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HomeMy WebLinkAbout1130~~ a 514804 • WARNING: lt is ille~al to drplk~te tbi~ eopT bY ohoto~tst or ohoto~raph. Ht05, I 12- 125M 4•7~ ~ 1i~ Ceet. pr sookl 1:11\IJtO\KEAI.TFI OF PF\\SYL\'~\IA t~.r t•. t-a DF.NARTNB\T OF HF~LTN C~tiuieaa. tt.N1 ~'IT~I. STATISTIf.S N~ 3 7 u 415 IACAL REGISTRAR'3 CERTIFICATION OF DEATH Registered No. ._..---•....-••-••••••........ Full ivame $elle of Decensed .................... .. .••-.•••-............._ ............. .............__._............... ......-••--.. --•.-.-••....._........~C~A~........_..._........................ ............ ~..t ~~k z...~ u'°8~ 10 Valle GFreen Dr p~~ Address ............................... ~......._... t.. ASt011 ~1.~-----....---.......---~-- . ............... ....~-- --................. ............................ N~~b~r StreN CN~ ~r t~.w CNwq State p~"~ °~ Middleto~rd Death .... .. ...-• . - •• ............ . ..... ........ . ... ................... ... . .... . .. - --._............... _..~1~............................... Pennsylvania C{t7. 8~rw~ ~r T~~w~-4 .,..... . Cwwtf Datt of Death .. . . .8~6~T~. ... . .. . . .. .... SRCial SecuriLy \o. .....~}92"D,~~fial?r..... .... Race ...... .. W~_ .... .... . .. bt.~~ai sa~~s ... ._Married . ~: _.. ..~?'s.. . ---. ... ..Date of Birth .....7!~.~~!~!1.9Q~ ................... .. .............. Occu tion Sousewifa .. ~irth ~~~~ ..... ex~sbur ..... P• _ ---- . . . ...... .... .. . .. . ... . . .. .... .. . . . .. P ~ 8.~ --Tann..--~~ --~--~--........... I: \'eteran, which VVar ....._..... . ............ ... . .. . Veteran'~ Serea! No. . ........_.....-- ----•_---._.._.._......._... MEDICAL CERTIFICATE Intesval Between Part i. Death was caused by: Onset and Death Immediate Caux ~.~ . .._...Cerebral..Infar.ct.ion ..... . .... ..... ......... ......... .....:... .... ..27--~d~.y~..-.... Due To !b) ... .. . A110~Q 2? dRy~ .. ... .. . ... _ . . ... ... ..... .. - -- -_. . . .... .. ... ....-• --~ - -.....-- D~~ To t~~ .. ... Aspiration & High AirNay Obstructiori 2? .,dayg ._.,. Part Il. OTHER SIG:~IFICANT l`Oi~DITIOAiS: contributing to death but not telated to the immediate cause ~iven in Part ( lal . .. .. . . .. .. . ... . . ._ . . . . . . ... . .. ... . . . ._ . . . . . ... ... . ........- ~ --_.- --- ... _..... - - ......_..._ Accidrnt. Suicide or Nomicide ACC~~IAYIt AS iration Ot' f'OOd _ ._.. . ... -_ How did injury occur . . ._.p ....... . . .... ... .. . ........... .. .... Name and Title of Persan - '- ~1'ho Certified Cause of Death ( ~i.D.~l~~ . ...s7. Wal.ter... Valanteen ........ ..... ... . . Address .. ..... .. ... . . . .. .._ . Nfl1dtOS~it'1. ..,~Qu$I'.~~ . ~8~ Sc.ere Cib ' This is to ceMifp that the informatic,n here Riven is correctly copied from an oriRinal certificate of death duly filed with me as Local Reqistrar. The oriKinal certificate will be forwarded to Stste ~'ital Statistics, Harrisburg, Yennsylvania for pprmanent liling. :, , ~-'~..~- . ................. ....................~.r.? .. 19 7~ ........... . ..... -' Date ~t Iwe ~/ 'I`ru Certl/k~tww . . _.. . ~-?-J - ... . .. _ .. _. 23-233 . . . Iwcd Re~i~u~r N Yit~l Rtatist:n Ubt~kl N~. 1~.15 N. Manor Dr. Aston .... -- - ... .. _. . . . ..... ........ .. . ... ..... . . . _-~ -.. ...---- -- Slreel ANreu Ctb. B~n~R~. T~~nsAq . . .- . ...-- ... _ . 8-7 .. ~s75. .... D~te Rec~i~rt ~~ (w~~l Re~btn~ ' 514~304 19~1 J~"126 .a•: 9~ ~4 ~: .. ., ;: F i!;•~~l[yl CL'~ ~ `. i : %' 51 F '- ~.,~rF p .^,0 i f::.~~ ~ c~' :.t. L.T :.~.~ti `~ .,9 ~ ~ - • ~ r ,.,K. ~'~"347 ~~~F1127 ~-.~ _<>. ~.>: r. .. . ~ - _ - .~ ° =- - ~