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HomeMy WebLinkAbout2954 . . _ N~ CONNECTICUT 31'ATE DEPARTMENT OF HEALTH NO ~ Bd~n ~E Vital SlaWtie~ - Hutioed. Co~~etie~~ U. A. • 110404 Csthficate of lhoth • 1~'13U0 ~l ~e~ ~i. " l. P~?cs e~ Dsntws t~) sstaa et Ca~¦eetiM• i. Vlviu. Ransr~s M Dsanass ~a1 SltE~ C011t1@CtiCl,~ r`~ _ lb) CeN~b (e) 'l~ew~ fl) C+oa~b (e) 'ldw~ _ A 1teiM~c~ iMIN ~w a New Haven ew aven I orth ~ ave ~''"'f t' a~ x.~. et xa.o~w or t..uw~ s~.~s x~meK - . ~ ' : ~ ^ w~iry. ~t• p : ~ fit wot h a Awo1W x taWWtlow ttn St~art Na lTt nraL lire loeatiowl ~ YM.'~*ii~i 'CW K ; et loe~tio~) riCOdl• . • ~ ~ ~ . . ; race New Haven Hos ital 1 0 Ma le Avenue~ ~ l~o.ic~h~~v~bn ,•;n,'` 3. PIAMi 0~ fFiesl! OIIdAN) I~.astl ' ' j~ SoRY~ $CI? . YM~sR , i J oNN S - /?E~G ~ 8-22+6 40 ~ ' ~ ' MEUI f ' :M_ ; PERSONAL ANO STATISTICAL lA1~7ICUI.ARS 32. Csuse w Dsntir . T~ A and_~ ~~~11!, t~M1~~ eYlb 1r.' 1~ ~o-~l 1l 1 (e1 i s. Sa R Rncs 7. ~[wwss (x Ne~s 1[~uw '-'ZT~T 4 y 4-, r~, ~ u~iml?u ~ ~ I ~ P~rt 1. DsnTlf MrAS• ~t11~ ~t : 4; ; q~r.raw ~ : ~ p~My 1M11i01A?i ~'iAV~t 'U~-~ Olq!! AII~ mAle t~?hite ~ ~'°'~°D ~ f.~..,_.:.,,..•. wsR ' .~.'>t'1~.-.- . ~.~•''p a ~I~avsa. wmo.ss ~ D~ro~c~w one D~tw~x x~sn a~ O G d~. , , ' Wvs aa Husu?xo ~ n ~ , /~f' FD~~~ ~i~~~d ~ Katherine Etzel nwts o. tllonir) t~.s) •t1e.r~ Doe iv ~ I~Ata Coadltiau. ' ~ D^Cerilh~r ~ =M'~1 ZS~B it anr. wsk~ , ' ii 1'f~~• w fi~~~q ?..r 1~n tNU It ~e3K 1 7~r It uMfer l da~ ~are ehe to . ~ „ ~sore eawe la.t ?irl?Ayl ~lowtlr ~ lh37 Horn M[as. (a). s4dnt . . • I I the nnderb• Dus ro (e) 3 u..~. , , F_ ~ il 0~1885 73 . ~ Il. Btarwn.~cs lCiqr or town) (State ar torei~s oonstr~) . • YA~T II OTNLt SICNVICANT COIt01T10Ni ODNTR!{UTING^ j,1, ~I- Ls f ~ @DOl't C011IlACt3.CLlt ro Dcwrn sur xor Rsurea ~ ixs Tsaxauu. Anrors~r ~ T Coyntnox GnrsH ut P~et I/a1. ~ i' ; 12. 1a) Uavw~ u~wno~ (Ci~e kind o[ oort done deria= most o( Yei N~ ~ i~+ ' worlcin[ Iile eren i~ retind) ~ t00~.-mBker-retired z~. saawY ~tnsr,?rT ro Coromoxs Raorrso ~x iax f ~ f~~~, ~OV • G oa Bus~rtas f~l Name ot opMUoa Date yerto*rNd i ~ ~r ~ ~ li. Wns Dccewseo w Vsrwxt Yes or Ho_- (b) ltrs a~ Irauar : (b) It rea. Rire .nar 2S. la) Acc~o~xr Sv~ao~ Horrcros H~er New~A. Dslr. l~ss f. ~ vntc or shtv _ O D O ,w, ; 4 ~ I~. NAMC John 0~ Nei 1 ~~l INJURY ~CCVRRtY (dl Pucs o~ Ixsutt (f./.. tt~ M~OOt~ AIAf~ ~ kt ( ~ (Citr or towal {5tate or IORitq tOYAtry) While at Not W6tle f~~*~. lK~. ~trKR o~te~ bl!/» ~ts.) I w ~a. Br~rciirucs Bridgeport Connecticut Hork wo~k p x~~'~ Anna Eckert ~e) Cttr. Towx. oa t.ocnnox Couxrtt Stsa ~ ~ li. NAM~ . . M I IC~t~ Or IOM~AI (Stl[! O~ tOKIt11 lOYOIry~ ~ w' y l I~ ~ 1~• 1~~irarucs $I'~t~ @1~01'i'i (~`OI'It1ACt ~CLIt Ifl D~xt~s now la~uaY Occuusa ' ~ ~ $ , IF.wte? Mtrro eJ twfrry fw Pp! J ~ 16. irroexwKYs Nw~ts er P~rt 11 sJ ite~ ~ohn Q~x@~1~~~~ 26. I HE EBY CSRTIFY. ~eac t acceea.a uea~ r~om r,gm' ~ I!. au.w~s~E,~G~iDEON[xe~1o. a n.te J~.T-~a9--~r-J'- " . to y y Is . ~ Ce~netM or C~XoYir~LZU~9YICA t~t I ast ~aw the dcee~~ed a1i~e on ~ 7! ~ ~ ~ Plaee ~Ie s t Haven;Conne ct i cut and ehat deatD is uW to 6ane oanrred s1 t ~ t0. I~AMt OI F.~i~u.xsa n BaoT ~rwt Sruucsa I Lltl11N Allmbtt a~ /7 • ~ ~ € 2T. Sur~ os. Peraawx ~ ~ ~ • ~ _ r~' ,1,~ I~um .en"~'em~'r`~a~"~in~'r'a~"Ad'~f~ • ~~f~,~+~%t.~:~,C~ • , ~ ~r~ j_''____~~.t.-~ i ran ~ ~ ~ ,?aan:: Z ~ ~ • ~~U1-~ a y 3/ ~ _ 1'!!IS CERTIPICA?$~~C$iV~D YOR RECORD ON .~TANiIARY 1~, ~96~9 - I 81 ~~F ~ ~ rto~ vs.~ u?tt ss~t . ~.t i..li~ ~ • ~ ' t~ycrNf~?. ~i~t tkia ~ i~..~C_ ~a tr~~serip~ iaforw~~tioa o~ t6e d~at6 reeora u rseordaa ia tLi~ e?•e~. r, . ` ~ = : % ~ 1 f~•'• ' Atta . . . . Ae~i~trar ~F Vitd :it~ti~tka ' ' ~!~~~~r vsx ~ D~~t.;'L'r'~'•1~ ~a . ..................T...~ ~f........................~..~ . i~ h. ~ ` ~ • :~ar coon wiTHOVr s~?~. oF c~n~nNC o~~c~~?i. ~ ~ t-.~.. v.~c ~ ~a' ~ _ . : - - - . . . ~ ~ ~ FILED AND RECOROED ST, I.UCIE COUNTY. FLA• ~ f~~.r`,~~ V~~~~~K~ 1'71300 . ~ '68 OCT 15 PM 2: S? . ~ - ~ ;.~J`,=`~ ,-.o.~~:.s CLERK ~iRC~'IT COURT ~ ~p~~~ Fi~C~r~7W ~ "~k . - _ ~ :