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HomeMy WebLinkAbout1761 l i _ - uy (P-16o~}.. .:~ln ~ . _ r ~ 5$94' _ f . { : _ AUGl 1419 yyaap~ , r r ~t'v 'rVt~ $Ta~i 0= ^ - ~ 1 ~ ~.r+i:~.~~,i~~it'a ~ i Yr.'s i;-....a./2 ~ ~ L _ ..s S•-•s~.'•T$ i TL:r r`; ~ _ ~ r, ~ : t .-.t.i:_ ~.~i i _ _ _ L _ ~ w HE]I JERSEY STATE OEPARTFIENT Oi HEARTH ~ ttlcwtFn.crturwce CERTIFICATE OF DEATH STAT[ilt[MtwOEtt ~l st+weu 1. NAME OF f aaU - (llr Lut) $e: 3. DATE OF DEATH ` .[tot row DECEASED Alacoque C `~olc~,rp1~1 Female June 10 1973 - sT~t ustl (TF?+ ee P?tat) T - • s . oN r ` ?twet 1. Ctrlor a< Rate S. Aje (n rn. U tender 1 Yr H order 21 Hrs. 6. pste d Binb 7. fas deceased erer is U.S. Ar.ed Farces. ~ last iirtLtlaF/ Nast s aFs Hoars Mrs (Yes. ao. o. rwltaeal Fes. ~iw trar a carts of serve) i . White 63 4 June b 2910 No 3. 9iahPiace /Scare tr /oreija coaetrr) 9. Citiaas d trhat totatgt Narriad (J~ lVetrer 4arried Q ll. Sotial Ser:witr No. - Paterson,NeN Jersey U.S+A+ •-tae-.ar> Di.attea0 151-OS-6181 acsrotrrea 2. PLACE OF DEATH 13. USUAL RESWE[KE (U iastittttiatt: tesidertce EKlere ad~issiata a, couatr Passaic &at: New Jerseys. cettatr Passa ~.c • , b. Car C~ (Check boa sad sure agate) c. City ~ (Check bw: sad si.e rtaste) ~ TH°t°C-~ Paterson Paterson e. Wae ea m sprrsl a taxutrtroa ji.e sweet address d. Street Address (!(rtsal, P.O. Address) "°'P"'' St. Jose h Hos ital 90 Chadwick Street tax verea !1. a. Usual Ocettpuiow rre lral o/ +rorlt Jose Jrrraj .toss o/ teorarws /i/e. ears r/ ntrrell Ii. 6. Kiad d Bttsraess w ladustq St. Anthony•s Guild IS. Fatba'a Na.e I6. Mother's Slaidee Haax John Edward Col an Katherine iNc Cawley ~ 7. lafwnar?e's Name and Address Edward Fvlcarelli 90. Chadwick-Street,Paterson,New Jersey cwusc t 1S. PART 1 DEATH EniS CAUSED BY Eater oa1F ar ceue l+r Ii,te /or Ux (i) teal (c) Apptoaireate itttonal btnoees f oasee and deaa? taatediate Caaae r : " : 1 C Gowlitiws, i/ aie), arts/ - saw rve to mere caase Dae ~ (i1 •7a/'. statiwj the rwlew Co.. t...«rr ten- b'r*j carne last Dee to(e) rr. y I.rrl, 1,,..+.. nt.r./ p,tRT If OTI(ER SIGti1FKA.YT COItiDITtO.+tS Iva. sas atr ,e oMr 19b. U ies, a.ete fudiass eoasideteo y1_ 1~ r 1 ~ 1~„ ! perteesed~ ie deterrsintes cause d deatb> / `I ,(4 .n. L C.Lt. ~ Y : .i-- Yes ( j ?Yo yes "..c[ or pa Accident Srucide Flooitide 20b. Date sad Flom d (u' •ct,oaw t ~ Q O 1~1 2()c. Floar Lajner Orttwed /Eett? werarr o/ upvF Pan 1 or 11 lteie lt1), : re for iesr o/ qr S+eearlelse. SI 27d. lajtrrr Occurred 20e. Place of lajtrr /e. a. sa or eFort iose, 20t. Cur, Tetra a I.ocuion Cowtty Srace 7orrk at © >t •or41e n /°7t' /ecrory, sheet. o//rct iNS.. etc.) :cross ct.ats. ~ 21. 1 (attended, eaaeieedl tAe deceased (!t°rr, oa) f / F : i to J :sad lax saw (h:et. tear) di.e on > / ~ i ~ i -•N.9 i - Orotb ecco.a/ er - .r. ow tbt 1ar? tulcd avow; aed to rir best o/ w~ keo,rlyd{t. /.nor rbe casts reseal o aCT 2a. Atrtndrns Phys. i Sled, Estw. r' Comt Ph s. r r ".b. Address Z2e. Dare S:saed Sieeuure ~ ' / 23a. Sruu{, Gtiear:ot•, Reaaral 23b_ Cemeurr a Crewtatdy tiante 33c. locarrrt,t C.t7 Jt ate tf>rcr/y! v Burial Holy Sepulchre Cemetery Toto:va,tia~r Jersey 'jJ. Butral Oare 1b. Oar Yr. 21a. ~uetral ko+re rant _la. Fr;rrera/ Ha..e Address June I3 1973 Gorn . 5 ~!ars:~a S•t Pate*son ~T J /7,S=y~"L,G rec: .rrtre :1. ~ ,cease :b. 27a. .u a'• .w'? s 5. wx~le as 'Jare i ,/J S et•d. b. Lxal ~ . - +to. a J/"'_. 2661 - ./t-.r N'~~ ~ x '~+!9 ~~P 14 ~ r 39 r , f ~ f sl~ 11r { f ~1~