Loading...
HomeMy WebLinkAbout2358 . j . ~ Y ~ i f ! ~ • _ . . _ _ - _~,.7~,~i;`~-__ ' ~z~.~= . NEW JERSEY STATE DEPARTMENT OF HEALTH ~ ~.~,~w JuIY 74 . ~ -a , F ~Ea ~?NO R~~~R~~ ~}~e~/9 ~ • ~ - " ~ r ; TRENTON, N.1. a~. uc~F co ~ ~ ` ~ ~ f~.ts~', . 4'~~' ROCER POITRAb ~::l+,.a ,.x.. . ~ , t.~ • ~ - ~ -t. ~r CLERK CIRCUiT COURT ? = ` ~ ~i ~ ^ S3~.:I~.~ S~ 19~T1t RECORQ YERff1E0 ~ - • ' i : ~ t;`", ate ~ . ~ ~ -~--~W ~ . ~ F~ y ' ~ ; THIS IS 70~LERT_IF`f~THAT THE FOLLOWING IS A TRUE COPY OF A RECORD FILED-IN THIS DEPARTMENT 4 - - y ~ . r, A~~/' _ - ~ C ~ f ~ ' ~ ~ Ssatz Co~t?nsssirirter-oj Health State Regisha?' of Vital Statistics - ; wARNING: DO TE DEPARTMENT OF HEALTH IS AFFIXED HERE0~1. OF THE M9315 t ST _ NEw JERSEY STATE DEPAZTMENT OF lJEALTM ~~3~~ ~ ~o~~.. s~LEhv»BER CERTIFICATE OF DE11TH srw:f =~~E ~_••3=_a { S?ACES \.ivF UF {FtrsU (MrdO1r) ILraN Ses ~~.~1T_ GF QEATH , F BElO~ FOR [IEC~.'~S: D ti ~ ~ ~ sr~rE VSE iT.~ c. P.~~:) :~.:A~Y ~LL~~ ~ 1 ~ ~ f~~ ~ _ oNtr . t P~~tE Co!or R~ce 5. .~~e 1re>~s. Ii un~ler 1 Yr If undn 2a Hrs_ 6_ Uxe of HcrcA ~~s =eceau: _:rr .\:r..ed Fw.:es~ , /ast ierlbdarl yu,:,cs Aurs Hw•s JM~w_ rYsa. v:~1:<_- ~..~s. y.t. o• _~rts st (2 reb 1~~19~0 T'O ~ "fl''?E - I - i: B. IIrt!+p:~:~ ~~rssr o• (o~eraw cun.rt.y) 9. Ci[iz~o e( ~ha[ eoun~ry'_ 10 ~ a:r:ed \ere: ~trt:e_' •1~? ~r:.a- ~-_r t. \o. ~ 7 ~ v r'' Ti C ~ ~nlu~rd; Uicorcc.:'_. f ~ ~ .~._~~~4 ~','O ~ '.°:1 _O_ 1 t~•v• • i ~eS~DEH-E ~I2_ PL1fE 0= DE.1TH IS_ t'~t;.iL RfSlS)F~~E'lf .-se.:_-.or. = e-ce -e:r.e a.'.~~ss.c- + a.Cwn: =-~tate 1~•~~. L~°G2~i ~i C a . . s, C~tc - ~Check lw: aod R:~e namel c_ Gty ~ - ~ iY:. a~n e ns~t~ ~ _ . Boro" : r~ 1 Y~i<I~. j„ p` - : .~G~i~.C r ~ : ~r ~ :ti ~ ~ . , T,~, - v4 c., ~ - - ~ c. tii~e ot (ti not m hosp~:ai w iostituew~n ~i~e secees ad~ess) d. Srrra 3ddress (I( rva:. P.O. !l~~ress= ~ Y.osFr~: or - - I.is~~~~ »a ~O.^.~~lU?'1? j", i%.P..^!OT~1%1~. 110S 1~3 :28(7 t'JP_ C ~ 1~. a. Csv.: Clevpa:wn ~G:rt 4.wdo; e.w! d~•a~ J~nn6 svst o/ ~ork:+~ f+fr. rrrr. •NutdJ ti. b. K~nd o! 5~saaess n~ :r__>':_ I housewife ~ o~ ' iS. Fa~hn's IL. ~So:Ar.'s 4ai3!n Aaoe _ ~ 3e~:~ . '+~alker Jer_.~ie c:.~;? ~~r~rn.~,~•:.~ ~a ~+aa?~:s i ~^o^!as ~luett sa^~e as ~1~ husbanc: CwuLE It~. P.1RT i D~.1TH Q1~ C.1I;JED BY Enftr wefY on~ tarst )r• l~et %w fal. !b! e~.i ;'.-F:::i-+a•- i: __---i ~e:+rea j =~sc- aai jea-~ t iaoed~ace Crise (.+7 ~ '`"C ` ti O - ~ 2 . . 1 II ~ i ~.;nd:::on~ ..w~. .F~cb Uue ro IGl `'~.7~s'T t`~ ~C.. T"~~ l. ~~LC~i:vt~-l ~ ~ ~ ~ i+ = j an~r .:tr Jc ecose cass? _ • ~ '7a1"' stst:+; t~~ rndrr- i .~3.+.e.~s aa~- l~rot tayst latt p~e to/r) ' • H ~o.S . r;..~^t.~'~•s PAR7 il r1TH~R 5lG11F(~.i\i C(~C)lTSO.~~ l'~i_ T~s a_:ra i= _r.- fir_.r~s _c-s:,eree petfor-rd'• 1 e. :..._;e~_s-_i'_rae~~ l 1t~ _ C< _ ~ t-~ s ; ~ : :0~. ~:c,C'^e S:r~c~de H..inde 2~. Uate a.~+d Ho~r of 4.~urr 2lTc_ Hos Inj~r; Occuer~d ~f-r.. urr~ -'-'-r ll *:e- :%r - ~ .:ir F. . 1.....1.dE~ y. . o~ •cr o• :9:!. In.~r~ tk:_re1 Yx. Place of InFmy/~ ~~+M ~b-,nt 6..-.r. IO(. C~cy. Torn ot 1 ocaun~ - :,i.- •cc~ac¦: CH.:e a: .`:r. fh~lr le.~. fa~tary sr.rrr a//r~~ b1Jg . rr. 1 . 't~+-1c Qnrk ~ 21. 1:a.~...1-:. e¦.n~neQl +he d~cras~.! fir~?. w+1 ~ E,~ 1)~:o - a^! las: saa !F.^ r r~:.:e - rs~~ (~t~•~ , e~. ~^ri rr _=L,~- o~ (F~ dsi. s.'c:.C Yppll. Yrnd !o bts7 0! 1nn.l.d~i j•. + tFr aess~. ae~vf ~ ~ ':a 1~cec::sg Yiys. 4~J F,ca.~. 3!. ~ o_nc; PA~c. i 1_*,.. A.Wr~sc c: , ~;z.~,-~~ fL r Lc~ C~ ~'7 ) ~~d 7~c Iti:~.~ ~ .re _ L. . ~ ~ i~ / ?-:~-c1t / tC / ~ y - -.ross ei•:s. N..:~i ?•rrs[eor. Rer.vcal Z~b. ( cery ar rvaatory \a.:.e a';e. I.o_i•.c~ ~~:e ~'•.ir~a2 Calavary Ce:,?et~ry ror;,~~o_: ~ Cf~.su5 ,j.! ~yj'.~: ~t~.~ ha1 lr Na. Funet~:l!.wwe Aane :J~_ F4~eta! N~-r ~ir~sa ~ TNw.T ?t~~':L 2~~~'~C~12 ~;~C:Z Fur.eral ~:0:`!e `~O:"S z:. . ~ .v . P !a: F.-.-..: I r~~ . ~.1: a;~ i. i ,.~a:~ Xo n~Fictra: (av.~nf 4rr,.r - tt -'i" o F . ! . . : " ~ , i ~ _J I' , ~t,:,c.rK~ ~,ti ~ / ~ l__- ~ - - - --j~ - - - - - - - - ~ _ _ ~ w - _ _ - ~ _ ,