HomeMy WebLinkAbout2705 V..ift•d Twnscript of O.wh 131 wuu.m,on I.a.. aoo~ co.. R«ne~ter. N. Y. 14609 .
A Verified Transcript from the Regiater of Death
Name of Dsceused ~~s ~~0~
Dots of Deoth ~y ix~ Re~istN No. ~
(Month) (Dcr) tY.or) ~
Pioee of Deatl+
Usual Residence ~ s•~
:
Len9th of Stoy in Town, Citr or Vilioge -
Sex _
Sinyls Married s Mlidowed Dtvorced
~ Aye: Yeors ~ Months ~ars . .
~ ~ ~~105
Sociol Sscuritr No. ST 1UCIE COi1NT1n
~
~ s ROCER POITRAS
~ Mor Vet~ron (ii yss, whot war) I!1 Fnr
RECORD YEP.IEIEp A~~
Z0~/1ft
Occupotion '
03 PM'l~f :
Birthploce -
Cttiz~n of Mlhaf Counfrr
Fatker s Name ~i'~ -
Mothsr's Maid~n Nom~ ~
Ca~s~ of Oeath (ntsrvai B~t~Kn
Onset ond Dwtl~
A. .
B. ~ ~+3.N~ :
~ C.
~ L s{kzac
~ Msdicol Attsndance or other Att~ndant
~~OfOMr 8i~drf ~.Ys
Undertoker
~~Z~
Place of Bvrioi
1 I+~rebr soi~mely aMest tAat this is a trus tro~script frow the R~yist~r of Deoths k~pt
in tF~s ~t~
- .
County of Stots of New York s- '
Dm•d ot p~ th• ' ~ • • dar ~ ,19
3
( Siqn~d, ~ ~ ~ 'CiL~~-1 i+.s~
DOOK ~V PACE~~ REG157RAR OF VITAI STATISTiCS
- ;~~,y~ ~
:x - i -
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