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HomeMy WebLinkAbout0757 -"'ra'.+ ~ , ~ 1t~iiiT1' • . ' ~ ~ - - - ~ ww[~ STATE OEPARTYENT OF MEAITH OF NEM 1ERSEY ~ 1C ~~s~~i? K`O` 1 tIACE OF GfATM ~ L USUAL RESMENtE ~*eere dec~~~d li~ad. 1 i~sei~~r:e~; resire~ce ?e(~ee w~ a covNrr1~( .e.;..».~. o.?+ CWYTY t STATE CRY (CAeck Aea ud si~e ~a~e) c. IENGTH OF c. CITY Cteck se+ ad ne iuwe) SOROIJGH STAY (i~ t?is Plate) J ? • SOROUGH ? } ~ TOfVSH1A ? ~ C~Y{~~.~,~ A, TOfNSHtP ? ~'^''~-'L~~ ~lK~ ; d. fULL NAYE OF l~wc iu 6Sspital p iastitutia4. te vrett ad ess u d. STREET - : ~ HOSPlTAI. OR • ~ ' ADORESS G~ ~ 7 L\'ST 11T10N ' t- !f rural. P.O. Address ( L,~.! . - • IFLs~) ~ rN.ddle) c. (LasU CIM ~ (D+1) (Ye~t) ' Nlu~f OF - - - f t, OLtE : DECEASED L ~ I j~ ~ _ _ : / • ~f- ~A~~i r+~ Of - - ~ ~ r 1T>~~ o. vn..~ f~= --J-r ---Lr- / CEATM • ~ar~rc~ ~ S. Sea 6. C~tor er Race 7. ~Yaried ~Xe~cr alarned ? S. Due of BinA 9. Ase (1~~t ~ri U~t t Yr. If wde~ ~ . lrst ~utL~ft~1 Mo+t~s Osrs Norq Y~~. 7 Z .~ao.~e p o~.«~a p ~ / ' 10+. t;sual Occup+tioelGir~ 1.~Jo~ rud lu+r IOS. K.i?! ei P~s~aess er tndYSCrti (1. BinA~ace (St~u a JornY~ ~owtryJ ~ !l. Citi~ ef f?at Ceurry~ ~ ~n.R ~oir y ~w.~; Ly~. •~to~I! ~ _ ' _ ' ` vat~~ar l3• ~xAcr•s Na~e _ U. 1btAer's , ide~ \a~e - ~ ~ t i~ ~ ~ / ~J _ J l c:_ ~ • _ ~.•?~G .~lc` -f ' ) ~ ~a.:._ c.. ; _ lS. tas DcceasoQ E.er ee G. 5. ArseQ Forces~ ~ :a: Secrt.ty ta lNFORMAMT ` AIMis - L~ 7•~L t~ IYts. wv~w rnkwowwl !1J ~is. Rn~r ua. o~ Ja~.s u/ irn./ ~ i. ' ' - .~/t ( ~ ~ f1lCtrwG _ ~~°s~ 19. CAUSE Of OEATN ~E+~~. owl~ w~ cus. fNe p. !~ti Ib ~1~) le~enal Pe~vee~ Pan I. DeuA'tas Caus~3 Pr: Oexc ad Deat\ ~ I~~ed~~ce Guae /a~ ~ ~,V. . Co~lua~; i~ wy Dur To (L) = w~iicL ~w~t ni~ io ' ~ v~ 1 ~iov~ ~ei~ (~A i ttq.~~ ~l~ ~¦an . ~ ~+j co~e fut. D~e To fo) ~ i t Pu~ IL OcAer SiRaiticaK Cond~~~oas Conn:Mr:~ ?e Oea~? Br Noi Relued w i?e Ter~iul Oisesse Co«i:cios G:K~ :a Part Y~1 19. ~as A~ops~ . ~.r • Pedor~ed~ ; ' ~ _ Yes? Nsl.~- i t ~e IW. Acc:de~r Swc:de No~ic~c 2~. Oesuae He. Mj~rr Occurred. (fre. ~s~rrr o/ ~.„ry Peti ? or P~n II o/ itrn It.) + V C ? ? ~ . KKt O~ J fo (Ar ~tq o lworfr/ r. •ccW[.~ V IOc. Tiwr ol Hor. alo+ts, D•r. r.r - - 0 I~~rr~ 4.t r ~.ra . ~ 20d. fe' Occurred Zpe- Place d 4i~rf f~ b. a~bw bu. p/. CK1. T~~a ar Locuiw ~wac~ Sixe ; fh:te x~ Noc iAile Jarn, l~'~ry, f+.eef, o//'rr ~tr.) fwk u ~«k pti~ ll. 1 ~ttnrfd rFt /ecwsel /row _ _ i _C _ c . .w~~ ~ t ~ rI lut sw~ ~lwl a~ ~ ' ~ ~ j • _ ~i • Di~+J errrwd ~r i-1-- ? a o~ th /~t~ ur~t Kov~: ~~Jto N~ bit eJ ~r ~,~e„1~,1~. Iro~ d~ c~rses x~ai ~ 22a.- SIG~IATURE fD~R.~i o? eu4) ?n,. ALdrtss t2c. Ore Si~wed ~ ` ` ~ _ r-<-~ _ ~ ~-I~i 23s, o_- '••*a~.or., :~e. Osu 27c- ~1s~e e1 Ce~etery or Ga~xor~ 2~. Ll~atie~ /Ciryy Nrw oi eo~ntr) fit~r) I~ ) V.i Rewava:... ~ ` ~ . ¦~~-tt ~ . L ( ~ Ots ~2 ~ ~ . t ~ ~ ~I ~l- ~Li./ ~-C_ i ~ J I ~ v(i ~~1~ 21. Fweraf Dir~cc«•s i, - N. J. lice~x Ke. Addt~i• . n. Oue ll~cd. br 4xa! Il~y Z6. Siajimr's Situnre~ ` f ~ ~ ~2 EC 2 7 . . . - ~ ~ . i.: ~ _ - _ • ~ . - . -~;:a.t,:.~6 . - --;T-r-= ` - . _ . i . CITY OF ELIZABETH, N. J. i LED ~NG REC~ROEp . OFFiCE OF REGISTRAR OF VITAL STATISTiCS s~• ~UCrE cOUN r~LA. ~ ~ ~ OGER POtTItAS ~ a ` CLERK CiT~.CUIT COURT ; - - RECO[t0 YF~;F~EO ' rt~yM} sT j%_ .t. ,(Dib) . YL~ ~ ~ ~ ~~2 0 vs AM ~3 _ _ . . ~ ` - r~~,.;:' ~o- ~,c~._ f :.~~Y`IFY THAT THE FORECOJNG IS A TRUE COPY OF A RECpRD iN MY OFFICE. 1QCR4FII~li 1~3l0 Legibility of writing, typing or printing unsatigfactorv in . tt119 documenL for microfilming.: p~o+•t~...+y~a~sat~.:ks City NtI~, ENzabetA, N. J. Q j~ Wamin Do not aooept this topr unles the raised sca! o[ the BOOK ~~U PACE 756 g City of Elizabeth, N. j, u~[Eixed hercon. r - Rr ;e ~ ~ z, : ~ - r = ..;~~'~...s., y_a2~x4=',