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HomeMy WebLinkAbout0711 . , on?~ow o. ~r+~ 4~684 . ~ „ _ euRZ?u or vnea sTw»sncs ~ ~ ~ tr ~ Tr~wfowr N. ~~8~~~11~5 . 3 . - . ~ .~.~~IT Ccu~T ' , ~ F~° { - ~8 ~,F~~ ~ , ~ ~ ` , . , ate . ZZ io aH'7R . T1~IS 1S 1U CEATIF'Y THp?T TRE~F~?1~A~N~ TRliE COPY OF 4 RECORD F1LED 1N THIS D 4~ 84 ~ . . ; " _ ' ~ ' - r - - ~ Rey~stsa, of VitclStat~tics . . _ 371~ , ~.4 aR~'_lvr _ Dp 1~I0? ACCBP'r 'P~iE9 ~'OPY UNL&SS TI~E Ra1~SED SEAL OF THE C1TY OF TRENPON IS AFFI3~D HEREUN - . : . . i . ; . , ~ -~lTA'iEfNF414:wA i# / h'fMyl1M~EY3T/rftOfPRNTMENt Of'lfEAtTM-' . . . Oo not wrte in tAn bbck ' 7 J CERTIFICATE OF DEATH _ T ss 1. NAYE OF - ffini/ lMrlrlNl Wst! 2. DATE OF UEATN ~ %oa 'UECEASED ~ ~~11 ~'f . . _ i ~SE ~Typtorirmll ~ ~ ~ ~ ~iG / ~D . : ~ . a_ E 7 Sew Cdw w Race 3 A~e l.n YK 11 unfe~ 1 Yr. H r 21 FNs 6 O~u of BxM 7. Wn detaaxd evw ~n U S. Armad Fo~ces~ ' i Iasr dirld~y/ IYe~, no d untno.wd !I/ Yd."y~.v w o~ Q~rs1 ; ~ .,M y_ 06 ~ E ~ 8 B~MWace (Sran a~ Ireq, caritryl 9. Gcue.+ ot ,~.na~ councry? 10. Nxned ~ 1~-.er ~?rrwd ~ I1. Soaal Secvr~ty No. ~.~N weo...a a„o.Qa ; sa..,w ? /S~i2 - O/-7/O.Z i _ i~i.C.O C1.oN/-O .7•~• _ ,.iF t?. PLACE OF DEA7 13. 115UA1 RES~ ENCE IU,.xuanwn:.esrlerxe ~~«e adm~aanl I - , c.~.,~a , s~~K ~ ti c~.n ~vG~S ~ ~f2~1~~, ! ~ e Gcr ICnect oo~ rd g.e nnnel e. Gtr ~1 (CJxdc no: ane q.e ns,ne) ~ ~°`o ~ ,~~t.rra~ ~',~d~C.~is t~, ~/e . c. Narne of 11} m~ ~n notp~tat u~Mhtu[qn ~Sf~~K xldressl d. S~rn~ e+~ ilf ~ural. P.O Add•e+sl o/ Deceaud Ho,a.wo. h/r~t t•?C ~i~~ /~dS/ms.-•oL /s`~ ! j~-,rs.r3~/~y lodiz: N~l InsutYl~on 11.. uu„ta~w+~~d+IC,ver.ndor..wtramedu.~n/..ws~or»o.tnyt.?ae+~w~,r.rr..adl te.o.xu,aoean~.~csso.ina.u.r ~~-~f~/A~/,s~ ~7J~iQA'1 v/~~/~1~f.s ~ 15 Fa!ne~'s Msme ~ 15. NbN~e~'s Made'~ N~me 17. nlam~nt s Name arwl Addrest . ~.,i.r~f -/o~tt~fr2 ~ ~ ~ ~/t~ ~~/ICf~r A~9J.c a?~ Gt.?>s NA~/L/! ~7.i•~~~~ l./~s 9~l~t?.c a r/-~. ; - . 18.PANT1 OfATHW/15CAUSEO mr?on/ycwmca.seye?l~efo~larlA/a~+dtc1 I1pp~o+~r++atev~ter•alWtoeen d anet f cord~~ deatA ~ u.~nee•.~. ct.x i,~ --5~~1~-"~_ ~i~'2i~_t 1L~---~-~ {L~'T< V~ ~ n , ~ ' ConAtidrs. ~/anr, rrh~rll ~ - _ _ _ y..~.,: ~,ao.. Pk tn? L~1~~a1~'L~- /~J~..l~~ C/`~' - ~ "1~1"" sr~nny lhewdr~ y~~ ~ / ~ /yl.~CiUM/Jf~ a~!~6~~~___ _ rC~ 0~ ~ ~ n ~ (*j.9f It OTNSR SiG~~FICnr~T CU~D~T~OM 19s 7rxwiopsy 196. If yey.we•etred•ngtcons~denel _ pt~formed' ~n detc~mm.~q cause of JtsM~ . I `C/ ~/7 ~ ~ / G-~ ~/7 [ IJ I ~I~• / ~ Yr. ~ i ftu Yn ^ ?+:o ~7 - 1~1. Acc.3rr: S. cC~r~ W~ ~afe Untr.or.n ]On D~T! 4'1O ~~OY~ G} In~+Hy 7Q: H~r. In~u y Occ.r+ee fFnter nrtw d.ryu+y ~n oe.t f o~ I! ol l~e~n l81 C! C: ~ ~o tM best c.I ~n v~ no+~d'X . !1 - i ( MO l~urY Occv.ed ! 70e. Ptri of uy~..r feq. n a+Ga~~hane. 10t.G.tv. Tua.+~u~ loc~t~on Cn,nev Sate . i ~ NT+te at ~ No~ Nrh.te . /rm. /x , we~rr, o/Lcebld! erc.1 ~ : ` Wwk ~ ~ ~t LWirk i 7I. I 1~w~r~. tRaT+nedl •hr deCf~sed ! on . . IO _ • - - . . _ t / ~ ~ Oydi acewred a~ . E/ m. on Ar dm if+ted aAon. rd fo Mt Drst o/ my tnow~edqr. /ryn d~e caum stanA 17~.Ce~t.l.r"sT4r+•lTYned~wrtb!taes'9^~^'l.Wo.vL- 71~?A~•~•~,yAdl.nsulCcrt.f,~r V~C ~ _ V R ~ I:~I~..S~i~`~ i.. . ~ n7@ If C, " t: a n . ~ i -r s`~°~` Tre , icFKt no., ~za o.~~ s.~ s ~ : ~ ~ , f _.d~~~~~, _ - 7~ ~ ~ t ?~o. E.~m S 7. . B~r~ai. -mn R r 2 . y ory N;me • 2k. L«ir~on Gty - Sute ~ . ! ./yl / ~ .q f ~...~trl~,~~ _~1/3S ~ : l3rf. B~r.il Oa!• Vo Qs~ Yr. 1~s i~. _.~I Ncrrw Nrne ~ ?te Funerd fbme Add•e+s ~ - , r , ~ .2 - 7- 76 as~~.~v ~i~ i~-a~T••~,e.~. S35/ ~yr~n .S~ - l?~-?:v.v ~ 21e. F~.w.a1 U.•ac[ ~ H lKe+ne lM+ ?5s Rr?urr.law+qPe~m~t - S~.+stve ?5A D+b Ree'd. t.y loca~ 7 ~ . ~ ~G~~~,,,~L,~-o..rci9 1 - - - ~r,~.« pp ~ ~ ~ ~ r ~ - - I ~y.~~ ~ ~ _ ~3 a ' . ~ ~ : . * ~ d-", . - •i v ~ _