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CITY OF NEWARK, N. ;J. _
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. - MRON H. HASKIN, M. D:, M.P:H.
~ ~ Re~istro~, Bureou af Virol Stotistics ~
Thu it to Certify that th~ followtng it cor~ectly ~copied from a record oJ death in my off~ce.
DO NOT ACGEr'T TNif CERTIFICATL~ UNLESe THt RAISEO atAl. iDP THis oUREAU Is ARFIXRO N~R[OH. -
'r~uw~ o~ oseusso ~ xwct o~ aun+ a?n as aswne
151 P~rker 9taeat
Gusrino J. Kacers waw~?ux. N. Mey 26, 19'r0
lOCML s[CIJRITY N1~M~[R stX . COLOR ~ MARITAL CONpIT10N DAT[ OF ~IRTN AO[
Y11~. MO~, DA1f~
~ry? Nala . Caucasian Married December 19 I919 50 - -
I~LAC[ OR ~IIITM CAW[ OP ~tATM
D83d CD s3'!'ival in h~pital•
Corona~y nrterJ abseeas, eevere~ ~+itJ~ postero eeptal n~yocardial
111a~~; ~ s s~a ~11F8I'C~OI~• .
s{1rPL[YOiTAi. INRORMATIOl1 tR O~ATM WA~ DU< TO QTtItNAL CAYS[~
ACCIOWT. fNiCIDt OR MOMICIDt ^ OATt Or OCQURtNC[
~ wetrr '
WM[R[ DIO IMJURY OC.CURf
- CtTt Oit TOw11 ~ . . G011NTT ~ ~TA/i -
` OID INJUIIY OGCUR IN OR A~OYT MOMl. ON FARM. IN INDUlTIIIAL rLACt, IN ttJ~UC lLAG[t
( sMC1IY TYK O~ ~LA~C[
WMI~.[ AT WORK1 M<ANS OF INJURY
NAMt OF rt1lfON WIW C[RTIRIW GAU~t 0I DSATN ADDRi/f
: Rosario Tasburri~ A. M. S. 150 Cabinet Bt., Hexarkj Ii, J.
l~ Wil+ass Wrisrsof, I have hereunto set my hmd u~d affixed the seal of Burcau of
' Vital Statistica, Newark, N. J., this......
28th ......day of..... ~ ...............A.D. 19.. ~
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_ - .Reqiscrsr oE.Vitsl Satistia...•.......»•.
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