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HomeMy WebLinkAbout1709 . i. ~ ~ ~ ~ ! ' ' ' TMI~ MA~ CE~i1F1r, Thet tbis ~s z tr;:~ rran~c'~pt o~ ths or~giq~ti fiied or recorded ~n the R:ca~ds ~f li~e Town of N~v~. M~~, Connecticut, in Vol. ...196~ ~ 3it~ a' . J~~~'- : ~ '•'r i : =S r';t Dated . . . . . . . l/25t/.~~~ _ •''i i,=?#~. . • 9 . r r.•: tM .~n~.. . ~ '3El~l~f'_ . . ~ ATTEST: . - . ~ ` f.- ~ . . ~ : - . ~ , 1~~ V ~ * • ' /~I s~~l./ ' • i l • C 1 - ?i~~ . ` ~ j As:istent ~rt~• •~G4k'~ . ~ 1, ; i;y 1~ ~ , _ CONNECT[CUT STATE DEPARTMENT OF HEALTH Public Nealth Statisties S~etioa-H~rtiotil. Gwreelic~t U.S.A. ~ ~ Csrtificarte of D~eath ' i 1. Pua o? D~wTx: la) State ot Coeneetieut 2. Vsuw~ Restosxc~ o~ p~snase: tai State ri0:121 . 1?) CeYw4 te1 lbwe ~D1 Cwt~b (e) 'Ib~~ fd1 la Residence I~aY~ ' ~ Litchfleld Ne~v Mf 1Pord itcl~P eld ew Milford ' ~"Y e°'°"`' u~"'- ~I td~ Ya~ee et Hos~iid er lestitutioe !e! S~rca Number Yes ~`j No C fl[ OK 10 s Iw~Oita1 x instiWtiou t+re Stn~tt 1~a II[ rvra~ sioe ioeatioe) It Ye~. w~ene CitY or K beatiM) He:w+x6 ~I New Mil for~i H~s . Inc. S Robin Rid e 3. N•rs o~ IYiml (Mie~iei 1Lsc) I ~,?L g~cuurr I~lursss i~ ~r,~': ;.~.e~ C1 arence q. Anderson j MEOICAL EATIFICATION (T~p K ~i) ~ rERSONAI. AND STATLSTICAL PARTICULJIRS i~ C~us o? D~wtw tEet~r e~y o~e niwe ~er bes /~1t~1 aM(e)1 s. Sac s. lt~ae . q. Mww~s 2~s~rss 1t~wso ~w~+es~4 ~ ? P~ar 1. DcwTw rr~s Cwu~ St: ~trvax ~ Ir~sou*s C~use (t) 11 iAi wmo~ro ~ R,ro.o. ~ ~ oxaa. a. Mwws. w~oo..s~ oa D~.wcsR w.t ytwusr t+wxs a? ~'1 Y~ C.~ t L NF~}~t T•~ ~ ee~Tn wws pt Hr~wxo Dorothy Ke11ev ~ Dwts lltvne~) IMr) (Ye~r) D~~s to (N Jt~nuary 19, 1968 ~ !t I0. Dwn o? B~rru Au (ie ~ean i[ under t year 1! ueder 1 iq a~ • Yont~a D~ys t[wn Mins. (a1. atntin~ ~ e~e aederb• Dus to !e) f 41~~/~~~~ ~ ~ - 11. DuTxrucs IC~ts or w.rn) (SUtt O~ IOtltsp lpYAt!'~) Pwrr II OTMp $ICNVN'Atti CONMiM~Yf CO%TqiVT~Mi s~. Nu :;bs~in~ton, Conn. ~~+?*x ~u~ Nor Rnwcsa to ms'1'saMiH~t, ~ss~a~ w~~ 1 ~ ~K c~~N r.Rr c a~. , Ii. (~1 l/~YA~ OCCU~wtfox IGi~e k~nd ot work dont durias a~ost ot ~ , L O a~~'~,;. ~ r. ~ j ~orkiot lite evea it rltirNi ''T`~S ~ ~ Y~~Q i Machine c~~9~ Zne2+ t~• sv~wY Rns•wMt *o Coxomoxs Raosn~ ~w Its~ Iwwsm oa Bua. f~/ N~ese ot ovM<<on I f~) D~t~ `~~Zl~rc ulachines 13. W~s Dscs~ w Vsnenn! Ya or No N~ (sl TrKS or iKic~r Il tlr! w•ir 2i. (a/ AC~t~p~t S~ttto[ llo~tttme Hw X~wfA. At~. ]'M? vAl~ K ~11 ? ? ? ~ H,?~~_ Nils AY1QC2'$O?l lel Iw~uRt Ote~•Raso ~A1 Pu?cso?IM~usr (~.~..iw~?~.tAwM, ~ lCit> or ~u.wl I~ute or lbre~n ewatrs) WAite ~t Y1ot W?ile 1~~*~. fset~ry. ~t.r~t. N1/.. ~b.) s + w s~.~~~.~.~?n Sweden ~?..k p.~ wak p , ltw~asH A?2t19t8 Anaeraon ~e) Cmr.?orM.oaLoeanow CouM*r Er•a i~ ~ i~. x.«~ ; ~uc~ to..? ~s~.te u. rorei~. ew~.ers? ,i ~ _ ~ 1T. Burun.~cs SyYe~jCn ( 1 Mor IN~uar Occv~w. ~ ~6rt~. w~t.re ~I :¦i.s~r ;t~ PWt I ~ 1~. 1N?ptr~nt's N?rs w P~~t ll H ithr ss.) ~I'$~ ~rot'~y An~ieraon I HEI~EQY CERTIFY. Wat 1 aw~N Uw !~w M - ~ o • r~ I!. tM~wl. l~r~lfowM~llna~+.t D~tf_- 1~c~.'~ I!~ ~ 1! ~ . b ( 9 l~ ~ c~ee~ er eRnnee~f- 1(n _m t~• i n ~rnt e t ~.se s.. w. ~ee...w .t~.. a. tt~+a.~ ~ ri.« ?3r! e• .~^t_,_. onn .4a ~~.t ~..ea a a..~e «~~..~a ~ ~ t0. AYt OI SM~~?l7~ta ~r Boot F•• F:~~•cxea j L,cew a~m?R ~ ~ ~ N• i n:iC~'!~. ~.~I1 i ~s37 'T. Su~~T~N~R N PMtYl7~/f~ ~-~--T~'~ • f~cr~u~a LKSrsco j~~`~Sa oR -1.~n ~,~u A~csw ~ ` ' ~ ~M ~rl ~ !-'w ~ , f :/f 1~~i{ h.~ • v 4~ ~ AOdnu ~lA ~ ~ :~JI'-~ti~~ :r'i • Ad~ress +lES~ inpton Q • . b1u 1~~~ 68 . ~ r ~ THId CtRT lCA 1 O . ( - ~ C~~ II _ / -t r~/--- • ~ ~ M u?~ t~~-~ - V ~ O ~ ~i7~ ~i706 oF ~ ~ ~ ~ . FICIAL RECORD t~c ~iO ~ : ~,o g b = ~ ~ ~ " - ` - _ . . e ~;~„`~,~„~s`~~~~,.~,~ _ „