HomeMy WebLinkAbout5264 :~s ~ DIVISION OF HEALTH f~~EO ~?ND RECOROEO ,
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~,~s!' BUREAU OF VITAI STATISTICS R~CER POITRAS j,
~ ~ . . 24~154 Tronron, N. ~ CLERI( CIECUIT COURT r~
o ~ RECOR~ VERIFIED.~.~,~
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Tj3~5 I ~ F3t-,T.HAT THE FOLLOWING IS A TRUE COPY OF A RECORD FILED IN THIS DEPARTDIENT
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y~`;'~~.~ ..,Y : ~ Rcgistrar of Vital .Statistics
~t~'ARNING: DO NOT ACCEPT THIS COPY UNL.E.SS THE RAISED SEAL OF THE CITY OF TRENTON IS
AFFIXED HEREON
REGISTER OF DEATHS. TRENTON, MERCER COUNTY, N. J.
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RepistraPs No. _
1. Plaee of Death 2 Usual Reatdence ~H~~ aece.,ea u.-ea_ u ~wuia~wn: .=si-
a. co~~ty ?:ercer a. st~ce i~. J b. Countr a~~ e~coR .a,4w~a,~
~ ~rcer
b. City (It outaide corporate limite, write c. Len th of c. City (It outalde rnrporate limite, wrlte RURAL and
- o~ BUR:'i. and ive to~vn gj~r S thls or give townahlp)
Borough ~7c'en~,n ~`r. 4~~iace) Borouph "j:'ir~ T~.
' d._Full name of_(It not in hospital or~nati~utfon, give d. Street (It rnral. give location)
Hos ~1-0~ i. - -~+d or location) _ _ Addreu ~ _ ; . _ }_T
' i~stPiution Cl ~lls~~f~t.:~~~ , ~ll~ ~eec.:t_ood ~ve. F:.~.---
` 8. Name ot a(First) b. (~tiddle) c. (Last) 4. Date (MontL) (Day) (Year~
Deceased Frederiek B. ?:orrison ot r~~~ n~ i.9~;;
(Type or Prist) Death
5. Sex 6. Color or race 7. Married, Never Ma~~led, ~ 8. Date oi Birth sse (m ~r.. it II~iQ 1]r. if [;~der L1 Hn.
~ ~ Wido ed(3PeeitY) t ~ rtea~s) ~[onw ina~. aou.s fun.
~ : ; :Ze ~ .+~:ite `~~rQi`~t~ nt.21,1~. 73 ( "81~' f ~ ~
; 10a. Usual Occupation (c~fe k~oa ot 10b. Kind of Busineu o~ In• 11. Birthplaee 12 Citizen ot
~rork d~oe dw~n6~ myst o[ ~orklas lile. ~ dYiL~~I • v *fWhat Countryt
~ i''E'-~•r-OOIe2~~ea ~r nu.~a, • oofing :onrce, i~1. y. -
~ 13. Father'a Name 14. Mother's Matden Name
~ • ~ afi,?~eri*.:e i:inc~icl
, J~:.es :,orr~..on
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~ 15. Was Deceased Ever in U. S. Armed ForcesT ~v 17. Informant
~ (Yes. ~OO~ unk~rowp)I~it re~. sl~e sar or dates ot ~efK,i}e~3~,T ~69kPi~• 1PCR ;;orrison, SOl:
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18. Cause oi Death Medical CertiAcation Interval Between
Enler onl~ one caux per Disease or Condition ~ O~sr.i,~q eath
~ ro~ c.~. cb~..oa c~~ Directly Leadinn to Death• ~a~ arterioselErotie heart cliseuse ~ ~~4`~~
Anteeedent Causes
~ •TAu doei not +wcan CongeS ~ive heart failu~ 1;.'f 3T'S
~ fke asode oJ d~iKy, ~orbid cowditiona, if aey. pir- Due to (b)
~ areA aa lleart Jailrre, inp riae fo th~ abooe corse (o)
~ aafkenio. t t c. 1 t +fatiwy tlte wwderiyisp oarie laat.
~ rweana t~e diaeate, iR- _ Due to (C)
~ il. Othe~ Si nificant Conditions
~ jrr~r~ or coa?p[icaliow Conditiowi contribrtia to tl~t dtall~ btit wot
~ ~cAicll cawed d~atA. D
reJstei to tAa di+cnie or conditiow rnwiwy deafA.
3 19a. Date oi Ope~a- I 19b. MaJo~ FindinQs ot Ope~ation 20. Au~opsyt
- tlon Yes ~ No ~
21a. Accident (Specity) ( 21b. Place oi Injury ce.s.. in or 2~c. (City, Borouph or Township) (County) (State)
Suleidt ~Dout home. farm. (~cto~p. ~trce~
_ Homleide omce b~as.. ecc.>
y; 21d.Time (MontD)(Day)(Year)(Hour) 2ta InJu~y Occurrcd 2H. How Did InJury Occur?
, o~ wnik •c xoe wmk
- ~11~Yfy m, I Work ~ st wort
22. I lkereb~r ee?tiJK tk^at po"ttewdtd tJte dttxaied fros~._~___:_~_~;~9____., to~~-- :~'19___-.. tlkat ! lait iaa t~e dcceased ~
dirt on.-------L- l-~j~u9---~.. swd thst teot~ oeerrred aa~_:_c.>s~A.. Jroa~ tl~e cosau awd oa tlle date atat~d aboce.
23a. Sipnaturo (DeBree or tir.le) I 23b. Address 23e. Date Sipned ;
.~otifrt Purcc~l. i'I.'1. 620 Par:,:~-- :ve.,"TM-n1~-~~: 2-1?--`: ~
y'. 24a. Burial, Crema- ~ 24b. Dats = 2~. Nams of Cemetery o~ Crematory? ccur. ~~[4 or town~6lp) ca~.cq
tion, Removai (Spea
ih) i~~~r-~Z (~-1~-rA ~ St.Peter's ~er.et,r;ry- ro•-~hl:censie, Y.
Y; Oate Rec'd by Loeal Repistrar'~~ Sipnaturo 26. Funeral Dirocto~ N. J. License No. Address
~ ~ 2-13-5~°Q' I 1~. F. Hartaence I John J. Inglesb;-,3rd- ~i2]1i1 Tr~ n ~on, i;. J.
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