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t. T1fPE ALL ENYRIE8 OR PRINT IN PERMANENT BLACK INK ~t
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3. tNCOMPLQTE CERTIFICATES WILL BE RETURNE0. 4"~6?544
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CERTIFICATE OF DEATH ~ -
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TO BE COMPLETE BY _OR_ TO BE COMPLETE Y
CERTIFYING PHYSICI ONLY ~ CORONER OR MEWCAL MINER ONLY
A TO THE •ESi OF Yr KNOwIEOGE. DEATH AT THE A ON THE DASH OF E7IAYRiATgN ANDI'011 tNYEST16AT1D1~
TIME. GATE AMp PLACE DUE TOTHE ST MwOPW10N DEATH OOCYRREOwr THE TWE, p"T[ DooRONEw
Z T tlAr YEAR ANO PLJICE AND DYE TO THE CAUSES STATED OORONERE
t t110NAT1111E ~P""a1C°"I'
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ATTENDED THE DECEASED G LAST PEEN ALIVE L MONOYNCED OEAO C. NDYR D. DATE SgMEO
30 ~ N ttAr rEM ttONTt1 wr YEAR YDNTN oAr YptTN wr YEAR YOtAN Dnr rW
~ 9 ~2 ~ 77 ~ 11 •15.79: 15 •79 ~ ~ ~
0. NAPE OP ATTENpNG PMrS+CMN. Y OTNE11 THAN CE.RiIF1ER E SIG?UITURE OF CORONERS P11rSKIAIt. Y' OTHER THAN C.E.RTKI~
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M John Cu Cetin~ O~• 286 Nor hEMa~n StAn o1a~ NY' 14006 EE
aT. DEATH MAa CAUSED w ENTER ONIr ONE CAUSE PER LINE FOIL fAL 1Di AND Iq. DETIME N OttSt:T AM
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PAIIT l tYYEDNtE CAUSE -
Carcinoma of s~ moil colon 2 ears
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IttYEpSTE •
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Ncrls v O Dc . p YES : p «o
FDA S?Etwr N ACCIDENT. NOYKIOE. 70D DATE I ax NOUR OP at+D OESCI•SE NDw INJURY OOWRREp
SUK.WE YNOETERYNIfQPENDIMO ~ DIIr YEAR RuIIRY 1
AMVEST16AT10M 1 t
OR t , , t t
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~ ~fACTORr.OFFtCE 11100. ETR ; LOCATION {STREET i NO. Gtr OR tlRiA64 T~~ TA~
OS .~1.~ ~ i - t
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ocoo ' 1980 DEB 20 AM ~ 37
;
FiLEO AiiO FECOitDEO
____s
.LtJC1E000MTY,F411.
_ - - - - - - - ~ s1R~~tIEwRDPOITR~IYt~SR - -
R[C61t0 VERtt'tED
I, CAROL A.'FRANEY, Deputy Registrar of Vital Statistics of the Taws of Evans,
Erie County, New York, do hereby certify that the foregoing~is a true copy of a
certificate of death of one .Norman E. Rechlin
Gated at Angola, New York February 7. t9$0
As filed in the offic~~2f ~e.ReQj,s~~r of Vital Statistics,ITown /o/~ Evans.
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