HomeMy WebLinkAbout2471~~. Fg6 .p~ CONNECTICUT STATE DEPARTMENT OF HEALTH
g~ UC E cORE~~~kiealtlt Statistics Swetiow-Hartford. Cowweetiee+t U.S.A.
-~ a~ c '~ ? `Y~ertified Copy of Death Record
~~9 SFP ~ ~ PH C NNCCEQQCTICUT STATE DEPARTMENT OF HEALTH
~u611d+~fealtlt Statistie• Seetioa-Hartford. Gwwt!etiewt U.S.A.
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C~SR4`'::. ~ =~Q~$ ~s Ce-tificate of Death
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ll) Calats te) Yb~ea tN Coob tel Td+rw Id1 Is Residence inside ~
Litchfield I Torrington Litchfield ( Cornwall ' t:"'`°' eoio°"~ ''i°'4"'
W) Name e[ Has.itsl K IastiWtion Is) Street Nw.sler Yesi 0 Ne ~
III wet Is a IasNtu or Iwatiatisw Strs Street No. tit neat Nw lecatlea) it Yea. wsme Cib sr
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Charlotte Hunaerford Hos>,it Pou»le _Swamv _Road___
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rERSONAL AND Si'ATiST1CAL PARTICULARS
A. Sttl t` WCt ?. NAtLb Nnsa ltAtifliw O
Male I Caucasia ~-~~ O 4"~p O
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PwaT II /natal SIaNnIrwNT tiONntTMNa Corn
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i1. )~tAttr DominlcK Cappe111er1
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~ ~ 17. BIRTIIr1.A!'L ? Italy
Ia. IMraaNANT'tl NAM!
qtrs. Elizabeth `Cappellieri
if. $tryAi,. CssMATiaN eli Rc11e+rAt. Date~jtlile 14 ^i,SLI~
Cealeterlr or Crew~atot7 C_a 1 hot~n CelIle terV
Flee Cornwall BridQe.Connecticut
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046-01- 184
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wart ~ at work
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Connecticut
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! esrtifY that tlli• b • tree transcript of the iaformatiow on the death record as recorded is t~i• e1Gee.
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i1 Attest( ......~,,,~,~C..... . r~ j~~y~`'`«e~~''t ............. ReEistrar eE Vital Stati.tiu
Dates ........1L1YlA ..1:7 ~ .. ~;~~~ ......................Teww of.... ~Q~'~16~~i.:.......................... ...... ~]
NOT GOOD W411THOUT SEAL OF CERTIFYING OFFICIAI.~O~K~~.•~/ ~~VV
Form Y 4 1 SC _ A ~ -
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