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I F ~ 1 I ~ ~ 1~1ea Y~rk 5tste I)op~r~.~seot of Health f%'~ ~ arr~c~ or wTw~ Accowo~ ed ~9Go CERTIFICAT~ OF DEA'E'H ~ + F ~ r. r. r.....r ?r ...+~..r ~ ruc~~auvw srxi+e cr Newr rarx t ~~oe~c: ~w+..~ +.....r u..~t N ~ ~ N~w r G TCWM K tl/A111 Or \ COIN~Y s TVM1i ~ ead ~i~oiv+u~wo'e Nessau North ~ii aTr a vuuce i cmr a v~u,~oe ~•••r~•.+~• ^ j~ ~ Williston Psrk Williat ~ rO I{ w{~Mtt Oi (il Mt sw Mwrt~r! « t+arNfwf«+. s;w .tirw ad~w w Ir~hw) a i1fE~t { MOSIITAt 0! AOGRli~t ~ ~ ~ ~ ~ 1!fli1T{E~10M . !V ~ 3. ~ d , ' ` I. ~TE Wr~A?) t" ~ ~rr•~ r~+~ Ro~ Edw in Johns on i o~?rn I.~~ 9 1~S 3. i~( d CO/Ot O! ~I1CE 7. SII~GtE. MA~IIEQ. WIDO'WED. ' R tt MlJtfilD, wicowtD oi`ciro~c~. ~1r~ ~i ~ r~ I M9 , w ~ onoRCm (sr.+ih~ I n~.,r..r ~ x ! ~.4 hi t e ? S in~ e_ 1.!«) w?r. 0 ~I OA~ O~ NR1N i 10. AGE (!n ~wrr~ ~ If UMDER 1~'EI?t;ti UtIDEt 2l M5, l1. NiTl1~lACE (3~a o~ iww~w e~rwNry) I ~ rirlh/v7) ' ~ i AIrMA~ (~e~s Mwn 61in. ~+~;~~~Q~? - -r~~--- ' I Aridqeport , Conn. z~~ occu.Ar~w+ cc,i.. k:~a o+ ~r«t d..,~. i~;rt~.....~ .f w...iw, ~~h, j i~e: [iNO a ws+NEU a~ ~NO~u:nrr ~ ~ sr~n H rs~M+6l ~ z~ m I SerYice ~tean P rofax Gas ..ompeny ~ I} 11. 1AYN@'S KAM! 1!. MATlit!'! A4AIDEii 1MAaA! e~ ~ Alex JQ son---_ _~~_~~~1 j~hn~ n i' Q ~ 1~. IYA~ fJK~AilD EVE~ tM U.i :\RMED IOfCE51 1 17. SOCIAI SECU~ITT ?!O. It IN/Of/AAMTS MAlNE A~r p,~,~ + ~Tw. aa. ~O r«. s;.. v... or d~7~. oi ~.n.odil M ~w~kn~w~ ~ ~ ~ ~j ~ t is. uuse oF oewrn ;~....,i, m~~ - ~ Q~ a. oE I .~aT ctnna wws uus~ .v: Z,.~+~i.u~~,C~.Ar-~L.e.,__._..~ ~ ` +~u~~n uusr tQ~ ~ W ~ ~ ~ ~ ~ p » ; Y ~..~c.•ti cc-l~.~--~ ~.~,t.~~ ~:E.~r ;cA~'~u ~ s.r• ~ ~ m ~ i~rs+]r.w+Ai~hr { DYE O _ ~ _ ~ . , ~a. .n eww (e), alalie~ ! . ~t ~ 1 _ i4 ~ ~ ~ :i ww~~r,~ i WE TO lc) - ~ --b~°~' - ~ ~j ?AR1 1. g SlG1i1fILA?R LOM0IT~OMS CO~('l7WTlFiG ~O DEATEI WT 110T StIATED I ' C TO TNE Ttl/A!w?L COldO1T10N GIVli~l IN ?I1iT SS~) . ~ . ~f ~ ~'V G-~ ~ , ~ ~ , y` ~ ~l ~ ~ ~ ~ I ~ E a ii.. ~e,cc~ntr+T, w~u ~ra~~uoi (sr.Ghi 2i1. ofscR~sE ++ow ,wuRr otc~e~. ciM« ~w.. ~ ra~s~ n.r- w~~'ir~~ . ~ 3 ` ~ ~ ~ ~ ' ~ - . p o ~ 3 _ - - - an ta M.w A`w?!~. ~or, r... _ : ~ ~ . IWNfr s, w. 'c ~ ~ ' ~ . ~i _ . ~ fI. iqxRr OCCURRE'D ~ 1~.. rutE a ~wurr c..,E., iw wwr 21t. w D~o c~q, ~e.+n t~ w?n..~ p Na wo,+r. p j ~..ti r.~...r..~...~. w~y,...«.~I iwusr acu~f ~ w..t w w..t ~ $ ~ / lwreby csriify that / olt tl~t dtcrassd froiw_,~~~ 19?1 ` ,:9 w 4 ~ J~Cesad ~1w~ or 19~~aJ N~at d~atk otcwrrd at LZaLt~+p., ro+~ tks caw~s sid aw $ ~ i ~r > o . /~I ' > >ir /t/rCS M~~AL, CRM1A?1CM Ct MMCVAI 3~. DAT! ~ lt011A1'11rl. 1lasstu 1Knolls Mem. P~rk l K i~.. ww~ w~.~uarrwR sn~naa »o. I~r.. o~?n K rr n~ . Y ~nd Broa. Inc. R262~' ( ~ 9 • } ~ • - . -