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HomeMy WebLinkAbout1124 v.s. so t+i~oi ~ w:cowoao o?st~~c• NiEW YpRK STATE s*~*e r~~c rvw~c~ )1 . ~ ~EPARTI?1ENT OF HEAtTH • /2L}~i S~`~ ~ ~~,sus s~ ~r~ BUR~AU OF VITAI RECORDS , iltACT 01VI514M .~a,,.~.,,,,...~, CERTlFICATE OF OEATH ` TYPE All. ENTRIES OR PRINT IN PERMANENT BLACK INK. . 1. NAM : F~RST MIODLH IAST 2_ s[a ~A. o~*~ O• ec~r. ]9, MpYw c 4Al[ /[M~IC MONTM OAr •CAA ~ . sraTi51~~4t D~lTllliT - / n_ ~ ~ ~w~ I ~ ~ J ~ : ~ O. /S%: ~ 4k:C. A~C[: IwMIT[, N(t110. S. Ai~ VMOC• 1•~, 1? uNOCR 1 OA. •A. tl[TLIIAM 01 V•s. ~RY[O I011C[SL OB. ~r tES - S~tCI/Y 111M., ' AYC11tGl1M INOIAM, tTC.1 wO~Twi OAY! NOY1~3 YIM. ~ OA1[S OI iC1111t[ / ~ 1 •p ro uwa~oMnl 1 . R F s. o Gf! ~ TG~ O~ rss. ~ ~ ? ~ ? 1 - . ~ ~ ~ q 1A. COYMTr (IiY3/ ~78. TOM1~ ~ 7C. C~TY' OA YIIIACE ~ 7~. LtNGTM OT STAY ~fl ,7E. Mpl~~7A~ OA OTN[A iM31fTVT~011 ` ~ ,~~~E ~ TOM~M~ CIT7 O~ YlilRit, (1/ M[11N(R~ CIY( STwI[T ~ MO.~ ~ 1 ~ ~ StliFc ~K oo~ rw ~lJ~CeN~[Of//J : ~`fe,~Tf/ 5~~3 ~ i~/ l~Pp 1'` 0 t.STATE O~ ~~ATN 9. 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