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New Yoek State Deputmeut oi HedtL
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DL`' Ni s.~,~es,~.,~.~... CEItTIFICATE OF DEATH ~a
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i. ?tACE Of oEATM: arAfE Of r+Ew rO~+c Z. uSUAI eEi1oENCt t1A~w Ma..d u..~. If MaNwBw
q~ COYN1r Ora11 e sT~~ New York
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~ Warwick ~TMa"~
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~ c c~n o~ Vl~ucu a cm o~ rnuAOE a..a+..o..i++d. n, ~aro..h w~i~~
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~ N Me.aw « M.K«K.,..H» dai... « I~M~w meeT Un i Qn C orne S •~s eu~oEace oN NNw?
~ 3 iasnnmoN Union Corner's Road A0D1~ Road ' '~A ~ O
s. wur~ of
ti~ ~°f~,,.`".~D,~,,~ William Henry Drew ~~TM Februa~y
a sac s. caoa ot ~u?cE ~ s+r~~, wuauE~ w~aowfo~, ~ n~~~, w~cow~a a~?oat~
~ 00 Male ! White I I~ari~~e~~ c«~~wx. Viola Daven o~t Smith
~ s ou? aetM 10. AGE (lw y~ort If UNOER 1 fEAR If UNON 21 NRS, ti. ut ts~w « aw~r) 3t emz~+ a w~uT
Au~, . 23 188~ !a' ' » waw I a,. N«.. I~w.. rnr E .,.i~.
~ New Jerse ( U~~~;
i~.11SUAl OCCU?ATION (Giw kisd e! ~rerR deM dwNp wat ~1 ~rorkip lih. 1~?. KI!!D O/ WSINE33 OR 1
z m ^ Farmer Own Dairq Farm
s. t~n+Era Mon~rs ~wo~
~ Jacob Drew Anna Mary Rutan '
~ lA. WAS OKEA3E0 EYR IN U.S. A~MED FOKESt i~. socuu sECUUn na iwow~Nrs wu~ ~ooeEu
~ :«No~~~'"""""~'°'''"'°`"""'~ 058 30_5763 iola Drew, R.D.2, ~iJarwick,N.Y.
~ ~ w N u?usE of ounl (Ew1.. «~r a» m~a. li~.) ~NtEtvu ~EtwEEN
?~ur r. outN wws uusta ~r:
w wx~ou~ uus~ c.~ ~oronary Thrombosis 1~~~u~sTM
pi
~j ~ IR oAM~j~?~ ~is~N DUE TO (6)
~ ~ iiwi~N I - -
~ ~ ewrs /aR 011E 10 (d
v ~ ~ s~cnirK~?n ca+ana+s to~tiwrrn+c~ To o~?rn wt ao~t ~u?~ WAi AUTOKY
i ~ ~ (•~~~M
~ ~ i0 TME TEfMtWlt CONDITtON ~i1VEN IN MRI 1(y ~lORMEOt
~ ACCIOElIT. SYKIDl, MO~AICIDE I~+~f) 210. DESCRUE qOYll INNIRY OCCYR~tOi. (E~r r/w~ iwjwp i~ IMf f~r hA tl p~ a
~ ~ ~a ~0
Y
~ 1~ Q`~ ~ la TIME Of Mw AM~IA, Ohr, Yw
~ ~ ~ p INNIIY a a .
~ F. a
211.1 WIIRY OCCIIRlE~ • 21~. W1CE Of 1 W WY (w~., in w aeo~A 21l. WMEtE OI~ CN~I er I~ww Cww1y :b1~
~ y~ w~w.~ p w. w~. p I ~«r.•*•w.~. s~.,.Ka! ~~n~r oocue+ .
~ p,~ w«t we~t
~ F~:a 1~eseb~r esrtijy tlwt ! e~tr,~ded tA~e dec~ared fro .__.19 to_ 19 t~ot I fort saw tMe
~ det~ared dim ~ 2~2 , i961 aird tial d~otJk ott~asad ot ~ ~ o~w f1~s tarres ad ow tbe dcte statid oboor
ft
~ bs. SIOW1i11RE (ONn~ v6 1~ I100lESS W?tE ilfiNt~
$ ~ m Samuel H. Littenbe~g M.D. 'rJarwick, N. Y. 2/4 » 61
~ Q 2~0. ?tACE OF Wt1Al. CRfMAT10N Ot REAWVAI 2b. TION CIiY. Ot A!O STAT~ 21e. DAif OF iUtlAl OR CREMAiION
~ ~ 7 F lo!~ i da Ceme tery ~
lor i c~a, ~
ew ~
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r~ C Feb~uar 6] 96]
K 0 2Sa SIGNATItRE Cf 11l~ElTAKER ~iGtSTRA IiQ ~lb. ADO~Eii Cf iM~EtTAI(ER
Alv3n D. Hi~gs DO-18~ Flo~ida, New York
wu~ or Esr~Nr ecwsn?nori uo. tso. a?~ ~?m ar wu~ 'w. s~cw?rueE of ~ccsisrw
' The Garfield Vanderbur~h F-2~16 Feb. 5, Y'9R5 A1 ice 0. Daube^t
r
r.~ {?...r a...~?, ce . a e _._..__+.o.~..f a... 1~eb. I.
9tate of New York
' Oonnty of Orang~e ss :
To~rri_ qf ~l,;~ick
" ~ ~ Alice 0. Daubert
~I,
=~,~[~~c (~egiettar) of t}ie Town of ~Varwick, do hereby
eer~fy~ ~hat I~tav~ compared this copp with the original
,
• D~a•t~ on file in tlus office. and find
...........:..c.,~... :
that thia ia s t~~ r.~py nnd the whole thereof. :
' ` • a • . . r . . ~C.LI~ ~,~~:-u- ~it.fCil~ . . . j
~ la~cb¦~a.8t) ~
Dated, Warwick, N.Y., ~ie
..7.
~t~.. dap of~uly.,...iA6 ~ . -
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FIC~O ANp RECORD~p • -
ST. IUCI~ COUMTY `
RECORp yE . F~A:
RIF~EO
'sl ~U! j580`~'6
14 pM 3 : 3? :
~t~ 68~ ~ ;o~~N 'l~1~ ?
. IERK CIRCUI TR~S ~
T COURT
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