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Home My WebLink About1463516`7~ ~ . WARNING: It I: iileqol to aher Ihts copy or to duplioot~ bp photostot w photaproph. H103 il! SODM RtV 4•7~ COMMONWEALTH OF PENNSYLVANIA i1o0 C.h. p.. boot) DEPARTMENT OF HEAtTH-VITAL STATISTICS ! (tEE FO! TNIS ~ CERTIfKAiE =2.00) N~ 1926915 I.OCAG RECISTRAR ERTIFIC.ITION OF DEA'I'H Na ~ d D~d • ~ ~ • ~w°a~. ~ • ~'!~p/~ RaWe~cs • ~ • N~~bM 3t- M ?oww (,~ ~ Place ot ...~. Destb ~ • pe~uoiqritaott Ci a~ Tw . ~ O~ ~fafh u,e~ oc B s M.riW se.eo~ . s«~.~ s~, rra/~ 7 ZO ,~~ v~~, saw rro.S'2 Z S.~l6 0 NEDICAL CERTiFICA7E ~' ~~~v g~~~ Part L Dea16 wa~ ao~ei ys Oss~t aid Dsatb ImncdLt~ Caast (~) -;~d~=~ac(,.~e~do'~J~d ~~ / • ~ ~ ~~l/i..~ ~ ~j Doc To (6) Dae To (e) Part !!. OTIiER SIGMl~1CANT COND17'l01r'S: contribut:us to death but aot nL~ted W t~e immediole ry~e ~i~ea ia hrt I ii) ~ , Aecidcnt, Suic{dc a: Homici~e , How did -fnJnr~ occor ! ti~y~u~~ac/ .a~b,yd ~'fjtk(~o[ Periou^_-•` (~y,p~ /~ ~ RYV l.~~Y-J~ L~ ~ iK~~L l•'77~Vi~ ~y l.~~R~ ~~ • I ~ ~aan.~ S"~~ _ /~ ;Z/f' _ ~ s,~.~ . rti TLb is to certify t4at tbe intormatioa 6en ~ireo b eorrecU eo irom a~ I Y -~ 1 certificate of deayh duly Hkd w~it6 ( me as Loca! Re~i+trrr." Tbe o~iud certi6c:te .vW be torw to tbe Sfs VfW Oftice tar permaucnt filln~. R ~ ~ ~ ,Q~,~/~!-t~,,~. . Ol • O f/ j ~F/ \~~ ~.a. ~ ~w ~-~ /~ oa.n- Ho I ~ ~ ' ~( ~ ~ L ~ ~ ~ :r ~ Str~ef Addr~aa Ciy, bro~qh, Townhfp ' ""~`='~`~ ~ ~'~ /I'~.1f~ ~ ~ Dat~ R~c~i~~d b~ locol pistrar i T" , /~~ . . Dot~ of Is~w oF Tlis 516'784 19~ fE~ 12 P1~ 2~ 28 F~c~ c ~-:r }~ coFr.cn Si.ICL+f COU~IY.il~1. R~'G~ft f'(:t ~ RAS ~ r,;.E~~K C:K:U,T C: ~j~ . . ~ g~R~ 348 PACE 1463 - ~ ~. v ~ . ~ - _ _ ~ _ ~'~ve'"' `n-.i ~.~5.a~`'~?„zst. ~ ' ..~ . _3 [~~~Y.~`~~ .