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; • A VERIFIED f RANSCRIPT FROM THE REGIS'~ t1t OF DEATHS
DiN. N~. 5126 ' 39-----.
f. K T I F' 1 C A T F, n F D l~: A T H Re~is n~ No..__ .
'j 1. ?IACE Of DEATX. STAiE Of NEW YORK ~ 2. USUAt RESIDENCE (WAN~ decwud I~~~d. II ~lilvlioe: ~~sid~nc~ b~lw~
o. cou?+~Y Suffolk ' i a. STA~E New York
- - -
? e. TOwN IENGTM QF b. COUNiY c OWN
Southampton ~jrjpRVItU1GE Suffolk Sjouthampton
~ c. CItY OR VIIIAGE d CITY OR VIItAGE h.n~d~wu .iNie ih caoo.~b G~niMt
( Southampton 3 yrs. ~mpton Bays rES r+o ~p
d. NAME Of (Ii noe ~n Aotpbl o~ instilVt~on,~q~.s ~Nt~t oddntf M lototiowl SitEET IS RESIDENCE ON fARMT
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;c°i Sautham ton Hos ital A0°"~ 29 Lyncliff Rd. f rES p wo pc
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NAMf Oi CATE (MonM) (Oor) lY~w)
~ OECEASED q
, ~T,o.,,.~.,,n Michael D'Arcy ~TM Feb. 18 6?
S. SEX 6. COIOR Ok RACE 7. SINGIE, MARRIEO, WIDOWED, If MAtR1EO, WiDOWED Ot OIYORCEO, PN~~ ef
~ p1V EO 4Sp~ciF ) N~~bawd
Male ! white ( ~arried ca~ w~ti Margaret D'Arcy
f. DATE OF ~IRTN ~ 10. AGE (fn r~o~~ j If UNDFR 1 1'EAR ~IF UNOER 2~ M[S. 11. ~IRTHIIACE (S/oh o~ foe~iOn ewnfry) 12. CITIZEN Oi WHAi
July 21, 1901~ ~"~5 ~ MonMs t Oer~ ~ Mo,,.,-~~- IreZand i ~S.'~~.
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2 lb. USUAI OCCU?ATION iG~.~ ?ind o( wwk don~ d~tinp ~nost o~ wort~np lif~, 1~A.1cIN~ OF tUSINESS d INOUSTR1f
~ ~vM if nKr~d) Y. lt
Re*_irec+ Police Dept. of N. y
1~. fATNEt'S NAME 1S. MOTNER'S MAIOEH NAME
James L. D'Arcy Mary.O'Sullivan
1A. wAS OECEASEO EVER IH U.S_ AtMED FORCES~ ~ 17. SOCIAL SECU~ITY NO. 1~. INFO~MANT'S NAME ADORESS
! i~k~Mn~ 'Jfy~s•9iv~nOordotpofw?.ic~)' ~•7_07-5537 Margaret D'Arcy, Hampton Bays, N.Y.
19_ CAUSE OF OEA/N (En~er only on~ coaa~ on o i'u») INTEtVAI tETWEEi~I
r~T oEw~M w~s c~usEO ~r- Congestive Heart Failure °~~'~1D°f'""
IMMEbIAtE CAUSE to) -
Cond~~~O°''~~O°r• H ertensive Heart Disease
~vAicA yor~ rit~ b ~ ~E io ~e~ _ - YP - -
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, eovs~ (o). ~roN~q ~ - ~
~ "'~~`I r"'~ DUE TO (r) _
aeva bN. ~ -
' p ?ARi II. OTMER S~GNIfIUNT CO?rO1T10N5 CONiIIWiING TO OEATM Wi HOT ~EU1TE0 10. ~MASI.UTO?S~
rERFORMEOt ~
~ TO TME TERMINAI COHDITION GWEN IN fAll 1(0)
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~ ~ 11~. ACCIOENT, SY~C10E, MOMIUDE (Sp~u/~) )lb. DESCl1~E MOW INJURT OCCURREO. (Entw we~w~ ef :ryory iw ?oA 1 er IoA 11 e1 ih~ If.)
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~ Zlc. i1ME OF NoVr A4o~dh. DoY. Ywr
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21d. INJUtt OCCURRED ' 21~. ?IACE OF IN/URT ;~.y.. :n or obouf 21f. WHERE DIO Ciy w Mwn CowN~ SNN
Wh~b a~ ~ Nm Wh~l~ ~ i bom~, lorm, foctory, s~nN, ollic~ bldp.. Nc)) 1lUURY OCCURI
Werk at Wo~k 4 -
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F l~~.tb~• cc.c+fy rhot 1 urtn+d.d th~ d«<~ucd J•orn_. ---.--_L-- -•1 to- • -•1 lko! //o.rt tom Ikt
dtuostd ali:•r on ~eb~ _ 18 , 14 G? ond f6a1 d~ath otc'wrtA af 4i~5~., frmn fl~t tarset owd ow !ht dnlt ttaltd abotx.
2b. SIGNAfUlE IOi9rN w 6H~) 27r. ADOlfSS ~ p DATE SIGfJED [
; Harvey Maron M. D. ~ I Hampton -Med.mGenterBays' ~2~18 » 67 i
f I Z~o. IIACE Oi lURIAI, CtEMAT10N OR REMOVAI 4~b. IpCA~tON (CITII, TOWN OR COUNTY AND STAiE) 2~c. DATE Of WR~AI OR CtEMAiION
~ St. Charles Cemetery inelawn, Suffolk County, N. Y. Feb. 21 , 1967
~ 1 ISo. SIGNATURE Of UNDEtiAKER REGISTRATION NO. 4Sb. AODRESS Of Ul~ERTARER ~
~ John M. O'Connell A03294 Saouthampton. N. Y. ~
~ 7Sc. NAME Of~, ~SHMENT REGISTRATION NO. 16u_ OATE fIIED ~r l t 26b. SIGNATUtE Oi REGISiRI?t
~ Leek',`E4- ~nell C-1452 Feb. 20, 19~- Donald J. Finlay Deputy
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; ~wr:~~%~,r.=.~s Don31d J. Finlay, Deputy ~,.o~~~ Feb. 20 ~q6?
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I~~F~~~ SOLEMNLY ATTEST that the above is a True Transcript from the
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RS~~E~~~:~~t~~;:as kept in the office of the Village Clerk, Viilage of Southampton , County of
; S`u~c..~;8t~te'of New York. ~
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~ : Daced at Southampton, N. Y. this ~ day o _ .
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~ Signe ~~-r-a-~ _Y!'~s . ~
~ ReRistrar of Vital Statistics
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