HomeMy WebLinkAbout1271 4~ 34i'75
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d'""r'~~ ~ STATE OF NEW JERSEY
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' OFfICE OF REGISTRAR OF VITAL STATISTICS
Voorhees Toti+nship Cmeden Comity
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CITI/. ROROYON OR TOrI/N>1NIr ANO OOYNTt/
Tbl to ~erafy that the foAowing is correctly copied from a record of Death in my ofllce.
NAME OF DECEASED ~ PLACE OF DEATH DATE OF DEATH
West Jersey Hospital •
Slls>,rorth L. Van Sciver Eastern Division
SOCIAL SECURITY•NUMBER SEX COLOR MARITAL CONDITION GATE OF BIRTH AGE
YRS. MOS. DAYS
154 05 5577 M X Married - 3-29-1909
PLACE OF BIRTH CAUSE OF DEATH
Neyr Jersey Acute ~rocardial Infarction •
SUPPLEMENTAL INFORMATION IF DEATH WAS DUE TO.EXTERNAL CAUSES
ACCIDENT,,SUICIOE OR HOMICIDE DATE OF OCCURRENCE
SPECIFY
WHERE DID INJURY OCCURT ~
CITY OR TOMN COUNTY STATE
DIO INJURY OCCUR IN OR ABOUT HOME. ON FARM, IN INDUSTRIAL PLACE, IN PUBLIC PLACET
SPECIFY TYPE OF PLACE
WHILE AT MfORKT MEANS OF INJURY
NAME OF PERSON WHO CERTIFIED CAUSE OF DEATH ADDRESS
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Be (}].eason~ M.D.
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R stray of Vital Statistics
620 Berlin Road Voorhees N,J. 08043
Jan. 3, 1974 Address
Date of Issue
e.H. sOtN - ,
UtN[R /YRUtNINC Co., INC. TIItNTON, N. J.
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F+LED ANC k~COR0E0
gLLUC1E CCI:NtY.FIA.
ROGER P01TRA5
CLERK CiRCUIt CQU tom'/
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