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HomeMy WebLinkAbout0136 4045 ~ - WAR!!1l18: M >r ~ ti r.~aa IIIIs scr,? h .A«..fat o..MtpirY. : - H103 112 SOOM REV 9-7ti . Clop tort. Dsr twokl OOMMONWiALTH OR fsSNNS1fLVAN1A (FEE FOR THIS D~ARTMftNT OR NtALTH CERTIFICATE i2 00) VITAL sTATItiTICf ~ ~ 8 9 712 4 LOCAL BSGLgTItAB'8 CEATiFICATiON OF D$ATH Iteyiseettd No. Full Name Doris R. Namy of Deceased HrM MYNr.~" 4tl dual 1128 Lindsay Rd. Carnegie Allegheny PA 15106 Address tbw~n slow - Cbp tm ter face of Pittsburgh Allegheny ^ CiM. MrNN « TwrMW Grwtr Dam ~ May 1..1977 ~~ty No. -178 12 3610 "White Status Married _______~z Feutale~M.~~~ of Btrch.. Bch 7,A 1922 Occupation Housewife Birthplace pA__..____ IE Veteraa, which War _ --_--_.._-___.Veteran's Serial No. MEDICAL C2;RTIFICATE - Idberval Betweea Part I. Death was calrscd by: - Onset and Death immediate Causc a Res irato Arrest - ' ~ Pneumonia Due To (b?_.._.._._.. Due To (c) Ilodgekin r s Disease Part If. OTtIER SIGNIFICANT ODNDITIONS: cantribut;aq to death but not related to the immediate cause given to Part I (a) ~ - Accident. Suidde or Homtcide .__How did injury occur Name and Title of Persoo Katherine A. Hoover Who Certified Cause of Death (I~l.D, ~l~~i~r) s Montefiore Hospital Pqh., PA E Address______._____._...... This is to certify that the information here given is oorrectlp copiod from an original certificate of death duly filed a-ith me as Local Registrar. Tht original certificate will be toraarded to the State Vital Statistics Office for permanent Ciling. j_..:._:.~_C°...^!:`.._..Q nil J .l - ~ ~ ~ i tec+l lNMtir ~t tIIrN sbNtf;a Oirtb IN. 515 Chestnut St., Carnegie, PA 15106 se.a ah. tMr.w?, r....utr ~ ~y 3 19 oew syo«.N M loot bol.sr•? : tlss .t tw..i ns, crax~:i 3 19 ~ 7. -..,r i ~ - 4~i045 190 t'.;:'..-9 A~ 1 S f IlE© sNC F = Y fit ~ S1.LUCfE G ROGER P ITRRS ELERK CIRCiJII COUPT ~~~K 331 PEE 136