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HI05.805 REV (01107)
LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
P 13989150
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.
thn.- ~ ~~~ ~ Z007
Local Registrar S ~ % riafe;lt~ued
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Fee for this certificate, $6.00
Certification Number
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REV 11/2006
, PRINT IN
~ANENT
CK INK
COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
(See Instructions and examples on reverse)
STATE FILE NUMBER
^ \ bt ~l1>D
93
Apr.14,1914
Harrisburg,PA
3. Social Security Number
Ada H. Behman
5. Age (LaSl Birlhday)
- 05 -0163
4. Dale of Death (Monlh, day, year)
Nov.11,2007
1. Name 01 Decedent (First. middle, last, suffix)
v"
6. Dale 01 Birth (Month, da . year)
Cumberland
Carlisle
Thornwald Home
9, Was Decedent of Hispanic Origin?
(If yes, specify Cuban.
Mexican, Puerto Rican, etc.)
Bb. County of Death
ad. Facility Name (II not inslillJtion, giv9 street and number)
11. Decedent's Usual tion Kind of war\( done durin most of world life, Do not state retired
Kind of Work Kind of Business 'Industry
secretary insurance
. 16. Decedent's Mailing Address (Street. city (town, stale, zip code)
505 Broad Circle
Mechanicsburg, PA 17055
12. Was Decedent ever in the
U.S. Armed Fore s?
Dves
13. Decedent's Education (Specify only highest grade completed)
Elemel'a2" Secondary (0-12) College (1-4 or 5+)
14. Marital $tatus: Married, Never Married,
Widowed, Divorced (Specif}1
widowed
~=~~nce Ha.Slate PennsYlvania
17b.Coun~ Cumberland
Did Decedent
Liveina
Township?
17c. 0 Yes, Decedent Uved in
17d.J8lNo, Decedent lived within
Actual Urnils 01
Twp.
Carlisle
City I Boro
18. Father's Name (Firs!. middle, l.ast, suffix)
Albert E. Hanawalt
19. Mothers Name (First, middle, maiden surname)
Ada Reed
208. Informant's Name (Type' Print}
Jane B. Hall
2Ob. Informant's Mailing Address (Street, city I town, slate. zip code)
505 Broad Circle, Mechanicsburg,FA17055
21b. Date of Disposition (Month, day, year) 21c. Place 01 Disposition (Name of cemetery, crematory or other place)
Blue Ridge Mem. Gardens
21 d. location (City I town, stale. zip code)
arrisburg,PA17112
FH&CS,324 Hummel Ave.,Lemoyne,PA17043
230. Dat~ 'ned (~onth, day, year)
f'l"(~7
Approximale interval:
Onselto Death
28. Did Tobacco Use Contribute 10 Death?
o Ves DProbabIy
\Ii:] No 0 Unknown
29. If Female'
S Not pregnanl within pest year
D Pr9QOBr\I at time of death
o Nol pregnant, but pregnanl within 42 days
of death
o Not pregnant, but pregnant 43 days to 1 year
beIoredealh
o Unknown il pregnant within the pas! year
32c. Place of Injury: Home. Farm, Street, Factory,
O1foce BU~ing, etc. (Specify)
Partll: Enter other
bu1 not resulting in the underfying cause given in Part l.
Seq~:~=='~~a
= umlERLYlNG CAUSE
(disease or injury thai initiated the
events resultihg In death) LAST.
a ,....{..sO,. f'r.t. +nf'V
Due 10 (or as. .~ce on, (
b. (:l.;s ,~
~ueloorasa nceof):
c.
Due to or as a COflS8Quence of):
Il,..{r~
hI ot;+h(O id ;""" rY'\
I
=~~cW.~ldiseas~
d.
35. Registrar's
~
l..:zl/ 1"'1/ I" I
32t1. l1me 01 Injury
32g. location of Injury (Street, city f town, slate)
Dves J2l No
Dves DNo
31. Manner of Death
.it! Natural 0 HomicKle
o Accident D Pending Investigation
o Suicide 0 Could Not be Determined
M.
308. Was an Autopsy
Periormed?
3Ob. Were Autopsy Flfldings
Ava~able Prior 10 Completion
of Cause of Death?
338. Certifier (check only one)
Certifying physician (Physician certifying cause of death vmen another physician has prooounced dealh and completed Item 23)
To the btst of my knowtedge, deeth occurred due to the cause(l) and mamer as stated... _...... _.. _ _...... -............ -.. -........ -.... - -....
~;:un~~ a: ~~h:~a:c~=; :hu=~::::~~da:rtZ~ol~:~':)~~~ manner 18 stated- .... _.. .... _.... .. _ ........ _ _ 0
~.::'t:::~":.~;~o;;: and I or Investigation, In my opinion, death occurred at the time, dele, and pIaca, and due to the cause(s) and manner a. stated.. 0