HomeMy WebLinkAbout03-27-07
H10S.90S REV.(O 1 104)
This is to certify that this is a true copy of the record which is on file in the Pennsylvania Division of Vital Records m accordance
with Act 66, P.L. 304, approved by the General Assembly, June 29, 1953.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
~ (jJ. II..),A
No.
Charles Hardester
State Registrar
Calvin B. Johnson, M.D., M.P.H.
Secretary of Health
3695424
MAR 2 2 2006
Date
~r
"1(6.143 Rev. 01.(16
TYPfJPAINT IN
I'EJIUANfllT
BLACK INK
1 Name of Decedent (First. 'niddIe,1as1)
Eleonore S. Spurling
5 IIGOiWt_
86
CORRECTED ITEM(S):l
PER: FD DATE:03-21-06 b8llMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF HEALTH . VITAL RECORDS
CERTIFICATE OF DEAlt!
STATE FILE NUMBER
014675
v"
7. OIleolBlrth
nth,dI,
. Dalo of 001111 (Manll1. day, year)
February 18, 2006
8. BIrth lace
and s1a1e or
10
,.
,; fib. County of 0eIttl
Cuntler land
Carlisle
10. Race: Atnerlcan Indilln, Bleck. WIlle, etc.
lSo>o<*il .
Wi'll te
30 Regency south
Carlisle, Pa 17013
12. Was Decedent ever in the US
Am1ed Forees1
oVeslllNo
_nrs
Actual Residence 178. State
13. Decedent's Educalion
E1emenlarytSecondary (0. 121
1.. Marlal $talus: Married, NeY<< rt'llnied,
_.O_(~
15. SuNNing SpollH (hR. giYe nUSen name)
16.
11b. Coun~
PA
CUntlerland
0iI00t_
live in a He. IX Ves, DecedelllUytd in
Township?
Middlesex Twp. T."
17d.O No,_lNodotlrin
AcIuat l.in*s of
Cly~
18, hitler's Nllme (FIISt. middIt.last)
Alfred Schroer
,... ............."" (Typelprint)
19. Mother's Name (first. niddle, maiden Sl.mIn'e)
Elfrieda Schroer
2Ob. Intlnronr. ""ling _... (S"". cilyllown. stet,. ,.,_1
Shirley E. Hill
95 Vasilios Dr., Carlisle, Pa 17013
fil
~
~
21C, PlaceofOispodian (Mime ofctmll.ery, crerrelOryororhet' place)
21d. LocaIionIClyIlown._.,.,_)
ColrlJIol._230.."",_COltilying
phyU:iIInllnoltvaillblllltimeofdll1hto
COIIlIy......of....II1.
. II.. 24.26 nut be COft1)IetIcI by E*SOI'I
...--.
Yorktowne Cremation Service York, PA 17404
220. ..""lIldolddr...ofFociiIy Hoffman-Roth Funeral Hane
219 North Hanover St., Carlisle, Pa 17013
231>. LicInH NunW 230. Dale S9*I
2., TnwofOtlIh
CScCS'1-"'\-:l.-\...
26. Wes Coso Roforrod 10. MadIcaI_1ColonoI?
~ Yes 1:l1lo
ParI I!: EN. other IDllcrinl condIioM rMImutm to IIMIh, 28.
....""'rodiIoill""lIIIdortrlngca...givon ill Poll!.
,"-\'. ~" l>M
CAUSE OF DEATH ISoI _.nd ........,
tIem'El. Plrt I: EnlerIht~-diHues, Injlries, or~lionlli-thatdirecllyC8llMd""death. DONor enter lenrinalevenlssueh IS ClrdiIc arrest,
reapirO:wy anal. Of vlf'llri:ullr ~ wilhoul ahowng the Iliology. 00 NOT .bbr..... Erg- only one &lUll on lint.
===~. S\f'O,,,~ (~V~______
Oue"/<!.Ies.CDflIIqllIIlCtf~:
Soquonlioilylllcondlion&.."!Y. b. A .\1'\", ,,- V:: ~ '''<:... ~. l~
. ===c::a. Out to jor.s I conaequtne:e of):
(diMutor~lhI1ln1i1ledttle c. Ouelol""'__oI):
......_iIl_IUST.
: 1Ipproxinatelntervll:
:ons<<lode8tlt
,---
DidTobocI:oUXIConlrb.loIoOoeth?
o Yes 0 PIIlbobly
II!I"1lo ou_
_~<;'",~___n. 29. =-~mwilh.pos1Y"
o I'ropm"linoof_
o NoI~boApr_n1_'2day&
of_
o NoCpr-",.boA_ol3days"'yesr
--
o _'pr_n1w11hi1""pos1yeor
32<. Plocooflnjury:_.FIlIT\S1r....F~.OlIi:o
Buidillg, Me. (SpociM
\.~,~~~~_"!.-s-_
rJ'l
~
~
!::
~
~
-
...."f""......- - Ct~~....,.....C'o._ L
o Ves lIIo1IS
d.
:JOb. Wore AuIop&y Findings
M_PriorIoColrlJlolion
of Cause of 0IaIh?
OV..CNo
31. Manl1orofOoalh
Ilo'tIl'lUI.1 D_
o Accidonl 0 Pending Invesli;etion
o Suicide 0 Could Not Be OelerlYi1ed
320. Dalool Injury (MonI!1. day, year)
,....,,............
321>. Ooocrt>o how Injury Occuflld:
b-",; \I,f.lo
32d. TImt of lnjwy
32;. localion (SIr.... cty_. sIolo)
301. Was an 1dopsy
--
M
l-
ii'i
fa
Irl
o
u.
o
UJ
~
;z
331. _ (chick ""''''1
~phyllcfan(Pflysicianc:erlifyingeluseofdNth1W1enlnoth.r~hes~delth.,nd~ed 1tem23)
To the bill of "'W' IcnowItdge. dIIth occuntd d.... to tM ClUII(I)lnd..nnIf 1S1lIlId.._..M...M._.._........._........._..M....._.............,..............H.....................................H.O
",""""",""nd...myq_lan(Physic8llbolh_lngdallh..._locaus.ofdallhJ
To tilt... of my knowledge. dNIh occurred It thet"",, date, and "ce, Ind dla Iotht ClUH(I)1nd N""" II 1tItIcl......................................_......................................
--/III
On 1IIt.. of lunnation and/or InvettIgaUon, In my opln50n. dulh occulTld It ttIe lime, dill, Ind p1aCI. IInd due to the cause(I)lnd ma.......1IIttd .........0
Number 36 Dale Fled (Manll'!. day, year)
34. Namlt'nd~~OfP,8rson..,_Who~~CJuse,Df~...- ,~~
1"<Ll'~,^, ~"-i-I;>
"Z..~~1,~...~b.Q_, .~:-, .../"
~. .' .1'0..,.; \ 0, 'l.
o
.;
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