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A VEFIFIED TRANSCRiPT FROM THE REGISTER OF DEATHS
District No............~..~...,-.~~.~
..........................Registered Nc.........1~._.......................
Daie af Death ..............:~.t4::Li~t 20,..2~'13........_..............................._................
Name of Deceased.......":`~.~h 3k'irt~.l1
~Lge......~~ fl ...............Years........................Months..................... Days......................... .
i:~il'rit~: ;
Si~gle, Married. wdowed (Indicate by S.. M.. W.)
Race.... :'`.hite
_ Occupation.......:c~+.i~...:tx::.~rOr:,c3r .
' ~Nd~IiEtORD£0~.........
f IlEO
Birthplace......, ::c: .1 10~~: ~t,A ST. ~t1C1E ~pQ,TaASI~.
.......................................................~GE.K.. T.
CLERK C11tC{1tT C~ ' ' '
4'i'~~~ZS.~..O Rf.CORO VER~FlEO
Social Security No
Father's Name.......t::~.~~-~:~..:::~..:.:~t~...... . ...D~c ! ~ ....9...°...°..~'T3..
Mother's Maiden Name........ ~i'.t.~?~?..:.'.e:i~-`.~
.................~~Dlir!~1........ '
Ptace of Deaih...::~.,.str:t'ri..:'~??~..Itil: ~a ~.a...`:
:'ti:'~:i1;!~?
~ri.. :a:..
Chief Cause of Death... :.ez!e~''1.,,-..~~.'~01`ril:s
.
ime from Aitask till Death - Du~ation ...............:..51.s;I.a..................................
. . > . .
Medical Attenda~t, or other Attestant...:::•X"~.~T:..+~w....r~~..~,T":,:iJ.,..,....:.............
c:I`Cn?Tnti~-;;~ - •
Place of Buriai...:~::,::... :i......::?.~',:;r... ~....:a:.~.xx.~';:.i~ri,~..:. .
I he~eby solemnly attest that this is a irue Transcript from tl~e Public Reqister of
Deaths as kept in the Greenport Village C~erk's ~fjo~~nty of Suffolk, State of
New York, ~ ~s,~ s~_. :
~~4'' .
fSignedl........ .
Registr df7/ital Stati ~tics, Vill" ~ f Greenport
" .t .
Oated at Greenport, N.Y. l~
the ...•--....day of.... . ~.f .c,!,~`.... , 19
C R ~
8U~?it FA~E