Loading...
HomeMy WebLinkAbout1516 a ~ ~ ~ ~ c~n~?Tt o~ osarn ~ oowa sTaTt oar. of ~m q4 ©Q /2, $ { - raw ~a . Jane Jose h ins Wa staff ~ ma ~*•*a DATt OF aIRTN I,rorM M•. •unr RACE - .rn. calla An14ta. AGt - un 1AyaA ~ nAA - naoa. ~ r• I PATE os OtATN . roam a•. •w July 28. 1897 w'~`~Ea M` .Oct. 27. 1974 ; oouNTr a otATN TOMIN of OEATN IrOMTAt OR OTTER a,laTrtv110Y- a•Ila r Tor w anwL aw am AO. Mlraa~ ~ . N Fairfield Stamford Stamford Hos ital pfY a aTATt 0/ aMlTl (OIr•Ir/. •.aa U.t/ GTIZEN 0/ fC.MiY// YARRE0. IrEYER YARRE0. wDOWtO. IIIaT a/OUSt A ~1. ~Iw ~aaM..w! M Hoboken, New Jersey U.S.A. 0n1°"~0` oALtr ARATto wiL~owe~' George A. Wa s taf f SOCIAL SECURITY NWaEII tlSl?AL OCCU?ATtON In•a aro r .iolal oo.a olaw non or qMp OF WaM1Eii OR wOWT11Y „044 20 1745 - ~"'r~`"ousew~(~'sR Home REawENCt - aTATt couNTr TANN aTREET ANO IRIa1aER Conn. ,~Fairf isld ~ Stamford >x 53 Hops Street WAa OtCEASEO A 11tTERANt fi YEa, QIYE MA11 UNIT OR a+a/ Rraa+• •p oll Tor l•r~ FATrIEq-NAYS wqt raou wT YDTIER-MAIDEN NAYS rw• r,eott wT r. Charles H. Marta r. Louisa Caseate MFORYANT-NAPE - YALM10 A0011ESa rar¦aa• a I?..a .O, olr• oA Toaa4 nAn. Drr I~lrs. Haathew Keneal 89 Woodmere Road Stamford Conn. ?ART L OEATH WAa CAUaED sr: (ENTER Oplr ONE CAUSE /EA L111E soR a,,. as AND 1q A/rlloaMMta arrallwa aarnaar f osa• ..o ous t r rrraoun uuaa I„ riardiaC 8T3'h3/th1Ri8 81inUt8g co.onora ~ •rn .woy ora ro. oA u . oosaaaua.a n. aw rK ro ,rrewn nth oea ra oll •a • oawaouara a. k'--_ Dowel-os~ndrome - - - -months /ART N. OTHER 51(swFMIWT CpIDIT10NS~ r,ona corTw.urro to on•r o11r nor AB/,ta. TO (rlaa anaw r nun ~ M AUTOgPS~,Y i YES ¦•.t r~.D+os (o+•.ealKa ,w ies ~°"`~es a.ura or oa.m ~ _ P_y_elone ritis ACCIDENT, SUICIDE. NOY1gDE. GATE OF W,R/1'Y arorrK w.. nAla MOIIi 110W a~I,RIRr OOL11N1ED Iw(aA unruat or .aa,lll• auwr AT •rOlrt ~ OR UNDETERYMJED prEarn nun , oll ?Nn ,(En M NaC7r• •Ef OII rp ~r. se. r >w aa. PLACE OF g1.RIRY A( aorc r•Ilr. tTKR LOGITION la•nE[r oe Rs a ra. an 011 roaal ar•m SURGERY RELEVANT TO CONDITION RNORTEO N rtEY (a r.C(0.•. OrrK[ MOa.. [TG pr[CV•1 M M ~rMy IM rM.~r~ ' 7r. Ira 7R ~ CEATIFICI1TNk1-/lIYSICIAN: rOrM M• rrwa rOM(M Oa• •IAA MI. l1W Lf Mr/M[Il .uva Or OE/1TN O .CEO Ow M O.n. w,a t0 M , rorlr a• •I•A «aiw aaa• or r. ,o.o.aaooe one ~ Nov. b 19?7oa~a Oct. 2?-197 Oct. 26 1 4 a0 rOx Ar `(•'a` , CERTIFiG1T10N ~ MEDICAL El(AYWER: r• rr arrrar. a Trt wn ..s rolMl or o1Am THE oEt[oOn rr•a r.OrOrrCaa ous i dx w (na uwaa srwno. oaw(n •aau~rao a a •aour rant aa• •w rpM m r aw r CERTirE11-NAPE R•r[ oA nllrr) aKiNATURE `~n C. Loris Fincke l// ,.a. YAIIINCf ADDRESS-CERTIFIER pllatt Oil Asa r0 an On raa f(•r[ D. GATE SNiN® /lor*M. o.•. •au. ~ 21 Broad Street Stamford, Connecticut 06901 asr October 29, 1974 BURIAL CREMATION. REMOVAL CEMETERY 011 CREMATORY-NAME ~ IoCAT1pN a•• a (ow s••n r~a~ Burial Fairfield}Memorial Park Stamford Conn. ' DATE Iro,rtw. w•. •EAA FUNERAL r10YE-NAME AND ADORE59 IarnEar a Aro. r0. an On *or. s(•ra. ~ c 30, 1974 ton b/ Reynolds Inc., 545 Bed~ord St., Stamford, Conn CTOR OR FJaBAWEA- / NAPE 0f EYBAIYEii r,oo• ana ErYtrao LICENSE NUMaER - Herman Frederick 1534 (~y~~~( 7, 47 7a. /Jy. N. n? V VT~ V 14 ~ tra REGISTRNI J ei"I - - - [ certify. that this is a true opy of the ce i ~ tae:, received _ f~ ; ~ 1 'or record. Attest: j''"f` •~trar ~ f ~ . I G ~ f~, - t~~ tE , x:,~`i' ~k s C ~ * ~ ~ i't! EC ~.`+C RECORDED { ~ '79 ~,r~ 6 Ayl 9:39 g~ ga~~306 -~~E1515 ~ ~