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HomeMy WebLinkAbout1176 5~1~29 WAANING: It ~s ~Ilr~;al c~- Jupl~cac~ ch~s rupy I~v photustal ur phutuKri~~h. APR ~; n 1978 :, ~~- 3og U~cc :~- .,~:. No. ~ .' 'f'h~. is tu ccrtify tl~at this is a true cbpy of the recq~~'vkyhich is~,c~n ~ilc ~n thc Pcnnsylvania J)c~artrncnt of Hcalth, in accordaneo with Aet 66, 'P. L. 304, aEspruvcd by thr Gcner~l Assc~nbly, Junc 29, 1953. ~ ~~ - ~ - . . ~ ~.,,..a.-.1 ~ a,~;o:~....----~ (Issued [ree on milit~-ry statue~ L~onard I3achman, M.D. .~ . . ' Sccretary of Health _„ . - Harrisburg, Pennsyl~~ania / %!1 :. : .: :YO. ~:+~v DtST- NO C/ I l_ L, %~. C:7MM~r:.'.1EALiHOi t.fN'.'.VIYA`~tA UkPANT41ENi Ui ~~F i1LT~~ VITAL STATISTICS CERTIFICATE OF DEATH STATE PI:.E NO PS-4137 . .. . ~tr.r.l,n.l ~{irs!~ . .l,l~...~ ...fs•i ' ... .~.. ..~.. ~ ... . ~. .. ti ~ f-t~~JL'2 /)1 ~ cFl.~1C ~ ~.`_ :~.-~c,~ •'',~ ' :~' ~. .,=' `` , y ~ Ln;tr 1•- .. ~ta t'i..y .-_ .~ :.r~•v.:,,~._. ~•)''~scc•"n~:ey ~ ie.ro~: ~'~~.:o .'.,. •. . . '. ~ .. .~ , . . .- ~~~~f~.•, . et~. i ~ V.t ~ .oa ~ .,~.ti l~r. :s '.t~ ~ 1 , rl- I L -' ~ ' _ - : J:'t ~_ ~i f~ rc G" 2 ~ ~ - . . .__ ~. . .~, ~ .~_-~_ , . . - _ '-- __ . . ~ n. T..~ r. . .tn i.~ . 'd, n• . ~ti ...c .. ilt ..,,T r.. . , . ,. , ... . . . , ' . . . . .r~,:i/G~~Z~`N /GC.~f G ~.'a-'Er_' ~-}ic..Ey L7E.~/ ~il2iL ~_':I.7F2 r ~;,"~:~i-~~~-r'%- ~ __-_ . ~;n .. . ~ ... ~ i..A Co:.~ ~ at .~ -tn ft~. .. .~r i.t. .:1 .i . ~ f . ~ ~.~ ., . . ... . . . .. .s.~ . ... . , .. . .. . . . . '~.t.~l , .~. . . .. ... . .. 1 fii . . . . . . .__-__ _ , __ _ .. - _. ..f .. ~,f: ~i.. •.f ~~ yJ.tf ~]b~Y'S+l~i V ~' ~r~ ~ . ~.~ ~. . ~. ~ . . ~~ .~a. , . .. ~ ~~ ~ . . . ..~ , ' ~ . _ .~ r ; .. . .. ~ .. U 5 A..naa [ ~.ias~ _ '.o . ..r. .. ~ . ~ . .'~ ~ Seus~ ~ Tt.: , . - , ~ - - . , - . ~ .~ ~ ~ ~7 ` ~ ~ t.~: . .. .. _ ' ~ .. . .. " _ . .. .. ..,n~• rc, ...t. 1.. , i: t, .i, t.:t~. ,.,.... .. . . . . . .. ,. . ~ ~ . "_ '_' .. ~1. .!~ ~.. ..~~1 :\ r., • •. ~ . ~ . ..C.~. t:,. ...t- ~ . r , . .~~1.. ~t.~. , .. , . .. . ~ • .~S' .1 ~. ~ ~.. ~)r .. r.. f • 1 . ~ v. .~ f. .l . .. . ~ .. ~ ~ . . . . .r . . ., . . . l-. .._ . .. . . .. . . . .. .'_' _ _ i . :~. . , {:.. ... ~ `Je . u~ . .~ ~ .~ . ~ ... .. . . , .~r ~ ~ ....,t.~ . ., . ,. _ ~ . . ... . , .. . . i: . , r/.. 1'~~ ~ . ~ .. . ~ _. , ~ . ~ ... _.. . .. . . .. . .. . . ~. ~ •P n1 r .ne• ~. d. rto- an~f ~•ce•~7•. ^.•~"':['• ~ . _ .. . ...:r . . . . . . ...... . . • _ ~ . _ -. - ~ -.l , ~ ~ . ~ ,~,- . :;. _ ~ ~ . _ _ . _ . _ . . _ _ _ - , ~ ~„r,. .. . ~ ~-= ~ . . _ ~ ~~: ~ - ~~t 'i~-U!~s'I C; . .. , . . .. . : . . ,. _ , ,. J'L~ !'~ i ~ . _ . . ~- - -. . . - . - ,:, _~,:.. _ ,. ~~,_ : , ~, < ,: ~• ,.. . , ~... :,. ,..~. . ~ .. .~ , .. . , . ~.,•, , ., „ .. , ~ - . ., . . . , , . , . . . . . . . , ~. . = ~ .,.: , :,~ ,.z ~~,..., :, .s; s•:,-~ . .. _~ Ijt L ~t L(,~~~' ~~ . .~ Cfi~t~~L~v~ ~' y , a , . . , _ ~ . . ~ . ., . . . . ,. A .. . , . ' _ ~ •r s' - ,: ~~ :t ~ ~,~. . A• , .•• ' . . ~ .. .~. ~ . . ~ . ,i•.• ~J ~~ ~~C~~' ' - t ~l]~ 'r 1 C', ~ - : . . .. • - . r. .. ` _-_ • c ._ _- ~ ~ i •.i'~.!)~(1 r~171~+STO' Cl~T~~.er :YhyS". .l •r~,~~. A~ f ~\~n~..~~r il• ~_V ~~~~.r~r. ~~~I !'.. U' 5~..•I ~ C / C t ,- .~"• . . • .. . ` J ~ ' ~ L , ~~4~E/2 ~ ~. 1~ j,~,r/ //-I~/~t~ ~L'L U~ ~~/L'~~ f ,.7~ ~ Z ri~1~'iL %~. -~ ~ ~ ~ - . . ;~~••~~~irl~w•t ~_~~..te f ~.., n,~ ~ „ . ~ i~~~r;.r. •p. (AI .~ a.•.• .~~ ~ ;r...~ ...~~ :t!..cr-. I ~. ;'lc?c~~ ~ /j~vec. ~ ~,~, 7,_ -~~~s-r~;zcz; iGiv ~~k:. „~ .....,•~,:,- - i i.:~: /~ 7 ~ iL' ,. c=. ,~ ~ !l~.~e t0. O' ds d .-or~.s~•::ue^.[e ^~ _ -- 1 •,ten• ~e:.tiC•-• ~ < < ~ ~ ' G"'ilt d`. 1 ,~rj•Ii ' ' i A i `* _. ~-1" !~ -~-- -- " _ - ~ u, t :~ o. ,s ~ -o,::~~,..r~:~ ~~ i ~ : ,;ar. ~ :.eu...e„ ' 1 :~r,ync a~~~t ura••, ~ 'Ci ,~ v , fl. (;th~r '',y,. ..,_a~,t C~ :•~~t~un, Con.f,r,r~.,s cor~~-,i,,.t~nq .o n.ratn ..,.. ..nt r a.s-~f t~ :.a~sr ~.~ .. .~ .,•~ ~ aa; . .~.~~~.:~ : r~i ._ ~s.. _t~r•'.~ . . . .~ ~• ,. ., .. i. (~-:/>~ , ~.. ,~' ~o:k'-r~ .ii . rs 7` ..~ . . ,if•.S• ~r.~. `AiP ~~ . , • ~ . • .IAY • _ , . . ... .~.. . 11 ~~~t:l 4 A~ 1 T~ ~:f4....hP n•)w ~~~i.iy (1~~ .•I!'1 r .• , 5~1'729 Eo~~ 35~ Fa~E 1173 19ci i~1;:~ 2n ,~'; ;I~ 08 e.~, ,•-,;.; , S1 l' ^~r r ~~ ~' .~f~_ . li( :i= Ft 1'CI~F::ti, .r.~...{~.1...'.~. (....,.~ . ~