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STATE OF NfrW .JERSEY ~
~ OFFICE OF REGISTRAR OF VITAL STATISTICS
~
~ CITY .OF SUMMIT. COUNTY OF UNION: NEW JERSEY ...'~a3~S r~
..City, Bocollslt o[~?o~sitip nd Cwl.cy
lTbis is to Ceti/y that the follo~ring is oonecdy copied from a record of Death in my office.
NAME OF DECEASED PLACE OF DEATH DATE OF DEATH
ver o0 ospi a
Oscar Weber Summit, N.J. Oct. 9, 1977
SOCIAL SECURITY NUMBER SEX COLOR MARITAL CONDITION DATE OF BIRTH AGE
136-10-8638A male white married July 6, 1905 ./o:. AY:
PLACE OF BIRTH CAUSE OF DEATH
Germany Act. left ventricular heart failure
SUPPLEMENTAL INFORMATION IF DEATH WAS DUE TO EXTERNAL CAUSES
ACCIDENT. SUICIDE OR HOMICIDE DATE OF OCCURRENCE
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WHERE D10 INJURY OCCURt
CITT OA TONM COYMTY lTAT[
DIO INJURY OCCUR IN OR ABOUT HOME. ON FARM. IN INDUSTRIAL PLACE. IN PUBLIC PLACE?
!r[CIrY TT?[ 0? rLAC[
' WHILc AT WORK? MEANS OF INJURY
I~ NAME OF PERSON WHO CERTIFIED CAUSE OF DEATH ADDRESS
E. V. Mueller, M. D. Summit, N.J.
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Reaistcar of Vital Statistics
SUMMIT. NEW JERSEY
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_._•,••........October 11.,...197.7....
Date of Issue
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