HomeMy WebLinkAbout09-20-12H~05-112 REV. t/05
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COMMONWEALTH OF PENNSYI.\.~'A~di,~ ~J'~(~p((''~~ ('~ '''y_[,~[ (~
DEPARTMENT OF HEALTH VITAL Ri=f'OHDS f~QRU~D ~JI~'E'RJG VT
LOCAL REGISTRAR'S CERTIFICATIC-N QF DEATH F~E~I~i,.~~. ~.';~ °9~~.I~,~
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~~~~ I~lN1ENT OF ~--~ ~ '
Name'of Decedent' Arlene Anna Fleisher
Female: ].76 - 32 - 4947 July 1, 2012
Sex Social Security No. __.__________._ ____-- Date of Death ______ _
Sept. 3' 191.4 Newport, PA
Date of Birth _ '_ 'Birthplace _- ---_------------___._--
Messah Villa a Cumberland Mechaniesbur
Place of Death g _ _.___-____ _ _ _ __ g' Pennsylvania
FaUiry nfame Oounb =uV B oggh or sh~
White US Army ~ Yes
Race Occupation _-__.__--_ Armed Forces. (Yes or No) _ _ _-
ecedent's
Marital Status Never Marrie~ai ing Address 100. Mt._Allen_ Drive Mechanicsburg PA 17055
- Nufibe~ 'Scree' crt. ,r T yvri State
Harvey Fleisher Sally A. Myers
Informant _~.- 'Fuheral Director-__.___-____-__-_ -_ __ _.._
Name and Address of David M. Myers... Funeral Home, 64 N. 2nd St. , Newport., PA 1:7074
Funeral Establishrnent___-__-- ----__._____:.---_-__--_~-- --~ _~
Interval Between
Part L• Immediate Cause Onset and Death
(a) Multiple diseases :of .aging -_ _-________--__ _- Ye-ors.
(b) Dementia ----------------- ---_ }--- Years`
(c) Cmbgestmve, heart fai ure ------------_-.-- ~~ Years
~d)
Part II: Other Signficaht Conditions
fUianner of Death
Natural [~X Homicide
Accident ^ ..Pending Inver#igation
Suicide ^ Could not be Determined ^
Name and Title of Certifier
Address _--
Describe how injury occurred:
Jennifer Weber
__
D.O.
`M.D., D.O:, Coroner, M:E.)
100 Mt. Allen Drive, Mechanicsburg, PA 17055
This is to certify .that the information here giveh is correctly copied from an original'certfic-ate
of death duty filed with me as Local Registrar. The original certificate will be forv~rarded o the
State Vital Records Office for permanent filing:
_ ~ ~ _ 50-455
.oral ReipRtrar or. Vital Feeor JS ~~~l.i~ ~ f ~_ -_-
July-6, 2012 101 Barnett St New Bloomfield, PA 17068
--- __ _
Date Kieceive4 h _oaal F6= _--- rt~~'
y ~ _gi~trar St n: Ad.1rF. s 'ry 13or uuh, Township