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HomeMy WebLinkAbout11-29-11HIU5.B0~~ RIiV IOI/1177 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 1772773 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 Local Registrar. The original certificate will be forwarded to the State Vital ~~ ((~~Re~~cords Of~~f~~ice fo{{,~r~~p----erm~~~~anent filing. L._Jlt-it~.~~T~P~J~Rk~t~D~ 2~ 2011 Loral Registrar Date Issued _ ,~ C"1 ~ = - -r ~~'~' ,, - ., T -p T1 y` Oxtosta3 REV ItlN08 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VRAL RECORDS PE /MN CERTIFICATE OF DEATH BLACK MI( (Sae Instructlona end examolea on rover8e) ~r.~ ~~~ ~ u~ ~..•~ 1. Noma d Deaart (FaN, rtedJe, reel eunrcl 2. Sea 3. Soda) Sanany Number ~. Deb d orm R.arm, esy, yrrl Dawn M. Monroe F 193 - 58 - 4189 August 19, 2011 5. Age Ben BMMry) l1Mx t Under 1 d 8. Dab d BiM Noah, 7. & end awe a can Be. Prey d Deem Check are Moak Dap Roue Mvxme Moepilal: Omer: 48 Yrs. 6 25 1963 Harrisbur , PA ^ Inpeesa ^ ER! aroatisd ^ DDA ^ Nursaq Rama ~ Redderce ^ Omer ~ Spetlty: ' eb. Daaar a Dam ac. city, Bcm. Twp. d Drm ed FedMy wme (n m irllenim, giw sveN and nuneeq s. wr Decedem a Repeat aqm? ®No ^ vas 1D. Rea: Amelcan mden, INacN, wbb, ac. e Cumberland Carlisle Boro. 331 " A " Street (~~xb R~kann', am.l lWhite DsaMiMS lyneY aan KYd d waN tlorr rrW d Ye. DO not alert • 1 t 12. Wr Decadent aver m do 13. Deatlrl's Educatla (seedy arty higlwat grade mnpbtad) 11. Memel $IaM: Married, Never Marled, 15. $uMving Spouse IN wee, 7v mdden rme) . IOrd dWak Ibd d @teeeeelyduby U.S. Armed Faraa7 Ewrlallery 1 Setoldery (0.12) Colege (1d a &) , ~'~ ISPr+/Yl Machine Operator Printing CC:AO ^ rea ~9 Na 12 Married Ste h R. Monroe 18. 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