HomeMy WebLinkAbout0856 - - - - - - - - - - . _ . _ - . . _ . . . _ • - a.__ .
_ ~c;.3'?'882 ~ ~~r lIIommvnu~rulth nf i~a~~~rt~~tsrit¢ y .
~ JOHN F. X. DI?VOREN aPRINGFIE~c~
~ dECRCTARY OF TNE COMMONWEALTH
Hampden ~ (Citr or Town makin~ tA@ rctare)
~ O . ........................(Couatr)-~..~.••...-...... B ~ DIVISION O~ VITAL STATISTIGS
~~IZ~I R-301 ~ Springfield STANDARO .
~ .
. (City or To~o) CERTIFICATE []F DEATH Rct~ered No.
_ ~
et~d tor barial permit Mercy Hospital (It dath xcarred in a ho~pital or in.titntioa,
.ith $eud ot Realth No. St. ~re ib ~i~31E inst~ad d strcct aad numDer)
er ie. ~ient. PHYSICIAN-[~1PORTAPI'f
~
.~T?c~-crro~s FoR IVER C ROSS ~t~
Ull'AL CERTIPICATE ~ 2 FCLL \A~IE .
(It dacessed is a mvried. sidoxed or di~aced soman. ~ire aho maidm nameJ U. S. ~Cu ~'~teoe,
~peci(r \~'AR) ,
PRI~T OR TYPE 305 Roosevelt Ave. ~ c j p t
Al'SF: OR CAlJSE3 . (a) Permaoent Y.esidence. ~o St. V.pX.J.II.b',1..i.~iS~.~.._MaSS..--•--....---.-.-•-••--.._....•-'
OF UtiA7l1 (Cilr or lOwo aed Sute)
4F ['\F.~DIXG BLACR `t -
~!C OR APPRO~ED " lIEUICAL CERTIFICA7E OF DEA?N PERSO\AL A\D SCATISi[C~L P~RTICtiLAT.:.
_~CF: Tt"F'F.~~'RITER p ~
RIHESO` ~ v~TE OF 9 SEX l0 COLOR tl SI\GLE (*rite thc ~xd)
~ DEATH .._ALLC~U S't....---------ZZa- •--~--.........1~ 72..------..__..._._.. Va1~rID0~\ Eo
c•~~~b~ cn=r~ c~-~~~~ Piale ~,Thite Di~•o~ccE~ ~arried
• I E R E B C C E R T F T, tt~ac I attended deceased (rom U\i:~01~Jf
l . :
~_._......~uly.. 13....., As._ ~0.__. ~o ~ua.us.~.... 1..._.., ~9..?.~. ,r ~„~.~a. ~~ao.r~a. a a;,~««a Viola Parsons .
I lut u~ b~.R1. alice oa Ll. 11S.t'..... V.+. 197~.. death u said to Hl'SB~XD o(
k hare acnrred on t6e date suted aboar. at r1..~-4 eJ. ~-----S.a---m• INTERYAL (Gire maiden name of ~ite in (ull)
~~7 d:.z ~~t nesw t6e iwoJs al , . ETWEE (or) I~IEE of -----_.._...._....••---•--(Hus~and's ~mme in~full)'--°~.___..-----..---
! N
0 SE7 AND
h:r 6e~.t Jailr~t, aitlFe- , DEATH RAS CA1F~F.D BY: IJIJIEDIATE CAIrSE p
' d::r__e. ~ rr?t^E'Q3'~1. 7~T0;:~^~=S :?_ti~ OfATN 69 3 8 It undtr 2s hwn
s h~: 6 caand drat~. ~i ( a) 1 e f t fl ~'7 i~(~] a O d a v 13 AGE Yean aionths Dafs (..--.:--Hours _..__Jiinnte•
~:-.~.:_*.r, i! aey, g6k6 ~~:e) !
.c.re /s1. itetie~ tlke} it tiue To . 1• Csual TOOl maker
:..:e l~,t. ) ~b~ Ariheroscleroszs ? a~~~~~ .._....-----.__..-~-----~..-~----~--.g._.----~---....__..._..6____._...__..__.
(ICind o( ~cat done durin mast o( ~ockiu lite)
Due To
~s iae~:~~ pirflite Tool b Desi n Inc.
c~~ - « a~~p~
-:::o. ~t :un:.i.`rtis~ to dr~tA OTHFR
t~ tRC tawiea! dit- SIGXIfIC~XT Ib Social Security l~o. _026.~~.4.-~.3Z..4....A.....-.----- -
• : _ ~ , !I coxntrtoxs ~ - :
~ ll BIRTHPLACf. [Citr) C8mf0.1'd.
~ : w-u autwsr ve~toraue' . _ uy :
. ntZ__._.___- cs~« a ~«~A ~ Conn .
; ` ~ ~CSat tnt eon6rmed diagnoais? .
~ GJ..l[71C~a...._.__ lb \A\fE Of pe[er Ross
~ ~ ~v FATf(F.R .
~ ~ t, ~ S N"u diseue or injury ia anp ~ay related to occupatioo ot deccued?..^RO-. :n 19 B[P.TifPL~CE OF
_ ' tiJ ~ ~ F. fAlHEtc (Ci~y)
~ ~ r ;i „ . ,;t~« « ~o~~~ry~ 1~ in1~:~d
z
%~/1 ^~a-t~ ~ g 1 , y/~:y.,~..~ 20 ~I~IUE\ \:?~IE
, ~
V6J ~?-OCU ~ p (~uature) .~C ......__...-.•------_..---."~"~R.D. OF ~:~~T:iER Caroline c1i1(Ie1SOI1
~ : c~ '
.
~ ~ ~•iax. t'~.._,llrt.c3.~l..s.._.i'1...A1.----------------~----...... <
` ~ z`, _ 21 B1RTfIP1.~CE OF
a~ -i~~ ~ .lPriwt ~r 7 e Ni~me) / a a10THI:F (CieY)-°--°-----°-...---•--------..••----°---.._....-----~~~......___..
l' r_ (Address)1~i8 SC_f10Q~.....~.~..~DUe ........~J..Zl.... t9_.~2 lState or couotry) Finland
~ .t - i..
o'`' $t. Miehael's S rin f ield ~ E fB~~T Y tAat a satis(utory standard catibcate of death ~u 6kd
s... J¢ ~ a ~v b . . . . ~ - P..........~..................,... M~~.s........._.._._.. ~BEF ,E burial o~Va~j; permit ~as issucd:
. W~ ~ P1ace ot Surial or Rx?C9Qti7p (Gcr or To.~n) I(i/
1~ ~ O ~
v, c~~, Au ust 23
l5igoawre of ee ~ rd oI i w ahcry,
~ DATE OF BL'RI~L .................--......__...---......_._..---.__t . t
~ 7 \~~IE OF Com~-~er °t F'ubl'~
Ernest A. B ron J.
FG\ERAL DIRECTOR ..........................°.....Y.---._. ...s......_r.e..._......._.....
684 State $t. ~ Sprin field j~~S Dcsigna:v~n) (Date Issu Fcrmi
AnnRess •
. RK~~-, ~?~d . . . . -~2-1 ~9.__...:
- s inra~e ~iol.a ..P......P~o~.& _ ;
_
3~5 Roosevelt Ave. ~ ~R~~n=)
;c.r-5-'1-e~9~zo (Address) . ......................f.....---•---...._..__......---•--•._-°-•°- A TRUE COPY ATTEST: 1I
Springfield, Mass.
~ HuG ~31972
y f ~ 9f~ , ,
~ Cit o S rin eld Mass.
~~irrrhy #~r~nsr anD ~x~ that 1 am the Assistant City Clerk oJ the Ciiy oj Spri»gfield,
~ Commonweaifh of 1Ylassachuseits. Thaf the records of birihs, marriages and deaths in said City
~ ore in my custody, and that the fo~ego~ng is a true copy of the return
- .
~ oJ a deaih on file in the o,~ice of the City Clerk of said Springf~eld.
~ ' i - ~ ~ ' ~ n'" , ~F
~ Witness my hand crnd the seal of the said City
: , . .
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, . . , . . ~ o~ Springfield, .
'J' , ~.z' ' ~ ' ~ ti ~ / J~ .7
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, . , - . Aitest .
~ , I, As:istan~ Cily Clak oJ SpringJ9eld, .ifass.
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