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HomeMy WebLinkAbout1737 - ` . . .~..-~-r-_ - - - ~ ~ f. CO;~I~ECTICU"f STATE DEPART1riENT OF HEALTH _ L3ureau of Vital Statistics - IiirtforJ, Coanecticut. U. S. A. 2S~19 Certificate of Death •^j4~; c~ DeAnr. tA) ~~~tc of ('onneeticut L~:VAL R~'~DF•N17C Q/ DECEAN:D: (a) St~te CGi1T1(: Ct 2CUt ,s~ C~an~r ~(r) 1~nrn (L) Cou~ty ~(e) 11~xn 1I ' (d) Ts 1:r.idenee 1nei~:• '.C•{ iJil\•t',Il ~ ~~CW Z::.iYCll j{ ~ti'~~' :iavcn ~ ~C:': I~i.1VE'.tl aC~ty or fiorw,~h I:a.:.~n? ~ (c) ~tm~a ~1u~iucr Ycs ~ :Co i,,~ r.e o[ lloapital or Inct~tution ~It nn: in a lwaDital or inatituli.u~ Cive Strcet \a (1f rural, circ beation) , / it Ycc. name Cit~ or ~ ~ _ ~o•a::on) ' .rae•. ' 7inC,~ Boro~rh y ~8 T3riCht Strcet 38 13ri~ht x'.c~ w`~~;£'~ C~: - r ' 1.:.::3~f ' , ~ . , • ~a~r. t~r lFi~xt) i~lidJtc) (I.a~l ~.k. . ~ - S~u. S[C~cm ~t;xau . ,;~t."° Genevieve ~ l~obg~; . . ~ ~i;x ~r PriDtl _ e,_~~ 1- ' a•~ - ; _ • i .:yEt71C~AL-'~C TSIFICA i ype or priat) pF.ItSO~7AL A~TD STA7ISTICI?1.. PARTICtJLARS ~ ~'LZ. C~~}e4or D TR (Eater ony:~c-l6-~}~'l~~Der bo: (a)(b1 an•I(ell ;E1 b. RACC ~ Q. )tARR1C0 ~V6Y6R a~AtilEO t. Y.. ~ y i\:t.AYAL ~ a(~ ? ~ P~aT~a'DLaj~~~ C~tisto ~~Z ~ ,~rt`. ~ sr.wtc~ ~ I~~tEWw wl~s6 (s),~ ; , 4~str w~D ~~:ale ~.Zzite ~v~.,~p ~q~~~p ~ . , ~V , ~ ~:R ; • ~ y.i :~--,~~j-1~, \\I.OVCEO JR DIC07:C60~ CtY6 a1AlOEN \A~iE W ~ I . 4:~_ '`kj + ~ . =-:iJ~~'-, ~C:ii GR Iil`SfAND 1 T r~7~ ~ . 1 ~ J l:obert i " 1~ • i 3~or+.t~i`s~~ ::oses . - . . r G: y. i~+~:c or (?lvmAl lDay) dYcar) ~~e' ~I ~ DvF :(1?~ n ConditioM, . :;:~::Lc, - LrwTtt ':~nrll 9 ZJa~17 d any. w6i2h :L. L~:s o?' Btatu AcE (~n s~» undcr 1 yrrr !~t undcr 1 d~y ~~~avc ri.tc [o ~%4- ' aborc eausc " last birthd~r) I~tontha Da~s ~ Ilours ~ Jtins. i(a). statin~ ~ - G9i:~ ',OY. 15 f ~ ~ ~ ~ th~ unacrlr- Dvs ro (e) in~ tause ~ i ::;e o; 1:i8 i 7? i , }~s~ ` t:. It~crurwcc tCiiy o~ town) (~wtc or furc:~n eountryl ~'I + ~ .:...^.:3;j 1'wr.s II Ornr::c S~c~u-~ra~t Cu~n~rt..~s Co~ruxcTC:c ~.3. 1ti~s ? I~ ZO u.:ATlI :tISC \uT TZ~=LAT!'i~ i4 TIiE ~EtHI\AL D[$LA~F .11::G?SY ~c~~r It;:~ven Conn. , Co~otnow Gn~s~ ix I'wr.r I(al. a ]'F_ Fo°YEJ' (a1 L3CAL OCiI'fAStOJi ICirc kind o f vrork Jum Surin~ roost o f aoricinq li[c awen i! rciimf) ~ L,Oai ~'tOqSZ:~T1fC at home 2~- ~ui:ceeY Itn.nw~t ro Co~:,mo~s Itcroarco ~x Irt:x 23. '-~~s ~ ib) I~n:rstaY an Itrslc~.s (al Namc aX~ ~~tiu~B10PS3/ of r. ~(b) Datc pezforran7~ ' ~ ~~~e ~P~'~3en ' "`'!."1" ?%~-~-`C ~-J (al sm w V~secw~T Ya orr- a? Yln f~-1."'~ ; i , ~j ~ : (bl T~~+e or 7~~ear ~!V 's (a) Amos~r Sa~c~os itoH~aos : ~ (bl It ~a+. ~~~o w~r - ; - ~ •di ~ Ilorr dloxth. Dny. 1'~os f , I Z/Al~~st~~v .:.~s-•. - . Q G O ~ m. ' ~ Idl 1'I.ec'F: os i~~CkY (r.y.. in or a6ort l.4rne. ! ~ fi. ra •r ~ ~i~ e r'~'t (~l 1~lcrY Occik~ _ tat~ fbrci~n eounirr) \Yhiie at ~ot ~Yhi{e i. J~rw, fartorY. atr~ct. o~ace b:dy.. ete.) City oY t ~ a en~~, , V T,= \~ork ~ nt ~Vurk Q ~ L;. Rtci 1 - dT 1 }i~;n t~ rina. . C, : ~c) Cttr. Tow,r, ot Locwrso~s Covrrtr STw:s • 'I :6.\w ' i` ~ = lEiti toqn) ,i. ~i ' foreicn eountrT) ! ~ i f . i y~' - ~w jia ~ - onn. ;y ~r; pF.~K:~~ ~~~w,,,~~Y o«~~_ ~ 3i. 1:ts:t:n.ACE ~/F,artr nalnrc oJ ixjrry in ParL J t i~. 1~:ua~:s~Ys \ ' or Part Il ol i cw? G?.) = ~ ' ~ ' ; . 6 ~ ~yy.• ~ ~ : . I ' :lr• =f0~ 'C~ ~I :J- IIERERY CERTIFI, that I attended tbe deeeaaei l;om i . . . . . :1 - ,~-4/ . „ s7 , w '~.-.~..;..1 ~ » . ~ ~ ~ I9. Bcu.~4 ~~io~_ • 19~ ~ C~metery• .~.b`ti`~ ,'i~ • •2'~ that I Iut saw the deceased alire on 1-~.• 13 ~ and that dcath is said W)urc oceurred o~ • - pu« ~~est iiav~rr;~ ~onn. ' ~ „ ' ,.o. ::~~:c or F.ww~xcx tr jSODY NAS E]i~ALJ1ED ~ L'uense number ~ 19e~7 ~t ~ h. n. : ~i ~ . . ~ •1a.ie~~J. Sisk Jr.-~ t 158~ =7. si~~•TU~ oP P~iisictwas _ ~.t. Sw~.?:~ac Ct Lusrsca Exa~wa~s oa I.icaxssn Fcrvesww DtnFxros (i~ be11-Y10 Lipton~~iL F f~2 : y^ . . . , . . ~~_t~j-f • _ ~ ~T~y . , . r he~r Eaven ~Co~nr_e c~ti cu~ ~ ,?,=a~~ ' ~ ew il:.ave~, ~Conn : ~ '1 ,\ddres~ }/L""'~-*1' Da:e _ ~ •e7 i ~ _ TlSiS C£FtTiFICa?E P.ECEIVED FOR~~ RD ON ~ litttFT.~~s • ; . APR 1 U 1J~ ' BY C'.~G.W' ~.~'-..(.~.~+'T--. ~'••t~ YS-~ (9-6i) l0Y " -----i•---- _ - --a:.s~~...r...,.r - - ~ I certify tbat this ia a true transcript of the information oa ihe death record a~ recorded in lhis office. ~ ~ .i ' • Attest: , Re~istrar of Vita: S:atistica ~ ~1aroh 21, 1973 ~ , ~ Dated ..................................................................Town of..~.......................................................................................................... ~ NOT GOOD WITHOU i S..AL OF CERTIFYING OFF[CIAL ~ i onn V_S• 131: ~ " ~ ~~~p~~p~ ~~e ~ ~ Q~ AK C~A•:11~T QQ~~T~ ~S 11A. lo~g't^ t~c5 Q 212 Pa~~.737AE00 0 Yf&IFIEO,.~._ 1119 y,~.. .~.t.s ~ . BooK ~?11 3 I I 1' ~M ' 3 N.~.~. .,p. Niw ;a~ . ~ -