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HomeMy WebLinkAbout0293 , •~.~w+~•.+ww.«.~ ~+'~3i$G~i~ri~i.li~f:t11Jl4+A4r.!!.:W~xr~~aY'wAJ4+~/.~Li..w•,.'.. +Jri,~ v....r... .,,.,,.~^h,~ ~~r..~xA,.,~~..~~r~... ~i. ' '`-'~..:..../~;rw. .r..,.d•'~ - ' 'wtirrrnwar ' , ~ew 1'urk ~tntr Urprrtm~nt ~~f flealtl~ . , ' I , Z~OI 01/ICt O~ VITAL RECOROf , • , 4 ~~r., , U~~t. C E R T 1 F I C~ 1' F 0~ D F~I T 11 R~;c ~~Md ; y ~ ~ 10 a~^~/Ir ~d 01 /M~.~ . ~r . . . . . i~ Eti~E~Nhrt~ CetM~W e4. If ,ntr h~ron~ r~wOra.~E ;,r ~ ~i~i~r~~~~~ i, /tACE Oi CIATX, SSArE OF NE'N rGaK ' ~~+j~~ t fS C ( J i I COUNIT ~ ~ ,~TA1E oa- u ~..,•„`~r . e.~c,,,._Yor~,._.~___._._. 1'~ ~ I 1~ fOWN t, }~iMk' f``~~"'~ ~Y c 10wH ` ~ ~ ~ 'tAY , : I~JJ.~Q ; t` i~ ~ i.- ~~ti YIIIAG! i~ a~•u.-~ti', I~~ ro~t~~~r~ ~a~~ o< w ~ , o CITY Ol VlI~AGE .~j', t ~ ~ . ,,1, ~ ,i ~ ~ , WJ ~ ~ . -r__ r,~ ~ ~~'~"~~~r ~ s er ~~s~; h~ ; ~ • ~LLQ~ ~ ~ • _...._.~C.GILE. • w:,,;~,,~QGl1.G' ~ _ ~ ~ + 1 d NM1E 01 {Ii nel ,n Ao+O~tol o~ ,mnf~li ' ; q~, ' t ' 'i~~9, I ~ , i,y3R1 } f, !S /ISiCf~CE G'~ ~ u ~ . ~ ~ hosr~r~t oR , 1~ Es ~o k ~ ~ c ~ ~NS,~r~T,a~-~~~!Y~~.~'~~ `~S.?_Ho%~en_-St,! ~Y _ . ~ , , . . . . . . . ~ d ~ 3. NIWE Oi ~ t. s , ~rR1 1~ D~tE (MUnrA~ ~Oarl ~ ir«+'i y j~.,' ~ N q ` DECf~SID / r 't'~' i 0~ ~v~~~' ~ ~ i~ (~~~.or?r~n~t L~U~~C _1 ~ ~ ( OF~rH /1~l7~_ i~~~ _.19 , ~ J„~¢ u,~ N J S!X 0. COlO! 01 AACE ~ Y. SiNGIf, M~~Q~,~WI ~ tJ~ : 1'` N tMA?d!!D, WIDOWID Gi D~YGPC(D~ ham~ ol Oivo~CEO,lsv.c rf ~ v ~ a q Fe.Cnd~e I Whr~Ie._I. M~rr~~ed ~ c~,, F._~Tos hw__T'ra~hol7`c _ ~ C~t ~ 1, O~tEO?eurH ~ Io.~GE ~+r.o~~ uuti~tRtrE~a~FUHat~1`inof'II, 10.SMIlACl~S~ot~o~lt~r~~c,r~~ii ~ 11 Citi.t~rCiwN~~ ~c ~ ~ 0 T Ja?O,rinJar~ . . . COUnta11 ~ OGC7 Is , V VI S~ Mon~M i Dar~ ; now~ i~M,n, Sd V - I-- - I Q ~ ~q~~ ~ dr~ndh N~Y usr, ~~m ' ~ ti~: u~WL OCCU~ATION ;c;:: ~~~a oi .o~~ e~~~ a~,~~ ~o~~ o~ :e.~',a ' ue ~~~+o oi ~:,~~,4;s oa (~~O~.~iT ~ t ~qn d nt~ad ~ ~ ~ ~ ~ No.v.s.e.w_r _ e___._. 4_ w~__ _h. c ~ ~ f. ~ 0 j~, ~MJMlR'S NAME ~ i~ tS. MOfNlt 3 MAI{,fN NAY~ ~ ~ _ ,._~__.__~7>.ho~r Ch~~e~%... . _ _ ~~csa ~~~~~~0 1 i w~ ~ I 10.. WAS DICE~SfD fVlt IN U S~ ~~~~D ICY:!>1 I7. SOC~ L:ICLi~1T N2 I I1~ l'Q.MANT S ~~A~! AUC~!',S , ~ a~ ~ iifa,n~o,orf Il~~~~q~~~rorcrdu~?cl~~r~~c~~ p?3'OS•37~G .~"y w~ , ~ ~ r,.~ . _ ~ ~ ~ . . r lh'.~a ~'1r.!'.h 1 ~ p ~p 19, CAU)E C~ G!~iM f~'a n~1r or~ rorw on o 6n~) „ . Q 1AR~ L GEAtM WAS C~I+.ED {r ~Qp A / ~ ~ • ~ ~7 ` 0 ~ (MMIOIAIE UUSE ia) ~f.l/'DIQI:I.i.C . ~n~:. fI/ ' r I • i ~ ~r„~, V y r ~ Co~d~~~oni, il an~, ^ , ~ w~,,tioo..,,~.~, out ra e; /9CU~_ ~1'~~L~L~f1~IJ! ~ FJf, .f ~J~fI. r l'J..'~•• i a a~,.,T~.a.a,~ ~ _ ~ x ~ p ~ E ~o~~~ ~a ~~~~,~v _ . _ . . . ' p ~ ~ IA~~~d~~f~,rp OUE 10 ~rl s ~ ~ ; , ~ ~ muw (nd, _ _ _ ~ 0 ~ I, ~ j, = IAA1 II, 01hlR SiGNiNCANI CO'~GiTiO~+S CON1116U11HG f0 DUM 6U1 hOf I!~A1tD ~ ^'1"~'r V~ F~ ~ 10 iME 1lR,~INAI CO!+LI(ION GIYEN IN MqI I,o) i ~ ~i~/~l~ f[~ M~", . , : ~a~, ~ ~ ; ~ fi'G/~C/!D , i ~N!,~I X...: ~ 21e~ ACCIDENT~ SU~CIOE, MOMICIG( (Spad~i ~Ib. DfSCqclE~NOw iN~urr OCC~racD~~;f~h~ earvi~ o~ ~~~.ry ? r" ~ o~ o~ h~+ ~9 i r.. . 0 rn • G~ ~ < ~ y ' . r f v, , _ . . . . _ Y ' r-..r. r.~.~ . . ~ n :AWCv~ ~ q 0"" ~ ~ie: tiME or no~r ea~~e, oor, rw~ ~ ;:,y ~n ! g INJURY T. ~ ~ ~yyyuyyy v ~ ~ ~ v. T. I _ . . . ~ ~ F ZIJ. IN1UAY pCCUOSfO 71~, I~ACE O~ IN1URf m a~ uteo+.~-- llt~ wi~!: f~C ~ ~ C'~ er ~..n Cao~y+.• . S'o'~ A~ E Whil~ ol O Nol Wh~l~ ~ I harn~, lorm, (ociory, ~rr~~t, o~ a c' :a . ~k INl.il U.W1 t , ~ ~ ~4, wo~k o~ wo,t_ . . ~ 1 ; j ~ 11 ,j r' ~ , C' ~ . . ; i ' l f ~ 1'~ hnrb~ h/ft~~ Oi~d! l 0:1l~'fis f~:! ul~f3.:f,~ hBI . . C~~~~~ f• ~0~ ~d ll ~ d ~ E O S ? deuartdcl~~~~on ~I) 1'+6J ~C!fi6)71~~:l~~J:C4/1r?:f /~~.~'/~_'1~ I ~:"t ~l~~ !•I 1 . ~ :l~ L4 c Slu~.tJ s I3 ~ L ~ ~ 7~0. S{Gti~' l~E ' / ,D~pr~r o ~,rl~, I]D, A~JiESS ~ ~ / ',tz J ~ ~ ~ ~ H ~ ~1 ' ~ i~ ~ ,~r~.Nl r ~ ' ~ ~ ~ ~~n /',-r~i f~ l`i' f ~i r ro ~ ! ; ~ ~ ' ~ 0 Z ~ ~ ' i 7~, I.ACE F tJ~~~l, C1EM~'~0'~ C~ pfw.~~t p~'F , ~ ~ ~ ,~i. ~ ~i~~ ~ ~ ~ ~ ~ O~S~ i w « ~ C f' ~ r ~ 'S~ ~ . f w olY 5~ ~~ch~~~rtz._--!'?aa ,0~3..,..c,r, L , , N . +~y[~ ~ ME P5 E ~EGISTRA110N h0/ :ou. C~tEIuE00! . C~t :C. S ~'•{L.t ~t. .'%~Z , ~ , 6• , r V ~ Vl ~TH~VS_~L~dK.C~n?CP~~~ _ ~T_2V3J~ / ~ Ici~ ~if"~~' I.', ~~r ~r~.~..~, R~~,. ~ ~ ~ron~d~~ hiT~l b~nd b/ _ . - ,i i ~ i.:C-.:... , ~ ~ ~ ~ p,~qo~:i~ ~ ~ . ~ ! 19 J ~ ~ ~ ~ y~ i.~j $~f~~~?i { €~"u~ 0