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IrOCA~ ~G~'S`:.~t~A1~A1~ OF D~A3`$ ~ : ; . . _ . _ ;
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Fns Name . $thel _ - _ . - I~, ~ ~ ~ err~ee - -
of Deeencd - _
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ctw~- : -939 North 9th Stree~,y Reading ~ A+srkf~ :County.,- Penna. -19604 _ -
: Adder - - _
Plstx oE. Reading- _ BerkB: County
Death _ P~m"'ylva°~
D.c~ ~ D~ 1%8/.1
?7 c,,.a~t rto; ,_„18709--0851 t:..,~ Ylhite
' Marital Status ~idtxaed - Female: - of Btu 1/4/1914
ott:upatiao .......Sales `C kk _ - ~ ~ .Penna.
If Veteran. w?hk6 wa< - vebrraa: SerW No.
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M~IxcAr. estTZ~IChT$----- - - 1---- -
Part LDeath .twas caused by: Onset tt+od Death
.Cardiac Arrest - 20 mina
tmmeaiate Came t=) .
Due To (h)_.._..... Hypertensive Cardiovascular disease 4 yrs.
Due To (c) _
Part Ii. OTf113R SIGNIFICANT CONDITIONS: oootributiny to death but not related to the issmediabe cause ~ivar in
Part t (a)
Accident. Suicide or Homicide _ did inhaY occtrr _
Name and Titk of Pt~rsan John WoynarOWSki , M . D .
Wbo Certified Cause of Dead? (M.D. DO.. Coroner)
Address._~.__.._..~.__ - ~ ~.1iea ing . _ P_ a .
s.w tyrr
This is to csrtity that the information bete is oorrtctty copied front an original oati5c~ta of death dutjr fibd wdt6 me as Local
Regisuar. The original certificate wall be [ to the States Vital Statistics Otfitx for permanent filing.
- t.ost tUN.u.r truM o1.MM ?r.. - _
H. 016A KUKOINSKI, S GIRARD AYE.; WYOMiSSING, PA, 19b10
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1919 AU6 3 i All ~ 4 B ~ (tetum to:
i tE0 ~ FECURpf p FRED J. WARD
s aTRAS Attorney
etEfrx cffrctNr c i92o E. Beach Bivd. .
- ~f ~ VERtFlEQ ~ Haliandate; Florida 33009 _
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