The URL can be used to link to this page

Home My WebLink About2047 H• . : ~ . s. •o ~~/to~ •ac ~~te ~~~rncr i'!Ew YORK STATE ' s~~~a •,.i .~~t• , ~ OEPARTMENT OF MEALTM ~tis.,s S~` ~ dUREAU OF VITAL RECORDS ' R4C T o~~~.~o?. Myy~(~ OEiI?IFiCATE OF OEATM ~ TYf~ Alt ENTRIES OR PRIHT IN PERMANENT BIACK INK. 1• N~Mt •~wst ~+~oa~t ~~s~ =t .r. o.•~ o. oc... .ow /~V ~ ~ Mn~~r • 1 _ o,,,,,~. ~ ~ , , - a , . 6 ~ f~- - ~GL~C;~`'.,.c~-L~L--'~ . f t~_?t k''~ ~ _ ! 1- ~8--~z'- r • .~u In ~ra. •~:~r: . .r • .r T . .,rt~. ~ • • ..•~r... a s. •w,.~: rc.:.. .i. . ?r~t~?. w~w. o¦ j •M~•~t~V •D•~w ~•C ....~I~~.S w •1~~ ~ . ;~•ICJ~sf\•Ct A ~ . ~ ti• ti.~~w? ~ . ~ ~ ~ - ~ ~z . . - o - 1 - _ V i• co.~r. ~.N~S~ ~7P .~w? ~TC :•r..~•v~ll~G[~~i~ . . rf ..,~r • :?o•. ~-.r . ..c~ ~ • ~ .'c.w•..± 1~.~..~.1~ . •..~.,:i~; `•~11- ~ w,- IY ~ ~ 1 • , ~ ~ / • ` ~ ~ / ~ ~f - - .~~1~~.~-- - j,~~r.~,.•:.,~ ' c- ~'y ~ ~ . : Cl~l7.=.1~1'~c~~n~~• ~u • ar~•[ ,t e t ~t~of~• 10 t~~~itr O? w..~• ~~u, . • .•f ~ f,~~v .~~c sr w ~f. ••~,er• w~~.t.l - _ - 1 .~,r. • r.]' _~c ~~,~.~1~~ ~ [CUti/At~ . i ~fcti~ ______i -f/-- ~t~:f~~_- ~ 'S ----~_~h.~_~~r~~~J~/~~-J~_~~_?'~'~ ( s~c.e~..o• e~r. r •t• •cc _--~8 . s....~ss o• TuC eot.a. ?aa.~~r• •O. ~ I ~ . - 1 ~ 2 1 /~•I L ~ `J:4. y + ~ ~LI~~G,, 1 ~ • r f? -.oc~cs w..~.~ .7 .•vcc ~r ' ~.~,a t~• co~_.,. ~K ~cwr ~~c , . o• ~~~a~s~ ~ w.r«~. ~~r Sr~tt~ ~tiDY'~M~1• . ,uan y ~ , I ~ . c:.e •ta . 1 •ou.a ur.~rs• 1 ~ ~ •cu sti a= 1 ~ i/~ I~ ~ ~ y LW'~ ' 4~i'aftiC{ 1 ? wo 1 • • ~ "~7 i ~ W~~ ~ l/C !~Q ' ~ ~ ~l~. r• e. ?~vt ~Stl s w.r~ a• r~w~l ~r . ,s• ..,co.~ - ~.sr . ~et ~~oo~e ~.s. . ~ ' i a /~i~ ~ 7 ' ~ ,?TTENTiON ~0~. ..r:~~.• vJwt f~~. r~~~~~~o ~ts> ~~c~~Ct t~ f~ 1 ~ -4. . , . ~ ~ . - , ~F , ^ ' ' : ! ~ ~ ~C!'n~~~F / t y 1 ~ :~srF~w • ca~- f L I.C~If V~~ •1 • .PAQT 1 O[~t.~ AA1 C~:~f['.~ lMT[~ Ohl• .~l ..ll l VC IO~ IBI ~IYO C !?~AJ~~Y?t~ ~ht[~f1? 1'/~~(M Q1~ll T ~ 1.[ ~~~a i - - M,:~~,.,~ - - • ~rf~ •(![D~[: ' ~ ~ ~ ' _ . ~ ~ ~~S~a ~t_~,~,,~~. ~..:t~- - :__wec.K~ . O_~ ] •c • [4rf~0ul~t[ O• 1 I:OwV~1.:~5 ~ Nr.~1C" r , j( ( T:-~nMl:. •tl P ~ . - :~~_t.~2'i-l_ ~d i}1.i1,1, /,~_un" ~i r.~ _~~~L.~ t' ~ jl~ ~ .ct•.• c. at . . ...c cw •ti • c~..s~:..i~cc ar ~ ~ ~ -___T"--~ ---1----- - ~ ~1 i - - ~ - . - ; ~ ~ - - - ~ - ~ ~ ;i+aa• ~ -~e f~G•~• t~w* :~w~ ~ . ~ ~hs fOM~~.~~..i.w~. e_.__-rf• •~_~J~••• ISO ?t~,w[R~ r v~ Mtf [M.s.?,t~14 • ; ~ [~f•.~ •li~~l' .fM •M v~~T 1~~~ : fi wli r.ft[1~4:? tiG fr~ •~~.t! J• :.1~~~• y r ~ +Z ~ } ? i._., s r ' .e ' ; ~Q l , 1 ~ l-~ ~ ~ ~etti• ~e~' ..G.~-C ~108 . ~u.._.~~• I•~C w~~• ~1iG ..Cw O~G • ,~e[.,~• lwr[~ ti~r.~l 7• • ti ef` ~ ~ ''f ~tttl~u.~.~ T"-_''~ ' ~ w . " . , i ~ • . ' - . . - ' . -~.1 . - - - ' - ~ ' . . _ 't` ~•fE w wo••~.___ ]~JC •.~c[ • ? .•JU¦ . 19. • a-. l~wrt• • w7 '_T• p• r ~.•:E. ~chw c:7..t• •l~ ~ _ ~ 1~ . .t~ (Y~'~ . •aC~A~? •~Oi . [1( 1 ~y ~ ~_l ~ L - TO 8E COMi'lETEO BY _pR_ TO 8E COMPIETED BY ~~p. , CERTIFYING PNYSICIAH ONLV ~q CORONER OR MEDICAI EXAMINER ONLY _ ' t..f ~ .[,w.[G4f . r •.t-. ~ 1• :ti i.~ •~f a l~~u.~~1:Cti •~G-O~ ~.I•t~4~r G•. v• ~y'' ..e • r :.~•al~.:~?_~r~ ~.c . i . ~ ' .e~w ov M~O• o~.r~ aeeu~~[o ..i -.vi. u~~e ~re ~~r . • afyl,~'[D1`\ ~,r ~ • lY~ ~ , C~f lp'~.l (~.a[S f~~~10 )•~~~C' Y ~ }1- • ~~J ~ + S 4~fL _ 'i:f • -t ~f~lwl.~i -e~•__!"[~`~•' ~~~i fl[w Al.~[ lB :~~cwJ-.uCi:".-~~~_ '-C ..Oi• O [~r! ~ ~ . T ::1. ~ - ' ::Z.~ .:~1~... 1 ~ ~ C , . , : I ' i . . . t~ iri ; r ! ~ . ~ ' - - y- i - - - - ` - ~ -~--1- - ---L-- - - ; ' a -r.~~.....s~t •r. ~[w . ~w~ It - ~ .w~+.~ e o...s r c~w• ..cw I { ! i ~ 1 ~ ' . •i . . . . ~ . . . uwqrf~. vcG~:. r• c~.r w1w 1 op-f,[,~r. v!. [•L _..:•o~ a ' ~ , ~ 1 ~ - _ r ` t=--~--~~----~ ~f~ ~ ''~1_L---,~1.~ 1 ~ ~ ~ ~ , ( t \ ~ ~ - ~ - - - . ~ ' • •n+•-T •.:•.__-~720 •~~c~ o. [~tv~~..~. ow ¦~uo•~a 23G to~~.:o• •c.~• .~..w~ 3f~~~+ 7~. ~ _ _ ~ ' ' ' ~ ; _ : - 1 ~ sg~ . = .'4 i~~/:~IF~~c<C6 -st~_~~ ' ~ ~ ZL •tlct; c l~ ~ ~ ..~~~R'aY..'~S->: sit~:liw~ .ti- .i~:~,•. . v / ~i L! ~_l'~~~LY~ 'sI'~- 'T-y - K lt.~i ~~~>:J~ i /r y~ /l'? 1 " ~ ~ I ~ Z , ~c ' ~ - fi~ , 1- ~ :f~L ll•~ ~ ~ J ~t___ L ~ L - ~-f~'}.~/J!~-. ~ '~.~~~,^Y ?i.{~~w~. ~ : ~B 4NT•A~~ /JM 17~~f~J• 2• •~1.'~~~•~ir ~1' i 1 r L ~ `~x^t~:_ +.y •n -s' ~ a . }1> 7 - , ~ • _I` ! lt7?~G~. c s ~ 'C ~ ~ ~ ~ 4 - --1'- - µ ~ ~~~i ~a~ frC~'t. / •.P `vJ.~. Li. .t~~~lE• wl~• ~.¦•tuo•~• r~~•• 1.?l0 ~ ~P~vG._,c~.r•(~w- ~ ~ i ~ 1~J / . ~ r • . r i ~ , I y~ ' ( ~i,' C At~r ~ C - / . ~ - ~ ~ ^ ~ - • - i / • r / t • r , ~ r--. ~ ~ Y s p ~ - ~'~`?6~"'' R EO - .•t~~t.:~~ c~;~E+a•._ . . • c • , . . - pc . _ r,.o..~e. ItE011N4 ~~~~Y fll~- 3 Nt p~ - s ~ •..w., , , . ..u • • ST.LUC~E ~OU _ J IIOCER POITRI?S c-~ - . •(~~l"~.~~-l ~y fO CIERK CR f EO COU~ : E . . . ~ • • - ~ / RECOa~ VE = 1 , ~lu~~-v~ j`~ i~ g ~ aM!'T i ? ~ ~ • i T~ A l_~~i ~ ~ a o-, ` " + o ~ a-.,: ~ . ~ 1QCROFIL[ ~t0 I~~~ibility oi writing, typing fR~,.f.~ ~ printing uneetiefactory in • ~ ~ docwnent for eiicrofilming . 4~9 y~la , Ji..i . rt,'- ~ ti3 - ~i9i ~1~42 _ - - - - - - - _ ~ "rt'SF_ _.s . . . . . ~ - . .