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MErJERSETSTATE DEPARTMENT Of NEAITH -
t.octu.~ttstrurtt CERTIFICATE-0F DEATH srattr~?t~wv[o
saatcf 1• NAME OF Frnl~ IM~JJ/er U 2. Sea t. DAfEUfUF_~iN
fcio¦ tort DECEASED L-~ ~ ~ 7 g ~ `J'
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o"'~r s, •oe IeeeareJ Bret + l4S Me+ed Fercra~
s~aC[ d• Color M Rave S. Atte /a )rn. M widtt 1 Y U rsJet 2d Ilra. t•. tAte el OwA (Yea, s~ M awMosst II/ +t t, trH trey r Jury saw!
lut M.KJepl • ey• ern tlra -
itThite 6 A r. 105 , No None
t, sittiylace IStete r /enrp cossrry! 9. Citiaee al .Sn ceaartyT 10. Mattted;X Neret wined[ ~ 11. ~ocia) Secwa~ !Y.
Nex York U.S.A. •..L..a[ • • a.«red[--~ 145-05-562? _
r«cs,ocrce 12. PLACE OP DEATH 11. tt~ltAi. RFCRfFTTtVI E /M rntthtw= we:~Mecepl~Khn .Juu'iN') `
a. Ceaaty a' QarrV ~ • V, a_ A. fewa~ ~rgeg_
City KAeck Soa and ttne sate) c, l~^;• K 6tat Sea rd As•e wc~e!
sere 1 ~4 Nor~L4Qd
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e, aot M spore a tsuawws tine .acct easl d. 4reet Mldres• 111 ravel. 1'.(f: AJdreaal
""p"'°`Pascack Yalle Hos 143 South Ave.
Matawiew -
ld. R. Uawl Occ.yetise 4n • o/ ew use .et wau n/ e.rlae.R lrle. errs artne t Id. S. 1[twd el Rsrraer• w -
Forman Retired. Sheffield Farina ~?11k Co.
IS. Farltet's Nana lb. llat~er'a Va.Jew Yaaw
Gustav Heuslein Doretta_ Zimmer
17. Isforswst's Naate aad Addrerr -
Mrs. Theresa Heuslein 143 South Ave, ::orwood, ti.J.
C sane lt. PART 1 DEATH SAS CAI'~FI1 ItY f er esl>. ace Hare N? Iree %a fal th a.1 t ~ylr.rss~are .wt rr. al trrwres
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° P T U OTHER SIGMFICANT (~QhTfITll7F5 / Ina: •ai+ artspsy 19s. N Fes. een ha.t.aj• cwadered
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'.oss c~ css. 21. l (attended, esa.- d) tAe decpsed (Gara• ) to V and last ue Ar.. k+j+li•t ea ~
Deed ecce?reJ n. es tie Jate stutJ • r, aeJ to tie bu o/ nr isw r/p. /n,r tb teas slets•J -
cc~ws 2~,AtteediatP s Med.E:ra Cawaey s.r`"] 22t+. Add OnceSidaed
TR4CT
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23a. 9wial• . Rerral 23b. enetery ar Ctesara~a,ae 27c. 1,.ecai City Stwe
Isp`r/''Burial t. Hope Cemetery astings on Hudson, N.Y. ~ .
23d. stria! Dace Ms. floy Ya 2ds. Fanaral Hone Nae,e 2A. Faeetd More Addrear
May ?,1°?0 oritz Funeral Some Inc 348 Dock Rd. Clo9ter, N.J.
2de. F D'trecter Sissat N. J .ice lle. 2Sa. tp ar (scartr Permit.- Si we !S ace Recd. S>. 4oca1
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..~rT~Tb~ ..Z~ TO CERTIFY THAT THIS CERTIFICATE IS AN+ p 43.4.893
- E%AC~ Y OF THE ORIGINAL FILED IN THIS OFFICHY FEB 22 P~) 2 ~ 2
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WESTSt100 BOARD ON Hr:ALTH
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