HomeMy WebLinkAbout03-09-07
105.805 REV 1/05 .
This is to certify that the information here given is correctly copied fro~ an original certificate of death duly. filed WIth me as
Local Registrar. The original certificate will be forwarded to the State VItal Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
No.
t~ 0. - (2oJJ~
Fee for this certificate, $6.00
Local Registrar
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13068106
FEB 282007
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COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
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Hl115-1<13 REV 1112008
TYPE , PRINT IN
PERMANENT
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