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HomeMy WebLinkAbout2260 _ _ _ _ _ _ _ . . _ . _ . . New Yoek State Dep~t ot Hedt~ ~ • • . • OF'FICi OR Yfl'AI. IttCOROf _ . • - p~, 2905 65 •,r.M,..~.es.~..~,,ro. CERTIFICATE OF DEATH ~ ~e nncE w oun~: suTe of ~+cw raac uswu ecs~oEwce tw~«. ~.o.wr a..~. u~..~ww ~w+~«~. ~a.w p ~ cou?m Naasan - ~ l~ev Tc~rk ~ ; ~ w Toww ~~crn of couNn a~aww ~ ~ He sLead cina"v~~uaE Haasa~ H tead , ' cmr oa v~iuc~ a. cin oR v~w?ae i.•••~••o..xw. s,. ~...e..+. w.;h~ Garden Cit,y ~ 6 ~noa. (iarden Cit~ p u~ ~ wuNc of c~r ~a ;n b+p~.+ « i~n;Mio., o~+•.a..~ asan.. « Mnli~ . steEer . n ets~oEllcE a+ f~wi a ~ NOSIIiAI OR ADOtEi3 O~ 3 +NSnrunoN 10 Mesdbl~ook Road 10 Meadb~c'ook Rd• "a C] MO 6i ~ a. wwi or s. a?tt w.•~w to..f r..~ ti~ i;~a a: Bernard P. Allen oum October S ~ s`. wc e. co~oe`oe uce S~NGIE. MARRIEO, wioowco, If MARtIEp, YrtOOWED avoee . N....~ ` ~ avoRCHar ied N~„~a ~ Male , White lo•~ w~~. T~1Sil~ Arid@r'sC~i ~ 9. OATE O/ HtTN t0. AGf 4i~ r~on IF UNOER 1 YEAR' Ii UNDER !1 MRS. 11, ~IlTMItACE tia1~ K ww1r1) L CITQEN Of wNAT ~ lo rlhdol) /~,~tAS Da/~ Mowa IM~n. COIJNTltt Dec. 3~,1885~ _~5 ! ~ i ~ New Tork CiLy USA 170_ USUAL OCCUfAi1pN (Gih kind of work dew~ dwiw0 woat of vror?ino lih. 1~?. K11O Of Wi1NEii O! (!p{IS1tY m Z Ticket A~ent Rac .q i~, r~n+e~•s wu~t is. ~?o s wu o~~• ~ Patrick Allen Sarah t}oi! ~ 16. WAS OKE/lSEO EYER IN U•3. AlME~ f0lCESt t 17. SOClAI SKUlIiY !!O. 1~. INFORMANT'S NAME wDORESf ~ ~ ~ ~io ~ 066-18-84b8 Elaie Allen/103 Meadbrook 8oad tiarden Cit J 9~ ~ ~ I!. UUSE Of OEATN (Ewea ewly ~ eo~ ew ~ IiM) , tMElVwI ~ETNEfM ~ > ~ ~AlT 1. DEATM WAS CAUSED iY: ~ • f ~ tl OMSETAMDDEAfN w g x°C g u~o+~rE uwsf c.~ C.. h r' o ~'1 t L e~ 0 Yt ~~h rl~`I ~ i~~r, w~,a ~ c~~., ~ a.,. ~t k F 11 ~-a~.. a~ j ~ pUE TO (6) 1 l Lt ~ m eev.. ro,..ro~~~q 1~C ~K~ f4' c~. f-~-~.L G~ ~ ~ ~ ~j ~ ~r"p OUE TO fc1 v ~ IAR1 11. OTNEt S~GNIFlCANT CONDITIOMS CONTl1~UTItiG TO D TN W? NOi tEtAT~ W~ A~~K~ I r i0 E TERMINAI CONOITION GIYEW IN MRT I(a) ~ ~ ~ v ; rt ~w ~ ~ ~ ! v Tlo. ACCIDENT. SUfC10E, HOMICIDE lip~c./~) I 216_ SC[t~E MOW tN!{!Rr OCCUltED. (EMs~ wdvs~ d iwjwr iw M 1~r hA 11 iN~ 1.) ~ ~ ~ 'd " ~ ~I~ ! ~ ~ 21t. TIME Of Now A{ewl1~. Oar. 1'pr; ~ O~ v IN1U[Y s. w~. t . ~ ~ ~ ~ 0. m_ ' - ~ 2id. tN)URII OCC4ltfp Z1~. ?1ACE Of IH)UR~ (e p., :n o~ obov~ 21f. MlMElE Dlp Cif~ e~ town C~Iy iti4 ~ Wh~l~ o~ ~ No1 Wh~{~ kwn~, forn+. toc~ory, saM, olf~c~ Wdp.. Nt)~ iNJIJtY OCCtIR1 _ G wo.k ot wo.t ' ~ r m ~ 1 R~.rb.~ c~rr:1, ~kat I ot:cnd:d ~Fr dccEwirA f•o,n - -.19 , to_ 19 . tAal I lott sam 1J~e ' i~+`Z deuarej ul~rc on_ V~_t - 19 ~y nn~ t6u~ dtoth oceN'rtiri at j'E ,w~., ~rww fGt tawti o~d ow tht drtfe ttated eboot. ~ 2 S1GNwtuRE fDra... w nH~l t7b. ADORESS /ih. W1tE SIGNt~ r ~ F C~C : ~,~.,G's ~.'~s~ i ~ w.- ~'s.w ~"'.13 Jt ~J • I tillan I (.C~r ~/91C ~~L i? Ci ~ I IJ~-T 11(i ~ 1sv ?IACE Os WRIAI, CREMAiION OR REMOVA! ~Ip. l0[AitON ~CIT~, TOwN OR GOlINTt ANO STATE) 21c. OA Oi WRIA[ O[ C!E/+AiION - Gate of Heaven Valhalla, Ne~r York October 8, Iqfib - v.~o _ 23f. S1G?~/1TURE Oi}UPDE~tAKE¦ tEGISTRATION NO. 2ib. ADDRESS Of UIOERTAKEt ~ . ~ _j,~ _l~ ~_,(_k"~~` il_-~2 L 00352 I201 Franklin Avet~u,e (3arden Cit NY 13c MAME Oi ES1~K~SMMEMT REGISTlATlON f10. 2M. OATE HIEa ~t IOCAI !M. O/''~If1l/1S Pu Y Fairchfld Sons; Inc. 0799 10-7-66 ~ - ~.«~.~.w.a?. ~ z~,-~.- ~ _ _ . .f ,.,.+h Octob~r 7th._._.»_66 J. _ , ~e p Y ob. _ ~ _ ci 1 A ~ ~ ' m ~ ~ ~ ~ ~ ~ c O c~ r-- - ~ n A , ~.i: ~mZ . , C u ~ _S `O ~ ='c~v ~i ~ n cm i ~ f7 ~ Z n ~ _ O t' h~ 0 t C~ 'r1-{~ i ~ ~ ~ ~ 'Ap ~ ~~76 ~?~257 - ! ~ . _ . - ~:~YZ. 4 _ _ _ _ _ ~ - -