Death Certificate - Gresh, John J Jr_5/22/19921�$.:129cy id8
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Name of Decedent
WARNING: IT IS ILLEGAL TO ALTER THIS COPY OR
TO DUPLI�ATE BY PHOTOSTAT OR PHOTOGRAPH.
OMMONWEALTH OF7ENNSYLVANIA �
^ARTMENT OF HEALTH VITAL RECOROS
LOCAL REGISTRAR'S.CERTIFICATION OF DEATH
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Sex ���-�- Social Security No. !�%? -� Date of Death :-✓��• .13 / i S i
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Date of Birth � -�-� . � / � `} � � Birthplace %%+�-�/��- -� ..�-��i_U�.- r%%�i,��.,-,�.�L• C�. 7�� .
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PI2Ce Of OBHth � / ' � � /i^1 = =�-<+--� � / /" " f' . • � - ^ •i�^-� renns ivaiva
)� . C'LpaaLry Nmv � .� Caur.ry / % r , � �, � � . BwwSn or Iwnsmo
Race Gl"��_Occupation �� �m- �-.-.,-�� /- ��- Armed Forces? (Yes or No) %7c.
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Marital Status ��- � �• �� ,� Mailing Address ��r i %1 �/c� -h' %' �--�,-: i �-� �-s-�-v-L
Numur ' Sveei ' ,� G.y or Town - S:aze
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Informant �i-,._-�-�.: ?��i��� _ Funeral Director �� �"._:- � l'� G'..-
Name and Address of . ; J �� .: �^ � � v'
Funeral Establishment ��!� ��'��,��il i Y�%r�,°��I'�''-'�� '��'�-�-1���=='4 � �
; Interval Between
Part I: Immediate Cause ; Onset and Death
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Part il: Other Significant
Manner of Death:
Natural � Homicide
Accident ❑ Pending Investigation
Suicide � Could not be Determined
Name and Title of Certifier i� .'�
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Address ' ��-= �
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Describe how injury occurred:
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This is to certify that ihe information here given is correctiy copied from an original certificate of
death duly fiied with me as Local Registrar. The oriainal ceriificate will be forwarded to ihe State
Vital Records Office for permanent filing. I j ;
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