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HomeMy WebLinkAbout1677fhis i~ to ccrtify that this is a t~uc copy of thc rca,rd .v~ich is on Glc in thc Pcnnsylvania Division of Vital Stati~. ,~, ~/ in acc~rdancc with Att 66. P.L. 304, approved by thc Ccncral Asumbly, June 29, 1953 (Fee for this ccrtiC~te, =3~00) . ~ . ~:, ~, _ ' , .f ~" ~~1i:~ • 51516'7 WA~1NG:' It:~iI~PAAI.to duplicate this o~py by photostat or photograph. _ .~~ , ~lt • • ~ -. . ~ .. f ~,~~ i , ~, ~ ,3 ~ \ ~ ~e ~,~ , •` ' ~~,• •r ~ ~ ~ `I'I '! f H : ~. i . ;. - ~r.1~1~~~ ~~ ; . No. : j, ~' _,v ~ )Z ~t+!~~ • .~~ ~ ' f:.~~.,. • `.~~ :: ~ ~1 ' ,l ~' ~~~~'_~f~.~`. . f ~. .. ~ ~v . • . ' r-•~- ~1 ~;: ~ ~;~• : ~ ~ .,:. _. • COMMONMIEALTN OF -ENNSYlVAN1A OE-A1ITMENT OF MEAITN • - VITA~ ~TATILTIC~ ~ 250Q2-149 CERTIFICATE OF OEATH .•R~~ANr O~ST.NO. C-~. ~ (~aries Ilardester ~ State Registrar STATE FIIE NO. / n~m~ 01 acwNd IFi~RI (~MWA~~1 IIMt) Sea Oat~ ot Owth IMo~O~~~ Vr.1 , Thomas E~,~ ~. t~ , May 13, 1980 Wc~ -(aa, NIAit~, s4c~, M~ ~ aKhdM If unde~ 1 r~- . If u~d•. 1 dor Oat~ o* bNtA S~ott w lo~~~yn County of b~rth C~~ Bore, o~ T~. ol w..... ~ee.1 Ires.l ~r~ Hows ~ Mu~. ~ v. cow~try ol b~rrl~ bir~li .. ~~e s.~ ~ s.. ~ sc ; 6~2_-~2-b ,~~g. Fa . bc. Eri e ~o Eri e Cc„ntY ol Je~~h C~qr, Boro, or T.ro. 01 dte~A Hqsoitel er Ins~i~ut~on (li oot ~:ther, 9i.e s~r~e~ 1( hosp. o. ins~. indicot~ D A, odd~essl OPif R. or inpoti~nt (sp~ci~) ,,,_ Erie 7e. ttillcreek Tvp. ~~_ Erie Osteopathfc Hospital ~o. Inpatient v~. !: ~~ Ada.~ss (St.eet o. RFO Ne.) lCi~r or To~n) IS~ot~) (ZiP Cod~) ~:tN Suuw Su.v~r~n~ Spouw Ilf w~f~. !.~ i..s~e~n n~) ~ 702 Colorado Dr . Erie Pa . 16505 Ai,~arried ,o Jeanne Dale.y C~~zen d wh~t couMry~ yea d~cedent ever in US Ar~n~d Forces? ~y~ S~cwity NwnMr ~~1 OccuWt.on fKinO 01 wor\ dOM dur- Kieb pf b~sin~as o~ .nOustrY QYes [~Ne Sn:al Ho. ~?5-07~?$ 3j~ ~M ~O~ ot wati~y litd ~~ USA 12 „ ,.~_ Superintendent „q~ f~ater ~Je~t. ""~'~ d`r G~d deceos~d live ~eceos~~ e. S+o» pa - ~Yes, deceos~d liv~d in ~o~nship. c:fually li~~? in o fo~nshiP? ~ b. Counyr F~p ~No, dtceosed (ived .ithin oc~ual liwuts ot ~~ ciry o~ Aorn ~' ~ C ~.tn~•s..~..y (Frp! IM~dOM) ,6 Dennis Rinn t n ro. ~n~nt'~ n~m~ (Typ~ w~-ind ,s,~ Jeanne Baley Rinn ~ T o... o~ ew~N. .sc. D sw:.~ Q t+....o.tl K p ~ 9 A ^ C~~^`~ion00tMr 19~. /~~~-'7 O 5- ~t r Of f el.r~ctot numDM Ilntl Ma~~.•~ m~~M ~MM tF.nd l4A~eaq1 ILNtI „ N;ary Osburn ~MO..o~n~'~ ISirNt o. RFO No.l (G[r o. Town) ~ (St~[~1 12~p tod~l M«~~~~~~~ ?02 Colorado Dr. Erie Pa. 1F5o5 •ss w.+~. o+ e.....i~.~ o. e.«.+.~wr loe~uon tGfr. bo.o. t+.p.l ISt~e.~ ,9c Calvary Cemetery 19O T,~i llcreek Twp. Fa . ' N~me ~~A ~~r~u ot tun~r~~ ~fbousnm~et ° ~~~~J jf ~ FD- ? -~ John J. Quinn Funeral Nome ~ ~s~ r~~~ ~.~....:.s.~..~.. " ~ ~ . .. ~..l.~... ~~ ~ ?28 .Je~t 9th St. Erie Pa 16502 ~ ~ ~s . ~ TotMwaofm - Ndqe. daM oce rW • A~ t~m~. dst~. seW p1ac~ ~ i On ~M Wus of ~iun ~~suo~ ~nd/or ~~res~.q~tip~. ~n m~ op~nqn, OeatA occur~~0 3 ~nd dw to tM c ( statW- ~ Z^ fi at th~ tim~. Mt~ ~nd ~ pl~c~ ~nd du~ to [A~ cause(s) s~~iW. ° < < S.~ytut~ ~ ; 2?w ~~~~ ~ n ~ ~J S~~tur! E " E ~ .~.e a:N - ° o ?3A ~.w t.tN O O. o v ~ U i~ Wte S~f^b ~A~r.r•.~ u~ : /~ w M. ~ u = j/ aiM ~ f-r 'l l E U~u 5.~r.~d ~Mo~D~Y rr ) Mou• 01 EDT ~ ~ ~ . , O~~tl~ A.M. ' " ~.M. m > f ~~~. ` ,~l. nc. ,- s J I 1 F O i 2~8. Z~C. ~.M. ~ Nr..~ anO as d cM.fi~r lTya:c:r+. 1M~d~cN Eu ' o~ Coron~r) (p~m m t~rpel Na-w ot ~u~nd~nf phrs.uan ~~. Garv F. Esner. D.O.. 5525 Peacb Street ' . Erie_ PA 1h5n9 I~s John M. Ferretti Lp.O. ~ 15 ~mm~dyt q Enpr Ir pn~ uus~ p~r I:M fo~ (A) (BI ~~O (C) / ~' ~ -~ '~ 1 InrnM W" ;~_, ~,d ~.~ -_. ~ .~., ,~~ ,. ~,. . Dw te. or ~~ c of: ~7 ~ ~{f..~ PaA ~ / / ~ InrnrM b~lwMn /~~ ' . ~ ~ ~s~ ~ .~ ~~.~~ .,~,~ i ~c.~.~i } onr~t ~nd O~W~ o.w'~o.orf •con~p~wnc~ ~~j • 'Z' / ~ ~ ~ - Ina~rN O~tw»n o..Mt «+d dwtw 1/ ~/~L.G7 ~~ ~.+~ (~/~/ ~`~-/ .ICI PKT II_ OIM~• fKMN CO~OitqM CO~YO~t~OM COI~t~~bYliny t0 dNM OYt ~Ot I~t~tW 10 C~uN aNn M FNt 1(~I ] ~ ~ ~ '~ AVtOM- WM CIM I~IM/W t0 M~dK~I O r E••^~~^K o. Co.o..«~ '~ 2 ~,E .'z.c-z l y :•. o ~« a«e ~s ~~~.cc.. S.,.c~J~,How., U~der.~D~n o* ~wr tMO.. o~r. r..l ~+w. or ~M. o~,c.~w noy. ~~y~rr «c ~.r.e c• P~nd. In.esf. (sPtci~l - ~^~~ --M ?9~- 29~. ~~C. - ?YD. ~f ryory (At wo.n~. ~km. st•Mt. ~[c.l '^,~•~ ~~ +.~7 ~ ' ~oc~aon ISa~ o. Rf0 No.l (C~tr. 6oro, or Two.) Isu~~l ~ Or~ O~ ~ 1aE _ 29G. ~ r 5i516'7 190{ J'~`~ 29 ~~: 3' 08 F~~ Ec• nn( ~f :ci~. : ~ S' LI:ClE Cf.;!t'Y.F: ~ RQGf.F7 PGI~R,1S CiEP.iS tiriCJIT CC'~~ "• i G" ~ r. '~ i ' ~- 9~1KJ4~ PAGEIV7~ i i i t~ ~~---~ .. ~~.~ ~.-~b._:~ ~: ;.. _:: -~ ~~~~~ 7~,_,.~ .f .; ;;