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CERTIFICATE OF DEATH
CONN. STATE DEPT. OF HEALTH
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GATE Df WITN seorrll. oA•.,w1 MCE- ,rta,e. reella Aw.wur ADE- IAS u~oee 1 rrAa were 1 wr DATE OF OEATN Iro•rtK WI•. •tAA
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Oi OEATM TOWN O~ OEATN MOSNTAE OR OT!rEa ¦ISTITUTION- a.lle P w» w e•twR a+rE aura, A40 bNlla[~
t• AR r_?'F'OnD _ TM ~ ~ Ih_ ~~~r~i~ LRAL HOSP~T.A~_
pTY t STATE OF lWTN fGeeM/1. f wot U.SJ CITIZEN Oi I~T1 YAR14E0. NEVER 11ARalE0. IM1O0WE0. EA$T St•OUSE (M rN, EM wNeiw rasa)
ORIORCEO, EEDALIV SE?AMTEO
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~~-0 8-12- 0 HOUSEWIFE AT HOME
RESIDENCE-STATE CDIMTT TOWN STIIEET AND MtRYER
y-CO CTICUT HARTFORD rtiSOUTHINGTON REDSTONE STREET
WAS pECE/~SED A vETEaANT N' TES. li1VE WAR UMT OR SNW
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iATNER-NAME Mar Irooat IIf, YotNER-YADEN NAPE Mal weas tAa,
wspwrArtT-NAME YAni+o ADDRESS wrlrer a e, a ra la,r a,ora atAta, trl
~t-W I C NEIL STONE ST SOUTHINGTON CONN.06 8
?ART E OEATN wAS CAUSED !V: (ENTER OrrlY allE CAUSE ?ER lwE FOR pk pk AND M A/IeOarMR rtes•r sarrsEr
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E~GRENiATION' ' ~ ~iaYL*r"T,L:C~~Y ~ aIiBPRINGF LDS Measee~~Fmms
DATE w•..al. ggERAI NOME-NAME ANO A0011ES3 Temeer ee wll e0..m 011 tea acre. an ~ - 0605
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FI,.ERAE oR - NAIE Ds eAAETEIT r .asr ..e a..lra. EICEMSf NllaraElT
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REa+STRAIT
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5~ 1979 ~ ,>R ~ '~C.z.~~'
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certify TlleT fhb b e nxriOt' of Tfie rEl~ aC t~c!4 .ny tr ~ •i~t ~ . . •
y,f !tl ~ ~ ~ ` . liwesu of di:e~ St
SeP~ember~ 1~~ ._.._...._.._....::~3~` ~ • ~ ~ITAIN, CONN.
vnT vnl.ID WITHnUT SEAL RdPRIi~T AND nRSGINIIL R-•~` -
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ROuER POITRAS
CLERM. CIRCUii CU
4'76830
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