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HomeMy WebLinkAbout0179 260338 ~ tLtDt~.• ~f~uKOFO T Li?t?i, :OJM1Y itL •~Lf f ~raAs e~~~~ :~~r ~auRT R~C1.-'~ tf~~ ._G~~ ~c t jo ~r3 . - - - > . , . , ~ ~cwi FES ~?.oo CONNECTICUT STATE D~PARTMENT OF HEALTH ~0~8 Publie Hsaltb Stati~lies Seetioa--Hartfora. Coaaeeticut U.3.A. . ' ~ Certified Copy of Death Recoi?d ~~3 . ; - - -A---- ~ . ELLSWi01tTH T. EVAEtTS Ma le ~*•n ~ wtE os w~n+ ~+o.n~ o... .w MCE -..n. .~«a .rtrur AGE - uw ~r«¦ ..w o.oc.. wTE as oE~n~ po~nK .w ; MP~1l l1C. pRCMM M~~7 M~M1 YOt MA Md~IM ~ 4 , s Y' ~ 1 1 2 • ~l 1 t E' ~ ~ . tl l 0 1 ' { ; ~ oown oF oEwn~ • TowN os oE~rw ~nrK a~ or?~n wsnrvr~ - rre r.o. «.t sn~r ; Net,~ }laven ~ Woodbrid~e k 40 Seldon Koad ~ cmr a sr~te oF w~tM f~..rr. r~.e v.s.J Grt~ aF tan+rl ~o. ~rt ~uaaEa~. awoowEO~. a~tr aro~uE ar.rr. ~+r.+..u+...q ` f I..Wallin ford Conn. USA .~Marrie~~~ »Martha Stevens' ; ~ socu?~ sEarwn? MwsEw u~ oocas~~noN w.E o.o o. .ow. eo.~ a.... ro.. a. ~aNO os su~ss a~ uousrnr ~owo~o u~[. tra~ r ~[tri[q i,..04L-O1-1980 Ketired clerk .~Chas. E. Leete Co. ' RESIDEHCE ~ i~ATE OOMITV ~OIMI STI~ET MQ M~rEll ~ . ' Conn. .~New Naven ~ Woodbrid e.~ 40 Seldon Road { ' I _ w~ c ~ v¢t~w+~ s ~rES, avE wM uNrt q~ sw . wrEw*~ a ~ ` ; Yes Peacetime ~ N8 ~ ~ ° 1 ~ FATMER-1Y1NE su~sT rowt Wt YOTIER-Y11D91 KIYE a~at raat[ utr . „ Wesley Evarts » Mary Bassett ~ rFORW1NT-NAIIE MMlNO MORESS /RnffT O~ V R r0. i71r O~ 10~R R~IE D~1 ~ Martha ~arts-wife ~~.40 Seldon Road Woodbrid e Conn. , ~ ofwrn wns cws~o av: t~rtEn aar o~ e~usE vat u~ saw W. Iq. a+o ~e1 .r..o.w.,~ ..e...a .n.Ea o.e[? Mo w*w ~ ~a w~awn rirwc ~ » Pr ~~~s2x A ~.'14~ b ' ~ " , . 0O~O1W~l. N Yt w~cw . aR 1Q OO b n OOwlEOIIOICl O: . a..c wsE m r.icwrc ' . t CMRt Ml f7AT1~ M M i {Ir0[Il~r{ CJM/i 1/1ft . ~ ~ 011! T4 OA Y~ OO~fEO1R~Iff O~- . ~ ~ w . : ?A(1T IL OT1FJ1 516Mf1GMT CON0ITIOMi oa~alWr COnMY~M 10 Oulll M rR bw/W t0 tJiM[ r~ O rYl?. M AI/iOPSY IF rMpwO,s ca~s~ot~E~ • I IKS o1~ o r u[tcwu+rs v+R[ os OurM = ' ~ ~ s i AOGOENT. SUCIOE. IIO~MC~D~ OA?E OF MJU11! ra~tq O~r. vfMV 110t111 HOIr MIli1Y OOQ/IRED ~NrtEi w~~Y1E Os aNRi M,AlN11 AT 1i0~1K 1! OR !lOETERMNEO prEanf rr~wr ~ w~ws ~ rrer ~ ycan ~[s a q ~ . ~ ~ s~ 7ti fc tt !t ~a. s 1 YIAGE OF NtAF1Y ~r ~wre s~r. si~[[r. 1OG71011 RnEn a1 wia ~o, an ow tor~ a~tq StJR6fNY RElE1fAMT TO OO~Ii10M NEIORTEO N rtEY N ~ ~~ttdn. O~~R wOO. Etc WEarrl , r r++~~: . 1 ' a ~ j CfRTif1CATIW --MYSKJAM: w~rtw Wr ~W rwn~ o~~ ~rf~u MO u~si W Mr.~b ~R a~ DEATX OOG/~~ O~ M~C r4 ~O nE _ ~IOwM O~~ tfM MO~~ ~ER O~ ~ o~O~lEOOE OUt ' ~~tr[MOEO swc ~ ~ ?o r+t fwwtl~ uwi[R !~a O[CWED s11W ~ M ~ t+a t~a ~ CERTr1C~TId1- i1EDICAI E~R M Ytr OrM~P4 O~ M O?i! MO M011~ O~ 0[w~M M OEf.~f wN w10n011rft0 OfM 1~ OYE M 1ME CMA[I!I t747t0. OEATM IIEAIITlO Olil OA NOYf YdIA O~~ • 7l~r MOU~ Gl ~ r ~s. r C . - 'j ~ ~ . ! ~ CEA'T~F~ER-NAME R~c w rwun . SKiNATURE a[o~s o~ mu ! . .a~ t ` taa ~ ~ . I Wuls1G ~DORESS-CENnF~EN vwcA w?ro wo ar. w raw s*~re sr OAtE SKilEO Monr. w.. .w ! ~ 77c ' • ~ ~Y~ i~ "V'i ~ i1/ a/. I ~I i E ~ BUWAL fAfLAiIOM. REMOYK CEYETEpY 01r'~BlliBl~-ItAYE ~ LOCAT101t on o~ iow stut • ~ ~ ~ Bur-'al ,Seaverdale ~ New Haven Conn. ~ ~ , t € DwTE ro¦~.. ~rt~w n iUNEAK ~q11E-MAME AND ADDNE~ a**caT aw ~sa w. on oR ~aw. s+~*c. sl ' : ~ Jul r 7c2 ~ 7~. ' k Brothers 128 Dwi ht St. New Haven Conn. ~ ' ~ iLNER~ dRf EV NA11E OF EYBALLEN ~s ~oo? ~rs [~r¦tr[o LICBiSE tttllSfA t ~ ~ ~ , + . -~~t~'ck H. Sisk 1718 ' ~ ~ TMS CERTIf1CATE RECO iOR C011D ON Btl ~y j) ~ NEGKTMR t ` - ~ • • . ' ~ ~y ~ 1 r+s ' . - - i j j ~ . Of~ ~ ' I sertifr tLat t1?u ia a tra~ tra~script of tl~ j~~El~Ort!°p! •!M~ .{ncori ss reeorded ia elis of~c.t. ~ ,r,~ ; k• ' ~ ~ .1 M f~ Atttstt . ~~w ~...«~~C~irl~.er.-.. R~siatrar ~f V;tal Stati•tiu . . ~ . ~ . € ' i~''L ~ ' . ~ • , , ' ~ D~t~d .~»~.t~......~. ~.i 9.2: Z..........Torna ~»~.%tir~- . . ....ryi......... ' NOT GOOD WITHOUT SEAL'O~! CERTiFY/NG OFFICIAL " .For~ V.S. 1LC " } - - a ~ S s 3 3f~M~ i •_et.• ~ = ~ ~ . _ . , . ~ . _ _ _ . - ~ >