HomeMy WebLinkAbout07-05-07
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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions snd .xample. on rever..)
3. _ s.cuno,_
192 - 30 - 7787
ea. _ "Ilodl CIlock one
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D~_ OERIOuopoaooo OOOA ONulJingHuno r;i-.,. 00lll0<.~
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Anna Sundae
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932 Hawthorne st. Enola
Fee for this certificate, $6.00
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13670764
Certification Number
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H1()S.143 REV 1112006
TYPE I PRINT ..
PERlAANENT
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1. _"_IF"", _, 1uI,.....
Dolores E. Peair
5 AgoI.....Ili_y) l>ldarl
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PA
7.
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68 y"
lb. CoonIy 01 DtaIh
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1939 Girardville
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15 Fortuna Lane
11. DectclMrs UsUII molt 01 WI. 00 not....
KInd"_ Kind""""'/1ocioay
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12. Wu Oecedenl:tverlnlhe
u.s, Armed For<:es?
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15 Fortuna Lane
Enola, PA 17025
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John KCMalick
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AauaI RI&idence 178. Slat.
Ill>. CoonIy
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24. TII'IMt 01 Dta"
25. Dale _Dead 1_. day. Ifill
4:05PM June 6, 2007
C-"USE OF DE-"TH (See ................... ..........1
1lem27. Pant Enlefitler.t:wllUIlDII- diieaaet,...,., or~-1hiddiflClycaused"'d8aII. OONOTenlerlennlnal8W:lflbsudlascarQacanesa,
fespiralOfy arrest, or Y8OOic:uIw abriIaIion wiIholi: showing !he etio6ogy. UllI: my one C8UliI 00 8ICh line.
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::: ~ur::'~ MdJ Of ~ In mr opWon, dNttI occwred at the time, da", Md plKe, and due 10 lhec.utl(s) Md NlmIf.. *Ml, 0
This is to certify that the information here given is
correctly copied from 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 filing.
ocal Registrar
07
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