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HomeMy WebLinkAbout039151s143 }. 1 ~ WARNIN6: It is ili~al to altt~ tAis e.~py or to duplicaU by photosW ot phototqph. ~ N~os ~~= soow~ aev =-» COMMONWEAI.TH OF PENN8YLVANIA ~~~~ ~"~' °~` °O°~`~ DEPARTMENT OF HEALTH-VITAL STATI8TIC8 ~~ 14 8 2013 (FEE F011 TH13 • CERTIRICATE {2.00) . 7 I.OCAL REGI.STRAR'S CERTtFiCAT10N OF DEATl1 Raiw~~ ~. F~q Name , or ~x~t.xa ~ .Pi~ .y,Pi~ /J.~.P~l~.f~f y Fus ' Middh - Lasl / Iteside~ce ~ ~f l'n.t' G~n I i f ./~!/~l /5/Fi~/~/ ~/S~ ~ t~lumMr sa..i , C~h e~ To.n Cwory % s1~ts Plsc~ of ' (ka16 ~LJ~.l~N y • Pean~YFraois ~ Counhr C~ty . 9orouyn o~ ownt kx i~l~v ~~ ~~« ~ uti~b l".~ ;~,e«~~ ~ y i9~o wn ~~, n~ Ih~e ot BlrtbS,E~~`- ~e~.~~ Bbthplace G(~/~/~~/) ~•/~ Msri~al Stn~~s L!ii ~s1~C/ _.~ ._ SocW Sec~uitv tio,/~Q.~~ •/~ 7/ Occ~tio~~~/a.v/wJi.~F /~i.AlE~etenn i Serid Yu. ~tEDlCAL CERTIPICA'IE . Is~errd Bet.cea !'ar1 1. Ikstb was csned b~: U~set wd tkstk iwee~te Caase la- ~~/F'!J//y ~ . ~~~ 7~ IMe To Ibl ~s~~~ ~ ~ ~~~~ Ih~e 1'o Ic- 1 Part Il. OT1iER SIG'~i1FIC11VT (Otipll'IU\Sr cootrib~tioX to dath bet pw retued to t6: immediue cawe Rirea te Par1 1 Iai ~ ~/~ (////G.v //`l~ 1 ~ Accideat, Sukide or Nomkidr Ilow did ioj~ occ~r ~ . . ~ ~am~ a~d 7itie of Penoo ~-., ,~ /~ . i~6o Ce-tifiad Ca~e of Ueath ~(N.D.! D.O. Coruaer, ii.E.1 ~U ~ ~J(~(~!(~~ .~dd..~.~1/.y "l ~'~ -.~' [ct' ; ~ ~~-~~t, ~C~' ~`c-~~~-z~-s-~' <J ~'4 . - StreM ,/Cdy ' Thfs n to cartif~~ d~at the iniwmate~ here ~irea is c~rrerNv cupied t.ws aw oriqiaal certificate ot desib duly tiled witl~ me u I.ocal Registrar. Tht orq;ioal certtJk•ate r~71 be ion~arded to Ibe Stale ~'iul Slattstics (~fice ior ptrrweesl filiuR. ' ~ '~ ~ ~~-fes ~~; G.~ - G..~9 . LOC f1s tln~ ol 1 St~tlsUGf DiftriCl No. - ~ ! ~' ,~-- AO~I~I`~- , ~ .~l J DGr ~i.L t ~t_-.- Str~et bdrsu Gy, Boiouyh, Tornst~tp ~e c /~ . /~~O 1 - oaa Aee.~..a b~ t.oe .y~serfr I .-;7~ ~l ' ~ ~ Oats ~ . 516143 i~ai f~f~ -s ~ ~~~ 23 ~IL£C ~NC °= GU:'Ui ~ Sf.t~C+f ~GLN: Y.1: a. ROGER FCI ~ f~ ~~ Q • CLERK CIFW:1 ry J^~ 1 , . ~~~ r ; f f. P'1 '~ t% ~ ~ ^ ~ i 4 i i i ~,~~~~ ~~i ~.~, ~ ~ i 4 ~ ~ ~ g~~v:'n . . ....: ..- ~ .._~ - . .- .,. .Y. 4.. .. ..-%`.a.~