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HomeMy WebLinkAbout0349 "1 / ' 1~;-`~ ~ _ , i~'~.~s~ EpST ORANGS DEPARTMENT pF~ ~ • . EAST ORANGE, NE~1. : ` i' , ~ ' ,`~i . ' ~ ~`.3 iiader ap? hand snd Department Sea]., ~•;,~~~'tity'~hat ~t~ is a trus record. photoststic reproduction f~c'oID? an? image:~S~:~Q~~~.. ~t ~ ~ .y. . ~,~;r~c~' or~- ;s3' i t~. ~ ~m~4~te ~r•~1~~ I~ ' ~ ~ ~ n ~ ~ nns NOV 61972 ID~~'~': p~ ~ -'l ~r '~3tal Sts?tiBt~Ca ~ ~,ca~,~., Regis~rar . of ~ • n ~C DO NOT ACCEPT 'PHIS TRANSCRIPT UN THE RAISED STAL OF TH$ CITY AEALTH - ~ ~ DEPART~iT IS AFP'IXS~ HER~~ • R.~, ~ ! _ - - _ . . _ ~ - - ~ ~ , ~ : K ~ STATE OEPARTMEN7 OF HEALTH OE NEM 1ERSEY " 1~..)p _ - - - . ` t?LACE OF OEwTM ~2. USUAL AES~OENCE ~iAero dece~acd I..ed. 11 inHi~u[~Ow: rtsi~tKt Aeforf ! , . : ~ ~ ~~'.T~ Esaez ~ STATEIIQ\/ Jer~e~r e- C01?HTY SOB1er~~'~i ~d~n~iwl. ~ _ ~ T1 Y ,•'he. k'~nt a~1 J'~~ nanr~ ' i c, i t~. ~ H l/f o<'lll. r-1 f~:Arck boa aad ~i~e ~a~t) ' ~71~' . ~n !F... `3re1 ",•R'"•." " - ~ast Oretn~[i~ N.J~ ~ HORtII'GFS ~ 21 Daya ~ ~„~,,,~N `J Somerville, N.J. :c~.~~tir- . 1~:J ?A~IF ~ t~ If rry i.~ M.p~r~t r.r .nc~aa~X~..n, Ri•~e vre~r .~d V~ .+.x d. ~iRF[T 85g Quarry Lane ~ 1!(n?•1! ~1 nR I.r a~:anr t .iDl)RF:~c - ~ : K.. East Ora~General flo r.o .,.w~.,~ j ` - ! :r••~ fi. ~V..fyIr. - - c. tLaal ~lbo~hl fD~vl IYeat~ ~ 1 AI~C9 DATf 3. D CEASEC , HI en~ ' oF Ko~reiober ~4 1983 ; • .r. . ue~rn ~ ~ - - - ~ _ - - - - - - - - - - - u ,.a~. ~ v._ ~r W.a« z~ t~c.. _ 4 ~ ~ ~ Ka `j~~ ~.~inr ~,r F.. e y tt~m~d ~ t:~«: \I~rn~J ~ N. hatr nf N~nA 7. 1Rt tl~ rtws ' 1. t~,l...e•1` ~ I~~..wacS~ ~ t October Za 1V1~ I,~~M~~~ .y~tAs f~sys Hoo.i ~.r~ i. ~ 1 Feeaale_ - -1 ----White ~ _ ~ - • ! t^,,.~. ~s ~.:p..•~,. t~~ i-...•a J~.... j I~tf.. K~n,} H~s~ncsa or {o-lvnr~ ~ 11. H.nlplace (~~r~..,. Jor..~ ror+~ry/ 17. Ci~~rew d That GwstrYr ~ ~ .l~~rr +•.~r ~~..RUt i~r~. n~w rrlniJJ g . _ _ Aouaewife _,l At Roede ' Bernardaville N.J USA •~~ii ` ~ . F i~~-r'. ~ r~ ~ t.t. Fb+fin's U~iden N~e~e ~ . Edxard Aa~erman Cbarlotte Nae6 , ,,<i~.,~;~~:,~- Fa«.: " :~~w,;. ~o. I' INfORMANT Anaband 889 Querr~ Lane = . . . .l.,...,..-~. . . . Mr.Devid H.Rleom Soaarville, N.J. _ - ~_~N(~ - . + - - _ _ _ _ _ ` slb U1~SE~fOEATN Fnt.~•.~Jrowr.•a~. .~w~ ~-~.~•i1~M~~wd~~1.~. , ~ iKendB~ne~w ~ 1' ~r l. i`r~•h ~sa t ~~s«.1 H~- . t ~ ~R~ned~ae~ 1 ~~sae ~~n - - - . ~ , ~ / ~ •~nartu-c. •f r.~r ITI~ 1•• •~1 _ ~ < ~ ~ rl~.h~s•~.rv (u ~ ~ _ _ . ' ~ a~aii.ar~i~~~. ( ~mps[ tF~ . rt- - z ~~R r~rt. lou. I~u' io - - ? ~ - ~ - Fm !i. lk6t' ~+R~dia ~n t,•,,,~,n~.pc ~..nrr~tiunn iu fkarh Hu~ Vw ReLud ~a ce~e Tr~win i•se Gaduion (;~ee~ in F~rl V~1 19. r~s A.saps~ a ~ Ptrfor~td> ~ 1 _ ~ r..~ neG • ~ •:f ~ ~ti 4 a:.~rw +w• ide -'-N~~mk idr r i0b. Ue~crwr Na~ {nt~~ ~h currtd. I~~rl~r n~fM~ o( ~n~rry ~w PM 1 r Prf ll o( un~ 7l.1 - ~ J • ' t _1° . ~ ~ - - ~ < ; . . : ~ ~MosM. nn,, r... ~ , ~ ~ ^ - --,n ; - - ` ~ 3 i~l ~ . le-„^ . ur•r: !:~e. 1y; ce .J in~~rs r.. `~'r. °h.tr ~•.,,n,, ; J~N. ~ ur, 1o~n w La~tien Co~wtr ` St~~~ i 1 s~:.e n i ~ . o.n.~..r•i.._ • .b(Y., ~ t: ,__i~_~? ^ . ~ _ ' _ 1__ . ` ~ ~ . . i.. . ~ , tu l~tt ~~a ~Lt~~ •w ~fYl'V ~''l / . . . 3 _ ' ~1F,>>~'6~ ~.Nt~t~~ ~r_ i f~ ~-_.~.--~-.~-i-o : ~ , . . .r ~1:111V~~:ti,~ .r.ir a ri.n.. ~a~h. ~F. b~.v •~~..s ~w~rlrJa•. i..w ~Ai.~~v. V~r~.L ! ~ ~ ~ ~ i ~ r - ' - - - - - t ~ - - j'; . ~ Ile. Usts S sed ~ SIGMAT ~ . i~r! ~ ~ ~ ~_I ~-t~1- ~ N - J-- ~~'~~iJ~ W~Y ~ ~ t.. aw.r vf ( r.nat~is .~r f r.mar~. . toc t. Myw w ~or+r,rl , i.~, F~ . . .....~n... ' . 1 ~ ~~r... . ~ ~ ~nrial _~Nov. 7,198'~ ~St.Bernnrde Cemeterp Bernardevills, ~ N.J. i,.••,~~•.:..~..•..•. ~.L1~~en>et.,. 16has•'~----r2S Dateflecd.brloca! eR. e~~a~ 's.~.f v~at w ~ ~ ~rthur K. $ro Inc. ~1R1~ Hontc~air, N.J. ' - - `~j' _ ~_-~_--___i_{~OU 6 - ~-.ra~`"~,t `~`~-~~~~.s+~•~ev~ ; ~0~8 ~~~E 3~9 - ~ ~ ~