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HomeMy WebLinkAbout1577 ~ ~4Q4~8 DEPARTMENT OF NEALTH AND MENTAL HYGIENE ~ / ~l- ~ ~ ~ ~ ~ ~ ~ 1~~ ~ CERTif ICATE Of DfATH ~ i,?,t~~FD~?wF Fr~~ M~ddt~ losf 1c DAtf Of 6fA1H ?D ~KiuQ ~ , iT~:~ a c~~•~? Dp;?j:: AI'Sj~77A 0.~ :D:t'i.F' JITf: r°"m 2z l~z~ •+,n; ~ ~ r.,?t4~ ~ •i~l W ~r.11 N YS ~ , ~E~ 1 RA(F S OAIf Of diR1M A AG( (u~ eas ` . o , . :'_.1L : ::;iIiF: APRTT~ 21~ l92] ,~b~c~orl r;,~~.~ ;..n •~o~ ~ ; ~;i ' v res i r~ b.plnPi4iE ,S'ate a?ve:g+ 7b UiIIEN Oi M'FiAi (pUhIR1'? ~ ~µRRIfD NfYfR MAQQdG~ 1(OINITY Of DEA1M ~o.,^i.ry1 W~WM'FD pYOR([D _ ~ t `'.l~?YT~•.*.'~ UNI'~~ 5P~1T~~ O ~3:1LTI2-'~''"' Me r 0( i+ Ot ~J.ti~ Of afAiH II hAM[0~ MOSVIIALOR iKSTIIUiION(If nplr Aosptat i7o USUAI Ol(UP~f10N (K~~d o~ .o~? do~* i1b tih~Of BU~.~NfiSGe c J :1) . y~ ~ 3 ~ 1~ ~I•L1~.:J~t 9+~~nteraddrest) .SA~1 c1n.i~:; K dV~~USP.}FTl~i~~,~.'tenJ~e~;red) tNDUSitr - ~ j H r; ) '~s l;i.At ~tS PEk(f (W~e+e aeieated 4.ed ~f ~mn~~wn Rtvdenie Eebn Ik (IN OR IOMfIi wvn <rr~ i.~nntv 13~ STREH AND AUJMBFQ ; ~ a~- St+~it ~3~ [Ottutr rES NO : -_~`~:j, $ ' • . _ _ _ BaltO~ C ~ln _ :_v~,_ "1214 .z . - - - ' ;f = i~ FAinEil ~:.Mi Frtit M~dJe tos~ li AWIHIRS MA~DfN NAMf Frst IWddk lau ;-i -s ~ ~ r.lisha C Cole MarRaret M 4'ard ~ m i6o NAS ~t(iA:iD F~ftt iM U S ARMfD ?OQ(ES~ 16E SO(iAl 5E(URiTr NO I7 uuORMIANT Addr.ss 1 ~ ~ti y i ' i~ ~ (Y!1 ~tOunlnVwr} ~ ~:.N+~.~.vaa~a~dv+nr _ ~ : + . ~ ~ " J ^ „e.+u a•tr.~ ~ }8 GUSf Oi DE11N jEn~er orly a+e causr ~ Me Fa (ol. (Dl. ond 1~I) 1 Mnrtt~ or,tr +uo oun~ ' ~4R1 1 pt+?~M w~5 uusED Br , _ ° ~ t~!NEDi4iF GUSF Io) ~ C'~T~" of *.he liver j , "r] /`7 `J. -1! , auc ro. oe u ~ caNSfa~~cf a ' . J t,.~r ~'~a-0ov i ~ ~ ~--1 m! to im(nedlalt uZe ~o) l (b) ~ A y~ct~rgy~Ae`~ i+de~r iause ~ 10. OR AS A(ONSEWEN(E OF ~ ~ ~ : ' N . I ~ btl" . • - r ~ . • ~ ~ ~ fAR1.1'OTH(R ICbqT ONDITIONS (UNiRiBUi~NG 10 OEA1H !U1 M07 RfIAfED 10 fHE 1EEMItW D15EASE OR(OM~I110N G1YfN IN PARI I(a) ~y , - s r ~ y a - t DAIF Of OPfRAi ~i' WcCONDITiON fOQ WHKN OPEtAiION WASPFRFORMfD 20o AU1pPST? 20e iF rES, wEef ?~nD~wGS (ONS~DEREU u1 tEet?Fr~NG ~ ` ; : V _ ~4 , ~ ~ ~ ~ ~ • fES NO ~ (AUSES Of DEATH~ : .i+c . . ~r.- - r _ j, ti• ~tc~ot~T: w~R~c[j 21D T1MF OF IN;URIf t1~ nOw wnlRr 0(cuRRED (EntK mrun ol .~„ry ~n ~on 1 or Pon 1. Ir~m 11 ~ ti"~ ~+twrnwt~~ , ~py OF YEATM NOUR A M MunM pup Yror t"~1a i~~;• ` ~3. edRet d} t[~' r` P M 11 21d M{~IRr 0((UR G 41e PIAtE Of iNwRr ~a~ sm[t rK~~~ tif IOG~IOM Sh~N a RF D No Gh a Town (ounq S~are i ~ Wlrle ~ Ng~Q ' a~rcE MnurG Et( t ~ ~ :s. ~ W~ ' t waf 01 wo~. - ~ 220. 1 certify,that QQ (t ~ospitai) aU~~d t deceosed~r~xn • to .iiW~ 91 19~~ thot (IY(we) bst f~~ - sow the d abve~, an J~'i+"J 193~ ond thot in our nion deoth occurred on the dote ond hour onC from th~ M ~T causes s ted ab (we) (d~d) ( ew the body after deoth. tte sw?uru~ m ~~tt s~t,~o ~ E'~ \ ~rrE~ ~uo STAfF Q - ~ . ofccrtf n+n ? ae~ua ? n+n ~ ' 1ra w,rs~a~u+s n. wacu r~ NAAAfI`tlD~f Rn~rr-~'1~' `~i'1,11.1.•1~^~}•nnn' ~l~T~~ 7F7(~ VC`T~i ~~'.rj :~ns.'._^n' !l!.j~ "~1~;}~~ ~ ` ' ~ ))0 6LY~A! (RFMAiION 1]0 OA1E 2k NAMF 0~ (EMEI[tt OR (tEMntORt l~d l0(AI~Op ((a~ a ~ownj ((ov~ry~ ~~uty ~ `~4Ni'~'!'''~ 6-?4-72 Moreland Memorial Dalto P$lto. t~ d• ~ j s H N N1kIGI lNt!(fOR LflORISS 2Sa ~~~t ~x fR~,, 13g,,,~G~}(~AR1~~ Leonard J Ruck Inc. Halto. Hd. 21211~ o~Tru=~ G~ ~~7 ~~~xO'" 24U438 ~ ~ o~ ~ ~ R~'1'o~ r-~ C G ~ 0~~~~ ~ ~ ~ O _ ~ ~ ~ N ~ ~~~K207 ~f15?? ~ _ ~ - ~.~p , ~ ~ - ~M ~ y-~