »s ~ a~? v-t~. : . . : nvo c.n. o.. s~au - c~ow~~~+ oR- i+s~~v~.vi?N~~ . _ - ' ~ oQ~n~+e~ orr etswi.rN _ 0 . ~ sz,oo : ~ : . N_ ~ 2801 z2 ~ - LOCAL R8GI8T~AR'$ CBRT[P'ICATiON"OF DBATS - ' . . Na. ~ ! Pnq Name ~ • of Dscaaed . ~ . Ktaw;' tw? . A~ ~ ~ q~.M. - ll~t t71lr w f~.n h..h , ~ ~ GM. f«~.~i a t~+~W . _ _ . . PlDniylv~di ; oaa~ of neatl~ ! .SoF1at_.5ew~ry? lvo,. ~ ~0--~- =-l-'~~ -:-.~8.0.~,?-.Raa- ~ ~ ' Marttat 5ta4~ . , ...............Datc of wrtd-L:X~~C:~~ , Oaapattou~`....J _._.....:yL,.QI~..,ra! ~._....._.&rt6plaoe~~. ra~-a~,s.•.•••~ ~ ~ " : ~ ~ , _ ~ . IF Veterao. whkb Wsr ~~~~c - .M._....._...._._Veterana Secial No. r%'_....~1..~.ws-~.b. ~ ; tnoe:vel BetvQeea ~ MEDICAL CF~LTIP[C1l'IE . Part Deatb ~ass. csused b'Y~ ~~set and Deatb ' Iwmed4te Cauae ta) ~~v / ~ ~ ~ Dur'1"o (b)_.~.vr..J i _ ` ` ~-so-~,.~ _ - Due To (cl_-- w.---- - _ ~ Put II. O~Tl~iPR SIGNIFiCANT GONDITIONS: ceat~rth~ w deatb but aot related o~ tht jmmed~ate cawe ~ivea m Part t (a) - • . - - ~ ~ Acrldeal, Sulcide or Homlcide --Haw did in~~y octus ~ ' Name ard Title of P~ersoo - ~ _ ~ Wtn Cestifkd Canse oE Death (iN.D.. D.O.. Corana} _ _ ~ Address...L ~ _ ~ ~ _ ~~l ~ iw..~ _ ar ~ ; T6is is to caufT thst We intormatios here~~ is axraettr topiod froat sn «i~iad artificate ot datb dnty filod with me s Loeal Re~tnr. Tlre otiaind cert~ca~e wilt be ton+aide~ to the State Viut Statiak~ics O[fice tor permanent filing. ~ ~p CWl~iO ~ . ~ ~Tf ~E ~6iT~IlAS~~. - r l'.~. ~e t~ 0 h3 - i1 ~ ~ ~ .~._...~t•. - y- . ~ ~i.o.+ « ..:as+k. wa.w M.. Cl~R1c SfRCUtT COII ~ drw ~ -f•'.:~111/~R-fIEF1~ ~...3.~Y~~S~l:-•"._ ~ / ~ swe rur.K , eu,?. ~...w~. T.r..kr ~ ~ 8 s5 ~ 1, ~ 4 .......19...~~ V : ~ j - - - - __~a~a lwbN_~ - ~ , ~ t.u~ ~ 19~ ~~13X ' rR1rc 00 O~M d lu~ d T pdtl~ ' - - - - - - - _ _ _ , _ _ _ _ . _ .