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Home My WebLink About1461 ~ ' t ' v.s. ~e • ,•sco~~a~ ~~~~~~ce NEyI YORK STATF s~•+c rns ¦v~~c• N f ~5~5 OEPMTMENT OF ME~ 1 ccNSVS ~v~. . ~,7 6UREAU OF VITAL RE(.v~tDS A. _ av~s~ow .~.,3 ~r...~. C~RTIFICATB Of OEATH ~ ~o TYPE ALL ENTRIES OR PRINT IN PERMANENT BIACK INK. NAMt: iMiT M~oo~~ ~wsT s~a o~ oc..M a~. ~ou~ ! YAL< ?lY~<~ VOMiM OA• o,...,~. MacGowan ~ 3 ?4 Jane ~ Sth; ~ 2:20P4r ~ iHEC. ~wN~~[. U[~AO. Af~ 1~ VMOI¦ 1•A. 1I YMO(A 1 OA. {A- •[fCA~M O? U.f. µy~0 IOAC~L~ 1~0. Iltlt~l~~CIIr M~A. O¦ ~ ~ AM[AICYI IMOIM. [T~.I YOMTN~, O~~! MOYwt , MIM. 1 O~1CS O? itAr1~( , 1 •t• WIwM~MU ~ 1 ~ • •A!. ~ ~ O ~`REl. O ~ 1 ~ r 7A. COYMfT lNYil I70. 101NM 17~,.C~~t OA rt«~f~~=O~YtN~1M0/l1~1~ IY ~7E. MOS?IT~~ OA O~M(A IMfT1~Yl10M . e~t~a~vuu~c U/ rt~~Y[~_ U11[ l~wt[T ~ 110.1 ` Suffolk ~rookhaven ~ ~ ` ~ ~ 2 ~ ~ : ~ ~ . cr • - ~ ~•.~T~T[ 0/ MATM t. O[C~OCM• •OAN IO. C1~11(M 0? MMAt 11. Yu1TAl ftAT11i WAYIrIM• s?ou~[ l~~ w~~G MAIO(M rAM[.~ 5•- ICOYMTw?.IIIIOTYf HpIfM OAr •[~A iOVMTA~1 . • ~ ~ W~ . 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NOY[. l~fi. LOCAr10M IfT11t[T • MO.• C~Tt OA YlllAi[. fOMM. COVMTf. li~I[~ [t MO 1 IACTOwT. OIhC~ KOi.. CTC. 1. a ~ ~ ~p BE COMPL EO BY ~R_ TO BE COI~APLETED BY ~ T~ CERTiFY1NG PHY~pAN ONLY 20. PART 11 ~~ER OR MEOICAL EXIWINER ONLV ; 11[ O~ Yt 1lMOM~ICOi[. OtATN OtWwA[O AT A. OM tM[ •~s~~ O• LiYI~MATIOr AMO/OA IMY[lT~iAT~OM, IM YT i T~Y[, O~Tt ~1M0 ~IAC[ AMO OV[ TO TM[ MO TM OAI AA O~~w10M OCAiM OCCYww~O A1 TMC ~IM[. OA~[ ~110 ~IAC[ AMO ~ s~s s c 3,~ t, ouc ro rwc cwscs srwTCO. k . s~swso___..._.____........._..._ T s~crco._..__.__._.._._.....»..........._...._.....•--......._.._... •~r~c.__._._._....__ i e.,rrc n~rs~c~a~ ATf[MO[O tN[ O[CEai[O t. ~wsr sccr ~t~r[ s. ~~owouwc[o o[ao C. wou• D. owTC siwco ~ MOMT OA~ VMTM OAf ?[~w VOr~M OA? T[AA 40NTM OA? ?C~A MONTM OAr 7C~A ~ ~ , :IAOW * . , TO: ~ 1 ~ . ( ~ ' ~ ~ / ~ ~ ~ AT _ Y. j ~ ~ i ' jr' ` ~ i D.~ATT[MCINi ~Nrfltl/W. tf OTN[A TMYI C[Rfl/ltw: E. COAOMCA'~ ~MrfIC1Y1. IF OtM[A TNAM C[At111[A: ~ ~ : ) ' _ ' _ - . ~ +A . ~ 2~.-w~c ~ro woo~css or C~A~I/ls~~~ ROAG ~ M v-~.lAti1M[1~. to~oNC~•s ~Nrs~c~iw. Y[OIC~L OIR[CT0~1): ~ i n Le Bow, t't.D. Bayport, New York ~ i~ , . t2A.- W~~w~ c~t~~T~ow ~wovk WOrTN o~r ru~ 22ts. •t~cc or w~~wt. tM~r~or o~ w[r~ov~~ 22C. tet~rior IC~Tt o~ rowr. sTwT[I ~ ' - - ? ? ~ ~ ,Sv n ~e?rep~iu~ Nav ~loirlt ~ 2~A. M~•~o ~o~css or ?uwcwa~ w c ~78. ~cc~sTwwr~or Mo. ~ s~.~.~ ze ir R~c so ~y Ne~ y~~rh ; ~ ~ ~ ~ Z~A. NW( OI ?YM[wAt OIA[C10• ,24~lIiN~~YA[ 01' M[A~l OI11[CTOII '21G. R[illTAATIOM MO. i ~ ~ ~ ~ W~ ~ 1 ~ ' .t... . ,~w~..•.._.»....... 23w. s~ wc o• c sr ¦ 2~~- rroM~M o• r ~a 2~A. ~ ow u ~r ~ co =~0. MOMT11 ~~r •[w~ H o~tc I. ~ I~lcO ~ ~ ~ ~ . ~ ~ ~1 : . . . . ~ • S~e of Ntw Yo~lc, j~; ~ ~ . Co~nty of Suffollc, j ~ G*~ ~~--~KU:~T K. BEHME, C1erk of the ?o~?n of Brookl~veq in uid State and . do have compared . . . ~ annexcd c . ~ ...%~!./...Q~r. . . . . . d of the rigina! filed in my office, and tt~t it is s ttue and mrrect cop' of snch caord ~r1?ole tfiereof. - ~~ti~wnl w'hc~of, I have hereunto set ~y hand and aff ~ sal of d~e said Ta~rn of _ . . . olcl~aven this ..~a:~,........~~SC~~ {•9~N#~ day of . 19..... ~ RocF~ ~~s'a o Afi \ RQ (~C E1EPK c ~utt 4. - a ~V~7~Vl~ RFrr~::. y~.. , .Fn.a~e+~s/~s..... . . ~ Qli~. 1~0'iV11 O~ 8!'OO~1tV!!1 ~ ~UG 5 2 0~ PM'i~l A A G Fp~ TC gO~K fACE 1~~ _ i ~ ; ~ • s ~ ~ ~ c"'~~s~.~ _ _ ~~_t.