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CERTIF1CATf ~i 00)
~F~F~,T?~ No.2886426
i ll(` A i RE~:~,a~~A`~ ~in
icia es i
1V1~1 Vl'' UL'~A"l'H R~'t~~ered No.
~yii :v"°'e Paul Williaae~ P~tera
or ~eA,~,a
FNu Middb Li+t
K~;ad~a 1018 Colvin Drive Beaver Beaver ~ Pa.
Number Sireet City or Town Counry State
Ptace of
t~eath Bea~ar Brighton TMIp ~ Pe~nsylvania
~^~Y Gry. Borouyh or Township
Sex r~~ Ilateotlhath APT' 2~~ 1982 1~1j,tQ
Uxte of Birth_ ~Ct 1924 ~;nhp~ce Beaver Falls, Psnna ~a~c~ s,at„~ Married
Social 3ecurity No. 199~12~9~~ Occupation Draftsman ~'eterao'a 3eria! No.
Atf:Dl(
_41. CE RTti~iCATE Interva! lietween
Nari 1. Den~h wae caused by; Onset and 13eat6
Immediate Cause (a) Hulti le 1K @ZODta
Uue To (b)
Due To (c)
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Part 11. (YI'HER SlGNIFICANT CONDITIOi~iS: contributing to death but not related to the immediate cauae given in
Yart 1 (a)
f{
~ acrident, Suicide or Homicide How did iajury occur
~
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~j ~iame and Title of Yerson
j Nho Certifird Cause of Death (.N.D., D.O., Coroner, at.t:.) D2'. John K. Baska M.ll.
~ Addrrss 336 College ~ve. Beaver, Pa. 15009
4 s~r~~ ~~,y
~ This is to certify t6at the i~tortaation here gi~en ie currectly cwpied [wm an original certific~te ot death dnly filed with
t me as I.ocat Registrar. Tbe original certiCecate v~~ll be forw•arded to t6c State ~'ita! Staliatics OI'Fice for permaaent filing.
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~ -H %,%~El.~1HQfpf~: ~e~[ ~G • ~rL-~-~ ~~~i `L,~~z! D'l~b dyT
~ 1~ y~ Local Rel~istrar of Vital StaGSt~CS District Mo.
~ I 4i t.
E ~ "o~. RD~2 Orchard ~rest Dr. IIeaver Falls, Pa. 15010
F ;4 ! a Street Address C~ty. Borough, Township
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~ n 4 A p r 2 1, 1 9$ 2
r'~/,~E~j-Q~i~t~" Dat¢ Received by ix81 Registrar
~ Apr 22, 19$2 -
~ Oate ot Issue of Tnis Certlficeuon
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