Loading...
HomeMy WebLinkAbout0086 i ~ ~ 31 ~~'~;~6~ ~ ~ ~ ~ - _ . _ _ . I ~ ~ ~ CERTIFICATEOFDEATH ~ . . , ' ' • . ,,OoMtw~H~wtAwbbck-? ~ . • ' ` ~ i . . ••~n i v~~FS 1 NA41E Of lfesN r,lt,kltrJ IIuU . 7.OM[ OF DEAIII _ . . Mf~ F~,« aecr~o ; RAaJ L ~ , , i,w.,. r„~d A. ~ ,~a,F,~~ DELORME Nov. 25,1974 . .3 D c.r~. . i R acE J Sec • f.u~d a N~te 5 Aqr rm y~s 11 unk~ 1 V~. 11 wrkr Hii. 6 Patr ol 8uth 7. Nlst ~lecN•.ed ~~t* u~ U S A~ ~n:A iur~ y? . ~rttA.tM,ry/ IYes.ppOw~liNaol /f/YK q~~~n+~o'rt.~fts/ . . M White 57 ~~w,~ „~pf 8I15/1917 N . . ' ~ - 6 N~~trqr.c~ ,iuMa lac~l~ea.nn~.: ~ ~J C~a.~,~ ut ..I,a; r wrt~yT 10 h1.~-.c4~ llc.n R1::r.n1 11. Soe,~! Sen»,ty 170 ' . ~ Paterson,N.J. U.S.A. ~Y.,.,~~.,~: ~~.,~t~~ ~..~~~t. 135-16-?~48 RES~nfq[i 1~ Pl AI:P ~1! DFAfN Il USUAI P.ESIpENCE 111 uyututwn. ~ruan~tefmfo~e..Mn~sa.on? ` ~ ' Ber en .,`'~"Now Jersey Ber~on - . b C~ty~ : (Ch.r? lwir a~d yw name) e. C~tr .-S ~ (Cl~ed twx .~nl 9~v+rw:nrl ~ . ~ ? • ~ " Seddle Bro~k ~ltnwood PArk ~ e. N.r•~r ol Of ~a~ u~ ewKru; ro~mut~n x~ ~Yt eaert arM~rstl d S~ert Addresf U~ ~ws~ P.O Add~dsl af Recras.A ~ . . - H:n~:.!s~ ,,,,,,,~,a°~addle Bro~k General Hospi al !~2 B Franklin St. . 1~. s. ll~.u~ /k.tyYt~(Y1 (GhY~i/k/0/qt!r~ JOnl111I/MlJrrpff U{ NOI(~~g;.IC. t+en d ietved/ 14 b Kud ul puvnnsw Irduitry ' . ~ Vat 0 erator Givduane Corp ? 15 Fart~'sk.~,K . ,6 ~~.-t ~ '~`~~a `~~S'e~orme";!}2 B Franklin 8t. ~ Robert A Delorme L dia Schreur Elmwood Park, N J• C~uSE IB.PARTI DEATHWASCAUSEDBY EnnraJyaaeca~sepsrhnelw/al.lA/irrllrl ADpor:mateNite*.a~Oenc~e* I~ anset of t~rrl.t~a~ and devM ' ~ 1~ ~ ~ti l a S 't ~ - :,,.,~....,~c.,.,s,.~ y~-- --:~.r~. ,,-a__ -~'y_~l~r~ ~_l ~?~~t"' Ar~3~~ ~.~_~r~w. F1i-•I 4~i-i•? 14 ~ j~.' ~ ce..drr~rrs.,,arw..n+cn ~ ;:..:...~.;V.- - ~ ~ ~.-:_~l[ ~~~-Z~`'~~ ? ~ . re r~sr to aM,e ~auze . Ous ra {A1 ~ ~~..:?t.?i.~as._. !c? L _ - , ..~a~.. s~~hnq Meu~akr- c~d~.mca+ /y;ng~a.seqst Owtolcl - u L..~ .,y ro eesu~ an w~ ~e.e~e ~o PART 11 OTHEH SIGNIFICANT CONDIitONS i l L„ 19a. Wn woopsr 19b. 11 yes. vrr~e !~i¦bnqs cm„de~[d ~ce ..,...,~.~r i `~~~~~Li piylo~med~ i~ deurm~rwy cuise o~ den~> ~-i ~ tJ?~lA~,+~ ~.2 l' l~ <~\tR ~ f~~ • A~.~ '~l j`L)v.a Yes f=1 No ? ves i i tu, ?Oa Ac,.. ~ e Su,cde Ffom.edr U.~A.w.m ?On Dar r,d Haw or lnnur ?0. H~m Inp.r~~ Uccvrod fEwter natued r~pry.nla~t /a!I o/Irem 181 . _ Ll ~ ' fo the heif d my knowkv!!' ~ ?1 . . j ?OJ hywy (kcw~eaf ?Oe P~xe of mp.ry iey. mw.+Ga.tAurne. ?Of GtY. Tormd Loeat~on Ct.unry Swe ~ Wh~le at - Not YYAde ` lym, /~rtOry. strett. ollKe ht,1q elr_/ Wwk' atNo~t ~ . . ~ ~ ~ ?t. 1 iatte:ded. eaam~nrJ? the e/eceascJ (f~on.. onl ~o ~Ct~[1ENT 1 - . . . , _~~~~,~.~~.m.,~,~,~~~, ~4- f--rti . - peyd~ ocnrred ar 1!-_~ - m. a. r Mx~ `!a(! f f~nd af~T,' ~nd M!M Aett o•' my knowkdye. /ram tAe tauses staKd. ' ?2a Cahtxr'sNamelTypeaRu~tb.-hre a~qmrg belorrl ?7b Ma6~g/4kfrescofCe~tif~ . ~ ~ ~tv.~ <<<-~~ C~ t-1 b ~ ~ ~ \ ~L,`-:, ~ w~.,: U ,v ~ l~u.~~r.l~ ~ 1 ~ ?h. Syrom.e IpKCt borl ~??et Date Sqned \ At~er~f,ng Phys. . ~ ~ ~ ~ v ~ l, t ~ tJ t MM Ezam. l_: C~'{~ Z T ~ l ~ ~ cnoSS C~ASS 23.i Bw~a~. Gemauon. Rrmo.a~ 236 Cemetery a Gertuto~y Nvrte 23c. Locat~on Gty S~~~e ~~d/~~ Burial Laurel Grove Cemetery Totowa Boro, N. J. ~ CENSUS ?3d. Bo*~al Datr ~40. I1~y Yr. 2~1a. F unr.al H:r.x Na.~u ?ab Fwurai Home /4ldress . ~ TR+1C T N.29,19711. J.H.Olthuis 1 9 Godwi Ave.Midland Park,N;J. . - dc ~ ,er tT..ector S:gnat:u N J i•crns• R3o 25a. R~strar Ics Perrrnt ~ S. t 25b Di!r Re:"J Ey Loc.J REG.16 1 J ~ Re9p~~ / SFPT I2 ~~~j Ll~,' 16~. _ - ~ ~~V~___. r ~ i ~ - - - . - - - - - - - _ . _ - - - ~ - - - - ~ - - ~ . • • - . . . ' • . ~ ~ ',r . . . . " . • . ~ ' ~ ~r ' - - - - - - ' - - ' _ • _ _ Under my hand and'Department Seal, I certify that this is a true Photostatic reproduction from an image of the original record. . . - _ - ,~~v.~~~ /~T ~ - b Date Regi rar of V "t - ' Y~ oSs~. ~'~'y~? . ~ • _ , =CuR4ED ~ ~ ,^~~~~w~ ~ •~fi o: F~(.~C ,:,:•TY fLA• , ~ :f~ ` . ; ST.IUC'~r `'~,-RAS ` s ~'•<,'"'~_r~__.~`'f~~ rL PU ;':t.T C~1f~ ~ • ; _ S~DDLE BROOK. NE1N JERSEY 07662 • • z ~'-•l.., _ . r S ~R ~ .t 3 3 P~ JU~ L3 , _ - _ • . . . . . 3a ~~s9 _ ~ : 60Rlf 242 PAGE (7V ~ ~ . ; ~ ~ ~ ? _ ~ - ~ . ~z~.-^~~v~.3~F~..'~'F _ ~!i''~~~~,a~~