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HomeMy WebLinkAbout2972183261 ~" $TATS OF New J1:~tsEY ~ OFFICE OF REGISTRAFtr OF VITAL. STATI8TIC5 NO M~R~4 of TOV~NSHIP OF NORTH BERGi3N, HUDSQN COU1~~Y, IVY ~. _•~ _- ~,- ,• .... ,:y•-- _ ,- ?fit a a Certyy that the following is co[rectly copied from a record of Death in ~ o6~oe: NAY[ o/ N[C[AS[f - M.AC[ O/ O[ATN OAT[ O/ O[ATM iOC1Al i[CYNITT r11N 'fR COLON NANITAL CONpIT10>!- .. GATE O/ tIRTN Ai[ KAdI ~/ NINTN CAUi[ O/ 0[11TN iY-/L[N[IITAL IN/ONYATION 1/ OUTN •Ai OY[ TO t><TpNAt CAYi[i ACCIO[MT. fYldO[ ON NOr1dO[ OATS OF OCCYRNENCt Kaprt RIHN[ q1 iIUYNT OCCYNt • 's: ,}'' - e~rtr a reww ewrn n~a Nl0 YYYNT OCCYI IN OR ANOYT NONt W /ANN. IN INOIIiTNIAL KA~:t`KA~[f - 1MN~ AT 11K>R[1 spew •s~s w ~a~oe N[ANi 0/ IIUYNT NAN[ 0/ /rN[ON X110 ~QTIF![QCAYi[ Olt D[ATN A9pR[if • h .'j-~+~ 'ec. ' t1 at ~ Vltal -~tatl8tlC3 ............... ..~~~............... ~ddresa Date of •~sane FILED At:D RCCORDED _~~~-_ ..,-.--fJ ~~ ~ • 183261 -• ' ' 55 r • r ...~ .: iY• ~ r.. _: BOOK1 /9 PACE2g~o