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t '"'~'`I r y . r STATE OF pEW JSR$SY
,r ~ u:: _ ~ . r ~ ' . OFFICS OF ASaISTRAR OF VITAL STATISTICS
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! ~ ' ,r.~r _ Y~ t TOWl~SHIP OF HILLSID~s -
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' '`'s~~;~ ~ _ This is to certi that the tollowing is ,e true 1
~~-"y copy -ot a record riled in this Township.
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~ 1078 j~1M ~ ~ !
e ~ ST~I~ ~ ~
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'Registrar of Yital Stat~~~
warning: Do not accept thiscopy unless-the reined seal o e~Fl~
ToMnehi~p of Hillside is etrixed therecn.
- NEW JERSEY STATE DEPAR TMENT OF HEALTH < s '
. ~ i!i:: S
CERTIFICATE OF DEATH - ~ ,.r - i
yhAOE 1. NAPE OF OECEAfED /fiW pEidt>ilpl flaw Z GATE OF DEATH ~~'z-
- Gertrude I+i. Flynn _ 7/2/~~9 -
_ _ ~ 3,. PLACE OF DEATH ICAy or Town! ~
3T Couttr 4~- Resdenoe (No. and S~1 . fib. Gty err Tow«
« - Union _ _1_
Union 1036 Thomas___St. Hillside
5a. Narssa of HosDttal a Msbttnton Itf rtot attter, 9tre ho. and sal ~c. County _ id. Stw M. Intwta City l"rnia
Memorial General Hospital Union NJ ~Yas oNo
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50.1f HotDital a Institutwn, tdrek oorrett bo: A. Marital StYUS 7a rllte Oawwd ear in U.S. Mliifay 70. War Ta Ow
Cl DOA ~ IttPatieM Z O Married 3 ~Wtdwed N "Ys~' arrear Wt trtd OsMa Frowt:
_ _ _ _ _ _ $ U Emegretcy n Otfrr: - 1 O Srtple 2 O Ssprstad • O Dieora0 O Yas No To:
`
ItpEMTµ ~ ~ fart 9. Date of BtrM /Q Aqe Last Brthday 11a Urtda "1" Year 110. llrtder "1' y
' Female 2/9/04 75 "~"-r"~ ~"mss nr«"
_ _ _ _ _ ~ _ lTa Birdt{Mioe !Stara a forti~rs Country) t 1?b. Gruen of what Cotaruy ~ /3. $urenrq Spouse UI Wde, Haden Naar) 11.'OEf', .
~ Newark N.J. USA _ s 13~+-~
s
` 1S Rarx O Arrtaian Indrn 18, EtMtic Ortgn ? ueeitars 17. Name std Address of Last Erttpbyar 4
E ~Othe+ Ispeafyl
- White O Other {Speufyl ? Pltaw Rtcan CI 141ian
~ U Bled _ _ Ctrbaq - D German-- -
91RfIM1.AC[ . 0 1S. llstrM Ooatoetian (Kind of work dory most of 19. Knd ul Busirrss as Irtdtnny -
_ `r1e~~ousewife ~ome -
! - - ~ ~ TQ NAME OF FATHER (First - (MtddN) Mast) T1. MAIDEN NAME OF MOTHER !First! Widdla) Ilwt1 i
• - Emma Schmidt
' - ~ William Barnes
r l}~~`-i• ~ ]1a Name a Mlorwne~t T10. RaWionYsq 21s: Nws~bw std Saaet 214 City a Town 41a Sew
~ Mildred Salerno dau hter Same as abo -
>>At~ Drposition O Rawwral 2Td Name of Csrrrlary err Gerrrtory TZc City or Toww ISL SIE!
i t
Burial O Otlw: i
. _ _ ~ < cr«waian . Ho ood Cemeter - Un3roA• * NJ
PEARB Of ~ T3a. Name sod Address of Ftwwal Hoar a of f 2St IR1 Lierttw No,
"4"°"R . Growney Funeral. Home i ~ ;,t~ 1 ~ ~~j~ ,J ~
1070 N. )3road Street I '~t~~^'
~ Illlsid~, t~)ew Jersey - _ _ -
TISa eletwe errs/ Aewe~ N ferttiat- U AnwteUa ~e tens E.rw O uwt. i Tyr, tv .n. r,w. of t ..m.w.., r wn. rr~0 - - - -
` Allen Rubinstein DO L .
~ Tic l>•te . 1bv of _ Roewunc~tl
ON9'~ - -
1020 Galloping Hill Road - _
w - ~ ~ L~ Otath tsouw OA~E
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_ _ _ _ _ TTa. PART 1 Immdrate Cause. (Fora Doty one came Da itne kx Ial, Ibl, lc?. Ntaral between anNt and daMA
I a i ! ~G'~~ - - - ill t~i~
Due to a as a mrreptrsrta of
b wo srq~ r-_ ~ ~~2~ ~i S c _ ~ ~ ~ r2 ~ .yv S
- - - --1
? -Due to a >K a oortseauertae a - - - - - -
<i
wo=
o * ` _ _ - - - - - - - _ _ t~ .e.«s a Medial i
PART 11 Other try,Aicant nortrLttunf eti.,rlnKx.t Dunn that. to death but not rNatad to caux n PART 1 28. Wfs AY 2G. Ww err r
= Eaarni r a GxaserT
u ~ _ O No O Yes
- 3D. Ikath A.w n. 1 I Itum.crle 1 .lla- De,an6e how htnrty rxturrd 11 D. DNe of Wt/Y 31a Mtwr d M*Iy '
I l Auatent [ 1 11rda Irreetitptittn I t'
Cl Sutcde_ _ Other -1- -
31d. Inuy at Work 31e. Place of Irpury 11 Ofltoe Butidety 31f L~xatrrtt Iwo. sod St.) 31s City or Town 311 Sues 1
t.tr.. ie
rr ~ ~ O Yes C] No ~ F1owr I7 Street L1 Other -
.ems 111 [7 Farm C] Faoory - - '
= ~R314 50~. _ .
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