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Htos ttz start Rev z-~e COMMONWEALTH OF PENNSYLVANIA
(tta Csrt. per Rook)
(FEE FOR THIS DEPARTMENT OF HEALTH-VITAL ,STATISTICS
. CERTIFICATE iz.00) NO ~ 054974
LOCAL EGISTRAR'S CERTIFICATION OF DEATH R istered No.
Full Name
of [kceased
FIK iddN
Redd ~ ~ / 9
ber Strost Clly or Town n tits
Place o
Ueatb PeunsYhania
County City , ough ? Township
Ses ° date of Death ~ Race--,~~
11ate of Binh ~ I Birthpluc Marital Status I '
,p ~ ,
Sonia! Security No ~ W Occupatiol • Veteran's Serial 10.
1fEUICAL CERTIFICATE Internal Between
Part Ihath was caused br: Oltsel abd Ueat6
)mmediate Cause )al
Uue To i b l " G~ X i
Uue Tu Ic) `
Pa II. OTIt£R S1GVIFICAh CO'SUff10'iS: MettributinR to death but not related to the immediate cause Risen et
1 )a)
a
~ ~ t
Accident. Suicide or Ilomicide tfuss did injure occur
\ame and Title of Person
Khu ('ertified Cause of 1)eat6 1}1„j~ U.U.. Coroner. ~ .I
/
?sst City
TLi ~ to certif. that t6 tforttutioo here gisen is come y copied from an origins rtificate of death duly filed with
me :s local Reghtrar. The original certificate wU! he forwarded to th to Vital Statist tce a nt filing.
ArENT !)F `
C Lo 1 Regist t Yital uttstles istriet No.
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f~ a reel Addr ss Cittr. rough. Township ~
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Oate o/ Issue of This Grt it:atfon
46103
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