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HomeMy WebLinkAbout11-25-09 (2) _ _ __ H105.805 R8V f0I/07) ~ ~ ~ ~ ~-" ~~`1 ~ ~' LOCAL REGISTRAR'S .CERTIFICATION OF CEATH WARNING: It is illegal to duplicate this copy by photostat or photograpFl. Fee for this certificate, $6.00 P 15838296 Certification Number This is to certify that the information here given is correctly copied front 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. ~~~ Local Fegistrar Date Issued ~.. ~ _r~ ICJ ~' ~',, s".:~s fT`i-r -~ ~ i"" t N ~ t ~' ~ ^ ' V3 ~ Ci1 t . r + ~.r^ r ~ ~ C3c7 ~F `-;; ©~ ro _ =~" ~ « Nl0.iaa3 REV 1120th COMMONWEALTH OF PENNSYLVANU • DEPARTMENT OF HEALTH • VITAL RECORDS •C ~~~"I_ tt~tnw CERTIFICATE OF DEATH '~ ~ I,r (See INwUueflona and exampNe on rovart6a) srnrF FILF NuueER ~i ~B 1. Nan. a tJxeroN )Fw, n.dda, mst sale) 2. Se. a soar S•caNy Nuroa ~. Dar a Dwn 1~. roY. Y••0 (~ ~a 5 Y>~ Gladys M. CarrtlanY F - - t 5. Ape Ilan eirYdrY) IAida t lAltlrr 1 N. DW Bntll 7. aro qra« d. Phu a Detlt Iloau Urns Lbws aaritn I kppiW: ONMr: ' 89 vm Auq. 10 1920 Shirertanstown PA ^ bpeeM ^ ER / Da4ra•wa ^ DDA raaeap Ibrtr ^ R.rgarca ^ one spec0y m. Cower d Doan &. Gry. Nao, Twp. d Dwn ea fadlly Nan (N rot Nnrulon, Or• atM and rrrn9•r) S. Was DandNd d INrprac Dr4a? No ^ Ya t0. Race: Amman Haan. Nlrcl.. wro.. ac. p ya, WaoM QErI, ISpadM Clsnberland Silver S ri The Bri at Bent Creek wdr.n "~^° "°^ "~) 11 Dacemn's user - d rark mr dr' moue ~ W. Do rol ate19 ~ 12. Waa D•udan •vW n M to Daadrlta EOUNOIt (SPaa+r oay ngrr p•d• ra•p WaA 1/. Wr1al SuhA: Wnad, ybrW Maud, IS. SrarNNp Spo w IN rr4. Sn• maUen narol I(ind a waa Iwo Eerawuf tndrnlry us. Armed Ferro? EWtrrlrrY Y Seoarary IPt21 CaN•D• Its « s.) wmnad, Oirornd !SP•crYF) ^ Y.a No Widaaed f6. Decemn'sMangAmesS lSNed, cnYlbwn, dale, zipnae) _ Decedaae Dd Oeudra tt' r~° Actor Residenn va n ~{pQ1 r~-n Tw i7c `(7 Yas Decadent fi e sbr ~*a^S T1 yaLLa ° P.O. 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