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HomeMy WebLinkAbout0406 ~ atco~oto o~~r• r NEW YORK STATE ~ >TAT~ wua~tR 7 D OEPARTMENT OF HEALTM ~n ~ - BUREAU OF VITAL RECORDS ~~1C~ ~ 1! w ¦cs~ cw ruwsc~ CERTIFICATE OF DEATH s~v~3~r"= n~ ~„o ~ ~~jf TYPE ALL ENTRIES OR PRINT IN PERMANENT BLACK IN1(. -'?-aC~ 0~ 1. NAME: FIR3T M1001.E LAST 2. ita ~A. OwTt O~ O[~n. ~S, MOY~ J'~~~~' ~ Y~L~ /~Y~L[ MONTM OAY 7tlA "~o~W N ~ c. - JAMES J06EPH CORBETT , ~ 7 ~ 1~ 7'3 3: 30 • - ~ ~ ~ L~ c~` -y ~ 1. RAC[: ~NM~Tt. N[6~10, AC~ YMO[II 1~11. 1/ YNO[11 ~ OA. •A. 11[~[11AM 01 u.s. ~u..~o ?owecst 00. Y[f ~ i~[CI?Y NAA~ O y~~ R. C'~ AM[111CAN INDIAN. [TG.1 _ MOMTNl, OAti NOYRS 1 MIM. o~TCS os usv~cs O •if MO WRN0IMM ~N C7 white ~ 68 r~~- : ' ~7 O O ~ WWTI . ~ 7A. COV11T1I (NY3/ 170~ tOWM j 7C. CITr OR YlttAit; 70. LtMtTM O~ iTAr IM ;7E. MpiI1TAl OA OTM~II INSTITYTION ~ ~ ~ ~ ~ TONN~ CIT1/ OII YILLA6[~ (II M[~TNLA~ CiY( fTRC[T ~ NO.1 ~b-, Nassau Y-Iem stead ~-Iempstead ~ 2wks ~ 2 days Hempstead Gen' 1 Hospita ~ O - •.fTAT[ 0/ ~IRTN O[C~0[qT ~p11N 10. CITIl[II O? MNAT " MMITAL irATY! 12. iYRV1Y1Mi SlOY![ (1? MI?[~ YAIO[It MAlrt. (COYS~TRY,~INOTYf MOMTM OI~y •tU! COYMTR7• ~ a~ New Yoxk 9~ 7~04 USA mazried Viola McCabe ~ ro t~w. usuw~ occu~wr~ow Itviw ir wcTiaso) 'tss. a~ro o? ws~ress ow ~rousr~r ' 1sC. ~OC~wL StCtlMiY M A .-i ~ .-i • . ~ a ~ ~•"~preman ~ Munici al Park ~114-30-6311 ~ ~ 1~A. iTATt, 1t~. COYN7Y l~t. ?OMr~I ' 1aD. CIT~ 01l rIL1.Ai[ 11E..MITN11~ TML I~F. 3T11[LT ANp MI~M~[R ~ V ~ ~ 1 wR~o~~rc t~r~»t I ' ' ~ 1 ( •ss ro ( ~ o?~ . New • Yor assau em stead ~Uniofldale ~ D ~ ~727 Windsor Rd. • 10~. 1rATN[11'i I~Y~[: yss. MOTMtA•~ MMY[p MAM[. ~ . (N ~ • hAiT MIOOLt ~ L~fT ~ ry11ST MIOp{,t LAfT ~ i a.? , ' UNK1~10WN LTNKNOIITN ,a O ~ 1SA. IM101WANT'i MAM[: '1f0. MMLIMi AOOI~ti~i ~IMCLYO[ 21/ COOp • I ~ ' N~ Viola Corbett ~ 727 Windsor Rd. Uniondale, N.Y. 11553 ' ~ v ~1 V PART 1. OcwT~ wws cwusco ~r twTC~ oMtt owc cwvst rcw ~~w~ ro~ tw~, lal, I1MY IC1. M~AO=IMATC 1!~TCAYAL ~ +y KTMLCM O!~i[T ~ O[4TM ~ ~ u.~co~~rc cwusc B gg lIl en @T1Cf7 f ~ ~ o- ~ ~e ~ r~v6 ~ay-! • ~ tv:C'S ~ ' - -OYt- ~-M~# COM~[011twC[ OI- - ~ COMOITIOMf, IF Al11/, MMICM ~-/r~ ~ ~ - ~ _ n ~ w ~ ~ ~ ~ ~.AVt I~IS[ TO IMM[DIATt. ' {~1 f~(A~. ~L~W~'~-~ • ~ CAY![ ~Ai lTw71Ni 7M[ . ~ 3, ~ ~ UMO[11LtIM6 CAY![ LAiT T Ai A COIIlL NC[ 0I r'~ ~ A, Lr/ 4 _ a} I ~ ~ W ~ ~C~ r~~ ~ ~ 1 I PART 11.'OTN[R SIGMIIICANT COMD1710Mi: O ITIOMi CONTRIWTIMf T I~A. AYTO~3~~ 1~8, IIY[l~1N[II[?IMOIMG! corsi~twco ~w ~ D[ATN ~yT MOT 11[~A7[O TO CAYit OI IN ~MT 1(A1 Y~f NO OC~[IIMINIM6 TM[ CAYi[ OI p[ATMT ~ ~ ~ ~ ~ O - - 1.~~_ ~ C'~-t~'~ ~ ~ ~ res ~ ro ~ •r-~ Q ~ /9A. ACCIO[MT, MOMICIO[, 178. MO~ITN OAr 19C. MOYI~ 100. MO~R 01C INIYAT OCCVRT 1[MT[II NATyJI[ Of IMJY~IIL! 11~ ~17 1~ OR 11.~ ~ iY1C10[, y1~0~1[IIMIN[O . ~ ro 1 1 1 ~ •~-t U ~ ~ y.~ ~ ` 19E, ~MN~11 Ai M~011R? 19F. ~IACt 0/ IMJYIIY; MOM[, 19G. LOCATIOM ~lT~1[LT ? NO., C~TT OR YIIIAG[, TOY~M, (pVMTr. LTA7[/ ~ ~ ?[i ~MO ' /ACTORt. 0//IC< ~L00.. [7C. ; w ~ .L:O~ ? ? ~ ~''a TO BE COMPLETED BY ,,,pR_ TO BE COMPLETED BY ~ b CER7IFYING PHY5ICIAN OiJLY CORONER OR MEQICAL ElCM~11TiER ONLY ~ 20_ PART 1 20. PART 11 A.. A,Tp TM[ t[iT O/ M• KMOYfL[OG[, OtATM OCCYA~I~O AT A. ON TM[ ~Alli O• [iaMIMATION ANO/OI~ IMY[lfICAT10R. IM Mr p ~ r TM[ TIM[, DAT[ AMO LAC[ AND OU[ TO TMi µpMTM OAr •LAII OtIM10M O[A7N OCCYAI~[O AT iN~ TIM[, OAT[ MO ~LAC[ A110 z . CAV STA OP . ~ DY[ TO TM[ C~y3[3 iT~T[O. - , " / . ~ • / 7'1 z SIWIt ....__~...-~J 1 ~ ~ i1CME0.»...».............._............».».................»............ T~TI.[.._~...-....»» 4"~ B. TM[ ?Mr31C1A!1 ATTGtOCO TM[ O[t~AlLO C. LAlT SE[N At1YC B, O110NWMC[O OEAD C. MOY11 DAT[ S/f~tS! ~ ~ ~ MpMT OA1~ [/1R MOMTN OA1I ?[A11 MONTN OAY Y[AI~ MONTM OA~ •[~f MONTM OAY •tJ?q ~ . ~ , ~ ~ Yj ~ R~ ~ W f110M: ~ TO' ~ ~ ~ ~ ~ ~ OM ~ j AT ~ M. ~ ~ ~,j ,~f ~ H O. ATT[MDIMi ~MYSICIA~1, t/ OT1~[R ~MAM CCOTAIEA: E. COROM[I!'1 VM1I31CIAN, 1/ OTML~1 TMAU C(RTIIICII: ~ ~ ~Q~ .1~ ~ ~r ~ ~ U 2 M/W[ AND A0011t I CC11T1/1[II 1?N1lIdAN. COROMC~I, MCOICAL [1fAMIM[II, CORON[O'3 IMTSIC M[OIC4L OIII[CTOII); ~ 4~ W ~ . . ~ _ ~~1 . ~~>Y~ / U% ~...~/7~n G //1 C (L ~C.(1 t L~ ~-t?,. U J) 'tl . : rd N~~ ~ W 22A. WR~AI Cl1[MA/tOM ~wovw~ wo«~h o~r •cw~ se, ~.cE,y~wy~~ a ~oY c' 22 cwT 9 ynr,~~• ' ? ? ? 7 ~5 ' 73 ' ~~.Lu[.b-F ~ri•~ ~ ~ e, cn A o ~ Q C~ 2~A. MAM[ /~MO AODR[f! ~0/ /YN[IIAt MOM[ 238, IILGIlT11ATtON KO. F r~ a x A~ artnett Funeral Home Hem stead N.Y. 550 ' 01084 ~ I4A. N/WL OI /UM[qAl DIII[CTOR '216. f1ATVAt IYN l '[CT '21C. 11[GIiTRAT10M MO. Charles H. P le ~ ~ ..._G~... 04513 _ SA. SIG TY1~[ OF 7t(~ ST11411 2sB• MONiN OAt 7[471 20A, WRIA OR R[YOYAL /[O l311t0 268. MONTM D4r 1/tAA AT[ 1 . ,«o , ,~3 ~'?°~•~~.~~i,,...a.h. ~ ~ ~ 7 3 ~ BOOK , PAGE V ~t~~ . - - ~ ; , , ~ ~r,~;~-~. , . . _ _