HomeMy WebLinkAbout1128 CERTIFICATE OF bEATN
CONN. STATE pEPT.•OF MEAITN
oEUASEO-NAAfE "w" pAS AL~O01e \ "`~'ALUMBU !
. .t.ti-~ 6 c, ! , Male nA1a ta[ rlratw
OATS Oi ON17N atorrr_ awr. "M RACE- w,.r[. MMD wrtw,c.w t w~f.-- tws? uwoaw ~ rsww Vroew. o•. DATE Oi OEATN It04rK O?r. "wq -
._May 19, 1904 wht~te ~,.w~ 71~~ Prot .Nov. 14, 1975 _
001MTr OF DEATH TOWM OF OEATM ~ HO6NTAL a1 OTMEII rtitrtUtlON- /Mtt r roc . piwq wnt awtn wwo gAlyry -
New Haven New Haven Hospital of St. Raphael
Crtr L tiTATE OF MM'N fC~wrF, /war Ili/ CITIZEN OF ICo.wr•,l WRRIED. NEVER YARRIEO. Et~110E M EM wttlatw ww~ww)
LECiAtyr ARATEO .?11110
~yn~a New Haven, Conn. USA ~ °~°~1°arrie~ ~18~$.
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. or EOGAL fEgR11Tr NUlMEII UEIIAI OOCVATWN laa .ro a tx:.. v.e auw~w cost d K1tO a ti11EMElS 011 /IOIm7/1Y r.
041-03-6614 President _
~::t`~:t Jack A. -Hal rin Inc.
" RE90ENCE - sTATE OOUNTr 70VM _ . _ - - 57REET AND NMME11 ~ _ .
Conn. New Haven - iaoodbrid a a. ltinmble Brook Road
NAS DECEASED A YE7EIUy11 i rES, avE NIM ~ - tlNlt a1 SfM
pRCrii rtt Ow wp
no
iAT1ER-NAYS pwn a.ooat twn ~ YOTMER-YAIOEN MAYS tllln wsatt usr
Baldassa Palumbo E„ Catherine Cataldo ;
DiORYAItT-NAPE WitwG ADDRESS Itrwen ow wrD w0- tarr Qw *Ort atwn, tw/
Mrs. Clara S. Palumbo (Wife Tumble Brook Rd. , Woodbridge, Conn.
?Mi 1. DEATH INAS CAUSED Eir: (ENTER oNLr 011E CAUSE FfA lwE iOR i.1 lpl. AND kl Ar.wor++r*e rttw.r attwtw I
owsn wio oewn. ~
v wreoun uwae -
w» G,G~+ r ~ ~ H G~ut3asts
cowo.twws w out to a u . oortewewcc ora=.~ 08 Clg PO C he 8e aae i -
...t .,e ip w.nm.tt H Rt D/S s~ t
r~~~~~. i4R4eRIDS~Lk-ltctl~
Due to. ow ti w corMOUtw~cc ot. I
Fr~.l i
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~NS ?MT N OTHER 51(igFIGlI11T CONDITIONS oorsiq.t cowrranuw ro a•n. wt w^* .ci•r[o to cwlrse2it~ ...wAi ~ « ALrtdKr i rES atwt ruro,wws co+s.oeKO ~ y "
I"t Ow rol~ ~ o[T[~ttMMt GYIE OI ot•Tw `
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if ACCDEIR. SUICIDE. MOMIGDE. DATE a• DAlURr Martw. W. rtwwf MOOR - ! _NOM NtAURY O - fMrp w?ryge O www? Otli>I1Y AT VeOR1(
OR UNOETERatnIEO It?e0il ~ - - ~ ~ run ~ Ow run w, rttr MI prtptr "t Ow wq '
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! "d Ink. FtAC.E OF tNAwTr wr wo.e. cur. siwtn. LOCATN7t1 ntwen ow wro w. t't• cw iowr stud SINGER1r RELEVANT TO COtOrt10N REPDRTEO M REM u j
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10 the CERTIFICATION-/HVSICIAN- rwwrw ro.tw~~ . .t• wwo l•fr L. w«n.tw wove a TM a i.t Hit. Aww, i0 cwt ;
{ c s in to ~ I .lowrw w• w. atn a r, u.oraeoae. Due
t~. IOECewfeO iwD1t I t~. N~1T. ~ ~ ~ ' e~• ~ / Ts l r0 M c.utelsl n•te~
u rred. _ ;
CERTIFIWITN)t/-MEDIIJLL EFJIMNIER .r r. on,won. aM iwe p•tt •+e wpyw Or of tw ~ twt o[C[atrt .ns ?worOUrCED OtwD = ~ ~L -
out to .w c•usewl nano. awtw wewwreo a w wsour _ ~ ! ra..Tw o•t .tul wcuw
CERTiIER-NAPE /t..E O. n.n~ SN•NATLKiE , otowtt ow nR[/ ~ ;
W0.111O ADDRESS-CERTYIER nw[n a wro w0 tm' M tow. n•te r. OATS 51GNED wloutw. ai. "ww, ,
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MltilAl. W ON. REMOVAL CE Rr al CREWTORr- IOCAfION On Ow tpN at•tt ! ?
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wtarn ~3
B ial >.St. Lawrence Cemetery„. West Haven, Conn.
DATE t[wII1 iM4RAl IIOtE-NAPE AND ADDRESS nrw[et Ow wro .O. uT Ow ro.w. stwrt 2M1
Noy , 1 7 s rothers_, 128 Dwi ht St. New Haven Con>3. ~
F OMECTOR R ~NAY~OF EYMLYER w wos..rt ewurto LICENSE NWIER ~
Patr ~ ''H. Sisk 1718 ~
THIS T Fat er - • ST ~ Flt •d .AND RECORDED -
n. Nbvenber 7, 1975 ~ I E ^ U~lTY, FLA
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r - '79 JAfI I! AM I i: i 6
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~ I certify that this is a true transcript infottmatioa ~ _ _
'~cw
j! ~°'~oi ~ as recorded in this office. E~ R K C ~
F y~, , v ~ U ry _
`~9'f~r Mj - ,ATTEST: ~
Con^ n+~ S.~ f
s'•r,,~J Assn gutrar of V Statistics
VS
~ November ...1973.
Dated at New Haden, Conntcticut, U.S.A., this ..1st Bail of s '
soar 301 Fa~E1123
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NOT GOOD WITHOUT SEAL'
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