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HomeMy WebLinkAbout0075 I CONNECTICUT STATE DEPARTMENT OF HEAI.TI~TD 107582 D~ A~H Publie He~lt6 Statistiea Seeliow-Ha~tford. Cowweetiedt U.S.A. 1V • Certificarte of lkarth .l.s9a3"~6 1. rr..a o. nc.tx: (a/ sate o[ coaneeck.t t. vsv~~ Rcsmsxcs o. ` ConneCtictiL- Fees =l. r ~qta.tH, s~.e~ . ' !?1 Csrnt~ fe/ 'ldw~ ~s) Co++nty .(2T '~sw-, ~13,~ (d) Is~'7l~P~ne~ InaiA~ ~ Nex Haven ! New Haven New Haven _ t~c~a~t~n~~~; c~~r H~~ouRh i.~~,~~.• i (d? N~we of Hweifal et Iwsttwtion (el 5aeet Numb~~ \ YM ~ No Ilf~sst ,n • Ao~Pilal ~e i~stit~tio~ ~iti Strtet Na Uf n~~L ~ire loc~ 1~~ ~r 11 `i 1~ j .I 1[ YN. w~me Cftr er ~~`e ~ew Haven Hoepital ~ ~ ' ` ' ` ~ ' j 4~ Vista Roa¢~ r,~~ orth Ae~ven N~~~ lllntAlld2'CM (lliddk) .'f ~ g•~~ '.1~ ~ S~co~mc ortKR ~r~o. ~ .~.c~ Y-1 ~~~~-.~.~v 8mt~h ~ ~ :t , `r~~ „ 3r 4244 PERSONAL ATiD STATI3TICAL PA ' S ~ , ' ' ' _ ~ ~ j.~ T~ ~ ~t~ RTfCU1.AR C ~ ~tE_~er e~ae ~re ~ee seu (•1(?1 ~Mfe)1 ! RAtt ~IA NMf 11ARttW ~ ~ L~~.~ ; i 81@ ~ CaUC ~ 0 P~er D~i~~ ~M~s•~~'j~~yf~~~ i~itt~ sri ~ ~ ~ ~ ~f0011't! ~ ~Il'pwRp ~ ~71IICC'.A ~ p~/~ 'j ~6'~ ~vDRATlYP ' ~3^ (I'(Aqfp, WfOON~W OR b1tiOR[!Y~ GIK ~AIORf 1'IAMt OI I~etaet~tia Cs~rcinomatoaia wus a~~~ Alice BaBSett oc,~j i I DA7t N /1loutbl /O~r) 1Year) ~ ' i pt~m Coeditlon~. _ 1~g - ApT~l ~'j 1~8 ~t aar. whkb O~/~ I l~. D~ts or D~aTn Aes (in se~r~ It under 1 7ear i[ nbder 1 d~f p~ ~f 'r r~~C rCLJ(~'~'~1!!l.~~ J,~j /~r,;•- ~t ~*~~y) 1[ontiq Uari Hours Miar. ~t~tlas t~e uude*b• vs so (e Dec 7 1896 ?1 ~ ~ a . 11. ~1sTNn.ACS (Cit~ or town) (St~te or loreisn eonAtq) Pwsr Il OTNp S10NIIIl'ANT CONMTin!f{ COi~TR1~U71NC 2~. a/~a Wallingford Connect~cut rn pc,~rH rur ~or R6l.ATiD 7O 1Hi TttI11NA4 Dt9tr1 ~~sr CoNanyN GIrsN t~ Pnat I(~I. I.~y,eR~~} 1t; l~1 U~v~~ Oecvr~Ta~ iCire kind ot .rotk done durtmr nast ot workin~ (ife erm it tetind) Y°~~~~ Mortgage Dept Z~. SuscaY Rasrwxr to Coxataxs Rse~a~as~ tr Issr Yl. t?1 INeom~r oa Bus~xw ew YeA aV~I1gS N~me ot operatiow ~ f61 D~te oerformel I~. WA3 DLC[AS[D A V[tERAN! Ya or Ne (A) '(~IN[ O~ TMJI'Rf 1Y1 It 7es. sire war ti. (a/ AtetasNr Sv~ttos Ho~tutos N~r~ M~wtA. Dr/. !'~r Untt or Ship ~ ? Q ~ _ ~ 11. Nwxe_.Isaae F Ru71 { R (e) iK~u~r Occuiuco ~e~ Pwce o? IN~v~r (~.o.. ~....e..t ~1iw~. = ICnr or torn) I~tate or Ibrei~s eountr~l Wh{k ~t Not WAiie r~rw, latt~+~r. ~Irlfl. ~~e~ HI~.. ~fe.f r w Nort ac woric ' ~ ~c.8~.~~~.~..~Millerton New York O O 1~~~~„ Mary A Smith t~1 Cmr. To..N, oR r.ou?non co~~nTM $r~ic : ~ ¦ it. Nwrt M ICit~ or to~nl lSate or lorei~e eountryl ~ b[scaue xovr IuiuRr Occuaaso. i ° Wallin ford Connecticut r~ ' 11. BtitTtlri.ACt g IEwf~r aat~?e ~J iwjiry rw Pssl 1 •r f Ia. -IN?ORMANT'a N~Ht o? P~.t !1 e! itew s2.) E MZ'$ Mdrew B1112~5 Wipf~e-)- Z~• I HEREBY CERTIF1. tA~t I at~aded tAe ~eceued f~om ! A Lv V~ ~ ~ 1! ~ ~ . !o r' ~ 1! I!. /11W4 CR[MATtON OR RlMMAL D~fly~ 1f,.. ~ ! ~ I~ Cwwuterr or C?enutor~~rth NgyPn (`gntar tb~! 1 last saw tAe da~~aed tli.e en 7~_ 1'!~ PI•ce North Haven ~Ol'1D@Ct~CUt and t\st ~eatb fs s~W to luw veenrnd ew.~_~~ ' t~. •MS w 6ru?~~u tr Boor w•a Ef1~ALM[9 Lieeu~ n~mDer ~;t t 0~ ~ Hawl~y i~ Lincoln ~ - - - + 1034 o~.~ ~ ~ ~7. sa~O~ j''.wT ~_Jr..,K:D. i !t. sK q~ w E t rsa, Fuwsw. Duscta~ - = - i, • , t - ~ , 4_ !1~[l~ ~ G t _ l. ~ . Ydle New: ~?v_Qn~Ho~pital , AAdnq ~dress % ` • • D~tt ' i ~ 7Efls C6 I t A . ~ BT I!y'l''~^'-:'~• _...i:~. - , + Y~11lI1 Y&~ , . • r"~ ; ~ : . ~ - - ~ . . e~rtif~ t`al tAi• i~ • Rr~N tt_ ~~erip!'~~ llii t~~ir~iaWf o~ e isat6 r~ee~J a~ e~eer~d iw l~i~ ~is~. .ti :G~`-• ~ ' _ __r; r'.)... - ~j ^~M . Re~i~trar Vital 'tatistk~ i ~.e.r J~Z..~~~...ar.~e ......................'r....t................~~11.. ~AtII................... Tt LEQ h~.P COROED ~ S x1TY:' f L"~•. NOT GOOf~ rNiT!lOUT 3l:AL O~ ~tRTlFYlMG OFFlCUL t' t~~~~ ~ ~.w v.a t~c 1 + 6 PM 2: i S ~ 68 AUG ~ ~i7~ ~ ?4 ~A ~ ::(l,.~:z : p,~;R'.S ; ~ C~ERK CIRCUIT COURT ~ _ ~ _ _a_ _ _ _ _ - - ,