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NEYYJERSEY STATE DEPARTMENT OF NEAItN STATE ,rEE Irtru~Elt
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CERTIFICATE OF DEATN
S?ACES 1 NAME Of (Fwt1 (Maldall (LnN ?DATE OF DEATH i
STAY[ tnE
Carlton Morte 11 2 76
ONIV
h ACE 3~1Sr¦ a Cda a Raa 5 A¢ frn rrt 1! order 1 Yr H urr#+ 7a H+s 6 Da+e o! bar to 7. •M decea t p w+ Annad Fams '
tale l~fiite 4,r br[Adp.J IYn, no a uM n~.w/ Ill Yeti. !re wr a darwl
70 .,andy ar: Mo:.rs ~M e t 27 1 No
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' ! B.rrhplxe 1yStsteor Io^e7^ counrryl 9 Ca.rTrr., oI what cw:.vy+ t0 Ma*+~ed kr.a Ma++•ed - 11 Su•aI Secw•ry No
Rl,Ode Island - y S A sir/owed _ D~rwcaA Srt.Matao - . 1 LjL ~5-~22V
1? PLACf OT DEATH IJ l1SUAL RESIDENCE IH.nsM1rut•on +esdencebe/aexbr+nvonl
a Cauntr Bey en - asra!r Nex Jersey h CwnrY Bergen
NESr DE NCE b C~h iChectc Dos and ¢w namel C. C.rT. IChed bo¦ and ¢¦e namet
E1do . - I~glexOOd R+•'o .Y
TwP Twp Bergenfield _
c. Name o1 (1} not .n hosp.t« a .rMUtut•On ¢n sne.r addrrssl A St+ert Add+ets I Ir .war. P O Addresil of Deceased
"°'°'"'a Englexood Hospital 28 West Church Street
InArtulgn
fa a. Uw« Occupat.on !Gyre a.rd of worn done drror, mdr o/ wort rn, r.le. Herr d rrr.redl 1a b K.nd o! Bus•ness a Irduury i
Retired -Interior Decorator C((ajjrklyott De~cforators
IS Fatrre+'s Name 16 Etathe.'a Mader Name i S. jr(8utllalIl9 jjorie
~Hera?an Movie Stisan Brady West Church Street,Bergenfield, N.J
GAU6E 18 PART 1 pEATH WA$ CA p B(Y~ Fnte? en/y °-y,~1r)..rrpr r.ne /or lal. !Al and !cJ '~j Aypro¦~mate •nte+. betwreen
• . _v_ r~ . / ~ ~~-1 ¦ mot y cyRp.rwn AeacH 3
Immed•ate Caux U1 ~
Gord+rrorn. airy, »?rtA ~ - ~ - - - -
,.re ro stare c,uf? oue To tbt _ - """~~~//1
•-I,l.. snbrr, tAe rder
eoMeo^r:w ryrn,cau,eratr Duerolel
vbnr..y ro oearw - t
eur r.or .rraraa ro PART II OTHER SIGNIFICANT CONDITIONS 19a Y1as autovsr 196 Ir yrs. were f.+dnps carndr+ed
+wa +r.+rMa•r ~ per!or med' - dete+m•n~nq~aux of OeaMr
caur Yn ~ NO
- ?Oa AccAent Su.c4e Hom.cOt UM mown ?ObDareanAHa,rollnlwv 7(k Nowt^IwrOccwredrEnrerrMrwe ~ury.nParllal7olltlrnr8l -
i ~ ~ •
~ ro rlse De,r oJ'r a nowMdye M -
20d Inlwr Occw+ad 20e Place o} +nnrrr /e, rr or aba.t Ao+ne. 761 C~tr Tow^ a locat•on County Sratr 1
I~ WMh at Nor Whyte /rm, bcROrY, sneer, o1/rce AId) erc I
tP Wort n Wort _
k 21. 1 Iatteade0. e¦am~nedi Ure decease0 Ilrorr~,prt _ to _ - _ std last saw iMm. hrri at.•e Or+ - . _
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ACCrpENT QNIA accord a1 _ man ,r+t can stand above ann ro.the tresr of my k'awMd,t. Iron ttbe causes stanN
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cA~ss etwss 23a Bw+«. Gemetan, « 7b Carr r a G r Name u . ~:F +tr Sun
Burial (]eorge Washington K p~~;, _ Nex Jersey
CE¦r91s tad 9una1 ale Eao ay Yr, 2u. Fs.ra« Horn. Name 4? : ~ ftrrn« Horrlt go. ~ahiTl$taon ave. ,
TIIACT Dece®?ber 1, 1976 R exerts Hetnorial Hods~t=,.~...=$~rgart~~~ ~~-;Nex Jersey 07621
REG Id 2fc~uwJ ..dot Synawre, N J. No 25b OaEE Rica Oy !Dial
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