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HomeMy WebLinkAbout2109 ~ _'~,a.,, ~_?~RT1~iENT Or= H=ALT}i . , ' '~l ~3~~~Kk~ E~=RS~Y !17~~: > ~ f ,~{?~tE COUNT~IA. i' ~ a P?~TRAs ~ "s' • . : , CLERKC(,o':CU~~ COUIIT - ' . . . . . . . - Pf+:~RC vER ~~E'~~'.; t ~ ~ .~`~~~~y~~ ~ ~ J~ OcT IS l i 22 AM 73 ; , ~ 266001 , s~,a~ , ~ - 266001 ' i i-:t~ iS TC GERTIFY Ti-:AT Ti-±~ =J~! ~,';I:P:`.i iS A i~Lt` CC?Y O~ ~ RcCORD ON ~+.L~ IN T'r~~ D:•.•:5lCti CiF VtTAL STATt~TICS OF T!-tE `~•4T~nSC!~ D~P.aRT!~'E"1T C'~' }+~ALTH. ALLEN YAGER. M.D.. VI.P.N.. ~ ~ DIRECTOR, DEPT. OF NEALTH REGtSTRAR OF VITAL STA715TIC5 ~ ~'lARNINC: DO HOT ACCEPT TMtS GOPY UNLE55 THE RAISEO SEAL OF THE P~T~RSON 90AR0 OF t1EALTH IS A~FIXEO HcR~'ON. HEM )lRSfY STATE DEPARTMEMT OF MEAITM ~,c„~ F,~s,,,,,.n~A _ CERTIFfCATE OF DEATH SS~TE fILE MLL~BER 1. NA.wE OF ~Fnsrl f.M~ el lLas~? 2. Sea 3. DATE OF t7EATH DFCEASED Alacoque C ~olcarelli Female June 1U,1973 - • - , = r7yp~ a. v.~srl _ Colur o~ Race ti. .1Xe ti+>•s it ~n3er l Yr. If w+der 2d Hn. Daee of BuiA ias dreeaud e.er in 1:.~_ .lreed Fo~ce~+ lasc b•.t~J~r ~.Monrws Da~s Herrs M~a. (Yra. e.., w ~njw~.rw/ !!I Y~s. dn i n~o. o. d~c.s vl s~^~. ~ White 63 O 4 June 6,1910 No ~ 9. BircApixe (S[atr w/o.r.~w co.w~ry/ 9. Ci~izee ai s6a[ tom~r~~ IO. Vrried (J~ Ke~et lHuned t L Socnl Secwuy Vo. , Paterson,vew Jersey U.S.A, •.a~••a~_; D~•«ccd~ ; 151-05-6181 ~ ~ - t;. PLACE OF DEATH I f• l%SUAL RESiDE~CE ~If ~~sdcui~on_ ~csdence befae ads~ss~onl , co,.n, Passaic 4=~ j:ew JerseSa. c~, Passaic ~ ~ b. ( ~tc ; ~i (Cl~t:k boa and ~i~e n~we) c_ C ~ ~Cl:eclt !Ma am1 ~~~e n?:atl j " Paterson "M~'~ ~ Pat~rson k ~i Tr.~ ? T..r- t ~ c. A~~x of f(f no~ m Rosp~ral or ~ns[uvuon R.~t strcec address) d. Screcc Address (1( tvs{, P_O_ Address) ~ St.Jose h Hos ital 90 Chadwick Street ia Inst~[ution ' ~ tiI 3. CSWI OCCUpi~tO/1 ~~.~c~ i~n~ o/ nn.k J..n~ Jurtnt wnst ~f rn.irw~ l.L. ..~a rl h. #:~t._ i•' °_;:»c~~ L-~.:w:r~ • ~ ~ St. Anthony's Gui1~1 ' ~It_ Faiher's `ase IG_ AbrAer's 4aiden Na~e ~ $ ~ John Ed:vard Col an Katherine ~tc Cauley ; °I1_ ir.(wmant's ~iam~ and !1d~ress i ~ Edward Folcarelli 9U Chadwick Street,Paterson,~iew Jersey ~ «i8_ P1RT 1 DEATH'~ASCAUSED BY Eete•onfr wa rarsr pe.l:wr %a.l~). (b)aw1/rI Appro=imue inre-.ai be~retm ? _ - onsn and dea~n ~ . ~ ~ Im~ed.ace Cwx 1' ' • tond~rrw, arry. ~.hrcb , davt ~~.st !o aiwt carst ~e to /6l - - •'tu~••. :rorn.a re. a+.s~.- - „ jl 1•.:nR cars~ ias~ pue ro~r! _ - ~ -p ~o d.erw~ PART II 07H~R >!G`IFI('.t.T ( O.`.MiIOX~ t'~~. 4+s ixopsy 1%- If ces. 1••e fi~ 4nas _~~s;dr.e_ • ~ p~rfor.-~~d' ~n 3ett:!~im~~ iuse _~t ~eac!f~ ~ ~ ~ _ ~ ~ t ~ , ~ . a ; . ti"~s _ "y. Y•~ ti ' - ~ i;::~. Acr.a'.ent ~a:.~_'t Hon~cr'_e :~i!+. b~te ~n.s korr ot In;uty _t!c. fi:•s I0~.1. (YC•1if~ !f -tr. ea:... or ,n~.•i rn i'.:•r 7-,• !1 i•r- '~1 ~ rfr b~sr or ,.'•atir .~Ri M ~ F Y. [n;:uc Uccurr-3 Pi3c~ o! Ir.~_rr R~•, .b•.~r t.~n. "If. ay. T~,~.. .x Lo.an~.n <.-r.- _ ucr ~ ,..:c ~r . .,..K'f?~~:_ , 'a.n ...~t~, , ~:.ir. o7/:a. o:~{ ~ ! ' ' - . . . : x ~r ,.,rk ~a - r ' g{i ~l. 1 . [ ~s.:n~n~~~~ cc~ .'ec~sc~~! . ' ~ ro ~ i~s• uai ~:t R ..-t• ai•:- ~ ~ ~ ' - ~ti h . , i . . ~ R l: . : ~1. .+f . . r. : R ..~.11~ . ..••1 " y _ . _~~_r_ r'~ ~ _ ~ , s'i . ~ ).1-.~ f a ce. t _ i'tioti ~ ' I ~I ^~...fSG _ _r!'~ . . . - - ~ ' ~ --~---'_--T.ur y'--' ' - - . . ~I~ :iil. ( t~~-.•:nr. ?.-nn ~i .b. ~ r:,.:• < <cnuor, .`.s."- { 'ic. i...:~• -e ` ( ~ ~ Y ,~J ~ r1. ~ ~ ~_`:ur~al_ HoZv_5~o~~lchr~ Ce~^etery_ ` _~To~o_va J~rs?y - ~ =t. '7' l~ ~c~ i r~i1~.r `.ir ! i„ H'~^e ~cs• ~ ~ ~Ti!:a3, Z~~7.'?!3 ~~,r~~T:!' i~^CQrP~u`L~~ Iz3r'y?. ~ 'ln \~3.~S~.3il t`~]`'~:s0".`. ^ ~ ~ i . fr..~_~ f .i.- 1 ~ . ' + nt ~n~ .1~.. - ~ j _ . ='er" ~ ~r' ~y_,- ~i. ~~dl i ~r~"~~~-'"f , n" -j_•, . s - _ - '-_Y ~ 'L'- ~ ~ _ -,-J-- - ~ / . - y----- ~ ff- - ~R .~0~ ~ ~Q~O - ' ~ . Legibility of ~riting, typing or printing unsatigfactorv in ' t!:? y ~~~~,t~~_Qnt ior mlcrofilming. _ _ _ ~ . _ ~ ~ ~ , _ ' ~ y ~ : ~.t- ~ _,-~~'~.,~:~_:'~~_a.,.'?^.~a~.~.~,., _ . - "~'~i ~s`~~-~...9