HomeMy WebLinkAbout0937 - -
.
a
1,
-
~ i
- -
t
c-i ~inmuwn~nralit~ of >~rl~uartts
JOHN F. X. DAVOREN
• r ~ Essex ' SECRETARY OF TIIE COMMONWEALTH
O (Cwr4~) OIV1810N Oi VITAL lTATItsTICB of Tan ~
1
~-301 ~ BTANOARD ~ ~ ~
3 (C[V er Toar.) CERTIFICATE OF DEATH Retisterea Ne. -w-.~!
.t.l aerr.it (il deat\ «trrred i• a IasORV of iastNStie..
H..tu, 1e ...._.......Bo.O.._.S~cnurs._Hns¢it$L_ sl. ~ 0i VAUt; rw~a+ of .teeet a..err)
70 East Street, Mettwen, Mass. raY$lcult-axroErwrre
.9 FOA
'lF1CATE t FCLL NAaIE _...._.~$._..Agnes._.._(.Ke.~my..~......._ _--.-80118--.---- U I~ d~~
{It det:eased 8 a mrriea r<idond or d~i~rorrid.?MU. pre alas aaidert easye.)
aoa~tr wnR)
R
ssF.s (a) Per..wt Residerte. I~o. _~~1_Q.ZI1spEet...Street~-___......_.. se. ..Methuen,.... t « a....a state)
v tlL/?1:~
tQYED IIBDICAL CbETIFtCATS OF DSATR PERSONAL AI3D STATIS[ICAL TARTICULARS
TRITER
3 DATE OF 9 sE?C !0 COLOR !t LB Grits t?e word)
DEATR _...-R~'.~E'eIQ~~'sL.___._~_Z9 .~J.~-. I[ARA[ED
cale,o) cDt~r) wear) Female white mv~cF~.D Married
- s 1 HEREBY C E A T I F 1, tLat [ uteadeA lros UN1CA'OWN -
Mri 1 19~.(z__.. to 197b...... !t 1[ carried ~rido~ea, or d'irarced
I last saw
~
a6're o...DeCeR~t---4Xc=-~ ~,I! death b said Rl'sSA.11D of ~e ~wc
late .aarei at tie date stated abate. u ._..._.7e.:.GQ...B.~. HrtIRYAi w1FE or Jose
~ 13S2i.J ~ ~ ~e ~ t.9)
!i /.Jy. DEATH MAB CAUSED BY: IIOIEifiATE CAU$S OjEEI (HarM.A's stage is !d)
tkr CGeaaR..r UtN If raadet t9 Matra
r.y,.~ deri. (a) ~/~Z ~ 6 13 Ac652 Yeah 9 Z,toatta l4 Days ~ _._.Iloses___xi..tes
.r, trkitl parer Dre Tr It Csaal -
Ocerpatiora
'`"i'` ~ cb) Clerk
ciCiad et .+ork doste dvis amt at ..rk[K Cite)
ai Ta 's Western Electric Co.
~.ctwa r• ~F" Is.sociai rl., 02?-14-0440
kc ta..;sat Jir- s1C\IFICAA7 Secrritr
~ i?as art ~ _ li SIRtHFLAC6 (Cit7)
opyr pertaratd. Q (sett « oo..trF) ass .
Rlat test ' ? BlODSaL.. Ii AfA11E OF
FATHER Solomon Z. Kearny
S aireast or iajsry i .a w of deceasedT NO•---.-- a - H BIRTHFi.ACB OF SChweir
>I~ur z is
~ ~ ca~i) Le non
• csiwt.~e) ?l.D. ~ to o~F uo~THN~ EJulia Maloof _
' ~ ,.._E1[~ '~.Q..._ < 21 BIRTHPLACE OF
70 st ~~~~tn a•~• e. uoTxER ccia)
(Aadrers) Date 19...Zb (sure ear oaaery) 8 S .
• Uhited~rian Cem~Ando tt I RERI:BYCERTIF)r tLt a aa~40a~r au.a~a p.ts~w deatR
~ 5 7 9 Fixes ~ Brril « Clreautioa eCitf or Tors) ~ 8 Mtrial err trarril pa.it sras isstaaa:
DATg of BURIAL _ December 31 7 C_~. ,H.O~~Act. Dir . .
_19,. .re or t Boca of Hahn otter)
: DIAIIE oP Public Health ~'s 12--30-76
FUICERAL DIREC'i~OR .~~~i~..~.~~n.........._ (a[&LI Desip.tb.) cDatr.t Isere r[ Fers.it> .
ADDRt~S 62 Park St., Lawrence, Mas t •
Jose,~Bolla - ~"etei~ a'd s><a ` cF ~ u......._. -
I.tor...t
~a-o9~a~ c,wa<e~) S90 Prospect__ St_.,,,~Methuen ~ ~ - l~, ciie~r~r~
w sRUE corY wTTSaT:
o
n -
45P~332
~T9 SAP ~ 2 ~ 'Z 20 A TRUE COPY A•iTEST:
a~lccra~rc~lr
~,powo trEal!'~~ ZITY CLERK
FEB 27197.9