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HomeMy WebLinkAbout0989 . ~ ` h WARNiNG: It is itkgo! lo aitQr this copy or to duplicate by pholostot or p~:otoqreph. { NiQS il? SQOM REV 2J8 COMMONWEALTH OF PENNSYLVANiA :(~oa t~~~. b~?> DEPARTMENT OF HEAtTH-VtTAI StATISTiCS ~0 1 i~2303 ~ ; (FEE FOR THIS 4 fERTIFICATE 52.00) [.OC:~[. REG[S1~R~R'S CERTlFIC~TI01 OF DEATH R~e~ ~a Fu~~ ae~~~so~; . . or n~~~a HAROLD N . - , Finl M:OOi~ lo~t i R~~~~ tdilitarv RoadT, Casc~de. ~ia~ :inF*or. ~'.arvlar.d. ~ N;,mb~r S'~~et C~+r w To.rn Cau*'~s Sr~~ Po ~`,~,~f, Frar.kl.in, _ ritiVllQSsJ02'01 r~~i.~;a ~ Cw.rM1 ~\t Cn~. 3wo~+4F io~.n~:c . ? ~ ?Sale____ nc~~ ~c va~ July 6, 19$0 _ ~fhitP , ~I ~ ~a~~ or s~ce Au~~2 .19?? _ B;~P~m _ ~ichigan - - .~,~a~ sr~n~ ltarr~ed I` ' ~ceial Security ~o. ___2_I O-1~_'~1_~~ _ Occupatio~ PPOf PS S02' _ _ _ ~'etersds Sai:l ~o. ~~14 I i ; ~iFO~c.a~. c•EKr~F~c~-r}: 1: i ~B~ ~ 4 Put I. Death was causrd b~: ~~CI 1 ( 4~ ~ ll~ ~3 ~ } immediate C.ause (al __t'aT3~8C ~Y'1"PS't - ~~L~~'~ i RCCsFR ; f -•r~~~ ('i r ~ ~tli~lli Q~&'~ i * FA i ; :.~~rccar~ial Infarctien LY ~ Due To (b) - . - ~ f ' „ 526'769 ~ v~t r~ i~~ ___--orer_arv_Arte~_~isease ~ Yari 11. U"I}iF~R 1tG\IFi('.~\T Ct)\UITtU\y: ~ootributiog to deyth but nof relatrd to t6e immrdiate c~se gi~en ia ~ Part I (a) i ; :lecident, Suicide ur H~uni.ide - - - - - }~nw did injnn ~xcnr . } I ~ame and ~itle ~if Percttn ~,y, ~ f w"hu ( crtit;ed Cau~e of Ueatb (~2.O.. U.O.. (~aruoer, ~i.E.1 ._t14,~?~ru-.~~le.~a-~-lia~a-.----- ~ ,~~a«<s _ 1g7~__ ~rPen~: i`11 ~ri.Y~-s----- - - ' ~~'-t_ .Pa~~-_- ~ , - i " ` 7hi+ ic tu ~ertif~ th~t We infurnc~tiu~ 6ue Ai~cn is corrtetl~ copied fruia yn oriqinal cettific:te r~! dreth dnh Akd }+t6 , mt :?ti Lv.al ftegi,trs+r. "Che origii~al certiGc~le wiU b~ tor~+sude to ihe ~+tatt ~ tf1l SIJVSIKY t~fice for perm~ucnt 61sa& ~ ~ or ~ - ,~~___~~!YT G D_ ~ 1~ e. Ye~.~-•o. o~ Y_toI 5•iror.cs ~.s••.c• !.o i ~ ' 2^~ WP~t Spcond St.. iY~v^.e~~ :oro! Pa. ~ , J 5-r~~' wasre+• :•r-~~_S'-?o~-~-•. t ~ \ .1 ~ i~ rf s~~~sY -Z-? ~ I : v.:-. :e. ..a Cl .wtr.~ er; ' -AU~g~--1-~~~ - ~a~--- f _ _ . ~ .,.o o~ . . ~ - : _ - - - = _ _ l I 8~~ t~ ! ~ 6 , "4 i n~ ~"--.r"~;_ , . . _ . . . ~