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HomeMy WebLinkAbout0422 eo ~~/soi •tco~oto a~r~~cr NEW YORK STATE / ~••~c r~.c MVM~(¦ ,?i~'LI'.Y,JOSGPII P DEPARTMENT OF MEAITM c eNSUS sus• S p BUREAU OF VITAL RECORDS .A~~T o~~~s~oN ~~.,,.~,,,,,,w.~„ CERTiFICATE OF OEATH 32~~.~`~ _T-- 1_ Z Z TYPE A~L ENTRlES OR PRINT IN PERMANEKT BLACK INK. t. NAME: i~ql7 MIDP?,E LAST 2. S[a ~A o~~~ O~ O[aiw )g u~~c •w~~t ..oT... na.T.c~s s..r,e~~c.i a.re~ct Y~ ~ - . ~t ~ J~ae h Patrick C wl ' 4~ ; P • e ~ : ~ '~tn • g : 3Sr iE~ i AAC(: lYlfNlt[. N[4A0. •G[ 1• ~MO[1~ 1?O. 1I UMD[¦ 1 D• •A. IC~.'.~Ati O~ ~J.S. A~1?~(O fO1~C[~f ~LS - S~[C~I• Yb~11. OII AM[RICIW IMOIA4. CTC.1 MOMJHS; O~ti! MOUwf' NIN. ~ [~~tC1 Of ~f~Y~(1 ~ 1C! NO VN~MOMiA ( ~ V~1ftC 68 ' ? ~ ? -~ts , ~ - o ' ' , ~ N 7A. COYNT•l_INY31 178. tOw~ ~ 7C. [~T*Kr' OA/ ~VIll1C[J¦, 7O, IChG~M Or St4r ~w ~1E. ~oso~T~t oA Orw~w ~rst~rvi.Ow < Weetoia~atar ~~W il•y~~~j~wM. t~t~owvi~~wcc~ \C~1M[A. rrlV( ST~[(T ~?O.1 ~ , W , ~ ' 3 yeare;New R~chelle Hoepital ~ O•.STA~[ 01 ~II~TM Y. O[CCO[NT ~O~M' IO. 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PART 1 CERTIFYING PHYSICIAN ONLY -~R 2o P.RT CORONER OR MEDICAL EXIIMINER ONIY _ , A.TO fMC ~[ST O~ M7 RNOML[OG~, OCA1M OCCy111~(D •T A, ON ~M[ •~SIS 0/ C~I~M~N/~T~Oti AFD/O~ IMY[STIGAT~ON~ ~M M? ,y ~ tN[ TIM[, DATL /1N0 ~lA[[ ANO DYE •O TN[ y y ~1 F OMTN O~• ~EA11 OO~MIOM DC.\~N OCCJAA[D •1 fMC TIM[, OAT( ~MD rl~C[ I1MD twuac tco - ~ . C',~ /1 ~j 1 D'J[ TO ?M( GAUSES 37aTtD. ~ ~'1~ ~ ~ f1GM[ ~~~l~~'7~~ S 7~ • ^7 ~ _ • . ~i~ ~ ~ ' r l16ME0...._..............................................__...""""'""...... T~~IC.................. 0. TNC /MYSICIAM ATT O[O ~MC DECfASEO C. LAST SEEN •Liv[ B. PNOMOUMCED DE~D C, r~py• D. O~TE S~G~[O Y • vI MOMT OA1 EAA YOM7M O~Y •(~A MON~M D~? 'IC~A MOV~N Qa• Y(AR 11IOYTM DAY YE~A ¦ ~-~.r 3 ~A i ~ . ~ ~ ~IA~7T ~ . ~ ,-~,s. ?110w• i ~ ' / 1 T' S ~ ~i'1 ! S '1f1 on ~ ' wr ?t. ~ . ~ w `V O. ATf[MOIMi /MrSICI/U1. tf OTMEA iNA1t C[RTrItCR' E. [0110M[A'S VMYS~C~11M, 11 O~HC¦ Tw~,N ccwr~r~cw _ J _ k ..t ~ ~ 21. MAM[ IWD ~DDI~C!! 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