HomeMy WebLinkAbout09-07-05 (2)
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This is to ~ertify 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 filin\~
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WARNING: It is illegal to duplicate this copy by photostat or photograph.
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Fee for this certificate. S6.00
AUG
6 2005
No.
Date
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COMMONWEALTH OF PENNSVLVANIA. DEPARTMENT OF HEALTH' YITAL RECORDS
CERTIFICATE OF DEATH
tHIPAtNT
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:RIlAHENT
UCKINk
NAME OF DECEDENT IFnr. t.Ciddl8. LallI
SEX
STRE FU NUMBER
SOCIAL SECUR'''''' NUMBER
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AGE {WI-vi
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COUNTY C# OERH
59 v"-.
UNDER 1 YEAR
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STANLEY WILKINSON
8lATHPlACE ICtv and
Stal8o:FCfe.gnCCU\tlVI
.. Male ,. 184 - 36
PLACE Of DEATH (Chech oNy 0C'Ie .. .nsI1uCt.0n9 on othel _I
HOSPfTAl'
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August 3, 2005
RACE . American INbA. Btack. WhIle. etc.
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Cumberland
OEcetlEHT.S UIlUAL ClCCIJM10N
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Custodian
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Black
SUlMI/ING SPOUSE
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UNITAL S'OO1JS .........
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Divorced
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YOTHER'S NAME: tFftl ModdIe......., Surname)
It. Helen M. Wright
lNFOAIIANT"S_AOll/IESS_~...... Zlp"-
508 Cherry Court, Carlisle, Pa 17013
Pt..ACEOFOOSI'OOIT1OH."""""-Y.c....-. t.OCR1OH.~ Stao. ZlpColla
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.~rland Valley Menorial Gdns.. Carlisle, Pa 17013
NAME AND AODRESSOF FACIJTY
Ronan Fureral Hare 255 York Rd.
uce_NUUBal
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R. Wilkinson
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Marilyn Brown
ME1llOD OF OIS1'OS1T1OH
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LOCATION (SIr... Oly/i)wn. 5aMt
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"CIRTftINQ MYIICIAN (PhySlCllfl cenIylno cauM d dIalh vd\efI M'IClIher ~ySIC"" has pronourud ded'l ano comPeted n.n 231
ToIM....ot...,~.dudlOCCUfNIIIdue.,...QUM(.'andrMfWI...as.t8ttd......,.........,......'........ ........ ... ,.. .......
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-PIIOIrIOl..aNC AND CERTIFYING PHUICIAH IPhysiielan tJo!h jJfOf\OUI'CIJlQ oealh .00 cettlfyll'lQ to caust aI asatt>)
'hi 1M bHI of my kno.......... ~..... a.e. d.... MId pIKe, and ~ to.... cause(lllnd ....nner.. stated.. . . . . . .
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.MEDICAL ElWIINERICOIlONER
On the buis at ......iNtlon andIor tnv~ in my opin'on. d..th occurruel the tI.... d.... ~nd place..nd due to the ClUH(s) and
fftaIIfter....-..s..........'.......-..........-..........................- p............ -,.. ....... -........... ....
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REGISTRAR'S SIGNATURE: ANO NUMBER
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