HomeMy WebLinkAbout0995 i~~ ~ ~ 22114'7
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_:iS IS TO CERTIFY THAT THE FOREGOING '~9.~1~'aE~G'OPY OF A RECORD IN THIS OFFICE.
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:.-:GISTRAR OF VIT TATISTICS - EP Y REGISTRAR
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.:::z~I~IG: DO NOT ACCEPT THIS COPY UNT;~S~e~y~1~tISED SEAL OF SH~~~~~~~j VISION
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OF HEALTH IS AFFIXED HEREON. RGGER P~i7R~s t~ ;
22114'7 RFCQRRV~ ~ouaT ~ i
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~ NEM JERSEY STATE DEPARTMENT OF MEALTM ~
~ IOC~?L iKE MUWE11 CERTIFICATE OF DEATN STATE fILE MUMOEA ~
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i. :~tbME OF (FfrsU (M~lllt) (L.srl ~ 2. Sei 3. DATE OF DEATH i
_~~~A ;i DECEASE~ DANIEL J. GA[1.AGllER 11a1e September 22. 1970 y
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~;,c ; i. a:oia w ii~ce i. nae ~r~ yrs. I( under 1 Yr if vnder 2f Hn. 6. D~t ot H~rtA 7. ~~s deceued e•er iu U.S. A+.cd Forces~
lsst 6. Jq) Mowr ~ D~ys How: A4a fYra. wo. or rAkwo~rwl (1/ yes. ~~ve wr a J~ui o/ inv.~ i
~~~hite b~ Nov. 30, 1903 yes NiW 2 ~
8. uirtnpi~ce iN~rt w joni~ corwtry) 9. Citiuw d ohat to~na>> 10. Married LX] Ne~er IJar~ied ~ l l. Social Stcariq No.
E ~ New Jersey USA .;ao.~ap o~.««ap 195-01-0679 ~
. ~.~e ':i2. FLIICE OF DEA7H ~3. USUAL RESIDENCE (11 iasticwioe: ~esidcsce Eetorc ~issio~) t
~ ..c~,~, ~Iiddlesex •-~x~ New Jerse b•~«~~ 1liddlesex ;
€ f b- ~~o~~ (Chtck bo: u~d ai~t Bame) Boro[] (Chcck boa ~nd ti~e w~~e) ~
~ ~ T. Ed 1 S Otl T! ~
~ c. haaee oi 1:+ot w Iwsp~sF or institution si~e stree~ ess d. Sueet Address (If ~urd, P.O. Address) ~
~ « . 11 Latonia Street
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y:11. Uswl Occopaiion fG,ve lt.I o/ ra.! lowe ~wt ~o ? o/ ra ~~s Ir/e. evr~ r/ n~utl) 1~. b. Kind of Bosiness a Indrstq ~
; a Retired Fire Ins e~tor Arsenal ;
' ; IS. FuAn'a Nwe 16. MocAer'a Naidea Na~e
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a Daniel J. Gallagher Aiar
"I7. IrJwmanc's Nase and Addres• ~
~ 3 rirs. Jennie Gallagher 11 Latonia Street Edison New Jerse
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` .'E I 18. PART 1 DEATH ~AS CAUSED BY E~rer o~f~ o~t c~~sr ~er liu Jor (~A (~I ~ ftl Apptoai~ut ~tuet~al be~~ees '
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' ; da~~e ris~ ~o ~bove urtt ~ to
'f.1". sr.ru.s ~be wJer-
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, . y ly~ns c~rse l~st p~e to fc)
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~~`~~d PART I! OTKE~NIFKANT CONDITJ~f~~~ 19a. sas autops~ L9b. It yes, rerc (indin~s coasidered
3 ~ r --ta,il• ~ perfased? ia dcte~inin c~use o( deaeb~
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Yes 0 No ['1~ Yes No
`z 20a. Acciden~ Suiude H.ic~d IOb. Dstt and Hour o( In~ur~ IOc. Ho~r In~ary Occurted (Eetn w~~rrr o/ ~~pry PM 1 or 11 0/ fl~~ !l~
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- to rh~ brs~ o/ wr lwovltd r. N•
i0d. Injurr Occ~red 20e. Plsct of Injut~ ft.~. iw a ~bort bowt. 20(. Cier, To.n or Locaeion Covnq Seau
: ~ 4hite ac 0::a ~ile /~ctory. slrs«. o//~ra 61JS.. e~r.)
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~ 21. 1 fa~tended. easmiMd) the deceased ((roei. on) to and lase sa~ (h~s. hcr) ~li~e oa
_~i D~.~6 o~trn~J e1 _ w. o~ /A~ dart star~! a vr, ~wJ fo /bt brsf o/ wr 4wo~rldat. /ron tA~ .~ri~s sbl~l.
~ ~T 22a. A~~end~n 1; Wed - nsr Phrs. ~ 22b. Addrtas 22c. D ce Sis d~
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3 ~ 21i. Dur~a{, Cre/nscion. Atao~al ?iD. ~ emeterr or 4ewatot~ Nawt 23c. Locstion Cig Scate
~sv"~~r~ E3urial St. tlary's Cemetery Perth Amboy~ New Jersey
13d. Burial Dau 1b. Dar Yr. IIa. Funersl Ho~e Na~e 21b. Funcral Iio.e Add~e» - t
" ~Sr_ptembe~ 25~ 1970 Gowen Funeral Home, Inc. 233 Somerset St. ~ New IIruns~vick
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~ 2k. Func~il ~~ec~ S~~e d ' se No. S. Reaixr~r Issu;n Pers' Siana~ve ZS6. Dae Rec'A. b~ Loc~l
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Boox 8 ~~~E 99~
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