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A Verified Transcript from the Regi.,ter of Deaths
Date of Death g~~,~,~,~_~~,_}.,_,_"I~,?,~__'n' Registered No.3o. I
Place of Death C.o.__L,.,l)__M.!U'~"h,ME,~9~1 A,L:..~,~p ,I! ~.':_ J ., tillO,~,? N, NY
Name of Deceased __......,c~.~~,~__~.s...~,.__.~.~,?~5,~,
Age ._____99...,.,.. ,__...__ Years ,.. ' Months J),lYS
Sex ..~_~,~. ,..._____,", , , ". __________. Color or Race ______._!!i.~:r.E_ ,.,
S. 1 'I . d ''t1"d d D' d MARR lED
mg e, J.l arne t III owe or lvorce ---,--------'.'-------.
Full Name of Husband or Wife ,Qo':",9.,I,I:4,:r____G,~IS1l0~O".....
TURIN, NY
Date of Birth F:'~Bu~..3",',___,I,,~9_1 '" Birthplace ,u".
Citizen of what Country __"u,",Us~______, ,__",,'.."
HowaLong l Here -----!!-~'" ",Q~TH.S __,I N,~':J,~so,~,.,'"
r I U ~ 'f F' ---
Residen~ I ~ E np R ~:' ~ r orelgn ----",--..." ,..------" __"______n n",__
OccupationP,AP,E:!t..JlUF.",.CQ" Social Security No.1 I 1..05-:-2286
Father's Name "--,.,,---,,~ ~,!.,~~--,..~,~,--,~,~,~--~--~--~,.,-''''
Mother's Maiden Name ____'_~~n~~'_'~,~,~..~"~..m
If Veteran, Name of '\" ar ,,,,,,!,W,,,__ff,!______ n, '''--""--,,
Cause of 1 Immediate Ceai?s~A,lI.,L,.,~J~~X~,~JJ~,N~,I,~H MYOCARD-
Death J Due to:5'~:'~~~I~'~';'~":~~"~'~~_~R~;:~,~,!..~,~,~L,f.ROS IS
Time D:~i;~:ndanee } ~-.=~~;~~;=~~:I~~.~:=:'
Medical Attendant or other -A'ttesmnt L ~,o ~,~,~,~....M. .__ f\!__I_E__~!~ L" ~
Place of BuriaJ E'R:~~'~:'?';'R'~-:~~":':~'~~'T--~.:-::-~,~~-E,~---,~--~,~"..,__,__'"
Undertaker ___________~'_'m_____'__._'___,.___'_____,_____________,__,____,__""____ _____, ----,__'..'..,..,___0,,,
I Hereby. Solem~y Attest, That this is a true Transcript from
the PublIc RegIster of Deaths, as kept in the Office of 4- he
Regist~r of Vital Statistics, City of Hudson, County L d
ColumbIa, State of New York.
Dated at Hudson, N. Y., the ,-----,---,-__,___,____5,11L__,_____________________________
day ,Of.-;--P7c/ /f-/ ~J,o
-- - (S~ned) - ,____ ~~~-,~
" , Official Title-Registrar ~Deput-;;--'Reii~~:;~'-
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