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LOCAL REGISTRAR'S CERTIFICATION OF DEATH
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
P 17114824
Certification Number
This is to certify that the information here given is
correctly copied from an original Certificate of Death
duly filed with me as Lclcal Registrar. The original
certificate will be forwarded to the State Vital
Records Office for permanent filing.
~.~~F+e-~c~ ~ ~c' .~A~ 2 7/2011
Local Registrar Date Issued
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rlta5.t44 ttEV ttnoo5 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
TrPEPeit:Nr~ CORONER'S CERTIFICATE OF DEATH
SLACK MN( ISae Instnectbns and e](rslnDles on reverse) STATF FII E Nl)MHEA
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Male 1 95- 46 - 21 49 Januar 25 2011
Steven Ma k
S. Ape (lea BMhdey) IArder t Under 1 6. Dees d ~ 7. rd etaM a d DrMr Check one
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S4 rm. November 13, 1956 Sharon Pa. ^ ER/adptlent ^DD" ^Fb"'a ^ ^0°"`'
i)eadr ed. Fatly ram. (M na halbtlon, yM ana aei nuroer) 9. was Decoded d FMeparic odgn7 ~ No ^ vee . to. woe: Anadran ~, wine, etc.
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widowed, DHorad (SpecYyl
land a work tOnd a FAaYaw / hArey u.s. Armed FacrT El.,,,.,,~,y / s.,,~,+d^n (at 2) co9pe (t-4 a 5.]
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Farrre 23ec Qtly when aerllyYrp 7Ja. boa a my IenwMdpe, deah oownd a tla rna, daa and plea aped. (sipuoee erd Ipe) , Lkarw • r-Y•M
plyaclen k nd weMeble p tare d deWr b
catlly torte d doew.
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24 25.Ow Praaurced Deal (lbnlh, day, reef ?8. wr Car Refsned b Medkal Examhor / Corawr for a Reeeon Odor ttan Crema9on a Daatbn7
Her 24,28 mrt be caroNMd by person . '"` ^N0
NA10ioi0e~h~ 2:31 A. M• Januar 25 2011
cntne of DEATTI (se» aaaucNorw aem rxampMs) , Appmehrate taerw: Pen M: Erder odwr 2e. Did Tobacco Ur Caddbde b orMr~
Man 27. Pat I: F3rW ill ~~~ - dFeewe, hKeMe, a mrrpteWorr - tlW dYedy calved IFro deah. DO MDT eda MnnYra evenle eudr r ardec erroet, r Oraet b Death hul nd rrdtlrrg h Ma undedykg awe gMn h Pal I. ^ '~ ^ PAY
rsepiraay meet, a veraidAar Ibrilwan wt9ara aa•'irq the otlolopy. Lht aNy ar trues an each Fhe. ~ ^ No ^ Urrkrawn
~`h ~~°Dea Acute M ocardial Infarction ~ 29.nFemele.
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Due b (a r a corwquence d): ~ ,
^ Prsgnarl a dme a death
M uaAhM M aon~lar, M anY. b. ~ ^ Na pregia~t, but pregxd wNhin 42 deyo
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UNDERLYMO ~~
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„a,,,'~{„'~,,,)'""'~,1e o• - ~ ^ Nd prsprwa, all pregrvxrt 43 days b 1 yea
~ Due b (a r a coroeQueraa a): ~ belaa OrM
d, r ^ tArleawn k pwgwM wWrh the pea yea
32c. O e &idrp, (~'K'MYI Sheet Factory,
31M. Wr n Aubpey 3ab. Were Aulopy Fhdnps 31. Mama d Deelh 92e. Dee d hf ry (MaMr, dry, year) 92b. Deealbs Flow lnFar Ocrxarsd
Pedorrrrd7 AvelebN Prior b CargMbn ~ ^ ~~
d Care d De~r7
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To tla boa d pr bpaNdOe, deph aerated M tla tlna, dell, and paoe, end dr b 11a cree(l) end rrrrarw r alele~ _ _ _ _ _ _ _ _ _ _ _ _ .. _ _ _ _ Januar 25 2011
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on dr heels d enmlrretbn and / a lnveeayallon, h my opYriorr, aeph oarand p Na tlaa, ear. err0 pre, end dw b tla eauea(a) and natter r staarL ~ ~. ~ ~ ~ k dear. d l7.aIM (non zn Typ. / Prid
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o c onto e, Coroner
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