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DISTWCT NO. 2950 ~b~v~'~~ REGISTERED NO..... ..1~~~ ,
Name of Deceased T~ITALTSR L_ BE'A EEt :
Date of Deat~+ ~~e 1~.~3,.970 Sex - 1~~ e Color or Race.~FL °
Place of Deoth_ 30uth NL~~BU C~mmueities He8n1ta1 A~eang~d~ ltwr Ys~+lr
Usual Residence 168 Farber DY'1Y~~ Tdeet Ba~?len ~8r Yeri~
Singk. Manied ~r~ ~ Name of Husband
1Nidowed or ~Frorced (or) W'
If DER 1 YR IF R 21 HRS.
µpalh/ ~a HOllff M1M
Date of Sirth u~ 26 _l8~ ege ~-Years
Citizen of
Birthplace N-tit Yerk Whar country? V-g -A. ,
Manuta.eturer ~"d°~•'? Caxbon Bru~~es
Usual Occupatio~ or eu:in~s~
Mothers
Fothers Name .TBv,r. g~$~1" Moiden Name ~Y'y~~~[lo~
~
y ~ u. s. s«ai
; k~a ~~z ves t~ 1~ I s«„~,? No_~3- A-ol
E
~ CAUSE OF DEATH: Time of Death-~..• ~ p 1~
(A).......---.AG11tB..Pl11ID~011a1"~f...EdB'mlL
~s~ . _ . . . . . . . . . ,A.rt erioa c~le ro
tic. . . Hesrt_ . .IIis eaa a . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
(C)............Chronic--~l3.brosi~...db..~op~y~ema---~----......--~
Certified by
~r1Y'gj-m Bt1¢IitCh M.p. Addres~ ~L~Bn L'~ t'.~_1'~Bti Y~l~
Placs of Buriol
or Cre Date of Burial T~i~a t c~ ~ n7n
Undertaker Wei~rand Bma ~~~Q. Address My Yarlc
I do hereby certify that the above is a transcript of a death record of
~ !r'e ~
~ .............•..........•.................•~~/~.....~.....s~.............~......~~~~~~~~~Y~_ ~N{.~I~r~~~~r~~..........~~~~~.~.~~.
~ as contained in the official records of the Regisha~ of Vital Statistia of the; T.tri~n;~q~'Nempstead, Nassau
~ County, New Yorlc ~ R . - ~ • _ V .
~ RCIIIT ~ • ' ~
Rt~ O ~ER~rltd..~+~ ~N TESTIMONY WHERE0~,1 fio~rrs=~i$reunta`set my hand
~ and affixed the official,seal of.#he'fown of:Hempstead,
,I~ 13 ! ~PM'1~ ~,~s._...... l~.tu..-~,? -.~;v~.. , , , ~9.~a. ,
~
233~J4 at Hempstead, New York.. -
N° 69125 ,Q,~o<<<<-~ ~~RE~RIC~t~ COSTANZO
R dt`of Vital Stotistics
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Y . . . . . . . .
~ ° R 204 • 634 B
bO~K P•,CE Registrar, De or Sub-Reg~strar
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