Loading...
HomeMy WebLinkAbout0642 - 44i X938 ~ w[:JwDID DIaTw.cT NEW YORK-STATE •~-I r ,.wtw ~ FIiV4~TM~NT (1F HF41 TN BUREAU OF VITAL RECORDS w _ S/~' - CERTIFICATE OF DEATH ~ wauaTt~ r„ •t• h b/ TYPE ALL ENTRIES OR PRINT IN PERf.1ANENT BLACK INK. 'L _ . _ . Q 1. NAPE i1R•T wOO~E LAST 2 s[¦ ]w c•~l O[ _O[•Tr )p ••GUw 4 •l[ rIM•[l vJr Tw 1'1D~~, r[•w w , T y GytsrRv BoRNM~~N ~ ~ ~2 3y7~_L~lY. - ~.[I• IMMIT C• rtGOC. •t[ llt urGlw t ur Olw 1 O• OA rl\l••r O• U.S •wrla tl 1u.a1 ST 1i6 •iS- sii C+f? w•f, pf ry ~ s _ _ _ • y'~, ~ 1~is 101«41 Ir Ol ul, CTt.I YOrT+a' O•\a LOV wa Ylr. 1 C•T Or a[wvlt[ 'V.:f• r ~ ~ ~ 1 \t3 r0 Vrl(r~O aTr 1 ti - ~ \wa . 1 ai ? j - -_.__1-_ .L-______- 1 1 1 a,~' A,. ~ .[YO. TO wr 17C. c1T? ow yr to •Gt 170. larGTw Or aT•T Ir '7E. «OS.IT•? Ow OT.1tw IraTIT VT10r (`L7 e 11 T~ 1 1 ITOwr, eITT Ow rIIG •it1 Ilr r[IT waw. Glrt sTw[[T • rOJ ~ - f- ' ~N PT• J~F~f ; $ v~E•KS; ST. C~1ARL~ 4.1 Y ~ v .a• . _ W ~ ~ay (T l Dt[tD[rT fOwr 10. c1T t1 [r Of ww 11 Y•wl l•l aT •TV• 12. SUwrl rlrG S•OV aI l1• Tll r[, V•1 Dlr h1YC.1 Y'+~• I' MT • ~?IfA YOr 7w 011\ T[Aw COVrTwT• w r - M 3 17 ~ qS u 5 • ~ . M aRRt 1.EN ~ ~t~ 8&R_T {a-.. - _ * • S • 'YttY. •110Y It r[r 1• w[T'w(D! 118. •IrD Or fU llr[SS Ow Ih O~lTwT 11 3C. SOC1•l SICVwI T? r0. q . 1s~~1 ~3~K~R ~ BA~~R ~s~-oq-bo88 . V - - IfA'f7~T[ IAB. tOUrt? 11C. TOww 11.0. [ITT Ow real •G[ 1iE. Trl TNlr twt lif. STw[tT •r0 rVY ltw ~ 1 1 ~ 1 cu¦•oun uY1TS• 1 o ~ N• j/• ;suF~u~ ;~aoKt~rva S~E~Fr1; 'o o Mq,~NOUR _ ~ ¦ [ I 1 \ w 1SA. f•Th(w'! r•.•[. I~B. YOTn Iw's u•.G[r r•Yl 3 4 nwsT YlDOa[ a•sT nwsT .aoolt uaT ~ C'rE~RG~ ~oR~ MRU u ti leA. ur0wu•rr•s+•YC:~--- -~TIeB ar•rc•rc •LOwI]s i,rclvo[ jl? coo[. ~E~A ~RtJ K~uU ~LZB l~R~u01ar1l? ~a• SEt~~N, __u. 1175 J PART Dl •TM wU [•V Sl f• [wTl• obit Crt c•c s[ .[w t•hl •ow :A• ~8• •rL .C' ! e[tw[[.. Dr]aT • Cl•T- C I » C..l lD Ow •1 • ccw]IOWrC[ Or-~~ _ ~ - - - II [Cr DI TIOhi Ir •r• wl(w / /f J~_ G•r[ wl s[ TC :uM[D.•T[ B: to ~U 3`LZS - _ Lt~~~-~C.~L~ _ ~ urDlw[\IrG [•V S[ ••ST G' • TO ,Or • [Cr sl OUlrC[ O• _ 3 _ _ ~ ' - !1 S ~ ..C~l ~.7c~ ~•cl -c'c~t-c.l.c~rLt •Ll - - - ~ - ~`iC'~ ~ ~ - - - ~ PART a JTw[w s:Gr.•.c •r• cc.L -~Dr1 co+D. T:owe corTw,f.nr- TD leA elor I1•B. Ir •ts, w[w[ r,rL eLw-:el wtL • ~ D[•tw w• hLT •TYG •O c•-r St G•r[r •r r•wT 1 :AS O : G[T(J •r.urG Tw[ s[ C• C[•T•• 2 1(t[PV71[ ~j - I .[a [iCl hD f -J J ~ - - - ' - 2 - - - 1_-- - - - ` 1•A •cc [hT •.0..•c.ot ~lc[• ~L••~•[••~1VC•.DUw 100 ••Lw GID •h:uw• oc cuw• ~[rrtw r•T„wl Or •r.u¦•[= .r wl7 ~ G• ~ . w•.wT. ,J ~ Vi Su1c~L! -;r G[TLr•r.r[D ; 1 ; 3 ' ~ - ~ - - - - - - - - - - - - - ~ I- - - h--- - - - , -o - - - + -r s9 0 [[T • ho c,T. ow r.l..G[. ~ 7oE . • •T ••Owr•- • lOf Lr ~ ,~,,w\ ••JMt. G. lOC •T• r ISTw TG •rr, cD.,r7\, s:•ltl v C ~ r•[! O 1 l•[TCw•. LI r.CI fI OG., [Tt- 1 w "-1 W • C'V V ~ IJ 1 _ i _ ~ 1 TOjBE COMPLETED BY _OR_ TO BE COMPLETED BY f V ~ CERTIFYING PHYSICIAN ONLY• 2c o•pT „ CORONER OR MEDICAL EXAMINER ONLY 2 0 c ws1 T 1 - - _ i ~ O To T••t wt s? Cr u• .I: Gt :t•T.. VcC wtD • ~ ur t•]•S Or t. h•? Dr 'Ow . r[]TIG•T .Ow- r•u• r. I Tw[ l.u(. L•T ELI\C-.~•C wL L_f TC Th[ •Jw.• D•~ -•C•~ Corr.Or c[•Tr OC [u•w[G Tw[+Tlui O•T[ •rG rO _ -1 [ TO ? l sls ST •Ta4 I i ~fL/ ~ ] crab 1 1 ] [O [ IB Tom[ cr•?S.C~•h •TTI~r G[O Tr! Lf C[•S[D Cr L•sT ,][t-h~•l lr[ B •.OrO hCl[ .-[•G C wGUw' --_--0- D•1[ S. Gr [G ~ 1 (uOwTw C•• 1 ow -a I•[~ 1 _ IL~•1 •[•w NOr TgLG•• •i Y MOhT~O•T ?[•w h 1r ,.o+•..Y I( ~ 1 6 •l: I rwOM I ~ • TO 1 Ori _ l___.. _ _ _ ~ -J - ~ •D •T TI rL.r Glrw•].U •r, :r D•~, L•.*~ c[wT~n[• ~ (E co worlrs .rT S•[~•r. Ir GT..I• T. •h c[wT. rl[w 21 r•u[ •rD •G Gw[SS Or [[wT1I •lw 1?.••]1 C: •r_ [OwDr [w- u[D.C•c a - w(w, CO.OrI •r.r CI •h, wrl Ot[K D~wlC lO wl S ~ G-C~ ~ S ~ y'~ _ ~ ~ - [ g - J _ 22• f.;•••~ [w[ •T.or w[+.or.• .r or Tr L•• .[•w 22l• •c[ or •L w. •t. cw[wr•T.oh o• •c 22C .oc•Tlor IuT\ ow To rrr, aT•Tu r ' 2)A. h•ul •wD LDw[1s 01 rvw tw•a MOM[ 23B [HST w•tlOw r0. ~o~vF ~ooo M~~~~E couN R1. 9F~~,~N. • ~ ~o4S9. [ 21A. NW[ or rUr[w•L O.w[[TOw------ 1 !8. s w•TUwt or r • Alw[tTO 2aC. ¦t Gla w~~TlOr ro. _ 5 _ I 2S• 1 GM •T Uw[ Or •[G~sT w•w r~8' OwT•. C•• •C•w 26 A. •Ywl •l O¦ w[wfOr•a •Lwr.1T 1l SU[O 268. MON TM D•r 1[•w _ • wn - v _ ~ - . F 1 5 t 4~~93~3 ~~19 GAT 2n ~3 ~~3~9 ~ ti4 tO ANC FrGlr::: U 1 S T.I.JCIE C~UYTY.iI A. 6t10K PdGE ieoGER f'017RAS _ CLERR CIRCUIT CQ~ ~