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HomeMy WebLinkAbout1617 -1~8383 ~ .io-~ . ' t ~ ' ~lew 1'ork :+tetc DCEtAi1IDCDt of He~lth ~FFICE OF VITAL Il[CORO• ~ }~D11• ~"•'?9'~~ CF.RTIFiCATE OF DEATH Re~i.te,+cdN • ~ To M ~ns~r»d br •p~?tror ~1 ?LACE pf DEATN: STAiE OF NEW YORK ` USUAL RESIDEMCE (wMh d~c~at~d I:r~d. 11 in~tihr?ion; r~sid~wq M/oN Q ~ a couN~ ;Jestchester ~ a su,~ o~;,,~,~. ~ J (1 e. TowN ?Er~cn1 oF s. couNflt a TowN f, 'i stAr ?N ~owN, ~ . Eastchc~ster ~~naev~~uae ~ ~lestcheeter ~astcheater ~ c CIT7 OR VILIAGE d C1TY C1R y~ilApt 1~ r~~id~nc~ ~riMi~ :ra cerpor~h ~:+n;t~? ~ 3ronxville ~ S Years Bronxville _ _ __!?ES~___NO ~ ~ - - a d. NAME O? tl~ nof in twipfol e? inttit~fion. pi~~ ~trNt oddr~u a lotm{en) S1~EET 'f. IS ~lSfDfHCE dN iARM~ o~ 1' STI'TUTIpN Lawrence Hospital ~~Stoneleigh Yes o r+o ~ 3. NAlAE Of 1. DA1E (MonM) (DeY) (YNr) OF DKEASED Bernice Hawkine Decker ~ March 27 ,6 t~~. ~ (Typ~ or ?rin!) _ OEATN 1 S 3. StX 6~ COLOR OR RALf 7. S1lIGtE. AtARR1ED. WIpOWEO. 0. If MARKIED, WIOOWE~ O! D~VORCED, l10~~ oi ~ °q Female ~ White ~ °"~"`ai•°z~~C"'$' ! Hvib°"d M e c«~ w;h Dr. Albert Decker 0 9. OATE O~ t1RTM ~ 10. AGE In y~on ~ If UNOER 1 YfAR .If UHOE~ 2l MRS. 1 L SIRTM?UtE (Sfab o? (eniqn cow~lry) 12. tIT2EN Of WMAT ` K h 9~ 1896 ~O~rthdo~l i Montha ~ Dor~-` -Mowa ( Min. c~ N Y I u~~"nertA ~ ~ . . • . . P l~O. UwAI aCU?ATION ~Giv~ k~nc~ of wu~t don~ dvrin~ ~ne~~ o! wo.k~ny I~h. 1]b. KIND O! WS{NESS OR INOUSTRY ~ S~~ a House ~life ~~M ~f nnnd) Own Home o i~. ~~n~ER•s ?+~t - ts ~on+tt~s eu?i~N r+~e ~ Fennie Callins ~ ~ fd wAS OKEASEO EVfR IN U.S. AWED iORCE57 17. SOt1Ai SECUtIT1f NO. 1~. INfORAAANT'S NAME ~ a~ w^~ piw v.w w dohs of wnic~)~ None Dr. Albert Decker, S ~ Y ~ < ~ v~ o ' 19. CAUSE Of OEATN (fnr•r onty on~ cous~ on o lin~) INf@VAL ~E?WEEN > ~ a a~"' ?ART 1. QEA~H WAS GAUS:D ~Y: O~A ~ 711 ;y Z( i g IMMEDIAtE UUSE !o) ~~_YS t~ mL(?[..~ ~ 1. s: s Cond:fieea, iI on7. y t' f ~ C: ~ y+ ~ wtich pov~ i:~~ ro' DUE TO (6) 1~ X~.-? ~"1t C~. / b/_.~ ~ ~ C t/ J obor~ unnnd.ot~ ~ ` ~ < ca ~ ro~..~o?.~ ; ' ; ~ ; , ~ ~n. ~,a.,~,;,ro ( eue To ;a . - . . _ ~ " ~ ~ ~ tART 11. O1Hf~ SIGNIlICA^t~CONO1~lON5 CONTRItUHNG TO DfAiN W~N~7 R6LA~ , ~~~J 10. WAS AUTOiST F i0 THF TERMINAI C~NDITION GIVEN M tART 1(0) ''L• rERFORMEOI 4~ ~ ~ ` - ~ .J ~ , ~ , y , 1 ~ YES ~ NO e W 21a. ACCIDENT. SWCIOE. MOM1C{~E (Sp~dir) t 216. OESCRI{~ r~OC(~1 ~ ~Ohrr e i '~lh IqA 1 w fa~t 11 0/ it«n 19.) ~ r 1 , ;~y fs , . :~i „~n t ` : _ s s - s l Q ~ 21r.11~E OF No~r MonM, Day. Yw.~- .:1.-a . - I r .~w O t?UUtT a, m. ~ . • h`f~. , . : t) . i . i r, ~ ~ ~ m. } ' ~ ~ ~1 - . ~ ~ 21a. 1HJURY OCtuRRED ~ II~. IIACE Oi 1 WUR1 (~.p., :n o. oeov~ '~If. WMERE DID . q [a,nq Saf. t. ~ r.-{~ Wh:l~ w(~ No? Wfi~l~ ~ honN. fonn, foctory. ~rnM, o1F:c~ bldp.~~~ ..~fllJlj! OCCy~~ ~•,a~- ~ S Q ~i Wwk d Wwk . ' • • ~ .7 • • . ~ . ~ ~ T~, ~ ~ ~ ! hartby ~erttfy iknt ! oNrndcd tk~ dtct A f•om_---_~s~1~~1 ~p ,19_. tkot ! (ast iotr tkt c.~ i dtcrartd a1r,•~ oK. -Jt ~s/_~619G ~ured tho~ d~eth ou~ered rre. ont tlrt tcwtt awd on ll~r datt statrd aborK. ( ~ ~ w ` Zio --tuiE ~ A ~ 10.~...«n~1~3 ~lb.1?DDR ~ 2~c. Stc,NE~ ' ~ ~ ~ ~ ~ E' ~ 19 ~ ~ ~ ACE O~ ~URtA ClEMAflON OR REMO~AI Ny~ 7~b OATE S 10 a~ Mt. Ho~e metery, Hastin s ~ ~ ~g~- ~ 2Sa Nw?A OF E t ~ SMw1 REG STlAT~ON ?~10. 260. DAtt N r ~ Fred ~i. ~c~ra~~i & Son, Inc. K~164~ ~ ,C , ? ---T-- , r ~ `"~:,.w~°' J ?«~n t..~ sr _ Q ~~4 • J-~L~ _ a...~ -3• - . . ~ 1:'' . ~ . _ ~ ,t~. -`~DS'rr't;'"c" .""~~-.;-s~es~ • -rs ~ ~ ~ eR ~ ~ p~LEp ANO RECORD~ A Y, I.UCtE COUN?Y, y~~ ~ S t ~~r. ~r..~:F fD YICAOFII~1 ~i!']i0 n, C _ ~ ~6 ~ i,e~ibility oi ~ritins. tqpint • ~ . Qd ~ or printin~ unss~isiactar~? in : ' 2~ ' this doc~ent tor •icrotilaius ~ '68 JUl :~~~t_~: ; v~~~as ~ ~~EltK C~RCUI~ COURT ~ ~ RK1 ~z ~~~lsas aoo _ - ~ . z~ - ~ ~ ~ ~v' ~ : - ~ -