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HomeMy WebLinkAbout1799 1 ~ . ~ ~ ~ATM ~ ~~CCCp ~ LEGAL FEE s200 '~tJ~~+~ ~ O~MlECTiCUT STATE DEPT. OF HEALTH OECEASEO-wwE nast roaa[ ~ws, SEx P~afa Koquade sals ~ ~ ft~1TE ItiE wNYI~[11 ' OATE OF Bu1TN ~ran~. wp.. rc.in n/tCE- .wrE. wcew. iu~[wuw--T-~GE-, wr wac~ ~ rw 1 wa~ ~ o.. rD11TE Oi OEATN aa.na a•. rwo 1 OCiti• A, lAf?O ~roiu~. trc. tirturn ~ r~rNO~,r ~~rt~uw ros wrs I ra~ws rw ~ 7 7V _ vhite 66 _1~ Jun~ 30, 19?5 COIJNTY Oi OEATN TOWN OF DEATH. ?106PITAL OR OTHEii INSTRUiWM- riurt N rOt w[~tnER OivE si~E~i ~w0 wi~E~1 Fhirtield Moairos 19 Anurd l~s C17Y a STATE OF Otl1TH (C.ow~~Y. I nW U.S.) pTIZFN OF ICewuryl YA1iRlE0. NEVER WMIED. WIDO~WEO. IAST SPOUSE lN w~1. 9~r+ ~wii~Orw niM/ 01YORCfD, LE6ALLY SEPAqATED ~a ° Hillabox~o ltei+ 8upahire { » U~3 A , aarried Csilia ~lbarron ~ ; _~r x~r~ SOCUL SECU~u1Y NUYBER UStMI OCGUPATWN ~wvc K~wo a wo~a oart ouwwa wsr v I Kw0 Of BUSYIESS OR MOSI5TRY t aoED :ti MOIr[~MO luE. EYi11 Y KiMEDI ~K L07-16-~263 Elsatrio leah ra~tired i~~ Gen~eacal Elecst.ria~Co. _ = RESiOENCE-STAiE r COUNiY _ TOYMN ~ STREET AND NWBfH - ~a• ~ Pfairfield i Kanr~oe_~_ ~ 1~ ~rci A~e. _ w~?s o~c~o ~ v~aw~ ~ ~c YES c~v~ w~?n uNrt oR swr ~ : Wordl War 2 ~ U.S. Ar~ InPantrt ; FwinEN-NAYE s~aT raac usT YOTHER-WWEN MAYE s~asr ~eoaaa iwat „ Oisa~r ~Quade N ~far~ E. Mnrptp INiORYANT-NAyE ~ ~ 4A4WCa ADURESS at~cn a~ wro wo. an aw Taw. aTwTa. rn Mra. FY-snols llaQuade 19 Hnrd A~rs. Manroe~ Coan, PMT 1. DEATH WAS U1!lSED BY: lEltTER OtilY ONE GUSE PER UNE FOR W. lp). AtA (cl ~ P, C RO~O ~O~MSTFT A~IfDMOEA7NETyl[EN ~,fu - - st. Lu~ ~ - ~rA~s ' ~ ial Infarltian f ~ c ` • " ; _ ~i'd ,s.~.; _ , _ t. COURT and eII wc ro cs .s , ca~ouewcc os - cu.o-na.s ~s.n..w~r,. - ! -;F ~ G~~ t~y ro ~WEp~TE RGri~~~) 1... °r~T=~° ~ a, ArterioeoleTOtic Aeart diaease ~ ~ears waOERnY UuSE u~fT _ , { olA f0. OI1 ~S ~ COrSEOVEMCE C~~ ' q ~~~~_'_~"'/j~ - - ^ v ~ - a~ _ .~1 , rears - K- - - ~i~i~44~_ _ ±'aoisa vi~Ti - _ ~:3L _ ~ - - - q~ ___'____T-`_____T__s-___`_--._-_ VAqi ~I OTHER SIfiNK~CANT CONp1?ION$: CoNOinOMS COw7w~~rp TO OEwn~ !ui tipi ~~wiEp i0 fAUSE WvE~ ~M ?Mi ~ 1~ j AIJrOPSV ; IF YES w[~[ rwaucs cows.oc~q ' ~~ES ~w wD~ ~ w otrt~rwho cwst ar ot~rti ~ ~N IIO -r- - - ---r----------- --f - AOCIDENT. SIRC~DE. NOYICiDE. • OATE OF EliJURY ~vCU•« W~. ~[~u4 ; MOUii ~ ( MOW INJURY OGCURAEO {ENTER M~iVK Of ~KwN1r I1WUflY AT WORK OR UMDETERYiNED RpEUnn i i i ~lun ~ an vurt n ITEY R?[PSn Rs d1 MW ~ ; i ~o. 1 s? r i~oe y~ PIACE OF ~NlURV •r .~or[. r~w. sr~ci ~ LOGT~ON ISt1EE1 pp hiD tio. an a~ Tor+. sr•rr~ ~SURGEq1l RELEYANT TO CONqT~Oq REPORTEp 1t~1 rtEM /6 s~cta~. ossKC woo . t~t ~vcasn : cw+. a.~«.n..~ twu w~a.r~ ~w + ara ~ r„ a CERTK'~CJIT~ON- pHY51GIW: rowr~ w. v¢~~ ra.rM w, .c~w . u+o usi snw wri+rt~ K~r[ ae~ DEATM OCCURAE~ or nrt wn. wo. ro rv~ ~ l1ttE'WEO inE TO YOMM W? ?Fw11 ~ iMOUW`F ~EST O~ Y'/ RhOMtEDOf. Q!E a,. acF~sen s~or L t'a- -----L~°- - -~_='a 7=l~ p~KLo n~ uusca~ sr~r¢o CEHTf1CAT10N-YEDICAL EIIMNNER: u r~ wuuar y. r~c o.r[ wr~ «ar~ or o[~h. ~ T~rt occcurr was +na~aircca ocw - - OtR 10 TME U!lSf73! 37A7FD DE~TM ~(~TED OA C~1 ~JOYT ' ~ a. ° ~ - 6 ?5 ~ - 9 15 P" - - - - - CERTF~£R-NAME rt+~[ o~ rti~n SIGNAtURE occ~t~ o~ ttn[ J J.D. GarritF !'I.D. M. E. ~ - S-. - - - ~ MAtUNG AD RE55-CfR7tF sr~[n p~ ~ra wo ar. on to~w sT~r[ r? _-~-ppTE S~GNfD ~eowtM. wr. vE,uf ~ F.]~ $ti~ KODI'Oe ri0Y1D• f ~ ?~1~75 BUAIAL. CPO1ATfON. REMOVAL I CfMETERY OH CREYATOpY-NANE LOCATION Orr a~ iow r~rE Burial - 1-=,~t.__lsiat,e?el' a ~e4etery Stratford _Cc~m. ~t - DATE ~v~w~w. w•. '~[wi4 i FUNEAAL NOME - NAYE AND AOON£59 rsr~tr ow e r o wo. an oe raw. sr~r[. an e' ^ Y• ~ - J~.Y 3, 1975 i~, ltiner Plmesal Noae 155 Metin St. ~ - ----1----- - - - - - . ~ - FUNERAL DIRECTOR OR EMBAL4ER - 510NATURE NAIIE OF EMBALMER ~s ~ov ws EwK~rto Kildred I, Kiner ~lildred Y. l~in6r TMS CERTiFIGATE RECEIVEO FOA RECORO ON $Y REGISTRM ~ r. ~ . n. J~,1 2~ 1~5 ~ rwli~s R~ Sia~ . '~t~~~lj .-l-~~-,~:~, =~i`~ ~~t. ~ _ _ - "'a~ :'Z':'; -•~it: `1 j~~~- I eertify tl+ot this is o true tronscript of the information on the d~oth recotd as recorde~~ ~l.p _",,;~~~:s;s;_ .Y:~ ~ UFTED :~11N OF i ~ StGNATURE ( e6~st?Qr o~ ~t[e[° . ..r~1F, ' i "r':_, ; ~ ~17 ~ ~.G2~--w~ ~ - ,s ~ 4 = , : ~ ~ -6 ~ , !i/~_ r ~ .~~yit. s =Z• 3 t,'~:.4~ ti- ? _ , ~ ~ct . ^_Jf !Zi.~" t~tf,~'~~_. ~ . NOT GOOD WiTHOUT SEAL OF CERTIFYING OFFICIAL - BOOK 243 P~~E 1`7~ ' y, r z W . '~~~''"~~'~F,7'' ~ .?"'`Y~>-+.5~r - S.s- r;a . : ~.-;a... ' } 7 . ,~C~!`:~E I II II J'~ - . :±w: ~_,.;.'s I~, _ ~ ' _ _ _ . . , . . _