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~ ~S~'~, _~~-v OFFICE OF REGiSTRAR Q~ VITAL STATISTICS ~T° 26948
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This u to Certify that the following ia correc~ly ~opied from a record of Death in my office
Ii1~ OF D~ASED PLACE OF DEATH Dll'IE OF D£A18
~lthl~ls Mr~11~tt~ BQA lbi~os'3sl at~ral . 19?3
50CIAL S~CIJNiY NUI~ER SFl OOLOA MAR1iifL OONDITION ' D~ITE OF BIRIH 1lGE
Yn. 1(os. ~ DaTs
08~}-10-t~80s2 Ksl~ ifhit~ llnrri~d J 1
M.ACE OF BIIiTH - CAtJSE OF DE~IiH ~
! Proba~bl• ooronsr~r ooolu~so,s.
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SUPP1ED~iTAL IIiFORMA110N ff DF.1lTH WAS DUE 70 EX7ESNAL CAUSES
ACCIDFai?. SUICIDE OH HOItOCmE DATE OF OG~U$RFIiCE
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~ WFffAE DID II~JITRY OCCtJRT
or Tawn Cauntt Sta1e
f DID II'TIUBY OCCUS W OR 1~OUT HOI~. ON FA1W. IIi II~IDIISIRW. PLACE. IN PUBLIC PLACEt
~ - ~ Specitt Tlpe at Plao~
~ WHII~E A? WOAL? ![F.ANS OF IIi]lT6Y
~ NAl~ OF PERSON WHO CERTlF~D CAUSE OF DEATH 1~DDRFSS
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~ Yilliaw T. 0'Con~os.l~.D.,,ast.M~diQal e~aia~s Union ~ona~ Co~st H~oua~, Slissb~th,M..T.
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l ~iC1E COUMTY ~1A. ~ c ~
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ROGER O04?RAS ~
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- CIERK CIkCU1T CO `
~ RECORD VEA?f1E0 , Frank Cerone, Registrar of Vital Statistics
~ 11~1 Z3 I PN'73 M`~~',~' B~'`~g
Friberqer Park
a 269083 Morris Avenue
~ Union, New Jersey 07083
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~ Date of Issue
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~ BG;~R~1 PALE
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