HomeMy WebLinkAbout0361 ; ,
4
~ .
_ ' 2-~
STATE O~ NEM JERSEY v~ 3 S ~
O F F I C E O F R E 6 1 S
T R A R O R Y I T
A L S
T
A
T I S
T I C S
BOROUGH OF CLEN RI06E, ESSEX C011NTY, NEN ~ERSEY jS:~ `7~j
This is to Certifr thot the ~ollowirq is conectlr copied fran o r~cord of D~ath in mr offic~.
N/WE OF OECEASED PLACE OF DEATH OATE OF OEATH
~ Abraham Dvkers GI.~, Rid~., N. December 29,1966
s
~ SOCIAL SECURITY NUMBER SEX MARITAI CON~ITION OATE OF IR H AGE
VRS. MOS. DAYS
237-10-~774 M Married ebruary 1$,1$$4 $z _
PIACE OF BIRTH CAUSE OF ~EATN
Holland Respiratory Failure
SUPPLEMENTAL INFORMATION IF DEATH MAS DUE TO EXTERHAL CAUSES
ACCIDENT, SUICIDE OR HOMICIDE ~ATE OF OCCURRENCE
SNci1p _
wHERE DIO INJURY OCCUR3
Ciy w Town CouMy Stot~ ~
DID INJURY OCCUR IN OR ABOUT HOAIE, ON FARM, IN INDUSTRIAL PLACE, IN PUBIiC PIACEt
S~~e1fp Trp~ ef Plx•
wHILE AT wORKT 1AEAN5 OF tNJURY
NAME OF PERSON MHO CERTIFIED CAUSE OF DEATH ADDRESS ?
~
k own M.D Little Falls i~.J.
~
~ f .~.F?~~:c~~.
R stror of Vital Statistics
~~lEp ANd RECORDEO
8T. ~.UCt~ CQUNTY. FU?,
~ - RFCQRD V~'RIF
De~ember...3~ 19 .
..Dat~ of Isw~ - ~~l- ct':i~ 9~~ 4' V
i'~3~
_ a~K~.64 ~ 35g _ na~~R ~o~r~~s =
~',LFc~r
-