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Home My WebLink About0993 BOARD OF HEAL.TH OF fHE TOWI~ISHiP OC MAPLEWOOD ~~!~~QO ia the Count~ of E:sex and St~t~ of New J~rs~y v CEIiTIFiC1TS A\D l:I~.COItD Oi~ D~~1TH. (Copy)cJs/~- rJr~r Fuu. x~. _~RQLD P. GILPIN z. PLACB OF DEATH 426 Elmw~od ~lve. I~4ag~ewood, N. J. ~ c., Resideaca. ro Di t t o LcoYth ot re~Ideace Is tiqr or tors w6uv deatb occarr~d rn. mo~. ds. Hor loa~ ia U. S.. U ot tonlta btrth? yrs, moa. d~. ' MEDICAL CERTIF?CATE OF DEATEI MEDICAI. CERTIFICATFS OF DEATH r 3. SEX 1. COLOR OR RACE b. Sin~lq Married. Wid' ' ~iit 16 ~ ~ph j, 'r,6 ~ o~red or D'~orud 16. DATE OF DEATH ' . ~ marr~ea May 23 'a 56 ~ b~. I( martled, MIdoM~~ or dtvorced HUSBA\D ot (or) WlFE of ~ EREB CERTIFY. ThRt I•ttmded deceased trom _ - - - - - ' ~e~. ~3 56 AR s,y 23 yo 6. DATE OF BIRTH 1~---. ~o-• lo__ Oct . ? ; 188G ~b.c ~ t..e ~~m .~:~..o M&Y 23 ~e `J6 7. ~1GE Years . Moat6~ D~y~ Houn ~ I Mia. j~nd tLat deat6 oecurrea. oa tiit dat~ ~tated ~b~ve, ~t22L G:IN, 69 ' i _ 7'L~ CA~ ~ vOF D TFI ~ra~ a(ollo~r~: a. OCCUPAT(ON OF DECEASED ~+ili'ori~C mye~ogonous leuke;~ia (a) Trade. profecaion, or ' parUcular kind o( work !b) Genetal aaturo ot [odu~tr~~ - busiees~, or e~tebit~6ment Ia vrhtch emplo~rd (or empior~r) (durado~) rrs mo~ d?. t~t.~. ot «noto>er - - - - _ COYTRIBIJ7'ORY - - - - (Secoadaryr) _ - e. BIRTHPIACE _ P i P8 • ' (duratb~) rr~ mo~ d~. . ~ t0. NAI?tE OF PATHER '~8- ~e» ~ras dtseas~ eoninet~d, _i1 a~haniel _ _ u .,~c .c o+~~• ar a~..er ; Z' 11. IIIRTHPI.ACE OF FATHER ~ Dtd ~a oper:tbn precede de~W 7 natt o( : w , ~ ` - - - - ~ Wa• t6ere •s ~atop~r 7 t2. bSAIDEN NAME OF MOTHER i 4' N' ~~--Y~'~+@---- - What test eoa6rmea dlasuosi~ T ~ ~ 13. BIRTHPI.ACE OF I+10THER ~ ~ (Sf~ned) Dr • Ben~~zr:nan Ai. D. (Addr~s~l 31 Roseville Av~. I~. ~~c. • !~,y~ ` ~ - - - - ? Inlorm~nt ~L2.iN.~a B_! pin _ ' l~. PLACE OP BURIAI~ CREJ~IATIpN. : DATE OF BUXIAI. ~ (Addres~) OR RE14(OVAL _ _:3estland btem. Pk. E. Hanova~r 5/26/5G ' t6. z0. UNDERTAKER ---.--ADDRESS - ; Fn~a-.`J-~-~~.. »`~i6 ~:e3~l~;r Ae6Ltrar. Robt• • C~le flj{• i € JL.i~ 1956-----i - - , I ~ - ~ c~~'c~rrG~i. ~ 3 s CL RK~C k~l? ~T• ~ ~ ~ o ~ REC~lP.D YERlfifB........~ ~ - o ~ ~ ~ M ~ 2 ~7~'7~J ~ « ; ~k.:s.;, , ~ _ . ~ ~ ~ ~ ~ ~ : ~ - ~41190 s ~ ,t ~ :~,t~~.., , : ~ ~ ~ ~ ~ ~ F , • ~ = • ~ - : . . k ~ _ ~ ~ w~, OR ~ ~p . BooK2~6 Pac~ 993 z . _y ; ~ ~ x f . - . _ . . : ~ ~ ~ '€:~,,.~...-r . . _ _ . . . ,F ~ - ' -