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~ d"""'~o STATE OF NEW .IERSEY No•------- 6~-~O~D____
~ OFFICE OF REGISTRAR OF VITAL STATISTICS
~ cf........ Midland _Park ........Bergen
ab. 9...11? . T..~ii c...~.
This is ~o C,ere~}'y that the following is cornctly copied from a reoord of Death in my o$'iae.
¦~~i of occcssco ru?c~ or o~?rM a?TC of nu?rn
MATTI E BAKEB MI DLAN D PAF~K , N. J. N OV 5, 196?
SOC~A~ SEGU~1Tt IIUII~ER fEI COIOw 11AR~TAL COpDIT10N OAiE OF HRTM ' AiE
NONE F WH MARRIED FEB 11 ~ 1911 r"s a?rs
56
KAC~ OF ~1\TM CAYfE Oi DEA?M
MAHWAH, N.J. UREIy:IA
SU?rLEYENTA~ INFORIIATION IF OEATN ~IAS DYE TO ExTEANAI CAUS[t
ACCIO[IIT, iU1WDE OR MOfIpOE DATt 0I OCCYR~iMCt '
~wc~~ _
MN[R[ WO INJURY OGCYtT
wn w em~w oewn ~r~n
OiD IMJU~t OGCYw 111 OA AW11T NOr[. OM IA~M. ~M INOYfTR1Al tU1CE. IN MI~LIC ~LACEI
NeCIR A!t OI AACt
wNILE AT *ORK1' •EANf OF 1NJY~? ~
NArt 01 ~[~fON ~NO C[R7tf1[O G~YiE Oi DEATM AODRLfS
GUSTAV FRIiDMANN, M.~. 4 Godwin Av., Midland Park, N.J.
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" . ~.i~~~
~ ~PutY Reg~strar o Vital Statistics
~ Municipa2 Building,
~ Midland Parl~~ N.J. _
, .
,
Address
~
` November. 6~..1967........
~ : Date of Issue
• 6. W. MlLttl~ ~ fON. Y~JNlCI?Al tU?KICf. ~wl14AD[3 ?AAR. N J
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fi~Ea An~ gECUaoE~ ~ /r
SL LUC~E ~OUNTY fL~ uV
ROCER PQ~tRAS
CLERK CiRCUiT COURT C ~
RECORO VEPIfIEO~ ~
Auc t5 3 PN'11
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214589
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BOOKIV~ PAGE ~7V
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