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- wARNlNQ: ~ !t is illegal td d • licatc this copy by photoswt orphotog~raph. ~ j /
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This is to. tbat_this~.is,?3s~t of the record which is on file in the Pennsylvania
DeparEnnent~ ~ea~tfi ~u'~.=at~•_ _ _ „c~,. h Act 66. P. L. 304, approved by the General •
Assembly. l 1~
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(Fee for this certifif ~ _ _ - t- ~ Leonard Bachman, MD:~ - ~ -
• { - • . ~ , y , Secretary of Health
- : ~ ~ i ~ ..i i ~ b ~ Harrisburg, Pennsylvania •
CDMMOIIOEALTN Oi PENNSYLVANIA _ '
' _ DEPARTMENT OF MEALTN -
VITAb:T~..liTlCi
CERTIFICATE OF OEATN - _
PRIMARY OIliT. NO. STATE FILE NO.
o. Nemt of Oteteat0 (FMStI pliddlal 1t.astl Boa Oats of 6ttth /trba0ayr Yr.)
Gabriel - A. Tiscione M , 1-15-?9
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"k tiact - (a:E. rVhltt, Stock, Ap leer WtthdaY II undtr 1 Yr• IF under 1 day Datt of birtA Stoll er (grtign County of birth ity~ Boro, or Twp. of
Arnerkan . ate.) IYr.~ (IMO,rOwr Yr.) country off birth
sw. 62 ss. ' •y. sc~" ' " sA3I2?/ 1 bs. Pa, sc. Ahe so. P h.
Cony of dtoth City, Bow, or Twp: of death Np;pitol er institution (If net aithar, yiw rtnat f has . er inst. indicott DOA,
Alle Monroeville taEast Suburban Health Center o~~•DO~°titnt (:pets )
~T 7A. g 78. 7C.
Moiling Add?tss (Stmt or RFD No.) (Gty or Town) (Stott) Qip Codt) Status Surwyingtipouee IltteiN, givt mardtn nanrt)
e. 290 McKenzie Dr. P h. Pa. 15235 a M ~ to.Teresa Abriola
Crtiien of what tWrttgi Mos dtctdent-ever in US Artred Forces? Soc•1 Stcurity NwnOar watt Octupet:on (Kind of ssork done dur- Xk+d et business er industry
®Yts ~No Serial No. ill most of workin0 tiNl
USA ,2. 33918420 , 206-05-942b ,,,A_self em s auto its
+Ri+trt ~ Cid deceased ii~a Penn Hills - townshi
deceased o. Stott Pa• ~Yts, dectosed lived in _ p•
ostuoll livt~ e ~ in a township?
y b. County g ONo, dectessd lived within actual limits of city or born
1 S.
FatherY earns lFirpl _ (Middlt) (l.tttl iMothtr"s mt:den nary (Pint) itrt:dete) hest)
rs 78 Gabriel Tiscione Frances - Costa -
Intormtnt's namt /Typt or hint) Informant's 1$trtet or RFD No.I IGttr or Towel ISLit) 12ip Code)
18,E Teresa Tiscione ss•""ddri"290 McKenzie Dr. Pgh. Pa. 15235
? Remount Om of btrriN, etc. Wernt of ctnMttry o. crtmatory LApLOn (Crty. gero; twp•) (States
'„N 14„_Dctm.,:anDan.. t,as.l-19-79 ,9c Mt. Carmel Cem. ~9D Penn Hills, Pa.
~ Siynaturo of funeral d:retxor sn0 IietMt n met rata o errata is enter
~ ~ _.~.~c;L FD- 0 0 9 0 3 -QL Charles W. Trent Funeral Hom
t:.giet..rlt - - n Da. rectiued by rt,;.u,r 11110 Frankstown Rd.
~~(/`~1lI1i i`Jt. .?./IC(/yl C/It /~7° 2oe Pgh. Pa. 15235
TO tht belt 01 my knowNdge, dNth tarred at tut amt, date, end 3 i On Ike basis of eaaminat:on and/or in.est:oat:on, :n my opinion, Meth occurred
~ a T Ind dw to tM eawelsl sttttd. _ <tA.D _i x ~ at ell t:nte, Mb end ptap Ind dw to the uuwlsl stated-
W
S:anaturo o ~ tg S~*taru.e
q E . ~ 22A. and eitte '~1~~` E 3 0 2~A •nd true
i ~ Date S.gned IMo..Day. r•-/ Hour of A.M. s 5 ate fined seoy v~ r. flour o
• U ; OeatA q ~ 7 - Death A.M.
° ~ € 22)1. 22C. a2.i.eG~ P-o't. tO., a ' 238. 23C. RM.
om '
~ Narnt~nd Atld?ttt W ctRif:er (Ph _
/ h C ysician, trtedictt E Or Coroner) ~~r or bpe) Nt.ne of •te.ndrno pnys.cwn
26. lrnmeditN pMa%t Enttr h/ pup p~i s:M ter /AI 181 and lCl { Inttnal Wtaieen
~ 1 ~ ansN and dNth
Ow to, or is • c of: t IntanrY beosrttrt
Pert / c' ~ ~~i~¢~ !•q 2~~(' 1 enwt Ind s..th
Ow to, M N • caneauenct eft ~ lntetvM Wtlattn
ICI ! onwt Ind datth ~
Part II. OtMr rt~cant Cond:t:ons - Cond:t:ons ~u:b,rting to dwtA twt not rNated to cause g:.en m ?rt t la} Autopsy Was cart rettrre0 to Medial
/J ~ ~ / ~ ~ y Euminer w COrontr?
.~f .~i~ij.c.Zr • ~.~..t ' ./1-*- f -'=~=r~Y.~ity-~'•_.- 27 L7 No Za. D Yt: O Ne
Acc., 5lricrdf,tlorsr., rJndef. flats of .r.Irrry IMO.. Oay, Yr.l tour or ~ sn• Oiacrree how .rqury oc[..rrtd
c. Pend. Invest. (spec:/y1 t"swy RM
29A. ?9!!. 24C. 2SD.
~n~ury at were i P4ce of .usury fAt homt; term, street, ete.1 Locatwn ISueN or qfD Nt./ IGty, soro, 01 Twp.) rate
? YM No -
1~E. i. 29G
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