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This is to cettif~-.:+t~,~!'t~i~.^[s a+truc copy of thc rccord whicl~ is on filc in thc Pennsylvania Division of Vital
Statistics in ~tso~da ce vvith Act~¢, P. L. 304, approvcd b~ thc Gcncral Assembly~ Junc 29, 1953.
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c~5' ~11G: It~is ittegal p~(duplicate this eapy by photostat or photograph. Char{es Hardcster
~_ j ; ,~,:~ . ~ ' State Registru
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02 1980.~
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No.
... _ z:-+.~ wcv. ~r/ss ~ ~~ \ COMMONWEAITii Of PENNSYLVANIA -
tOUI REG. NO ...............~___~__..._.__.-.__._. OEPARTMENT Of HEAITH
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` VITAI STATISTICS ~14 7 7 5 3 ~~~ .
P~"""RY 4 CERT1fICATE OF DEATH
ais1. No.. ~_~~~-4._-""--~-~-_-._'....
t DfA1H o. Counry b_ C~Ir or borougA ~ ~ 2• DECEASEO'3 0. St~eet add~ess, R. O., or Bo: N~mbe~
OCCURRED AAAIUNG
~ ,N: Deiauxire ADDRESS 15~ Lexington Aue.
c. If dwt6 did nol occvr i~ Citr b. Posf OSfice, 2one, and Stol~
or lwrough, giw non~ of fownship Dnrb
tDa no~ us. R. D. o. e~ Nu.~be.) y ~Q$t L.arsd~u~ne ~ Pennn_ _ .
a F~~~ ~• Fi t zgera I d Nerc y Nosp• 3. VE~fRAN YesX] ~'
oF Hoipita) 117755
o~ inNitul'as lif nof in hospilol, giv~ streel addreis) Darby, Pa_ a. wu~~ti wo... .V_ Y.I-- ------ t-- s~.wi Ho--- ----------------
4 NAME Of ^ o. (first) ' b. (Midd~e) c. (loat) _. S. DATE iMonth) (Doy) (Ysor)
DECEASED ~f yQ 21 19b5
~Tra~ a. p.~~r) Charies • E. Durant oE~TH y
6 WNERE OtQ c. O:d deceosed live in a townaF~ip?
CfCEASED o. s~or~----Pennn.------------------- O v~., deceosed 1'~.ed in----------••-----•--•-•---•--------- lornnthip.
AcTU~tiY Deiarvare E. Lansdowne ~ 8
tlVE? b. Countp..__------ ------- -- ----- ---- - ^ No, deceosed lived wit6in oNval lunifs of.- .----- ------- .--... .. .M~-u borou ti.
7. SEX 8. ~OLOR OR RACE 9. MARRIE~ (} NEVER MARRIED ^ 10. DATE OF 61RTH 11_ AGE t~n rcars If vnde~ 1 reor ~ li ~nder 21 6ours
WIOOWEO ^ DIVORCEO ^ 4~26~97 68"yrs.Y~ µonths i Oaysi No~rs I Min.
~la1e Nhite ~
12 USUAI OCCUPATION (e~eo if ret'ued) ( 13. SOCIAL SECURITY NO. I 1»_ SIRTHPL/-CE (Stote or foreign counlrr)I I5. CIi1ZEN Of WHAT COUNTRY?
:et. F,ngineer 161-10-07~j ~ HatnniorQS ~ Penna_ 1L..S~
I i 6 Nll NAME OF SPOUSE ~ 17. MOTMER'S MAIDEN NAME
ELizubeth Kurth DurQnt Etta Nichois
t9. fAiHER'S NMAE 19. INFORMANT'S NAME AND A~ RE,~S ~~v ~extngzo NUf2•
Thedore Durant ~ ~[ izabeth Durant ~~°a..,~„G.,~
, ~•
; r~E~~CAI CERTIFICATE a~~• ~ throug6 23 m~st be canpleted br pl~psicion onlr) INTERYAI aEiMlEEN~
`~ 20. CAUSE OF DE/1TH: Enter onlr on~ w~se per line for (o), (b) ~(c)• ONSfi AND DEAiH
Acute Nyocardiat Infarctian
~ ,. ~ ~ Im~c a ~-
PAAT L Death ~ros covsed br: ' i ~-.-~_ ~ / (~ /'~ j ` _
<i~_ f~L L G C~ p`~ir_(- / r~ Y r`i ~::- ~_L~
. , • -r / •--•
~--°--~-;-=------~--------------- '-------._...------~-- - ~ -----------------------------~
IMMEDIAiE CAUSE (o) ---•-- ~ ----~--° ~-----`-- ` ~ r y`
Conditions, if ony, w~+iC~f ~
DUE 70 lb) ----------• ------------------•-- ------------------------------
I ;~.e .~s~ to ebow eouu -------•-•--- •-----------------•--------•-------------•
a; sto~~~g ~ti~ ~~~y~~
' Aouse lost. DUE TO (e) ------ ----- • - ------•------ .............. .•---- ----•---•---- ------------- ---- -- --------------------•-
~ kT II. OTHER SIGNIfICANi CONDITIONS: coMribvtLng to deo~h 6ut not reloted lo tAe imaicdial~ tovs~ gi~en ie Part 1(a) 21. WAS AUTOPSY
P£RFORMEDT
Yes ^ No ^ -
2: a. ACCIOENT ?2. b. DESCRIOE NOW ACCIOENi OC~URRED 2?. c. TIME Hour Month Doy Year
OF m
Yes ^ No ^ ACCiDENT f.S.T.
- ~? d. ACCIDENT OCCURRED ?2. e. %ACE OF ACCIDENT (e.g., home, 2?. f. CIiY, dOROUGM, TOWNSMIP COUNiY SiATE
' Wh~{e ot Not wbilt foren, slreet, etc.)
wcrk ^ ot work ^ ! 'l 1
%? I herebr ceAifr thof 1 otti ded t . ed c osed end that death occurred from the couus and on 1he date stated abore a~ ~~,.!~+-, E.S_T.
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o S~qnoture ~ `^ ~ ~ tc'- j ~G ~ ~` ~L `- . ~-~" b. Addreu , ` . ,- ~ ~ . , ~ ,• n _ ~ ~ ~c. Dofe siyned , ~ ~ ~ iz",
: y o. BURfAI ~} , 24. b, OATf 21. c_ NAMf OF CEMETERY OR CREMAIORY 21. d. LOCA710N (Citr, doro., Twp., A~ "Cwintr) (Stare)
CREMATION ^ KQy 25~ 965 S S Peter and Pnut Broomatl DeLCo. Pa.,
REMOVAL ^ /~, _ •
24. RE T R' S1G URf _ 2T ~ IGNATUQE ND ADDRESS ~ tUy~Al D~ECT ~,
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