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HomeMy WebLinkAbout1129 4~9~89 `319 J~,;;J ~ 7 A!; a 4 7 FI~EU ANtt F~CORUtO S RQGER PO TRA5~~ . CLERti GRCU~T COIJA; ~ ~.rr ~~~~.:u.t::?:~, ~Si1S/-_~ ~~~9 --r--- - - ~ ~ ~ - ~ Ni 11 i ams - 04-23054222 ' WARr11NG: is i0~:sa1 te d~ofkat~ 1Ait tePy !r plN~tptit ~r ~heto~t~l?. 1~ ?atCS1i2500MF[: ~-75 I~ ~o'. Cert ~er nc.: COHMONWEALTH OF P E N NSYLVANIA . i ~ %EE FQp T?•IS DEPAP.TMENT OF HEALTM w(~ ~O R CE:iT~fICATE !7 ' ~r ~ VITAL STATISTICS LOCAL REGISTRAB'S CERTIFICATION OF DEATH I~ ~ Rcyistacd No. - Fu1: Name 1:'~ f ! oF Deceaxd • ~.~t 1t:~~[ ' - • --....--•--_....._(.,.~L. ' .~~.s~ / M~ser taW'_..___._____......__...._..._..... f . r. ~ ~a~ u _..~.~L_.~.~----~-:.__~..._. ._..._.__-~~.~,::..1___ ~7.~~s:..t?~:~._,--~~...._~-_ • N..a. sr«~ ,c~1r « c..N, ~ P1ace of ~ i j ~ i ' 7eath ~ Pennaylvani~ : . - Cib, Ser~~? ~t TMr~a i:~ate of Dea~h ._._.......~1_....~ :__1..''~_~~_......_~~.._SocEal Security No.~li'.I _-I L~--•~i.•-1 ~7.Q...._.._.Ract__.~j.,eF~~ , Ij ' ' r ~ . . , r . ~1:~-~tat St:~cus fG~l~-~-i.-i-C..~iG:~_...---•---._..--Sez~1-':~-1.~-LC -.....Date of Birth......-°--•--•-~~--~.3r..- .I L~ ~7 '7ccupatiott --•-••-`•~iE"Jr.~/.~_=----.___ . .._Birthplace ---•--~i---'7l~th-t~.,..~._. _L~ i i% ;i i! \'c!cran. vhich War -.-.•--.........Vctcran's Serial No. . t ~ til:DICAL CERTIFICA'IE Interval Beiwcen~ Part I. Dcath was cauard bX: Onset aad Death ! ~ , lr.:mcdlate Caus.~ ~ • - . (a)..-°• Q :~y.L.2-L~'Y~I~~~'~ .4._Gi---- - iI ~ Jnc To Ibl. - • , i ; Dur To Ic j - - ' Part 11. OTHER SIGIvIF:CAT\T CONDITiONS: cantributing to death bat not rdated to the immcdiate eause given i~ ! ~I Part 1 (a) . . ; , ~i f I~' _ ~ - t f l Acc:dent. Suicide or Ha~aicidt ------How did injury oceur - ; ; ^ : ti.+me artd Titk c.f Perwt !t/ 1(j i~ 3 I~ ~~'ho Certtif~cd Cause of ~kath (f~. D.O.. G.ron~r) t- •-.f.~..._ - ~ / ~ F , - / > . , f~ /1f ~ r :jC:f(SS SfMt - . .t _ ~C_~1..i.-~li.i'.l.`" j'~Lt,._.~.-...__. . - ~ . - - ? - t ~ Jy . ~ ~ tu~. i~. t.~ :~~;i~~ i:~:.~ th: i:i(o.mai...~~ :~r-_ ,.:r.,r. ;r~: c~,pi~•ci f~on rr ~r~gm~l .ertif~C•rtt te~th Juh filed witn me is L~x~: ~ F:-•• n:sar. ~ he c ~r.n.t~ .erufi~-atC will hc i~~ru::r.i~•d :u ~t,,!r 4'~tal Siaustir OfLce for prrn.anent [i~ir.g ~ • 1 • ~ i . . r , . , _ / . - . e ' ~r.......xG..f.~: - 1L-_......~.~C.L.~`t~--------~ ~ ~ t•.~e~ iNis rcr d Vibt S~ou~t~n p~tricf Ne i! y ~ ' ' • ~ , : ,"1 '»g - S ~f! , ~ l ~ ' %t/7 :>'~~~~i~i~-C~.~~-d-._.._.V.~~..`~.{~,:~.;..c.'~~~.~~~~ ,ti- . ij S~nel Addr~s~ 6h. ~or~~~\. a?eAtp ~ 5 ; I ~ 'r~ / , ' - _ ~ • -•-•--ovi: ~«.i:w e~~ i«vi e.~:.~ e:~--...... .:-?.------..__.19:;'7 _ - _ - = i - , 7 ' e n~~G 2__.. ----19--- 1 ~ { ;I ~ I I - Do•~ ef lu~: of TA'~ Grt fie7tier r• •~s ~ ~?i o ~}'d , . ~ C~'-C ~~~~-O ~ -~K~C" ~t, i~-f.-~ ~~It ~ `~1 ? ~ '~d s , Q f ~ p f~ ^ t'' . 7 ` ~ %1~l! !9~ ~ ~ . * ~ ~ ~ ~ . ~ ~s:'~ • ~ 4.~.~'o,~~,,•. ` PNtIUP 1. REMIN fC 0~ NOIARY PUBUC ~ RIDIEY TOYVNSHIP, DElAWARE COUNiY ~~i ' • 4 ~ YY C061MtSS10l1 EXPIRES APRIL l. 1980 ~s+~~?~~~`~ ~ j _ w...'_' iiin~wt. rsNnsTr?RIIiATiOGi~[IOUYf IIO~1R ~ ? a ~ ~ ~~~311 ~fii28